Multimedia manual of cardiothoracic surgery : MMCTS / European Association for Cardio-Thoracic Surgery最新文献

{"title":"A robotic-assisted Pancoast tumour resection.","authors":"Anam Ali, Aishah Mughal, Ahmed Oliemy, Ahmed M Habib","doi":"10.1510/mmcts.2025.014","DOIUrl":"https://doi.org/10.1510/mmcts.2025.014","url":null,"abstract":"<p><p>Pancoast tumours, a rare subset of superior sulcus tumours, arise at the apex of the lung and pose significant surgical challenges due to their anatomical location and propensity to invade adjacent critical structures, including the brachial plexus, subclavian vessels and the thoracic spine. Historically, these tumours were considered inoperable, but advancements in multimodal treatment, including neoadjuvant chemoradiotherapy followed by surgical resection, have improved survival rates. Conventional open surgical techniques are associated with significant morbidity, prolonged recovery and suboptimal visualization of critical structures. Robotic-assisted thoracic surgery, particularly with the da Vinci Xi surgical system, offers enhanced three-dimensional visualization, dexterity and precision in confined spaces, potentially transforming the surgical management of these complex resections. This video tutorial explores the application of a robotic-assisted Pancoast tumour resection using the da Vinci Xi platform, focusing on perioperative management and patient outcomes.</p>","PeriodicalId":53474,"journal":{"name":"Multimedia manual of cardiothoracic surgery : MMCTS / European Association for Cardio-Thoracic Surgery","volume":"2025 ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-05-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144175543","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Scarless aortic valve replacement (periareolar approach) with a limited suture technique.","authors":"Bassem Gadallah, Abdelrahman Abdelbar, Eslam Elhelw, Joseph Zacharias","doi":"10.1510/mmcts.2025.031","DOIUrl":"https://doi.org/10.1510/mmcts.2025.031","url":null,"abstract":"<p><p>Periareolar incision for endoscopic aortic valve replacement via the 9-suture technique Femoral Vessel Exposure Incision above the groin crease reduces complications. Partial vessel exposure (no full isolation) with purse-string sutures (4/0 Prolene for vein, pledgeted 5/0 Gore-Tex for artery). Surgical Access Periareolar incision (third intercostal space): muscle-sparing, hidden scar, Alexis retractor for exposure. Left ventricular vent (fifth intercostal space): CO₂ insufflation (2 L/min) to prevent air embolism. Camera port (third intercostal space: for visualization and retraction). Femoral Cannulation Seldinger's technique under transoesophageal echocardiography guidance; venous cannula to the superior vena cava (vacuum-assisted), artery. Pericardiotomy and Clamp Placement Incision anterior to phrenic nerve; stay sutures for exposure. Chitwood clamp inserted via second intercostal space to stabilize the aorta. Cardioplegia and Aortotomy Antegrade Custodiol cardioplegia via 3-0 Prolene purse-string suture. Horizontal aortotomy after cross-clamping. Valve Excision and Suture Placement (9-Suture Technique) Valve excised; annulus decalcified. Pledgeted horizontal mattress sutures (3 commissural, 2 per cusp) placed strategically. Valve Implant and Closure Sutures passed through the prosthetic valve, parachuted, secured with Cor-Knot. Aortotomy closed in two layers (pledgeted mattress + running suture). De-airing and Weaning Trendelenburg, left ventricle vent suction, isolated lung ventilation. Pacing wires placed; pericardium closed. Chest Drain and Closure Drains inserted; femoral cannulae removed post-heparin reversal. Periareolar incision closed with muscle suture for cosmesis. Outcome No paravalvular leak, early extubation (2 h), discharge by postoperative day 4. Cosmetic advantage, less pain, faster recovery versus sternotomy. Reduced suture count lowers left ventricular outflow tract gradients without increasing leak risk. Conclusion This minimally invasive approach improves outcomes and patient satisfaction, supported by optimized anticoagulation (international normalized ratio 1.5-2.0) for newer version of mechanical valves.</p>","PeriodicalId":53474,"journal":{"name":"Multimedia manual of cardiothoracic surgery : MMCTS / European Association for Cardio-Thoracic Surgery","volume":"2025 ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-05-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144163521","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Intraoperative iatrogenic aortic dissection.","authors":"Jingge Zhao, Hidefumi Nishida, Ryota Nakamura, Rihito Tamaki, Kohei Abe","doi":"10.1510/mmcts.2025.030","DOIUrl":"https://doi.org/10.1510/mmcts.2025.030","url":null,"abstract":"<p><p>Iatrogenic aortic dissection is rare but remains a lethal complication in cardiac surgery despite advances in surgical technology. The crisis associated with iatrogenic aortic dissection highlights the importance of using extreme caution. We experienced an iatrogenic aortic dissection during an elective ascending aortic replacement procedure for an ascending aortic aneurysm. After a cardiac surgery fellow placed the aortic cannula in the ascending aorta, pulsatility in the cardiopulmonary bypass circuit was confirmed. Cardiopulmonary bypass was initiated following the placement of the venous cannula., The iatrogenic aortic dissection was unexpectedly detected 4 minutes after the initiation of cardiopulmonary bypass, as revealed by transoesophageal echocardiography. Cardiopulmonary bypass was discontinued immediately. To establish secured cardiopulmonary bypass, we performed ultrasound-guided guidewire cannulation, targeting the true lumen in the dissected ascending aorta. An alternative aortic cannula was placed over the wire into the true lumen. Then cardiopulmonary bypass was resumed, and we proceeded with the remaining steps of the operation. The patient recovered without complications and was discharged on postoperative day 8. The intraoperative video captured the ongoing bluish discoloration and dilatation of the ascending aorta at the initiation of cardiopulmonary bypass. Because cannulation procedures are often performed by surgical fellows for educational purposes, this case report serves as a valuable learning tool. The repair strategy we used offers a promising and reliable alternative option.