​New Eyes For Surgeons

NUHCS’s innovative Endopsis Retractor System enhances minimally invasive heart surgeries

PULSE Issue 39 | June 2022

The conventional method of reaching the heart requires a sternotomy surgical approach, where the surgeon cuts through the breastbone and then spreads it apart with steel structures to access the thoracic cavity. Naturally, the stretching of bone, muscles, and ligaments results in pain and discomfort after surgery, and some necessary downtime is required for the patient to fully recover. To overcome such post-operative trauma, various advancements in the medical field including innovative surgical techniques and technological devices have been developed over the last decade. In particular, devices and techniques that are minimally invasive are preferred due to the smaller incisions required to access the patient’s anatomy. Small incisions in surgery provide many advantages for patients, including reduced blood loss, lower risk of wound infection and the resulting effect of a more cosmetically acceptable wound compared to a long scar after an operation. Minimally invasive surgeries also allow patients to recover faster and return to their normal activities sooner.

At the National University Heart Centre, Singapore (NUHCS), the team of surgeons at the Department of Cardiac, Thoracic and Vascular Surgery (CTVS) invented a new video camera system that further enhances such minimally invasive surgeries. The Endopsis Retractor System comprises of a hollow shaft that holds the heart open while a flexible miniature video camera passes through it to provide a wide range of vision inside the patient’s heart for the surgeon. An advanced type of screw is then used to hold the camera in place by pressing against the surface of the chest, negating the need for additional steel fixators that can be heavy and bulky. With this latest system, the camera is not only held in place with the advanced screws, but is also flexible and can be easily maneuvered to provide different viewing angles for the surgeon, especially during complex operations. Current endoscopic instruments use a 4 to 6 centimetre incision between the ribs on the side of the chest. However, the Endopsis Retractor System only requires a 2 to 3 centimetre incision through the groin area to reach the patient’s heart. Having used the Endopsis Retractor System for a mitral valve repair surgery, Dr Chang Guohao, Consultant, Department of CTVS, NUHCS concurred that the new system is user-friendly, capable of providing high-resolution images and allows the operative field to be de-cluttered due to its much simpler set-up, all of which contributes to the ease and efficiency of the operation process. This innovative Endopsis Retractor System has now been used for numerous successful surgeries and will continue to undergo clinical trials at NUHCS to further enhance the application process.