Journal of visualized surgery最新文献

{"title":"Hybrid robotic thoracic surgery for excision of large mediastinal masses.","authors":"Dario Amore,&nbsp;Marcellino Cicalese,&nbsp;Roberto Scaramuzzi,&nbsp;Davide Di Natale,&nbsp;Dino Casazza,&nbsp;Carlo Curcio","doi":"10.21037/jovs.2018.05.17","DOIUrl":"https://doi.org/10.21037/jovs.2018.05.17","url":null,"abstract":"<p><p>Between April 2016 and October 2017, we retrospectively reviewed all patients undergoing excision of large mediastinal masses using a hybrid robotic thoracic approach at the Unit of Thoracic Surgery of Monaldi Hospital in Naples. The inclusion criteria for this approach were: evident unilateral predominance of the mass; absence of invasion to surrounding structures. Planned conversion to sternotomy was necessary in one patient for tenacious adhesions between the mediastinal goiter and the left innominate vein. In all cases the postoperative course was uneventful. The hybrid robotic approach, adopted in our Unit, consists of a thoracic procedure performed completely with articulated surgical instruments under three-dimensional vision and followed by final extension of a port-site incision to retrieve the voluminous specimen. This approach uses all the advantages of robotic technology that enables to perform a fine dissection in the small space of the anterior mediastinum and at the same time, through the simple extension of a minimally invasive access, avoids the painful sequelae of thoracotomy. In selected cases, with increased experience in robotic surgery, it can be proposed for excision of large mediastinal masses, although a longer follow-up period is necessary to validate our findings.</p>","PeriodicalId":17587,"journal":{"name":"Journal of visualized surgery","volume":"4 ","pages":"105"},"PeriodicalIF":0.0,"publicationDate":"2018-05-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.21037/jovs.2018.05.17","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"36276140","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The influence of the trocar choice on post-operative acute pain after thoracoscopy.","authors":"Andrea Dell'Amore,&nbsp;Alessio Campisi,&nbsp;Domenica Giunta,&nbsp;Stefano Congiu,&nbsp;Niccolò Daddi,&nbsp;Giampiero Dolci,&nbsp;Niccolò Barbera,&nbsp;Letizia Bacchi Reggiani","doi":"10.21037/jovs.2018.05.16","DOIUrl":"https://doi.org/10.21037/jovs.2018.05.16","url":null,"abstract":"Background Acute post-operative pain following thoracic surgery procedures is still an unresolved problem despite the introduction of minimally invasive procedures such as video assisted surgery. Until now it is never investigated if different surgical instruments could influence post-operative pain. The aim of our study is to investigate the role of different type of trocar on post-operative pain in minimally invasive thoracic surgery. Methods This was a prospective randomized single center study. We identified 53 patients randomized into three groups underwent single port thoracoscopy for malignant pleural effusion with drainage of the fluid and talc poudrage. The three groups differ for the trocar type, rigid, flexible and wound protector. Results We compared the postoperative pain between the three groups in which there was no statistical difference. Rigid trocar seems to give a more stable level of pain during the days, flexible trocar gains more pain in the first few hours, however the pain at discharge decreases significantly, reaching the similar values, in all the three groups. The association between pain at discharge and operative time or days of drainage was analyzed by means of linear regression, no statistically significant difference was found. Conclusions Our study showed that different type of trocars during video assisted thoracic surgery (VATS) produces similar level of acute postoperative pain. In future, further randomized study with a great number of patients enrolled needs to confirm our results.","PeriodicalId":17587,"journal":{"name":"Journal of visualized surgery","volume":"4 ","pages":"104"},"PeriodicalIF":0.0,"publicationDate":"2018-05-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.21037/jovs.2018.05.16","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"36276139","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Bicuspid aortic valve repair in the setting of severe aortic insufficiency.","authors":"Ziv Beckerman, Michael O Kayatta, LaRonica McPherson, Jose N Binongo, Yi Lasanajak, Bradley G Leshnower, Edward P Chen","doi":"10.21037/jovs.2018.04.13","DOIUrl":"10.21037/jovs.2018.04.13","url":null,"abstract":"<p><strong>Background: </strong>Bicuspid aortic valve (BAV) is a common cardiac anomaly that affects 0.5-2% of adults. Valve sparing root replacement (VSRR) in bicuspid aortopathy is gaining popularity. We discuss the technical aspects of the procedure as well as the mid- to long-term results of performing VSRR in the setting of a bicuspid valve.