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Conversion technique from venovenous to venopulmonary ECMO support. 从静脉到静脉肺 ECMO 支持的转换技术。
Yuriy Stukov, Mindaugas Rackauskas, Marc O Maybauer

We present the cannulation technique for venopulmonary extracorporeal membrane oxygenation using the ProtekDuo dual-lumen cannula in a patient who, after a bilateral orthotopic lung transplant and coronavirus disease 2019 infection, was converted from a multisite venovenous extracorporeal membrane oxygenation configuration, using the same vessel.

我们介绍了使用 ProtekDuo 双腔套管进行静脉肺体外膜氧合的插管技术,该患者在接受了双侧正位肺移植和冠状病毒病 2019 感染后,从使用相同血管的多部位静脉体外膜氧合配置转为使用 ProtekDuo 双腔套管进行静脉肺体外膜氧合。
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引用次数: 0
Robotic-assisted left atrial appendage occlusion. 机器人辅助左心房阑尾闭塞术。
Massimo Baudo, Amanda Yakobitis, Courtney Murray, Gianluca Torregrossa

Atrial fibrillation poses significant stroke risks, particularly in patients undergoing cardiac surgery. Left atrial appendage occlusion has emerged as a crucial strategy for stroke prevention, garnering a Class I recommendation. This paper presents a technical framework for performing robotic left atrial appendage occlusion as an isolated procedure or concurrently with robotic coronary artery bypass grafting using the AtriCure AtriClip Pro2 device.

心房颤动有很大的中风风险,尤其是在接受心脏手术的患者中。左心房阑尾封堵术已成为预防中风的重要策略,获得了一级推荐。本文介绍了使用 AtriCure AtriClip Pro2 设备进行机器人左房阑尾闭塞术的技术框架,该手术既可以单独进行,也可以与机器人冠状动脉搭桥术同时进行。
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引用次数: 0
Subxiphoid robot-assisted complete resection for postchemotherapy primary mediastinal yolk sac tumour. 剑突下机器人辅助完全切除化疗后原发性纵隔卵黄囊肿瘤。
Yasunori Fukushima, Koyo Shirahashi, Hiroyasu Komuro, Yusaku Miyamoto, Mitsuyoshi Matsumoto, Hirotaka Yamamoto, Norihiko Ishikawa, Hisashi Iwata

The standard treatment for primary mediastinal yolk sac tumour involves neoadjuvant chemotherapy followed by residual tumour resection, typically performed through a median sternotomy or a thoracotomy. However, in this case, a 16-year-old patient with a large anterior mediastinal tumour underwent less invasive, subxiphoid, robot-assisted surgery using a 4-arm da Vinci Xi system with CO2 insufflation at 8 mmHg. The tumour, located in the right thymic lobe, was dissected using a technique similar to blunt dissection, bipolar electrocautery and vessel sealer. Pericardiotomy was performed suspecting tumour invasion, with the thickened pericardial border incised circularly from the left side. Preservation of the right phrenic nerve involved careful separation from the densely adherent tumour. A pulmonary wedge resection was also performed using a stapler. The pericardial defect was reconstructed using an expanded polytetrafluoroethylene sheet, sutured together with nylon threads, and the resected tumour was extracted with a retrieval bag. This subxiphoid robot-assisted approach is a minimally invasive option for malignant mediastinal tumours.

