Learning that one, or one`s loved one, is diagnosed with a heart or lung condition that requires an intervention is extremely challenging and intimidating. Keyhole (minimally invasive) endoscopic and robotic techniques by experience surgeons provide equal or improved results compared to conventional breastbone splitting (sternotomy) or chest wall opening (thoracotomy) procedures, which is still regarded as the gold-standard by many practices. Dr. Johan van der Merwe and the compassionate Keyhole Thorax Centre team have been performing keyhole (minimally invasive) approaches without splitting the breastbone or opening the chest at Netcare Blaauwberg Hospital since 2017.
No broken bones / faster recovery / smaller and subtle scars / less pain / Low risk of infections / no waiting times
Anyone with symptoms of heart or lung disease (chest pain, shortness of breath, heart murmers, dizziness, palpitations, persistent coughing, wheezing and many other) is welcome to enquire about diagnostic modalities and keyhole (minimally invasive) procedures:
- Keyhole (minimally invasive) heart surgery
The heart is specialised organ with 4 chambers that receives and pumps blood to the various organs through blood vessels, has its own blood supply, has valves that ensure blood flow in one direction without any resistance, is a muscle that contracts and relaxes and has its own nervous supply that ensures coordinated contraction. An extensive list of isolated or combination of diseases affecting any of these components require early diagnosis, careful management and appropriate interventions that will ensure preservation of both quality of life and optimal prognosis.
- Keyhole (minimally invasive) aorta surgery
The aorta is the large blood vessel that transports blood from your heart to smaller branches and organs. Intervention on the aorta is required when the aorta dilates (becomes bigger that normal diameters, which is also called an aneurysm), ruptures (life-threatening) or tears (life-threatening, also called a dissection). Surgery for these conditions are complex and often emergency procedures and Dr. Johan van der Merwe will offer an approach that is safe within the clinical context. The most common keyhole (minimally invasive) aortic surgery procedures include aortic ascendance / arch surgery and transcatheter endovascular aortic replacement (TEVAR).
Keyhole (minimally invasive) aortic surgery
- 4-6 cm central access with only partial splitting of the breastbone
- 4cm groin incision
- Hospitalization 5-7 days
- Recovery 4-6 weeks
Keyhole (minimally invasive) transcatheter endovascular aortic replacement (TEVAR)
- No incisions, 2 x groin punctures
- Hospitalization 2-5 days
- Recovery 2-4 weeks
- Keyhole (minimally invasive) heart valve surgery
Heart valves ensure that blood flows in one direction without any resistance. Heart murmurs, shortness of breath, chest pain or discomfort, dizziness, palpitations, swelling of the legs and decrease in effort tolerance are amongst the symptoms of one or more of the heart valve leaking (called regurgitation) or not opening well (called stenosis). Dr. Johan van der Merwe developed a special interest in heart valve disease and provide a comprehensive diagnostic and treatment pathway that is based on latest evidence and international consensus recommendations. Various diagnostic information obtained from ultrasounds, CT-scans and other modalities guide best evidence practice.
- Keyhole (minimally invasive) aortic valve surgery
Dr. Johan van der Merwe will offer a keyhole repair or replacement of an obstructive or leaking aortic valve once objective criteria that justify surgery are identified. The 3 most common keyhole aortic valve approaches are through a mini-sternotomy (left) and right upper anterior thoracotomy (centre) and transcatheter intervention (right), each with specific benefits as outlined below. The treatment options of medical therapy and regular reviews and each of the described procedures, as well as the various types of available devices, will be discussed in detail and tailored according to patient expectations and requirements.
Keyhole (minimally invasive) aortic valve replacement by mini-sternotomy
- 4-6 cm central access with only partial splitting of the breastbone
- 4cm groin incision
- Hospitalization 5-7 days
- Recovery 2-4 weeks
Keyhole (minimally invasive) aortic valve replacement by right anterior thoracotomy
- 4cm right chest incision with 4cm groin incision
- No breastbone splitting
- 4-6 days hospitalization
- 2-4 weeks recovery
Keyhole (minimally invasive) transcatheter aortic valve replacement (TAVR)
- No incisions or breastbone splitting
- 3-5 days hospitalization
- Immediate recovery
- Keyhole (minimally invasive) mitral valve- and tricuspid valve surgery
The mitral- and tricuspid valves, collective known as as the atrioventricular valves, are located between the upper and lower chambers of the heart. Dr. Johan van der Merwe will offer a keyhole repair or replacement of a leaking or obstructive atrioventricular valves in isolation or in combination once objective criteria that justify surgery are identified. The 2 most common keyhole (minimally invasive) atrioventricular valve approaches are through a right mini-chest incision access (left) and transcatheter intervention (right), each with specific benefits as outlined below. The treatment options of medical therapy and regular reviews and each of the described procedures will be discussed in detail and tailored according to patient expectations and requirements.
