首页 > 最新文献

Journal of visualized surgery最新文献

英文 中文
Hybrid robotic thoracic surgery for excision of large mediastinal masses. 混合机器人胸腔手术切除大纵隔肿块。
Pub Date : 2018-05-18 eCollection Date: 2018-01-01 DOI: 10.21037/jovs.2018.05.17
Dario Amore, Marcellino Cicalese, Roberto Scaramuzzi, Davide Di Natale, Dino Casazza, Carlo Curcio

Between April 2016 and October 2017, we retrospectively reviewed all patients undergoing excision of large mediastinal masses using a hybrid robotic thoracic approach at the Unit of Thoracic Surgery of Monaldi Hospital in Naples. The inclusion criteria for this approach were: evident unilateral predominance of the mass; absence of invasion to surrounding structures. Planned conversion to sternotomy was necessary in one patient for tenacious adhesions between the mediastinal goiter and the left innominate vein. In all cases the postoperative course was uneventful. The hybrid robotic approach, adopted in our Unit, consists of a thoracic procedure performed completely with articulated surgical instruments under three-dimensional vision and followed by final extension of a port-site incision to retrieve the voluminous specimen. This approach uses all the advantages of robotic technology that enables to perform a fine dissection in the small space of the anterior mediastinum and at the same time, through the simple extension of a minimally invasive access, avoids the painful sequelae of thoracotomy. In selected cases, with increased experience in robotic surgery, it can be proposed for excision of large mediastinal masses, although a longer follow-up period is necessary to validate our findings.

2016年4月至2017年10月,我们回顾性分析了所有在那不勒斯Monaldi医院胸外科采用混合机器人胸外科入路切除大纵隔肿块的患者。该入路的入选标准为:肿块明显单侧优势;对周围结构无侵犯。计划转换到胸骨切开术是必要的,在一个病人之间的顽固粘连纵隔甲状腺肿和左无名静脉。所有病例的术后过程均平安无事。本单位采用的混合机器人入路包括在三维视觉下完全用关节手术器械完成的胸部手术,然后最后延长端口切口以取出体积大的标本。该方法利用了机器人技术的所有优点,能够在前纵隔的小空间内进行精细的解剖,同时,通过简单的微创通道延伸,避免了开胸手术的痛苦后遗症。在选定的病例中,随着机器人手术经验的增加,可以建议切除大型纵隔肿块,尽管需要更长的随访时间来验证我们的发现。
{"title":"Hybrid robotic thoracic surgery for excision of large mediastinal masses.","authors":"Dario Amore,&nbsp;Marcellino Cicalese,&nbsp;Roberto Scaramuzzi,&nbsp;Davide Di Natale,&nbsp;Dino Casazza,&nbsp;Carlo Curcio","doi":"10.21037/jovs.2018.05.17","DOIUrl":"https://doi.org/10.21037/jovs.2018.05.17","url":null,"abstract":"<p><p>Between April 2016 and October 2017, we retrospectively reviewed all patients undergoing excision of large mediastinal masses using a hybrid robotic thoracic approach at the Unit of Thoracic Surgery of Monaldi Hospital in Naples. The inclusion criteria for this approach were: evident unilateral predominance of the mass; absence of invasion to surrounding structures. Planned conversion to sternotomy was necessary in one patient for tenacious adhesions between the mediastinal goiter and the left innominate vein. In all cases the postoperative course was uneventful. The hybrid robotic approach, adopted in our Unit, consists of a thoracic procedure performed completely with articulated surgical instruments under three-dimensional vision and followed by final extension of a port-site incision to retrieve the voluminous specimen. This approach uses all the advantages of robotic technology that enables to perform a fine dissection in the small space of the anterior mediastinum and at the same time, through the simple extension of a minimally invasive access, avoids the painful sequelae of thoracotomy. In selected cases, with increased experience in robotic surgery, it can be proposed for excision of large mediastinal masses, although a longer follow-up period is necessary to validate our findings.</p>","PeriodicalId":17587,"journal":{"name":"Journal of visualized surgery","volume":"4 ","pages":"105"},"PeriodicalIF":0.0,"publicationDate":"2018-05-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.21037/jovs.2018.05.17","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"36276140","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 3
The influence of the trocar choice on post-operative acute pain after thoracoscopy. 套管针选择对胸腔镜术后急性疼痛的影响。
Pub Date : 2018-05-17 eCollection Date: 2018-01-01 DOI: 10.21037/jovs.2018.05.16
Andrea Dell'Amore, Alessio Campisi, Domenica Giunta, Stefano Congiu, Niccolò Daddi, Giampiero Dolci, Niccolò Barbera, Letizia Bacchi Reggiani
