The Cervico-Parasternal Thoracotomy (CPT): A New Surgical Approach for the Resection of Cervicothoracic Neuroblastomas

Cervicothoracic neuroblastomas (NBs) pose unique surgical challenges due to the complexity of the neurovascular structures located in the thoracic inlet. To date, two main techniques have been reported to completely remove these tumours in children: the trans-manubrial and the trap-door approaches. Herein, the authors propose a third new surgical approach that allows a complete exposure of the posterior costovertebral space starting from the retro-clavicular space: Cervico-Parasternal Thoracotomy (CPT). The incision is made along the anterior margin of the sternocleidomastoid muscle until its sternal insertion, and then the incision proceeds vertically following the ipsilateral parasternal line. The major pectoralis muscle is detached, and the clavicle and the ribs are disarticulated from their sternal insertions. Following an accurate isolation of the major subclavian blood vessels and the brachial plexus roots, the tumour is then completely exposed and resected by switching from a frontal to a lateral view of the costo-vertebral space. By adopting this technique, five cervicothoracic NBs were completely resected in a median operative time of 370 min (range: 230–480 min). By proceeding in safety with the heart apart, neither vascular injuries nor nerve damages occurred, and all patients were safely discharged in a median postoperative time of 11 days (range: 7–14 days). At the last follow-up visit (median: 16 months, range: 13–21 months), all patients were alive and disease-free.

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Importance of the vessel distribution at splenic hilum for laparoscopic Warshaw procedure

International Surgery Journal ◽

10.18203/2349-2902.isj20214382 ◽

2021 ◽

Vol 8 (11) ◽

pp. 3416

Author(s):

Shinichiro Ono ◽

Tomohiko Adchi ◽

Amane Kitasato ◽

Masaaki Hidaka ◽

Akihiko Soyama ◽

...

Keyword(s):

High Risk ◽

Operative Time ◽

Gastric Varices ◽

Splenic Infarction ◽

Safe Procedure ◽

Splenic Vessel ◽

Splenic Hilum ◽

Splenic Vessels ◽

Median Operative Time

The laparoscopic Warshaw procedure (LWP) is a considered to carry a risk of splenic infarction and perigastric varices formation. We retrospectively analyzed the clinical outcomes and relationship between the distribution of the splenic hilum vessels and splenic infarction in patients who underwent LWP from February 2007 to February 2017. A total of 19 patients underwent LWP, and the median follow-up duration was 78 months. The median operative time and blood loss were 295 min and 200 gr. Six patients with splenic partial infarction and 3 with gastric varices were detected, but they have not needed any treatments. According to the classification by Michels, the distribution of splenic vessels were divided as distributed type and magistral type at the splenic hilum. In our study, 16 patients were distributed type and 3 were magistral type. Three of the 16 patients developed splenic infarction in distributed type. In contrast, all of magistral patients showed splenic infarction. Although LWP is a safe procedure, there is a high risk of splenic infarction if the splenic vessel distribution is a magistral type. Understanding the type before surgery leads to the identification of an appropriate vascular dissection position and reduces postoperative complications.

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Laminectomy versus Unilateral Hemilaminectomy for the Removal of Intraspinal Schwannoma: Experience of a Single Institution and Review of Literature

Journal of Neurological Surgery Part A Central European Neurosurgery ◽

10.1055/s-0041-1722968 ◽

2021 ◽

Author(s):

Mauro Dobran ◽

Riccardo Paracino ◽

Davide Nasi ◽

Denis Aiudi ◽

Mara Capece ◽

...

Keyword(s):

