Robotic-Assisted Tubular Transoral Parapharyngeal Approach to the Ventral Craniovertebral Junction

2021 ◽  
Author(s):  
Jaafar Basma ◽  
Sanjeet V Rangarajan ◽  
L Madison Michael ◽  
J Scott Magnuson ◽  
Michael S Muhlbauer ◽  
...  
Keyword(s):  
Parapharyngeal Space ◽  
Surgical Techniques ◽  
Length Of Hospital Stay ◽  
Craniovertebral Junction ◽  
Transoral Robotic Surgery ◽  
Normal Diet ◽  
Robotic Assisted ◽  
Soft Diet ◽  
Early Return ◽  
Malignant Lesions

Abstract BACKGROUND Transoral robotic surgery (TORS) has become a routine technique for treating benign and malignant lesions of the oropharynx with the advantage of reducing morbidity compared to open surgical techniques. However, TORS has not been used routinely for accessing lesions of the spine. OBJECTIVE To describe how TORS can be used to access spinal lesions. METHODS We describe our technique of accessing the parapharyngeal space using the robotic technique, and then dissecting the prevertebral muscles to expose the ventral craniovertebral junction. Tubular retraction with endoscopic visualization is then employed for surgical resection. We then report a case of a 14-yr-old competitive athlete who presented with an osseous lesion of C1, which underwent resection using this novel TORS approach. RESULTS Our patient underwent successful resection of a lateral C1 osteoid osteoma utilizing a combined TORS/endoscopic approach. She tolerated soft diet immediately and was discharged on postoperative day 2. Postoperative imaging revealed complete resection of the lesion, and she returned to competitive athletics within 6 wk. CONCLUSION Utilizing this novel, robotic-assisted approach can definitively treat osseous cervical spine lesions while reducing morbidity, allowing for early return to normal diet and minimizing overall length of hospital stay.

scholarly journals Surgical Outpatient Care: Triage, Time and Test

2021 ◽  
Author(s):  
Satyendra K. Tiwary
Keyword(s):  
Surgical Procedures ◽  
Day Care ◽  
Surgical Techniques ◽  
Length Of Hospital Stay ◽  
Developed Countries ◽  
Day Care Surgery ◽  
Minimally Invasive Surgical ◽  
Early Return ◽  
Treat All ◽  
Care Surgery

Day care surgery is the standard of care for minor surgical procedures in developed countries and rapidly increasing in practice in developing countries. The main advantages of day care surgery are cost containment, early mobilization of the patient, less pain because of minimally invasive surgical techniques, early return of patient to their home and work. The downsides of day care surgery include the inability to treat all patients and perform all surgical procedures since surgical fitness for day care procedures is demanding, unforeseen readmission, the need for more operating rooms, and increasing expertise among health care workers. Considering day care surgery as systematic, scheduled and short duration stay in hospital, it is very important to select or sort out the cases which fit in the criteria according to all conventional definitions of triage. It is well organized within stipulated time frame and performed in fixed unit with proper assessment by anesthesia and nursing team in addition to core assessment of surgical team. Surgical option exercised and close follow up with ability to manage complications are integral components in working team. Delivery of more surgery in primary care has potential for enhancing patient-centred management by promoting the development of multi-specialty community providers and reducing length of hospital stay. The outpatient surgical centers provide many benefits and advantages for surgical patients with proper organizations, dedicated services, and meticulous procedures.

Transoral Robotic Surgery for Parapharyngeal Space Masses: Indications and Results

2013 ◽  
Vol 74 (S 01) ◽  
Author(s):  
Christopher Rassekh ◽  
Shayanne Lajud ◽  
Courtney Shires ◽  
Laurie Loevner ◽  
Ara Chalian ◽  
...  
Keyword(s):  
Robotic Surgery ◽  
Parapharyngeal Space ◽  
Transoral Robotic Surgery

Outcomes of Transoral Robotic Surgery for Parapharyngeal Space Salivary Gland Neoplasms

