Surgical strategy for pulmonary sequestration: Focus on precautions for aberrant vessels under minimally invasive surgery

Background Recently, thoracoscopic resection of pulmonary sequestration has become more common, since resection of an aberrant artery using an end-stapler is a safe maneuver in many cases. However, injury of the vessels can lead to major hemorrhage. We reported our surgical experience based on thoracoscopic surgery, with five cases of interlobar pulmonary sequestration, focusing on precautions for aberrant arterial vessels. Object and methods We performed pulmonary resections for five patients with interlobar pulmonary sequestration in a lower lobe (left, n = 4; right, n = 1) between April 2004 and May 2020. All aberrant vessels were derived from the lower thoracic artery. Two patients had a single aberrant artery and three had multiple. In four patients, these vessels were detected before surgery, and pulmonary sequestration was diagnosed in four. In one elderly patient, the aberrant vessel was overlooked, and lung cancer was suspected before surgery. Angiography or multidetector-row computed tomography was subsequently performed in four cases. The surgical plan was determined according to the location and size of the pulmonary lesion and three-dimensional images of aberrant vessels. Result In all patients, approaches were made thoracoscopically. Hemorrhage from an anomalous vessel was encountered in one case. Pulmonary resections included two lobectomies and three limited resections. Angioplasty for the root of anomalous branches was performed following pulmonary resections under converted minimal lateral thoracotomy in two cases. Conclusion Preoperative assessment of the anatomical variations in abnormal vessels is essential to achieve safe surgical procedures. According to the situation of the aberrant vessels, selecting surgical procedures with consideration of potential subsequent complications arising over a long period of time is important.

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Pulmonary sequestration mimicring lun cancer: A case report

Vojnosanitetski pregled ◽

10.2298/vsp150603129a ◽

2016 ◽

Vol 73 (11) ◽

pp. 1060-1063

Author(s):

Tatjana Adzic-Vukicevic ◽

Dragan Radovanovic ◽

Bojana Acimovic ◽

Marko Popovic

Keyword(s):

Case Report ◽

Gold Standard ◽

Lower Lobe ◽

Pulmonary Sequestration ◽

Left Lower Lobe ◽

Intravenous Contrast ◽

Therapy Regimen ◽

Intralobar Pulmonary Sequestration ◽

Aberrant Artery ◽

Malignant Lesions

Introduction. Pulmonary sequestration is a rare congenital anomaly and most intralobar sequestrations were located in lower lobes. Case report. We reported an unusual 28-yearold female patient with intralobar pulmonary sequestration on the left lower lobe, successfully treated with lobectomy. Computed tomography (CT) of the chest with intravenous contrast revealed multiple clustered cystic lesions in the left lower lobe with aberrant artery from descedenting aorta. Additional aortography showed an aberrant artery (3 mm in diameter) arising from the abdominal aorta and flowing into the lesion. Conclusion. Standard therapy regimen for pulmonary sequestration includes surgery. CT scan of thorax with intravenous contrast and aortography represent the gold standard for its diagnosis. Tumor-like shadows seen on the chest radiography or CT scans should not be always suspected on malignant lesions.

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Video-Assisted Thoracoscopic Surgery for Pulmonary Sequestrations: Series of 35 Consecutive Patients in a Single Center

The Thoracic and Cardiovascular Surgeon ◽

10.1055/s-0038-1668596 ◽

2018 ◽

Vol 67 (01) ◽

pp. 073-078 ◽

Cited By ~ 3

Author(s):

Shaodong Wang ◽

Yun Li ◽

Jun Wang

Keyword(s):

