Background: Left atrial myxoma (LAM) is the most common heart tumor in adults, requiring prompt surgical removal to prevent complications like valvular obstruction or embolization. Objectives: This study aimed to comp...Background: Left atrial myxoma (LAM) is the most common heart tumor in adults, requiring prompt surgical removal to prevent complications like valvular obstruction or embolization. Objectives: This study aimed to compare early postoperative outcomes between two surgical approaches—right mini-thoracotomy and median sternotomy—for the removal of isolated left atrial myxoma. Methods: We conducted a prospective observational study at the Department of Cardiac Surgery, National Heart Foundation Hospital & Research Institute (NHFH&RI), Mirpur, Dhaka, from March 2017 to August 2019. Twenty-eight patients undergoing surgery for isolated left atrial myxoma were included. The surgical approach was determined by the operating surgeon. We analyzed outcomes like intubation time, Intensive Care Unit (ICU) stay, pain levels (Visual Analogue Scale score), and overall hospital stay using SPSS. Statistical significance was set at p Results: Patients in the right mini-thoracotomy group had longer mean intubation times (11.43 vs. 5.93 hours, p Conclusion: Despite longer intubation and ICU times, the right mini-thoracotomy approach offers a minimally invasive alternative for isolated left atrial myxoma excision, with favorable outcomes overall.展开更多
Purpose: Right mini thoracotomy has been evaluated in many studies for mitral valve repair mainly in degenerative valvular disease but not in rheumatic heart disease. Mitral valve repair is more challenging in rheumat...Purpose: Right mini thoracotomy has been evaluated in many studies for mitral valve repair mainly in degenerative valvular disease but not in rheumatic heart disease. Mitral valve repair is more challenging in rheumatic etiology due to complexity of lesions. This prospective randomized case control study was designed to evaluate repair through mini right thoracotomy and to compare the clinical and echocardiographic outcomes with sternotomy in rheumatic patients. Methods: 25 patients of rheumatic heart disease underwent mitral valve repair through mini right thoracotomy (group I). Various clinical and functional parameters were compared with 25 patients of mitral valve repair through sternotomy (group II). On follow up the results were compared in both groups for clinical and echocardiographic parameters. Results: The various pre-operative demographic parameters were comparable in two groups. Equal rate of mitral valve repair (group I-21/25, 84% and group II-21/25, 84%) was achieved in both groups. The various intra-operative and post-operative clinical parameters were better in group I .There were equivalent functional and valve related outcomes in both groups in term of NYHA class (1.28 ± 0.613 vs 1.08 ± 0.276, P = 0.144), post-operative mitral valve area (2.43 ± 0.891 vs 2.82 ± 0.662, P = 0.090), incidence of more than mild mitral regurgitation (0) and mean pressure gradient across mitral valve (4.98 ± 3.33 vs 4.23 ± 1.5, P = 0.309). Conclusion: Mitral valve repair through mini right thoracotomy approach in rheumatic etiology is feasible and safe with equivalent rate of successful repair as compared to median sternotomy. It is associated with lesser morbidity, cosmetic advantage and lesser resource utilization.展开更多
Objective: To compare the clinical outcomes of minimally invasive right subaxillary vertical thoracotomy and traditional median stemotomy through right atrium in treatment of common congenital heart diseases. Methods:...Objective: To compare the clinical outcomes of minimally invasive right subaxillary vertical thoracotomy and traditional median stemotomy through right atrium in treatment of common congenital heart diseases. Methods: Clinical data of 59 cases of common congenital heart diseases treated with minimally invasive right axillary vertical thoracotomy from May, 2011 to February, 2013 and 77 cases of same diseases with traditional median stemotomy in the past three years were retrospectively analyzed, including atrial septal defect, membranous ventricular septal defect and partial endocardial cushion defect. The results were compared from the two groups, including the time for operation and cardiopulmonary bypass, amount of blood transfusion, postoperative drainage, ventilation time, hospital stay, and prognosis. Results: No severe complications