A Novel Robot-Assisted Technique for Excision of a Posterior Mediastinal Thyroid Goiter

2009 ◽  
Vol 4 (4) ◽  
pp. 225-228 ◽  
Author(s):  
Eitan Podgaetz ◽  
Farid Gharagozloo ◽  
Farzad Najam ◽  
Nader Sadeghi ◽  
Marc Margolis ◽  
...  
Keyword(s):  
Minimally Invasive ◽  
Surgical Techniques ◽  
Invasive Procedure ◽  
Posterior Mediastinum ◽  
Robot Assisted ◽  
Robotic Assisted ◽  
Cervical Incision ◽  
Thyroid Goiter ◽  
Cervical Approach ◽  
The Right

Objective Intrathoracic thyroid goiter is an uncommon condition. Most goiters are found in the superior and anterior mediastinum, which can be removed either through a cervical approach or through a combined cervicotomy and sternotomy approach. Extension of the goiter into the posterior mediastinum is even less common. Transcervival approach to thyroid goiters in the posterior mediastinum can be difficult, necessitating a thoracotomy, with its associated morbidity. Methods A 69-year-old patient underwent robotic assisted minimally invasive procedure, with the daVinci surgical robotic system to excise a thyroid goiter that extended into the posterior mediastinum. The blood supply of the mediastinal portion of the goiter originated from the right internal thoracic artery. The thoracic and mediastinal portion of the goiter was approached with robot-assisted minimally invasive surgical techniques. Small incisions were used to gain access to the posterior mediastinum via the right pleural cavity, obviating the need for thoracotomy. Using precise movements of the robotic arm, the mediastinal part of the goiter was dissected off vital structures, from within the posterior mediastinum. Total thyroidectomy was then completed using the cervical approach. Results The patient tolerated the procedure well, with minimal intraoperative blood loss. The patient was discharged home after a short hospital stay. Conclusions Robotic surgical techniques for removal of a substernal goiter and other thyroid masses with mediastinal extension, in combination with cervical incision, are effective. Robotic-assisted techniques can complement video-assisted thoracic surgical techniques and broaden the indications for minimally invasive surgery.

Robotic-Assisted Retroperitoneoscopic Adrenalectomy: Making a Good Procedure Even Better

2013 ◽  
Vol 79 (1) ◽  
pp. 84-89 ◽  
Author(s):  
Paxton V. Dickson ◽  
Gillian C. Alex ◽  
Elizabeth G. Grubbs ◽  
Camilo Jimenez ◽  
Jeffrey E. Lee ◽  
...  
Keyword(s):  
Minimally Invasive ◽  
Perioperative Complications ◽  
Three Dimensional ◽  
Invasive Procedure ◽  
Robotic Assisted ◽  
Surgical Technology ◽  
Laparoscopic Operation ◽  
Retroperitoneoscopic Adrenalectomy ◽  
Postoperative Blood Transfusion ◽  
Minimally Invasive Adrenalectomy

Posterior retroperitoneoscopic adrenalectomy (PRA) is a minimally invasive procedure offering several advantages over a transabdominal laparoscopic operation. The three-dimensional optics and articulating instrumentation offered by current robotic surgical technology potentially improve this procedure. Robotic-assisted PRA (RA-PRA) was performed in patients meeting standard criteria for minimally invasive adrenalectomy. We prospectively collected demographic, clinical, perioperative, and pathologic data on patients undergoing RA-PRA. Thirty consecutive RA-PRAs were performed in 28 patients (26 unilateral and 2 bilateral). Indications for adrenalectomy included pheochromocytoma (8), hyperaldosteronism (3), hypercortisolism (8), oligometastases (5), and nonfunctional tumors (6). Mean tumor size was 3.8 ± 1.6 cm. Mean body mass index was 30.7 ± 6.5 kg/m2. Mean operative time was 154 ± 43 minutes for unilateral total adrenalectomy. Four patients with multiple endocrine neoplasia Type 2A-associated pheochromocytomas underwent cortical-preserving procedures. Three patients experienced perioperative complications (one pneumothorax, one urinary retention, one required postoperative blood transfusion). No patient required conversion to an open procedure. Robotic surgical technology is an excellent complement to retroperitoneoscopic adrenalectomy. The three-dimensional view and ergonomic advantages of a robotic procedure promote better visualization and a more flexible approach to dissection. We believe these features may optimize the ability to maintain a vascularized remnant during minimally invasive cortical-sparing adrenalectomy.

scholarly journals Advances in Minimally Invasive Surgery for Lung Cancer

2020 ◽  
Author(s):  
Rachit Shah ◽  
Nils-Tomas Delagar McBride
Keyword(s):  
Lung Cancer ◽  
Minimally Invasive Surgery ◽  
Minimally Invasive ◽  
Wedge Resection ◽  
Surgical Techniques ◽  
Robotic Assisted ◽  
Current State ◽  
Chest Disease ◽  
History Of ◽  
Vats Wedge Resection