Postoperative Pain ◽

Operative Time ◽

Bed Rest ◽

Tumor Location ◽

Spinal Instability ◽

Extramedullary Tumor ◽

Postoperative Time ◽

Intradural Extramedullary ◽

Slow Growing

Abstract Background and Study Aims Spinal schwannomas are benign slow-growing tumors, and gross total resection is the gold standard of treatment. The conventional surgical approach is laminectomy, which provides a wide working area. Today minimally invasive surgery (MIS) is popular because it is associated with shorter hospital stay, less operative blood loss, minimized tissue traumas and relative postoperative pain, and, and spine surgery, avoidance of spinal instability. Material and Methods From January 2016 to December 2019, we operated on 40 patients with spinal intradural extramedullary tumor (schwannoma) with laminectomy or hemilaminectomy. Baseline medical data, including patients' sex and age, tumor location, days of postoperative bed rest, operative time, length of hospitalization, and 1-month visual analog scale (VAS) value were collected and analyzed. Data analysis was performed using STATA/IC 13.1 statistical package (StataCorp LP, College Station, Texas, United States). Results Hemilaminectomy was associated with faster operative time (p < 0.001), shorter postoperative time spent in bed (p < 0.001), and shorter hospitalization (p < 0.001). At 1-month follow-up, the mean VAS score was 4.6 (1.7) among the laminectomy patients and 2.5 (1.3) among the hemilaminectomy patients (p < 0.001). Postoperative complications occurred in 1 (7.7%) and 7 (25.9%) patients in the hemilaminectomy and laminectomy groups, respectively (p = 0.177). Conclusions Unilateral hemilaminectomy has significant advantages compared with laminectomy in spinal schwannoma surgery including shorter operative time, less time spent in bed, shorter hospitalization, and less postoperative pain.

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Evaluation of parallel endplate osteotomy for severe rigid spinal deformities: a retrospective analysis of 36 cases with a minimum 2-year follow-up

BMC Musculoskeletal Disorders ◽

10.1186/s12891-021-04877-3 ◽

2021 ◽

Vol 22 (1) ◽

Author(s):

Hang Liao ◽

Peng Xie ◽

Guizhou Zheng ◽

Houguang Miao ◽

Ningdao Li ◽

...

Keyword(s):

Operative Time ◽

Bodily Pain ◽

Clinical Results ◽

Spinal Deformities ◽

Effective Technique ◽

Estimated Blood Loss ◽

Sf 36 ◽

Scoliosis Correction ◽

Median Operative Time

Abstract Background To report on the technique and results of parallel endplate osteotomy (PEO) for severe rigid spinal deformity. Methods We retrospectively reviewed the clinical data of 36 patients with severe rigid spinal deformities who underwent PEO between July 2016 and December 2018 and who were followed up for at least 24 months. Results Following PEO, the kyphosis and scoliosis correction rates reached 77.4 ± 14.0% and 72.2 ± 18.2%, respectively. The median intraoperative estimated blood loss was 1500 mL and the median operative time was 6.8 h. The SF-36 scores of physical function, role-physical, bodily pain, general health, vitality, social function, role-emotional and mental health changed from 62 ± 28, 51 ± 26, 49 ± 29, 35 ± 30, 53 ± 28, 45 ± 30, 32 ± 34 and 54 ± 18 at baseline to 81 ± 16, 66 ± 41, 72 ± 40, 64 ± 44, 75 ± 25, 71 ± 46, 66 ± 34 and 76 ± 28 at 12 months postoperatively, 82 ± 32, 67 ± 42, 81 ± 30, 71 ± 41, 80 ± 30, 74 ± 36, 68 ± 35 and 85 ± 33 at 18 months postoperatively, and 86 ± 21, 83 ± 33, 88 ± 26, 79 ± 39, 86 ± 36, 86 ± 48, 80 ± 47 and 91 ± 39 at 24 months postoperatively, respectively. Conclusions PEO is an effective technique for successful correction of spinal deformities. At the two-year follow-up visit, all patients achieved better clinical results based on the SF-36 scores.

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Ambulatory surgery of umbilical, epigastric and small incisional hernias: open preperitoneal flat mesh technique in local anaesthesia

Acta chirurgica iugoslavica ◽

10.2298/aci0601029z ◽

2006 ◽

Vol 53 (1) ◽

pp. 29-34 ◽

Cited By ~ 5

Author(s):

M. Zuvela ◽

M. Milicevic ◽

D. Galun ◽

N.N. Lekic ◽

P. Bulajic ◽

...

Keyword(s):