Thoracoscopic Surgery ◽

Lower Lobe ◽

Pulmonary Sequestration ◽

Single Center ◽

Term Outcome ◽

Long Term Outcome ◽

Video Assisted ◽

Extralobar Pulmonary Sequestration ◽

Video Assisted Thoracoscopic Surgery

Objective The aim of this report is to summarize the experience of completely video-assisted thoracoscopic surgery (VATS) for pulmonary sequestration in a single center and to evaluate the long-term outcome in a larger series of patients. Methods The data of 35 pulmonary sequestrations who received completely VATS consecutively in Peking University People's Hospital between January 2008 and November 2017 were retrospectively reviewed. Twenty-three females and twelve males with an average of 38 years old were included. Results A total of 28 (80%) patients had preoperative symptoms; leading symptoms were recurrent infections (22), fever (11), hemoptysis (11), chest pain (9), and shortness of breath (4). Twenty-nine (82.9%) patients were intralobar pulmonary sequestration (22 in the left lower lobe, 6 in the right lower lobe, and 1 in the left upper lobe) and six (17.1%) patients were extralobar pulmonary sequestration. All the patients underwent VATS excision successfully, 26 underwent lobectomy, 2 underwent wedge resection, 1 underwent occlusion of the aberrant artery, and 6 underwent mass resection in all of those with extralobar pulmonary sequestration. The median surgery time and estimated blood loss was 150 (75–300) minutes and 50 (10–600) mL, respectively. There was no mortality. Only one patient suffered postoperative complication (recurrent laryngeal nerve injury). During the median follow-up period of 57 months, none of the patients presented recurrence. Conclusions Completely VATS was a safe and effective mini-invasive procedure for pulmonary sequestration in an experienced team. Its long-term outcome was remarkable.

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A Modified VATS Procedure for Treating Adult Intralobar Pulmonary Sequestration

The Thoracic and Cardiovascular Surgeon ◽

10.1055/s-0040-1708870 ◽

2020 ◽

Author(s):

Bo Zeng ◽

Jianyong Zou ◽

Weixiong Yang ◽

Zhenguo Liu ◽

Chunying Xie ◽

...

Keyword(s):

Open Surgery ◽

Thoracoscopic Surgery ◽

Pulmonary Sequestration ◽

Risk Of Bleeding ◽

Massive Blood Loss ◽

Intralobar Sequestration ◽

Intralobar Pulmonary Sequestration ◽

Conventional Open Surgery ◽

Aberrant Vessels ◽

Video Assisted Thoracoscopic Surgery

AbstractVideo-assisted thoracoscopic surgery (VATS) makes it possible to treat intralobar sequestration (ILS) more minimally invasive compared with conventional open surgery. However, this procedure is challenging to expose and isolate the aberrant arteries of ILS and the risk of bleeding is high. Herein, we developed a modified VATS procedure in which the aberrant vessels are treated in the last step of lobectomy, rather than at the beginning. In this way, we can expose the aberrant vessels easier and reduce the risk of massive blood loss, also simplifying the surgical procedure.

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Anatomical Variations of the Recurrent Laryngeal Nerve and Implications for Injury Prevention during Surgical Procedures of the Neck

Diagnostics ◽

10.3390/diagnostics10090670 ◽

2020 ◽

Vol 10 (9) ◽

pp. 670

Author(s):

Alison M. Thomas ◽

Daniel K. Fahim ◽

Jickssa M. Gemechu

Keyword(s):