</p><p><strong>Methods: </strong>A single institutional database identified 280 patients who underwent VSRR from 2005-2016. Outcomes were analyzed in 60 consecutive patients undergoing a VSRR in the setting of a BAV with aortic regurgitation (AR). Patients were followed prospectively and had annual echocardiograms.</p><p><strong>Results: </strong>The average age in this series was 42±11 years. Moderate or more AR was present in 50% of patients preoperatively. The incidence of operative death, stroke, and renal failure was 0%. Mean follow-up was 39±30 months. At latest follow-up, 62% of patients had zero AR and 87% of patients had <1+ AR. At 9 years, freedom from >2+ AR was 97% and freedom from aortic valve repair (AVR) was 96%.</p><p><strong>Conclusions: </strong>VSRR can be safely and effectively performed in young patients with bicuspid valve anatomy regardless of degree of pre-operative AR. Valve function is durable and the incidence of valve-related complications is low. VSRR is an attractive and potentially superior option to conventional root replacement in appropriately selected patients with bicuspid aortopathy.</p>","PeriodicalId":17587,"journal":{"name":"Journal of visualized surgery","volume":"4 ","pages":"101"},"PeriodicalIF":0.0,"publicationDate":"2018-05-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5994457/pdf/jovs-04-2018.04.13.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"36274173","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Transcaval transcatheter aortic valve replacement: a visual case review.","authors":"Kamran I Muhammad,&nbsp;Georgianne C Tokarchik","doi":"10.21037/jovs.2018.04.02","DOIUrl":"https://doi.org/10.21037/jovs.2018.04.02","url":null,"abstract":"<p><p>Transcatheter aortic valve replacement (TAVR) has emerged as a viable, minimally-invasive and widely adopted approach for the treatment of severe symptomatic aortic stenosis in patients who are intermediate-risk or greater for surgical aortic valve replacement. Numerous studies have demonstrated favorable outcomes with TAVR in this population, particularly with transfemoral access TAVR. Transfemoral TAVR has been shown to be safer and associated less morbidity, shorter lengths of hospital stay and more rapid recovery as compared with traditional thoracic alternative-access TAVR (transapical or transaortic). Despite iterative advancements in transcatheter heart valve technology and delivery system, there remain a portion of patients with iliofemoral arterial vessel sizes that are too small for safe transfemoral TAVR. Paradoxically, these patients are generally higher risk and are thus less favorable candidates for open surgery or traditional alternative-access TAVR. With these considerations in mind, transcaval TAVR was developed as a fully percutaneous, non-surgical approach for aortic valve replacement in patients who are poor candidates for traditional alternative-access TAVR. In this manuscript we describe the principles on which transcaval TAVR was developed, the outcomes from the largest trial completed evaluating this technique as well as describing the technique used to perform this procedure in a case-based format.</p>","PeriodicalId":17587,"journal":{"name":"Journal of visualized surgery","volume":"4 ","pages":"102"},"PeriodicalIF":0.0,"publicationDate":"2018-05-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.21037/jovs.2018.04.02","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"36274174","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Novel extra-thoracic VATS minimally invasive technique for management of multiple rib fractures.","authors":"Natalie N Merchant,&nbsp;Osita Onugha","doi":"10.21037/jovs.2018.05.08","DOIUrl":"https://doi.org/10.21037/jovs.2018.05.08","url":null,"abstract":"We report an elderly patient with chronic obstructive pulmonary disease (COPD), Alzheimer's disease and early dementia who presented with multiple displaced rib fractures of left ribs 4 through 9 with flail segments of ribs 4 through 8 and an associated traumatic pneumatocele from rib puncture of the left upper lobe. The decision to treat this patient operatively was based on the presence of flail chest, the patient's age, baseline