Retrospective Study ◽

Incisional Hernia ◽

Local Anaesthesia ◽

Umbilical Hernia ◽

Operative Time ◽

Ambulatory Surgery ◽

Superficial Infection ◽

Mesh Technique ◽

Median Operative Time

Introduction. The dilemma whether to use the mesh or non mesh technique in the management of umbilical, epigastric and small incisional hernia is slowly fading away. The open preperitoneal "flat mesh" technique performed as ambulatory surgery may be one of the solutions. The Aim. The aim of this retrospective study is to present the results of open preperitoneal "flat mesh" technique in the management of umbilical, epigastric and small incisional hernia within Material and methods. This study included 34 patients (11 of them with umbilical, 13 with epigastric and 8 of them with small incisional hernia) operated by one surgeon in the period January 2004 - January 2006. Results. The median operative time was 52 minutes for umbilical hernia?s, 43 minutes for epgastric and 54 minutes for incisional hernia?s. The ambulatory surgery was performed at 91% of patients. The median hospitalization was 4h for patients with umbilical hernia?s, 3,7h for patients with epigastric and, 7,7h for patients with small incisional hernia. The follow up is 10,5 months. Apart of one superficial infection other complications were absent. Conclusion. The open preperitoneal "flat mesh" technique performed in local anesthesia as an ambulatory surgery provides good results in the management of umbilical, epigastric and small incisional hernia.

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Effectiveness of Thoracoscopic Truncal Vagotomy in the Treatment of Marginal Ulcers after Laparoscopic Roux-en-Y Gastric Bypass

The American Surgeon ◽

10.1177/000313481207800619 ◽

2012 ◽

Vol 78 (6) ◽

pp. 663-668 ◽

Cited By ~ 7

Author(s):

John Hunter ◽

Richard D. Stahl ◽

Manasi Kakade ◽

Igal Breitman ◽

Jayleen Grams ◽

...

Keyword(s):

Gastric Bypass ◽

Chart Review ◽

Operative Time ◽

Telephone Interview ◽

Marginal Ulcer ◽

Symptomatic Improvement ◽

Truncal Vagotomy ◽

Peptic Ulcers ◽

Median Operative Time

Marginal ulcer is a significant complication of laparoscopic Roux-en-Y gastric bypass (LRYGB). Most marginal ulcers resolve with medical management, but nonhealing ulcers may require revision of the gastrojejunostomy, a procedure with significant morbidity and mortality. Traditionally, surgical therapy for refractory peptic ulcers includes a vagotomy. The current study evaluates the effectiveness of thoracoscopic truncal vagotomy (TTV) in the management of refractory marginal ulcers. All patients at two institutions with an intractable marginal ulcer after LRYGB treated with TTV between 2003 and 2010 were reviewed. Data were collected from chart review and telephone interview. Seventeen patients (mean age, 39 ± 13 years; 16 females) were diagnosed with marginal ulceration a median of 18 months after LRYGB and proceeded to TTV at a mean of 39 ± 43 weeks (range, 1 to 114 weeks) after the diagnosis. The median operative time was 89 ± 65 minutes (range, 45 to 318 minutes). Four patients had a complication (sympathetic contralateral pleural effusion, pneumothorax, operative bleeding, and readmission for emesis). Eleven patients had follow-up of 3 months to 6 years (median, 7 months). Nine patients (82%) had symptomatic improvement and/or endoscopic resolution, whereas two (18%) did not. No patient had endoscopic evidence of persistent or recurrent marginal ulcer. TTV achieves symptomatic improvement and/or endoscopic resolution of intractable marginal ulcers in over 80 per cent of patients status post gastric bypass and therefore offers a less morbid alternative to revision of the gastrojejunostomy.

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The Feasibility, Technique, and Medium-Term Follow-Up of Laparoscopic Transvesical Diverticulectomy

Urologia Internationalis ◽

10.1159/000510242 ◽

2020 ◽

Vol 104 (11-12) ◽

pp. 923-927

Author(s):

Klaus Eredics ◽

Michael Rauchenwald ◽

Lukas Lusuardi ◽

Thomas Kunit ◽

Hans Christoph Klingler ◽

...

Keyword(s):

Operative Time ◽

Medium Term ◽

Ureter Injury ◽

Day Range ◽

Valuable Procedure ◽

Median Diameter ◽

Transurethral Catheter ◽

Bladder Diverticula ◽

Median Operative Time

Background: To present our experience and results with the transvesical laparoscopic diverticulectomy, developed by Pansadoro et al. [BJU Int. 2009;103(3):412–24], as treatment of symptomatic bladder diverticula, with a medium-term follow-up. Methods: Between June 2010 and July 2018, we successfully operated 15 patients (13 male/2 female), aged 32–85 years (mean age 61 years) in 2 centers in Austria, using the aforementioned technique. Results: The median operative time was 297 min (range 83–488 min), and the blood loss was minimal. The median diameter of the diverticula was 94 mm (range 40–110 mm). The transurethral catheter was removed in most patients on day 7 (range 1–26 days), and cystography was performed before catheter removal. Patients were discharged on the ninth postoperative day (range 4–18 days). One case had a Clavien-Dindo grade IIIb complication (ureter injury), and 2 cases had a grade IIIa complication (nephrostomy drainage). After a median follow-up of 19 months, no recurrences were observed. Conclusion: The laparoscopic, transvesical diverticulectomy is a feasible and valuable procedure with good outcomes. To avoid complications, the ureter needs to be spared meticulously.

