Content from the Journal of the American Neurological Surgeons.
Patient Selection Traumatic thoracic aortic transection (TSXN) is a potentially lethal injury that occurs following blunt injury to the chest, most commonly as the result of motor vehicle crashes or falls [1]. Endograft repair of thoracic aortic TSXN is increasingly utilized as a less invasive alternative to open surgical repair [2]. Currently available thoracic endografts,…
Operative Steps Upon Arrival Call transplant center to indicate arrival at the site of donor harvest. Ascertain the organs to be taken and specific plans for each donor retrieval team. Assess patient’s hemodynamic status. If necessary, optimize hemodynamic status by volume loading and weaning beta adrenergic pressers and beginning alpha agents to maintain perfusion. Review…
Operative Steps Incision A midline sternotomy is generally employed A minimal approach using a lower ½ sternotomy may also be employed. Cardiopulmonary bypass The operation is performed on cardiopulmonary bypass using a single venous cannula (two stage) with oxygenated blood return to the ascending aorta. Two venous cannulae are employed in cases of extensive infection…
Partial anomalous pulmonary venous connection of the left upper lobe to a vertical vein is a rare congenital anomaly which can give rise to significant left-to-right cardiac shunting. We present the surgical technique employed in addressing this lesion through a left thoracotomy and include a video demonstration of the procedure. Introduction Partial anomalous pulmonary venous…
Introduction Dr. Gerbode first described a left ventricle (LV) to right atrial (RA) shunt in 1958. These defects are usually congenital, but cases of acquired defects secondary to aortic or tricuspid valve endocarditis have been described. The acquired defect differs from the congenital defect in that it is a direct communication between the left ventricle…
Obstruction of the central airways may develop in 30-40% of all patients with lung cancer and is being increasingly diagnosed in patients with benign disorders such as post intubation tracheal stenosis and connective tissue diseases. Introduction Obstruction of the central airways may develop in 30-40% of all patients with lung cancer and is being increasingly…
Radio frequency ablation (RFA) of lung tumors is a relatively new procedure allowing local treatment with minimal parenchymal damage. In fact, this technique is able to induce coagulative necrosis in a limited pulmonary area. Radio frequency ablation (RFA) of lung tumors is a relatively new procedure allowing local treatment with minimal parenchymal damage. In fact,…
Tissue sealing remains a requirement for advanced general thoracic procedures with the aims of improving hemostasis, diminishing lymphatic fluid production, and prevention of postoperative air leaks. Different products have become available in recent years that include commercial biological glues, autologous glues made on-site, and biological fibrin-based products. Introduction Tissue sealing remains a requirement for advanced…
Introduction Figure 1: The Sahara S-1100 Deknatel drainage system with the 7 chamber air leak meter. Although air leaks remain the most common complication after pulmonary resection, they have received little scientific study until recently. Despite the development and adoption of a classification system for air leaks [1, 2] and several recent prospective randomized studies…
The impetus for intrabronchial treatment of emphysema came from the experiences with lung volume reduction surgery (LVRS). Introduction The impetus for intrabronchial treatment of emphysema came from the experiences with lung volume reduction surgery (LVRS). LVRS improves survival, function, exercise capacity, and quality of life in selected patients with severe chronic obstructive pulmonary disease (COPD)…
The desire for an objective method to record, quantify, and store lung sound information was the impetus for development of the field of computer-assisted mapping of lung sounds. Techniques are constantly evolving, with many different types of sensors, sensor coupling methods, and digital signal processing techniques in existence. Introduction The desire for an objective method…
IntroductionAir leaks continue to be the most common complication after lung surgery, as well as an accepted morbidity. Minor leaks are generally innocuous and can be managed conservatively by chest tube drainage; but prolonged leaks, defined as those lasting more than 7 days, may require further interventions resulting in a delay of discharge and thus…
Introduction Figure 1: The Sahara S-1100 Deknatel drainage system with the 7 chamber air leak meter. Although air leaks remain the most common complication after pulmonary resection, they have received little scientific study until recently. Despite the development and adoption of a classification system for air leaks [1, 2] and several recent prospective randomized studies…
Approaches to lung resection for early stage cancer. This survey was posted during November 2006. A total of 41 responses were received; most were from North American surgeons. Most surgeons preferred a VATS wedge resection for diagnosis. There was a considerable range of approaches for resection, including muscle sparing thoracotomy, muscle dividing thoracotomy, and VATS…
Practice patterns of surgical therapy for esophageal cancer This esophageal cancer management survey was posted during the months of August and September 2006. A total of 145 responses were received, the majority of which were from North American participants. Most surgeons recommend induction therapy prior to resection for regionally advanced esophageal cancer. It is interesting…
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