Recurrent Laryngeal Nerve ◽

Surgical Procedures ◽

Anatomical Variations ◽

Laryngeal Nerve ◽

Inferior Thyroid Artery ◽

Branching Pattern ◽

The Right ◽

Relationship Of ◽

Intrinsic Laryngeal Muscles ◽

Formalin Fixed

Accurate knowledge of anatomical variations of the recurrent laryngeal nerve (RLN) provides information to prevent inadvertent intraoperative injury and ultimately guide best clinical and surgical practices. The present study aims to assess the potential anatomical variability of RLN pertaining to its course, branching pattern, and relationship to the inferior thyroid artery, which makes it vulnerable during surgical procedures of the neck. Fifty-five formalin-fixed cadavers were carefully dissected and examined, with the course of the RLN carefully evaluated and documented bilaterally. Our findings indicate that extra-laryngeal branches coming off the RLN on both the right and left side innervate the esophagus, trachea, and mainly intrinsic laryngeal muscles. On the right side, 89.1% of the cadavers demonstrated 2–5 extra-laryngeal branches. On the left, 74.6% of the cadavers demonstrated 2–3 extra-laryngeal branches. In relation to the inferior thyroid artery (ITA), 67.9% of right RLNs were located anteriorly, while 32.1% were located posteriorly. On the other hand, 32.1% of left RLNs were anterior to the ITA, while 67.9% were related posteriorly. On both sides, 3–5% of RLN crossed in between the branches of the ITA. Anatomical consideration of the variations in the course, branching pattern, and relationship of the RLNs is essential to minimize complications associated with surgical procedures of the neck, especially thyroidectomy and anterior cervical discectomy and fusion (ACDF) surgery. The information gained in this study emphasizes the need to preferentially utilize left-sided approaches for ACDF surgery whenever possible.

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Minimal Invazive Surgical Treatment of Piriformis Syndrome and the Results

Advances in Neurology and Neuroscience ◽

10.33140/an.02.01.01 ◽

2019 ◽

Vol 2 (1) ◽

Keyword(s):

Surgical Treatment ◽

Sciatic Nerve ◽

Conservative Treatment ◽

Surgical Procedures ◽

Pain Syndrome ◽

Anatomical Variations ◽

Clinical Findings ◽

Piriformis Syndrome ◽

Minimally Invasive Surgical ◽

Magnetic Resonance Imaging Mri

Piriformis syndrome is a neuromuscular pain syndrome occurring as a result of compression on the underlying sciatic nerve due to various causes including the hypertrophy, inflammation, mass lesions or anatomical variations occuring in the deep gluteal space. Patients with piriformis syndrome often experience pain and numbness in the hip, thigh and leg, similar to those of sciatica. In addition to clinical findings, electrophysiological examinations and magnetic resonance imaging (MRI) is useful for diagnosis. Once diagnosed, the treatment approach is stepwise and conservative treatment is successful in majority of cases. Surgical treatment should be performed for the cases in whom conservative treatment methods fail and when the sciatic nerve should be decompressed. Surgery is an important treatment option for unresolved piriformis syndrome with its simplicity and low morbidity. Several surgical procedures have been described for the decompression of affected sciatic nerve. Due to excessive fibrosis tissue that may be developed around the sciatic nerve in classical surgical procedures, person's return to social and work life may be delayed. In the present study, we will evaluate the surgical indication criteria of our cases who underwent minimally invasive surgical treatment due to piriformis syndrome, the definition of the surgical procedure and the outcomes.

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Anatomical variations in pneumatization of the anterior clinoid process

Journal of Neurosurgery ◽

10.3171/jns.2007.106.1.170 ◽

2007 ◽

Vol 106 (1) ◽

pp. 170-174 ◽

Cited By ~ 35

Author(s):

Takeshi Mikami ◽

Yoshihiro Minamida ◽

Izumi Koyanagi ◽

Takeo Baba ◽

Kiyohiro Houkin

Keyword(s):