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Hepatic hydatid cyst: a non-surgical approach

Revista da Sociedade Brasileira de Medicina Tropical ◽

10.1590/s0037-86822012000600025 ◽

2012 ◽

Vol 45 (6) ◽

pp. 774-776 ◽

Cited By ~ 2

Author(s):

Pedro Silva Vaz ◽

Eduardo Pereira ◽

Sergiu Usurelu ◽

Ana Monteiro ◽

Ana Caldeira ◽

...

Keyword(s):

Public Health ◽

Hydatid Cyst ◽

Surgical Approach ◽

Public Health Problem ◽

Hepatic Hydatid Cyst ◽

Endoscopic Retrograde ◽

Hepatic Hydatid Disease ◽

Disease Free ◽

Hepatic Hydatid

Echinococcosis/hydatidosis is common in societies where agriculture and livestock are frequent, and represents a public health problem. The therapeutic management depends on the cyst's characteristics, the patient, and surgical contraindications. Endoscopic retrograde cholangiopancreatography is a valuable tool in the diagnosis and treatment of complicated hepatic hydatid disease. Ultrasonography is a useful diagnostic, therapeutic and follow-up tool. The authors report a case of a 56 years old patient who was diagnosed with a hepatic hydatid cyst in the IVa/VIII segments, describe the therapeutic options and 50 months of disease-free follow-up.

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Laparoscopic splenectomy both for primary cytoreductive surgery for advanced ovarian cancer and for secondary surgery for isolated spleen recurrence: feasibility and technique

BMC Surgery ◽

10.1186/s12893-021-01368-z ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Antonio Macciò ◽

Elisabetta Sanna ◽

Fabrizio Lavra ◽

Giacomo Chiappe ◽

Marco Petrillo ◽

...

Keyword(s):

Ovarian Cancer ◽

Cytoreductive Surgery ◽

Laparoscopic Splenectomy ◽

Operative Time ◽

Advanced Ovarian Cancer ◽

Open Approach ◽

Advanced Stage ◽

Secondary Surgery ◽

Median Operative Time

Abstract Background This study investigated the feasibility and safety of laparoscopic splenectomy conducted in the contexts of both laparoscopic secondary surgery for isolated recurrence in the spleen and primary laparoscopic cytoreductive surgery for advanced ovarian cancer. Methods We performed a perspective observational study including all consecutive patients with ovarian cancer who underwent laparoscopic splenectomy as part of primary cytoreductive procedures for advanced stage ovarian cancer or secondary surgery for isolated splenic recurrence between January 2016 and May 2020. Results We enrolled 13 consecutive patients, candidate to laparoscopic splenectomy as part of primary cytoreductive procedures for advanced stage ovarian cancer (6 patients) or secondary surgery for isolated splenic recurrence of platinum-sensitive ovarian cancer (7 patients). Median operative time (509 min [range, 200–845]) for primary cytoreductive surgery varied according to surgical complexity depending on the extensiveness of the disease. Median operative time for secondary surgery for isolated splenic metastasis was 253 min (90–380). Only 1 patient with isolated splenic recurrence required conversion to an open approach. No intraoperative complication occurred, and no intraoperative blood transfusions were required. Median hospital stay was 3 days (range, 2–5) for isolated recurrence and 9 days (7–18) for primary cytoreductive surgery. Complete tumor resection was achieved in all patients. Median time from surgery to adjuvant chemotherapy was 16 days (7–24). All six patients who underwent laparoscopic splenectomy during primary cytoreductive surgery remain alive, four of whom exhibit no evidence of disease (median follow-up 25 months [4–36]). Among patients who underwent laparoscopic splenectomy during secondary surgery for isolated splenic relapse, all patients are alive and only one had a central diaphragmatic relapse 2 years after surgery (median follow-up 17 months ([5–48 months]). Conclusions The laparoscopic approach to splenectomy is feasible and safe both in patients undergoing primary cytoreductive surgery for advanced stage disease and those with isolated recurrence of ovarian cancer, without compromising survival and allowing early initiation of postoperative systemic chemotherapy.