Background Acute post-operative pain following thoracic surgery procedures is still an unresolved problem despite the introduction of minimally invasive procedures such as video assisted surgery. Until now it is never investigated if different surgical instruments could influence post-operative pain. The aim of our study is to investigate the role of different type of trocar on post-operative pain in minimally invasive thoracic surgery. Methods This was a prospective randomized single center study. We identified 53 patients randomized into three groups underwent single port thoracoscopy for malignant pleural effusion with drainage of the fluid and talc poudrage. The three groups differ for the trocar type, rigid, flexible and wound protector. Results We compared the postoperative pain between the three groups in which there was no statistical difference. Rigid trocar seems to give a more stable level of pain during the days, flexible trocar gains more pain in the first few hours, however the pain at discharge decreases significantly, reaching the similar values, in all the three groups. The association between pain at discharge and operative time or days of drainage was analyzed by means of linear regression, no statistically significant difference was found. Conclusions Our study showed that different type of trocars during video assisted thoracic surgery (VATS) produces similar level of acute postoperative pain. In future, further randomized study with a great number of patients enrolled needs to confirm our results.
背景:胸外科手术后急性术后疼痛仍然是一个未解决的问题,尽管引入了微创手术,如视频辅助手术。到目前为止,还没有研究过不同的手术器械是否会影响术后疼痛。我们的研究目的是探讨不同类型的套管针对微创胸外科术后疼痛的作用。方法:这是一项前瞻性随机单中心研究。我们将53例患者随机分为三组,接受单孔胸腔镜治疗恶性胸腔积液并引流液体和滑石粉。三组套管针类型不同,刚性,柔性和伤口保护器。结果:三组患者术后疼痛比较无统计学差异。刚性套管针似乎在白天给予更稳定的疼痛水平,柔性套管针在最初几个小时内获得更多的疼痛,但在出院时疼痛显着减少,在所有三组中达到相似的值。采用线性回归分析出院疼痛与手术时间、引流天数的关系,差异无统计学意义。结论:我们的研究表明,不同类型的套管针在视频辅助胸外科手术(VATS)中产生相似程度的急性术后疼痛。未来还需要更多的随机研究来证实我们的结果。
{"title":"The influence of the trocar choice on post-operative acute pain after thoracoscopy.","authors":"Andrea Dell'Amore,&nbsp;Alessio Campisi,&nbsp;Domenica Giunta,&nbsp;Stefano Congiu,&nbsp;Niccolò Daddi,&nbsp;Giampiero Dolci,&nbsp;Niccolò Barbera,&nbsp;Letizia Bacchi Reggiani","doi":"10.21037/jovs.2018.05.16","DOIUrl":"https://doi.org/10.21037/jovs.2018.05.16","url":null,"abstract":"Background Acute post-operative pain following thoracic surgery procedures is still an unresolved problem despite the introduction of minimally invasive procedures such as video assisted surgery. Until now it is never investigated if different surgical instruments could influence post-operative pain. The aim of our study is to investigate the role of different type of trocar on post-operative pain in minimally invasive thoracic surgery. Methods This was a prospective randomized single center study. We identified 53 patients randomized into three groups underwent single port thoracoscopy for malignant pleural effusion with drainage of the fluid and talc poudrage. The three groups differ for the trocar type, rigid, flexible and wound protector. Results We compared the postoperative pain between the three groups in which there was no statistical difference. Rigid trocar seems to give a more stable level of pain during the days, flexible trocar gains more pain in the first few hours, however the pain at discharge decreases significantly, reaching the similar values, in all the three groups. The association between pain at discharge and operative time or days of drainage was analyzed by means of linear regression, no statistically significant difference was found. Conclusions Our study showed that different type of trocars during video assisted thoracic surgery (VATS) produces similar level of acute postoperative pain. In future, further randomized study with a great number of patients enrolled needs to confirm our results.","PeriodicalId":17587,"journal":{"name":"Journal of visualized surgery","volume":"4 ","pages":"104"},"PeriodicalIF":0.0,"publicationDate":"2018-05-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.21037/jovs.2018.05.16","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"36276139","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 3
Bicuspid aortic valve repair in the setting of severe aortic insufficiency. 严重主动脉瓣关闭不全情况下的双尖瓣主动脉瓣修复术。
Pub Date : 2018-05-14 eCollection Date: 2018-01-01 DOI: 10.21037/jovs.2018.04.13
Ziv Beckerman, Michael O Kayatta, LaRonica McPherson, Jose N Binongo, Yi Lasanajak, Bradley G Leshnower, Edward P Chen

