Innovations : technology and techniques in cardiothoracic and vascular surgery
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Innovations (Phila) · Jan 2012
Evolution of cannulation techniques for minimally invasive cardiac surgery: a 10-year journey.
For minimally invasive cardiac surgery (MICS) procedures requiring cardiopulmonary bypass (CPB), cannulation techniques vary and seem to be important determinants of technical difficulty and clinical outcomes. Over 10 years of MICS, we have modified our techniques substantially, and the present report outlines the evolution of our current cannulation platform. ⋯ Over 10 years, our cannulation strategy for MICS has evolved to favor central aortic over femoral arterial cannulation, percutaneous femoral dual-stage bicaval venous drainage over percutaneous neck access, and transaxillary clamping over endoaortic balloon occlusion of the aorta. In our experience, this approach has resulted in low complication rates and a reliable platform for a variety of MICS procedures.
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Innovations (Phila) · Jan 2012
Lobectomy for non-small cell lung cancer: differences in morbidity and mortality between thoracotomy and thoracoscopy.
Until the last decade, lobectomy by thoracotomy (TL) was the "gold standard" for treatment of patients with operable lung carcinoma. Today, video-assisted thoracic surgery lobectomy (VATS-L) has become accepted as a safe and effective procedure to treat early-stage lung cancer. We analyzed and compared postoperative complications, hospital stay, morbidity, and mortality after TL and VATS-L in patients with non-small cell lung carcinoma (NSCLC). ⋯ Our clinical impression is that VATS-L offers advantages over TL in terms of lower morbidity, fewer and less serious complications, shorter hospital stays, and the possibility to operate on patients with more comorbidities.
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Innovations (Phila) · Jul 2011
An audit of pain control pathways following video-assisted thoracoscopic surgery.
To compare different modes of pain management following video-assisted thoracoscopic surgery (VATS) to our national standard. ⋯ We are not compliant with the standards set by the audit commission. Pain management in theater recovery needs to be targeted. In the light of these results, we recommend the use of percutaneous thoracic paravertebral catheter +/- morphine PCA for postoperative VATS pain relief.
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Innovations (Phila) · Mar 2011
Short- and long-term outcomes in octogenarian patients undergoing off-pump coronary artery bypass grafting compared with on-pump coronary artery bypass grafting.
: Coronary artery bypass grafting (CAB) on elderly patients presenting with multivessel coronary artery disease has become routine in modern day operating rooms. The aim of our study was to compare short- and long-term outcomes in octogenarian patients undergoing off-pump CAB (OPCAB) versus on-pump CAB (ONCAB). ⋯ : In this series, OPCAB reduced the incidence of in-hospital mortality compared with ONCAB. Long-term mortality was similar between groups.
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Innovations (Phila) · Jan 2011
The techniques of endobronchial ultrasound-guided transbronchial needle aspiration.
Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) is a minimally invasive modality for mediastinal lymph node staging in lung cancer patients as well as for the diagnosis of mediastinal and hilar adenopathy. The high diagnostic yield of EBUS-TBNA for lymph node staging has been shown in systematic reviews and meta-analysis. It has attracted physicians and surgeons as an alternative modality to surgical biopsy for the assessment of patients with enlarged mediastinal and/or hilar lymph nodes. ⋯ Training is mandatory for achieving high diagnostic yield without complications. The learning curve of EBUS-TBNA is different from each physician, and continuous training program will be needed for impartiality. This article explains the detailed techniques of EBUS-TBNA to master this innovative procedure.