Surgical Technology International
38th Edition
Contains 63 peer-reviewed articles featuring the latest advances in surgical techniques and technologies.
June 2021 - ISSN:1090-3941
1 year Institutional Subscription
both electronic and print versions
Micro-Dosing of Indocyanine Green for Intraoperative Fluorescence Cholangiography
Jorge G. Zarate Rodriguez, MD, Chet W. Hammill, MD, MCR, FACS, Associate Professor of Surgery, Barnes-Jewish Hospital and the Alvin J. Siteman Cancer Center, Washington University School of Medicine, St. Louis, MO, USA
1388
Background: Surgery involving the biliary tree is common but has the potential for serious complications. Adjuncts such as intraoperative cholangiogram and, more recently, indocyanine green (ICG) fluorescence cholangiography, have been used to more accurately define the relevant anatomy and decrease the risk of common bile duct injury. The optimal ICG dose is unknown, but the most commonly cited dose in the literature is 2.5 mg. We describe our experience using micro-dosing of ICG as proof-of-concept for its successful use in the identification of biliary structures.
Methods: A video library from a variety of hepatobiliary surgeries which included micro-dosing of ICG was compiled between 2018 and 2020. These videos were retrospectively reviewed and graded for the degree of visualization of biliary structures (complete, partial, none) and the degree of background liver fluorescence (significant, moderate, minimal).
Results: Overall, 40 videos were reviewed; 70% were minimally invasive cholecystectomies. Micro-dosing was used in all patients; complete visualization was achieved in 52.5% of the patients, partial visualization in 40%, and no visualization in 7.6%. Eighty percent of patients had minimal to moderate background fluorescence. Despite ICG micro-dosing, 20% of the patients still had significant liver dye uptake.
Conclusion: ICG cholangiography is an alternative to more invasive means of intraoperative imaging during biliary surgery, but the optimal dose of ICG is unknown. We have used a 0.05 mg micro-dose of ICG to successfully visualize biliary structures and reduce background liver fluorescence. This preliminary report can be used to develop further studies into whether micro-dosing of ICG is associated with improved clinical outcomes.
Order Digital ePrint:
PDF Format - $115.00
100 ePrints - $495.00
1 Year Subscription
including this article:
Online PDF - $399.00
The TransEnterix European Patient Registry for Robotic-Assisted Laparoscopic Procedures in Urology, Abdominal, Thoracic, and Gynecologic Surgery (“TRUST”)
Dietmar Stephan, MD, Professor, Saitama Medical University, Saitama, Japan, Ibrahim Darwich, MD, Frank Willeke, MD, PhD, Professor, Clinic for General and Visceral Surgery, St. Marien – Krankenhaus, Siegen, Germany
1394
Introduction: Robotic surgery was first introduced in the mid-1980s, and at the end of the '90s, the da Vinci® System (Intuitive Surgical Inc., Sunnyvale, California) was introduced in Europe and held a monopoly for years afterward. In 2016, Senhance™ digital laparoscopic platform (TransEnterix Inc., Morrisville, North Carolina) came to the market. This new platform is based on laparoscopic movements and is designed for laparoscopic surgeons. This study shows the surgical outcomes of patients after different visceral, colorectal, gynecological, and urological surgical procedures done with the Senhance™ digital laparoscopic platform with a focus on safety.
Materials and Methods: The study population consists of 871 patients who underwent robotic surgery with the Senhance™ platform. The most common procedures were hernia repairs (unilateral and bilateral), cholecystectomies, and prostatectomies. The procedures were performed in five centers in Europe between February 2017 and July 2020 by experienced laparoscopic surgeons.
Results: 220 (25.3 %) out of 871 patients had a unilateral hernia repair, 70 (8.0%) a bilateral hernia repair, 159 (18.3%) underwent a cholecystectomy, and 168 (19.3%) a prostatectomy. The other procedures included visceral, colorectal, and gynecological surgery procedures. The median docking time was 7.46 minutes for the four most common procedures. The duration of surgery varied from 32 to 313 minutes, the average time was 114.31 minutes.
Adverse events were rare overall. There were 48 (5.5 %) adverse events out of 871 patients, 24 of them (2.8 % of all cases) were severe. Out of all 24 severe adverse events, five events (20.8%) were likely related to the robot, 17 events (70.8%) were unlikely related to the robot, and two events (8.3%) could not be categorized.
Regarding complications following unilateral hernia repairs, data from 212 patients was available. Thirteen (6.1%) complications occurred, and six of those (2.8%) were serious. Out of 68 patients with a bilateral hernia repair, six patients (8.8%) developed complications, three of which were severe (4.4%). The complication rate was 2.8% in the patients following a cholecystectomy (4/144); two of them serious. After prostatectomy, six out of 141 patients (4.3 %) had complications; one serious (0.7%) No mortality was observed.
Data about unplanned conversions to laparoscopic surgery could be collected from 761 patients which is a rate of 3.7%. There were 12 conversions out of 760 procedures to open surgery (1.6%).