原发性纵隔卵黄囊肿瘤的标准治疗方法包括新辅助化疗,然后切除残余肿瘤,通常通过胸骨正中切开术或胸廓切开术进行。然而,在本病例中,一名患有巨大前纵隔肿瘤的16岁患者使用4臂达芬奇Xi系统,在8毫米汞柱二氧化碳充气条件下,接受了剑突下机器人辅助的微创手术。肿瘤位于右胸腺叶,采用类似钝性剥离、双极电灼和血管封堵器的技术对肿瘤进行了解剖。在怀疑肿瘤侵犯的情况下进行了心包切开术,从左侧环形切开增厚的心包边界。在保留右侧膈神经时,需要小心翼翼地与密集粘连的肿瘤分离。还使用订书机进行了肺楔形切除。使用膨体聚四氟乙烯片重建心包缺损,并用尼龙线缝合在一起,然后用取物袋取出切除的肿瘤。这种剑突下机器人辅助方法是治疗恶性纵隔肿瘤的微创选择。
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引用次数: 0
Successful minimally invasive treatment of a young patient with a dislocated Amplatzer Septal Occluder. 成功微创治疗一名 Amplatzer 间隔闭塞器脱位的年轻患者。
Gianpiero Buttiglione, Can Gollmann-Tepeköylü, Daniel Höfer, Michael Grimm, Nikolaos Bonaros

In this case report, we illustrate the minimally invasive endoscopic repair of an atrial septal defect via a right minithoracotomy in a young patient with a dislocated Amplatzer Septal Occluder.

在本病例报告中,我们展示了通过右侧小胸腔切口对一名 Amplatzer 房间隔封堵器脱位的年轻患者进行微创内窥镜修复房间隔缺损的手术。
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引用次数: 0
The role of 3-dimensional reconstruction imaging in bronchopulmonary sequestration. 三维重建成像在支气管肺栓塞中的作用。
Aishah Z Mughal, Ahmed El-Zeki, Ahmed M Habib

Bronchopulmonary sequestration is a congenital abnormality characterized by non-functioning lung tissue, abnormal connection with the tracheobronchial tree and anomalous systemic arterial supply. Although considered a rare phenomenon presenting early in life, sequestration may also present with recurrent chest infections in late adulthood. Additionally, bronchopulmonary sequestration may rarely be incidentally encountered during thoracic surgery. Several subtypes exist including intralobar, extralobar and hybrid bronchopulmonary sequestration (congenital pulmonary artery malformation). Surgical resection is curative and serves as the treatment of choice for symptomatic patients. Radiological imaging prior to surgery is essential in these patients because the arterial supply may be anatomically complex, and aberrant artery branches are common. Utilization of virtual 3-dimensional remodelling and computed tomography reconstruction imaging can not only establish a diagnosis of bronchopulmonary sequestration but can also optimize preoperative planning. This approach will ultimately prove useful in anticipating surgically challenging steps and avoiding unnecessary intraoperative complications. We present a video tutorial on the role of 3-dimensional reconstruction imaging in bronchopulmonary sequestration and a step-by-step guide for performing a right robotic-assisted surgical resection of an S2 hybrid bronchopulmonary sequestrated segment. This case is followed by a second case of intralobar bronchopulmonary sequestration encountered incidentally during thoracic surgery.

支气管肺动脉栓塞是一种先天性畸形,其特点是肺组织无功能、与气管支气管树的连接异常以及全身动脉供应异常。虽然被认为是一种罕见的现象,但在成年晚期也可能出现反复胸部感染。此外,支气管肺动脉栓塞很少会在胸外科手术中偶然发现。支气管肺动脉栓塞有几种亚型,包括肺内、肺外和混合型支气管肺动脉栓塞(先天性肺动脉畸形)。手术切除是治愈性的,是有症状患者的首选治疗方法。由于动脉供应在解剖学上可能很复杂,而且异常动脉分支很常见,因此手术前的放射成像对这些患者至关重要。利用虚拟三维重塑和计算机断层扫描重建成像不仅能确定支气管肺动脉栓塞的诊断,还能优化术前计划。这种方法最终将被证明有助于预测手术挑战性步骤并避免不必要的术中并发症。我们将通过视频教程介绍三维重建成像在支气管肺动脉栓塞中的作用,并逐步指导如何在机器人辅助下对 S2 混合支气管肺动脉栓塞段进行右侧手术切除。本病例之后是第二例在胸外科手术中偶然遇到的支气管肺内栓塞病例。
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引用次数: 0
Non-circulatory arrest aortic arch replacement. 非循环停止主动脉弓置换术。
Stephen M Spindel, Manuel Giraldo-Grueso

