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Video-assisted mediastinoscopic transhiatal esophagectomy combined with laparoscopy for esophageal cancer
Bin Wu, Lei Xue, Ming Qiu, Xiangmin Zheng, Lei Zhong, Xiong Qin, Zhifei Xu
Journal of Cardiothoracic Surgery , 2010, DOI: 10.1186/1749-8090-5-132
Abstract: 40 cases of video-assisted mediastinoscopic transhiatal esophagectomy were performed and divided into two groups.32 patients were received surgical therapy of single mediastinoscopic esophagectomy with open gastroplasty in group A, while 8 patients were received surgical therapy of mediastinoscopic esophagectomy combined with laparoscopic lower esophageal and gastric dissection in group B. The perioperative complications were recorded.Video-assisted mediastinoscopic transhiatal esophagectomy was performed successfully both in group A and B. It suggested that mediastinoscopy combined with laparoscopy be better than single mediastinoscopy because of less blood loss, less pain, shorter ICU stay and complete lower mediastinal lymph nodes resection.Video-assisted mediastinoscopic transhiatal esophagectomy combined with laparoscopy is a safe and minimally invasive technique with whole esophagus and mediastinal lymph node dissection in the clear visualization of the mediastinum, reducing the abdominal trauma.Since the late 1980 s, minimally invasive surgical technique has been widely used in diagnosis and treatment of chest disease. The overall advantages of minimally invasive surgery are to complete the same operation through small incision avoiding the trauma of open operation. Traditional operation for esophageal carcionma requires thoracotomy and laparotomy, which is one of the most complex operations in gastrointestinal surgery. The trauma is large and the morbidity of surgical complications is high. So the surgeons are searching for a minimal invasive operative method instead of traditional esophagectomy.The basic uses of mediastinoscopy include mediastinal mass biopsy, lymph node biopsy for the diagnosis. With the development of endoscopic technology, the applicative area of mediastinoscopy expanded. By now video-assisted mediastinoscopy can be used for the separation of esophageal tumor. Esophagectomy via mediastinoscopy was firstly reported by Buess[1] in 1990. Th
Mediastinoscopy and More  [PDF]
Akif Turna
Journal of Clinical and Analytical Medicine , 2012, DOI: 10.4328
Abstract: Mediastinal lymph nodes are of great importance in surgically resectable non-small cell lung cancer patients and resectional surgery in N2 patients has been proven to be futile. Mediastinoscopy still remains gold standard despite the improvements in computerized tomography, PET-CT, introduction of Endobronchial Ultrasonography guided Transbronchial Needle Aspiration (EBUS-TBNA). EBUS-TBNA has been defined as a non-invasive and effective method for mediastinal lymph node staging. However, the falsenegativity of the technique seemed to increase with probability of N2 disease. The method is feasible in patients with low N2 frequency. The morbidity of the procedure is very low and the morbidity is nearly nil. Extended mediastinoscopy is another technique to evaluate the anterior mediastinal lymph nodes.. Remediastinoscopy (repeat mediastinoscopy) is theoretically feasible procedure for the evaluation of the patients who had previously proven me-diastinal lymph node involvement and received neoadjuvant therapy. However, it is usually suboptimally done due to the fibrous adhesions caused by previous intervention. New methods such as video-assisted mediastinoscopic lymphadectomy (VAMLA) and Transcervical extended mediastinal lymphadectomy (TEMLA) are lymph node dissection methods that remove all accessible lymph nodes and aim to reach 100% of accuracy. In conclusion, mediastinoscopy can be deemed as a gold standard method for evaluation of mediastinal involvement in patients with mediastinal tumor and non-small cell lung cancer. TEMLA and VAMLA as methods for total lymphadenectomy seem promising and will be considered more in future.
C. Bradea
Jurnalul de Chirurgie , 2009,
Abstract: Video assisted techniques were documented by M.Gagner (1996 – video assisted parathyroidectomy), Henry (1999), Shimizu (1999), Ohgami (2000), Miccoli (2000 – video assisted parathyroidectomy and thyroidectomy). The advantage of this kind of surgery: aesthetics i.e. trying to make only small scars on the neck. Our first case of video assisted thyroidectomy was a female 50 years of age, with multinodular goiter, nodules of 2-3 cm in each lobe, admitted in our clinic in December 2008. History of the disease: 9 years; treatment: hormones pills. The refractive thyroid goiter became surgical in the last four years. The intervention was delayed because of pulmonary tuberculosis the patient suffered from. The video assited technique is inspired from Websurg site (Miccoli technique, 2007), modified by the author. We started with general anesthesia, patient lying, without hiper extension of the neck. The skin incision was on midline of the neck, 15 mm long, horizontal, at 2 cm above the inferior limit of the neck, with electric scalpel. By this skin incision we entered the thyroid space gland with classical instruments; then we introduce a 10 mm, 0 degree telescope, together with a 5 mm Ligasure grasp. After coagulation and section with Ligasure, the superior thyroid pedicle, the right thyroid lobe was dissected all around. Finally, we extracted the right thyroid lobe and then we severed with Ligasure the inferior right thyroid pedicle. The same procedure was used on the left side; it needn’t any drainage; the closure was anatomically tipical. The evolution was uneventful. The histopathological exam result was chronical Hashimoto thyroiditis. Conclusions: Video assisted thyroidectomy can be considered feasible and safe and allows for an excellent cosmetic result and has possible new promising indications such as prophylactic thyroidectomy. Not all patients are eligible for this procedure, but in selected cases it can be a valid option for the surgical treatment of thyroid diseases.
