Variation in surgical methods used for total laryngectomy in Australia

AbstractDeglutition disorders (dysphagia) are common following total laryngectomy. As the aetiology of the disorder is poorly understood, its incidence is probably under-estimated. Dysphagia may result from many factors, including the type of laryngectomy surgery employed and the use of adjuvant treatments (e.g. radiotherapy and chemotherapy). Dysphagia may also be compounded by other co-morbid factors, such as ageing and depression.Aim:To investigate the methods of surgical closure used by Australian ENT and head and neck surgeons after undertaking total laryngectomy surgery.Method:In order to audit surgical variation, 56 short questionnaires were sent to all Australian ENT and head and neck surgeons who were registered members of the Australia and New Zealand Head and Neck Society. Twenty-eight questionnaires (50 per cent) were completed and returned.Results:Respondents reported using a variety of different reconstructive methods after total laryngectomy surgery. Specifically, there were differences in the type and levels of pharyngeal closure employed and the suturing techniques used.Conclusion:Currently, there is no scientific evidence to direct surgeons to the optimal pharyngeal reconstruction technique(s) ensuring for good swallowing results post-laryngectomy. An analysis of the effect of surgical reconstruction technique on laryngectomees' post-operative swallowing ability is needed, in order to provide evidence to determine optimal surgical techniques.

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Comparison of Doty and McGoon techniques for surgical reconstruction of congenital supravalvular aortic stenosis

Cardiology in the Young ◽

10.1017/s1047951121004467 ◽

2021 ◽

pp. 1-8

Author(s):

Mehmet Biçer ◽

Mehmet Dedemoğlu ◽

Oktay Korun ◽

Hüsnü F. Altın ◽

Okan Yurdakök ◽

...

Keyword(s):

Aortic Stenosis ◽

Surgical Repair ◽

Pulmonary Stenosis ◽

Surgical Techniques ◽

Supravalvular Aortic Stenosis ◽

Surgical Reconstruction ◽

Residual Stenosis ◽

Post Operative Period ◽

Surgical Methods

Abstract Background: We aimed to compare the results of two surgical methods for the treatment of congenital supravalvular aortic stenosis. Methods: From May 2004 to January 2020, 29 patients underwent surgical repair for supravalvular aportic stenosis in a single centre. The perioperative evaluation of the patients was retrospectively reviewed. Results: Fifteen (51.7%) and 14 (48.2%) patients were treated with the Doty and the McGoon methods, respectively. The median age of our cohort was 4.5 (3.0–9.9) years. Ten (34.5%) patients had Williams–Beuren syndrome, and pulmonary stenosis was observed in 12 (41.3%) patients. The median follow-up time was 2.5 (0.7–7.3) years. On follow-up, five patients had residual stenosis with the McGoon technique and one with the Doty technique (p = 0.05). One patient died early in the post-operative period in the Doty group, and three patients were re-operated on due to restenosis in the McGoon group. Freedom from re-operation in the Doty group at 1, 3, 5, and 10 years was 100%. In the McGoon group, freedom from re-operation rates at the 1-, 3-, and 7-year follow-up were 100, 88.9, and 44.4%, respectively (p = 0.08). Conclusion: Our results with both surgical techniques suggest that supravalvular aortic stenosis can be treated with good results. The Doty method provided better relief for the supravalvular aortic segment, considering the residual stenosis and the re-operation rates.

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Impact of Multilayer Vascularized Reconstruction after Skull Base Endoscopic Endonasal Approaches

Journal of Neurological Surgery Part B Skull Base ◽

10.1055/s-0039-1677705 ◽

2019 ◽

Vol 81 (02) ◽

pp. 128-135 ◽

Cited By ~ 1

Author(s):

Juan Antonio Simal-Julián ◽

Pablo Miranda-Lloret ◽

Laila Pérez de San Román Mena ◽

Pablo Sanromán-Álvarez ◽

Alfonso García-Piñero ◽

...

