Robotic En Bloc First-Rib Resection for Paget-Schroetter Disease, a Form of Thoracic Outlet Syndrome Technique and Initial Results

2012 ◽  
Vol 7 (1) ◽  
pp. 39-44 ◽  
Author(s):  
Farid Gharagozloo ◽  
Mark Meyer ◽  
Barbara J. Tempesta ◽  
Marc Margolis ◽  
Eric T. Strother ◽  
...  
Keyword(s):  
Minimally Invasive ◽  
Subclavian Vein ◽  
Preoperative Assessment ◽  
En Bloc Resection ◽  
Bloc Resection ◽  
En Bloc ◽  
Invasive Approach ◽  
Rib Resection ◽  
First Rib ◽  
First Rib Resection

Objective First-rib resection is a key component of the treatment of Paget-Schroetter disease. There are many controversies regarding the management of this disease. We report a safe, effective, minimally invasive robotic transthoracic approach for resection of the first rib. Methods Over an 8-month period, five patients underwent robotic first-rib resection. Preoperative assessment included physical examination and bilateral venous angiography. On a thoracoscopic platform using three 2-cm incisions and one 1-cm incision, the robot was used to dissect the first rib and divide the scalene muscles. Success of the first-rib resection was assessed by postoperative venous angiography. Results There were four men and one woman. Mean age was 34.6 ± 10 years. Mean operative time was 195 ± 24.6 minutes. There were no complications and no mortality. All patients had a patent subclavian vein on the postoperative venogram and were anticoagulated with warfarin for 3 months. At a median follow-up of 12 months, all patients had an open subclavian vein for a patency rate of 100%. Conclusions Robotic thoracoscopic first-rib resection represents a feasible minimally invasive approach to en bloc resection of the first rib. This technique minimizes the risk of neurovascular complications that are associated with conventional techniques.

A Video-Assisted Thoracoscopic Approach to Transaxillary First Rib Resection

2015 ◽  
Vol 10 (1) ◽  
pp. 21-26 ◽  
Author(s):  
Harmik J. Soukiasian ◽  
Daniel Shouhed ◽  
Derek Serna-Gallgos ◽  
Robert McKenna ◽  
Vahak J. Bairamian ◽  
...  
Keyword(s):  
Minimally Invasive ◽  
Thoracoscopic Surgery ◽  
Invasive Approach ◽  
Thoracoscopic Approach ◽  
Rib Resection ◽  
Video Assisted ◽  
First Rib ◽  
The Mean ◽  
First Rib Resection ◽  
Video Assisted Thoracoscopic Surgery

Objective Thoracic outlet syndrome (TOS) can be associated with neurologic, arterial, or venous deficiencies. When nonsurgical treatment has failed to adequately palliate TOS, surgical intervention is indicated. The supraclavicular and transaxillary approaches are currently the most commonly used approaches for first rib resection, yet little has been reported to date on outcomes of minimally invasive procedures, such as video-assisted thoracoscopic surgery (VATS). The purpose of this article was to describe a minimally invasive approach to TOS and the associated outcomes. Methods This study is a retrospective analysis of a prospectively maintained database. Patients who failed nonsurgical therapy for TOS were referred to our practice for evaluation of surgery with a VATS minimally invasive first rib resection. Between 2001 and 2010, 66 VATS procedures were performed on 58 patients (41 women, 17 men). Patients were followed postoperatively for a mean time of 13.5 months. Results Forty-one patients were women (70.7%), and the mean age was 40.5 years, with a patient age range of 17 to 59 years. The mean length of hospital stay was 2.47 days; median length of stay was 2 days. There were a total of eight complications (12.1%). There were no mortalities. Conclusions Video-assisted thoracoscopic surgery first rib resection for TOS is another feasible option for TOS, which can be added to the armamentarium of the thoracic surgeon. The outcomes associated with our technique are comparable with the outcomes related to other current standards of care.

scholarly journals How I do it: minimally invasive resection of a sub-ependymoma of the fourth ventricle

2020 ◽  
Author(s):  
Marco V. Corniola ◽  
Torstein R. Meling
Keyword(s):  
Minimally Invasive ◽  
Surgical Management ◽  
Fourth Ventricle ◽  
En Bloc Resection ◽  
Bloc Resection ◽  
Midline Incision ◽  
En Bloc

Abstract Background A 54-year-old female was referred to our clinic with a lesion of the lower fourth ventricle extending to the median aperture. Here, we report the use a minimally invasive sub-occipital approach (MISA) as a safe and effective surgical management. Method We performed a MISA using a short midline incision and a 1-cm sub-occipital craniectomy. Dissection of the lesion was performed, and “en bloc” resection could be achieved. The lesion was confirmed to be a grade I sub-ependymoma. Conclusion MISA can be safely used when confronted to a lesion of the lower fourth ventricle.