The definitive management of combined aortic arch and descending aortic pathologies such as aneurysms and dissections is either a single or staged operation associated with high morbidity and mortality. Stroke, kidney dysfunction, coagulopathy and high blood transfusion requirements are all affiliated with hypothermic circulatory arrest and prolonged cardiopulmonary bypass times. Considering the perilous nature of these operations, the authors describe a step-by-step zone 2 arch replacement as a staged frozen elephant trunk procedure, which provides an adequate landing zone for a later-placed endovascular stent yet maintains a short cardiopulmonary bypass time and no circulatory arrest.

合并主动脉弓和降主动脉病变(如动脉瘤和主动脉夹层)的最终治疗方法是单次或分期手术,其发病率和死亡率都很高。中风、肾功能障碍、凝血功能障碍和高输血需求都与低体温循环停止和心肺旁路时间延长有关。考虑到这些手术的危险性,作者描述了一种分步进行的 2 区足弓置换术,即分阶段冷冻大象躯干手术,该手术为随后放置的血管内支架提供了足够的着床区,同时保持了较短的心肺旁路时间,不会出现循环停止。
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引用次数: 0
The Commando procedure for mechanical double valve prosthesis endocarditis with destruction of the aortomitral continuity. 突击队手术治疗伴有主动脉连续性破坏的机械双瓣人工心内膜炎。
Sami Mouritane, Birgit Zirngast, Melanie Arnreiter, Günther Laufer, Daniel Zimpfer

Infective endocarditis, particularly after implanting valve prostheses, poses significant surgical challenges, often requiring complex interventions. We describe a case of a 37-year-old male with Staphylococcus aureus endocarditis, unsuccessfully treated with mechanical valve prostheses. Continued infection led to the destruction of the intervalvular fibrous body, necessitating a Commando procedure involving radical debridement and replacement of both aortic and mitral valves with complex patch reconstruction. Prosthesis selection remains contentious, considering recurrence risk and long-term prognosis. Our case underscores timely intervention and meticulous technique in managing such complex situations. It highlights successful strategies for treating infective endocarditis with destruction of aortomitral continuity, emphasizing the pivotal role of the Commando procedure.

感染性心内膜炎,尤其是植入人工瓣膜后的感染性心内膜炎,给外科手术带来了巨大挑战,往往需要复杂的干预措施。我们描述了一例患有金黄色葡萄球菌心内膜炎的 37 岁男性病例,该患者使用机械瓣膜修复术治疗未果。持续感染导致瓣间纤维体被破坏,因此必须进行突击队手术,包括根治性清创、主动脉瓣和二尖瓣置换以及复杂的补片重建。考虑到复发风险和长期预后,假体的选择仍然存在争议。我们的病例强调了在处理此类复杂情况时的及时干预和细致技术。该病例强调了治疗主动脉-二尖瓣连续性破坏的感染性心内膜炎的成功策略,强调了突击队手术的关键作用。
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引用次数: 0
A robotic left S6 and S1/2c segmentectomy using the lung-inverted approach. 采用肺倒置方法的机器人左侧 S6 和 S1/2c 节段切除术。
Hitoshi Igai, Akinobu Ida, Kazuki Numajiri, Kazuhito Nii, Mitsuhiro Kamiyoshihara

In pulmonary segmentectomy, the dominant pulmonary arteries are traditionally divided at the fissure. However, this approach sometimes leads to inadvertent injury to the pulmonary artery and prolonged air leak when the fissure is fused. To overcome these problems, by taking advantage of the good visualization provided by robotic surgery, we have adopted the lung-inverted approach without fissure dissection for segmentectomy. We have successfully performed a robotic left S6 and S1+2c segmentectomy using the lung-inverted approach. In addition to a good postoperative course, the console time was 57 minutes, which was considered relatively short. This approach may have contributed to the short operating time because it did not require repeated rotation of the lung. A clear understanding of the anatomy was required to perform this approach properly, because each branch of the pulmonary vessels and bronchi was treated inverted at the hilum. A preoperative 3-dimensional computed tomography broncho-angiographic scan was considered useful because it allowed us to recognize the relative positions of the dominant pulmonary vessels, the bronchi and other structures that were preserved.

