Ultrasound, endoscopy, and the recurrent nerve

Background. Although the procedure requires a small surgical incision and a short duration, incision infection rate is very low in thyroidectomy; however, doctors still have misgivings about infection events.Aim. We retrospectively analyzed the prevention of incision infection without perioperative use of antibacterial medications following thyroidectomy.Materials and Methods. 1166 patients of thyroidectomy were not administered perioperative antibiotics. Unilateral total lobectomy or partial thyroidectomy was performed in 68.0% patients with single-side nodular goiter or thyroid adenoma. Bilateral partial thyroidectomy was performed in 25.5% patients with nodular goiter or Graves’ disease. The mean time of operation was 80.6 ± 4.87 (range: 25–390) min.Results.Resuturing was performed in two patients of secondary hemorrhage from residual thyroid following bilateral partial thyroidectomy. Temporally recurrent nerve paralysis was reported following right-side total lobectomy and left-side subtotal lobectomy in a nodular goiter patient. One case had suppurative infection in neck incision 5 days after bilateral partial thyroidectomy.Conclusions. Thyroidectomy, which is a clean incision, involves a small incision, short duration, and minor hemorrhage. If the operation is performed under strict conditions of sterility and hemostasis, antibacterial medications may not be required to prevent incision infection, which reduces cost and discourages the excessive use of antibiotics.

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Electrical stimulation mapping of the pulmonary artery in swine: impact on pulmonary artery denervation procedure for pulmonary hypertension

European Heart Journal ◽

10.1093/ehjci/ehaa946.3805 ◽

2020 ◽

Vol 41 (Supplement_2) ◽

Author(s):

H.I Condori Leandro ◽

N Goncharova ◽

A Vakhrushev ◽

L Korobchenko ◽

E Andreeva ◽

...

Keyword(s):

Pulmonary Artery ◽

High Frequency ◽

Sinus Bradycardia ◽

Final Analysis ◽

High Frequency Stimulation ◽

Funding Source ◽

Recurrent Nerve ◽

Autopsy Study ◽

Frequency Stimulation ◽

Laryngeal Recurrent Nerve

Abstract Introduction Pulmonary artery denervation (PAD) has been recently shown to decrease pulmonary artery (PA) pressure. However, there is a lack of data related to target sites for ablation. Purpose To determine the optimal PA ablation sites based on response to high-frequency stimulation mapping and anatomical areas where radiofrequency ablation (RFA) should be avoided due to the risk of severe collateral damage. Methods A total of 17 Landrace swines were included into the study. PA angiography, hemodynamic measurements by right heart-sided catheterization and electrophysiological mapping (EM) using low (cycle length 330 ms) and high-frequency (33Hz) stimulation (HFS). Stimulation was performed at PA bifurcation and proximal parts of the main PA branches with a 5-mm distance between points; catheter manipulation was performed under fluoroscopic guidance in multiple projections. Points with evoked reactions were tagged on a 3-dimentional PA model in each case. In order to confirm reproducibility of reactions, HFS was performed at least twice at each point with a response. PA models obtained from all animals were combined in one for the final analysis. RFA using an open-irrigated catheter (40 Watts; 40 s; irrigation 30 ml/min) were performed at sites with evoked reactions. Repeated HFS was performed at ablation sites. After the procedure all animals were euthanized and underwent an autopsy study. Results Low-frequency stimulation (LFS) allowed to define areas of ventricular capture (VC) where HFS was avoided due to ventricular fibrillation induction risk. During HFS the following evoked responses were documented: sinus bradycardia, sinus rhythm (SR) acceleration, phrenic nerve capture (PNC), and laryngeal recurrent nerve capture. HFS captured left and right phrenic nerves in all animals at PA trunk, and its course was tagged (Figure 1). Laryngeal recurrent nerve capture was found in 4 (23%) of animals. Atrial capture was found in all cases while LFS at the anterior aspects of both PAs even at low output, and this precluded evaluation of neural autonomic reactions in these areas. Evoked bradycardia and SR acceleration were both found during HFS in 10 (59%) of cases each. Following RFA application evoked reactions were non-reproducible in all cases. RFA was applied in areas where no PNC or VC points were observed. An autopsy study confirmed the presence of RF-induced lesions of the PA wall. Conclusions There are two important findings of our study. First, stimulation-guided PA mapping is feasible and reveals several specific responses to HFS. Ablation at points with responses leads to non-reproducibility of the evoked reactions, confirming that transcatheter RFA may be an adequate approach for PA denervation. Second, previously proposed circular PA ablation might be associated with phrenic and laryngeal recurrent nerve damage. Stimulation-guided PA denervation can be proposed as a safer procedure, and should be evaluated in clinical settings. Figure 1. PA schematic representation Funding Acknowledgement Type of funding source: Public grant(s) – National budget only. Main funding source(s): Russian Foundation for Basic Research

