690 MINIMALLY INVASIVE APPROACH FOR ESOPHAGEAL LEIOMYOMA

2021 ◽  
Vol 34 (Supplement_1) ◽  
Author(s):  
Norberto Daniel Velasco Hernandez ◽  
Héctor Rául Horiuchi ◽  
Lucas Abal ◽  
Matías Sabatini ◽  
Agustina Redondo ◽  
...  

Abstract   Esophageal leiomyoma is the most common benign tumor of the esophagus. Although enucleation via thoracotomy has been considered standard treatment, minimally invasive surgery is increasingly used for the treatment of this disease. The authors report the clinical outcomes of three procedures for enucleation. Methods From November 2011 to December 2020, 3 females (52, 58, and 67 years old) patients were treated for leiomyoma of the middle third of the esophagus. A history of dysphagia and chest pain was present. Upper gastrointestinal endoscopic, computerized tomography, and endoscopic ultrasound were performed, in only one case barium swallow was used. Results The surgical approaches included right thoracoscopy in prone position, enucleation, and small thoracotomy for removing the specimen. There were no major morbidities, including deaths. One patient presented a leak, which was resolved with an endoscopic stent. Conclusion Minimally invasive enucleation of esophageal leiomyoma can be performed effectively and safely. Right thoracoscopic in prone position for the removal of esophageal leiomyomas may be recommended as the treatment of choice in centers experienced with esophageal surgery.

2019 ◽  
Vol 5 (1) ◽  
pp. 205511691985064
Author(s):  
Margaret Amparo Placer ◽  
Cindy McManis

Case summary A 6-month-old male domestic shorthair cat presenting with abdominal distension and an acute history of renal azotemia was diagnosed with bilateral perinephric pseudocysts and International Renal Interest Society (IRIS) grade 3 acute kidney injury. Ultrasound-guided drainage of the cysts was performed initially; bilateral subtotal resection of the perinephric pseudocysts was later performed using laparoscopy as a more long-term solution. There was no regrowth or reformation of the perinephric pseudocysts 1 year after the procedure, and the cat remained in IRIS stage 2 chronic kidney disease 1 year postoperatively. Relevance and novel information Compared with traditional surgical approaches, laparoscopic resection of perinephric pseudocysts provides a less invasive approach. Bilateral perinephric pseudocyst in a pediatric feline patient (and associated treatment) has not previously been documented in the literature.


2018 ◽  
Vol 06 (01) ◽  
pp. e18-e22 ◽  
Author(s):  
Mariela Dore ◽  
Paloma Triana Junco ◽  
Carlos De La Torre ◽  
Alejandra Vilanova-Sánchez ◽  
Monserrat Bret ◽  
...  

Introduction Minimally invasive repair for pectus excavatum (MIRPE) is controversial in extremely severe cases of pectus excavatum (PE) and an open repair is usually favored. Our aim is to describe a case of a patient with an extremely severe PE that underwent a minimally invasive approach. Case report An 8-year-old girl with severe sternum depression was assessed. She had a history of exercise intolerance, nocturnal dyspnea, fatigue, and shortness of breath. Chest computed tomography showed that sternum depression was posterior to the anterior vertebral column; therefore, Haller and correction index could not be measured. Spirometry indicated an obstructive ventilation pattern (forced expiratory volume in 1 second = 74.4%), and echocardiogram revealed a dilated inferior vena cava, mitral valve prolapse with normal ventricular function. After multidisciplinary committee evaluation, a MIRPE approach was performed.All symptoms had disappeared at the 3-month postoperative follow-up; the desired sternum shape was achieved and normalization of cardiopulmonary function was observed. The Nuss bars were removed after a 2-year period. After 18-month follow-up, the patient can carry out normal exercise and is content with the cosmetic result. Conclusion Nuss procedure is feasible in our 8-year-old patient. In this case, both the Haller and correction index were not useful to assess the severity of PE. Therefore, under these circumstances, other radiologic parameters have to be taken into consideration for patient evaluation.


2020 ◽  
Vol 81 (04) ◽  
pp. 357-368
Author(s):  
N. Goncalves ◽  
D.E. Lubbe

AbstractSphenoid wing meningiomas are benign tumors that can result in proptosis, visual impairment, and pain. Traditional open surgical approaches are associated with significant morbidity. Transorbital endoscopic surgery has been developed as a minimally invasive approach to gain access to these tumors and address the main presenting symptoms. Case series reporting transorbital endoscopic resection of sphenoid wing meningiomas using combined endonasal, pre-caruncular, and extended superior eyelid approaches have demonstrated stable and/or improved short- and medium-term visual outcomes. Earlier medial optic nerve decompression appears to result in more favorable long-term visual outcomes. Transorbital endoscopic surgery therefore represents an emerging minimally invasive alternative to deal with these challenging lesions.