在肺段切除术中,传统的做法是在肺裂处分割主要的肺动脉。然而,这种方法有时会导致肺动脉意外损伤,并在融合裂口时造成长时间漏气。为了克服这些问题,我们利用机器人手术提供的良好可视性,采用了不进行裂隙剥离的肺倒置方法进行肺段切除术。我们采用肺倒转方式成功实施了机器人左侧 S6 和 S1+2c 区段切除术。除了术后效果良好外,控制台时间为 57 分钟,相对较短。这种方法可能是手术时间短的原因之一,因为它不需要反复旋转肺部。由于肺血管和支气管的每个分支都是在肺门处倒置处理的,因此需要对解剖结构有清楚的了解才能正确实施这种方法。术前的三维计算机断层扫描支气管血管扫描被认为是非常有用的,因为它使我们能够识别主要肺血管、支气管和其他保留结构的相对位置。
{"title":"A robotic left S6 and S1/2c segmentectomy using the lung-inverted approach.","authors":"Hitoshi Igai, Akinobu Ida, Kazuki Numajiri, Kazuhito Nii, Mitsuhiro Kamiyoshihara","doi":"10.1510/mmcts.2024.051","DOIUrl":"10.1510/mmcts.2024.051","url":null,"abstract":"<p><p>In pulmonary segmentectomy, the dominant pulmonary arteries are traditionally divided at the fissure. However, this approach sometimes leads to inadvertent injury to the pulmonary artery and prolonged air leak when the fissure is fused. To overcome these problems, by taking advantage of the good visualization provided by robotic surgery, we have adopted the lung-inverted approach without fissure dissection for segmentectomy. We have successfully performed a robotic left S6 and S1+2c segmentectomy using the lung-inverted approach. In addition to a good postoperative course, the console time was 57 minutes, which was considered relatively short. This approach may have contributed to the short operating time because it did not require repeated rotation of the lung. A clear understanding of the anatomy was required to perform this approach properly, because each branch of the pulmonary vessels and bronchi was treated inverted at the hilum. A preoperative 3-dimensional computed tomography broncho-angiographic scan was considered useful because it allowed us to recognize the relative positions of the dominant pulmonary vessels, the bronchi and other structures that were preserved.</p>","PeriodicalId":53474,"journal":{"name":"Multimedia manual of cardiothoracic surgery : MMCTS / European Association for Cardio-Thoracic Surgery","volume":"2024 ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-08-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141898882","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
Robotic intrapericardial bilobectomy with stapler on the atrium and pericardial reconstruction. 机器人心包内双腔切除术,在心房上用订书机订书,并重建心包。
Haisam Saad, Nicole Asemota, Obadah Alqudah, Ahmad Asqalan, Joanna Fuentes-Warr, Stephen Wilson, May Thu Han, Vasileios Kouritas

Few intrapericardial robotic lung resection cases have been reported in the literature because of the perceived complexity of the procedure, with most surgeons embarking on an open resection via a thoracotomy. We present the case of a right middle and lower lobe tumour involving the pericardium and the origin of the right middle lobe vein. An intrapericardial lower bilobectomy was performed, with pericardial resection, pre-pericardial fat resection and mesh reconstruction. The vascular stapler for the right middle lobe vein was fired on the atrium. The resection was completed via a retrograde and fissureless approach, dividing the bronchus intermedius first, because it was impossible to open the fissure, leaving the division of the pulmonary artery until last. The case was performed solely robotically, with no complications and excellent postoperative recovery. Robotic resection can be performed successfully when pericardial lung tumours are involved.