co-morbidities and limited physiological reserve. Surgical rib fixation is traditionally performed with a thoracotomy incision and open exposure for extra-thoracic rib fixation, however, this patient underwent chest wall stabilization using an extra-thoracic video-assisted thoracic surgery (VATS) technique. We discuss our operative technique using universal rib plating system, optimal retraction for exposure and use of balloon dilation to create an accessible extra-thoracic working space. This surgical approach provided a faster recovery to this patient's baseline with minimal use of narcotics thereby highlighting the impact and importance of this surgical technique for patients presenting with multiple fib fractures, especially the elderly. We show that VATS assisted minimally invasive technique for operative management of multiple rib fractures is a viable surgical option demonstrated by this patient's recovery and return to function with minimal need for pain control despite her advanced age and baseline co-morbidities.","PeriodicalId":17587,"journal":{"name":"Journal of visualized surgery","volume":"4 ","pages":"103"},"PeriodicalIF":0.0,"publicationDate":"2018-05-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.21037/jovs.2018.05.08","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"36274175","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Aortic and mitral valve repair for anterior mitral leaflet perforation caused by severe aortic regurgitation.","authors":"Kristof De Brabandere,&nbsp;Jens-Uwe Voigt,&nbsp;Stephen Rex,&nbsp;Bart Meuris,&nbsp;Peter Verbrugghe","doi":"10.21037/jovs.2018.04.16","DOIUrl":"https://doi.org/10.21037/jovs.2018.04.16","url":null,"abstract":"<p><p>A 23-year-old man presented with acute onset of dyspnea on exert. Preoperative echocardiography showed a severe regurgitation of the bicuspid aortic valve (due to prolapse of the fused cusp) creating a jet directed through the defect in the anterior leaflet of the mitral valve. Both valves were repaired. Endocarditis was excluded with cultures and polymerase chain reaction (PCR). Postoperative course was uneventful.</p>","PeriodicalId":17587,"journal":{"name":"Journal of visualized surgery","volume":"4 ","pages":"99"},"PeriodicalIF":0.0,"publicationDate":"2018-05-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.21037/jovs.2018.04.16","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"36274171","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Endoscopic Port Access^TM left ventricle outflow tract resection and atrioventricular valve surgery.","authors":"Johan van der Merwe,&nbsp;Filip Casselman,&nbsp;Frank Van Praet","doi":"10.21037/jovs.2018.05.01","DOIUrl":"https://doi.org/10.21037/jovs.2018.05.01","url":null,"abstract":"<p><p>The continuous evolution in robotic-, endoscopic- and trans-catheter cardiac interventions resulted in innovative techniques that simultaneously address left ventricular outflow tract obstruction (LVOTO) and concomitant atrioventricular valve (AVV) pathology in the context of hypertrophic obstructive cardiomyopathy (HOCM). We present our brief report of 13 consecutive HOCM patients with concomitant AVV disease, who underwent endoscopic left ventricular septal myomectomy (LVSM) and AVV surgery by Endoscopic Port Access^TM Surgery (EPAS) between March 1st 2010 and October 31st 2015. Our EPAS technique in the context of HOCM utilizes peripheral cardiopulmonary bypass, endo-aortic balloon occlusion and a 4-cm right antero-lateral thoracic working port. Access to the LVOTO is obtained by detaching the anterior mitral valve (MV) leaflet from the annulus. Controlled sharp LVSM is then performed from the aortic leaflet base to the papillary muscles. Subsequent routine AVV surgery is performed using long shafted instruments. There were no sternotomy conversions, LVSM complications or 30-day mortalities. The mean length of hospitalization was 17.7±18.1 days. Long-term clinical and echocardiographic analysis of 645.7 patient-months (n=13, 100.0% complete) identified two late mortalities, which were not procedure-, HOCM- or AVV-related. All patients (n=13, 100.0%), including the late mortalities, had significant improvement in their quality of life, a 100% long-term freedom from re-intervention and no residual peak instantaneous LVOTO gradients more than 15 mmHg. This brief report emphasises that simultaneous LVSM and concomitant AVV surgery by EPAS can safely be performed in experienced centres with favourable long-term outcomes.