Robotic-Assisted Transperitoneal Aortic Lymphadenectomy as Part of Staging Procedure for Gynaecological Malignancies: Single Institution Experience  [PDF]
V. Zanagnolo,D. Rollo,T. Tomaselli,P. G. Rosenberg,L. Bocciolone,F. Landoni,G. Aletti,M. Peiretti,F. Sanguineti,A. Maggioni
Obstetrics and Gynecology International , 2013, DOI: 10.1155/2013/931318
Abstract: Introduction. This study was designed to confirm the feasibility and safety of robotic-assisted transperitoneal aortic lymphadenectomy as part of staging procedure for gynecologic malignancies. Methods. Chart review of 51 patients who had undergone robotic staging with aortic lymphadenectomy for different gynaecologic malignancies was performed. Results. The primary diagnosis was as follows: 6 cases of endometrial cancer, 31 epithelial ovarian cancer, 9 nonepithelial ovarian cancer, 4 tubal cancer, and 1 cervical cancer. Median BMI was 23?kg/m2. Except for a single case of aortic lymphadenectomy only, both aortic and pelvic lymphadenectomies were performed at the time of the staging procedure. All the para-aortic lymphadenectomies were carried out to the level of the renal veinl but 6 cases were carried out to the level of the inferior mesenteric artery. Hysterectomy was performed in 24 patiens (47%). There was no conversion to LPT. The median console time was 285 (range 195–402) with a significant difference between patients who underwent hysterectomy and those who did not. The median estimated blood loss was 50?mL (range 20–200). The mean number of removed nodes was . The mean number of pelvic nodes was , whereas the mean number of para-aortic nodes was . Conclusions. Robotic transperitoneal infrarenal aortic lymphadenectomy as part of staging procedure is feasible and can be safely performed. Additional trocars are needed when pelvic surgery is also performed. 1. Introduction The feasibility and safety of robotically assisted para-aortic lymphadenectomy (PAL) have been already well reported, both with the robotic setup for pelvic surgery or with the sovrapubic approach [1, 2]. However, the upper limit, up to the left renal vein, is still debated, and technical aspects of PAL may differ depending on whether this procedure is the only one performed, or it is combined with other staging procedures for gynaecologic malignancies, such as pelvic lymphadenectomy, hysterectomy, omentectomy, and random peritoneal sampling. The inframesenteric aortic nodes in most patients can be accessed and removed with the robotic setup for pelvic surgery. However, removal of the infrarenal aortic nodes up to the renal veins and, in particular, the left group can be very challenging. The infrarenal nodes have been reported as one of the most common site of nodal metastases in epithelial ovarian cancer, and recently they have been shown to be positive nodes in the absence of metastases in the ipsilateral inframesenteric nodes in endometrial cancer [3]. One of the major
Application of laparoscopic pelvic lymphadenectomy assisted radical vaginal hysterectomy(LARVH) for malignant uterine neoplasm  [cached]
Li CHEN,En-feng ZHAO,Wei-ping LI,Ning ZHOU
Medical Journal of Chinese People's Liberation Army , 2011,
Abstract: Objective To assess the feasibility and therapeutic efficacy of radical vaginal pan-hysterectomy or sub-total hysterectomy assisted by laparoscopic pelvic lymphadenectomy for malignant uterine neoplasm.Methods During the period of Oct.2006 to April 2010,radical vaginal pan-hysterectomy or sub-total hysterectomy assisted by laparoscopic pelvic lymphadenectomy were performed in 38 patients with cervical cancers and 6 patients with endometrial cancers.The intra-and post-operative data and follow-up data were collected and analyzed.Results LARVH was successfully performed in the total 44 patients,with average operating time of 219(146-460) minutes,average blood loss of 300(100~800) millimeters and clearance of average number of pelvic lymph nodes of 13(2~29).Injuries of urinary system occurred in 3 cases during operation.The first deflation occurred 2(1~2) days after operation,recovery time of bladder function was 12(8~38) days,postoperative length of stay was 14(9~32) days,and recurrences were found in 2 cases during the follow-up of 4 to 49 months.Conclusion It is worth extended application to treat the malignant uterine neoplasm with LARVH for satisfactory therapeutic efficacy,less injuries and shorter time of recovery.