Minimally Invasive Endoscopy-Assisted Approach for En Bloc Resection of Septal Tumors

2014 ◽  
Vol 75 (S 01) ◽  
Author(s):  
Anuraag Parikh ◽  
Justin Cohen ◽  
Monica Tadros ◽  
Rahmatullah Rahmati
Keyword(s):  
Minimally Invasive ◽  
En Bloc Resection ◽  
Bloc Resection ◽  
En Bloc

485 MINIMALLY INVASIVE EN-BLOC OESOPHAGECTOMY: ANALYSIS OF THE OUTCOMES ALONG A LEARNING CURVE

2020 ◽  
Vol 33 (Supplement_1) ◽  
Author(s):  
F Di Maggio ◽  
A Lee ◽  
Z Vrakopoulou ◽  
H Deere ◽  
A Botha
Keyword(s):  
Survival Rate ◽  
Minimally Invasive ◽  
Learning Curve ◽  
Hospital Stay ◽  
Open Surgery ◽  
En Bloc Resection ◽  
Bloc Resection ◽  
Resection Margins ◽  
En Bloc ◽  
Minimally Invasive Oesophagectomy

Abstract   Minimally invasive oesophagectomy is technically demanding but benefits perioperative morbidity and intra-hospital mortality. We previously described open total adventitial resection of the cardia (TARC) as an optimal anatomical resection technique for lower oesophageal and gastro-esophageal junction cancers. We wanted to investigate whether the peri-operative benefits of minimally invasive techniques, along with en-bloc resection of the primary tumour, translate into long term survival benefit in a specialized high volume center along a surgeon learning curve. Methods Data from 198 consecutive patients undergoing oesophagectomy by a single surgeon was collected prospectively. Patient stratification was made to chronologically reflect four main stages of our learning curve: open surgery, Laparoscopic Ivor Lewis, laparoscopy/thoracoscopy with mini-thoracotomy and laparoscopic TARC. Primary outcomes included five-year survival rate, operating time, hospital stay, specimen lymphnodes. Peri-operative complications and mortality are also described. 45 patients had open surgery; laparoscopy (n = 50) was initiated after two years, and thoracoscopy (n = 56) introduced after case 94. MIO was performed for the last 47 patients. Patients in all groups had similar demographics, histological diagnosis, preoperative and pathological staging. Results 158 patients were male (79.8%); age was 63 +/− 10 years. Overall five-year survival rate was 45%; perioperative mortality rate was 1.5% (n = 3); 13 patients were returned to theatre. Hospital stay was 22+/−23 days. Specimen lymph nodes were 21+/− 8. Resection margins were negative (ACP) in 193 cases (97.4%). Five-year survival rates during the 4 phases were 38.6%, 44.9%, 42.8% and 59% respectively, showing a benefit trend towards the end of the learning curve (p = 0.03). Specimen lymph nodes were: open = 20.5+/−9.5; Lap = 19.5+/− 7; mini-tho = 19.9+/− 7; MIO = 25+/− 10 (p = 0.027). Resection margins were > 1 mm in 68.1%(open), 67.3%(lap), 64.2%(mini-tho) and 79.5(MIO). Conclusion Laparoscopic en-bloc resection of cancers of the OGJ requires a long learning curve. Proficiency gains along this learning curve affects oncological quality of oesophageal resectional surgery and benefits patients survival after minimally invasive oesophagectomy.

Parathyroid carcinoma. Mini-series of patients successfully treated with minimally invasive surgery using intra-operative PTH assays, and literature review.

2009 ◽  
Vol 54 (2) ◽  
pp. 58-58
Author(s):  
OO Komolafe ◽  
AG McMinn ◽  
JC Doughty ◽  
CR Wilson
Keyword(s):  
Minimally Invasive Surgery ◽  
Minimally Invasive ◽  
Invasive Surgery ◽  
Single Case ◽  
Radical Resection ◽  
En Bloc Resection ◽  
Bloc Resection ◽  
Parathyroid Cancer ◽  
En Bloc ◽  
Initial Surgery

Parathyroid cancer is a rare cause of primary hyperparathyroidism, with a surgeon anecdotally expected to see a single case in his/her entire career. In our unit, however, we have treated three patients recently. The accepted optimal treatment of parathyroid cancer is radical resection at the initial surgery, but a low index of suspicion means that most parathyroid cancers are not identified pre- or intra-operatively. This results in the majority of patients having inadequate surgery. All three patients were treated by minimally invasive surgery, with radical en bloc resection based on intra-operative suspicion of malignancy. Pre-operative imaging guides the neck exploration, and intra-operative PTH assays confirm excision of the source of excess PTH. All patients have remained well with no recurrence to date. We review the literature on parathyroid cancer, and suggest features that point to a parathyroid tumour being malignant.

Minimally Invasive En Bloc Resection of Massive Obstructive Atrial Tumour

2016 ◽  
Vol 32 (12) ◽  
pp. 1575.e21-1575.e23
Author(s):  
Claudia L. Cote ◽  
Nasser Alkhamees ◽  
Martin Goldbach ◽  
Rodrigo Bagur ◽  
Michael W.A. Chu
Keyword(s):  
Minimally Invasive ◽  
En Bloc Resection ◽  
Bloc Resection ◽  
En Bloc
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