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Innovations: Technology and Techniques in Cardiothoracic and Vascular Surgery最新文献

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Response to: Facilitating Proximal Anastomosis in Minimally Invasive Coronary Artery Bypass Grafting. 回应:促进微创冠状动脉旁路移植术的近端吻合。
IF 1.6 Q2 SURGERY Pub Date : 2024-05-01 DOI: 10.1177/15569845241258488
Hiroki Sakai, Keita Kikuchi
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引用次数: 0
The 10 Commandments for Endoscopic Minimally Invasive Tricuspid Valve Repair. 内窥镜微创三尖瓣修复十诫
IF 1.6 Q2 SURGERY Pub Date : 2024-05-01 DOI: 10.1177/15569845241264571
Mohsyn Imran Malik, Michael W A Chu
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引用次数: 0
Single-Port Robotic Trans-Subxiphoid Surgery for Anterior Mediastinal Disease: A Pilot Trial. 单孔机器人经剑突下手术治疗前纵隔疾病:试点试验
IF 1.6 Q2 SURGERY Pub Date : 2024-05-01 Epub Date: 2024-05-09 DOI: 10.1177/15569845241248641
Chuan Cheng, Evangelos Tagkalos, Chong Beng Ng, Ya-Chun Hsu, Yu Ya Huang, Ching Feng Wu, Yin-Kai Chao

Objective: In recent years, there has been an increasing focus on minimally invasive mediastinal surgery using a trans-subxiphoid single-port thoracoscopic approach. Despite its potential advantages, the widespread adoption of this method has been hindered by the intricate surgical maneuvers required within the confined retrosternal space. Robotic surgery offers the potential to overcome the limitations inherent in the thoracoscopic technique.

Methods: This was a clinical trial (NCT05455840) to evaluate the feasibility and safety of utilizing the da Vinci® SP system (Intuitive Surgical, Sunnyvale, CA, USA) for trans-subxiphoid single-port surgery in patients with anterior mediastinal disease. The primary endpoints encompassed conversion rates and the secondary endpoints included the occurrence of perioperative complications.

Results: Between August 2022 and April 2023, a total of 15 patients (7 men and 8 women; median age = 56 years, interquartile range [IQR]: 49 to 65 years) underwent trans-subxiphoid robotic surgery using da Vinci SP platform for maximal thymectomy (n = 2) or removal of anterior mediastinal masses (n = 13). All surgical procedures were carried out with success, with no need for conversion to open surgery or the creation of additional ports. The median docking time was 2 min (IQR: 1 to 4 min), while the console time had a median of 152 min (IQR: 95 to 191 min). There were no postoperative complications and patients experienced a median postoperative hospital stay of 2 days with no unplanned 30-day readmission.

Conclusions: This study shows that trans-subxiphoid single-port robotic surgery employing the da Vinci SP system in patients with anterior mediastinal disease is clinically viable with acceptable safety and short-term outcomes.

目的:近年来,经剑突下单孔胸腔镜微创纵隔手术越来越受到关注。尽管这种方法具有潜在的优势,但由于需要在狭窄的胸骨后空间进行复杂的手术操作,因此阻碍了这种方法的广泛采用。机器人手术有可能克服胸腔镜技术固有的局限性:这是一项临床试验(NCT05455840),旨在评估在前纵隔疾病患者中使用达芬奇® SP 系统(Intuitive Surgical, Sunnyvale, CA, USA)进行经剑突下单孔手术的可行性和安全性。主要终点包括转换率,次要终点包括围手术期并发症的发生率:2022年8月至2023年4月期间,共有15名患者(7名男性,8名女性;中位年龄=56岁,四分位距[IQR]:49岁至65岁)接受了经胸手术:中位年龄=56岁,四分位数范围[IQR]:49至65岁)接受了经剑突下机器人手术,使用达芬奇SP平台进行最大胸腺切除术(2例)或前纵隔肿块切除术(13例)。所有手术均顺利进行,无需转为开放手术或创建额外的端口。对接时间的中位数为2分钟(IQR:1至4分钟),控制台时间的中位数为152分钟(IQR:95至191分钟)。术后无并发症,患者术后住院时间中位数为 2 天,30 天内无意外再入院:这项研究表明,在前纵隔疾病患者中使用达芬奇SP系统进行经剑突下单孔机器人手术在临床上是可行的,其安全性和短期疗效均可接受。
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引用次数: 0
Robotic Beating-Heart Totally Endoscopic Coronary Artery Bypass: Impact of Chest Wall Dimensions in Single and Multivessel Bypass. 机器人心跳-心脏全内镜冠状动脉搭桥术:单血管和多血管搭桥术中胸壁尺寸的影响。
IF 1.6 Q2 SURGERY Pub Date : 2024-05-01 Epub Date: 2024-06-04 DOI: 10.1177/15569845241252170
Tatsuya Watanabe, Hiroto Kitahara, Sarah Nisivaco, Charocka Coleman, Brooke Patel, Husam H Balkhy

