Programme-building aspects with introducing minimally invasive axillary thoracotomy repairs in children

Minimally invasive vertical right axillary thoracotomy offers an excellent cosmetic and functional alternative to standard median sternotomy for congenital heart repairs in children. We report the steps taken and challenges involved in building an emerging programmes and outcomes in repairing diverse CHDs.

We performed a retrospective review of the first 152 paediatric patients who underwent repair of selected CHDs using the minimal invasive vertical right axillary thoracotomy approach between April 2022 and December 2025 at our institution and outline our multi-disciplinary team-building protocol.

Pre-commencement protocolar team teaching was implicated 2 months prior to the first case, using information gained through a combination of surgical site visits abroad by the surgeons, protocolar experience exchange with foreign experts, and multimedia educational platforms. The median age was 4.9 years (range: 4 months-13 years), and median weight was 16 kg (6-41 kg). The median lengths of ICU stay and hospital stay were 1.2 and 4.6 days, respectively. No in-hospital deaths or conversions to median sternotomy occurred. No late deaths or reoperations occurred during a median follow-up of 16 months (range 5 months-4 years).

The minimal invasive vertical right axillary thoracotomy can be safely introduced for a broad spectrum of CHDs. Educating all team members is critical to achieving excellent outcomes in a short-time frame. This approach provides excellent cosmetic results with a small "hidden" scar and stands as a good alternative to median sternotomy in selected paediatric patients.