Keyword(s):

Skull Base ◽

Scientific Evidence ◽

Surgical Reconstruction ◽

Csf Leak ◽

Outcome Variable ◽

Reconstruction Technique ◽

Endoscopic Endonasal ◽

Postoperative Leak ◽

Skull Base Defects ◽

Reconstructive Techniques

Abstract Background The use of vascularized flap to reconstruct the skull base defects has dramatically changed the postoperative cerebrospinal fluid (CSF) leak rates allowing the expansion of endoscopic skull base procedures. At present, there is insufficient scientific evidence to permit identification of the optimal reconstruction technique after the endoscopic endonasal approach (EEA). Objective The main purpose of this article is to establish the risk factors for failure in the reconstruction after EEA and whether the use of a surgical reconstruction protocol can improve the surgical results. Material and Methods A retrospective cohort study was conducted in our institution, selecting patients that underwent EEA with intraoperative CSF leak. Two reconstructive protocols were defined based on different reconstructive techniques; both were vascularized but one monolayer and the other multilayer. A multivariate analysis was performed with outcome variable presentation of postoperative leak. Results One hundred one patients were included in the study. Patients reconstructed with protocol 1, with the diagnosis different to the pituitary adenoma and older than 45 years old had higher risk of presenting postoperative leak, and with statistically significant differences when we adjusted for the remaining variables. Conclusion The vascularized reconstructions after endoscopic endonasal skull base approaches have demonstrated to be able to obtain a low rate of postoperative CSF leak. The multilayer vascularized technique may provide a more evolved technique, even reducing the postoperative leak rates comparing with the monolayer vascularized one. The reconstructive protocol employed in each case, as well as age and histological diagnosis, is independent risk factor for presenting postoperative leak.

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Combined application of virtual surgery and 3D printing technology in postoperative reconstruction of head and neck cancers

BMC Surgery ◽

10.1186/s12893-019-0616-3 ◽

2019 ◽

Vol 19 (1) ◽

Cited By ~ 2

Author(s):

Chao Li ◽

Yongchong Cai ◽

Wei Wang ◽

Yan Sun ◽

Guojun Li ◽

...

Keyword(s):

Head And Neck ◽

Surgical Techniques ◽

Neck Surgery ◽

Vital Role ◽

Head And Neck Surgery ◽

Surgical Reconstruction ◽

Virtual Surgery ◽

Surgical Technology ◽

Formidable Challenge ◽

Complex Anatomy

Abstract Background The complex anatomy of the head and neck creates a formidable challenge for surgical reconstruction. However, good functional reconstruction plays a vital role in the quality of life of patients undergoing head and neck surgery. Precision medical treatment in the field of head and neck surgery can greatly improve the prognosis of patients with head and neck tumors. In order to achieve better shape and function, a variety of modern techniques have been introduced to improve the restoration and reconstruction of head and neck surgical defects. Digital surgical technology has great potential applications in the clinical treatment of head and neck cancer because of its advantages of personalization and accuracy. Case presentation Our department has identified the value of modern digital surgical techniques in the field of head and neck surgery and has explored its utility, including CAD/CAM technology and VR technology. We have achieved good results in the reconstruction of head and neck surgical resection defects. Conclusion In this article, we share five typical cases from the department of head and neck surgery where the reconstruction was performed with the assistance of digital surgical technology.

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Distal radioulnar joint stabilization with open foveal reinsertion versus tendon graft reconstruction: an experimental study using radiostereometry

Journal of Experimental Orthopaedics ◽

10.1186/s40634-021-00329-y ◽

2021 ◽

Vol 8 (1) ◽

Author(s):

Janni Kjærgaard Thillemann ◽

Sepp De Raedt ◽

Torben Bæk Hansen ◽

Bo Munk ◽

Maiken Stilling

Keyword(s):

Experimental Study ◽

Surgical Techniques ◽

Distal Radioulnar Joint ◽

Tendon Graft ◽

Imaging Method ◽

Radioulnar Joint ◽

Clinical Recommendation ◽

Surgical Methods ◽

Custom Made ◽

Stabilizing Effect

Abstract Purpose Symptomatic instability of the distal radioulnar joint (DRUJ) caused by lesion of the Triangular Fibrocartilage Complex (TFCC) can be treated with a number of surgical techniques. Clinical examination of DRUJ translation is subjective and limited by inter-observer variability. The aim of this study was to compare the stabilizing effect on DRUJ translation with two different surgical methods using the Piano-key test and a new precise low-dose, non-invasive radiostereometric imaging method (AutoRSA). Methods In a randomized experimental study we evaluated the DRUJ translation in ten human cadaver arms (8 males, mean age 78 years) after cutting the proximal and distal TFCC insertions, and after open surgical TFCC reinsertion (n = 5) or TFCC reconstruction using a palmaris longus tendon graft ad modum Adams (n = 5). The cadaver arms were mounted in a custom-made fixture for a standardized Piano-key test. Radiostereometric images were recorded and AutoRSA software was used for image analyses. Standardised anatomical axes and coordinate systems of the forearm computer tomography bone models were applied to estimate DRUJ translation after TFCC lesions and after surgical repair. Results The DRUJ translation after cutting the proximal and distal TFCC insertions was 2.48 mm (95% CI 1.61; 3.36). Foveal TFCC reinsertion reduced DRUJ translation by 1.78 mm (95% CI 0.82; 2.74, p = 0.007), while TFCC reconstruction reduced DRUJ translation by 1.01 mm (95% CI -1.58; 3.60, p = 0.17). Conclusion In conclusion, foveal TFCC reinsertion significantly decreased DRUJ translation while the stabilizing effect of Adams TFCC reconstruction was heterogeneous. This supports the clinical recommendation of TFCC reinsertion in patients suffering from symptomatic DRUJ instability due to acute fovea TFCC lesions.