2020 ◽  
Vol 33 (03) ◽  
pp. 113-127
Author(s):  
Heather Carmichael ◽  
Patricia Sylla

AbstractMinimally invasive techniques continue to transform the field of colorectal surgery. Because traditional surgical approaches for rectal cancer are associated with significant mortality and morbidity, developing less invasive approaches to this disease is paramount. Natural orifice transluminal endoscopic surgery (NOTES), commonly known as “no incision surgery,” represents the ultimate minimally invasive approach to disease. Although transgastric and transvaginal approaches for NOTES surgery were the initially explored, a transrectal approach for colorectal disease is intuitive given that it makes use of the resected organ for transluminal access. Furthermore, the transanal approach allows for improved, precise visualization of the presacral mesorectal plane compared with an abdominal viewpoint, particularly in the narrow, male pelvis. Finally, experience with existing transanal platforms that have been used for decades for local excision of rectal disease made the development of a transanal approach to total mesorectal excision (TME) feasible. Here, we will review the evolution of minimally invasive and transanal surgical techniques that allowed for the development of transanal TME and its introduction into clinical practice.


Children ◽  
2020 ◽  
Vol 7 (8) ◽  
pp. 94
Author(s):  
Jonathon H. Nelson ◽  
Samantha L. Brackett ◽  
Chima O. Oluigbo ◽  
Srijaya K. Reddy

Robotic assisted neurosurgery has become increasingly utilized for its high degree of precision and minimally invasive approach. Robotic stereotactic assistance (ROSA®) for neurosurgery has been infrequently reported in the pediatric population. The goal of this case series was to describe the clinical experience, anesthetic and operative management, and treatment outcomes for pediatric patients with intractable epilepsy undergoing ROSA® neurosurgery at a single-center institution. Patients who underwent implantation of stereoelectroencephalography (SEEG) leads for intractable epilepsy with ROSA® were retrospectively evaluated between August 2016 and June 2018. Demographics, perioperative management details, complications, and preliminary seizure outcomes after resective or ablative surgery were reviewed. Nineteen children who underwent 23 ROSA® procedures for SEEG implantation were included in the study. Mean operative time was 148 min. Eleven patients had subsequent resective or ablative surgery, and ROSA® was used to assist with laser probe insertion in five patients for seizure foci ablation. In total, 148 SEEG electrodes were placed without any perioperative complications. ROSA® is minimally invasive, provides superior accuracy for electrode placement, and requires less time than traditional surgical approaches for brain mapping. This emerging technology may improve the perioperative outcomes for pediatric patients with intractable epilepsy since large craniotomies are avoided; however, long-term follow-up studies are needed.


2014 ◽  
Vol 5 (1) ◽  
pp. ar.2014.5.0073 ◽  
Author(s):  
Nicholas L. Deep ◽  
Mohamad R. Chaaban ◽  
Ajaz L. Chaudhry ◽  
Bradford A. Woodworth

A case report of a massive cholesterol granuloma (CG) of the frontal sinus in a 15-year-old male subject treated endoscopically is reported. CGs are slowly expanding, cystic lesions that are rarely observed in the frontal sinus. Frontal sinus CGs characteristically present with proptosis, diplopia, and a unilateral painless expanding mass above the orbit. Patients frequently report a history of chronic nasal obstruction or head trauma. Although the pathogenesis is unclear, it is likely multifactorial in etiology. Surgical resection via endoscopic sinus surgery has been gaining popularity because of the minimally invasive approach and lower rates of recurrence.


2017 ◽  
Vol 45 ◽  
pp. 4
Author(s):  
Pedro Paulo Maia Teixeira ◽  
Felipe Pereira Farias da Câmara Barros ◽  
Luisa Pucci Bueno Borges ◽  
Aline Eyko Kawanami ◽  
Marco Augusto Machado Silva ◽  
...  

