Why surgeons typically don’t ‘crack your chest open’ anymore

Have you ever heard someone say that the surgeon “cracked their chest open” for heart surgery or another procedure? While some surgeries still involve opening up the chest, often referred to as a sternotomy, your doctor may talk to you about other options.

During a sternotomy, a surgeon will make an incision in the skin of your chest above your breastbone. Then, the doctor will cut through your sternum. This gives a surgeon access to your chest to operate on your lungs, heart and other organs. However, a sternotomy usually comes with a long recovery time — you often won’t be back to 100% for three to four months.

“Initially, the goal of surgery was just to get the patient safely through the operation. As surgeons have learned more over time, there’s been a much greater focus on doing operations in a minimally invasive way,” says Dr. Eric Weiss, heart surgeon and medical director of the valve program at Aurora St. Luke’s Medical Center. “In the past 40 years, surgeons have focused on minimally invasive operations to speed up recovery, decrease the length of time in the hospital, reduce pain and improve cosmetic results.”

Minimally invasive surgery often involves special instruments designed to allow a surgeon to operate through small incisions in soft tissue. The goal is to avoid going through bone and to minimize the size of any incisions. Some surgeons will use robots or special tools that are longer and allow for microscopic precision. For heart surgery, this can involve a transcatheter procedure where a catheter is inserted through an artery in the groin or a small incision in the ribs.

It may seem strange for a surgeon to operate from the side rather than the front, but for a complicated, three-dimensional structure like the heart, it can actually make things easier.

“You might think we can’t see things as well during minimally invasive surgery, but that’s actually not true,” says Dr. Weiss. “For certain procedures like an operation on the mitral valve of the heart, going in through the ribs actually allows you to operate with it straight ahead of you.”

Minimally invasive surgeries have shorter recovery times, lower risk of complications or infection, less pain and shorter hospital stays. While some surgeries are broadly available as minimally invasive procedures, finding an experienced surgeon can make a significant difference.

“I’m only willing to do a surgery in a minimally invasive way if you’ll get the same or better outcome,” says Dr. Weiss. “Just because someone does minimally invasive surgery doesn’t mean that they have robust experience. It’s important to find a surgeon who does these kinds of surgeries all the time since they’ll bring all of that experience into your procedure as well, which helps make sure you get the best possible outcome.”

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