430 Works

Surgery for Membranous Tracheomalacia: Tracheobronchoplasty

Anna Muñoz Fos, Francisco Cerezo Madueño, Javier Cosano, Francisco Javier González García, David Poveda, Eloísa Ruíz, María Melgar, Paula Moreno Casado, Javier Algar Algar, Carlos Baamonde Laborda, Ángel Salvatierra Velázquez & Antonio Álvarez Kindelan
The authors present a 59-year-old woman with a history of asthma, episodes of bronchospasm, and multiple ICU readmissions requiring orotracheal intubation. After a trial period with a tracheobronchial Y-shaped silicone stent (DumonTM stent), a tracheobronchoplasty was indicated as a definitive surgical treatment.The objective of surgery was to stabilize and add rigidity to the membranous wall of the trachea in order to prevent intrusion of the membranous wall into the lumen of the airway.
The surgery was...

Untitled ItemA “Y” Incision/Rectangular Patch to Enlarge the Aortic Annulus by 4 Valve Sizes in TAV and BAV Patients

Bo Yang &
We previously described using a “Y” incision and rectangular patch to enlarge the aortic annulus by 2-3 valve sizes for aortic valve replacement (AVR) with bioprosthesis (1) or mechanical valve (2) in patients with trileaflet aortic valve (TAV). As we are becoming more experienced, we are able to enlarge the aortic annulus by 4 valve sizes routinely in either TAV or bicuspid aortic valve (BAV). In this video we used a case of TAV to...

Left Ventricle Pseudoaneurysm Repair and CABG Through the Left Anterior Minithoracotomy

Anton Marchenko, Oleksandr Babliak, Dmytro Babliak &
We are presenting the case of minimally invasive repair of large left ventricle inferior pseudoaneurysm and concomitant CABG procedure. The patient was a 63 years old man who was presented with shortness of breath and severe angina pectoris.
Operation plan consisted of: left anterior minithoracotomy in 4th intercostal space, left internal mammary artery harvesting, peripheral cannulation for cardiopulmonary bypass, aortic cross-clamp and cardioplegia administration, pseudoaneurysm repair and LIMA to LAD anastomosis.
Postop ECHO showed...

Left Ventricle Pseudoaneurysm Repair and CABG Through the Left Anterior Minithoracotomy

Anton Marchenko, Oleksandr Babliak, Dmytro Babliak &
We are presenting the case of minimally invasive repair of large left ventricle inferior pseudoaneurysm and concomitant CABG procedure. The patient was a 63 years old man who was presented with shortness of breath and severe angina pectoris.
Operation plan consisted of: left anterior minithoracotomy in 4th intercostal space, left internal mammary artery harvesting, peripheral cannulation for cardiopulmonary bypass, aortic cross-clamp and cardioplegia administration, pseudoaneurysm repair and LIMA to LAD anastomosis.
Postop ECHO showed...

Robotic-Assisted Treatment of Aberrant Retroesophageal Right Subclavian Artery

, Lee Hafen, Anthony Tran & William Shutze
Aberrant right subclavian artery (ARSA) is a rare anomaly but is the most common congenital abnormality of the aortic arch with an incidence of 0.3-3.0% (1, 2). The vessel embryologically is the 4th branch of the aortic arch, most commonly passes behind the esophagus and crosses the midline between the esophagus and the vertebral column to reach the right arm (3). Approximately 60% may be aneurysmal at their origin (4). An aberrant right subclavian artery...

Left Ventricular Outflow Tract Aneurysm Compressing the Left Main

Mohamed Ibrahim, , Jacob Aju & Mohammed Idhrees
Left ventricular outflow tract aneurysm compressing the left main. A 44 –year-old male patient presented with shortness of breath and chest pain. ECG showed ST depression in the lateral leads. Echocardiogram showed subaortic aneurysm below the left coronary and non-coronary cusp with impaired LV function. Left coronary angiogram revealed 90% obstruction of Left Main due to dynamic compression by LVOT aneurysm. CT shows the bulge of the aneurysm with compression of Left Main. Cardiopulmonary bypass...

Robot-Assisted Laparoscopic Re-Do Paraesophageal Hernia Repair With Nissen Fundoplication

Benjamin A. Palleiko, Ryan J. Hendrix, Karl Uy, , Donald Czerniach & Mark W. Maxfield
In this video, we present a patient with a recurrent paraesophageal hernia who underwent robot-assisted laparoscopic re-do paraesophageal hernia repair with Nissen fundoplication. The patient is a 76M with a past medical history significant for longstanding and symptomatic GERD, status post laparoscopic paraesophageal hernia repair and Stamm gastrostomy. He had a series of workups that ultimately demonstrated irregularities consistent with Barrett’s esophagus and a large type III paraesophageal hernia. The patient was taken to the...

Off-Pump LIMA to LAD Coronary Artery Bypass Through Left Anterior Minithoracotomy

Olivier Fabre, Mihai Radutoiu, Olivier Rebet, Ionut Carjaliu, Laurence Gautier & Ilir Hysi
Minimally invasive approaches are slowly but surely entering the field of cardiac surgery. It is important to notice that in this direction, the valvular pathology has developed first and an important experience through the years has been accumulated by the surgical community. Regarding the coronary artery bypass surgery (CABG), minimally invasive accesses remain somehow confidential. Even though some authors have reported very interesting results in multiple arterial or venous bypasses (1,2), the spread of the...