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LAPAROSCOPIC TRANS-ABDOMINAL PRE-PERITONEAL (TAPP) REPAIR FOR TREATMENT INGUINAL HERNIA DISEASE

Journal of Medicine and Pharmacy ◽

10.34071/jmp.2018.4.11 ◽

2018 ◽

Vol 8 (4) ◽

pp. 76-80

Author(s):

Thao Nguyen Minh ◽

Vu Pham Anh ◽

Tri Nguyen Huu ◽

Phu Nguyen Doan Van ◽

Phuc Nguyen Thanh ◽

...

Keyword(s):

Inguinal Hernia ◽

Operative Time ◽

Bilateral Hernia ◽

Repair Method ◽

Tapp Repair ◽

Post Operation ◽

Average Operative Time ◽

The Mean

Background: Inguinal hernia is one of the commonest surgical diseases and there are many different techniques applied. The laparoscopic trans-abdominal pre-peritoneal (TAPP) repair allows a better view of the inguinal anatomy, evaluation of opposite side and resolve combined peritoneal diseases as well. Patient and method: The study included 60 cases with inguinal hernia that have been treated by laparoscopic transabdominal pre-peritoneal (TAPP) repair. Method: Description, prospective follow-up. Result: The mean age was 58±18.2. 96.7% were males. The average operative time was 45.6±15.1 minutes for one side hernia, 73±25.2 minutes for bilateral hernia. 02 cases have been post-operation inguinal seroma complication (3.3%), 02 cases with hydrocele (3.3%), 01 case with abdominal seroma (1.7%). 04 cases (6.7%) opposite inguinal hernia were detected and 05 cases (8.3%) with combined diseases were resolved. Duration of post-operative stay was 3.9±1.1 days. Conclusion: TAPP is a safe and feasible procedure, allows evaluation of opposite side and resolve combined peritoneal diseases.

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Incidence of valvular regurgitation and leaflet perforation by using automated titanium fasteners (CORKNOT®) in heart valve repair or replacement: less usual than reported

Journal of Cardiothoracic Surgery ◽

10.1186/s13019-021-01512-z ◽

2021 ◽

Vol 16 (1) ◽

Author(s):

Faizus Sazzad ◽

Ong Zhi Xian ◽

Ashlynn Ler ◽

Chang Guohao ◽

Kang Giap Swee ◽

...

Keyword(s):

Heart Valve ◽

Operative Time ◽

Tertiary Care ◽

Paravalvular Leak ◽

Valvular Regurgitation ◽

Care Hospital ◽

Valve Repair ◽

Replacement Surgery ◽

Triple Valve

Abstract Background CORKNOT® facilitates a reduction in cardiopulmonary bypass (CPB) time, aortic cross clamp (ACC) time and operative time, but reported to be associated with other complications. We aim to quantify the incidence of valvular complications related to CORKNOT® and determine the feasibility of its use between different valvular surgeries. Methods Patients who underwent heart valve repair or replacement surgery via the use of automated titanium suture fasteners (CORKNOT®) in a tertiary care hospital were included in the study. This single-centre retrospective study was conducted on 132 patients between January 2016 and June 2018. Results In our study, the overall mean operative time was 320.0 ± 97.0 min, mean CPB time was 171.4 ± 76.0 min and the calculated mean ACC time was 105.9 ± 54.0 min. Fifty-eight patients (43.9%) underwent minimally invasive valve replacement or repair surgery and 66 patients (50.0%) underwent concomitant procedures. A total of 157 valves were operated on, with 112 (84.8%) single valve surgeries, 15 (11.4%) double valve surgeries and 5 (3.8%) triple valve surgeries. After reviewed by the cardiologist blinded towards the study, we report trivial and/or mild paravalvular leak (PVL) in immediate post-operative echocardiography was found in 1 (1.01%) patients. There were no reported cases of valvular thrombosis, leaflet perforation, device dislodgement or embolization, moderate and/or severe PVL during hospitalization and follow-up echocardiography within 1 year. Single mitral valve and aortic surgeries had comparable incidences of post surgical complications. Conclusion We conclude the feasibility of CORKNOT® utilisation in mitral and aortic valve surgeries. Additionally, incidence of CORKNOT® related complications in heart valve repair or replacement surgery is less usual in our setting than previously reported. These results motivate the use of CORKNOT® as a valid alternative with complete commitment.

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