Objective: There can be anatomical constraints on patient selection for minimally invasive surgery. For example, robot-assisted coronary artery bypass was reported to be more challenging when patients had a cardiothoracic ratio >50% and a sternum-vertebra anteroposterior and transverse diameter ratio <0.45. We sought to examine the impact of chest wall anatomic parameters on surgical outcomes in our totally endoscopic coronary artery bypass (TECAB) procedures.

Methods: We retrospectively reviewed patients who underwent robotic TECAB, all of whom had a preoperative chest radiograph at our institution from July 2017 to October 2021. The cohort was divided into 2 groups, which were patients undergoing single-vessel grafting using the left internal thoracic artery (ITA; group 1) and patients undergoing multivessel grafting with bilateral ITA grafts (group 2). We measured several anatomical parameters from the preoperative chest radiograph.

Results: A total of 352 patients undergoing TECAB were retrospectively analyzed. After exclusions, 193 were included in this study. In group 1 (n = 91), no parameters correlated with operative time. In group 2 (n = 102), a significant negative correlation was observed between operative time and the sternum-vertebrae anteroposterior diameter (rs = -0.228, P = 0.022) and lung anteroposterior diameter (rs = -0.246, P = 0.013). To confirm these results in group 2, a propensity-matched analysis was performed and showed a statistically significant difference in surgical time based on chest anteroposterior diameters.

Conclusions: In single-vessel robotic TECAB, chest wall anatomic dimensions measured on chest radiograph did not affect operative time. In multivessel cases with bilateral ITA grafts, larger anteroposterior diameter correlated with shorter operative times.

目的:微创手术患者的选择可能会受到解剖结构的限制。例如,据报道,如果患者的心胸比例大于 50%,胸骨与椎体的前后径和横径之比大于 50%,那么机器人辅助冠状动脉搭桥术就更具挑战性:我们回顾性研究了2017年7月至2021年10月期间在我院接受机器人TECAB手术的患者,所有患者均有术前胸片。该组患者分为两组,即使用左胸内动脉(ITA)进行单血管移植的患者(第1组)和使用双侧ITA移植进行多血管移植的患者(第2组)。我们根据术前胸片测量了几个解剖参数:我们对 352 名接受 TECAB 手术的患者进行了回顾性分析。经排除后,193 例患者被纳入本研究。在第一组(91 人)中,没有参数与手术时间相关。在第2组(n = 102)中,观察到手术时间与胸骨-椎体前后径(rs = -0.228,P = 0.022)和肺脏前后径(rs = -0.246,P = 0.013)之间存在显著负相关。为了在第2组中证实这些结果,进行了倾向匹配分析,结果显示,根据胸部前胸直径,手术时间的差异具有统计学意义:在单血管机器人 TECAB 中,胸片上测量的胸壁解剖尺寸不会影响手术时间。在使用双侧ITA移植物的多血管病例中,前胸直径越大,手术时间越短。
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引用次数: 0
Impact of Pleural Integrity Preservation After Minimally Invasive Aortic Valve Surgery. 微创主动脉瓣手术后胸膜完整性保护的影响
IF 1.6 Q2 SURGERY Pub Date : 2024-05-01 Epub Date: 2024-07-27 DOI: 10.1177/15569845241237241
Beatrice Bacchi, Francesco Cabrucci, Bruno Chiarello, Aleksander Dokollari, Massimo Bonacchi

