Multimedia manual of cardiothoracic surgery : MMCTS / European Association for Cardio-Thoracic Surgery最新文献

Accidental ingestion of dentures is a relatively infrequent yet clinically significant problem, often resulting in oesophageal impaction, particularly in edentulous patients who wear removable dentures. Ingestion of dentures poses a significant risk of mucosal injury or perforation during endoscopic retrieval, owing to their large size, sharp edges and metal clasps, and hence requires a low threshold for surgical intervention. This video tutorial demonstrates the technique of robotic-assisted thoracoscopic oesophagotomy and removal of the impacted denture followed by repair of the oesophagotomy.

Our objective is to underline that patients with small aortic annulus can present with concomitant left outflow tract obstruction, and both pathologies need to be addressed during surgery to avoid residual symptoms and early re-intervention. We present a third-time re-operation where intra-operative findings revealed degenerated sutureless valve with pannus underneath, which was explanted after meticulous dissection of the prosthesis cuff from the left ventricular outflow tract. The fibrotic ridge was excised and a basal septal myectomy was performed, removing 2.8 g of septal muscle. The aortotomy was extended through the left-non coronary commissure and toward the right and left fibrous trigones. A posterior bovine pericardium 'Y' patch was used for annular enlargement to accommodate a 25 mm INSPIRIS valve. Nonetheless, the mitral valve was repaired with a 29 mm posterior annuloplasty ring, and the tricuspid valve with a 30 mm annuloplasty ring.

This report presents a novel robotic-assisted surgical technique for bronchial reimplantation in patients with complete bronchial stenosis after tuberculosis treatment. A 34-year-old female patient with progressive dyspnoea was diagnosed with complete bronchial stenosis and total left lung atelectasis. After unsuccessful bronchial dilation attempts, robotic-assisted bronchial reimplantation with veno-venous extracorporeal membrane oxygenation support was undertaken. Intra-operative bronchoscopy ensured airway patency throughout the procedure. At 1-year follow-up, the patient remained asymptomatic in daily activities, with no late complications or restenosis, reinforcing the long-term efficacy of the procedure. This technique demonstrates the potential for enhanced surgical outcomes in managing complex bronchial stenosis. The findings highlight the viability of this advanced technique in improving respiratory function and patient recovery.

Ganglioneuromas are rare, benign neurogenic tumours, most often located in the posterior mediastinum. We present an exceptional case of a stellate ganglion ganglioneuroma at the left cervicothoracic junction, abutting the subclavian artery, oesophagus, sympathetic chain and vertebral bodies. The patient presented with significant shortness of breath and paraesthesia in the left arm. Cross-sectional imaging confirmed a well-encapsulated paravertebral mass in the left posterior mediastinum. Given the intricate anatomy of the thoracic inlet and proximity to multiple critical structures, a robotic-assisted thoracic surgical approach using the da Vinci Xi platform was employed. Robot-assisted resection transformed this complex and confined space into a clear, magnified operative field, enabling micro-instrument precision to safely mobilize the mass while avoiding injury to adjacent neurovascular structures. Complete excision was achieved with histopathology confirming ganglioneuroma. The patient's compressive symptoms resolved, though she developed Harlequin syndrome as a direct consequence of partial stellate ganglion resection. This case highlights both the rarity of stellate ganglion ganglioneuromas and the unique value of robotic-assisted surgery in navigating anatomically complex regions. The enhanced visualization and precision of the da Vinci Xi system enabled safe resection with reduced morbidity and expedited recovery.

Persistent and long-standing persistent atrial fibrillation are associated with numerous adverse outcomes and significantly impaired quality of life. Endocardial catheter ablation (CA) alone has limited efficacy in this population. Hybrid approaches combining epicardial ablation, including left atrial appendage exclusion, with complementary endocardial CA have demonstrated improved outcomes. This video tutorial illustrates a hybrid technique involving left atrial dome ablation and left atrial appendage exclusion via left thoracotomy, along with posterior left atrial wall ablation through a subxiphoid approach. Endocardial CA is subsequently performed during the same procedure.