Background: Bicuspid aortic valve (BAV) is a common cardiac anomaly that affects 0.5-2% of adults. Valve sparing root replacement (VSRR) in bicuspid aortopathy is gaining popularity. We discuss the technical aspects of the procedure as well as the mid- to long-term results of performing VSRR in the setting of a bicuspid valve.

Methods: A single institutional database identified 280 patients who underwent VSRR from 2005-2016. Outcomes were analyzed in 60 consecutive patients undergoing a VSRR in the setting of a BAV with aortic regurgitation (AR). Patients were followed prospectively and had annual echocardiograms.

Results: The average age in this series was 42±11 years. Moderate or more AR was present in 50% of patients preoperatively. The incidence of operative death, stroke, and renal failure was 0%. Mean follow-up was 39±30 months. At latest follow-up, 62% of patients had zero AR and 87% of patients had <1+ AR. At 9 years, freedom from >2+ AR was 97% and freedom from aortic valve repair (AVR) was 96%.

Conclusions: VSRR can be safely and effectively performed in young patients with bicuspid valve anatomy regardless of degree of pre-operative AR. Valve function is durable and the incidence of valve-related complications is low. VSRR is an attractive and potentially superior option to conventional root replacement in appropriately selected patients with bicuspid aortopathy.

背景:主动脉瓣双尖瓣(BAV)是一种常见的心脏畸形,影响着0.5-2%的成年人。二尖瓣主动脉病变的瓣膜根部置换术(VSRR)越来越受欢迎。我们讨论了该手术的技术方面以及在双尖瓣情况下实施 VSRR 的中长期效果:一个机构的数据库确定了 2005-2016 年间接受 VSRR 的 280 名患者。对 60 名连续接受 VSRR 的患者的结果进行了分析,这些患者均为 BAV 并伴有主动脉瓣反流 (AR)。对患者进行了前瞻性随访,并每年进行超声心动图检查:结果:该系列患者的平均年龄为 42±11 岁。50%的患者术前存在中度或更严重的主动脉瓣反流。手术死亡、中风和肾衰竭的发生率为 0%。平均随访时间为 39±30 个月。最近一次随访时,62%的患者 AR 为零,87%的患者 AR 为 2+ (97%),主动脉瓣修复(AVR)的自由度为 96%:结论:无论术前AR程度如何,VSRR都能安全有效地用于双尖瓣解剖结构的年轻患者。瓣膜功能持久,瓣膜相关并发症发生率低。对于经过适当选择的二尖瓣主动脉病患者来说,VSRR是一种极具吸引力且可能优于传统根部置换术的选择。
{"title":"Bicuspid aortic valve repair in the setting of severe aortic insufficiency.","authors":"Ziv Beckerman, Michael O Kayatta, LaRonica McPherson, Jose N Binongo, Yi Lasanajak, Bradley G Leshnower, Edward P Chen","doi":"10.21037/jovs.2018.04.13","DOIUrl":"10.21037/jovs.2018.04.13","url":null,"abstract":"<p><strong>Background: </strong>Bicuspid aortic valve (BAV) is a common cardiac anomaly that affects 0.5-2% of adults. Valve sparing root replacement (VSRR) in bicuspid aortopathy is gaining popularity. We discuss the technical aspects of the procedure as well as the mid- to long-term results of performing VSRR in the setting of a bicuspid valve.</p><p><strong>Methods: </strong>A single institutional database identified 280 patients who underwent VSRR from 2005-2016. Outcomes were analyzed in 60 consecutive patients undergoing a VSRR in the setting of a BAV with aortic regurgitation (AR). Patients were followed prospectively and had annual echocardiograms.</p><p><strong>Results: </strong>The average age in this series was 42±11 years. Moderate or more AR was present in 50% of patients preoperatively. The incidence of operative death, stroke, and renal failure was 0%. Mean follow-up was 39±30 months. At latest follow-up, 62% of patients had zero AR and 87% of patients had <1+ AR. At 9 years, freedom from >2+ AR was 97% and freedom from aortic valve repair (AVR) was 96%.</p><p><strong>Conclusions: </strong>VSRR can be safely and effectively performed in young patients with bicuspid valve anatomy regardless of degree of pre-operative AR. Valve function is durable and the incidence of valve-related complications is low. VSRR is an attractive and potentially superior option to conventional root replacement in appropriately selected patients with bicuspid aortopathy.</p>","PeriodicalId":17587,"journal":{"name":"Journal of visualized surgery","volume":"4 ","pages":"101"},"PeriodicalIF":0.0,"publicationDate":"2018-05-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5994457/pdf/jovs-04-2018.04.13.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"36274173","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Transcaval transcatheter aortic valve replacement: a visual case review. 经颅经导管主动脉瓣置换术:一个目视病例回顾。
Pub Date : 2018-05-14 eCollection Date: 2018-01-01 DOI: 10.21037/jovs.2018.04.02
Kamran I Muhammad, Georgianne C Tokarchik

Transcatheter aortic valve replacement (TAVR) has emerged as a viable, minimally-invasive and widely adopted approach for the treatment of severe symptomatic aortic stenosis in patients who are intermediate-risk or greater for surgical aortic valve replacement. Numerous studies have demonstrated favorable outcomes with TAVR in this population, particularly with transfemoral access TAVR. Transfemoral TAVR has been shown to be safer and associated less morbidity, shorter lengths of hospital stay and more rapid recovery as compared with traditional thoracic alternative-access TAVR (transapical or transaortic). Despite iterative advancements in transcatheter heart valve technology and delivery system, there remain a portion of patients with iliofemoral arterial vessel sizes that are too small for safe transfemoral TAVR. Paradoxically, these patients are generally higher risk and are thus less favorable candidates for open surgery or traditional alternative-access TAVR. With these considerations in mind, transcaval TAVR was developed as a fully percutaneous, non-surgical approach for aortic valve replacement in patients who are poor candidates for traditional alternative-access TAVR. In this manuscript we describe the principles on which transcaval TAVR was developed, the outcomes from the largest trial completed evaluating this technique as well as describing the technique used to perform this procedure in a case-based format.

