scholarly journals Robot-Assisted Thoracoscopic Surgery of Neurogenic Tumours in the Apical Chest: A Case Series

2020 ◽  
Author(s):  
Yu Zheng ◽  
Han-Lu Zhang ◽  
Fu-Qiang Wang ◽  
Guang-Hao Qiu ◽  
Guo-Wei Che ◽  
...  
Keyword(s):  
Thoracoscopic Surgery ◽  
Tumour Size ◽  
Case Series ◽  
Perioperative Period ◽  
Massive Bleeding ◽  
Perioperative Outcomes ◽  
Neurogenic Tumour ◽  
Joint Plane ◽  
Alternative Modality ◽  
Posterior Mediastinal

Abstract Background: Superior posterior mediastinal tumours may arise in the apical chest. However, the removal of such tumours via conventional minimally invasive approaches remains challenging. In this paper, we demonstrate our experience of robotic-assisted thoracoscopic surgery (RATS) for patients with neurogenic apical chest tumours (ACT). Methods: We retrospectively included 15 consecutive patients who underwent the resection of posterior mediastinal neurogenic tumour wherein the upper extent of the tumour extended upwards to the sternoclavicular joint plane based on chest imaging findings. The clinical characteristics and perioperative outcomes of these patients were collected and analysed.Results: Between April 2017 and June 2020, a total of 15 consecutive cases with ACT underwent radical surgical resection through RATS by our team. These patients showed encouraging short-term outcomes after surgery and there was no conversion to thoracotomy. The median tumour size was 4.0 (2.1-10.6) cm. Five large tumours (> = 5.0 cm) were completely resected. The median overall time of surgery was 100 (range, 30–240) minutes. In only one case, a patient experienced massive bleeding (> 500 mL) with a left schwannoma (10.6*5.8*4.8 cm). This resulted in intraoperative haemorrhage because of significant adhesion around the lesion. However, this case was successfully managed by robotic manoeuvres. The median hospital stay was 3 (range, 4–7) days. The median duration of the chest tube was 2 (range, 1–3) days. One case suffered from a non-permanent Horner’s syndrome and recovered within seven months. No patients developed brachial plexus-associated complications. No death occurred during the perioperative period. Conclusions: RATS is a safe and effective alternative modality for the treatment of ACT. The technique extends conventional thoracoscopic indications for posterior mediastinal lesions including apical chest lesions.

Nonintubated Uniportal Thoracoscopic Thymectomy with Laryngeal Mask

2019 ◽  
Vol 68 (05) ◽  
pp. 450-456 ◽  
Author(s):  
Zhengcheng Liu ◽  
Rusong Yang ◽  
Yang Sun
Keyword(s):  
Thoracoscopic Surgery ◽  
Anterior Mediastinum ◽  
Laryngeal Mask ◽  
Double Lumen Tube ◽  
Perioperative Outcomes ◽  
Video Assisted ◽  
Incision Size ◽  
The Mean ◽  
End Tidal ◽  
Video Assisted Thoracoscopic Surgery

Abstract Objective To investigate whether laryngeal mask anesthesia had more favorable postoperative outcomes than double-lumen tube intubation anesthesia in uniportal thoracoscopic thymectomy. Methods Data were collected retrospectively from December 2013 to December 2017. A total of 96 patients with anterior mediastinum mass underwent nonintubated uniportal video-assisted thoracoscopic thymectomy with laryngeal mask, and 129 patients underwent intubated uniportal video-assisted thoracoscopic thymectomy. A single incision of ∼3 cm was made in an intercostal space along the anterior axillary line. Perioperative outcomes between nonintubated uniportal video-assisted thoracoscopic surgery (NU-VATS) and intubated uniportal video-assisted thoracoscopic surgery (IU-VATS) were compared. Results In both groups, incision size was kept to a minimum, with a median of 3 cm, and complete thymectomy was performed in all patients. Mean operative time was 61 minutes. The mean lowest SpO2 during operation was not significantly different. However, the mean peak end-tidal carbon dioxide in the NU-VATS group was higher than in the IU-VATS group. Mean chest tube duration in NU-VATS group was 1.9 days. Mean postoperative hospital stay was 2.5 days, with a range of 1 to 4 days. Time to oral fluid intake in the NU-VATS group was significantly less than in the IU-VATS group (p < 0.01). Several complications were significantly less in the NU-VATS group than in the IU-VATS group, including sore throat, nausea, irritable cough, and urinary retention. Conclusion Compared with intubated approach, nonintubated uniportal thoracoscopic thymectomy with laryngeal mask is feasible for anterior mediastinum lesion, and patients recovered faster with less complications.

