Direct Vision Cardiac Surgery via Minimal Lateral Thoracotomy: Which Procedure is it Most Suitable for?

Introduction: Minimal approaches have become popular in cardiac surgery in recent years worldwide; as in other surgical specialties, minimal right anterior thoracotomy (RAT) and minimal right lateral thoracotomy (RLT) techniques can be used for some cardiac procedures.This study compares and presents the operative and postoperative advantages and disadvantages of both techniques.Methods: Between March 2021 and July 2024, a total of 40 patients underwent cardiac surgery via direct vision minimally invasive right thoracotomy approach at Cardiovascular Surgery Center of University of Health Sciences Türkiye, Dr. Siyami Ersek Thoracic and Cardiovascular Surgery Training and Research Hospital.Eight of these patients underwent surgery with the RAT technique, and 32 underwent surgery with the RLT technique.Operative and postoperative outcomes were compared.Results: One patient who underwent RAT died during the operative period, and two patients who underwent RLT died during the postoperative period.Cross-clamp and cardiopulmonary bypass times were longer for RAT during the operative period.While there was no difference in extubation times or intensive care stay durations, tube drainage times and hospital stays were shorter for RLT in the postoperative period.Conclusion: These findings suggest a potential clinical advantage of direct-vision RLT; however, they require further validation in large-scale, prospective studies.The situation may be different in camera-assisted approaches.