Over the last 25 years, improvement in instrumentation and surgical techniques has led to widespread adaptation of thoracoscopic (VATS) surgery in the field of thoracic oncology. What once was a niche operation like VATS wedge resection to now hybrid VATS chest wall resections, and advanced surgeries like bronchoplasty and sleeve resections are done with VATS. This has led to improved surgical outcomes for our patients and increased use of surgery in the treatment of chest disease. We review the history of VATS and its current state with most recent changes and upgrades in the technique in this chapter. We review the advancement in uniportal VATS, robotic assisted resection, complex VATS resection, and awake lung surgery with VATS.

scholarly journals Bowel Injury following Lumbar Discectomy using Minimally Invasive Retractors

2007 ◽  
Vol 34 (4) ◽  
pp. 485-487 ◽  
Author(s):  
Aleksa Cenic ◽  
Niv Sne ◽  
Michael Lisi ◽  
Allan Okrainac ◽  
Kesava Reddy
Keyword(s):  
Minimally Invasive ◽  
Clinical Outcomes ◽  
Lumbar Disc ◽  
Intraoperative Complications ◽  
Adult Population ◽  
Surgical Techniques ◽  
Length Of Hospital Stay ◽  
Invasive Procedure ◽  
Invasive Technique ◽  
Tubular Retractor

Prevalence of symptomatic lumbar disc herniation is 1-3% in the adult population. When conservative therapy (e.g., physiotherapy, anti-inflammatories, epidural injections, etc.) fails, open microsurgical discectomy is regarded as the treatment of choice.With this procedure, the incidence of injury to visceral bowel is reported to be 3.8 per 10,000 cases. With the recent advent of tubular retractor systems, an increasing number of surgeons are using this minimally invasive procedure to replace traditional open microsurgical discectomy. The advantages include a smaller skin incision and a muscle splitting rather than muscle incising technique. As a result post-operative pain, blood loss and length of hospital stay may decrease significantly. Multiple studies have compared the two surgical techniques with regards to their clinical outcomes. The results of these studies reveal equal if not superior clinical outcomes with the minimally invasive technique. Despite the success of the minimally invasive microdiscectomy, none of the studies reported any intraoperative complications using this novel technique.

Posterior Mediastinal Goiter Removal Through Cervical Incision

2021 ◽  
pp. 000313482110335
Author(s):  
Komal Gupta ◽  
Neha Gupta ◽  
Kamal Kataria
Keyword(s):  
Posterior Mediastinum ◽  
Intrathoracic Goiter ◽  
Adenomatous Goiter ◽  
Vessel Sealing ◽  
Cervical Incision ◽  
Cervical Approach ◽  
Posterior Mediastinal ◽  
Case Basis ◽  
Lateral Thoracotomy ◽  
Mediastinal Goiter

Intrathoracic goiter when encountered can be treated by thyroidectomy using cervical incision, only occasionally requiring extra cervical approach. We are reporting one such case in a patient with pituitary macroadenoma with extension of the adenomatous goiter into the posterior mediastinum. It was removed through the cervical collar incision using a vessel sealing device. There were no intraoperative and postoperative complications during the procedure. The need for extra cervical incision should be decided on a case-to-case basis to avoid the increased morbidity associated with sternotomy and lateral thoracotomy incision.

scholarly journals Robot-assisted esophageal surgery using the da Vinci® Xi system for Benign and malignant diseases of esophagus：Preliminary experience of robot assisted modified Sweet operation

2020 ◽  
Author(s):  
Bei Lu ◽  
Li xin Sun ◽  
Zhonghao Wang ◽  
Xi Yan ◽  
Zhenzhong Ai ◽  
...  
Keyword(s):  
Esophageal Cancer ◽  
Thoracoscopic Surgery ◽  
Esophageal Surgery ◽  
Thoracic Cavity ◽  
Malignant Diseases ◽  
Robot Assisted ◽  
Esophageal Diseases ◽  
Benign Diseases ◽  
Robotic Assisted ◽  
The Right