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Surgical Reconstruction Technique of Two Patients With Tarsal Type Preaxial Polydactyly: Two True Prehalluces

The Journal of Foot & Ankle Surgery ◽

10.1053/j.jfas.2018.12.011 ◽

2019 ◽

Vol 58 (4) ◽

pp. 814-820

Author(s):

Daniel H. Ferman ◽

Laura D. Bauler ◽

Karen Bovid

Keyword(s):

Surgical Reconstruction ◽

Reconstruction Technique ◽

Preaxial Polydactyly

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Postlaryngectomy Pharyngocutaneous Fistula: Incidence, Predisposing Factors, and Therapy

Otolaryngology ◽

10.1016/j.otohns.2005.07.025 ◽

2005 ◽

Vol 133 (5) ◽

pp. 689-694 ◽

Cited By ~ 76

Author(s):

Jacopo Galli ◽

Eugenio De Corso ◽

Mariangela Volante ◽

Giovanni Almadori ◽

Gaetano Paludetti

Keyword(s):

Risk Factor ◽

Total Laryngectomy ◽

Radical Neck Dissection ◽

Predisposing Factors ◽

Spontaneous Closure ◽

Pharyngocutaneous Fistula ◽

Systemic Diseases ◽

Surgical Closure ◽

Number Of Factors ◽

Wait And See

OBJECTIVE: The pharyngocutaneous fistula (PCF) is a serious complication after total laryngectomy, and its etiology is not well understood yet. The aim of our study was to evaluate predisposing factors, incidence, and management of this complication. STUDY DESIGN AND SETTING: This was a retrospective study of 268 patients who underwent total laryngectomy in our clinic (January 1990-December 2001). A number of factors potentially predisposing to PCF formation were evaluated. RESULTS: A PCF was observed in 16% of patients. Systemic diseases, previous radiotherapy, supraglottic origin of tumor, and concurrent radical neck dissection were significantly associated with PCF. Spontaneous closure was noted in 28 patients, whereas a surgical closure was necessary in 15 patients. CONCLUSIONS: In presence of a specific risk factor, PCF can be expected; nevertheless, its prevention remains very difficult. Moreover, given the high percentage of spontaneous closure, we suggest the “wait and see” approach for 28 days before proceeding with a surgical approach.

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The Infratemporal Retro-Eustachian Transposition of the Temporoparietal Fascial Flap for Clival Reconstruction After Endoscopic Endonasal Approach: An Anatomic Conceptual Technique

Operative Neurosurgery ◽

10.1093/ons/opab105 ◽

2021 ◽

Author(s):

Giulio Cecchini ◽

Huy Q Truong ◽

Francesco Di Biase ◽

Antonio Musio ◽

Juan C Fernandez Miranda

Keyword(s):

Infratemporal Fossa ◽

Surgical Techniques ◽

Pedicled Flap ◽

Reconstruction Technique ◽

Clinical Validation ◽

Endoscopic Endonasal Approach ◽

Endoscopic Endonasal ◽

Fascial Flap ◽

The Times ◽

Lower Clivus

Abstract BACKGROUND Reconstruction after endoscopic endonasal approaches is a key element. Lower clivus reconstruction is difficult and most of the times a pedicled flap is not available. As the complexity and the dimensions of the exposure increase, a reliable reconstruction technique becomes more and more important. OBJECTIVE To describe the anatomic and technical nuances of the transposition of the temporoparietal fascial flap for lower clivus reconstruction. METHODS A specific temporoparietal fascial flap (TPFF) design and tunneling technique has been studied using 4 head specimens, microscopic and endoscopic surgical techniques, and neuronavigation. RESULTS The L-shaped flap offers several advantages. It can be tunneled directly toward the lower clivus passing through the infratemporal fossa. CONCLUSION The infratemporal retro-eustachian transposition of an L-shaped TPFF provides a vascularized tissue virtually without dimension limits. This is the only technique that allows the flap to be tunneled directly in the lower clivus with the most vascular portion being at the bottom of the defect. Clinical validation is still required since more issues may become relevant in a real-surgery setting. Though, due to its possible complications, this methodology needs further testing and should not be attempted in less experienced hands.

