Content from the Journal of the American Neurological Surgeons.
VATS Lobectomy Training and Instruction For purposes of this survey, participants were asked to assume that they consulted on an otherwise healthy middle aged patient who had a peripheral 2 cm right upper lobe adenocarcinoma, clinical stage Ia, not amenable to wedge resection or segmentectomy. There were no contraindications to lobectomy. The vast majority…
A number of prosthetic materials, including GORE-TEX® and Marlex Mesh sandwiched with methylmethacrylate cement, have been described to restore the rigid chest wall contour. We discuss the role of a new rigid system for chest-wall reconstruction, consisting in moldable titanium bars and rib clips used in combination with a biological patch. Introduction Primary tumors and congenital…
Editor’s Note CTSNet seeks, through the Expert’s Techniques Section, to provide information on the latest techniques in use by surgeons working at the forefront of the field. However, presentation on the web site should not be considered an endorsement of the techniques used. Unlike mitral valve repair, where the superiority and durability of the techniques…
This article describes the different techniques of pericardial reconstruction after partial pericardiectomy in thoracic surgery. Emphasis is put on reconstruction using synthetic meshes. Patient Selection Pericardial reconstruction after partial pericardiectomy is performed for the prophylaxis of cardiac herniation. Pericardial defects that require reconstruction result after lung resections with partial pericardiectomy, extrapleural pneumonectomy for diffuse malignant…
This video demonstrates the technical details of videothoracoscopic parietal pleurectomy and decortication performed through three ports for tuberculosis empyema. The patient is a 24-year old male patient suffering from dyspnea. Five years earlier the patient presented with left sided pleural tuberculosis and was given anti-tuberculosis treatment, partially reducing the pleural effusion. Decortication was planned at…
Healing complications after cardiac surgery such as dehiscence, osteomyelitis, mediastinitis, and superficial wound infection may occur. This video shows a new and potentially superior method of sternal closure with thermoreactive NITINOL clips that provide semirigid fixation. NITINOL belongs to a family of intermetallic materials that contain a nearly equal mixture of nickel and titanium. Nitinol…
Management of Thymoma For purposes of this survey, participants were asked to assume that they were consulting on a middle aged patient who had findings on CT compatible with a small (2 cm) encapsulated thymoma. The patient had no symptoms related to the abnormality. The patient was otherwise healthy and had no symptoms of…
Attitudes regarding surgeon performance and operating room environment The survey on “Attitudes regarding surgeon performance and operating room environment” engendered the largest response to a survey to date. Whether this is a result of increased awareness of the surveys or whether the subject matter was of greater interest will be evident as more surveys are…
Patient Selection Patients with non-metastatic thymoma or thymic carcinoma or with myasthenia gravis (with or without thymoma) are candidates for thymectomy. Treatment for myasthenia gravis is initiated by a neurologist, who recommends surgical treatment when indicated. Some of the common indications are: failure of medical treatment; young patients with short duration of symptoms; and patients…
Ivor Lewis esophagectomy is occasionally required in patients who have previously undergone gastric surgery. A technique is described to salvage a gastric conduit by preserving the left gastric pedicle during esophagectomy. Background Gastric reconstruction of the esophagus following esophagectomy typically requires division of the left gastric pedicle to attain sufficient length for an esophagogastric anastomosis1.…
A unique approach to surgical repair of descending thoracic aortic saccular aneurysm due to penetrating atherosclerotic ulcer is described in a very high-risk patient with severe peripheral and cerebrovascular occlusive disease, coronary artery disease, chronic renal failue and COPD. This video is available in the CTSNet China Resource Center for CTSNet users who are unable…
A 42-year-old man with chronic obstructive pulmonary disease (COPD) presented to the emergency department (ED) complaining of worsening shortness of breath and respiratory distress. His home oxygen requirement was 2 liters by nasal canula, and he has had multiple prior hospital admissions for respiratory failure. Patient Presentation A 42-year-old man with chronic obstructive pulmonary disease…
Introduction Pericardial cysts are an uncommon benign congenital anomaly in the middle mediastinum. They represent 6% of mediastinal masses, and 33% of mediastinal cysts. Other cysts in the mediastinum are bronchogenic – 34%, enteric – 12%, thymic and others – 21%[1]. In the middle mediastinum 61% of presenting masses are cysts[1]. Pericardial and bronchogenic cysts…
Hemodynamically stable patients with an undiagnosed pericardial effusion are well suited for a thoracoscopic window. When pericardial, pleural, or pulmonary pathology co-exist and require diagnosis or therapy, a thoracoscopic approach is ideal. Patient Selection Figure 1. CT scan showing pericardial effusion. Hemodynamically stable patients with an undiagnosed pericardial effusion are well suited for a thoracoscopic…
On May 30, 2010 the field of cardiovascular surgery, physicians and friends mourned the loss of a mentor, colleague and friend. Kit Arom died in Bangkok on this day after a long battle with pancreatic carcinoma. Born Kitipan Visudharom, Kit came to the United States to do his internship at the University of Kentucky and…
Repair of generalized mitral prolapse associated with Barlow’s valves has been difficult with resectional techniques. This video, presented at the 2004 STS meeting, illustrates a simple non-resectional method of using multiple Gore-Tex artificial chords to repair generalized prolapse associated with Barlow’s Syndrome. Two chords are positioned in both papillary muscles initially, and after ring placement,…
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