Content from the Journal of the American Neurological Surgeons.
Thymectomy for myasthenia gravis, thymic cysts, thymoma less than two centimeters in size, and mediastinal parathyroid adenoma within the thymus are all indications for a video-assisted extended transcervical thymectomy. Patient Selection Figure 1: CT scan of the chest with arrow pointing out the thymus gland. Thymectomy for myasthenia gravis, thymic cysts, thymoma less than two…
Epiphrenic diverticuli are acquired mucosal outpouchings protruding through the muscular wall of the distal 10 cm of the esophagus. Most are associated with an underlying esophageal motility disorder. Patient Selection Epiphrenic diverticuli are acquired mucosal outpouchings protruding through the muscular wall of the distal 10 cm of the esophagus [1]. Most are associated with an…
Patient Selection The initial selection is performed by the spine surgeon for typical indications of spine stabilization, resection of tumor, drainage of an abscess, and re-operation for complications of previous spine surgery [1-3]. The transthoracic approach (thoracotomy) affords the spine surgeon excellent visualization and access to the anterior thoracic spine, the vertebral bodies, intervertebral disks,…
Several surgical approaches have been described for the management of adult patients with acquired heart disease and paraductal coarctation of the aorta. Options are a staged procedure using median sternotomy and left thoracotomy, a catheter-based intervention of the coarctation combined with sternotomy, and single-stage simultaneous correction of lesions via sternotomy. Patient Selection Several surgical approaches…
Stainless steel wires are currently used for median sternotomy closure in cardiac and general thoracic surgery; this method is safe, effective, and fast. However, the wires can damage and cut bone during respiratory and chest motion. A novel sternal reinforcement device has been designed to prevent wires cutting into the bone. Stainless steel wires are…
Unilateral diaphragmatic agenesis is a rare diagnosis typically made early in infancy and generally associated with other genetic anomalies. We present an unusual case of adult onset progressive shortness of breath and peripartum hepatic herniation into the chest, which on intraoperative exploration revealed diaphragmatic agenesis. IntroductionUnilateral diaphragmatic agenesis is a rare diagnosis typically made early…
Introduction Intrathoracic goiters are encountered less often today than they were in previous decades. Nonetheless, they are still considered a diagnostic possibility in all anterosuperior mediastinal masses, particularly in Eastern Europe and Asia. Creswell and Wells [1] in 1992 reported that intrathoracic thyroid masses accounted for 5.8% of all mediastinal masses. For an intrathoracic thyroid,…
Patient Selection Currently, only patients with preexisting, paroxysmal atrial fibrillation undergoing OPCAB have been offered an adjuvant off-pump Maze procedure. Patients with previous thromboembolism or warfarin complication, as well as those with palpitations or antiarrythmic drug intolerance are offered this therapy when undergoing concomitant OPCAB. Patients with long standing atrial fibrillation are currently not candidates…
ABSTRACT Ten-year old child presented with recurrent hemoptysis and a bout of massive hemoptysis. Chest radiography and computerized tomography revealed a soft tissue mass in the right lower lobe. Emergency right lower lobectomy revealed echinococcal cyst as the cause of the exsanguinating bleed. PRESENTATION In the evening of July 1, 2005 a ten-year old child…
Patient Selection The edge-to-edge technique is a method to treat mitral valve regurgitation by suturing the edges of the leaflets at the site of regurgitation. Although the method is technically simple, its application should follow a few rules to ensure effective and durable results, and to avoid complications. The most critical issue is to avoid…
Surgical stapling devices have been used in Thoracic surgery for over 20 years and have proven as reliable as suturing for the bronchus, pulmonary artery, pulmonary vein or lung parenchyma. They have allowed for the widespread application of thoracoscopy to complex procedures within the chest. Introduction Surgical stapling devices have been used in Thoracic surgery…
Bronchoscopic alternatives to lung volume reduction surgery (LVRS) have been recently proposed; the airway bypass [1-3] and bronchoscopic lung volume reduction (BLVR) are certainly one step beyond current LVRS practice. In particular, BLVR with one–way valves has been attempted in the experimental laboratory [4] and in selected clinical settings [5-8]. The one–way valve allows air…
Various diathermy techniques have been proposed to reduce intraoperative blood loss in surgery. In particular, standard bipolar technology is able to coagulate small vessels, with a diameter ranging from 1 mm to 3 mm, but it has some disadvantages, including sticking, charring, and significant thermal spread [1,2]. A new electrothermal bipolar tissue sealing system (LigaSure,…
Operative Steps The patient is anesthetized in the supine position and intubated with a single lumen endotracheal tube. Defibrillator patches are placed on the patient’s back and anterior left chest wall. A transesophageal echo Doppler probe is placed to assess the pathoanatomy of the aortic valve disease and assist in removing air from the heart…
Operative Steps The patient is positioned supine, anesthetized and intubated with a single lumen endotracheal tube and then prepped and draped in the usual fashion. Defibrillator patches are placed on the patient’s back and anterior left chest wall. A transesophageal echo probe is placed to assess the pathology of the mitral valve disease and assist…
Operative Steps Modified Subcoronary Implantation AortotomyPartially transect the aorta in a horizontal fashion 1.5 to 2 cm above the right coronary. Looking inside the aorta, extend the incision to the left ending 1.5 to 2 cm above the left coronary ostia, and to the right, ending 1.5 to 2 cm above the left non-coronary commissure…
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