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Surgical techniques: past, present and future

Surgical Techniques Development ◽

10.4081/std.2012.e9 ◽

2012 ◽

Vol 2 (1) ◽

pp. 9 ◽

Cited By ~ 1

Author(s):

Karim Qayumi

Keyword(s):

Middle Ages ◽

Technological Progress ◽

Surgical Techniques ◽

Neolithic Period ◽

Minimally Invasive Surgical ◽

Surgical Methods ◽

Modern Hospital ◽

The 19Th Century ◽

Further Development ◽

Shed Light

The aim of this paper is to provide an analytical survey of the information available on the development of past and present surgical techniques, and to make projections for the future. For the purposes of this paper, the Past starts in the Neolithic period and ends in the 1800s. In this context, I have divided the Past into Prehistoric, Ancient and Middle Ages, and this period ends in the second half of the 19th century when the major obstacles to the further development of surgery, such as overcoming pain and infection, were removed. We will discuss the development of surgical techniques, and the obstacles and opportunities prevalent in these periods. In the context of this paper, the Present begins in 1867, when Louis Pasteur discovered microorganisms, and ends in the present day. There have been many important changes in the development of surgical techniques during this period, such as the transfer of surgery from the unsterile operating room to the modern hospital operating theater, the development of advanced and specialized surgical practices, such as transplants and laparoscopy, and minimally invasive surgical methods, robotic and Natural Orifice Transluminal Endoscopic Surgery. It is very difficult to foresee how surgical techniques will develop in the Future because of the unpredictable nature of technological progress. Therefore, in this paper, the forecast for the Future is limited to the next 50- 100 years and is a realistic calculation based on already existing technologies. In this context, the Future is divided into the development of surgical techniques that will develop in the near and distant future. It is anticipated that this overview will shed light on the historical perspective of surgical techniques and stimulate interest in their further development.

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General Principles of Surgical Reconstruction in Head and Neck Cancers

Head and Neck Cancer Clinics - Resection and Reconstruction of Head & Neck Cancers ◽

10.1007/978-981-13-2444-4_3 ◽

2018 ◽

pp. 29-41

Author(s):

Chang-Cheng Chang ◽

Yu-Tsung Chen ◽

Jen-Hsiang Shen

Keyword(s):

Head And Neck ◽

Head And Neck Cancers ◽

Surgical Reconstruction

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Different Surgical Techniques in Tubo-ovarian Abscess Management

Gynecology Obstetrics and Reproductive Medicine ◽

10.21613/gorm.2016.639 ◽

2017 ◽

pp. 1

Author(s):

Hale GÖKSEVER ÇELİK ◽

Engin Çelik ◽

Semra Yüksel ◽

Ercan Baştu ◽

Hasan Cemal Ark

Keyword(s):

Surgical Techniques ◽

Operation Technique ◽

Blood Cell Count ◽

Abscess Drainage ◽

Mean Values ◽

Surgical Methods ◽

Training And Research ◽

Poor Outcomes ◽

One Year ◽

Ovarian Abscess

Objectıve: Tubo-ovarian abscess is mostly a consequence of pelvic inflammatory disease. We aimed to compare success of the different surgical methods in tubo-ovarian abscess treatment. Study Design: 53 patients with Tubo-ovarian abscess that were hospitalized and operated in the Department of Obstetrics and Gynecology at Kanuni Sultan Suleyman Training and Research Hospital during one year were included. Patients who had underwent salpingectomy/salpingo-oophorectomy and only abscess drainage were compared. Results: Salpingectomy/salpingo-oophorectomy had been done in 74.5% of cases and only drainage had been applied in 25.5% of cases. Difference in mean values between 2 groups were not observed except white blood cell count. Conclusıon: Treatment of Tubo-ovarian abscess must be a combination of parenteral antibiotics and early surgical procedure to prevent poor outcomes. There is not any difference between different surgical techniques. But additionally more studies are needed to better understand which operation technique is more effective and less complicated.

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