Off-Pump LIMA to LAD Coronary Artery Bypass Through Left Anterior Minithoracotomy

Olivier Fabre, Mihai Radutoiu, Olivier Rebet, Ionut Carjaliu, Laurence Gautier & Ilir Hysi
Minimally invasive approaches are slowly but surely entering the field of cardiac surgery. It is important to notice that in this direction, the valvular pathology has developed first and an important experience through the years has been accumulated by the surgical community. Regarding the coronary artery bypass surgery (CABG), minimally invasive accesses remain somehow confidential. Even though some authors have reported very interesting results in multiple arterial or venous bypasses (1,2), the spread of the...

Re-VATS Left Upper Lobectomy With Pulmonary Artery Plasty After Induction Cemotherapy

Andrea Dell'Amore & Alessandro Pangoni
Partial or complete resection of the pulmonary artery is a well-known technique in the context of the treatment of non-small cell lung cancer that provides optimal results in terms of disease control and blood flow[1,2]. In this video tutorial we demonstrate how to carry out a left upper lobectomy associated to a plasty of the left pulmonary artery using a re-VATS approach. Careful pre-operative planning and evaluation of the patient is mandatory in order to...

Direct Anatomic Reimplantation of Malignant Right Coronary Artery Without Aortotomy: A Two Patient Case Report

Douglas O’Connell & Amod Tendulkar
Background
Historically, direct reimplantation is a technique that requires a partial aortotomy and xeno-pericardial patch.1 A recent report outlined a simplified approach for the reimplantation of a right anomalous aortic origin of a coronary artery (AAOCA) that outlined a skeletonized technique that employs the principles of a standard aortic anastomosis in coronary artery bypass grafting.2 This technique mobilizes the coronary artery's proximal end by its removal from the aortic sinus. The excised hole can be...

Repair of Cardiac Total Anomalous Pulmonary Venous Connection by Unroofing the Coronary Sinus in a Neonate

Sufina Shales, Debasis Das, Nilanjan Dutta, Pradeep Narayan, Shyamal Maiti & Shubhadeep Das
Surgical repair of a cardiac type Total Anomalous Pulmonary venous connection is simple yet challenging surgical procedure, especially when it is done in a neonate. The goal of the surgery is creating an unobstructed communication of the pulmonary veins to the left atrium . It is a time tested , standard technique to treat this important congenital cardiac defect.[1,2,3]
This is a video demonstration of surgical repair of Cardiac type of TAPVC by unroofing the...

How to Set Up a Minimally Invasive Mitral Valve Surgery: Step by Step Approach

Qasim Al Abri, Lamees I. El Nihum, Moritz C. Wyler von Ballmoos & Mahesh Ramchandani
In this video, we demonstrate the set-up for a minimally invasive mitral valve surgery in a step-by-step approach. Femoral cannulation is done through an oblique incision in the right groin. Both femoral vein and femoral artery are exposed, purse string suture 5-0 Prolene is taken in both vessels. Seldinger technique is used where a wire is passed and echocardiographic guidance in a bicaval view to visualize the wire all the way up to the SVC....

Robotic Ectopic Thyroid Resection Presenting as an Anterior Mediastinal Mass

João Marcelo Lopes Toscano de Brito, Giovani Waltrick Mezzalira, Eserval Rocha Junior, Alessandro Wasum Mariani, José Ribas Milanez de Campos & Ricardo Mingarini Terra
The surgical management of anterior mediastinal masses are almost a consensus in great majority of cases. However, the surgical approach to reach optimal results, is in continuous debate. Therefore, we present a robotic strategy to achieve complete resection of a huge anterior mediastinal mass in a rare presentation of ectopic thyroids. We present a case of a 51-year-old female who sought medical care due to symptoms of breathless and a retrosternal compression sensation during decubitus....

RATS Lobectomy in a Totally Adherent Post-Empyema Pleura

Henrik Aamodt, Rune Eggum & Frode Reier-Nilsen
The totally adherent pleura poses a challenge in mini-invasive procedures such as the RATS lobectomy. We were introduced to the SyncroSeal energy device for the DaVinci robot six months ago, and we have since performed lobectomies in three such patients. In this video we present our surgical strategy when faced with the totally adherent pleura.

RATS Lobectomy in a Totally Adherent Post-Empyema Pleura

Henrik Aamodt, Rune Eggum & Frode Reier-Nilsen
The totally adherent pleura poses a challenge in mini-invasive procedures such as the RATS lobectomy. We were introduced to the SyncroSeal energy device for the DaVinci robot six months ago, and we have since performed lobectomies in three such patients. In this video we present our surgical strategy when faced with the totally adherent pleura.

