1,007 Works

Resection of Fibroelstoma in Left Ventricular Outflow Tract by Minimally Invasive Approach

Mariano Vrancic, Manuel Cervetti, Julian Benavidez, Mario Acosta, Manuel Chiappe, Mariano Camporrotondo, Fernando Piccinini & Daniel Navia
This video demonstrates the resection of a fibroelastoma in the left ventricular outflow tract using a minimally invasive approach. The 83-year-old female patient was asymptomatic. Her cardiovascular history included a stent for infrarenal aortic aneurysm. Computed tomography angiography showed no lesions. The transesophageal echocardiography showed a hyperechoic mobile image that protruded towards the left ventricular outflow tract, impacted the noncoronary valve, and was attached to the septum by a small pedicle. Mild aortic insufficiency was...

Port Access and Minithoracotomy Mitral Valve Surgery

William H. Ryan & William J. Hoffman
This video demonstrates the technique of port access mitral valve surgery.
Patient Selection
• Any patient with mitral valve disease with or without tricuspid disease, atrial septal defect, and atrial fibrillation can be considered for a port access approach.
• The preoperative exam determines the suitability of the particular patient.
• If a thick chest wall or a prominent pectus deformity are found on exam, the procedure may be better suited to a robotic approach. A pectus deformity of...

Robotic Anterior Basilar Segmentectomy

Bernard J. Park
Robotic technology is being increasingly utilized for the performance of anatomic pulmonary resection. An excellent example of the technical advantages of the robotic platform over conventional minimally invasive video-assisted thoracoscopic techniques is in the execution of more complex resections. One such type of procedure is the single anatomic segmentectomy, particularly of the basilar segments. In this video, a single anterior basilar segmentectomy of the left lower lobe is demonstrated.
ReferencePardolesi A, Park B, Petrella F, Borri...

When to Repair a Rheumatic Aortic Valve

Manuel J. Antunes
Manuel J. Antunes of the University Hospital in Coimbra, Portugal, presents a discussion on aortic stenosis and aortic insufficiency in rheumatic heart disease.This presentation was originally given during the SCTS Ionescu University program at the 2018 Annual Meeting of the Society for Cardiothoracic Surgery in Great Britain and Ireland. This content is published with the permission of SCTS. Please click here for more information on SCTS educational programs.

Repair of Barlow’s Disease: The 4-Chords Technique

Kevin Hodges, Raphaelle Chemtob, Stephanie Mick, A. Marc Gillinov & Per Wierup
This video demonstrates a straightforward, reproducible technique for the repair of bileaflet prolapse in Barlow’s disease. The valve is repaired with two sets of chordae to each of the anterior and posterior leaflets. The key technical consideration is the sizing of the chordae. For the anterior leaflet, chordae are sized by pulling the leading edge of the leaflet to the corresponding hinge-point on the mitral annulus. Posterior chordae are sized to be very restrictive and...

Progress and Innovation in Minimally Invasive Thoracic Surgery: What is the Future?

Gaetano Rocco
Gaetano Rocco of the Memorial Sloan Kettering Cancer Center in New York, USA, discusses the future of minimally invasive thoracic surgery. He proposes that improved training and educational tools for established surgeons are the most critical innovation for the future of minimally invasive thoracic approaches.This presentation was originally given during the SCTS Ionescu University program at the 2018 Annual Meeting of the Society for Cardiothoracic Surgery in Great Britain and Ireland. This content is published...

Novel Cannulation Technique for Temporary Right Ventricular Assist Device After Left Ventricular Assist Device Placement

William Z. Chancellor, Jared P. Beller, Emily A. Downs & Leora Yarboro
DisclosureThis presentation describes the off-label use of the Centrimag™ Ventricular Assist Device (Abbott).ObjectivesRight ventricular (RV) failure is a life-threatening complication after left ventricular assist device (LVAD) implantation. Increasingly, temporary right ventricular assist devices (RVAD) are used to support postoperative right heart failure and cardiogenic shock. Typically, temporary RVAD placement is limited by the need for delayed sternal closure, reoperative sternotomy for removal, or restricted patient mobility due to a femoral venous catheter.MethodsThe authors describe a...

Tips and Tricks to Simplify Multiarterial CABG

Om P Yadava & Clifford Barlow
Dr Om P. Yadava, CEO and Chief Cardiac Surgeon of the National Heart Institute in New Delhi, India, and Editor-in-Chief of the Indian Journal of Thoracic and Cardiovascular Surgery, and Mr Clifford Barlow, Senior Consultant Cardiac Surgeon at the University Hospital in Southampton, UK, discuss ways to increase the uptake of multiarterial grafting in CABG through simplification rather than complex configurations.
Dr Yadava laments that despite the literature available, total arterial grafting is not catching...

