Technical Modifications to Prevent Massive Hemothorax Following Sternal Plating

Abstract Background Totally intracorporeal surgery for left-sided resection carries numerous potential advantages by avoiding crossing staple lines and eliminating the need for an abdominal incision. For those with complicated diverticulitis, minimally invasive surgery is known to be technically challenging due to inflamed tissue, distorted pelvic anatomy, and obliterated tissue planes, resulting in high conversion rates. We aim to illustrate the stepwise approach and modifications required to successful complete the robotic Natural-orifice IntraCorporeal anastomosis with transrectal specimen Extraction (NICE) procedure in this cohort. Methods Consecutive, elective, unselected patients presenting with complicated diverticulitis defined as fistula, abscess and stricture underwent the NICE procedure over a 24-month period. Demographic and intraoperative data were collected, and video recordings were reviewed and edited on encrypted server. Results A total of 60 patients (50% female) underwent the NICE procedure for complicated diverticulitis with a mean age of 58.9 years and mean BMI of 30.7 kg/m2. The mean operative time was 231.6 min. All cases (100%) were achieved with intracorporeal anastomosis using a circular stapling device. All but one patient (98.3%) had successful transrectal extraction of the specimen. Forty-four (73%) of the specimens required a specimen-thinning maneuver to successfully extract the specimen and there were no conversions. We identified seven key technical modifications and considerations to facilitate successful completion of the procedure which are illustrated, including early release of the disease, mesentery-sparing dissection, dual instrument control of the mesenteric vasculature, release of the rectal reflection, use of NICE back table, specimen-thinning maneuver, and closure of the rectal cuff. Conclusion We present a stepwise approach with key modifications to successfully achieve totally robotic intracorporeal resection for those presenting with complicated diverticulitis. This approach may help overcome the technical challenges and provide a foundation for reproducible results.

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Technical Modifications for Laparoscopic Appendectomy and Other Pelvic Procedures Using Microinstruments

Surgical Laparoscopy Endoscopy & Percutaneous Techniques ◽

10.1097/00129689-200008000-00005 ◽

2000 ◽

Vol 10 (4) ◽

pp. 211-214

Author(s):

Jorge Cueto ◽

Martín Salvador Valencia-Reyes ◽

Jose Antonio Vazquez-Frias ◽

Pablo Castaneda-Leeder ◽

Roberto Nevarez-Bernal ◽

...

Keyword(s):

Laparoscopic Appendectomy ◽

Technical Modifications

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Successful treatment of massive hemothorax with class IV shock using aortography with transcatheter embolization of actively bleeding posterior left intercostal arteries after penetrating left chest trauma: A case for the hybrid OR

International Journal of Surgery Case Reports ◽

10.1016/j.ijscr.2018.04.023 ◽

2018 ◽

Vol 48 ◽

pp. 109-112

Author(s):

Carolyn Moore ◽

Golda Kwayisi ◽

Prince Esiobu ◽

Keren A. Bashan-Gilzenrat ◽

Leslie R. Matthews ◽

...

Keyword(s):

Successful Treatment ◽

Chest Trauma ◽

Transcatheter Embolization ◽

Left Chest ◽

Massive Hemothorax ◽

Class Iv

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Technical modifications in bar removal in the Nuss procedure

European Journal of Cardio-Thoracic Surgery ◽

10.1016/j.ejcts.2009.09.006 ◽

2010 ◽

Vol 37 (3) ◽

pp. 747-748

Author(s):

José M. Mier ◽

Laureano Molins ◽

Juan J. Flibla

Keyword(s):

Nuss Procedure ◽

Technical Modifications

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Conjugated and unconjugated bilirubins in bile of humans and rhesus monkeys. Structure of adult human and rhesus-monkey bilirubins compared with dog bilirubins

Biochemical Journal ◽

10.1042/bj1670535 ◽

1977 ◽

Vol 167 (3) ◽

pp. 535-548 ◽

Cited By ~ 29

Author(s):

S G Blumenthal ◽

D B Taggart ◽

R Ikeda ◽

B H Ruebner ◽

D E Bergstrom

Keyword(s):

Chemical Composition ◽

Gall Bladder ◽

Rhesus Monkey ◽

Rhesus Monkeys ◽

Glucuronic Acid ◽

Unknown Compound ◽

Adult Human ◽

Adult Humans ◽

Technical Modifications ◽

Working Day

1. Bilirubin-IXalpha, -IXalpha diglucuronide, -IXalpha monoglucuronide, -IXalpha monoglucoside -IXalpha monoxyloside, a bilirubin-IXalpha diconjugate containing glucose and another unknown compound, and bilirubin-IXbeta are present in gall-bladder bile of adult human, rhesus monkey and dog. Dog bile normally also contains other bilirubin-IXalpha diconjugates, i.e. compounds containing two conjugating sugars such as glucuronic acid and glucose, glucuronic acid and xylose and glucose xylose. 2. Azopigments alphaF, alphaO, alpha2, alpha3, betax and delta derived from human and rhesus-monkey bilirubins are identical in their chemical composition with those obtained from the dog. 3. Azopigments alphaF and betax found in diazotized biles of adult humans, rhesus monkeys and dogs are products of unconjugated bilirubin-IXbeta. 4. Technical modifications of previously published procedures [Heirwegh, Fevery, Michiels, Van Hees & Compernolle, (1975) Biochem. J. 145, 185-199] were introduced which make it possible to separate the bilirubins, diazotize the separated bilirubins, extract the azopigments and chromatograph them in one working day (6-8h).

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