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Surgical Technology International XXVI contains 50 peer-reviewed articles featuring the latest advances in surgical techniques and technologies.
2015 - ISSN:1090-3941
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Cardiovascular Surgery
Successful Valve Prolapse Repair for Ischemic Mitral Regurgitation: Combined Papillary Muscle Approximation and Mitral Chordae System Replacement
Francesco Nappi, MD, Cardiac Surgery Consultant, Cardiac Surgery Centre, Cardiologique du Nord de Saint-Denis, Paris, France, Department of Cardiovascular Surgery, University Campus Bio-Medico of Rome, Rome, Italy, Cristiano Spadaccio MD, PhD, Cardiac Surgery Consultant, Department of Cardiothoracic Surgery, Golden Jubilee National Hospital, Clydebank, Glasgow, United Kingdom, Department of Cardiovascular Surgery, University Campus Bio-Medico of Rome, Rome, Italy, Raffaele Barbato MD, Cardiac Surgery Consultant, Department of Cardiovascular Surgery, University Campus Bio-Medico of Rome, Rome, Italy, Mario Lusini MD, PhD, Cardiac Surgery Consultant/Associate Professor, Department of Cardiovascular Surgery, University Campus Bio-Medico of Rome, Rome, Italy, Massimo Chello, MD, Professor, Department of Cardiovascular Surgery, University Campus Bio-Medico of Rome, Rome, Italy
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Mitral valve prolapse occurs in 33.6% of patients undergoing surgery for ischemic mitral regurgitation (IMR). In the context of IMR, reparative strategy cannot disregard the underlying mechanism of pathogenesis and the progressive geometric alteration affecting left ventricle and papillary muscles. We present a case of extended mitral prolapse of the posteromedial commissure and A3 concomitant to chordal injury after inferior myocardial infarction. We propose a combined sequential approach including papillary muscle approximation and a mitral chordae system replacement.
An Evolving Understanding of the Genetic Causes of Abdominal Aortic Aneurysm Disease
Grace H. Miner, BS, PhD Student, Kevin D. Costa, PhD, Associate Professor, Basil G. Hanss, PhD, Associate Professor, Michael L. Marin, MD, Professor and System Chair, Icahn School of Medicine at Mount Sinai, New York, New York
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Aneurysms of the abdominal aorta (AAA) are relatively common - affecting as many as 8% of men and 1% of women over the age of 65. AAAs are characterized by a 50% increase in the diameter of the aneurysmal aorta compared with the normal vessel. Degeneration of structural components of the aortic wall is believed to be central in the pathogenesis of AAAs. The exact mechanism of degeneration is not well characterized, although degradation of elastin and collagen has been clearly shown. At least six genetic variants have been associated with AAA in genome-wide association studies: CDKN2BAS1, DAB2IP, LDLR, LRP1, SORT1, and IL6R. These variants reach genome-wide significance; however, they have not been replicated in multiple cohorts, nor have they been clearly shown to be disease causative. AAA is a challenging disease for investigation because it is most often asymptomatic and generally has a late disease onset, making it difficult to diagnose. Determination of the genetic mechanism behind aneurysm formation, progression, and rupture crosses disciplines requiring input from multiple fields of study, larger patient cohorts, and the evolving modalities of genetic testing.
Novel Techniques in Video-assisted Thoracic Surgery (VATS) Lobectomy
Nur A. Ismail, MBChB, Clinical Fellow in Cardiothoracic Surgery, Mohamed Elsaegh, MD, Clinical Fellow in Cardiothoracic Surgery, Joel Dunning, MD, Consultant Cardiothoracic Surgeon, Department of Cardiothoracic Surgery, James Cook University Hospital, Middlesbrough, United Kingdom
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Twenty years ago, thoracic surgery witnessed the leap from thoracotomy to the first video-assisted thoracic surgery (VATS) lobectomy. Gradually VATS lobectomy has become widely accepted and practiced worldwide. As the idea of less-invasive, fewer, and smaller incisions is taken up by surgeons, thoracic surgery has witnessed the progress of the conventional three-port VATS lung resection to two-port VATS and finally the birth of uniportal VATS lobectomy. Incisions have also become much smaller over the years, such as those seen in total port access lobectomy or microlobectomy. A modified version of the uniportal VATS lobectomy through the subxiphoid incision has also recently been used. The movement 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. Reported outcomes and results of these new developments are encouraging.