Perioperative outcomes for patients on chronic buprenorphine undergoing spine surgery: A case series

2021 ◽  
Vol 17 (7) ◽  
pp. 171-177
Author(s):  
Ashley L. Sharp, MD ◽  
Stephanie Gilbert, MD ◽  
Danielle N. Perez, MD ◽  
Kerstin Kolodzie, MD, PhD, MAS ◽  
Matthias Behrends, MD
Keyword(s):  
Pain Management ◽  
Outcome Measures ◽  
Spine Surgery ◽  
Elective Surgery ◽  
Medical Center ◽  
Academic Medical Center ◽  
Case Series ◽  
Perioperative Outcomes ◽  
Perioperative Pain ◽  
Perioperative Pain Management

Objective: Pain management following spine surgery can be challenging as patients routinely suffer from chronic pain and opioid tolerance. The increasing popularity of buprenorphine use for pain management in this population may further complicate perioperative pain management due to the limited efficacy of other opioids in the presence of buprenorphine. This study describes perioperative management and outcomes in patients on chronic buprenorphine who underwent elective inpatient spine surgery.Design: The authors performed a retrospective chart review of all patients 18 years of age taking chronic buprenorphine for any indication who had elective inpatient spine surgery at a single institution. Perioperative pain management data were analyzed for all patients who underwent spine surgery and were maintained on buprenorphine during their hospital stay.Setting: The study was performed at a single tertiary academic medical center. Main outcome measures: The primary outcome measures were post-operative pain scores and analgesic medication requirements.Results: Twelve patients on buprenorphine underwent inpatient spine surgery. Acceptable pain control was achieved in all cases. Management included preoperative dose limitation of buprenorphine when indicated and the extensive use of multimodal analgesia.Conclusion: The question whether patients presenting for painful, elective surgery should continue using buprenorphine perioperatively is an area of controversy, and the present manuscript provides more evidence for the concept of therapy continuation with buprenorphine.

Evaluation of perioperative outcomes from a case series of robotic treatment of colo-vesical fistula without bowel resection

2019 ◽  
Vol 18 (6) ◽  
pp. e2671-e2674
Author(s):  
G. Cochetti ◽  
A. Paladini ◽  
M. Del Zingaro ◽  
J.A. Rossi De Vermandois ◽  
E. Lepri ◽  
...  
Keyword(s):  
Bowel Resection ◽  
Case Series ◽  
Perioperative Outcomes ◽  
Vesical Fistula

scholarly journals Safety of Achilles Repair Using the Mini-Open Approach in Supine Position vs Prone Position: A Retrospective Study

2019 ◽  
Vol 4 (4) ◽  
pp. 2473011419S0023
Author(s):  
James Rush Jones ◽  
Haley McKissack ◽  
Aaradhana J. Jha ◽  
Leonardo V. M. Moraes ◽  
Jun Kit He ◽  
...  
Keyword(s):  
Achilles Tendon ◽  
Operating Room ◽  
Prone Position ◽  
Supine Position ◽  
Surgical Repair ◽  
Traditional Approach ◽  
Perioperative Period ◽  
Perioperative Outcomes ◽  
Open Approach ◽  
Mini Open

Category: Sports Introduction/Purpose: Surgical repair of the Achilles tendon is a commonly-performed procedure in cases of acute tendon rupture. Open Achilles tendon surgery with traditional extensile approach is most often performed with the patient in prone position, but this can interfere with airway access, put increased pressure on the abdomen, and subject to increase perioperative period and comorbidities. Mini-open approach in supine repair may potentially avoid the risks of the prone position, but the safety and utility of this approach have not been established. The purpose of this study is to compare perioperative outcomes between patients undergoing acute Achilles rupture repair with mini-open approach in the supine position versus traditional approach in the prone position. Methods: Patients who underwent surgical repair of acute Achilles rupture between the years 2011 and 2018 at a single institution were retrospectively identified using CPT code 27650. Patients who underwent concurrent procedures for additional injuries were excluded. Charts of included patients were retrospectively reviewed for demographic information, intraoperative characteristics, and postoperative outcomes. Statistical analysis was conducted and p-values =0.05 were considered significant. Results: A total of 81 patients were included for analysis, 26 supine and 55 prone. Baseline characteristics were statistically similar between the two groups. Average total time in the operating room was significantly greater among patients in the prone position (118.7 minutes) than those in the supine position (100 minutes) (p = 0.0011). Average surgery time, blood loss, and time in PACU were greater among the prone group than the supine group, although these differences were not statistically significant. Average postoperative pain score, infection rate, dehiscence rate, sepsis rate, and DVT rate were also similar between the two groups. Conclusion: The mini open approach in supine position may be advantageous in repair of acute Achilles rupture in that it significantly reduces total time in the operating room while maintaining positive patient outcomes. Prospective clinical studies are warranted to validate these assessments.