经导管主动脉瓣置换术(Transcatheter aortic valve replacement, TAVR)是一种可行的、微创的、被广泛采用的治疗严重症状性主动脉瓣狭窄的方法,适用于手术主动脉瓣置换术的中度或更大风险患者。许多研究已经证明TAVR在这一人群中有良好的结果,特别是经股通道TAVR。经股骨TAVR已被证明比传统的胸椎可选通道TAVR(经根尖或经主动脉)更安全,发病率更低,住院时间更短,恢复更快。尽管经导管心脏瓣膜技术和输送系统不断进步,但仍有一部分患者髂股动脉血管太小,无法进行安全的经股TAVR。矛盾的是,这些患者通常风险较高,因此不太适合开放手术或传统的替代通道TAVR。考虑到这些因素,经腔TAVR作为一种完全经皮、非手术的主动脉瓣置换术被开发出来,用于那些不适合传统替代通道TAVR的患者。在这篇文章中,我们描述了开发经颅TAVR的原理,完成了评估该技术的最大试验的结果,并描述了以病例为基础的格式执行该程序所使用的技术。
{"title":"Transcaval transcatheter aortic valve replacement: a visual case review.","authors":"Kamran I Muhammad,&nbsp;Georgianne C Tokarchik","doi":"10.21037/jovs.2018.04.02","DOIUrl":"https://doi.org/10.21037/jovs.2018.04.02","url":null,"abstract":"<p><p>Transcatheter aortic valve replacement (TAVR) has emerged as a viable, minimally-invasive and widely adopted approach for the treatment of severe symptomatic aortic stenosis in patients who are intermediate-risk or greater for surgical aortic valve replacement. Numerous studies have demonstrated favorable outcomes with TAVR in this population, particularly with transfemoral access TAVR. Transfemoral TAVR has been shown to be safer and associated less morbidity, shorter lengths of hospital stay and more rapid recovery as compared with traditional thoracic alternative-access TAVR (transapical or transaortic). Despite iterative advancements in transcatheter heart valve technology and delivery system, there remain a portion of patients with iliofemoral arterial vessel sizes that are too small for safe transfemoral TAVR. Paradoxically, these patients are generally higher risk and are thus less favorable candidates for open surgery or traditional alternative-access TAVR. With these considerations in mind, transcaval TAVR was developed as a fully percutaneous, non-surgical approach for aortic valve replacement in patients who are poor candidates for traditional alternative-access TAVR. In this manuscript we describe the principles on which transcaval TAVR was developed, the outcomes from the largest trial completed evaluating this technique as well as describing the technique used to perform this procedure in a case-based format.</p>","PeriodicalId":17587,"journal":{"name":"Journal of visualized surgery","volume":"4 ","pages":"102"},"PeriodicalIF":0.0,"publicationDate":"2018-05-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.21037/jovs.2018.04.02","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"36274174","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 3
Novel extra-thoracic VATS minimally invasive technique for management of multiple rib fractures. 新型胸外VATS微创技术治疗多发性肋骨骨折。
Pub Date : 2018-05-14 eCollection Date: 2018-01-01 DOI: 10.21037/jovs.2018.05.08
Natalie N Merchant, Osita Onugha
We report an elderly patient with chronic obstructive pulmonary disease (COPD), Alzheimer's disease and early dementia who presented with multiple displaced rib fractures of left ribs 4 through 9 with flail segments of ribs 4 through 8 and an associated traumatic pneumatocele from rib puncture of the left upper lobe. The decision to treat this patient operatively was based on the presence of flail chest, the patient's age, baseline co-morbidities and limited physiological reserve. Surgical rib fixation is traditionally performed with a thoracotomy incision and open exposure for extra-thoracic rib fixation, however, this patient underwent chest wall stabilization using an extra-thoracic video-assisted thoracic surgery (VATS) technique. We discuss our operative technique using universal rib plating system, optimal retraction for exposure and use of balloon dilation to create an accessible extra-thoracic working space. This surgical approach provided a faster recovery to this patient's baseline with minimal use of narcotics thereby highlighting the impact and importance of this surgical technique for patients presenting with multiple fib fractures, especially the elderly. We show that VATS assisted minimally invasive technique for operative management of multiple rib fractures is a viable surgical option demonstrated by this patient's recovery and return to function with minimal need for pain control despite her advanced age and baseline co-morbidities.
我们报告了一位患有慢性阻塞性肺疾病(COPD)、阿尔茨海默病和早期痴呆的老年患者,其表现为左肋骨4至9的多处移位性肋骨骨折,肋骨4至8的连枷节段,并伴有左上肺叶肋骨穿刺引起的创伤性气膨出。决定对该患者进行手术治疗是基于连枷胸的存在、患者的年龄、基线合并症和有限的生理储备。外科肋骨固定传统上是通过开胸切口和开放暴露进行胸外肋骨固定,然而,该患者使用胸外视频辅助胸外科(VATS)技术进行胸壁稳定。我们讨论了我们的手术技术,使用通用肋骨电镀系统,最佳的暴露回缩和使用球囊扩张来创造一个可接近的胸外工作空间。该手术方法以最小的麻醉药用量使患者更快地恢复到基线,从而突出了该手术技术对多发fib骨折患者,特别是老年人的影响和重要性。我们表明,VATS辅助微创技术用于多处肋骨骨折的手术治疗是一种可行的手术选择,该患者尽管高龄和基线合并症,但恢复和恢复功能的疼痛控制需求最小。
{"title":"Novel extra-thoracic VATS minimally invasive technique for management of multiple rib fractures.","authors":"Natalie N Merchant,&nbsp;Osita Onugha","doi":"10.21037/jovs.2018.05.08","DOIUrl":"https://doi.org/10.21037/jovs.2018.05.08","url":null,"abstract":"We report an elderly patient with chronic obstructive pulmonary disease (COPD), Alzheimer's disease and early dementia who presented with multiple displaced rib fractures of left ribs 4 through 9 with flail segments of ribs 4 through 8 and an associated traumatic pneumatocele from rib puncture of the left upper lobe. The decision to treat this patient operatively was based on the presence of flail chest, the patient's age, baseline co-morbidities and limited physiological reserve. Surgical rib fixation is traditionally performed with a thoracotomy incision and open exposure for extra-thoracic rib fixation, however, this patient underwent chest wall stabilization using an extra-thoracic video-assisted thoracic surgery (VATS) technique. We discuss our operative technique using universal rib plating system, optimal retraction for exposure and use of balloon dilation to create an accessible extra-thoracic working space. This surgical approach provided a faster recovery to this patient's baseline with minimal use of narcotics thereby highlighting the impact and importance of this surgical technique for patients presenting with multiple fib fractures, especially the elderly. We show that VATS assisted minimally invasive technique for operative management of multiple rib fractures is a viable surgical option demonstrated by this patient's recovery and return to function with minimal need for pain control despite her advanced age and baseline co-morbidities.","PeriodicalId":17587,"journal":{"name":"Journal of visualized surgery","volume":"4 ","pages":"103"},"PeriodicalIF":0.0,"publicationDate":"2018-05-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.21037/jovs.2018.05.08","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"36274175","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 5
Aortic and mitral valve repair for anterior mitral leaflet perforation caused by severe aortic regurgitation. 主动脉瓣及二尖瓣修补术治疗严重主动脉反流引起的二尖瓣前叶穿孔。
Pub Date : 2018-05-11 eCollection Date: 2018-01-01 DOI: 10.21037/jovs.2018.04.16
Kristof De Brabandere, Jens-Uwe Voigt, Stephen Rex, Bart Meuris, Peter Verbrugghe

