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Surgical Technology International 30

 

STI Volume 30

$195.00

 

Surgical Technology International Vol. 30 contains 73 peer-reviewed articles featuring the latest advances in surgical techniques and technologies.

 

June-2017- ISSN:1090-3941

 

1 year Institutional Subscription 

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Cardiovascular and Thoracic Surgery

Novel Techniques and Approaches to Minimally Invasive Thoracic Surgery
Osita Onugha, MD, MBA, Assistant Professor, John Wayne Cancer Institute, Santa Monica, California, Rasheed Ivey, MS, Medical Student, Charles R. Drew University/DGSOM at UCLA MEP, Los Angeles, California, Robert McKenna, MD, Professor, John Wayne Cancer Institute, Santa Monica, California

 

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Abstract


Approximately two decades ago, thoracic surgery witnessed the leap from thoracotomy to the first video-assisted thoracic surgery (VATS) lobectomy. Minimally invasive lobectomy and hilar lymphadenectomy is now widely established as a safe and oncological sound technique that is the standard of care for early-stage lung cancer. The move toward less invasive surgery has no doubt driven the innovation of sophisticated instruments and technology to cope with the demanding need of working through a restricted incision. We will discuss the use of minimally invasive thoracic surgery techniques for sympathectomy, cardiac arrhythmia, and first rib resection, as well as traditional lung resections (e.g., pneumonectomy, lobectomy, and segmentectomy). We will also discuss thoracic incisions and approaches using VATS, single port VATS, and robot-assisted thoracic surgery.

 

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The Use of Branched Endografts for the Aortic Arch in the Endovascular Era
Rami O. Tadros, MD, Associate Professor, Department of Surgery and Radiology, Associate Program Director, Vascular Surgery Residency, Director, Off-site Vascular Lab, Scott R. Safir, MD, Research Fellow, Department of Surgery, Peter L. Faries, MD, Professor, Department of Surgery and Radiology, Program Director, Vascular Surgery Residency, Daniel K. Han, MD, Assistant Professor, Department of Surgery and Radiology, Rajiv K. Chander, MD, Assistant Professor, Department of Surgery, Division of Vascular Surgery, Icahn School of Medicine at Mount Sinai Hospital, New York, New York, Cherrie Z. Abraham, MD, Director, Aortic Center, Knight Cardiovascular Institute, Associate Professor of Surgery, Division of Vascular and Endovascular Surgery, Oregon Health & Science University, Portland, Oregon, Michael L. Marin, MD, Professor and System Chair, Department of Surgery, Allan S. Stewart, MD, Associate Professor, Department of Cardiovascular Surgery, Icahn School of Medicine at Mount Sinai Hospital, New York, New York

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Abstract

The endovascular realm has steadily increased its footing in the treatment of the aorta and all of its territories since the foundational case in 1990 by Parodi. The aortic arch, however, continues to be one of the last bastions for treatment via open surgery, which remains the gold standard. Significant comorbidity and prior cardiac surgery prevent open surgery from being the only preferred option, allowing novel endovascular procedures to be considered. Since 1999, more advanced endovascular systems have been created by companies such as Cook Medical, Bolton Medical, Medtronic, Endospan, Gore Medical, and, recently, Kawasumi. The unique shape and angulation of the aortic arch often require the use of custom-made grafts, though arch reconstruction may also include in situ or back-table physician alterations to off-the-shelf devices. The goal of branched endografts is to exclude the aneurysm, while maintaining flow to supra-aortic trunk vessels. Technical success and device durability are limited by the physical constraints of the aortic arch, though greater experience may yield better patient outcomes. Typically, the initial stent-graft (SG) is introduced and deployed into the arch first. Bridging SG are then inserted via axillary or carotid access. Most often, the bridging SG extends from the innominate branch to the distal innominate, and from the left carotid branch to the left common carotid. The major concern is that manipulation of catheters and wires, both within the carotid arteries and aortic arch, create the potential for emboli leading to stroke and paraplegia. The development of endovascular-only techniques for aortic arch pathology will only increase with the aging population of the United States and associated accumulation of comorbidities, making open surgery too grave of a risk.

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Hybrid Repair Techniques for Complex Aneurysms and Dissections Involving the Aortic Arch and Thoracic Aorta
Rami Tadros, MD, Associate Professor, Department of Surgery and Radiology, Associate Program Director, Vascular Surgery Residency, Director, Off-site Vascular Lab, Scott R. Safir, MD, Research Fellow, Department of Surgery, Peter L. Faries, MD, Professor, Department of Surgery and Radiology, Program Director, Vascular Surgery Residency, Division of Vascular Surgery, Daniel K. Han, MD, Assistant Professor, Department of Surgery and Radiology, Rajiv K. Chander, MD, Assistant Professor, Department of Surgery , James F. McKinsey, MD, Professor and Vice Chairman, Department of Surgery, Systems Chief of Complex Aortic Intervention for Mount Sinai Health System, Mount Sinai West, Michael L. Marin, MD, Professor and System Chair, Department of Surgery , Division of Vascular Surgery, Icahn School of Medicine at Mount Sinai Hospital, New York, New York, Allan S. Stewart, MD, Associate Professor, Department of Cardiovascular Surgery, Icahn School of Medicine at Mount Sinai Hospital, New York, New York, , Sharif Ellozy, MD, Associate Professor of Clinical Surgery, Division of Vascular and Endovascular Surgery , Weill Cornell Medical College , New York, New York

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Abstract

Aortic aneurysms involving the ascending aorta, aortic arch, and descending thoracic aorta have been a challenging entity to surgically treat for over 60 years. Despite the mortality of the disease, early open surgical procedures also had significant morbidity and mortality. The inherent risk in treating multiple anatomic segments simultaneously led to the innovation of the staged elephant trunk (ET) approach by Borst in 1983. To avoid the thoracotomy and associated complications related to the second stage of the procedure, an endovascular completion paradigm was begun by Volodos in 1991. This theoretical hybrid technique combinined shorter and less elaborate open supra-aortic trunk debranching with less invasive endovascular exclusion and has grown since then in terms of different approaches and case volume. The rise of thoracic endovascular aortic repair (TEVAR) combined with debranching bypass has allowed certain lesions to be treated without a large scale intrathoracic open surgical procedure. The complexity and extensiveness of certain lesions, however, has necessitated a hybrid approach such as the frozen elephant trunk (FET) and the standard ET with second stage TEVAR. The former has been used to treat multifocal degenerative aneurysms, chronic dissections with aneurysm, and acute extensive dissections. After conventional proximal aortic replacement, a stent-graft (SG) is delivered antegrade through the transected arch where it is sutured proximally and then “frozen” distally via endovascular means. The FET has the advantage of avoiding a second stage, but potentially introduces a greater rate of spinal cord ischemia compared to the standard elephant trunk. Improvements on the FET procedure have included the development of more advanced hybrid SG such as the Vascutek® Thoraflex™ Hybrid graft (Vascutek Ltd, Scotland, UK), which consists of a distal en,dograft sealed to a proximal four-branched Vascutek Gelweave™ Vascutek Ltd, Scotland, UK) and incorporated sewing collar. While open surgery continues to be a component of complex aortic arch aneurysms, the development of hybrid devices that can bridge the gap between open and endovascular surgery will continue to flourish.

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