happened in both groups, like deaths or secondary surgery caused by bleeding. No significant differences were in CPB time and postoperative ventilator time between groups (P>0.05), while for all of the operative time, the length of incision, postoperative drainage and hospital stay, minimally invasive right axillary vertical thoracotomy was superior to median stemotomy, with statistically significant differences (P<0.05). In six month followup after operation, no complications of residual deformity and pericardial effusion were found in both groups by doing echocardiography, but mild pectus carinatum was found in 8 patients in the traditional median sternotomy group (traditional group), whereas patients in another group were well recovered. Conclusions: Minimally invasive right subaxillary vertical thoracotomy for common congenital heart diseases is as safe as traditional median stemotomy, without the increasing incidence of postoperative complications. Additionally, compared with traditional median stemotomy, minimally - invasive right subaxillary vertical thoracotomy is better in the aspects of hidden incision, appearance, and postoperative recovery.展开更多
Objective: To define the indications for cardiac surgeries through right anterolateral thoracotomy, and render it clinically feasible in a carefully controlled scope. Methods: Ninety-eight patients requiring cardiac s...Objective: To define the indications for cardiac surgeries through right anterolateral thoracotomy, and render it clinically feasible in a carefully controlled scope. Methods: Ninety-eight patients requiring cardiac surgeries were operated through this approaach. Incisions were made in the fourth or on intercostal space. The upper costal cartilage near the incision was routinely removed. Aortic cannulation was performed through the lateral wall of the aorta. The procedures on the heart itself were the same as that of the median sternotomy. Results: The average lengths of the incisions, for the male and female patients, were (10.6±3.2) cm and (10.3 ± 2.2) cm respectively. The mean bypass time was (61.3 ±t 25. 1) min, and the mean heart arrest time was (49.5±19.2) min. The postoperative drainage was (410± 125) ml. All but 1 patient with aortic valve operation had satisfactory exposure . The complications included chest pain (n = 5), rib fracture (n =3), pleural effusion (n=5), and pneumothorax(n=6). Conclusion: The right anterolateral tholacotomy was a satisfactory alternative of median sternotomy for the surgeries that can be performed through a right atrium access.展开更多
<strong>Background:</strong> <span style="font-family:;" "=""><span style="font-family:Verdana;">Atrial Septal Defect (ASD) closure is a common cardiac surgic...<strong>Background:</strong> <span style="font-family:;" "=""><span style="font-family:Verdana;">Atrial Septal Defect (ASD) closure is a common cardiac surgical procedure performed worldwide. Due to favourable clinical outcome, minimal invasive approach is becoming popular. Hence this study was conducted to compare the outcome of two surgical approaches, median sternotomy and mini thoracotomy with total peripheral cannulation, in a developing country Nepal.</span><b><span style="font-family:Verdana;"> Methods: </span></b><span style="font-family:Verdana;">A prospective study of 62 ASD patients, randomized to undergo surgical closure either via right anterior mini thoracotomy or median sternotomy was conducted and followed up over three years. The clinical outcome parameters like intensive care unit stay, hospital stay, post-operative duration of ventilation, cardiopulmonary bypass time, aortic cross clamp time, mediastinal drainage, size of scar and complication were compared between two groups. </span><b><span style="font-family:Verdana;">Results: </span></b><span style="font-family:Verdana;">Cardiopulmonary bypass time and aortic cross clamp time were significantly longer in right anterior mini thoracotomy group as compared to median sternotomy group (43.97</span></span><span style="font-family:;" "=""> </span><span style="font-family:Verdana;">min ± 12.70</span><span style="font-family:;" "=""> </span><span style="font-family:Verdana;">min vs 34.42</span><span style="font-family:;" "=""> </span><span style="font-family:Verdana;">min ± 10.42</span><span style="font-family:;" "=""> </span><span style="font-family:Verdana;">min and 25.13</span><span style="font-family:;" "=""> </span><span style="font-family:Verdana;">min </span><span style="font-family:Verdana;">±</span><span style="font-family:;" "=""> </span><span style="font-family:Verdana;">7.82</span><span style="font-family:;" "=""> </span><span style="font-family:Verdana;">min vs 19.48</span><span style="font-family:;" "=""> </span><span style="font-family:Verdana;">min ± 6.93</span><span style="font-family:;" "=""> </span><span style="font-family:Verdana;">min respectively, p</span><span style="font-family:Verdana;">-</span><span style="font-family:Verdana;">value</span><span style="font-family:;" "=""> </span><span style="font-family:Verdana;"><</span><span style="font-family:;" "=""> </span><span style="font-family:Verdana;">0.05). There was no significant difference in duration of surgery (2.75</span><span style="font-family:;" "=""> </span><span style="font-family:Verdana;">hrs ± 0.43</span><span style="font-family:;" "=""> </span><span style="font-family:Verdana;">hrs vs 2.56</span><span style="font-family:;" "=""> </span><span style="font-family:Verdana;">hrs ± 0.41</span><span style="font-family:;" "=""> </span><span style="font-family:Verdana;">hrs, p-value</span><span style="font-family:Verdana;"> = </span><span style="font-family:Verdana;">0.09), post-operative ventilation (2.90</span><span style="font-family:;" "=""> </span><span style="font-family:Verdana;">hrs ± 1.22</span><span style="font-family:;" "=""> </span><span style="font-family:Verdana;">hrs and 2.88</span><span style="font-family:;" "=""> </span><span style="font-family:Verdana;">hrs ± 1.07</span><span style="font-family:;" "=""> </span><span style="font-family:Verdana;">hrs, p</span><span style="font-family:Verdana;">-</span><span style="font-family:Verdana;">value</span><span style="font-family:Verdana;"> = </span><span style="font-family:Verdana;">0.96) between two groups. Post-operative mediastinal drainage was significantly less in right anterior mini thoracotomy group (214.52</span><span style="font-family:;" "=""> </span><span style="font-family:Verdana;">ml ± 91.79</span><span style="font-family:;" "=""> </span><span style="font-family:Verdana;">ml vs 284.03</span><span style="font-family:;" "=""> </span><span style="font-family:Verdana;">ml ± 158.91</span><span style="font-family:;" "=""> </span><span style="font-family:Verdana;">ml, p</span><span style="font-family:Verdana;">-</span><span style="font-family:Verdana;">value</span><span style="font-family:Verdana;"> = </span><span style="font-family:;" "=""><span style="font-family:Verdana;">0.04). There was no significant difference in ICU stay and hospital stay. </span><b><span style="font-family:Verdana;">Conclusion:</span></b><span style="font-family:Verdana;"> Atrial septal defect can be safely closed by right anterior mini thoracotomy with a small, cosmetically acceptable submammary scar with less pain and bleeding.</span></span>展开更多
Penetrating injuries to anterior chest may result in life-threatening complications such as massive haemothorax,?as a result of injury to the internal mammary artery.?Isolated internal mammary injury is a very rare ca...Penetrating injuries to anterior chest may result in life-threatening complications such as massive haemothorax,?as a result of injury to the internal mammary artery.?Isolated internal mammary injury is a very rare cause of massive haemothorax and associated with high mortality.?We are presenting this?32-year-old gentleman who sustained a thoracic stab wound and had an emergency right anterior mini-thoracotomy?by extending the stab wound rather than standard thoracotomy or sternotomy.?This case of isolated penetrating IMA injury managed with mini-thoracotomy is the only documented case so far. We are publishing this case report with patient’s both written and informed consent and institutional approval.?This potentially life-threating injury can be managed by mini-thoracotomy with enhanced recovery;however, it is case specific and needs proper judgement.展开更多