Tips and Tricks to Simplify Multiarterial CABG

Om P Yadava & Clifford Barlow
Dr Om P. Yadava, CEO and Chief Cardiac Surgeon of the National Heart Institute in New Delhi, India, and Editor-in-Chief of the Indian Journal of Thoracic and Cardiovascular Surgery, and Mr Clifford Barlow, Senior Consultant Cardiac Surgeon at the University Hospital in Southampton, UK, discuss ways to increase the uptake of multiarterial grafting in CABG through simplification rather than complex configurations.
Dr Yadava laments that despite the literature available, total arterial grafting is not catching...

Minimally Invasive Mitral Valve Repair Through Nonresectional Posterior Leaflet Remodeling

Alfonso Agnino & Amedeo Anselmi
In this video, the authors present a novel technique for the correction of mitral regurgitation associated with degenerative disease of the posterior leaflet, called posterior leaflet remodeling or free margin running suture. This technique has been developed in the setting of minimally invasive surgery, although it can be employed through sternotomy.
In the first procedure shown, the authors consider a patient with prolapse of the P2 and P3 scallops. Three-dimensional echocardiography confirmed the extension of the...

Subcostal Biportal Right Lower Lobectomy Day Surgery

Karel Pfeuty, Betty Maillot, Lucie Soulabaille, Morgane Vitry & Bernard Lenot
This video describes a video-assisted thoracoscopic surgery (VATS) subcostal biportal right lower lobectomy performed as a day surgery. This abdominal extrathoracic approach is inspired by both Chinese and UK experience in VATS subxiphoid major pulmonary resections. The motivation was to explore an original way for better recovery and minimizing invasiveness, without making any concessions on safety or carcinologic resection. The patient was a 69-year-old man with normal pulmonary function who presented with a 2 cm...

Shared Mental Model in VATS Lobectomy

René Horsleben Petersen
Since the introduction of video-assisted thoracoscopic lobectomy more than 25 years ago, the focus for thoracic surgeons has been to enhance the surgeon’s technical skills. This has been implemented with success across the world, and a minimal invasive approach to lung cancer is standard of care in many units today. However, major intraoperative complications occur occasionally. To improve patient outcome and safety, it is important that the entire team perform at a high level.
Teamwork...

Management of Gastroesophageal Reflux Disease De-Mystified

Lisa Brown, Brian Louie & Inderpal Sarkaria
Filmed at the 2018 STS Annual Meeting in Fort Lauderdale, Florida, Lisa Brown of UC Davis Medical Center in Sacramento, California, USA, moderates a discussion on the management of gastroesophageal reflux disease. She is joined by Brian Louie of the Swedish Medical Center in Seattle, Washington, USA, and Inderpal Sarkaria of the University of Pittsburgh in Pennsylvania, USA. They discuss how they counsel patients with heartburn through diagnosis and treatment, touching upon testing methods, patient-tracked...

Giants of Cardiothoracic Surgery: An Interview With Shaf Keshavjee

Vaibhav Gupta & Shaf Keshavjee
In this Giants of Cardiothoracic Surgery interview, Vaibhav Gupta of the University of Toronto in Ontario, Canada, speaks with Shaf Keshavjee of the Toronto General Hospital about his career and his experience as a surgeon-scientist. They discuss Dr Keshavjee’s training in the University of Toronto surgeon-scientist program, balancing time between clinical and research responsibilities, and the importance of continued surgical skill development and research collaborations. Dr Keshavjee also talks about the highlights and recent developments...

Minimally Invasive Techniques are Safer Than Median Sternotomy

Torsten Doenst
Torsten Doenst of the University Hospital Jena in Germany presents the argument for minimally invasive techniques over median sternotomy in the treatment of mitral valve disease.
This presentation was originally given during the SCTS Ionescu University program at the 2018 Annual Meeting of the Society for Cardiothoracic Surgery in Great Britain and Ireland. This content is published with the permission of SCTS. Please click here for more information on SCTS educational programs..

Pushing the Boundaries in the Surgical Management of Lung Cancer

Paul Van Schil
Paul Van Schil of Antwerp University Hospital in Belgium discusses surgical approaches for various stages of non-small cell lung cancer.
This presentation was originally given during the SCTS Ionescu University program at the 2018 Annual Meeting of the Society for Cardiothoracic Surgery in Great Britain and Ireland. This content is published with the permission of SCTS. Please click here for more information on SCTS educational programs.

Bilateral Internal Thoracic Artery Grafting: Technical Aspects

Daniel Navia, Nestor Manuel Clusa, Mariano Camporrotondo, Juan Carlos Espinoza, Fernando Piccinini, Juan Mariano Vrancic, Manuel Cervetti & Simonetto Bruno
The use of both internal thoracic arteries (ITAs) has been shown to provide a decreased risk of death, need for reoperation, or need for percutaneous coronary intervention when compared with one ITA in combination with vein grafts.Inadequate length of the free right ITA (RITA) has often limited the ability to bypass the posterior marginal branches of the circumflex and the distal right coronary artery (RCA) with this conduit. Tector and coworkers describe a technique in...

