Journal of laparoendoscopic & advanced surgical techniques. Part A
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J Laparoendosc Adv Surg Tech A · Dec 2018
Minimally Invasive Surgical Approach for Posterior Tracheopexy to Treat Severe Tracheomalacia: Lessons Learned from Initial Case Series.
Background/Purpose: Posterior tracheopexy directly addresses membranous tracheal intrusion in severe tracheomalacia (TM). We have previously reported our experience of posterior tracheopexy through open approach in a large series of patients. This study aimed to review lessons learned from our initial series posterior tracheopexy through the video-assisted or robotic video-assisted thoracoscopic approach. Methods: We retrospectively reviewed our single-institution experience on all patients who underwent video-assisted or robotic video-assisted posterior tracheopexy for treatment of symptomatic TM between October 2016 and February 2018. Results: Ten patients underwent video-assisted (n = 4) or robotic video-assisted (n = 6) thoracoscopic posterior tracheopexy (age range: 8 months-19 years). ⋯ Improved respiratory symptoms were noted in 9/10 patients following the operation. The 1 patient with preexisting tracheostomy had reduced ventilator dependence but remained hospitalized with ongoing respiratory symptoms. Conclusions: The thoracoscopic approach for posterior tracheopexy, while challenging, can be applied to a select cohort of children with severe TM. Thoracoscopic surgery with robotic assistance can eliminate some technical limitations of the video-assisted approach by providing an easier platform for more complicated suturing angles.
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J Laparoendosc Adv Surg Tech A · Dec 2018
Comparative StudyControl Comparison of the New EndoWrist and Traditional Laparoscopic Staplers for Anterior Rectal Resection with the Da Vinci Xi: A Case Study.
Background: A new robotic stapler for the da Vinci Xi® is directly controlled by the surgeon at the console and equipped with EndoWrist® technology. We evaluated operative and short-term results of the first patients who underwent anterior rectal resection for cancer with the da Vinci Xi and new staplers, and compared the results with those of a comparable group treated with traditional laparoscopic staplers. Methods: From December 2015 to December 2017, 25 patients underwent anterior rectal resection for cancer with robotic EndoWrist staplers (EndoWrist group). ⋯ The interval between rectal resection and stoma closure was shorter in the EndoWrist group (3.4 ± 2.5 versus 4.2 ± 2.9 months in the Control group; P = .2), although the difference was not significant. Conclusions: Our experience suggests that the new robotic staplers simplify transection, which could reduce the average number of stapler firings used during rectal resection and could decrease the incidence of anastomotic leakage. These findings require confirmation in larger studies.
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J Laparoendosc Adv Surg Tech A · Nov 2018
Case ReportsHidden in Plain Sight: Transoral and Submental Thyroidectomy as a Compelling Alternative to "Scarless" Thyroidectomy.
Minimally invasive and remote access thyroid surgery has been evolving with the transoral endoscopic thyroidectomy vestibular approach (TOETVA) emerging as a true "scarless" thyroidectomy. In this study, we describe a hybrid transoral and submental thyroidectomy (TOaST) technique for thyroid lobectomy. ⋯ This is the first reported case of a hybrid TOaST technique. It aims to maintain the principles and advantages of TOETVA while addressing its limitations related to large tumor extraction, mental nerve injury, and chin sensory changes. The shorter distance of dissection required may reduce postoperative pain. This approach may expand the indications for transoral thyroidectomy while maintaining excellent cosmetic outcomes.
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J Laparoendosc Adv Surg Tech A · Nov 2018
Meta AnalysisPain and Surgical Outcomes Reporting After Laparoscopic Ventral Hernia Repair in Relation to Mesh Fixation Technique: A Systematic Review and Meta-Analysis of Randomized Clinical Trials.
The aim of this meta-analysis was to examine postoperative pain and surgical outcomes (operative time, hospital stay, the incidence of seroma and recurrence) with different mesh fixation methods following laparoscopic ventral hernia repair (LVHR). ⋯ Meta-analysis of RCTs comparing tacks to suture fixation in LVHR showed comparable results with regard to postoperative chronic pain incidence and PI, and hernia recurrence. However, the operative time is shorter with tacks compared to suture fixation technique.
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J Laparoendosc Adv Surg Tech A · Nov 2018
Outcomes Using Cryoablation for Postoperative Pain Control in Children Following Minimally Invasive Pectus Excavatum Repair.
Pain is the main factor that determines the postoperative course for patients undergoing pectus bar placement. Cryoablation of the intercostal nerves has been suggested to mitigate this pain. We instituted a protocol for using intercostal cryoablation and report our early results compared to our immediately previous cohort. ⋯ Cryoablation after pectus bar placement dramatically decreases narcotic usage and postoperative length of stay.