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548 COMPARISON OF ESOPHAGECTOMY OUTCOMES BETWEEN A NATIONAL CENTER, A NATIONAL AUDIT COLLABORATIVE, AND AN INTERNATIONAL DATABASE USING ECCG STANDARDIZED DEFINITIONS

Diseases of the Esophagus ◽

10.1093/dote/doab052.548 ◽

2021 ◽

Vol 34 (Supplement_1) ◽

Cited By ~ 1

Author(s):

John V Reynolds ◽

Jessie A Elliott ◽

Noel Donlon ◽

Claire Donohoe ◽

Narayanasamy Ravi ◽

...

Keyword(s):

Anastomotic Leak ◽

Leak Rate ◽

Collaborative Group ◽

Surgical Approaches ◽

Consecutive Series ◽

Recurrent Nerve ◽

En Bloc ◽

Curative Intent ◽

Chyle Leak ◽

Anastomotic Leak Rate

Abstract The ECCG developed a standardized platform for reporting operative complications, with consensus definitions, and DUCA adopted these definitions and have reported a comparison against these benchmarks. The aim of this study was to report five year complications data using the standardized definitions of the Esophageal Complications Consensus Group (ECCG), and to compare with published ECCG benchmark studies from the collaborative group and from the Dutch Upper Gastrointestinal Cancer Audit (DUCA). Methods All patients undergoing multimodal therapy or surgery with curative intent from 2014 to 2018 inclusive were studied. All data were recorded prospectively and maintained internally as well as entered onto a secure online database (Esodata.org) from 2015. Statistical analysis was performed using SPSS® (version 18.0). Results 219 patients (mean age 67; 77% male) underwent open resection, 66.6% via transthoracic en bloc resection. 30-day and 90-day mortality were 0.0 and 0.9%, respectively. The anastomotic leak rate was 5.4%, and chyle leak 5.4%. Pneumonia was recorded in 18.2%, respiratory failure 10.9%, and ARDS in 2.7%. Atrial dysrhythmia occurred in 22.8%, recurrent nerve injury 3.1%, and delirium in 5.0%. Compared with both ECCG and DUCA, where MIE constituted 47% and 86% of surgical approaches, respectively, overall complications were similar in this open series, as was complications severity, however anastomotic leak rate were several-fold less, and mortality rates were lower. Conclusion In this unselected consecutive series and comparative audit with benchmark averages from the ECCG and DUCA publication, a low mortality and anastomotic leak rate were the key differential findings. Although not risk-stratified or directly matched, the severity of complications from this ‘open’ series is consistent with series containing large numbers of total or hybrid MIE, highlighting a need to adhere to these strictly defined definitions in further prospective research and randomized studies.