Objective: While the benefits of minimally invasive aortic valve surgery compared with standard sternotomy have been widely described, the impact of preservation of pleural integrity (PPI) in minimally invasive surgery is still widely discussed. This study aims to define the role of PPI on postoperative and long-term outcomes after minimally invasive aortic valve replacement (MIAVR).

Methods: All 2,430 consecutive patients undergoing MIAVR (ministernotomy or right anterior minithoracotomy) between 1997 and 2022 were included in the study. Patients were divided into 2 groups: patients with and without PPI. PPI was considered the maintenance of the pleura closed without the need for a chest tube insertion at the end of the surgical procedure. A propensity-matched analysis was used to compare the PPI and not-PPI groups.

Results: After propensity matching, 848 patients were included in each group (PPI and not-PPI). The mean age was 70.21 versus 71.42 years, and the mean Society of Thoracic Surgeons predicted risk of mortality was 0.31% versus 0.30% in not-PPI versus PPI, respectively. The mean follow-up time was 147.4 months. Postoperatively, not-PPI versus PPI patients had a longer intensive care unit stay (9.7 vs 17.3 h, P < 0.001) and hospital length of stay (5.2 vs 8.9 days, P < 0.001). The rate of respiratory complications including the incidence of pneumothorax or subcutaneous emphysema, pulmonary atelectasis, and pleural effusion events requiring thoracentesis/drainage was significantly higher in not-PPI versus PPI. The 30-day all-cause mortality was higher in not-PPI versus PPI (0.029 vs 0.010, P = 0.003). Perioperative, short-term, and long-term all-cause mortality was significantly higher in the not-PPI group.

Conclusions: PPI after MIAVR is associated with reduced incidence of postoperative complications, reduced lengths of stay, and improved overall survival compared with not-PPI. Therefore, a MIAVR tailored patient-procedure approach to maintaining the pleura integrity positively impacts short-term and long-term outcomes.

