scholarly journals Application of intraoperative nerve monitoring for recurrent laryngeal nerves in minimally invasive McKeown esophagectomy

2021 ◽  
Author(s):  
Luo Zhao ◽  
Jia He ◽  
Yingzhi Qin ◽  
Hongsheng Liu ◽  
Shanqing Li ◽  
...  
Keyword(s):  
Minimally Invasive ◽  
Pulmonary Complications ◽  
Control Group ◽  
Postoperative Pulmonary Complications ◽  
Nerve Monitoring ◽  
Mediastinal Lymphadenectomy ◽  
Significant Difference ◽  
Recurrent Laryngeal Nerves ◽  
Intraoperative Nerve Monitoring ◽  
Mckeown Esophagectomy

Abstract Background Mediastinal lymphadenectomy is of great importance during esophagectomy for esophageal squamous cell carcinoma. However, recurrent laryngeal nerve (RLN) injury is a severe complication caused by lymphadenectomy along the RLN. Intraoperative nerve monitoring (IONM) can effectively identify the RLN and reduce the incidence of postoperative vocal cord paralysis (VCP). Here, we describe the feasibility and effectiveness of IONM in minimally invasive McKeown esophagectomy. Methods A total of 150 patients who underwent minimally invasive McKeown esophagectomy from 2016 to 2020 were enrolled in this study. We divided the patients into two groups: a neuromonitoring group (IONM, n = 70) and a control group (control, n = 80). Clinical data, surgical variables, and postoperative complications were retrospectively analyzed and compared. Results There was no significant difference in baseline data between the two groups. Postoperative VCP occurred in six cases (8.6%) in the IONM group, which was lower than that in the control group (21.3%, P = 0.032). Postoperative pulmonary complications were found in five cases (7.1%) and 14 in the control group (18.8%, P = 0.037). The postoperative hospital stay in the IONM group was significantly shorter than that in the control group (8 vs. 12, median, P < 0.001). The number of RLN lymph nodes harvested in the IONM group was higher than that in the control group (13.74 ± 5.77 vs. 11.03 ± 5.78, P = 0.005). The sensitivity and specificity of IONM monitoring VCP were 83.8% and 100%, respectively. A total of 66.7% of patients with a reduction in signal showed transient VCP, whereas 100% with a loss of signal showed permanent VCP. Conclusion IONM is feasible in minimally invasive McKeown esophagectomy. It showed advantages for distinguishing RLN and achieving thorough mediastinal lymphadenectomy with less RLN injury. Abnormal IONM signals can provide an accurate prediction of postoperative VCP incidence.

P180 OPTIMIZING UPPER MEDIASTINAL LYMPHADENECTOMY DURING MINIMALLY INVASIVE OESOPHAGECTOMY IN PRONE POSITION: FROM 2D THORACOSCOPY AND DOUBLE LUMEN (DL) ENDOTRACHEAL TUBE VENTILATION TO 3D THORACOSCOPY AND SINGLE LUMEN (SL) TUBE VENTILATION

2019 ◽  
Vol 32 (Supplement_2) ◽  
Author(s):  
Lorenzi Bruno ◽  
O’Hara David ◽  
Corsi Gabriele ◽  
Pragatheswaran Parameswaran ◽  
Vinayagamoorthi Thusyanthan ◽  
...  
Keyword(s):  
Minimally Invasive ◽  
Endotracheal Tube ◽  
Operative Time ◽  
Gastric Surgery ◽  
3D Technology ◽  
Mediastinal Lymphadenectomy ◽  
Single Lumen ◽  
Significant Difference ◽  
Recurrent Laryngeal Nerves ◽  
Minimally Invasive Oesophagectomy

Abstract Aim Upper mediastinal lymphadenectomy is a fundamental step of a radical oesophagectomy. Nodal dissection around the recurrent laryngeal nerves may be difficult and different approaches have been described in minimally invasive surgery. We describe our experience including recent technological advancements leading to improved outcomes. Background & Methods A retrospective analysis was performed among patients who underwent minimally invasive oesophageal resection for cancer including upper mediastinal lymphadenectomy between January 2016 and October 2018 at our Regional Centre for Oesophago-gastric Surgery (Broomfield Hospital, Chelmsford). A comparison between the initial cases performed using 2D thoracoscopy and DL endotracheal tube ventilation vs the more recent ones adopting 3D technology and SL tube ventilation was carried out. Length of operative time for this part of the operation, number of nodes removed and related peri-operative complications were among the data collected. Results A total of 14 patients were included in the study. 2D thoracoscopy and DL endotracheal tube ventilation was used in 10 patients whilst 3D technology and SL tube ventilation was adopted in 4 cases. Operative time was reduced in the 3D group. Complications related to upper mediastinal lymphadenectomy were noted in 5 patients (all of the 2D group) and included 5 recurrent laryngeal nerve palsies and 2 temporary tracheostomies for glottis oedema. There was no significant difference in the number of nodes retrieved. Conclusion Lymphadenectomy of the upper mediastinal nodes can be challenging and is associated with significant morbidity. In our experience, the use of SL tube ventilation facilitates the retraction of the trachea and the exposure of the area, and 3D thoracoscopy gives optimal magnified visualization of the recurrent nerves reducing the risk of damage.