Abstract Background Since our hospital installed the DaVinci ® Xi system, we have performed 60 thoracic surgeries in four months. As 25 of these 60 patients contain various types of esophageal benign and malignant diseases, we have no time to summarize our work after understanding and learning the experience of previous experts, so as to share our preliminary experience in using DaVinci ® Xi system in esophageal surgery. Because robot surgery system is the most effective for small and hard to reach areas, we have made many attempts in benign esophageal diseases. Compared with DaVinci ® Si, DaVinci ® Xi has many new functions, so we explore new surgical methods for some special esophageal cancer cases, such as the robot assisted modified Sweet operation.Methods Using DaVinci® Xi system(Intuitive Surgical, China), we performed robotic assisted thoracoscopic surgery (RATS) on 15 patients with esophageal cancer and 10 patients with various types of esophageal benign diseases. Among all esophageal cancer patients, 6 patients with lower esophageal cancer underwent resection of left thoracic esophageal cancer and lymphadenectomy, then diaphragm was cut, stomach was separated from abdominal cavity and lymphadenectomy was performed. Finally, 5 cases were anastomosed with stomach and esophagus under the aortic arch, and 1 case was anastomosed with stomach and esophagus in the neck combined with mediastinoscopic neck lymphadenectomy. McKeown was performed in 3 of the other 9 cases. Six patients underwent the Ivor Lewis operation, one of them was converted to the left thoracogastrostomy because of the extensive adhesion of the right thoracic cavity. Other benign diseases included esophageal leiomyomectomy in 3 cases, esophageal diverticulum in 1 case, hiatal hernia in 4 cases, esophageal cyst in 1 case, achalasia in 1 case. Results All the procedures were successfully completed by robot except one patient with extensive adhesion of right thoracic cavity and only abdominal operation. The median operation time of esophageal cancer patients was 286（240-348 minutes,There were no complications during operation. One patient had a neck anastomotic leakage and the wound healed after local washing for 3 weeks. Because of the short time of observation, there is no death of malignant tumor and no serious complication of benign disease. Conclusions Through the experience of such a small series of robotic assisted thoracoscopic surgery for various esophageal diseases, we support the impression that: 1. The esophagus is an ideal organ for robotic surgery, which is a good indication for malignant tumor surgery; 2. Under the vision of the robot, each layer of esophageal mucosa can be seen clearly, which is very conducive to the resection of small leiomyoma or cyst In addition, 3. Flexible arms can be used for various anastomosis or suture operations. 4. Through the left thorax and diaphragm incision can be used as a "robot" Sweet operation for the right patient, with mediastinoscopy to clean up the upper mediastinal lymph nodes can achieve better results.

scholarly journals Primary intrathoracic goiter: a rare mediastinal tumor

2017 ◽  
Vol 4 (6) ◽  
pp. 1833
Author(s):  
Hazem Zribi ◽  
Amina Abdelkbir ◽  
Sarra Maazaoui ◽  
Imen Bouacida ◽  
Hanen Smadhi ◽  
...  
Keyword(s):  
Retrospective Study ◽  
Thoracic Surgery ◽  
Postoperative Complication ◽  
Mediastinal Tumor ◽  
Posterior Mediastinum ◽  
Anterior Mediastinum ◽  
Transthoracic Approach ◽  
Intrathoracic Goiter ◽  
Cervical Approach ◽  
The Right

Background: Substernal goiters are usually classified as secondary or primary intrathoracic goiters. Primary ones result from an abnormal embryologic migration of the thyroid and represents less than 1% of all goiters. Secondary substernal goiters develop from the descent of the thyroid into the mediastinum and represents 98-99% of goiters.Methods: This was a retrospective study which discuss the symptoms, the diagnosis and the treatment of 7 primary intrathoracic goiters.Results: Goiter was located in the anterior mediastinum in 5 cases, in the posterior mediastinum in 1 case and in the medium mediastinum in 1 case. The mass was located on the right in 5 cases cervical approach was performed in 3 cases. Two patients required a transthoracic approach, 1 required sternotomy and in 1 case video-thoracic surgery was sufficient. Only one patient had postoperative complication which was secondary pneumothorax. All tumors were benign.Conclusions: Mediastinal ectopic goitre is rare. However it should be discussed among the different etiologies of mediastinal masses.

Robotic Transthoracic Primary Repair of a Diaphragmatic Hernia and Reduction of an Intrathoracic Liver

2018 ◽  
Vol 13 (1) ◽  
pp. 54-55 ◽  
Author(s):  
Sarah J. Counts ◽  
Areo G. Saffarzadeh ◽  
Justin D. Blasberg ◽  
Anthony W. Kim
Keyword(s):  
Minimally Invasive ◽  
Operating Room ◽  
Diaphragmatic Hernia ◽  
Motor Vehicle ◽  
Primary Repair ◽  
Abdominal Injuries ◽  
Robotic Platform ◽  
Robotic Assisted ◽  
Vehicle Collision ◽  
The Right

This case involves a 70-year-old woman who presented after a low-speed motor vehicle collision with a traumatic right hemidiaphragm rupture and herniation of the liver into the right chest. She was brought to the operating room for a robotic-assisted minimally invasive transthoracic repair of this hernia with diaphragm plication. The case and video described in this report highlight the utility of the robotic platform in performing a transthoracic diaphragm repair and plication after a right-sided traumatic diaphragm rupture in a patient without concomitant abdominal injuries.

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