A 23-year-old man presented with acute onset of dyspnea on exert. Preoperative echocardiography showed a severe regurgitation of the bicuspid aortic valve (due to prolapse of the fused cusp) creating a jet directed through the defect in the anterior leaflet of the mitral valve. Both valves were repaired. Endocarditis was excluded with cultures and polymerase chain reaction (PCR). Postoperative course was uneventful.

一名23岁男性,在运动时出现急性呼吸困难。术前超声心动图显示二尖主动脉瓣严重反流(由于融合瓣尖脱垂),形成一个直接穿过二尖瓣前叶缺陷的射流。两个阀门都修好了。通过培养和聚合酶链反应(PCR)排除心内膜炎。术后过程顺利。
{"title":"Aortic and mitral valve repair for anterior mitral leaflet perforation caused by severe aortic regurgitation.","authors":"Kristof De Brabandere,&nbsp;Jens-Uwe Voigt,&nbsp;Stephen Rex,&nbsp;Bart Meuris,&nbsp;Peter Verbrugghe","doi":"10.21037/jovs.2018.04.16","DOIUrl":"https://doi.org/10.21037/jovs.2018.04.16","url":null,"abstract":"<p><p>A 23-year-old man presented with acute onset of dyspnea on exert. Preoperative echocardiography showed a severe regurgitation of the bicuspid aortic valve (due to prolapse of the fused cusp) creating a jet directed through the defect in the anterior leaflet of the mitral valve. Both valves were repaired. Endocarditis was excluded with cultures and polymerase chain reaction (PCR). Postoperative course was uneventful.</p>","PeriodicalId":17587,"journal":{"name":"Journal of visualized surgery","volume":"4 ","pages":"99"},"PeriodicalIF":0.0,"publicationDate":"2018-05-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.21037/jovs.2018.04.16","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"36274171","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 2
Endoscopic Port AccessTM left ventricle outflow tract resection and atrioventricular valve surgery. 内镜下左心室流出道切除及房室瓣膜手术。
Pub Date : 2018-05-11 eCollection Date: 2018-01-01 DOI: 10.21037/jovs.2018.05.01
Johan van der Merwe, Filip Casselman, Frank Van Praet

The continuous evolution in robotic-, endoscopic- and trans-catheter cardiac interventions resulted in innovative techniques that simultaneously address left ventricular outflow tract obstruction (LVOTO) and concomitant atrioventricular valve (AVV) pathology in the context of hypertrophic obstructive cardiomyopathy (HOCM). We present our brief report of 13 consecutive HOCM patients with concomitant AVV disease, who underwent endoscopic left ventricular septal myomectomy (LVSM) and AVV surgery by Endoscopic Port AccessTM Surgery (EPAS) between March 1st 2010 and October 31st 2015. Our EPAS technique in the context of HOCM utilizes peripheral cardiopulmonary bypass, endo-aortic balloon occlusion and a 4-cm right antero-lateral thoracic working port. Access to the LVOTO is obtained by detaching the anterior mitral valve (MV) leaflet from the annulus. Controlled sharp LVSM is then performed from the aortic leaflet base to the papillary muscles. Subsequent routine AVV surgery is performed using long shafted instruments. There were no sternotomy conversions, LVSM complications or 30-day mortalities. The mean length of hospitalization was 17.7±18.1 days. Long-term clinical and echocardiographic analysis of 645.7 patient-months (n=13, 100.0% complete) identified two late mortalities, which were not procedure-, HOCM- or AVV-related. All patients (n=13, 100.0%), including the late mortalities, had significant improvement in their quality of life, a 100% long-term freedom from re-intervention and no residual peak instantaneous LVOTO gradients more than 15 mmHg. This brief report emphasises that simultaneous LVSM and concomitant AVV surgery by EPAS can safely be performed in experienced centres with favourable long-term outcomes.