This work is a topic highlight on the surgical treatment of the right colon pathologies,focusing on the literature state of art and comparing the open surgery to the different laparoscopic and robotic procedures.Diffe...This work is a topic highlight on the surgical treatment of the right colon pathologies,focusing on the literature state of art and comparing the open surgery to the different laparoscopic and robotic procedures.Different laparoscopic procedures have been described for the treatment of right colon tumors: Totally laparoscopic right colectomy,laparoscopic assisted right colectomy,laparoscopic facilitated right colectomy,hand-assisted right colectomy,single incision laparoscopic surgery colectomy,robotic right colectomy.Two main characteristics of these techniques are the different type of anastomosis: Intracorporeal(for totally laparoscopic right colectomy,single incision laparoscopic surgery colectomy,laparoscopic assisted right colectomy and robotic technique) or extracorporeal(for laparoscopic assisted right colectomy,laparoscopic facilitated right colectomy,hand-assisted right colectomy and open right colectomy) and the different incision(suprapubic,median or transverse on the right side of abdomen).The different laparoscopic techniques meet the same oncological criteria of radicalism as the open surgery for the right colon.The totally laparoscopic right colectomy with intracorporeal anastomosis and even more the single incision laparoscopic surgery colectomy,remain a technical challenge due to the complexity of procedures(especially for the single incision laparoscopic surgery colectomy) and the particular right colon vascular anatomy but they seem to have some theoretical advantages compared to the other laparoscopic and open procedures.Data reported in literature while confirming the advantages of laparoscopic approach,do not allow to solve controversies about which is the best laparoscopic technique(Intracorporeal vs Extracorporeal Anastomosis) to treat the right colon cancer.However,the laparoscopic techniques with intracorporeal anastomosis for the right colon seem to show some theoretical advantages(functional,technical,oncological and cosmetic advantages) even if all studies conclude that further prospective randomized trials are necessary.Robotic technique may be useful to overcome the problems related to inexperience in laparoscopy in some surgical centers.展开更多
Minimally invasive approaches for cardiac surgery in children have been lagging in comparison to the adult world.A wide range of the most common congenital heart defects in infants and children can be repaired suc-ces...Minimally invasive approaches for cardiac surgery in children have been lagging in comparison to the adult world.A wide range of the most common congenital heart defects in infants and children can be repaired suc-cessfully through a variety of non-sternotomy incisions.This has been shown to be associated with superior cos-metic results,shorter hospital stays,and rapid return to full activity compared to sternotomy.These approaches have been around for decades,but they have not been widely adopted for a variety of reasons.Right axillary thor-acotomy is one of these approaches that we believe should be the new standard for the repair of a wide variety of heart defects in children and will be the focus of our current review.展开更多
本文阐述了两例犬血管环异常(vascular ring anomaly,VRA)的CT血管造影(CT angiography,CTA)诊断及手术治疗。通过术前对患犬进行CTA诊断,进行经左侧第4肋间开胸动脉韧带切断的手术治疗,并在术后对病例1进行食道球囊扩张。CTA显示两只...本文阐述了两例犬血管环异常(vascular ring anomaly,VRA)的CT血管造影(CT angiography,CTA)诊断及手术治疗。通过术前对患犬进行CTA诊断,进行经左侧第4肋间开胸动脉韧带切断的手术治疗,并在术后对病例1进行食道球囊扩张。CTA显示两只犬均存在持久性右主动脉弓(persistent right aortic arch,PRAA),并分别伴有右侧颈动脉异位发育和持久性左前腔静脉。手术治疗后,食道狭窄基本得到纠正,返流消失。CTA可对VRA进行更精确地诊断,并有助于制订具体手术方案;犬PRAA的手术治疗效果良好。展开更多
文摘Background: Left atrial myxoma (LAM) is the most common heart tumor in adults, requiring prompt surgical removal to prevent complications like valvular obstruction or embolization. Objectives: This study aimed to compare early postoperative outcomes between two surgical approaches—right mini-thoracotomy and median sternotomy—for the removal of isolated left atrial myxoma. Methods: We conducted a prospective observational study at the Department of Cardiac Surgery, National Heart Foundation Hospital & Research Institute (NHFH&RI), Mirpur, Dhaka, from March 2017 to August 2019. Twenty-eight patients undergoing surgery for isolated left atrial myxoma were included. The surgical approach was determined by the operating surgeon. We analyzed outcomes like intubation time, Intensive Care Unit (ICU) stay, pain levels (Visual Analogue Scale score), and overall hospital stay using SPSS. Statistical significance was set at p Results: Patients in the right mini-thoracotomy group had longer mean intubation times (11.43 vs. 5.93 hours, p Conclusion: Despite longer intubation and ICU times, the right mini-thoracotomy approach offers a minimally invasive alternative for isolated left atrial myxoma excision, with favorable outcomes overall.