Computed Tomography ◽

Anatomical Variations ◽

Statistical Dependence ◽

Multidetector Row Computed Tomography ◽

Type I ◽

Anterior Clinoid Process ◽

Anterior Clinoidectomy ◽

Computed Tomography Scans ◽

Preoperative Ct ◽

Cerebrospinal Fluid Leaks

Object An anterior clinoidectomy can provide enormous benefits, facilitating the management of paraclinoid and upper basilar artery lesions, but it also carries the potential risk of cerebrospinal fluid leaks. The aim of this study was to assess the variation in the pneumatization of the anterior clinoid process (ACP) in an attempt to reduce the complications associated with an anterior clinoidectomy. Methods The authors analyzed the anatomical variations in the pneumatization of the ACP and optical strut (OS) in 600 sides of 300 consecutive patients by using multidetector-row computed tomography (CT). Computed tomography scans with a 0.5-mm thickness were obtained, and coronal and sagittal reconstructions of the images were displayed in all cases. Pneumatization of the ACP was found in 9.2% of all sides. The origin of pneumatization was the sphenoid sinus in 81.8% of all the sides, the ethmoid sinus in 10.9%, and both of these sinuses in 7.3%. Pneumatized patterns were divided into three groups according to the route: 74.5% were Type I, in which pneumatization occurred via the OS; 14.5% were Type II, pneumatization via the anterior root (AR); and 10.9% were Type III, pneumatization via both the OS and the AR. The origin of pneumatization and the pneumatization pattern showed statistical dependence (p < 0.001). Pneumatization of the OS beyond its narrowest point was found in 6.8% of all sides. Conclusions An awareness of the different variations in pneumatization can prevent destruction of the mucous membrane and facilitate orientation during reconstruction with cranialization. During an anterior clinoidectomy, preoperative CT assessments are necessary to evaluate pneumatization of the ACP.

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Evaluation of different airway tests to determine difficult intubation in apparently normal adult patients: undergoing surgical procedures

Patient Safety in Surgery ◽

10.1186/s13037-020-00263-5 ◽

2020 ◽

Vol 14 (1) ◽

Author(s):

Khaled El-Radaideh ◽

Ehab Dheeb ◽

Hamzeh Shbool ◽

Saif Garaibeh ◽

Adel Bataineh ◽

...

Keyword(s):

Surgical Procedures ◽

Medical Center ◽

Academic Medical Center ◽

Preoperative Assessment ◽

Adult Patients ◽

Normal Adult ◽

Clinical Tests ◽

Tongue Protrusion ◽

Specific Test ◽

Youden’S Index

Abstract Background Inadequate maintenance of a patient’s airway represents a major cause of anesthesia-related morbidity and mortality. This study was designed to evaluate common preoperative clinical tests to determine the risk of difficult endotracheal intubation in apparent “normal” adult patients undergoing surgical procedures. Methods A prospective observational cohort study was performed on 160 consecutive adult patients undergoing surgical procedures at an academic medical center in Jordan from 20 May 2019 until 11 February 2020. Preoperative assessment of airway risk stratification was performed by the following clinical tests: the mandible protrusion test (MPT), thyromental (TMD) and sternomental (SMD) distances, inter-incisor gap (IIG), and the modified Mallampati tests with tongue protrusion (MMT-TP) and without tongue protrusion (MMT-NTP). Grade C on the MPT, TMD ≤ 6 cm, SMD ≤ 12 cm, and MMT grades III and IV were considered to be predictors of difficult endotracheal intubations. A modified Cormack-Lehane grading (MCLG) of laryngoscopic views with backward, upward, and right-sided pressure on the thyroid and cricoid cartilages (BURP) maneuver was also documented, with grades 2B, 3, and 4 considered to be difficult airways for intubation. Results Fifteen patients (9.4%) were classified as MCLG 2B, 3, and 4, with age significantly associated with the MCLG grade (P = 0.028). The sensitivity and Youden’s index of MMT-TP were found to be the lowest (40% and 0.29, respectively). The MPT was the most accurate and specific test (90.63 and 95.17%, respectively), with the highest PPV (50%), Youden’s index (0.42), and area under the curve (AUC) (0.781). Bivariant analysis of MPT and the t-test of the mean TMDs and SMDs revealed significant associations between these airway tests and the difficulty of intubation (P values: < 0.001, 0.02, < 0.01, respectively). Conclusion The MPT, with its highest accuracy, specificity, positive predictive value, and good sensitivity may be used as a routine screening test for preoperative prediction of difficult endotracheal intubations.

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