Q&A: Minimally invasive heart surgery technique reaches 20 years of use
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Key takeaways:
- The “Miami Method” of surgery enables heart procedures to be performed without cutting open the patient’s breastbone.
- It has now been used for over 20 years, with training given to more than 1,000 surgeons.
Heart surgery is normally an invasive procedure involving a sternotomy, in which a surgeon cuts open the patient’s breastbone or sternum. Twenty years ago, Joseph Lamelas, MD, thought it did not always need to be that way.
To reduce the trauma and complications for patients and enable them to leave the hospital and return to their normal lifestyle sooner, Lamelas pioneered the “Miami Method,” a minimally invasive technique involving a right lateral thoracotomy that enables the surgeon, with the help of specially developed tools, to access the heart via an incision between the ribs instead of via a sternotomy. The technique has now been used for more than 20 years for procedures such as heart valve repair or replacement, removal of cardiac tumors and replacement of the ascending aorta, and Lamelas has trained more than 1,000 surgeons around the world in how to perform it.
Healio spoke to Lamelas, chief of the division of cardiothoracic surgery, professor of surgery and program director at the University of Miami Health System, about why the technique was developed, how it works, how patients benefit from it and what the future might bring for it.
Healio: What challenges in cardiac surgery led you to develop the Miami Method?
Lamelas: I have been in practice for 33 years. Back in 2003, after being in practice for 13 years, I realized that all the other specialties were doing procedures with less invasive techniques, and we needed to provide a less invasive approach to address different pathologies in the heart. So I started embarking on a technique where you could perform heart surgery to repair one or more valves in the heart, to correct different congenital defects in the heart, to perform arrhythmia surgery, to remove tumors from the heart, and, most significantly, to replace the entire ascending aorta plus the hemiarch. I have acquired so much experience with this that I patients from all over the world, especially now that have discovered there are less invasive ways to perform surgery on the aorta. Expanding the technique to multiple pathologies has been exciting. As is I have considered this surgery for ‘all comers’.. It is not limited to a certain type of body habitus or a certain age. Obviously, there are patients who are not operable for any technique, but this is an all-comer approach to minimally invasive cardiac surgery.
Healio: How does the Miami Method work, and how does it differ from other surgical approaches?
Lamelas: It is one of the least invasive approaches to cardiac surgery. The operation is done through a 4 cm incision, where the access is between the ribs, without breaking the ribs or interrupting any type of skeletal component of the chest wall. It is one incision, and the entire operation is performed through this one approach. Many of the instruments that we use today for this approach are instruments that I developed, and have worked with various manufacturers and distributors to market. Years ago, as I started this approach, we did not have the tools and the facilitating devices to do these operations, so I embarked on a journey to develop instrumentation to facilitate the operations, and to allow other surgeons around the country and the world to be able to do it.
Healio: What do the data show about the effectiveness of the Miami Method?
Lamelas: The results have been excellent. They are equivalent to and probably even better compared with the sternotomy-based approaches, because in experienced hands, once you are comfortable with the technique, the results are better than the sternotomy-based approach, where the sternum is cut down the middle.
Healio: Twenty years later, how common is it to use the Miami Method?
Lamelas: In my practice, I perform four to five heart surgeries per day. It accounts for about 85% of the procedures I perform today. I have patients not only from Florida, but all over the country and the world because of the great results and the ability of patients to return to a normal lifestyle quicker than with the conventional sternotomy-based approaches.
Healio: Has it been adopted at other centers by other teams?
Lamelas: I have trained more than 1,000 surgeons from around the world. The majority have embarked on a minimally invasive program. Most surgeons are not initially trained to use this technique. Training is usually done with the sternotomy-based approach. The surgeon has to develop new skills and be receptive to doing surgery through a limited incision with limited exposure. Those that want to offer their patients less invasive approaches, that impact them in a positive fashion, have been able to do it and have had great results.
Healio: What has the impact of the Miami Method been on patients?
Lamelas: It is one of the least invasive approaches to different cardiac pathologies, and therefore that translates to less bleeding during the operation, fewer transfusions during surgery, a shorter ICU stay, a shorter hospital stay, the ability to ambulate sooner and a quicker return to a normal lifestyle.
Healio: How might the Miami Method be further developed or used in the future?
Lamelas: It has allowed cardiac surgery to move into the future, and this is just the beginning. As we advance with different instrumentation and devices, we can apply this approach to different aspects of cardiac surgery, not only valves, but also mechanical assist devices.
The Miami Method, which is a technique that I’ve pioneered, has been impactful on my practice and that of other surgeons. The patient benefit the most, and the results have been excellent.
For more information:
Joseph Lamelas, MD, can be reached at jlamelas@miami.edu.
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