在肥厚性梗阻心肌病(HOCM)的背景下,机器人、内窥镜和经导管心脏介入治疗的不断发展导致了创新技术的出现,这些技术同时解决了左心室流出道阻塞(LVOTO)和伴随的房室瓣膜(AVV)病理。我们报告了2010年3月1日至2015年10月31日期间连续13例合并AVV疾病的HOCM患者,他们接受了内窥镜左室间隔肌瘤切除术(LVSM)和内窥镜Port AccessTM手术(EPAS)的AVV手术。在HOCM的情况下,我们的EPAS技术利用外周体外循环、主动脉内球囊闭塞和一个4厘米的右胸前外侧工作口。通过将前二尖瓣(MV)小叶从二尖瓣环上分离,可以进入左二尖瓣。然后从主动脉小叶基部到乳头肌进行有控制的尖锐LVSM。随后的常规AVV手术使用长轴器械进行。无胸骨切开术转换、LVSM并发症或30天死亡率。平均住院时间为17.7±18.1 d。645.7个患者月的长期临床和超声心动图分析(n=13, 100.0%完成)确定了2例晚期死亡,与手术、HOCM或avv无关。所有患者(n=13, 100.0%),包括晚期死亡患者,其生活质量均有显著改善,100%长期免于再干预,且无残余峰值瞬时LVOTO梯度超过15 mmHg。这份简短的报告强调,在经验丰富的中心,EPAS同时进行LVSM和伴随的AVV手术可以安全进行,并具有良好的长期预后。
{"title":"Endoscopic Port Access<sup>TM</sup> left ventricle outflow tract resection and atrioventricular valve surgery.","authors":"Johan van der Merwe,&nbsp;Filip Casselman,&nbsp;Frank Van Praet","doi":"10.21037/jovs.2018.05.01","DOIUrl":"https://doi.org/10.21037/jovs.2018.05.01","url":null,"abstract":"<p><p>The continuous evolution in robotic-, endoscopic- and trans-catheter cardiac interventions resulted in innovative techniques that simultaneously address left ventricular outflow tract obstruction (LVOTO) and concomitant atrioventricular valve (AVV) pathology in the context of hypertrophic obstructive cardiomyopathy (HOCM). We present our brief report of 13 consecutive HOCM patients with concomitant AVV disease, who underwent endoscopic left ventricular septal myomectomy (LVSM) and AVV surgery by Endoscopic Port Access<sup>TM</sup> Surgery (EPAS) between March 1st 2010 and October 31st 2015. Our EPAS technique in the context of HOCM utilizes peripheral cardiopulmonary bypass, endo-aortic balloon occlusion and a 4-cm right antero-lateral thoracic working port. Access to the LVOTO is obtained by detaching the anterior mitral valve (MV) leaflet from the annulus. Controlled sharp LVSM is then performed from the aortic leaflet base to the papillary muscles. Subsequent routine AVV surgery is performed using long shafted instruments. There were no sternotomy conversions, LVSM complications or 30-day mortalities. The mean length of hospitalization was 17.7±18.1 days. Long-term clinical and echocardiographic analysis of 645.7 patient-months (n=13, 100.0% complete) identified two late mortalities, which were not procedure-, HOCM- or AVV-related. All patients (n=13, 100.0%), including the late mortalities, had significant improvement in their quality of life, a 100% long-term freedom from re-intervention and no residual peak instantaneous LVOTO gradients more than 15 mmHg. This brief report emphasises that simultaneous LVSM and concomitant AVV surgery by EPAS can safely be performed in experienced centres with favourable long-term outcomes.</p>","PeriodicalId":17587,"journal":{"name":"Journal of visualized surgery","volume":"4 ","pages":"100"},"PeriodicalIF":0.0,"publicationDate":"2018-05-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.21037/jovs.2018.05.01","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"36274172","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 1
The evidence in a Bentall procedure with Valsalva graft: is this standard of care? 本特尔手术与Valsalva移植物的证据:这是标准的护理吗?
Pub Date : 2018-05-10 eCollection Date: 2018-01-01 DOI: 10.21037/jovs.2018.04.05
Ziv Beckerman, Bradley G Leshnower, LaRonica McPherson, Jose N Binongo, Yi Lasanajak, Edward P Chen

Background: Biologic valved-conduits avoids the need for anticoagulation and can exploit the excellent hemodynamic performance of stentless valves. Incorporation of the sinuses of Valsalva into the neoaortic root can improve the function and longevity of stentless valves. We report our experience in performing the Bentall procedure with a self-prefabricated composite valved-conduit and review the published experience with the Valsalva graft.

Methods: From Feb 2005 through Sep 2017, 428 patients underwent aortic root replacement utilizing a composite graft constructed from a 27-29-mm Freestyle MS valve (Medtronic) sutured into a 28-30-mm Gelweave Valsalva prosthesis (Sulzer Vascutek, Renfrewshire, Scotland). Data were retrospectively analyzed.

Results: Mean age was 58±13 years, with a male predominance (337, 79%). Additional surgical procedures included a mitral valve repair/replacement in 10 patients (2%), coronary artery bypass graft (CABG) in 114 patients (27%), and aortic arch (hemi or total) replacement in 252 patients (59%). Average cardiopulmonary bypass, cross-clamp, and circulatory arrest times were 210±57, 180±44, and 29±15 min, respectively. Thirty-day mortality was 7% (31 patients). Mean echocardiography follow-up was 27.2±29.0 months (range, 1-138 months). Pressure gradients (mean, peak) across the aortic valve on latest echocardiography were 5.59, 10.57 mmHg respectively. Freedom from >2+ aortic insufficiency (AI) at 6 and 9 years was 96%, and 87% respectively. Freedom from aortic valve replacement (AVR) at 6 and 9 years was 99%, and 95% respectively. To date, 4 (1%) patients required an additional aortic valve intervention secondary to structural valve degeneration.