2015 ◽  
Vol 76 (S 01) ◽  
Author(s):  
Christopher Rassekh ◽  
Gregory Weinstein ◽  
Laurie Loevner ◽  
Ara Chalian ◽  
Bert O'Malley
Keyword(s):  
Salivary Gland ◽  
Robotic Surgery ◽  
Parapharyngeal Space ◽  
Transoral Robotic Surgery ◽  
Salivary Gland Neoplasms

Transoral Robotic Surgery for Parapharyngeal Space Tumors

ORL ◽  
2010 ◽  
Vol 72 (6) ◽  
pp. 332-336 ◽  
Author(s):  
Bert W. O’Malley Jr. ◽  
Harry Quon ◽  
Fernando D. Leonhardt ◽  
Ara A. Chalian ◽  
Gregory S. Weinstein
Keyword(s):  
Robotic Surgery ◽  
Parapharyngeal Space ◽  
Transoral Robotic Surgery ◽  
Parapharyngeal Space Tumors

Robotic-Assisted Tubular Transoral Parapharyngeal Approach to the Ventral Craniovertebral Junction

2021 ◽  
Author(s):  
Jaafar Basma ◽  
Sanjeet Rangarajan ◽  
Madison Michael ◽  
John P. Gleysteen
Keyword(s):  
Craniovertebral Junction ◽  
Robotic Assisted

scholarly journals Ordering a Normal Diet at the End of Surgery—Justified or Overhasty?

Nutrients ◽  
2018 ◽  
Vol 10 (11) ◽  
pp. 1758 ◽  
Author(s):  
Fabian Grass ◽  
Martin Hübner ◽  
Jenna Lovely ◽  
Jacopo Crippa ◽  
Kellie Mathis ◽  
...  
Keyword(s):  
Enhanced Recovery ◽  
Length Of Hospital Stay ◽  
Outcome Data ◽  
Normal Diet ◽  
Oral Feeding ◽  
Prolonged Length ◽  
Early Oral Feeding ◽  
American Society ◽  
Independent Decision ◽  
Recovery Pathways

Early re-alimentation is advocated by enhanced recovery pathways (ERP). This study aimed to assess compliance to ERP-set early re-alimentation policy and to compare outcomes of early fed patients and patients in whom early feeding was withhold due to the independent decision making of the surgeon. For this purpose, demographic, surgical and outcome data of all consecutive elective colorectal surgical procedures (2011–2016) were retrieved from a prospectively maintained institutional ERP database. The primary endpoint was postoperative ileus (POI). Surgical 30-day outcome and length of stay were compared between patients undergoing the pathway-intended early re-alimentation pattern and patients in whom early re-alimentation was not compliant. Out of the 7103 patients included, 1241 (17.4%) were not compliant with ERP re-alimentation. Patients with delayed re-alimentation presented with more postoperative complications (37 vs. 21%, p < 0.001) and a prolonged length of hospital stay (8 ± 7 vs. 5 ± 4 days, p < 0.001). While male gender (odds ratio (OR) 1.24; 95% confidence interval (CI) 1.04–1.32), fluid overload (OR 1.38; 95% CI 1.16–1.65) and high American Society of Anaesthesiologists (ASA) score (OR 1.51; 95% CI 1.27–1.8) were independent risk factors for POI, laparoscopy (OR 0.51; 95% CI 0.38–0.68) and ERP compliant diet (OR 0.46; 95% CI 0.36–0.6) were both protective. Hence, this study provides further evidence of the beneficial effect of early oral feeding after colorectal surgery.

scholarly journals Video-assisted thoracoscopic extended thymectomy in myasthenic children

2013 ◽  
Vol 5 (1) ◽  
pp. 4 ◽  
Author(s):  
Rita Sonzogni ◽  
Lorenzo Novellino ◽  
Alberto Benigni ◽  
Ilaria Busi ◽  
Magda Khotcholava ◽  
...  
Keyword(s):  
Case Reports ◽  
Preoperative Evaluation ◽  
Surgical Techniques ◽  
Length Of Hospital Stay ◽  
Ventilator Weaning ◽  
New Drugs ◽  
Extended Thymectomy ◽  
Myasthenic Patient ◽  
Surgical Department ◽  
Video Assisted

