Seminars in thoracic and cardiovascular surgery
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Semin. Thorac. Cardiovasc. Surg. · Jan 2002
ReviewCurrent status and future directions in computer-enhanced video- and robotic-assisted coronary bypass surgery.
Since 1997, both the Cleveland Clinic and London Health Sciences Centre groups have embraced robotic assistance and more recently demonstrated the efficacy of this technology in totally closed-chest, beating heart myocardial revascularization. This endeavor involved an orderly progression and the learning of new surgical skill sets. We review the evolution of robot-enhanced coronary surgery and forecast the future of endoscopic and computer-enhanced, robotic-enabling technology for coronary revascularization. ⋯ Bleeding, ventilatory times, arrhythmias, hospital lengths of stay, and return to normal activity have been reduced. Recently, we have developed a new robotic revascularization strategy called Atraumatic Coronary Artery Bypass that is a promising mid-term step on the pathway to totally endoscopic, beating-heart coronary artery bypass. We conclude that computer-enhanced robotic techniques are safe, and further clinical studies are required to define the full potential of this evolving technology.
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Semin. Thorac. Cardiovasc. Surg. · Jan 2002
The role of pulmonary metastasectomy in soft tissue sarcoma.
Pulmonary metastases are common in patients with soft tissue sarcoma. The majority of patients who develop pulmonary metastases are asymptomatic and are diagnosed during routine follow-up visits. There is evidence to suggest that pulmonary metastasectomy is associated with improved overall survival but only in patients with complete surgical resection. ⋯ The majority of resectable patients have peripheral lesions that are amenable to wedge resection. There is little evidence to suggest that chemotherapy improves survival. Future research is needed to better identify patients for metastasectomy, to determine the role of minimally invasive procedures, and to develop better adjuvant therapy.