Keyhole (minimally invasive) mitral valve repair and replacement
- 4-6cm right chest incision and access with 4cm groin incision
- Repair or replacement of defective mitral valve
- 4-6 days hospitalization
- 2-4 weeks recovery
Keyhole (minimally invasive) transcatheter mitral valve replacement (TAMR)
- No incisions
- 4-6 days hospitalization
- Recovery 2-4 weeks
- Keyhole (minimally invasive) coronary artery bypass surgery
The heart muscle has its own blood supply through a network of specialised blood vessels that supply oxygen and nutrients. Various diseases and risk factors can cause gradual narrowing or sudden obstruction of these vessels that result in progressive coronary artery disease symptoms (chest pain on exertion, shortness of breath, palpitations, body swelling) or a sudden heart attack (life-threatening) respectively. Dr. Johan van der Merwe will offer an approach that is safe within the clinical context. The most common procedures to restore blood supply to the heart muscle are through skin punctures and stent placements (left) and keyhole (minimally invasive) bypass surgery as outlined below. The appropriate procedure will be tailored according to the clinical context, patient expectations and requirements.
Keyhole (minimally invasive) percutaneous coronary interventions (PCI)
- Puncture of skin in the wrist or the groin
- Placement of stents within blocked arteries
- 2-4 day hospitalization
- Immediate recovery
Keyhole (minimally invasive) coronary artery bypass surgery
- 4-6cm left chest incision and access with 4cm groin incision
- Robotic or keyhole harvesting and implantation of appropriate conduits beyond blockages
- 3-6 days hospitalization
- 2-4 weeks recovery
- Keyhole (minimally invasive) atrial septal defect surgery
The upper chambers of the heart are separated by a septum, which can be underdeveloped and result in abnormal bloodflow through the heart and lungs. Closure of this defect is indicated if specific criteria are identified and can be performed by keyhole (minimally invasive) percutaneous device implantation (left) or keyhole (minimally invasive) surgical closure (right) as outlined below:
Percutaneous atrial septal defect closure
- No incisions, skin punctures in the groin
- Immediate recovery
- Hospitalization 2-4 days
Keyhole (minimally invasive) atrial septal defect closure
- 4-6cm right chest incision with 4cm right groin incision
- Hospitalization 3-5 days
- 2-4 weeks recovery
- Keyhole (minimally invasive) intracardiac neoplastic surgery
Abnormal growths within the heart, of which the most common is a myxoma, require excision. Dr. Johan van der Merwe will discuss the option of a keyhole (minimally invasive) resection of identified tumours in detail:
Keyhole (minimally invasive) intracardiac neoplastic resection
- 4-6cm right chest incision with 4cm right groin incision
- Hospitalization 3-5 days
- 2-4 weeks recovery
- Keyhole (minimally invasive) heart sac (pericardium) surgery
Various diseases can produce abnormal fluid volume within the heart sac (pericardial effusion) that may compression and subsequent sudden or progressive shortness of breath, poor effort tolerance and swelling of the legs. Severe compression of the heart within the heart sac is life-threatening (cardiac tamponade) and need emergency intervention. Dr. Johan van der Merwe will discuss and suggest the various keyhole (minimally invasive) procedure options and suggest the most appropriate according to the clinical context. The most frequent diagnostic and therapeutic options for heart sac disease include a pericardiocentesis (left), a keyhole (minimally invasive) sub-xyphoid or left mini-thoractomy pericardial window (centre) and a keyhole (minimally invasive) pericardectomy or pericardiac growth excision (right).