Conclusions: Our series shows these procedures are safe and reproducible. The findings suggest that the surgical results after robotic surgery with the Senhance™ system are promising. Long-term data regarding complication rates should be the subject of future studies.
Order Digital ePrint:
PDF Format - $115.00
100 ePrints - $495.00
1 Year Subscription
including this article:
Online PDF - $399.00
An Improved Recurrent Laryngeal Nerve-Monitoring Device: Technical Note for NIM Vital™
Antonella Pino, MD, Gianlorenzo Dionigi, MD, PhD, FACS, Professor of Surgery, University of Messina, Messina, Italy, Francesco Frattini, MD, ASST Settelaghi, Varese, Italy, Hui Sun, MD, Professor of Surgery, Daqi Zhang, MD, PhD, Professor of Surgery, Jilin Provincial Key, Laboratory of Surgical Translational Medicine, Changchun, China, Ozer Makay, MD, PhD, Professor of General Surgery, Ege University School of Medicine, Izmir, Turkey, Stefano Rausei, MD, ASST Valle Olona, Gallarate, VA, Italy, Che Wei Wu, MD, PhD, Professor of Otolaryngology-Head and Neck Surgery, Kaohsiung Medical University, Kaohsiung, Taiwan, Hoon Yub Kim, MD, Professor of Surgery, KUMC Thyroid Center Korea University, Anam Hospital, Seoul, Republic of Korea, Per Giorgio Calò, MD, Professor of Surgery, University of Cagliari, Cagliari, Italy, Paolo Del Rio, MD, Professor of Surgery, University of Parma, Parma, Italy, Gabriele Materazzi, MD, Professor of Surgery, University of Pisa, Pisa, Italy
1443
A new device for monitoring the laryngeal nerves during thyroid surgery has been developed. NIM Vital™ (Medtronic Xomed, Inc., Jacksonville, FL, USA) incorporates (a) a new wireless design, (b) NIM NerveTrendTM (Medtronic Xomed) EMG reporting, (c) intelligent noise-reduction technology that suppresses artifacts, (d) smart troubleshooting pop-up alerts, and (e) NIM Nervassure ™ (Medtronic Xomed) for continuous monitoring. This device offers enhanced stability and flexibility for both intermittent and continuous laryngeal nerve monitoring. The new NIM NerveTrend ™ EMG reporting makes it possible to track the recurrent laryngeal nerve condition throughout a procedure, even when using intermittent nerve monitoring. During both continuous and intermittent monitoring, green, yellow and red status bars provide visual information and associated tones provide audible cues, making it easy to monitor nerve function and interpret EMG trends. This new tool for laryngeal nerve monitoring has the potential to augment nerve dissection during surgery. Measurements of long-term outcome are needed to establish their efficacy.
Should Negative Pressure Therapy Replace Any Other Temporary Abdominal Closure Device in Open-Abdomen Management of Secondary Peritonitis?
Vincenzo Pappalardo, MD, Ospedale di Circolo, ASST Settelaghi, Varese, Italy, Stefano Rausei, MD, PhD, ASST Valle Olona, Gallarate, Italy, Vincenzo Ardita, MD, IRCCS San Raffaele Scientific Institute, Milan, Italy, Luigi Boni, MD, FACS, Full Professor of Surgery, Fondazione IRCCS, Ca' Granda Ospedale Maggiore Policlinico di Milano, University of Milan, Milan, Italy, Gianlorenzo Dionigi, MD, FACS, Full Professor of Surgery, "G. Barresi" University Hospital - Policlinico "G. Martino", The University of Messina, Messina, Italy
1386
AIM: To clarify the advantages of negative pressure therapy (NPT) compared to other methods of temporary abdominal closure (TAC) in the management of secondary peritonitis.
METHODS: We retraced the history of known methods of TAC, and analyzed their advantages and disadvantages. We evaluated as the NPT mechanisms, both from the macroscopic that bio-molecular point of view, well suits to manage this difficult condition.
RESULTS: The ideal TAC technique should be quick to apply, easy to change, protect and contain the abdominal viscera, decrease bowel edema, prevent loss of domain and abdominal compartment syndrome, limit contamination, allow egress of peritoneal fluid (and its estimation) and not result in adhesions. It should also be cost-effective, minimize the number of dressing changes and the number of surgical revisions, and ensure a high rate of early closure with a low rate of complications (especially entero-atmospheric fistula). For NPT, the reported fistula rate is 7%, primary fascial closure ranges from 33 to 100% (average 60%) and the mortality rate is about 20%. With the use of NPT as TAC, it may be possible to extend the window of time to achieve primary fascial closure (for up to 20-40 days).
CONCLUSION: NPT has several potential advantages in open-abdomen (OA) management of secondary peritonitis and may make it possible to achieve all the goals suggested above for an ideal TAC system. Only trained staff should use NPT, following the manufacturer’s instructions when commercial products are used. Even if there was a significant evolution in OA management, we believe that further research into the role of NPT for secondary peritonitis is necessary.
