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.
{"title":"Conversion technique from venovenous to venopulmonary ECMO support.","authors":"Yuriy Stukov, Mindaugas Rackauskas, Marc O Maybauer","doi":"10.1510/mmcts.2024.055","DOIUrl":"10.1510/mmcts.2024.055","url":null,"abstract":"<p><p>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.</p>","PeriodicalId":53474,"journal":{"name":"Multimedia manual of cardiothoracic surgery : MMCTS / European Association for Cardio-Thoracic Surgery","volume":"2024 ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-08-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142082560","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}
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.
{"title":"Robotic-assisted left atrial appendage occlusion.","authors":"Massimo Baudo, Amanda Yakobitis, Courtney Murray, Gianluca Torregrossa","doi":"10.1510/mmcts.2024.065","DOIUrl":"https://doi.org/10.1510/mmcts.2024.065","url":null,"abstract":"<p><p>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.</p>","PeriodicalId":53474,"journal":{"name":"Multimedia manual of cardiothoracic surgery : MMCTS / European Association for Cardio-Thoracic Surgery","volume":"2024 ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-08-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142082561","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}
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.
{"title":"Subxiphoid robot-assisted complete resection for postchemotherapy primary mediastinal yolk sac tumour.","authors":"Yasunori Fukushima, Koyo Shirahashi, Hiroyasu Komuro, Yusaku Miyamoto, Mitsuyoshi Matsumoto, Hirotaka Yamamoto, Norihiko Ishikawa, Hisashi Iwata","doi":"10.1510/mmcts.2023.103","DOIUrl":"10.1510/mmcts.2023.103","url":null,"abstract":"<p><p>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.</p>","PeriodicalId":53474,"journal":{"name":"Multimedia manual of cardiothoracic surgery : MMCTS / European Association for Cardio-Thoracic Surgery","volume":"2024 ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-08-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142082562","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}
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.
{"title":"Successful minimally invasive treatment of a young patient with a dislocated Amplatzer Septal Occluder.","authors":"Gianpiero Buttiglione, Can Gollmann-Tepeköylü, Daniel Höfer, Michael Grimm, Nikolaos Bonaros","doi":"10.1510/mmcts.2024.043","DOIUrl":"10.1510/mmcts.2024.043","url":null,"abstract":"<p><p>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.</p>","PeriodicalId":53474,"journal":{"name":"Multimedia manual of cardiothoracic surgery : MMCTS / European Association for Cardio-Thoracic Surgery","volume":"2024 ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-08-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142082563","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}
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.
{"title":"The role of 3-dimensional reconstruction imaging in bronchopulmonary sequestration.","authors":"Aishah Z Mughal, Ahmed El-Zeki, Ahmed M Habib","doi":"10.1510/mmcts.2024.076","DOIUrl":"10.1510/mmcts.2024.076","url":null,"abstract":"<p><p>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.</p>","PeriodicalId":53474,"journal":{"name":"Multimedia manual of cardiothoracic surgery : MMCTS / European Association for Cardio-Thoracic Surgery","volume":"2024 ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-08-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142082564","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}
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.
{"title":"Non-circulatory arrest aortic arch replacement.","authors":"Stephen M Spindel, Manuel Giraldo-Grueso","doi":"10.1510/mmcts.2024.023","DOIUrl":"10.1510/mmcts.2024.023","url":null,"abstract":"<p><p>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.</p>","PeriodicalId":53474,"journal":{"name":"Multimedia manual of cardiothoracic surgery : MMCTS / European Association for Cardio-Thoracic Surgery","volume":"2024 ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-08-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142114725","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}
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.
{"title":"The Commando procedure for mechanical double valve prosthesis endocarditis with destruction of the aortomitral continuity.","authors":"Sami Mouritane, Birgit Zirngast, Melanie Arnreiter, Günther Laufer, Daniel Zimpfer","doi":"10.1510/mmcts.2024.052","DOIUrl":"10.1510/mmcts.2024.052","url":null,"abstract":"<p><p>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.</p>","PeriodicalId":53474,"journal":{"name":"Multimedia manual of cardiothoracic surgery : MMCTS / European Association for Cardio-Thoracic Surgery","volume":"2024 ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-08-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141977172","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}
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.
{"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}
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.
{"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}
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.
{"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}