目的:与标准胸骨切开术相比,微创主动脉瓣手术的优势已被广泛描述,但在微创手术中保留胸膜完整性(PPI)的影响仍被广泛讨论。本研究旨在明确 PPI 对微创主动脉瓣置换术(MIAVR)术后和长期预后的作用:研究纳入了 1997 年至 2022 年间接受微创主动脉瓣置换术(小切口或右前小切口)的所有 2430 名连续患者。患者被分为两组:使用和未使用 PPI 的患者。PPI 被认为是在手术结束时无需插入胸管即可保持胸膜闭合。采用倾向匹配分析来比较PPI组和非PPI组:经过倾向匹配后,每组(PPI 组和非 PPI 组)均纳入了 848 名患者。两组患者的平均年龄分别为 70.21 岁和 71.42 岁,胸外科医师协会预测的平均死亡风险分别为 0.31% 和 0.30%。平均随访时间为 147.4 个月。术后,非 PPI 与 PPI 患者在重症监护室的住院时间(9.7 小时 vs 17.3 小时,P < 0.001)和住院时间(5.2 天 vs 8.9 天,P < 0.001)更长。非 PPI 与 PPI 相比,呼吸系统并发症(包括气胸或皮下气肿、肺不张和胸腔积液)的发生率明显更高。非 PPI 与 PPI 相比,30 天全因死亡率更高(0.029 vs 0.010,P = 0.003)。非 PPI 组的围手术期、短期和长期全因死亡率均显著高于 PPI 组:结论:与不使用 PPI 相比,MIAVR 术后使用 PPI 可降低术后并发症的发生率、缩短住院时间并提高总生存率。因此,为患者量身定制的 MIAVR 手术方法可保持胸膜完整性,对短期和长期预后均有积极影响。
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引用次数: 0
Surgical Bailout of Transcatheter Aortic Valve Embolization Using a Right Anterior Minithoracotomy Approach. 使用右前小胸廓切开术进行经导管主动脉瓣栓塞的手术抢救。
IF 1.6 Q2 SURGERY Pub Date : 2024-05-01 Epub Date: 2024-05-09 DOI: 10.1177/15569845241248657
Anthony D Sinobas, Bleri Celmeta, Arturo Bisogno, Tommaso Viva, Antonio Miceli, Vito Domenico Bruno, Mattia Glauber
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引用次数: 0
Optimal Positioning of Adherent Pacing Leads During Tricuspid Valve Repair. 三尖瓣修复术中粘连起搏导线的最佳定位。
IF 1.6 Q2 SURGERY Pub Date : 2024-05-01 DOI: 10.1177/15569845241265651
Yoyo Wang, Allison R Thompson, Neal M Duggal, Gorav Ailawadi
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引用次数: 0
A Personalized 3D-Printed Chest Protector. 个性化 3D 印刷护胸。
IF 1.6 Q2 SURGERY Pub Date : 2024-05-01 Epub Date: 2024-05-14 DOI: 10.1177/15569845241252388
Inbar Nardi Agmon, Yarden Mor, Ran Kornowski, Leor Perl
{"title":"A Personalized 3D-Printed Chest Protector.","authors":"Inbar Nardi Agmon, Yarden Mor, Ran Kornowski, Leor Perl","doi":"10.1177/15569845241252388","DOIUrl":"10.1177/15569845241252388","url":null,"abstract":"","PeriodicalId":13574,"journal":{"name":"Innovations: Technology and Techniques in Cardiothoracic and Vascular Surgery","volume":null,"pages":null},"PeriodicalIF":1.6,"publicationDate":"2024-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140916338","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Mitral Valve Surgery With Previous Aortic Valve Replacement: A Robotic Endoscopic Approach Provides Excellent Visualization. 曾接受主动脉瓣置换术的二尖瓣手术:机器人内窥镜方法提供卓越的可视性
IF 1.6 Q2 SURGERY Pub Date : 2024-05-01 Epub Date: 2024-05-09 DOI: 10.1177/15569845241248620
Riya Bhasin, Philip Erwin, Hiroto Kitahara, Kaitlin Grady, Husam H Balkhy
{"title":"Mitral Valve Surgery With Previous Aortic Valve Replacement: A Robotic Endoscopic Approach Provides Excellent Visualization.","authors":"Riya Bhasin, Philip Erwin, Hiroto Kitahara, Kaitlin Grady, Husam H Balkhy","doi":"10.1177/15569845241248620","DOIUrl":"10.1177/15569845241248620","url":null,"abstract":"","PeriodicalId":13574,"journal":{"name":"Innovations: Technology and Techniques in Cardiothoracic and Vascular Surgery","volume":null,"pages":null},"PeriodicalIF":1.6,"publicationDate":"2024-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140897488","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Aortopexy Using Upper Hemisternotomy. 使用上半身切开术进行大动脉成形术
IF 1.6 Q2 SURGERY Pub Date : 2024-05-01 Epub Date: 2024-06-03 DOI: 10.1177/15569845241253275
Yash Vaidya, Bradley Segura, Samuel Goldfarb, Pranava Sinha
{"title":"Aortopexy Using Upper Hemisternotomy.","authors":"Yash Vaidya, Bradley Segura, Samuel Goldfarb, Pranava Sinha","doi":"10.1177/15569845241253275","DOIUrl":"10.1177/15569845241253275","url":null,"abstract":"","PeriodicalId":13574,"journal":{"name":"Innovations: Technology and Techniques in Cardiothoracic and Vascular Surgery","volume":null,"pages":null},"PeriodicalIF":1.6,"publicationDate":"2024-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141199800","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
期刊
Innovations: Technology and Techniques in Cardiothoracic and Vascular Surgery
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