We report a case of a 77-year-old woman with an aneurysmal coronary-pulmonary artery fistula, which was incidentally identified on contrast-enhanced computed tomography. To prevent rupture and other potential complications, surgical repair was indicated. The procedure was performed via bilateral minithoracotomy, providing sufficient exposure while minimizing invasiveness. The aneurysmal segment was successfully excluded without intra-operative complications. Post-operative contrast-enhanced computed tomography confirmed complete exclusion of the lesion with no residual opacification. The patient's recovery was uneventful. This video tutorial demonstrates the step-by-step surgical technique used in this case, highlighting key considerations in exposure, fistula identification and closure. A bilateral minimally invasive approach may be a safe and effective option for selected patients with aneurysmal coronary-pulmonary artery fistulae, especially when conventional sternotomy is not desirable. This case adds to the limited literature on minimally invasive treatment of this rare condition and may assist surgeons in planning similar procedures.

Robotic mitral repair is often associated with longer ischaemic and cardiopulmonary bypass times, particularly early in the learning curve. We demonstrate a semi-continuous, three-suture technique for robotic annuloplasty that retains the mechanical principles of traditional interrupted sutures while leveraging the advantages of robotic precision and exposure. The use of pre-knotted sutures minimizes intra-cardiac knot tying, further enhancing procedural efficiency.

Three-dimensional (3D) guided robotic-assisted thoracic surgery is increasingly recognized as a leading technique for undertaking the most complex pulmonary resections, providing high-definition 3D visualization, advanced instrument control and tremor-free tissue handling. Compared with open thoracotomy, the robotic platform offers reduced peri-operative complications, shorter hospital stays and faster patient recovery. Nevertheless, sublobar resections, such as segmentectomies, remain both anatomically intricate and technically challenging, particularly when resecting multiple segments, as in this left S1 and S2 segmentectomy. Incorporating 3D reconstruction imaging facilitates comprehensive pre-operative evaluation of bronchovascular anatomy, enabling tailored operative planning and therefore more precise dissection. Despite these benefits, the consistent use of 3D virtual modelling in thoracic surgery is still limited and underrepresented within the current literature. This video tutorial constitutes the fifth entry in the "Segmentectomies Made Easy" atlas and showcases a robotic left S1 and S2 segmentectomy performed for a primary pulmonary lesion in the S2 segment. Pre-operative 3D imaging identified key anatomical variances that directly informed the surgical approach. The tutorial delivers a structured, step-by-step overview of the operation, from port placement through to vascular division and complex anatomical delineation, highlighting the ways in which 3D visualization augments surgical precision, enhances intra-operative decision-making and contributes to optimized robotic-assisted thoracic surgery outcomes.

Birt-Hogg-Dubé syndrome (BHDS) is an autosomal dominant inherited disorder caused by mutation in a tumour suppressor gene, FLCN, leading to skin tumours (fibrofolliculomas), renal tumours and pulmonary cysts. Lung involvement is predominantly observed in 70% of the cases of BHDS, manifesting in the form of recurrent primary spontaneous pneumothorax. This video tutorial showcases the surgical management of recurrent right primary spontaneous pneumothorax in a young adult with a history of multiple episodes of bilateral pneumothorax managed by surgical intervention previously. The study underscores the efficacy of video-assisted thoracic surgery surgical management coupled with talc pleurodesis in restoring incomplete pleural symphysis in BHDS patients, as evident from successful surgery and uneventful recovery of the patient.

The patient had rheumatic heart disease, which resulted in severe aortic and mitral valve regurgitation. Repair of both valves was performed at 9 years of age. During surgery, the retracted aortic valve cusps required extension with bovine pericardial patches and suture reduction annuloplasty, and the mitral valve was repaired using a Cosgrove-Edwards (Edwards Lifesciences LLC, Irvine, CA) annuloplasty band. Post-operative echocardiography showed no regurgitation in either valve. The patient is doing well at 2 years of follow-up.