由于手术的复杂性,文献中鲜有心包内机器人肺切除术病例的报道,大多数外科医生都是通过开胸手术进行切除。我们介绍了一例右肺中下叶肿瘤病例,肿瘤累及心包和右肺中叶静脉起源。手术进行了心包内下双叶切除术,包括心包切除、心包前脂肪切除和网状结构重建。右中叶静脉的血管缝合器在心房上发射。切除手术通过逆行无裂隙方式完成,首先分割中间支气管,因为无法打开裂隙,最后才分割肺动脉。该病例完全由机器人完成,无并发症,术后恢复良好。当涉及心包肺肿瘤时,机器人切除术也能成功实施。
{"title":"Robotic intrapericardial bilobectomy with stapler on the atrium and pericardial reconstruction.","authors":"Haisam Saad, Nicole Asemota, Obadah Alqudah, Ahmad Asqalan, Joanna Fuentes-Warr, Stephen Wilson, May Thu Han, Vasileios Kouritas","doi":"10.1510/mmcts.2024.032","DOIUrl":"10.1510/mmcts.2024.032","url":null,"abstract":"<p><p>Few intrapericardial robotic lung resection cases have been reported in the literature because of the perceived complexity of the procedure, with most surgeons embarking on an open resection via a thoracotomy. We present the case of a right middle and lower lobe tumour involving the pericardium and the origin of the right middle lobe vein. An intrapericardial lower bilobectomy was performed, with pericardial resection, pre-pericardial fat resection and mesh reconstruction. The vascular stapler for the right middle lobe vein was fired on the atrium. The resection was completed via a retrograde and fissureless approach, dividing the bronchus intermedius first, because it was impossible to open the fissure, leaving the division of the pulmonary artery until last. The case was performed solely robotically, with no complications and excellent postoperative recovery. Robotic resection can be performed successfully when pericardial lung tumours are involved.</p>","PeriodicalId":53474,"journal":{"name":"Multimedia manual of cardiothoracic surgery : MMCTS / European Association for Cardio-Thoracic Surgery","volume":"2024 ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-08-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141890921","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
A heart transplant and concomitant hemiarch repair in a patient with a large ascending aortic aneurysm and a challenging sternal re-entry. 一名患有巨大升主动脉瘤和胸骨再入路的患者接受了心脏移植手术并同时进行了半弓修补术。
Junichi Shimamura, David Spielvogel, Stephen Pan, Hayoung Lee, Suguru Ohira

An orthotopic heart transplant and an aortic operation can be done concomitantly at centres that are experienced in both aortic operations and heart transplants with meticulous surgical strategy.

在对主动脉手术和心脏移植手术都有丰富经验的中心,可以同时进行正位心脏移植和主动脉手术,并采取缜密的手术策略。
{"title":"A heart transplant and concomitant hemiarch repair in a patient with a large ascending aortic aneurysm and a challenging sternal re-entry.","authors":"Junichi Shimamura, David Spielvogel, Stephen Pan, Hayoung Lee, Suguru Ohira","doi":"10.1510/mmcts.2024.025","DOIUrl":"https://doi.org/10.1510/mmcts.2024.025","url":null,"abstract":"<p><p>An orthotopic heart transplant and an aortic operation can be done concomitantly at centres that are experienced in both aortic operations and heart transplants with meticulous surgical strategy.</p>","PeriodicalId":53474,"journal":{"name":"Multimedia manual of cardiothoracic surgery : MMCTS / European Association for Cardio-Thoracic Surgery","volume":"2024 ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-08-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141890920","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
Multimedia manual of cardiothoracic surgery : MMCTS / European Association for Cardio-Thoracic Surgery
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