Book Review: Endoscopic Cardiac Surgery

Abstract 

“Endoscopic Cardiac Surgery” (2023) by Dr. Joseph Zacharias is a comprehensive and authoritative guide to minimally invasive cardiac surgery. This landmark text combines foundational principles with the latest advancements in endoscopic techniques, offering in-depth insights into perioperative management, valve surgeries, coronary artery bypass grafting, and training innovations. Featuring contributions from global experts, the book emphasizes preoperative preparation, setups, and practical strategies for mastering endoscopic procedures. Enhanced by procedural videos, it serves as a valuable resource for cardiac surgeons, trainees, and multidisciplinary teams. Endoscopic Cardiac Surgery is a critical reference for advancing minimally invasive cardiac surgery, combining technical depth with real-world applicability. 

Book Review 

“Endoscopic Cardiac Surgery” (Springer, 2023), by Dr. Joseph Zacharias, is a significant and timely contribution to the field of minimally invasive cardiac surgery. As one of the leading experts in this area, Dr. Zacharias presents a comprehensive and up-to-date exploration of the techniques, innovations, and clinical outcomes associated with endoscopic approaches to treating heart disease. The book builds on earlier iterations of his work, incorporating the latest technological advancements and evidence-based practices in this rapidly evolving specialty. 

The structure of the book is meticulously organized into thematic sections, making it an invaluable resource for both clinicians and trainees. It covers foundational aspects of endoscopic cardiac surgery while providing detailed insights into the latest procedures, technologies, and patient management strategies. 

Primarily aimed at practicing cardiac surgeons, surgical fellows, and residents, this book is also relevant to anesthesiologists, surgical care practitioners, and members of the multidisciplinary team involved in cardiac surgery. While its technical depth may be challenging for those new to the field, it remains an essential resource for advanced practitioners looking to enhance their knowledge and skills in minimally invasive cardiac surgery. 

One of the unique features of this book is the inclusion of short procedural videos accompanying each key topic, making it easier for readers to understand the techniques and appreciate the crucial steps involved. 

Dr. Zacharias showcased this book, a remarkable exploration of the practical aspects of modern endoscopic cardiac surgery, at the British and Irish Society for Minimally Invasive Cardiac Surgery (BISMICS) annual conference.   The book's structure, depth, and practical advice are impressive. 

Dr. Zacharias’s journey with minimally invasive cardiac surgery began in 2007 when he observed Professor Hugo Vanermen as a young graduate student. During the past 20 years, he has witnessed and contributed to significant advancements in the field. His leadership as a former president of BISMICS and active participation in annual meetings further solidify his authority on the subject. 

The book is comprised of 24 chapters, covering topics ranging from perioperative management and conduit harvesting to valve surgeries, coronary artery bypass grafting (CABG), and innovations in training. One of the book’s greatest strengths is its emphasis on preoperative preparation and case setup. For instance, the chapter on mitral valve surgery by Professor Patrick Perrier not only details peri-areolar incision techniques but also highlights practical tips, such as preventing seroma at femoral cannulation sites. 

The core message of this book, as articulated by Professor Perrier, is that "...the setup should always be the same and kept simple." Each chapter emphasizes preoperative assessment, case setup, and weaning from cardiopulmonary bypass, underscoring the importance of preparation over technical execution. 

This book convincingly argues that high-definition cameras and other technological advancements provide better learning opportunities for young surgeons. It offers practical advice on patient selection, case planning, and managing intraoperative challenges, making it an indispensable guide for climbing the learning curve. 

The book also integrates the latest technologies, such as 3D imaging and advanced robotic systems, while offering practical insights into their applications in everyday practice. It offers comprehensive coverage of minimally invasive cardiac surgery, serving as both a technical manual and a practical guide for practitioners. Its content benefits from global contributions, featuring insights from surgeons around the world, making it a universal consensus document. The text showcases innovative technologies such as the RAM device, Cor-Knot systems, and 3D imaging, emphasizing a forward-thinking approach to surgical advancements. Additionally, the book adopts a multidisciplinary perspective, incorporating valuable input from fields such as anesthesiology, nursing, and radiology to highlight the collaborative nature of modern cardiac care. 

Furthermore, the book features three hours of exclusive, author-created embedded videos that effectively enhance the understanding of concepts through dynamic visuals. These videos provide detailed, real-world applications of endoscopic techniques, offering readers valuable insights into their clinical use and outcomes. Additionally, they are likely to be particularly beneficial for cardiology trainees, aiding in correlating the material with echocardiographic images during their training. 

While the book provides valuable insights into minimal access to cardiac surgery, there are a few areas where it could be further enhanced to provide a more comprehensive resource for readers. Some chapters delve deeply into technical details, which may present a challenge for those without prior experience in the field. 

It would be beneficial to include more discussion on topics such as complications, conversion rates, and managing difficult access cases, as these are important aspects of the practice. Additionally, exploring long-term patient outcomes compared to traditional surgical approaches could offer a more well-rounded perspective. Including insights into redo cardiac surgeries with minimally invasive techniques could also add significant value to the text. Although the author intended to establish endoscopic cardiac surgery as a distinct subspecialty, incorporating robotic surgery in future editions could be valuable, given its growing significance in the field. 

Finally, a chapter on enhanced recovery would align well with the principles of minimally invasive surgery and could further enrich the book. These additions would not only strengthen the text but also broaden its appeal to a wider range of readers. 

Conclusion 

“Endoscopic Cardiac Surgery” by Dr. Joseph Zacharias is an essential read for cardiac surgeons and trainees eager to explore minimally invasive techniques. The book stands out for its comprehensive coverage, practical insights, and emphasis on cutting-edge technology, making it a valuable resource in the field. 

Dr. Zacharias and the contributing authors are to be commended for their tremendous effort in compiling the latest advancements in minimally invasive cardiac surgery into this textbook. Arriving at just the right time to support the growing adoption of endoscopic cardiac surgery, this book is an indispensable guide for surgeons seeking to enhance their surgical expertise. 

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