Keyhole (minimally invasive) pericardiocentesis
- Skin puncture with a needle and drainage of fluid
- No incisions
- Insertion of a small heart sac drain
- Hospitalization period depends on the underlying cause
Keyhole (minimally invasive) pericardial window
- 3-4cm incision under the tip of the breastbone or under the left breast with drainage of fluid, resection of heart sac and insertion of a small drain into the space
- Hospitalization course depend on the final diagnosis
Keyhole (minimally invasive) pericardectomy
- Right or left 4-6cm chest incision with resection of the heart sac or growth
- Hospitalization period of 3-7 days
- Recovery 1-2 weeks
- Keyhole (minimally invasive) heart rhythm surgery
The heart generates its own impulses that are systematically conducted to all muscles in a synchronous manner. Various diseases can result in either abnormally fast-, slow – or erratic heart rhythms that may require interventions. Dr. Johan van der Merwe work in close collaboration with specialist electrophysiologists (heart specialists with special interest in rhythm abnormalities) and will suggest diagnostic and therapeutic keyhole (minimally invasive) interventions according to the clinical context. The most common keyhole (minimally invasive) heart rhythm interventions performed are pacemaker / defibrillator implantations (left), transcatheter heart rhythm ablation (centre) and keyhole (minimally invasive) heart rhythm surgery (right).
Pacemaker / defibrillator implantation
- 4cm right or left chest incision with implantation of wires and a battery
- Hospitalization 2-5 days
- Recovery 1-2 weeks
Transcatheter heart rhythm ablation
- Skin punctures in both groins, no incisions
- Ablation of abnormal nerve conduction pathways using special equipment
- Hospitalization 1 week
- Recovery 1-2 weeks
Keyhole (minimally invasive) heart rhythm surgery
- 3-4cm right or left chest incision
- Ablation of abnormal nerve conduction pathways (Modified Maze III procedure) and occlusion of the left atrial appendage
- Hospitalization 2-5 days
- Recovery 1-2 weeks
- Keyhole (minimally invasive) chest and lung surgery
The thorax (chest) contains the heart, mayor bloodvessels, the airways, the esophagus (swallow pipe), the lungs, nerve complexes, lymphatic pathways, the diaphragm and many more smaller structures. The thorax consists of a chest wall, pleura, lungs and mediastinal structures. An extensive list of diseases can occur in each component, which may require intervention for both diagnostic and therapeutic purposes to preserve quality of life and an optimal prognosis.
- Keyhole (minimally invasive) chest wall surgery
The human chest consists of skin, fatty tissue, connective tissue, muscles, nervous tissue, bloodvessels and a bony skeleton. A variety of developmental chest wall deformities (pectus excavatum / carinatum), trauma, neuro-vascular compression (thoracic outlet syndrome), infection and abnormal growths (cancers and non-cancerous growths) of each chest wall component can occur. Dr. Johan van der Merwe will discuss the various options to diagnose and treat these abnormalities within the clinical context. Common keyhole (minimally invasive) chest wall procedure include pectus excavatum correction (left) and keyhole chest wall growth resections (right).
Keyhole (minimally invasive) pectus excavatum repair
- 3-4cm incision on both the left and right chest
- Immediate correction
- Hospitalization 1 week
- Recovery 2-3 weeks
Keyhole (minimally invasive) robotic rib resection
- 3 x 2cm incision
- Hospitalization 2-5 days
- Recovery 1-2 weeks
- Keyhole (minimally invasive) pleura surgery
The lung and chest wall have a special lining (pleura) that are in continuity. An extensive list of diseases can cause abnormal accumulation of air (pneumothorax) or fluid (hydrothorax, haemothorax, pyothorax, chylothorax) that result in compression of the lung with subsequent sudden or progressive shortness of breath or chest pain. Dr. Johan van der Merwe will discuss the various options to diagnose and treat these abnormalities within the clinical context. The most common keyhole (minimally invasive) pleural interventions include intercostal pleural drainage (left), closure of persistent air leaks, decortication and empyema clearance (centre), pleural biopsy and pleurodesis (right).
Keyhole (minimally invasive) intercostal drainage
- No incisions, insertion of a small drain into pleural space
- Hospitalization depend on cause of disease
Keyhole (minimally invasive) closure of air leaks, decortication and empyema clearance
- 3-5cm chest wall incision with camera and special equipment
- no rib-spreading, minimal discomfort
- Hospitalization depend on underlying cause
- Recovery 1-4 weeks
Keyhole (minimally invasive) pleural biopsy and pleurodeses
- 3-5cm chest wall incision with camera and special equipment
- no rib-spreading, minimal discomfort
- Hospitalization depend on underlying cause
- Recovery 1-4 weeks
Keyhole (minimally invasive) robotic pleural surgery
- Three 2cm incisions
- No rib spreading
- Hospitalization depend on underlying cause
- Recovery 1-2 weeks
- Keyhole (minimally invasive) lung surgery
An extensive list of infective, inflammatory or growths (cancers and non-cancers) occur in the lung, with consist of 3 lung lobes on the right and 2 lung lobes on the left. Well defined criteria determine the need for lung resection to optimise both quality of life and survival. Dr. Johan van der Merwe will discuss the various diagnostic and therapeutic options in detail. The most common keyhole (minimally invasive) lung resection procedures are lung biopsies, lobectomy (removal of a lung lobe) and pneumonectomy (complete lung removal) and are performed robotically (left) or endoscopically (right).