</p>","PeriodicalId":53474,"journal":{"name":"Multimedia manual of cardiothoracic surgery : MMCTS / European Association for Cardio-Thoracic Surgery","volume":"2025 ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-05-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144152784","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Totally endoscopic aortic valve replacement after open surgical and subsequent transcatheter aortic valve replacement.","authors":"Silke Van Genechten, William Hillen, Jade Claessens, Loren Packlé, Hanne Oosterbos, Samuel Heuts, Alaaddin Yilmaz","doi":"10.1510/mmcts.2024.126","DOIUrl":"https://doi.org/10.1510/mmcts.2024.126","url":null,"abstract":"<p><p>Transcatheter aortic valve replacement is increasingly being offered to younger and lower risk patients, including patients with previous surgical aortic valve replacement. The long-term outcome of valve-in-valve transcatheter aortic valve replacement after surgical valve replacement remains uncertain. We present the case of a fully thoracoscopic redo aortic valve replacement for symptomatic valve-in-valve stenosis after previous open surgical aortic valve replacement and secondary valve-in-valve transcatheter aortic valve replacement. This procedure has proven to be difficult and high risk, in part due to the redo nature of the operation and the extensive neo- endothelialization over the transcatheter aortic valve replacement stent frame. This article demonstrates the feasibility of a minimally invasive approach for transcatheter aortic valve replacement and bioprosthetic valve explant while simultaneously highlighting the essential role of the heart team in selecting the correct treatment strategy for patients with bioprosthetic valve degeneration.</p>","PeriodicalId":53474,"journal":{"name":"Multimedia manual of cardiothoracic surgery : MMCTS / European Association for Cardio-Thoracic Surgery","volume":"2025 ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-05-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144095426","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A challenging case of a giant thymoma resected using the clamshell approach.","authors":"Giulia Pagliarini, Vincenzo Verzeletti, Alessandro Bonis, Gianluca Canu, Marco Mammana, Samuele Nicotra, Andrea Dell'Amore, Federico Rea","doi":"10.1510/mmcts.2025.019","DOIUrl":"10.1510/mmcts.2025.019","url":null,"abstract":"<p><p>Extensive intrathoracic tumours demand an aggressive surgical approach due to their size and proximity to vital structures, thereby increasing procedural risks. A thymoma can expand substantially before detection and affect surrounding tissues. An operation is the primary therapy, sometimes supplemented by chemotherapy or radiation. In this case report, we present the case of a giant thymoma managed with the clamshell approach.</p>","PeriodicalId":53474,"journal":{"name":"Multimedia manual of cardiothoracic surgery : MMCTS / European Association for Cardio-Thoracic Surgery","volume":"2025 ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-05-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144058096","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Descending aortic stenosis caused by intramural thrombus in the setting of severe thrombocytosis: a rare mimicker of aortic angiosarcoma.","authors":"Susumu Oshima, Hirokami Tomohiro, Sakurai Shigeru","doi":"10.1510/mmcts.2025.025","DOIUrl":"https://doi.org/10.1510/mmcts.2025.025","url":null,"abstract":"<p><p>A rare case of descending aortic stenosis caused by intramural thrombus in a patient with severe thrombocytosis is presented. A 50-year-old man exhibited progressive bilateral claudication. Imaging revealed a suspicious intramural lesion with no significant enhancement on positron emission tomography-computed tomography scans. Because primary aortic angiosarcoma could not be excluded, an oncological surgical strategy was used. The lesion was removed en bloc without luminal entry, and a 22-mm Dacron graft was used for reconstruction. Histopathological analysis confirmed thrombus without malignancy. Postoperative recovery was uneventful, with resolution of claudication, normalization of the ankle-brachial index (ABI) and ongoing cytoreductive therapy for confirmed essential thrombocythaemia. This case highlights the importance of considering haematologic disorders in aortic pathology and demonstrates a safe surgical strategy in diagnostically uncertain cases.</p>","PeriodicalId":53474,"journal":{"name":"Multimedia manual of cardiothoracic surgery : MMCTS / European Association for Cardio-Thoracic Surgery","volume":"2025 ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-05-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144026521","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Minimally invasive resection of a subaortic membrane via a vertical right axillary thoracotomy in a child.","authors":"Ali H Mashadi, Maryam Alomair, Sameh M Said","doi":"10.1510/mmcts.2024.138","DOIUrl":"https://doi.org/10.1510/mmcts.2024.138","url":null,"abstract":"<p><p>We present the technical steps and pitfalls of the minimally invasive resection of a subaortic membrane via a vertical right axillary thoracotomy in a child.