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The application of an endoscopic stabilizer (Intuitive Surgical, Mountain View, CA, USA) enables closed chest off-pump coronary artery bypass via a four-point stab incision avoiding sternotomy and minithoracotomy.

In order to evaluate the traumatic effects of median sternotomy and cardiopulmonary bypass (CPB) in conventional and minimally invasive coronary artery bypass grafting, inflammatory response was studied in a prospective randomized trial in patients referred to single-vessel coronary artery bypass grafting.

New less invasive surgical techniques for the treatment of coronary artery single-vessel disease have been developed by either avoiding median sternotomy or cardiopulmonary bypass or both, however, until now no prospective randomized trial has been carried out to compare these techniques to the conventional approach with special respect to the psychosomatical effects.

In order to evaluate the benefit provided through less invasive surgical techniques for the treatment of multivessel coronary artery disease, a prospective clinical trial was started.

Using the initial experiences with the Port-Access technique for the treatment of mitral valve disease some changes were made thus resulting in more simple and faster procedures.

The treatment of coronary single vessel disease under minimally invasive surgical conditions was followed by the treatment of coronary multivessel disease using a new technique.

Abstract: In 24 human cadaver femora standardized instable pertrochanteric osteotomies were created. The right and left femur of each pair were alternately selected for osteosyntheses with the gamma nail and the dynamic hip screw. Afterwards an examination of stability was performed. Cyclical loads were increased in 500 N increments to the maximum loading capacity, while the deformation rate was continuously measured. Radiographs, were taken to prove the results of loading. The mean deformation was much greater in the DHS group than for the gamma nail, the maximum load to failure was significantly lower. Femoral shaft fractures caused by the loading occured five times as often in the gamma nail osteosyntheses than in the DHS.

Standardized osteotomies were performed to mimic fractures classified as (a) stable, (b) partly unstable and (c) complete unstable (according to Evans) in 32 postmortem femoral bones. The stability of all preparations was examined after the performance of an osteosynthesis with a dynamic hip screw. Cycled loadings were increased stepwise every 500 N to the maximum loading capacity (load of facture). In addition, the distorsion at 2000 N was measured. There were no statistically significant differences between the three groups (a), (b), and (c). The average maximum load capacity was significantly lower in group (c) than in groups (a) and (b). Nevertheless, the lowest value (2275 N) recorded for the maximum loading capacity in our study means that in a normal weight person full weight-bearing can be allowed postoperatively.

In order to avoid sternotomy-related complication after cardiac surgery minimally invasive cardiac surgery has been developed successfully for the treatment of coronary artery disease, however, those techniques were still limited to the treatment of single-vessel disease. Therefore a new surgical technique for the treatment of multi-vessel disease has been developed.

This is the initial experience with a new minimally invasive surgical technique for the treatment of mitral valve disease using a PortAccess system.

Zusammenfassung: Im Rahmen einer retrospektiven Krankenblattanalyse sowie durch Nachuntersuchungen wurden 202 multimorbide geriatrische Patienten (Durchschnittsalter 82,9 Jahre), die mit einer Hftgelenkendoprothese versorgt worden waren, erfat. 103 Flle mit perioperativer Cefazolin-Prophylaxe wurden mit 99 Patienten, die keine systemischen Antibiotika erhalten hatten, verglichen. In der Cefazolin-Gruppe war die Wundinfektionsquote mit 13,6% gegenber 26,3% in der Kontrollgruppe statistisch signifikant erniedrigt. Ebenfalls signifikante Erniedrigungen bot die Cefazolin-Gruppe gegenber der Vergleichsgruppe bei den erforderlichen Revisionseingriffen, bei postoperativ aufgetretenem Dekubitus und bei Harnwegsinfektionen.

Zusammenfassung: In einer retrospektiven Studie wurden 246 Patienten (Durchschnittsalter 82,4 Jahre) mit koxalen Femurfrakturen, die je nach Frakturtyp mit Intermedirprothese, Gleitlaschenschraube oder durch Ender-Nagelung versorgt worden waren, analysiert. Dabei wurden die bestehenden Vorerkrankungen, Operationsdauer, postoperativ aufgetretene Komplikationen, das verabreichte Transfusionsvolumen, die Verweildauer in der Akutklinik, der erzielte Mobilittsgrad und die Sterbequote ermittelt. Die Ergebnisse ergaben eine altersentsprechend hohe Multimorbiditt, bei den Patienten mit Ender-Nagelung die hchsten Transfusionsmengen, eine geraume Phase zur Erzielung postoperativer Mobilitt, einen langen stationren Aufenthalt und eine Klinikletalitt, die mit dem Durchsnittsalter und der durchschnittlichen Verweildauer zunahm.

If coronary disease is the target of a minimally invasive procedure, median sternotomy or cardiopulmonary bypass or both can be avoided. Similar to the development in other fields of surgery, minimally invasive surgical techniques are gaining increased acceptance in the field of cardiothoracic surgery. Our experience with an off pump coronary artery bypass (OPCAB) technique in a special patients group with serious risk factors for the application of cardiopulmonary bypass has been analyzed.

Minimally invasive surgical techniques have been introduced into cardiac surgery in order to avoid median sternotomy related complications. Surgical trauma to the patient can be significantly reduced without compromising the safety. In addition, a small lateral chest incision results in improved cosmesis, especially in female patients.