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CAUSES OF ADVERSE SURGERY EFFECTS IN TREATMENT OF PATIENTS WITH ESOPHAGUS STENOTIC DISEASES

International Medical Journal ◽

10.37436/2308-5274-2020-3-5 ◽

2020 ◽

pp. 23-27

Author(s):

A. Yu. Korolevska ◽

S. Yu. Bityak ◽

V. V. Zhidetskyi ◽

A. B. Starikova ◽

Ye. A. Novikov

Keyword(s):

Postoperative Complications ◽

Pleural Empyema ◽

Esophageal Stenosis ◽

Mechanical Trauma ◽

Recurrent Nerve ◽

Peptic Ulcers ◽

Esophageal Lumen ◽

Post Surgery ◽

Tracheal Tear ◽

Primary Trauma

Esophageal stenosis requires a responsible approach to the choice of rational treatment tactics. Intraoperatively, bleeding, interponate necrosis, complications associated with the wrong choice of the path of the interponate imposition to the neck, damage to the nutrient vessel (the arcade rupture), pleural leaves during the formation of the thoracic tunnel, n. vagus and its branches, pneumothorax, hemothorax, uncontrolled mediastinal bleeding, the need for drainage of the pleural cavity due to injury to the latter, iatrogenic splenectomy, membranous tracheal tear. Post−surgery complications are developed at different times after esophagoplasty. Most often, early postoperative complications occur because of the wound: bleeding and failure of the sutures of the anastomosis line. Complications resulted from the respiratory system are as follows: tracheobronchitis, pleurisy, "congestive", nosocomial pneumonia and atelectasis, pleural empyema. In the remote post−surgery period, the patients may experience: stenosis of the esophageal (or pharyngeal) anastomosis, adhesions, fistulas, reflux, peptic ulcers of the esophagus, pain, inflections and excess loops, complications associated with mechanical trauma of implant, scar−altered cancer esophagus, polyposis of the colon, various disorders associated with primary trauma, nonspecific complications. Damage to the recurrent nerve in patients causes constant hoarseness and difficult swallowing. Occasionally there are cardiac arrhythmias in the form of atrial fibrillation, "sympathetic" pleurisy, reflux, post−vagotomy symptom and dumping syndrome, delayed gastric emptying due to insufficient dilated pyloromyotomy in the patients with a combination of stenosis of the esophageal lumen and esophageal lumen hernia. Key words: esophageal stenosis, esophageal anastomosis, postoperative complications.

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PS02.069: CERVICAL GASTROPLASTY ANASTOMOSIS AFTER ESOPHAGECTOMY: INDOCYANINE GREEN FLUORESCENCE IMAGING EVALUATION AND TECHNICAL SURGICAL ASPECTS

Diseases of the Esophagus ◽

10.1093/dote/doy089.ps02.069 ◽

2018 ◽

Vol 31 (Supplement_1) ◽

pp. 140-140

Author(s):

Flavio Takeda ◽

Ulysses Ribeiro Jr ◽

Rubens Sallum ◽

Julio Mariano Rocha ◽

Andre Duarte ◽

...

Keyword(s):

Indocyanine Green ◽

Fluorescence Imaging ◽

Conflicts Of Interest ◽

Visual Assessment ◽

Gastric Conduit ◽

Linear Stapler ◽

Recurrent Nerve ◽

Imaging Evaluation ◽

Indocyanine Green Fluorescence ◽

Surgical Aspects

Abstract Description One of the most frequent complication after esophagectomy is the anastomotic leakage, which is a determiming factor of morbidity and mortality after surgical treatment. The best location for the esophagogastric anastomosis (cervical or intra-thoracic) has been topic of discussion for many years, and surgical aspects as resected margins, recurrent nerve trauma and mainly the vascularization of the anastomosis. In this video we performed a cervical gastroplasty anastomosis (McKeown), side-to-side, stapled (linear stapler) with a thin gastric tube conduit, and after that we aimed to determine the feasibility and usefulness of indocyanine green (ICG) fluorescence imaging to evaluate the gastric conduit perfusion during an esophagectomy. After pulling up the gastric conduit trhought the mediastinum and after performing the cervical anastomosis, 5 mg of ICG was in jected as a bolus and visual assessment of the blood supply of the gastric conduit was seen. This patient was a 63 years old, male, with adenocarcinoma of esophago-gastric junction (Siewert II) underwent to neoadjuvant quimiotherapy (FOLFOX regimen) and submitted after 3 cycles to esophagectomy (thoracoscopy and laparoscopy). No fistula was found in post operative follow-up, and either complications. Disclosure All authors have declared no conflicts of interest.