Order Digital ePrint:
PDF Format - $115.00
100 ePrints - $495.00
1 Year Subscription
including this article:
Online PDF - $399.00
Treatment of Recurrent Respiratory Papillomatosis: Case Series and Review of Technique
Christopher Manley, MD, DAABIP, Assistant Professor of Medicine, Fox Chase Cancer Center, Philadelphia, PA, Christoph Hutchinson, MD, MA, Assistant Professor, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, Amit Mahajan, MD, FCCP, DAABIP, Inova Heart and Vascular Institute, Inova Fairfax Hospital, Falls Church, VA, Omar Ibrahim, MD, Assistant Professor of Medicine, UConn Health, Pulmonary/Critical Care, Farmington, CT, Erik Folch, MD, MSc, Massachusetts General Hospital, Harvard Medical School, Boston, MA, Rohit Kumar, MD, Associate Professor, Fox Chase Cancer Center, Philadelphia, PA
1408
Adult Recurrent Respiratory Papillomatosis (RRP) is a rare disease caused by the human papilloma virus in which papilloma grows from the respiratory epithelium. Patients can suffer from significant respiratory distress secondary to tracheal or bronchial obstruction by papilloma and the mainstay of treatment is bronchoscopic debridement. There are a variety of techniques to resect the endoluminal tumor, including CO2 or YAG laser, argon plasma coagulation, microdebrider and cold forceps. There have been documented cases of healthcare workers contracting HPV after exposure to surgical smoke during ablation of papilloma and measures should be taken to avoid inhalation of the smoke plume. For proximal lesions that are accessible to a microdebrider, this appears to be a safe and effective technique that does not generate heat or surgical smoke.
The rate of recurrence of adult-onset respiratory papilloma after initial debulking varies and adjuvant medical therapy including intralesional cidofovir, interferon, or oral indole-3-carbinol has been used to slow recurrence. Malignant transformation of adult-onset RRP to squamous cell carcinoma has been reported to occur in 3-7% of cases. Therefore, ongoing surveillance is needed to monitor for disease progression and malignant transformation.
Here we describe three patients whose tracheal disease was managed with an Nd-YAG laser and microdebrider. One patient was treated with adjuvant systemic indole-3 carbinol and another was maintained with serial debridement only. The third patient presented with obstructing squamous cell carcinoma of the trachea and was treated with definitive chemoradiation. She presented with a new left mainstem lesion 6 months later which was diagnosed as RRP. She was started on indole-3 carbinol, but unfortunately it transformed to squamous cell carcinoma 8 months later
Order Digital ePrint:
PDF Format - $115.00
100 ePrints - $495.00
1 Year Subscription
including this article:
Online PDF - $399.00
C2 Xplore® for Intermittent and Continuous Laryngeal Nerve Monitoring: Technical Note
Antonella Pino, MD, Gianlorenzo Dionigi, MD, PhD, FACS, Professor of Surgery, University Hospital G. Martino, University of Messina, Messina, Italy, Che Wei Wu, MD, PhD, Professor of Otolaryngology-Head and Neck Surgery, Kaohsiung Medical University, Kaohsiung, Taiwan, Hoon Yub Kim, MD, Professor of Surgery, KUMC Thyroid Center Korea University, Anam Hospital, Seoul, Republic of Korea, Francesco Frattini, MD, Ospedale di Circolo e Fondazione Macchi di Varese - ASST dei Sette Laghi, Italy, Hui Sun, MD, Professor of Surgery, Daqi Zhang, MD, PhD, Professor of Surgery, Jilin Provincial Key Laboratory of Surgical Translational Medicine, Changchun, Jilin Province, China
1442
Due to the direct anatomical relationship between the recurrent laryngeal nerve (RLN) and the thyroid gland, the function and anatomical integrity of the RLN is fundamentally at risk in every thyroid operation. While a RLN morbidity rate of less than 5% is achieved in specialized clinics, the morbidity rates are significantly higher in non-specialized centers. Thus, the aim is to reduce the complication rate by establishing standardized interventions. Exact knowledge of the anatomical course of the RLN, the nerve-sparing dissection technique and the supportive use of intraoperative neuro-monitoring (IONM) to identify anatomical variations are the basis for nerve-sparing surgery. We tested the new C2 Xplore® system (inomed Medizintechnik GmbH, Emmendingen, Germany) as a tool for performing intermittent and continuous laryngeal nerve monitoring during thyroid surgery. The C2 Xplore® helps to enhance surgeon-IONM interaction, and provides comprehensive digital EMG documentation with EMG quantification. EMG artifacts are removed. Image quality and EMG feedback are highly acceptable for intraoperative monitoring. The C2 Xplore® system does not have a deleterious impact on the proper function of other surgical instruments. C2 Xplore® is effective for intraoperative monitoring, optimizing RLN dissection, and supporting surgical deliberations, and for forensic use and research. A step-by-step C2 Xplore® procedure is described.
Order Digital ePrint:
PDF Format - $115.00
100 ePrints - $495.00
1 Year Subscription
including this article:
Online PDF - $399.00