Background: Foreign bodies are most commonly diagnosed in stomach (proventriculus and gizzard) of galliformes birds and waterfowl. Endoscopyis routinely used to assess birds’ respiratory, gastrointestinal and urogenital tracts. Endosurgeryis also used for sex determination and intra-coelomaticorgan biopsy. Benefits of endoscopic approaches are widely reported in birds. Conventional surgical approaches are far more invasive and risky for those patients. Thus, the purpose of this study was to describe a successful case of gizzard foreign body removal in a greylag goose (Anseranser), using a rigid endoscopic approach through a minimally invasive percutaneous access. Case: A 2-year-old female greylag goose, weighting 3,116 g, was referred to a Veterinary Teaching Hospital presenting apathy and anorexia for at least 24 h. The results on hematologic assessment were within normal range for the species. Radiographic examination indicated presence of radiopaque content, resembling gizzard sediment. Thus, the patient undergone to endoscopy for examination and aspiration of the content. The goose was fasted for 6 h. Anesthesia was induced by face mask and maintained by endotracheal tube, using isoflurane vaporized in 100% oxygen. The patient was positionedin the lateral recumbence. The patient’s neck was longer than the working length of the rigid endoscope. Thus, the telescope was inserted into the esophagus following a small distal esophagotomy, carried out on the caudal third of the neck. A 0º 10-mm operative rigid telescope, with a 6-mm working channel, and a 5-mm diameter and 42-cm in length laparoscopic Babcock forceps were used. The endoscope was inserted through the esophagotomy up to the ventricle level. Sand sediments and stones were viewed. The stones were grasped and retrieved, and the sediments were rinsed with normal saline solution and aspirated with a suction cannula through the working channel of the telescope. Inspection following sediment and foreign body retrieval revealed moderate inflammation of the gizzard mucosa. Total procedure time was 24 min. The patient recovered uneventfully and was discharged following 72 h. Discussion: Rigid endoscopy provided accurate visualization of the thoracic esophagus, proventriculus and gizzard. In general, endosurgery is usually employed for sex determination in birds. It is also useful to access digestive tract using rigid endoscopy, in order to remove foreign body. Such minimally approach reduces postoperative morbidity, which is usually seen following conventional surgical approaches. This technique has been used for removal of foreign body in the digestive tract of several species. Foreign bodies found within crop should require ingluviotomy. However, could be easily removed by endoscopy. If the foreign body is within the proventriculus or gizzard, rigid endoscopy may be useful, as celiotomy could cause morbidity. The small esophagotomy access at the base of the neck was essential for the procedure. In short-necked birds, a 30º Trendelenburg positioning provides more caudal access to the digestive tract. In this case, such positioning was unnecessary. In conclusion, the use of an operative telescope provided accurate retrieval of foreign bodies and drainage of sediments within the digestive tract. Moreover, it can be used as a minimally invasive approach to foreign bodies in the esophagus, crop or stomach (esophagus and gizzard) of geese.


Author(s):  
V. Ya. Lishchishin ◽  
A. G. Barishev ◽  
A. N. Petrovsky ◽  
A. N. Lishchenko ◽  
A. Y. Popov ◽  
...  

Aim. To evaluate the reproducibility and safety of the developed pancreatogastric anastomosis with various surgical approaches during pancreatoduodenectomy.Materials and methods. The experience of surgical treatment of 47 patients with malignant tumours of the periampullary zone, who underwent pancreatoduodenectomy, was considered. The proposed variant of anastomose was performed to 14 (29.8%) patients: in 7 cases with a minimally invasive approach to perform pancreatoduodenectomy; and in 7 cases with an open approach. To compare retrospectively 33 (70.2%) patients who underwent pancreatogastric anastomosis according to the Bassi technique: 9 – with minimally invasive surgery, 24 – with open surgery. The frequency of pancreatic fistulas, the number of repeated interferences, and hospital mortality were taken into account.Results. A significant advantage of the new method of forming an anastomosis in the duration of the operation was noted in comparison with the Bassi technique. There were no statistically significant differences in blood loss while various types of anastomoses (p > 0.05). When using the proposed technique, the formation of pancreatic fistulas was not revealed. The development of pancreatic fistula was observed in 4 (16.7%) patients after open surgery and in 7 (77.8%) patients after minimally invasive Bassi anastomose formation. Reoperations were performed after open surgery in 3 (12.5%) cases and in 4 (44.4%) cases of minimally invasive surgery according to the Bassi technique. There were 2 (22.2%) deaths in the minimally invasive group.Conclusion. The proposed pancreatogastric anastomosis is applicable in clinical practice. This method allows to create relatively fast and less challenging anastomosis, including with a minimally invasive approach. The use of this technique makes it possible to reduce mortality and postoperative complications in patients with a “complex” pancreas.


2020 ◽  
Vol 19 (3) ◽  
pp. 330-340 ◽  
Author(s):  
Carmine Antonio Donofrio ◽  
Jody Filippo Capitanio ◽  
Lucia Riccio ◽  
Aalap Herur-Raman ◽  
Anthony J Caputy ◽  
...  

Abstract BACKGROUND Surgical approaches to the orbit are challenging and require combined multispecialist skills. Considering its increasing relevance in neurosurgical practice, keyhole surgery could be also applied to this field. However, mastering a minimally invasive approach necessitates an extended learning curve. For this reason, virtual reality (VR) can be effectively used for planning and training in this demanding surgical technique. OBJECTIVE To validate the mini fronto-orbital (mFO) approach to the superomedial orbit, using VR planning and specimen dissections, conjugating the principles of skull base and keyhole neurosurgery. METHODS Three-dimensional measurements were performed thanks to Surgical Theater (Surgical Theater© LLC), and then, simulated craniotomies were implemented on cadaver specimens. RESULTS The mFO approach affords optimal exposure and operability in the target area and reduced risks of surrounding normal tissue injuries. The eyebrow skin incision, the minimal soft-tissue retraction, the limited temporalis muscle dissection and the single-piece craniotomy, as planned with VR, are the key elements of this minimally invasive approach. Furthermore, the “window-opening” cotton-tip intraorbital dissection technique, based on widening surgical corridors between neuromuscular bundles, provides a safe orientation and a deep access inside the orbit, thereby significantly limiting the risk of jeopardizing neurovascular structures. CONCLUSION The mFO approach associated to the window-opening dissection technique can be considered safe, effective, suitable, and convenient for treating lesions located in the superomedial orbital aspect, up to the orbital apex.


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