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Midazolam and pethidine versus propofol and fentanyl patient controlled sedation/analgesia for upper gastrointestinal tract ultrasound endoscopy: A prospective randomized controlled trial

Digestive and Liver Disease ◽

10.1016/j.dld.2007.08.004 ◽

2007 ◽

Vol 39 (11) ◽

pp. 1024-1029 ◽

Cited By ~ 25

Author(s):

M. Agostoni ◽

L. Fanti ◽

P.G. Arcidiacono ◽

M. Gemma ◽

G. Strini ◽

...

Keyword(s):

Randomized Controlled Trial ◽

Gastrointestinal Tract ◽

Controlled Trial ◽

Upper Gastrointestinal Tract ◽

Randomized Controlled ◽

Prospective Randomized Controlled Trial ◽

Upper Gastrointestinal ◽

Ultrasound Endoscopy

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Recurrent laryngeal nerve palsy secondary to benign thyroid disease

The Journal of Laryngology & Otology ◽

10.1017/s0022215100128385 ◽

1994 ◽

Vol 108 (10) ◽

pp. 878-880 ◽

Cited By ~ 12

Author(s):

J. E. Fenton ◽

C. I. Timon ◽

D. P. McShane

Keyword(s):

Recurrent Laryngeal Nerve ◽

Thyroid Disease ◽

Nerve Palsy ◽

Recurrent Laryngeal Nerve Palsy ◽

Laryngeal Nerve ◽

Recurrent Laryngeal Nerve Paralysis ◽

Recurrent Nerve ◽

Benign Thyroid Disease ◽

Nerve Paralysis ◽

Benign Thyroid

Abstract: A recurrent nerve palsy occurring in the presence of a goitre is considered to be caused by thyroid malignancy until proven otherwise.Three cases are described in which benign thyroid disease resulted in recurrent laryngeal nerve paralysis. Recent haemorrhage was implicated histologically as the possible aetiology in all three cases. The importance of identifying and preserving the recurrent laryngeal nerve in the surgical management is highlighted.

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VS01.09: ROBOTIC MCKEOWN ESOPHAGECTOMY: LESSONS LEARNED AFTER 50 CASES

Diseases of the Esophagus ◽

10.1093/dote/doy089.vs01.09 ◽

2018 ◽

Vol 31 (Supplement_1) ◽

pp. 45-46

Author(s):

Rubens Sallum ◽

Flavio Takeda ◽

Marco Santo ◽

Andre Duarte ◽

Ivan Cecconello

Keyword(s):

Aortic Arch ◽

Conflicts Of Interest ◽

Azygos Vein ◽

Lessons Learned ◽

Thoracoscopic Esophagectomy ◽

Recurrent Nerve ◽

Cervical Anastomosis ◽

Robotic Arms ◽

Mckeown Esophagectomy

Abstract Description Authors show the lessons learned after 50 robotic esophagectomies: the new positioning of the 4 robotic arms in the thorax avoiding collisions, fixation of the arches of the azygos vein arch (after section) and retraction of the trachea allowing the dissection of the left recurrent nerve lymph nodal chain, especially within the aortic arch. Abdominal dissection and cervical anastomosis are also presented. The film end with the results compared to Thoracoscopic Esophagectomy Disclosure All authors have declared no conflicts of interest.

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