scholarly journals Incidence of postoperative pulmonary complications in patients undergoing minimally invasive versus median sternotomy valve surgery: propensity score matching

2021 ◽  
Vol 16 (1) ◽  
Author(s):  
Mohamed Abdulkadir Mohamed ◽  
Cai Cheng ◽  
Xiang Wei
Keyword(s):  
Propensity Score ◽  
Minimally Invasive ◽  
Hospital Stay ◽  
Propensity Score Matching ◽  
Multivariable Analysis ◽  
Median Sternotomy ◽  
Pulmonary Complications ◽  
Valve Surgery ◽  
Postoperative Pulmonary Complications ◽  
Significant Difference

Abstract Objective Postoperative pulmonary complications (PPCs) are common incidents associated with an increased hospital stay, readmissions into the intensive care unit (ICU), increased costs, and mortality after cardiac surgery. Our study aims to analyze whether minimally invasive valve surgery (MIVS) can reduce the incidence of postoperative pulmonary complications compared to the full median sternotomy (FS) approach. Methods We reviewed the records of 1076 patients who underwent isolated mitral or aortic valve surgery (80 MIVS and 996 FS) in our institution between January 2015 and December 2019. Propensity score-matching analysis was used to compare outcomes between the groups and to reduce selection bias. Results Propensity score matching revealed no significant difference in hospital mortality between the groups. The incidence of PPCs was significantly less in the MIVS group than in the FS group (19% vs. 69%, respectively; P < 0.0001). The most common PPCs were atelectasis (P = 0.034), pleural effusions (P = 0.042), and pulmonary infection (P = 0.001). Prolonged mechanical ventilation time (> 24 h) (P = 0.016), blood transfusion amount (P = 0.006), length of hospital stay (P < 0.0001), and ICU stay (P < 0.0001) were significantly less in the MIVS group. Cardiopulmonary bypass (CBP), aortic cross-clamping, and operative time intervals were significantly longer in the MIVS group than in the matched FS group (P < 0.001). A multivariable analysis revealed a decreased risk of PPCs in patients undergoing MIVS (odds ratio, 0.25; 95% confidence interval, 0.006–0.180; P < 0.0001). Conclusion MIVS for isolated valve surgery reduces the risk of PPCs compared with the FS approach.

scholarly journals Treatment of thoracolumbar trauma by short-segment percutaneous transpedicular screw instrumentation: prospective comparative study with a minimum 2-year follow-up

2014 ◽  
Vol 20 (2) ◽  
pp. 150-156 ◽  
Author(s):  
Petr Vanek ◽  
Ondrej Bradac ◽  
Renata Konopkova ◽  
Patricia de Lacy ◽  
Jiri Lacman ◽  
...  
Keyword(s):  
Blood Loss ◽  
Minimally Invasive ◽  
Cobb Angle ◽  
Control Group ◽  
Working Ability ◽  
Short Segment ◽  
Transpedicular Screw ◽  
Significant Difference ◽  
Screw Group

Object The main aim of this study was to compare clinical and radiological outcomes after stabilization by a percutaneous transpedicular system and stabilization from the standard open approach for thoracolumbar spine injury. Methods Thirty-seven consecutive patients were enrolled in the study over a period of 16 months. Patients were included in the study if they experienced 1 thoracolumbar fracture (A3.1–A3.3, according to the AO/Magerl classification), had an absence of neurological deficits, had no other significant injuries, and were willing to participate. Eighteen patients were treated by short-segment, minimally invasive, percutaneous pedicle screw instrumentation. The control group was composed of 19 patients who were stabilized using a short-segment transpedicular construct, which was performed through a standard midline incision. The pain profile was assessed by a visual analog scale (VAS), and overall satisfaction by a simple 4-stage scale relating to performance of daily activities. Working ability and return to original occupation were also monitored. Radiographic follow-up was defined by the vertebral body index (VBI), vertebral body angle (VBA), and bisegmental Cobb angle. The accuracy of screw placement was examined using CT. Results The mean surgical duration in the percutaneous screw group was 53 ± 10 minutes, compared with 60 ± 9 minutes in the control group (p = 0.032). The percutaneous screw group had a significantly lower perioperative blood loss of 56 ± 17 ml, compared with 331 ± 149 ml in the control group (p < 0.001). Scores on the VAS in patients in the percutaneous screw group during the first 7 postoperative days were significantly lower than those in the control group (p < 0.001). There was no significant difference between groups in VBI, VBA, and Cobb angle values during follow-up. There was no significant difference in screw placement accuracy between the groups and no patients required surgical revision. There was no significant difference between groups in overall satisfaction at the 2-year follow-up (p = 0.402). Working ability was insignificantly better in the percutaneous screw group; previous working position was achieved in 17 patients in this group and in 12 cases in the control group (p = 0.088). Conclusions This study confirms that the percutaneous transpedicular screw technique represents a viable option in the treatment of preselected thoracolumbar fractures. A significant reduction in blood loss, postoperative pain, and surgical time were the main advantages associated with this minimally invasive technique. Clinical, functional, and radiological results were at least the same as those achieved using the open technique after a 2-year follow-up. The short-term benefits of the percutaneous transpedicular screw technique are apparent, and long-term results have to be studied in other well-designed studies evaluating the theoretical benefit of the percutaneous technique and assessing whether the results of the latter are as durable as the ones achieved by open surgery.

