Content from the Journal of the American Neurological Surgeons.
Traumatic rupture of the thoracic aorta is a common cause of death after motor vehicle accidents. The gold standard for treatment of traumatic rupture of the descending thoracic aorta is a left thoraoctomy with replacement of the affected aorta. The endovascular treatment of aortic transection is an emerging alternative in multi-traumatized patients. Traumatic rupture of…
Introduction Endovascular approaches are being increasingly utilized to treat a variety of thoracic aortic pathologies, including aneurysms, dissections, and transections [1-5]. Ongoing challenges to endovascular strategies for thoracic aortic pathology include relatively restricted endoprosthesis configurations, lack of FDA-approved devices of appropriate size for the small thoracic aorta, and problems associated with endovascular access. Here we…
Patient Selection Figure 1: Computed tomography showing a typical right upper lobe lung lesion. surrounded by lung parenchyma suitable for VATS lobectomy VATS lobectomies are performed on patients with clinical stage I lung cancer assessed by computed tomography (CT) and positron emission tomography (PET). The procedure is usually performed for tumors less than 4 cm…
Patient Selection The purpose of airway stenting is to relieve airway obstruction caused by strictures not suitable for resection and reconstruction. Historical attempts at airway stenting began in the 19th century, and tracheostomy tubes and Montgomery tracheal T tubes have been extensively used to palliate benign and malignant strictures [1]. More recently, a variety of…
Patient Selection Bullous emphysema is histologically referred to as the presence of emphysematous areas with a complete destruction of lung tissue producing an airspace greater than 1 cm in diameter. Bullae must be clearly differentiated from other disorders as lung cysts (developmental anomalies; they are lined by respiratory epithelium) and blebs (small sub pleural collections…
This video shows an unusual approach robotically with the patient in the prone position for the intrathoracic dissection. The patient is then turned supine for the abdominal part of the procedure. Transthoracic esophagolymphadenectomy can offer the best chance of cure. Robot-assisted technique can allow precise dissection in minimally invasive manner without losing the advantages of…
Patient Selection Gastroesophageal reflux disease (GERD) is one of the most common gastrointestinal disorders in the US today with a prevalence of 360/100,000 people. For the majority of patients this is a self limited condition that may be improved with changes in lifestyle or medical therapy. However, approximately 25% of patients with GERD will develop…
Patient Selection Conventional esophagectomy requires either a laparotomy with a transhiatal dissection or laparotomy combined with thoracotomy and is associated with significant morbidity and mortality. Reductions in complication rates have been reported in centers with a high volume of esophageal surgery but morbidity remains considerable. As advances in minimally invasive surgical instrumentation and technique continue,…
This procedure is performed in patients with emphysema to improve their exercise tolerance and quality of life. Specific criteria were established by the National Emphysema Treatment Trial (NETT) published in 2003. Patient Selection Figure 1 This procedure is performed in patients with emphysema to improve their exercise tolerance and quality of life. Specific criteria were…
Patient Selection Superior vena cava syndrome (SCVS) is an obstruction of blood flow through the superior vena cava. It is a medical emergency usually manifesting a malignant disease process within the thorax in at least 60% of cases [1]. It requires immediate diagnostic evaluation and therapy. SVC obstruction was originally described by William Hunter in 1757 in…
Patient Selection Patients should be evaluated to confirm the diagnosis of primary achalasia. While a barium swallow can suggest the diagnosis, confirmation is best obtained with a motility study. In addition to confirming the diagnosis, the lower esophageal sphincter pressure measured on preoperative motility studies has been correlated with outcome after myotomy for achalasia (USC…
ANTICOAGULATION Patient Target INR Date PT (INR) Coumadin (mg) PTT Heparin (U/hr) …
By Anil M. Patwardhan, MS Video:
By A. Sampath Kumar, MD and Carlos MG Duran, MD, PhD Editor’s Note This video demonstrates a very elegant technique of creating a trileaflet aortic valve utilizing the patient’s own pericardium. Although the technique is very impressive, its clinical application is questionable. The neo-aortic valve has no advantage over a stented or stentless bioprosthesis or a homograft,…
By J. Scott Rankin, MD, Ricardo E. Orozco MD and Calvin A. Burrichter, MD American Heart Association 2007 Video:
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