文摘Purpose: Right mini thoracotomy has been evaluated in many studies for mitral valve repair mainly in degenerative valvular disease but not in rheumatic heart disease. Mitral valve repair is more challenging in rheumatic etiology due to complexity of lesions. This prospective randomized case control study was designed to evaluate repair through mini right thoracotomy and to compare the clinical and echocardiographic outcomes with sternotomy in rheumatic patients. Methods: 25 patients of rheumatic heart disease underwent mitral valve repair through mini right thoracotomy (group I). Various clinical and functional parameters were compared with 25 patients of mitral valve repair through sternotomy (group II). On follow up the results were compared in both groups for clinical and echocardiographic parameters. Results: The various pre-operative demographic parameters were comparable in two groups. Equal rate of mitral valve repair (group I-21/25, 84% and group II-21/25, 84%) was achieved in both groups. The various intra-operative and post-operative clinical parameters were better in group I .There were equivalent functional and valve related outcomes in both groups in term of NYHA class (1.28 ± 0.613 vs 1.08 ± 0.276, P = 0.144), post-operative mitral valve area (2.43 ± 0.891 vs 2.82 ± 0.662, P = 0.090), incidence of more than mild mitral regurgitation (0) and mean pressure gradient across mitral valve (4.98 ± 3.33 vs 4.23 ± 1.5, P = 0.309). Conclusion: Mitral valve repair through mini right thoracotomy approach in rheumatic etiology is feasible and safe with equivalent rate of successful repair as compared to median sternotomy. It is associated with lesser morbidity, cosmetic advantage and lesser resource utilization.
基金supported by college medical journal clinicalspecial funds(11321587)
文摘Objective: To compare the clinical outcomes of minimally invasive right subaxillary vertical thoracotomy and traditional median stemotomy through right atrium in treatment of common congenital heart diseases. Methods: Clinical data of 59 cases of common congenital heart diseases treated with minimally invasive right axillary vertical thoracotomy from May, 2011 to February, 2013 and 77 cases of same diseases with traditional median stemotomy in the past three years were retrospectively analyzed, including atrial septal defect, membranous ventricular septal defect and partial endocardial cushion defect. The results were compared from the two groups, including the time for operation and cardiopulmonary bypass, amount of blood transfusion, postoperative drainage, ventilation time, hospital stay, and prognosis. Results: No severe complications happened in both groups, like deaths or secondary surgery caused by bleeding. No significant differences were in CPB time and postoperative ventilator time between groups (P>0.05), while for all of the operative time, the length of incision, postoperative drainage and hospital stay, minimally invasive right axillary vertical thoracotomy was superior to median stemotomy, with statistically significant differences (P<0.05). In six month followup after operation, no complications of residual deformity and pericardial effusion were found in both groups by doing echocardiography, but mild pectus carinatum was found in 8 patients in the traditional median sternotomy group (traditional group), whereas patients in another group were well recovered. Conclusions: Minimally invasive right subaxillary vertical thoracotomy for common congenital heart diseases is as safe as traditional median stemotomy, without the increasing incidence of postoperative complications. Additionally, compared with traditional median stemotomy, minimally - invasive right subaxillary vertical thoracotomy is better in the aspects of hidden incision, appearance, and postoperative recovery.
文摘Objective: To define the indications for cardiac surgeries through right anterolateral thoracotomy, and render it clinically feasible in a carefully controlled scope. Methods: Ninety-eight patients requiring cardiac surgeries were operated through this approaach. Incisions were made in the fourth or on intercostal space. The upper costal cartilage near the incision was routinely removed. Aortic cannulation was performed through the lateral wall of the aorta. The procedures on the heart itself were the same as that of the median sternotomy. Results: The average lengths of the incisions, for the male and female patients, were (10.6±3.2) cm and (10.3 ± 2.2) cm respectively. The mean bypass time was (61.3 ±t 25. 1) min, and the mean heart arrest time was (49.5±19.2) min. The postoperative drainage was (410± 125) ml. All but 1 patient with aortic valve operation had satisfactory exposure . The complications included chest pain (n = 5), rib fracture (n =3), pleural effusion (n=5), and pneumothorax(n=6). Conclusion: The right anterolateral tholacotomy was a satisfactory alternative of median sternotomy for the surgeries that can be performed through a right atrium access.