Congenital Aortic Valve Fenestration Repair & Root Remodeling in Heterotaxy Syndrome & Interrupted Inferior Vena Cava

Aditya Sengupta, Elbert E. Williams, Ismail El-Hamamsy & Paul E Stelzer
Fenestrations of the aortic valve have been described in patients with Down syndrome, Marfan syndrome, in those with bicuspid or quadricuspid valves, and in patient with myxomatous valvular degeneration. While rare and an infrequent cause of valve disease, congenital fenestrations can also occur (1). When indicated, such fenestrations can be repaired using a variety of strategies (2). We herein present the case of a 24-year-old woman with pathologic aortic root enlargement (6.2 cm in greatest...

Video Demonstration of a Left VATS Thymectomy With Instruments Mimicking the Human Hand

Alexander Kern
In this video, we are demonstrating a left VATS thymectomy with complete dissection of the superior horns using the new wristed Artisential instruments by livsmed. Our patient is a 62 year old woman, approach is semi-supine with left arm attatched; we used three ports and a 30° camera and CO2 insufflation. We used three Artisential instruments, the fenestrated forceps, the bipolar precise dissector and the monopolar hook, together with a Caiman energy device from Aesculap....

Fast-Track Arterial Switch Operation

Sameh M. Said & Sandeep Sainathan
This is a 3. 3 kg, male neonate who was born with a prenatal diagnosis of dextro-transposition of the great arteries (d-TGA) and intact ventricular septum. At birth, he was deeply cyanotic and was intubated and prostaglandin infusion was initiated to maintain ductal patency. Transthoracic echocardiogram confirmed the prenatal diagnosis and normal coronary pattern for d-TGA (1 LCx, 2RCA). Due to restricted atrial communication, a bedside echo-guided balloon atrial septostomy was performed. He was subsequently...

The da Silva Cone Operation After the Starnes Procedure for Ebstein's Anomaly

Allison Beckham Davila, Raymond Morales, Victor O. Morell, Jose Pedro da Silva & Luciana da Fonseca da Silva
Severe neonatal Ebstein's Anomaly can present a surgical challenge, and the advent of the Starnes Procedure has improved survival in these critically ill neonates. Importantly, however; this does not commit then to a single ventricle physiology for their entire lives, and they can be successfully converted to 1.5 or 2 ventricle physiology later in life. Here we present a 2.5 year old who initially underwent a Starnes Procedure at day 3 of life for severe...

Warden Procedure via Vertical Right Thoracotomy in a 7-Year-Old Girl

Sameh M. Said & Gamal Marey
A 7-year-old, 41 kg, girl presented with murmur and evidence of right-sided cardiac chamber enlargement. She was asymptomatic. Echocardiography and cross sectional imaging demonstrated partial anomalous pulmonary venous connection of the right upper and middle lobar pulmonary veins to the superior vena cava (SVC) and superior vena caval/right atrial junction. There was a moderate size superior sinus venosus atrial septal defect. Due to the high insertion of the anomalous pulmonary veins, a Warden procedure with...

VATS Resection of Right Cardiophrenic Lymphnodes

Francesco Petrella & Lorenzo Spaggiari
The cardiophrenic angle lymphnodes were classified by Rouvière (1) as diaphragmatic lymphnodes and divided into: 1)Anterior (prepericardic) draining portions of the diaphragm, liver , pleura and abdominal wall into the internal mammary chain 2) Middle (lateropericardic or juxtaphrenic) draining portions of the diaphragm, pericardium, pleura and liver into the anterior mediastinal chain. They are rarely involved in primary thoracic malignancies but are frequently affected in ovarian cancer. In this case we describe VATS resection of...

Healthcare Disparities in Lung Cancer

Azante Griffith, Aaron Delman & Robert Van Haren
In the United States, lung cancer is the second most common cancer and the leading cause of cancer mortality. Among those diagnosed, African American and Black men have both the highest incidence rate and the highest age-adjusted mortality rate. Additionally, although this population has comparable rates of tobacco use to other demographics, they still have the highest rates of lung cancer mortality. Lung cancer screening encourages CT imaging on patients age 55 years or older...

Lung Cancer Screening: Challenges for Vulnerable Rural Populations

Rian M. Hasson
Lung cancer is the leading cause of cancer death in the United States, and it is estimated that smoking is the cause in approximately 80-90% of cases. Traditionally, tobacco prevention and cessation interventions have been the focus of efforts designed to decrease lung cancer incidence and mortality; unfortunately these programs are not always successful, and millions of current and former smokers remain at substantial risk for diagnosis. While researchers have more recently redirected their efforts...

Healthcare Disparities in the Treatment of Advanced Lung Cancer

Brittney Williams, Patricia Rivera, Marjory Charlot & Gita Mody
This CTSNet virtual Roundtable invites experts from the Multidisciplinary Thoracic Oncology Program of the University of North Carolina at Chapel Hill to discuss health care disparities in the treatment of advanced lung cancer. Participants are Dr. Brittney Williams, fourth-year general surgery resident; Dr. M. Patricia Rivera, pulmonologist and Director of the UNC Lung Cancer Screening Program; Dr. Marjory Charlot, medical oncologist and Assistant Director of the Lineberger Comprehensive Cancer Center’s Community Outreach and Engagement program;...

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