Myasthenia gravis (MG) is an autoimmune disease marked by weakness of voluntary musculature. Medical and surgical therapy of adult myasthenia is well documented. There is little pediatric surgical evidence, only a few case reports being available. The aim of this paper is to verify whether the surgical and anesthesiological techniques can warrant an early and safe discharge from the operating room. The secondary aim is to assess the presence of perioperative indicators that can eventually be used as predictors of postoperative care. During the years 2006-2009, 10 pediatric patients were treated according to a surgical approach based on video assisted thoracoscopic extended thymectomy (VATET). Standard preoperative evaluation is integrated with functional respiratory tests. Anesthetic induction was made with propofol and fentanyl/remifentanyl and maintenance was obtained with sevoflurane/desflurane/propofol ± remifentanyl. A muscle relaxant was used in only one patient. Right or left double-lumen bronchial tube (Ruesch Bronchopart® Carlens) placement was performed. Six patients were transferred directly to the surgical ward while 4 were discharged to the intensive care unit (ICU); ICU stay was no longer than 24 h. Length of hospital stay was 4.4±0.51 days. No patient was readmitted to the hospital and no surgical complications were reported. Volatile and intravenous anesthetics do not affect ventilator weaning, extubation or the postoperative course. Paralyzing agents are not totally contraindicated, especially if short-lasting agents are used with neuromuscular monitoring devices and new reversal drugs. Perioperative evaluation of the myasthenic patient is mandatory to assess the need for postoperative respiratory support and also predict timely extubation with early transfer to the surgical department. Availability of new drugs and of reversal drugs, the current practice of mini-invasive surgical techniques, and the availability of post anesthesia care units are the keys to the safety and successful prognosis of patients affected by MG who undergo thymectomy.

scholarly journals Outcome of Recipient Surgery and 6-Month Follow-Up of the Swedish Live Donor Robotic Uterus Transplantation Trial

2020 ◽  
Vol 9 (8) ◽  
pp. 2338 ◽  
Author(s):  
Mats Brännström ◽  
Pernilla Dahm-Kähler ◽  
Jana Ekberg ◽  
Randa Akouri ◽  
Klaus Groth ◽  
...  
Keyword(s):  
Blood Flow ◽  
Color Doppler ◽  
Surgical Techniques ◽  
Length Of Hospital Stay ◽  
Artery Blood Flow ◽  
Exclusion Criteria ◽  
Uterus Transplantation ◽  
Uterine Perfusion ◽  
Robotic Assisted Laparoscopy

Uterus transplantation has proved to be a feasible treatment for uterine factor infertility. Herein, we report on recipient outcome in the robotic uterus transplantation trial of 2017–2019. The eight recipients had congenital uterine aplasia. The donors were six mothers, one sister, and one family friend. Donor surgery was by robotic-assisted laparoscopy. Recipient surgery was by laparotomy and vascular anastomoses to the external iliacs. The duration (median (ranges)) of recipient surgery, blood loss, measured (left/right) uterine artery blood flow after reperfusion, and length of hospital stay were 5.15 h (4.5–6.6), 300 mL (150–600), 43.5 mL/min (20–125)/37.5 mL/min (10–98), and 6 days (5–9), respectively. Postoperative uterine perfusion evaluated by color Doppler showed open anastomoses but restricted blood distribution in two cases. Repeated cervical biopsies in these two cases initially showed ischemia and, later, necrosis. Endometrial growth was not seen, and hysterectomy was later performed, with pathology showing partly viable myometrium and fibrosis but necrosis towards the cavity. The other six patients acquired regular menstrual cyclicity. Surgery was performed in two patients to correct vaginal stenosis. Reversible rejection episodes were seen in two patients. In conclusion, the rate of viable uterine grafts during the initial 6-months of the present study (75%) leaves room for improvement in the inclusion/exclusion criteria of donors and in surgical techniques. Initial low blood flow may indicate subsequent graft failure.

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