Third-Generation Minimally Invasive Chevron-Akin Osteotomy for Hallux Valgus Produces Similar Clinical and Radiological Outcomes as Scarf-Akin Osteotomy at 2 Years: A Matched Cohort Study

2021 ◽  
pp. 107110072110491
Author(s):  
Adriel You Wei Tay ◽  
Graham S. Goh ◽  
Kevin Koo ◽  
Nicholas Eng Meng Yeo
Keyword(s):  
Minimally Invasive ◽  
Hallux Valgus ◽  
Physical Component Score ◽  
Control Group ◽  
Component Score ◽  
Vas Score ◽  
Sf 36 ◽  
Significant Difference ◽  
Akin Osteotomy ◽  
New Generation

Background: The minimally invasive chevron-Akin (MICA) osteotomy is an increasingly popular technique for the correction of hallux valgus. However, there is a paucity of literature comparing it with traditional open techniques. The purpose of this study was to compare the clinical and radiological outcomes of the MICA osteotomy using a new-generation MICA screw and scarf-Akin osteotomy for hallux valgus correction. Methods: Thirty cases of MICA osteotomy were propensity score matched 1:1 with a control group of 30 scarf-Akin osteotomy cases. The groups were matched for age, sex, body mass index, preoperative visual analog scale (VAS) score, American Orthopaedic Foot & Ankle Society (AOFAS) metatarsophalangeal-interphalangeal (MTP-IP) score, 36-Item Short-Form Health Survey (SF-36) physical component score (PCS) and mental component score (MCS), preoperative hallux valgus angle (HVA) and intermetatarsal angle (IMA), and concomitant procedures. Outcomes were compared at 6 and 24 months postoperatively. Early postoperative VAS scores were also compared. Results: Both groups demonstrated significant improvements in VAS score, AOFAS score, and SF-36 PCS and MCS at 6 and 24 months postoperatively. For the MICA group, HVA improved from 23.5 to 7.7 degrees, and IMA improved from 13.5 to 7.5 degrees. For the scarf-Akin osteotomy group, HVA improved from 23.7 to 9.3 degrees, and IMA improved from 13.6 to 7.8 degrees. The first 24-hour postoperative VAS score was significantly lower in the MICA group compared with the scarf-Akin group (2.0 ± 2.0 vs 3.4 ± 2.6, P = .029). However, there was no significant difference in clinical or radiological outcomes between the groups at 6 and 24 months. Conclusion: The MICA procedure with the new-generation MICA screw is an attractive option for the correction of hallux valgus, yielding similar midterm radiological and clinical outcomes compared with the well-established scarf-Akin osteotomy. The first 24-hour postoperative VAS score in the MICA group was also statistically lower, although its clinical significance remains to be determined. Level of Evidence: Level III, retrospective comparative study.

scholarly journals Preoperative Incentive Spirometry for Preventing Postoperative Pulmonary Complications in Patients Undergoing Coronary Artery Bypass Graft Surgery: A Prospective, Randomized Controlled Trial

2021 ◽  
Author(s):  
Essa M Sweity ◽  
Aidah A Alkaissi ◽  
Wafiq Othman ◽  
Ahmad Salahat
Keyword(s):  
Artery Bypass ◽  
Bypass Graft ◽  
Hospital Length ◽  
Pulmonary Complications ◽  
Hospital Length Of Stay ◽  
Control Group ◽  
Postoperative Pulmonary Complications ◽  
Mechanical Ventilation Duration ◽  
Postoperative Oxygenation ◽  
Incentive Spirometry