</p>","PeriodicalId":53474,"journal":{"name":"Multimedia manual of cardiothoracic surgery : MMCTS / European Association for Cardio-Thoracic Surgery","volume":"2025 ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-05-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144044453","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Uniportal video-assisted thoracoscopic surgery: left S6 sleeve segmentectomy.","authors":"Ints Siliņš, Filips Aksjutins, Helmuts Bināns, Oksana Mahmajeva, Marina Gaidukova, Rihards Mikilps-Mikgelbs","doi":"10.1510/mmcts.2025.018","DOIUrl":"https://doi.org/10.1510/mmcts.2025.018","url":null,"abstract":"<p><p>A typical carcinoid has been described as a low-grade malignancy belonging to the group of neuroendocrine tumours. Surgical resection is the treatment of choice for early-stage carcinoid tumours, resulting in excellent five-year survival rates. Resection of tumours located in peripheral parts of the lung is usually straightforward and well described. However, resection of endobronchial tumours located in the major airway may represent a serious challenge. Different types of bronchial sleeve resections have been developed to address this issue and to avoid unnecessary loss of otherwise healthy pulmonary tissue. A sleeve segmentectomy could be an option in cases with limited airway involvement at the level of the segmental bronchus. Nevertheless, reports of this technique in the literature are rare. We present our technique for a uniportal video-assisted thoracoscopic surgery bronchial sleeve segmentectomy.</p>","PeriodicalId":53474,"journal":{"name":"Multimedia manual of cardiothoracic surgery : MMCTS / European Association for Cardio-Thoracic Surgery","volume":"2025 ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144059933","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A robotic fissureless en bloc resection of left S6 and S1+2a+b for lung cancer located at an incomplete fissure.","authors":"Hiroyuki Tao","doi":"10.1510/mmcts.2025.027","DOIUrl":"https://doi.org/10.1510/mmcts.2025.027","url":null,"abstract":"<p><p>The fissureless technique is useful for avoiding postoperative air leaks after pulmonary lobectomy or segmentectomy when the interlobar fissure is incomplete or fused. This technique is also useful for lung cancers with interlobar invasion or located in incomplete or fused fissures. In a recent case, we successfully utilized robotic-assisted thoracoscopic surgery to perform the fissureless technique on a patient diagnosed with lung adenocarcinoma. The tumour was located in the left superior segment (S6) and had spread beyond the incomplete fissure towards the apicodorsal segment (S1+2). The use of the fissureless technique allowed us to achieve a sufficient tumour margin, which is crucial for reducing the risk of recurrence. The pathological examination confirmed a diagnosis of node-negative papillary adenocarcinoma with pleural invasion. The patient experienced no recurrence at three years postoperatively. En bloc combined segmentectomy using the fissureless technique is useful to ensure adequate tumour margins for lung cancer arising in incomplete or fused fissures. Robotic surgery is suitable for this technique, which proceeds from a single direction.</p>","PeriodicalId":53474,"journal":{"name":"Multimedia manual of cardiothoracic surgery : MMCTS / European Association for Cardio-Thoracic Surgery","volume":"2025 ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-04-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144056695","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Three different surgical approaches for complex transposition of the great arteries with ventricular septal defect and pulmonary stenosis.","authors":"Tomasz Nalecz, Alexandre Pelouze, Rares-Alexandru Eniu, Mélanie Frei, Jalal Jolou, Charlotte Leclercq, Julie Wacker, Tornike Sologashvili","doi":"10.1510/mmcts.2025.037","DOIUrl":"https://doi.org/10.1510/mmcts.2025.037","url":null,"abstract":"<p><p>The treatment of complex transposition of the great arteries with a ventricular septal defect and pulmonary stenosis/left outflow tract obstruction poses significant challenges. The decision between performing a Rastelli procedure, a Nikaidoh procedure or a double root rotation depends on the cardiac anatomy, especially the location of the ventricular septal defect, its spatial relationship with the great arteries, the presence of straddling of the atrioventricular valve and the appreciation of the pulmonary valve. In our centre, our goal is to provide the most physiologic repair tailored to each patient's unique anatomy and to try to preserve the pulmonary valve in the pulmonary position, despite some degree of residual stenosis. We demonstrate three different surgical techniques adapted for various anatomies: one en bloc double root rotation, one double root translocation with separation of the roots and one modified Nikaidoh procedure.</p>","PeriodicalId":53474,"journal":{"name":"Multimedia manual of cardiothoracic surgery : MMCTS / European Association for Cardio-Thoracic Surgery","volume":"2025 ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-04-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144041213","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}