Keyhole (minimally invasive) robotic lung resections
- 3-4 x 2cm incisions
- Hospitalization 2-5 days
- Recovery 1-2 weeks
Keyhole (minimally invasive) endoscopic lung resection
- 4cm chest incision with 2 x 2cm incisions
- Hospitalization 2-5 days
- Recovery 1-2 weeks
- Keyhole (minimally invasive) airway surgery
Air reach the lungs through a network of dividing airways. An extensive list of diseases can cause narrowing, external compression, infection or inflammation of the airways. Dr. Johan van der Merwe will discuss the various options to diagnose and treat these abnormalities within the clinical context. The most common keyhole (minimally invasive) airway interventions include bronchoscopy (left) through which diagnostic and therapeutic endobronchial interventions are performed and tracheal reconstruction procedures for narrowed airways (right).
Keyhole (minimally invasive) bronchoscopy with additional diagnostic or therapeutic interventions
- No incisions
- Same day discharge
Keyhole (minimally invasive) airway reconstruction
- 4-6 cm neck incision
- Hospitalization 5-7 days
- Recovery 4-6 weeks
- Keyhole (minimally invasive) mediastinal mass surgery
The area within the chest between the two lungs is called the mediastinum and contains vital organs like the heart, mayor bloodvessels, the oesophagus, dense nervous networks, thymus, fat, connective tissue and lymphatic structures. An extensive list of infective, inflammatory and tumour (cancerous and non-cancerous) diseases can cause mediastinal disease that are usually identified on CT-scan of chest. Dr. Johan van der Merwe will discuss the various options to diagnose and treat these abnormalities within the clinical context. The most common keyhole (minimally invasive) mediastinal surgery include endobronchial ultrasound (left), mediastinoscopy (centre) and robotic / endoscopic surgery (right).
Keyhole (minimally invasive) endobronchial ultrasound guided diagnostics
- No incisions
- Same day discharge
Keyhole (minimally invasive) mediastinoscopy
- 2cm neck incision
- Hospitalization 1-2 days
- Recovery 5-7 days
Keyhole (minimally invasive) robotic mediastinal surgery
- 3 x 2cm chest incisions
- Hospitalization 2-5 days
- Recovery 2-3 weeks
Keyhole (minimally invasive) endoscopic mediastinal surgery
- 4cm chest incisions
- Hospitalization 2-5 days
- Recovery 2-3 weeks
Keyhole (minimally invasive) robotic surgery for hyperhidrosis
- 3 x 2cm chest incisions
- Hospitalization 2-5 days
- Recovery 2-3 weeks
Keyhole (minimally invasive) endoscopic surgery for hyperhidrosis
- 4cm chest incisions
- Hospitalization 2-5 days
- Recovery 2-3 weeks
- Keyhole (minimally invasive) diaphragm surgery
The diaphragm separates the chest and abdomen and is an important component of normal breathing. An extensive list of congenital- and acquired abnormalities can result in developmental- (hernias, eventration) and other defects that may require interventions. Dr. Johan van der Merwe will discuss the various options to diagnose and treat these abnormalities within the clinical context. The most common keyhole (minimally invasive) and robotic diaphragm surgery include various types of diaphragmatic hernia repairs (left) and diaphragm plication procedures (right).
Keyhole (minimally invasive) robotic diaphragmatic hernia repairs
- 3 x 2cm chest incision
- Hospitalization 3-5 days
- Recovery 2-4 weeks
Keyhole (minimally invasive) endoscopic diaphragmatic hernia repairs
- 4-6 cm chest incision
- Hospitalization 3-5 days
- Recovery 2-4 weeks
Keyhole (minimally invasive) robotic diaphragmatic plication
- 3 x 2cm chest incision
- Hospitalization 3-5 days
- Recovery 2-4 weeks
Keyhole (minimally invasive) endoscopic diaphragmatic plication
- 4-6 cm chest incision
- Hospitalization 3-5 days
- Recovery 2-4 weeks