Abstract Background: Postoperative pulmonary complications (PPCs) often occur after cardiac operations, and are a leading cause of morbidity, inhibit oxygenation, and increase hospital length of stay, and mortality. Although clinical evidence for PPCs prevention is often unclear and crucial, measures take place to reduce PPCs. One device usually used for this reason is the incentive spirometry (IS). The Aim of the study is to evaluate the effect of preoperative incentive spirometry to prevent postoperative pulmonary complications, improve postoperative oxygenation, and decrease hospital stay following coronary artery bypass graft (CABG) surgery patients. Methods: This was a clinical randomized prospective study. A total of 80 patients were selected as candidates for CABG at An-Najah National University Hospital, Nablus-Palestine. Patients had been randomly assigned into two groups: incentive spirometry group (IS), SI performed before surgery (study group) and control group, preoperative spirometry was not performed. The 40 patients in each group received the same protocol of anesthesia and ventilation in the operating room. Result: The study findings showed that there was a significant difference between the IS group and control group in the incidence of postoperative atelectasis, there were 8 patients (20.0%) in IS group and 17 patients (42.5 %) in the control group (p= 0.03). Mechanical ventilation duration was significantly less in group IS group, the median was four hours versus six hours in the control group (p < 0.001). Hospital length of stay was significantly less in group IS group, the median was six days versus seven days in the control group (p < 0.001). Median of the amount of arterial blood oxygen and oxygen saturation was significantly effective improvement in IS group with (p < 0.005). Conclusion: Preoperative incentive spirometry for 2 days along with exercises of deep breathing, encouraged coughing and early ambulation following CABG are in connection with prevention and decrease incidence of atelectasis, hospital stay, mechanical ventilation duration and improved postoperative oxygenation with better pain control. A difference that can be considered both significant and clinically relevant.Trial registration Thai Clinical Trials Registry: TCTR20201020005. Registered 17 October 2020 - Retrospectively registered.

scholarly journals Predicting primary postoperative pulmonary complications in patients undergoing minimally invasive surgery for colorectal cancer

2020 ◽  
Vol 72 (4) ◽  
pp. 977-983
Author(s):  
Mohamed A. Abd El Aziz ◽  
William R. Perry ◽  
Fabian Grass ◽  
Kellie L. Mathis ◽  
David W. Larson ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Minimally Invasive Surgery ◽  
Minimally Invasive ◽  
Invasive Surgery ◽  
Pulmonary Complications ◽  
Postoperative Pulmonary Complications

Perioperative breathing training to prevent postoperative pulmonary complications in patients undergoing laparoscopic colorectal surgery: A randomized controlled trial

2020 ◽  
pp. 026921552097264
Author(s):  
Pei-pei Qin ◽  
Ju-ying Jin ◽  
Wen-jian Wang ◽  
Su Min
Keyword(s):  
Colorectal Surgery ◽  
Laparoscopic Colorectal Surgery ◽  
Controlled Trial ◽  
Training Group ◽  
Pulmonary Complications ◽  
Hospital Charges ◽  
Control Group ◽  
Arterial Oxygenation ◽  
Postoperative Pulmonary Complications ◽  
Breathing Training

Objective: The aim of this study was to determine whether perioperative breathing training reduces the incidence of postoperative pulmonary complications in patients undergoing laparoscopic colorectal surgery. Design: A randomized controlled trial. Setting: University hospital. Subjects: A total of 240 patients undergoing laparoscopic colorectal surgery participated in this study. Intervention: The enrolled patients were randomized into an intervention or control group. Patients in the intervention group received perioperative breathing training, including deep breathing and coughing exercise, balloon-blowing exercise, and pursed lip breathing exercise. The control group received standard perioperative care without any breathing training. Main measures: The primary endpoint was the incidence of postoperative pulmonary complications. The secondary objectives were to evaluate the effect of perioperative breathing training on arterial oxygenation, incidence of other postoperative complications, patient satisfaction, length of stay, and hospital charges. Results: The incidence of postoperative pulmonary complications in the breathing training group was lower than that in the control group (5/120 [4%] vs 14/120 [12%]; RR 0.357, 95%CI 0.133–0.960; P = 0.031). In addition, PaO2 and arterial oxygenation index on the first and fourth days after surgery were significantly higher in the breathing training group than in the control group ( P < 0.001). In addition, patients with breathing training had shorter length of stay (6d [IQR 5–7] vs 8d [IQR 7–9]), lower hospital charges (7761 ± 1679 vs 8212 ± 1326), and higher patient satisfaction (9.46 ± 0.65 vs 9.21 ± 0.47) than those without. Conclusion: Perioperative breathing training may reduce the incidence of postoperative pulmonary complications and preserve of arterial oxygenation after laparoscopic colorectal surgery.

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