Conclusions: Use of the Valsalva graft combined with the Freestyle valve for Bentall procedures is associated with favorable results. Clinical outcomes are excellent and in longitudinal follow-up, valve-related complications are minimal.

背景:生物瓣膜导管避免了抗凝的需要,利用了无支架瓣膜良好的血流动力学性能。将Valsalva窦合并到新主动脉根部可以改善无支架瓣膜的功能和寿命。我们报告了我们使用自预制复合瓣膜导管进行本特尔手术的经验,并回顾了Valsalva移植物的已发表经验。方法:从2005年2月到2017年9月,428例患者接受了主动脉根部置换术,使用27-29毫米自由式MS瓣膜(美多力)与28-30毫米Gelweave Valsalva假体(Sulzer Vascutek, Renfrewshire, Scotland)缝合而成的复合移植物。回顾性分析资料。结果:平均年龄58±13岁,男性居多(337,79 %)。其他手术包括10例(2%)的二尖瓣修复/置换术,114例(27%)的冠状动脉旁路移植(CABG), 252例(59%)的主动脉弓(部分或全部)置换术。体外循环、交叉钳夹和循环停止的平均时间分别为210±57分钟、180±44分钟和29±15分钟。30天死亡率为7%(31例)。超声心动图随访时间平均27.2±29.0个月(范围1 ~ 138个月)。最新超声心动图显示主动脉瓣压力梯度(平均值、峰值)分别为5.59、10.57 mmHg。6年和9年无>2+主动脉不全(AI)分别为96%和87%。6年和9年主动脉瓣置换术(AVR)的自由度分别为99%和95%。到目前为止,4例(1%)患者因结构性瓣膜退变需要额外的主动脉瓣介入治疗。结论:在Bentall手术中使用Valsalva移植物联合Freestyle瓣膜具有良好的效果。临床结果很好,在纵向随访中,瓣膜相关并发症很少。
{"title":"The evidence in a Bentall procedure with Valsalva graft: is this standard of care?","authors":"Ziv Beckerman,&nbsp;Bradley G Leshnower,&nbsp;LaRonica McPherson,&nbsp;Jose N Binongo,&nbsp;Yi Lasanajak,&nbsp;Edward P Chen","doi":"10.21037/jovs.2018.04.05","DOIUrl":"https://doi.org/10.21037/jovs.2018.04.05","url":null,"abstract":"<p><strong>Background: </strong>Biologic valved-conduits avoids the need for anticoagulation and can exploit the excellent hemodynamic performance of stentless valves. Incorporation of the sinuses of Valsalva into the neoaortic root can improve the function and longevity of stentless valves. We report our experience in performing the Bentall procedure with a self-prefabricated composite valved-conduit and review the published experience with the Valsalva graft.</p><p><strong>Methods: </strong>From Feb 2005 through Sep 2017, 428 patients underwent aortic root replacement utilizing a composite graft constructed from a 27-29-mm Freestyle MS valve (Medtronic) sutured into a 28-30-mm Gelweave Valsalva prosthesis (Sulzer Vascutek, Renfrewshire, Scotland). Data were retrospectively analyzed.</p><p><strong>Results: </strong>Mean age was 58±13 years, with a male predominance (337, 79%). Additional surgical procedures included a mitral valve repair/replacement in 10 patients (2%), coronary artery bypass graft (CABG) in 114 patients (27%), and aortic arch (hemi or total) replacement in 252 patients (59%). Average cardiopulmonary bypass, cross-clamp, and circulatory arrest times were 210±57, 180±44, and 29±15 min, respectively. Thirty-day mortality was 7% (31 patients). Mean echocardiography follow-up was 27.2±29.0 months (range, 1-138 months). Pressure gradients (mean, peak) across the aortic valve on latest echocardiography were 5.59, 10.57 mmHg respectively. Freedom from >2+ aortic insufficiency (AI) at 6 and 9 years was 96%, and 87% respectively. Freedom from aortic valve replacement (AVR) at 6 and 9 years was 99%, and 95% respectively. To date, 4 (1%) patients required an additional aortic valve intervention secondary to structural valve degeneration.</p><p><strong>Conclusions: </strong>Use of the Valsalva graft combined with the Freestyle valve for Bentall procedures is associated with favorable results. Clinical outcomes are excellent and in longitudinal follow-up, valve-related complications are minimal.</p>","PeriodicalId":17587,"journal":{"name":"Journal of visualized surgery","volume":"4 ","pages":"98"},"PeriodicalIF":0.0,"publicationDate":"2018-05-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.21037/jovs.2018.04.05","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"36274170","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 6
Uniportal, single incision VATS for the skeptics. 对怀疑论者来说,单切口,单通道VATS。
Pub Date : 2018-05-09 eCollection Date: 2018-01-01 DOI: 10.21037/jovs.2018.05.06
Marcello Migliore
As surgeons we are living in an amazing era. Rapid advances in technology transform our surgeries in countless ways. After 20 years the first uniportal VATS were performed (1-3), the procedure has its own space in the thoracic surgery (4), and this special issue takes the readers to reflect on the exciting recent development and future expectations of this modern and futuristic surgical approach.