文摘<strong>Background:</strong> <span style="font-family:;" "=""><span style="font-family:Verdana;">Atrial Septal Defect (ASD) closure is a common cardiac surgical procedure performed worldwide. Due to favourable clinical outcome, minimal invasive approach is becoming popular. Hence this study was conducted to compare the outcome of two surgical approaches, median sternotomy and mini thoracotomy with total peripheral cannulation, in a developing country Nepal.</span><b><span style="font-family:Verdana;"> Methods: </span></b><span style="font-family:Verdana;">A prospective study of 62 ASD patients, randomized to undergo surgical closure either via right anterior mini thoracotomy or median sternotomy was conducted and followed up over three years. The clinical outcome parameters like intensive care unit stay, hospital stay, post-operative duration of ventilation, cardiopulmonary bypass time, aortic cross clamp time, mediastinal drainage, size of scar and complication were compared between two groups. </span><b><span style="font-family:Verdana;">Results: </span></b><span style="font-family:Verdana;">Cardiopulmonary bypass time and aortic cross clamp time were significantly longer in right anterior mini thoracotomy group as compared to median sternotomy group (43.97</span></span><span style="font-family:;" "=""> </span><span style="font-family:Verdana;">min ± 12.70</span><span style="font-family:;" "=""> </span><span style="font-family:Verdana;">min vs 34.42</span><span style="font-family:;" "=""> </span><span style="font-family:Verdana;">min ± 10.42</span><span style="font-family:;" "=""> </span><span style="font-family:Verdana;">min and 25.13</span><span style="font-family:;" "=""> </span><span style="font-family:Verdana;">min </span><span style="font-family:Verdana;">±</span><span style="font-family:;" "=""> </span><span style="font-family:Verdana;">7.82</span><span style="font-family:;" "=""> </span><span style="font-family:Verdana;">min vs 19.48</span><span style="font-family:;" "=""> </span><span style="font-family:Verdana;">min ± 6.93</span><span style="font-family:;" "=""> </span><span style="font-family:Verdana;">min respectively, p</span><span style="font-family:Verdana;">-</span><span style="font-family:Verdana;">value</span><span style="font-family:;" "=""> </span><span style="font-family:Verdana;"><</span><span style="font-family:;" "=""> </span><span style="font-family:Verdana;">0.05). There was no significant difference in duration of surgery (2.75</span><span style="font-family:;" "=""> </span><span style="font-family:Verdana;">hrs ± 0.43</span><span style="font-family:;" "=""> </span><span style="font-family:Verdana;">hrs vs 2.56</span><span style="font-family:;" "=""> </span><span style="font-family:Verdana;">hrs ± 0.41</span><span style="font-family:;" "=""> </span><span style="font-family:Verdana;">hrs, p-value</span><span style="font-family:Verdana;"> = </span><span style="font-family:Verdana;">0.09), post-operative ventilation (2.90</span><span style="font-family:;" "=""> </span><span style="font-family:Verdana;">hrs ± 1.22</span><span style="font-family:;" "=""> </span><span style="font-family:Verdana;">hrs and 2.88</span><span style="font-family:;" "=""> </span><span style="font-family:Verdana;">hrs ± 1.07</span><span style="font-family:;" "=""> </span><span style="font-family:Verdana;">hrs, p</span><span style="font-family:Verdana;">-</span><span style="font-family:Verdana;">value</span><span style="font-family:Verdana;"> = </span><span style="font-family:Verdana;">0.96) between two groups. Post-operative mediastinal drainage was significantly less in right anterior mini thoracotomy group (214.52</span><span style="font-family:;" "=""> </span><span style="font-family:Verdana;">ml ± 91.79</span><span style="font-family:;" "=""> </span><span style="font-family:Verdana;">ml vs 284.03</span><span style="font-family:;" "=""> </span><span style="font-family:Verdana;">ml ± 158.91</span><span style="font-family:;" "=""> </span><span style="font-family:Verdana;">ml, p</span><span style="font-family:Verdana;">-</span><span style="font-family:Verdana;">value</span><span style="font-family:Verdana;"> = </span><span style="font-family:;" "=""><span style="font-family:Verdana;">0.04). There was no significant difference in ICU stay and hospital stay. </span><b><span style="font-family:Verdana;">Conclusion:</span></b><span style="font-family:Verdana;"> Atrial septal defect can be safely closed by right anterior mini thoracotomy with a small, cosmetically acceptable submammary scar with less pain and bleeding.</span></span>
文摘Penetrating injuries to anterior chest may result in life-threatening complications such as massive haemothorax,?as a result of injury to the internal mammary artery.?Isolated internal mammary injury is a very rare cause of massive haemothorax and associated with high mortality.?We are presenting this?32-year-old gentleman who sustained a thoracic stab wound and had an emergency right anterior mini-thoracotomy?by extending the stab wound rather than standard thoracotomy or sternotomy.?This case of isolated penetrating IMA injury managed with mini-thoracotomy is the only documented case so far. We are publishing this case report with patient’s both written and informed consent and institutional approval.?This potentially life-threating injury can be managed by mini-thoracotomy with enhanced recovery;however, it is case specific and needs proper judgement.