Treatment of an Aortoesophageal Fistula After Thoracic Endovascular Repair for an Extensive Aortic Arch Aneurysm

Akihiro Yoshitake, Akinori Hirano, Masataka Yamazaki, Tatsuro Takahashi, Kanako Hayashi, Yu Inaba, Yasunori Iida & Hideyuki Shimizu
The authors present an urgent procedure that was performed to treat an aortoesophageal fistula, which developed after a thoracic endovascular aortic repair (TEVAR) for an extensive aortic arch aneurysm.The patient was a 69-year-old man who had undergone abdominal aortic replacement for aortic rupture three years before. Two years previously, TEVAR using a Najuta stent graft and a left subclavian artery occlusion were performed to treat an aortic aneurysm that was 96 mm in diameter and...

Uniportal VATS En Bloc Anatomical Resection of Right S2, S6, and S10a

Firas Abu-Akar & Diego Gonzalez Rivas
This video demonstrates a complex segmental resection via the uniportal VATS technique in a 65-year-old woman with a lesion located between S2 and S6 of the right lung. The lesion was avid in a PET-CT scan with no mediastinal uptake. The decision to perform an anatomical segmentectomy was taken in order to avoid a pneumonectomy. The video also shows some anatomical variations. The operative and postoperative courses were uneventful, and the patient discharged home on...

Robotic Lower Bilobectomy for an Endobronchial Mass: Suspicion of Carcinoid Tumor

Jean-Marc Baste, Valentin Soldea, Benjamin Bottet & Christophe Peillon
Compared to other bronchopulmonary cancers, carcinoid tumors represent a rare occurrence. Depending on the intrabronchial localization, the surgical treatment options range from a limited lung-sparing anatomical resection to a major pulmonary resection. This is the case of a 64-year-old male who presented with a hemoptoic cough. The CT scan found an intrabronchial mass. Bronchoscopy showed an uneasy intrabronchial localization, extending at the level of the intermediate bronchus right up to the S6 bronchus. The decision...

Robotic Right Lower Lobectomy With Subxiphoid Utility Port

Devan Limbachia & Joel Dunning
The authors demonstrate a robotic right lower lobectomy with utilization of subxiphoid assistant port. The patient was a 73-year-old man who underwent surgery for a 35 mm lung nodule secondary to metastatic adenocarcinoma of the colon.
A station 7 lymphadenectomy was performed along with taking multiple station 10 samples. The right lower lobe pulmonary artery was divided using a tan 45 (gold tip with a leader catheter) reload and Covidien Signia™ powered stapler. The right lower...

Ethics Debate: When a Child's Heart is Failing

Robert M. Sade, Jessica M. Turnbull & Minoo N. Kavarana
Filmed at the 2017 Annual STS Meeting in Houston, Texas, Dr Robert Sade of the Medical University of South Carolina moderates a debate on the appropriate course of care in the fictional case of a child who cannot be weaned from bypass following mitral valve surgery. Dr Minoo Kavarana of the Medical University of South Carolina and Dr Jessica Turnbull of Vanderbilt University in Tennessee present the cases for and against placing the child on...

Four Cases of Redo Lung Surgery by VATS

Marco Nardini, Marcello Migliore, Shruti Jayakumar, Mohamed El Saegh, Izanee M. Mydin & Joel Dunning
The authors present a video demonstrating redo lung resection by VATS to show that previous surgery on the thorax does not contraindicate a minimally invasive re-intervention. The literature on this topic currently consists of case reports and small case series. Although there is little in the literature on this subject, D’Amico et al do not list redo surgery within the contraindications for VATS. The authors’ experiences confirm this. This video shows four lung resection procedures,...

Ion Robotic Bronchoscopy and Da Vinci Robotic Resection for a Solitary Pulmonary Nodule

Matthew L. Inra & Janani S. Reisenauer
The authors present a case of Ion robotic bronchoscopy and robotic lung resection for a solitary pulmonary nodule.The patient was a 68-year-old man and a never smoker who presented with an enlarging right lower lobe solitary pulmonary nodule. It was first seen on chest x-ray in 2016 and enlarged on serial imaging to its greatest size of 16 by 12 millimeters in 2019. The patient had a significant medical history of right shoulder melanoma that...

Ion Robotic Bronchoscopy and Da Vinci Robotic Resection for a Solitary Pulmonary Nodule

Matthew L. Inra & Janani S. Reisenauer
The authors present a case of Ion robotic bronchoscopy and robotic lung resection for a solitary pulmonary nodule.The patient was a 68-year-old man and a never smoker who presented with an enlarging right lower lobe solitary pulmonary nodule. It was first seen on chest x-ray in 2016 and enlarged on serial imaging to its greatest size of 16 by 12 millimeters in 2019. The patient had a significant medical history of right shoulder melanoma that...

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