{"title":"Uniportal, single incision VATS for the skeptics.","authors":"Marcello Migliore","doi":"10.21037/jovs.2018.05.06","DOIUrl":"https://doi.org/10.21037/jovs.2018.05.06","url":null,"abstract":"As surgeons we are living in an amazing era. Rapid advances in technology transform our surgeries in countless ways. After 20 years the first uniportal VATS were performed (1-3), the procedure has its own space in the thoracic surgery (4), and this special issue takes the readers to reflect on the exciting recent development and future expectations of this modern and futuristic surgical approach.","PeriodicalId":17587,"journal":{"name":"Journal of visualized surgery","volume":"4 ","pages":"97"},"PeriodicalIF":0.0,"publicationDate":"2018-05-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5994449/pdf/jovs-04-2018.05.06.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"36274169","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 2
Made for each other. 为彼此而生。
Pub Date : 2018-05-09 eCollection Date: 2018-01-01 DOI: 10.21037/jovs.2018.05.12
Alan D L Sihoe, Diego Gonzalez-Rivas
This special issue represents the perfect marriage of two of the strongest trends in thoracic surgery today.
{"title":"Made for each other.","authors":"Alan D L Sihoe,&nbsp;Diego Gonzalez-Rivas","doi":"10.21037/jovs.2018.05.12","DOIUrl":"https://doi.org/10.21037/jovs.2018.05.12","url":null,"abstract":"This special issue represents the perfect marriage of two of the strongest trends in thoracic surgery today.","PeriodicalId":17587,"journal":{"name":"Journal of visualized surgery","volume":"4 ","pages":"96"},"PeriodicalIF":0.0,"publicationDate":"2018-05-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5994445/pdf/jovs-04-2018.05.12.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"36274167","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 9
期刊
Journal of visualized surgery
全部 Acc. Chem. Res. ACS Applied Bio Materials ACS Appl. Electron. Mater. ACS Appl. Energy Mater. ACS Appl. Mater. Interfaces ACS Appl. Nano Mater. ACS Appl. Polym. Mater. ACS BIOMATER-SCI ENG ACS Catal. ACS Cent. Sci. ACS Chem. Biol. ACS Chemical Health & Safety ACS Chem. Neurosci. ACS Comb. Sci. ACS Earth Space Chem. ACS Energy Lett. ACS Infect. Dis. ACS Macro Lett. ACS Mater. Lett. ACS Med. Chem. Lett. ACS Nano ACS Omega ACS Photonics ACS Sens. ACS Sustainable Chem. Eng. ACS Synth. Biol. Anal. Chem. BIOCHEMISTRY-US Bioconjugate Chem. BIOMACROMOLECULES Chem. Res. Toxicol. Chem. Rev. Chem. Mater. CRYST GROWTH DES ENERG FUEL Environ. Sci. Technol. Environ. Sci. Technol. Lett. Eur. J. Inorg. Chem. IND ENG CHEM RES Inorg. Chem. J. Agric. Food. Chem. J. Chem. Eng. Data J. Chem. Educ. J. Chem. Inf. Model. J. Chem. Theory Comput. J. Med. Chem. J. Nat. Prod. J PROTEOME RES J. Am. Chem. Soc. LANGMUIR MACROMOLECULES Mol. Pharmaceutics Nano Lett. Org. Lett. ORG PROCESS RES DEV ORGANOMETALLICS J. Org. Chem. J. Phys. Chem. J. Phys. Chem. A J. Phys. Chem. B J. Phys. Chem. C J. Phys. Chem. Lett. Analyst Anal. Methods Biomater. Sci. Catal. Sci. Technol. Chem. Commun. Chem. Soc. Rev. CHEM EDUC RES PRACT CRYSTENGCOMM Dalton Trans. Energy Environ. Sci. ENVIRON SCI-NANO ENVIRON SCI-PROC IMP ENVIRON SCI-WAT RES Faraday Discuss. Food Funct. Green Chem. Inorg. Chem. Front. Integr. Biol. J. Anal. At. Spectrom. J. Mater. Chem. A J. Mater. Chem. B J. Mater. Chem. C Lab Chip Mater. Chem. Front. Mater. Horiz. MEDCHEMCOMM Metallomics Mol. Biosyst. Mol. Syst. Des. Eng. Nanoscale Nanoscale Horiz. Nat. Prod. Rep. New J. Chem. Org. Biomol. Chem. Org. Chem. Front. PHOTOCH PHOTOBIO SCI PCCP Polym. Chem.
×
引用
GB/T 7714-2015
复制
MLA
复制
APA
复制
导出至
BibTeX EndNote RefMan NoteFirst NoteExpress
×
0
微信
客服QQ
Book学术公众号 扫码关注我们
反馈
×
意见反馈
请填写您的意见或建议
请填写您的手机或邮箱
×
提示
您的信息不完整,为了账户安全,请先补充。
现在去补充
×
提示
您因"违规操作"
具体请查看互助需知
我知道了
×
提示
现在去查看 取消
×
提示
确定
Book学术官方微信
Book学术文献互助
Book学术文献互助群
群 号:481959085
Book学术
文献互助 智能选刊 最新文献 互助须知 联系我们:info@booksci.cn
Book学术提供免费学术资源搜索服务,方便国内外学者检索中英文文献。致力于提供最便捷和优质的服务体验。
Copyright © 2023 Book学术 All rights reserved.
ghs 京公网安备 11010802042870号 京ICP备2023020795号-1