</p>","PeriodicalId":17587,"journal":{"name":"Journal of visualized surgery","volume":"4 ","pages":"100"},"PeriodicalIF":0.0,"publicationDate":"2018-05-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.21037/jovs.2018.05.01","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"36274172","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The evidence in a Bentall procedure with Valsalva graft: is this standard of care?","authors":"Ziv Beckerman,&nbsp;Bradley G Leshnower,&nbsp;LaRonica McPherson,&nbsp;Jose N Binongo,&nbsp;Yi Lasanajak,&nbsp;Edward P Chen","doi":"10.21037/jovs.2018.04.05","DOIUrl":"https://doi.org/10.21037/jovs.2018.04.05","url":null,"abstract":"<p><strong>Background: </strong>Biologic valved-conduits avoids the need for anticoagulation and can exploit the excellent hemodynamic performance of stentless valves. Incorporation of the sinuses of Valsalva into the neoaortic root can improve the function and longevity of stentless valves. We report our experience in performing the Bentall procedure with a self-prefabricated composite valved-conduit and review the published experience with the Valsalva graft.</p><p><strong>Methods: </strong>From Feb 2005 through Sep 2017, 428 patients underwent aortic root replacement utilizing a composite graft constructed from a 27-29-mm Freestyle MS valve (Medtronic) sutured into a 28-30-mm Gelweave Valsalva prosthesis (Sulzer Vascutek, Renfrewshire, Scotland). Data were retrospectively analyzed.</p><p><strong>Results: </strong>Mean age was 58±13 years, with a male predominance (337, 79%). Additional surgical procedures included a mitral valve repair/replacement in 10 patients (2%), coronary artery bypass graft (CABG) in 114 patients (27%), and aortic arch (hemi or total) replacement in 252 patients (59%). Average cardiopulmonary bypass, cross-clamp, and circulatory arrest times were 210±57, 180±44, and 29±15 min, respectively. Thirty-day mortality was 7% (31 patients). Mean echocardiography follow-up was 27.2±29.0 months (range, 1-138 months). Pressure gradients (mean, peak) across the aortic valve on latest echocardiography were 5.59, 10.57 mmHg respectively. Freedom from >2+ aortic insufficiency (AI) at 6 and 9 years was 96%, and 87% respectively. Freedom from aortic valve replacement (AVR) at 6 and 9 years was 99%, and 95% respectively. To date, 4 (1%) patients required an additional aortic valve intervention secondary to structural valve degeneration.</p><p><strong>Conclusions: </strong>Use of the Valsalva graft combined with the Freestyle valve for Bentall procedures is associated with favorable results. Clinical outcomes are excellent and in longitudinal follow-up, valve-related complications are minimal.</p>","PeriodicalId":17587,"journal":{"name":"Journal of visualized surgery","volume":"4 ","pages":"98"},"PeriodicalIF":0.0,"publicationDate":"2018-05-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.21037/jovs.2018.04.05","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"36274170","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Uniportal, single incision VATS for the skeptics.","authors":"Marcello Migliore","doi":"10.21037/jovs.2018.05.06","DOIUrl":"https://doi.org/10.21037/jovs.2018.05.06","url":null,"abstract":"As surgeons we are living in an amazing era. Rapid advances in technology transform our surgeries in countless ways. After 20 years the first uniportal VATS were performed (1-3), the procedure has its own space in the thoracic surgery (4), and this special issue takes the readers to reflect on the exciting recent development and future expectations of this modern and futuristic surgical approach.","PeriodicalId":17587,"journal":{"name":"Journal of visualized surgery","volume":"4 ","pages":"97"},"PeriodicalIF":0.0,"publicationDate":"2018-05-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5994449/pdf/jovs-04-2018.05.06.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"36274169","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Made for each other.","authors":"Alan D L Sihoe,&nbsp;Diego Gonzalez-Rivas","doi":"10.21037/jovs.2018.05.12","DOIUrl":"https://doi.org/10.21037/jovs.2018.05.12","url":null,"abstract":"This special issue represents the perfect marriage of two of the strongest trends in thoracic surgery today.","PeriodicalId":17587,"journal":{"name":"Journal of visualized surgery","volume":"4 ","pages":"96"},"PeriodicalIF":0.0,"publicationDate":"2018-05-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5994445/pdf/jovs-04-2018.05.12.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"36274167","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}