文摘This work is a topic highlight on the surgical treatment of the right colon pathologies,focusing on the literature state of art and comparing the open surgery to the different laparoscopic and robotic procedures.Different laparoscopic procedures have been described for the treatment of right colon tumors: Totally laparoscopic right colectomy,laparoscopic assisted right colectomy,laparoscopic facilitated right colectomy,hand-assisted right colectomy,single incision laparoscopic surgery colectomy,robotic right colectomy.Two main characteristics of these techniques are the different type of anastomosis: Intracorporeal(for totally laparoscopic right colectomy,single incision laparoscopic surgery colectomy,laparoscopic assisted right colectomy and robotic technique) or extracorporeal(for laparoscopic assisted right colectomy,laparoscopic facilitated right colectomy,hand-assisted right colectomy and open right colectomy) and the different incision(suprapubic,median or transverse on the right side of abdomen).The different laparoscopic techniques meet the same oncological criteria of radicalism as the open surgery for the right colon.The totally laparoscopic right colectomy with intracorporeal anastomosis and even more the single incision laparoscopic surgery colectomy,remain a technical challenge due to the complexity of procedures(especially for the single incision laparoscopic surgery colectomy) and the particular right colon vascular anatomy but they seem to have some theoretical advantages compared to the other laparoscopic and open procedures.Data reported in literature while confirming the advantages of laparoscopic approach,do not allow to solve controversies about which is the best laparoscopic technique(Intracorporeal vs Extracorporeal Anastomosis) to treat the right colon cancer.However,the laparoscopic techniques with intracorporeal anastomosis for the right colon seem to show some theoretical advantages(functional,technical,oncological and cosmetic advantages) even if all studies conclude that further prospective randomized trials are necessary.Robotic technique may be useful to overcome the problems related to inexperience in laparoscopy in some surgical centers.
文摘Minimally invasive approaches for cardiac surgery in children have been lagging in comparison to the adult world.A wide range of the most common congenital heart defects in infants and children can be repaired suc-cessfully through a variety of non-sternotomy incisions.This has been shown to be associated with superior cos-metic results,shorter hospital stays,and rapid return to full activity compared to sternotomy.These approaches have been around for decades,but they have not been widely adopted for a variety of reasons.Right axillary thor-acotomy is one of these approaches that we believe should be the new standard for the repair of a wide variety of heart defects in children and will be the focus of our current review.
文摘本文阐述了两例犬血管环异常(vascular ring anomaly,VRA)的CT血管造影(CT angiography,CTA)诊断及手术治疗。通过术前对患犬进行CTA诊断,进行经左侧第4肋间开胸动脉韧带切断的手术治疗,并在术后对病例1进行食道球囊扩张。CTA显示两只犬均存在持久性右主动脉弓(persistent right aortic arch,PRAA),并分别伴有右侧颈动脉异位发育和持久性左前腔静脉。手术治疗后,食道狭窄基本得到纠正,返流消失。CTA可对VRA进行更精确地诊断,并有助于制订具体手术方案;犬PRAA的手术治疗效果良好。