scholarly journals Management of Jugular Bulb Injuries during Endoscopic Ear Surgery: Our Experience

2019 ◽  
Vol 80 (06) ◽  
pp. 608-611 ◽  
Author(s):  
Gaetano Ferri ◽  
Matteo Fermi ◽  
Matteo Alicandri-Ciufelli ◽  
Domenico Villari ◽  
Livio Presutti
Keyword(s):  
Preoperative Evaluation ◽  
Case Series ◽  
Vascular Complications ◽  
Chronic Otitis Media ◽  
Jugular Bulb ◽  
Massive Bleeding ◽  
Endoscopic Management ◽  
Endoscopic Ear Surgery ◽  
Ear Surgery ◽  
Tertiary Referral Center

Objectives The main objective of this article is to describe endoscopic management of intraoperative massive bleeding from jugular bulb injury during exclusively transcanal endoscopic procedures for middle ear pathologies. Design Case series with chart review. Setting Tertiary referral center. Participants We retrospectively reviewed two patients who experienced jugular bulb injury during endoscopic transcanal approach for glomus tympanicum and chronic otitis media. The surgical videos and charts were carefully investigated and analyzed. Main Outcome Measures Feasibility and suitability of exclusive endoscopic management of jugular bulb bleeding and description of surgical maneuvers that should be performed to obtain safe and effective hemostasis. Results In both patients, jugular bulb bleeding was progressively controlled by means of exclusive endoscopic approach with no need to convert to microscopic approach. None of the cases required a second surgeon helping in keeping the endoscope during hemostatic maneuvers. Both patients had a normal postoperative period with no recurrence of hemorrhage. Conclusions Endoscopic management of jugular bulb bleeding is feasible by using the technique described with reasonable efficacy and with no additional risk or morbidity to the procedure. Knowledge of anatomy and its variants, preoperative evaluation of imaging, and the ability of the surgeon to adapt the surgical technique to the specific case are recommended to prevent vascular complications during endoscopic ear surgery.

scholarly journals Robotic Stereotactic Assistance (ROSA) for Pediatric Epilepsy: A Single-Center Experience of 23 Consecutive Cases

Children ◽  
2020 ◽  
Vol 7 (8) ◽  
pp. 94
Author(s):  
Jonathon H. Nelson ◽  
Samantha L. Brackett ◽  
Chima O. Oluigbo ◽  
Srijaya K. Reddy
Keyword(s):  
Minimally Invasive ◽  
Pediatric Patients ◽  
Case Series ◽  
Intractable Epilepsy ◽  
Electrode Placement ◽  
Perioperative Outcomes ◽  
Surgical Approaches ◽  
Single Center ◽  
Invasive Approach ◽  
Ablative Surgery

Robotic assisted neurosurgery has become increasingly utilized for its high degree of precision and minimally invasive approach. Robotic stereotactic assistance (ROSA®) for neurosurgery has been infrequently reported in the pediatric population. The goal of this case series was to describe the clinical experience, anesthetic and operative management, and treatment outcomes for pediatric patients with intractable epilepsy undergoing ROSA® neurosurgery at a single-center institution. Patients who underwent implantation of stereoelectroencephalography (SEEG) leads for intractable epilepsy with ROSA® were retrospectively evaluated between August 2016 and June 2018. Demographics, perioperative management details, complications, and preliminary seizure outcomes after resective or ablative surgery were reviewed. Nineteen children who underwent 23 ROSA® procedures for SEEG implantation were included in the study. Mean operative time was 148 min. Eleven patients had subsequent resective or ablative surgery, and ROSA® was used to assist with laser probe insertion in five patients for seizure foci ablation. In total, 148 SEEG electrodes were placed without any perioperative complications. ROSA® is minimally invasive, provides superior accuracy for electrode placement, and requires less time than traditional surgical approaches for brain mapping. This emerging technology may improve the perioperative outcomes for pediatric patients with intractable epilepsy since large craniotomies are avoided; however, long-term follow-up studies are needed.

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