Recent Advancements in Infrapopliteal Revascularization
Chun K. Yang, MD, Surgery Resident, Deptment of Surgery, Mount Sinai St. Luke’s Hospital and Mount Sinai Roosevelt Hospital, New York, NY, Nicole Ilonzo, MD, Surgery Resident, Department of Surgery, Mount Sinai St. Luke’s Hospital and Mount Sinai Roosevelt Hospital, New York, NY, Jakob Nowotny, MD, Surgery Resident, Department of Surgery, Mount Sinai St. Luke’s Hospital and Mount Sinai Roosevelt Hospital, New York, NY, John C. Lantis, II, MD, Professor of Surgery/Chief of, Vascular-Endovascular Surgery, Department of Surgery, Mount Sinai St. Luke’s Hospital and Mount Sinai Roosevelt Hospital, New York, NY
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Infrapopliteal arterial disease is a challenging problem to treat. A shift toward an endovascular treatment approach over surgical bypass has occurred over recent years. Although current standard percutaneous transluminal balloon and bare metal stents are employed, their durability and outcomes are questionable. A number of endovascular advancements in the treatment of infrapopliteal (IP) arterial disease have recently been made. We review the recent literature for new atherectomy, stent, and balloon technologies.
Mechanochemical Endovenous Occlusion of Varicose Veins Using the ClariVein® Device
Marianne E. Witte, MD, FEBVS, Consultant Vascular Surgeon, Department of Surgery, Gelre Hospital, Apeldoorn, The Netherlands, Michel M. P. J. Reijnen, MD, PhD, Consultant Vascular Surgeon, Department of Surgery, Rijnstate Hospital, Arnhem, The Netherlands, Jean-Paul de Vries, MD, PhD, Consultant Vascular Surgeon, Department of Surgery, Antonius Hospital, Nieuwegein, The Netherlands, Clark J. Zeebregts, MD, PhD, Professor of Vascular Surgery, Consultant Vascular Surgeon, Department of Surgery, (Division of Vascular Surgery), University Medical Center, University of Groningen, Groningen, The Netherlands
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Introduction: In the last decade, minimally invasive endothermal ablation techniques have replaced surgery for the treatment of superficial venous insufficiency to reduce postoperative complications and recovery time and to improve quality of life. To avoid the risks of nerve damage and need for tumescent anesthesia to improve patient comfort, an alternative heatless technique has been introduced recently. Methods: Endovenous mechanochemical occlusion using the ClariVein® catheter (Vascular Insights LLC, Quincy, MA) is a new technique combining mechanical injury to the venous endothelium coupled with simultaneous catheter-guided infusion of a liquid sclerosant. This produces irreversible damage to the endothelium resulting in fibrosis of the vein. Results: The technique is related to a low complication rate and a success rate of 96% at two years and sustained quality of life improvement. This closure rate is comparable to endothermal techniques, but significantly less postoperative pain and earlier return to normal activities and work has been reported with endovenous mechanochemical occlusion. Conclusion: Mechanochemical occlusion using ClariVein® has proven to be safe and effective and has several advantages compared to endothermal techniques. The possibility of retrograde ablation of distal SSV insufficiency in C6 ulceration is considered a significant advantage. Randomized comparative studies with long-term follow up will continue to define the definite place of mechanochemical occlusion.
Abdominal Aortic Aneurysm Repair Using Nellix™ EndoVascular Aneurysm Sealing
Leo H. van den Ham, MD, Clinical Researcher, Department of Surgery, Division of Vascular Surgery, Rijnstate Hospital, Arnhem, The Netherlands, Clark J. Zeebregts, MD, PhD, Department of Surgery, (Division of Vascular Surgery), Consultant Vascular Surgeon, Professor of Vascular Surgery, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands, Jean Paul P.M. de Vries, MD, PhD, Consultant Vascular Surgeon Department of, Vascular Surgery, St. Antonius Hospital, Nieuwegein, The Netherlands, Michel M.P.J. Reijnen, MD, PhD, Consultant Vascular Surgeon, Department of Surgery, Division of Vascular Surgery, Rijnstate Hospital, Arnhem, The Netherlands
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Since the dawn of endovascular aortic aneurysm repair (EVAR), starting from its initial report in 1991, there has been a significant evolution in stent graft design and delivery systems. Complications, mostly endoleaks, and re-intervention rates after EVAR remain amongst the most challenging aspects in comparison with traditional open repair. The use of a sac-anchoring endograft changes the approach of aneurysm exclusion. The Nellix™ EndoVascular Aneurysm Sealing system (Endologix Inc., Irvine, CA) consists of balloon expandable stents surrounded by endobags that are filled with a polymer thereby sealing the aneurysm. By sealing the aneurysm sac instead of exclusion with only proximal and distal fixation, the risk of stent migration and endoleaks is theoretically diminished. Current investigational use is aimed to confirm clinical success, decreased complication, and secondary intervention rates compared to conventional endovascular repair.