Video endoscopic inguinal lymphadenectomy (VEIL): Initial case report and comparison with open radical procedure
Tobias-Machado,Marcos; Tavares,Alessandro; Molina Jr.,Wilson R.; Zambon,Jo?o Paulo; Medina,Jimmy Angel; Forseto Jr,Pedro H.; Juliano,Roberto V.; Wroclawski,Eric R.;
Archivos Espa?oles de Urología (Ed. impresa) , 2006, DOI: 10.4321/S0004-06142006000800020
Abstract: objectives: inguinal metastases are one of the major determinants of mortality in patients with penile cancer. in high risk patients, while prophylatic inguinal lymphadenectomy may offer survival advantages, it still carries a relatively high morbidity. we describe in this paper the first report of the video endoscopic inguinal lymphadenectomy (veil) in the clinical practice, a technique which aims at reducing the morbidity of the procedure without compromising the cancer control or reducing the template of the dissection. methods: a 40-year old male with a pt2 penile cancer underwent prophylatic bilateral inguinal lymphadenectomy 6 weeks after partial penectomy. we performed the veil technique at the right and a standard radical inguinal lymphadenectomy through an inguinal incision at the left (control). after developing a plane deep to scarpa?s fascia, locating 3 ports and infusing gas at 5-10 mmhg, a retrograde dissection with the same limits as the standard open surgery was performed. intraoperative data, patology, post operatory evolution and oncological follow-up is described for both sides. results: operative time was 130 min for the veil and 90 min for open surgery. eight and 7 lymphnodes were retrieved at the veil side and open side, respectively, and none of then showed positivity at pathology. there were no complications in the limb which underwent the veil and there was skin necrosis in the side of the open surgery. after 25 months of follow up, no signs of disease progression were noted. asked about how he felt about both surgeries, the patient chose the endoscopic approach. conclusions: veil is feasible in clinical practice. new studies with a greater number of patients and long-term follow-up may confirm the oncological ef.cacy and possible lower morbidity of these new approach.
Video assisted thoracic surgery in children  [cached]
Shah Rasik,Reddy A,Dhende Nitin
Journal of Minimal Access Surgery , 2007,
Abstract: Thoracoscopic surgery, i.e., video assisted thoracic surgery (VATS) has been in use in children for last 98 years. Its use initially was restricted to the diagnostic purposes. However, with the improvement in the optics, better understanding of the physiology with CO2 insufflation, better capabilities in achieving the single lung ventilation and newer vessel sealing devices have rapidly expanded the spectrum of the indication of VATS. At present many complex lung resections, excision of mediastinal tumors are performed by VATS in the experienced centre. The VATS has become the standard of care in empyema, lung biopsy, Mediastinal Lymphnode biopsy, repair of diaphragmatic hernia, etc. The article discusses the indications of VATS, techniques to achieve the selective ventilation and surgical steps in the different surgical conditions in children.
Video-assisted thoracoscopic surgery lobectomy – early experience  [cached]
Jozef Belák,Marián Kudlá?,Robert ?imon
Videosurgery and Other Miniinvasive Techniques , 2010,
Abstract: Introduction: Video-assisted thoracoscopic surgery (VATS) lobectomy is the anatomical resection of a whole lobe ofthe lung followed by removal of the lymph nodes from the mediastinum using a thoracoscope and an access incision(small thoracotomy ≤ 5 cm) without using the rib spreader. Aim: To present the early experience with VATS lobectomy. Material and methods: Five patients were treated surgically using the VATS technique of anatomical lung resection atthe 2nd Department of Surgery, Pavol Jozef afárik University, University Hospital of L. Pasteur, Ko ice, (Slovak Republic)within 12 months from 10.2008 to 10.2009. Lobectomy was performed in 4 patients and pneumonectomy in 1 patient. Results: The mean operating time was 120 min (range 80-170 min). Following lobectomy a drain was inserted into thepleural cavity in 4 cases, whereas there was no drainage after 1 pneumonectomy. Drains were removed 2-5 days afterthe surgery. Four patients suffered from lung carcinoma (1 squamous cell carcinoma, 3 adenocarcinomas); 1 patienthad chondroid hamartoma. Postoperative condition was good in all patients. There were no early complications andpatients were released home on the 6th postoperative day on average. Conclusions: The advantages of VATS lobectomy have been widely discussed. There is a consensus that in elderlypatients with non-small cell lung cancer VATS lobectomy accompanied by mediastinal lymphadenectomy reduces theincidence of complications after the surgery and patients recover faster.
Video assisted thoracoscopic surgery for spinal conditions  [cached]
Liu Gabriel,Kit Wong
Neurology India , 2005,
Abstract: Video-assisted thoracoscopic surgery (VATS) has become an alternative treatment tool for a variety of spinal conditions in the last two decades. This endoscopic or `keyhole′ approach minimizes the chest wall morbidity related to the traditional thoracotomy. The current indications for VATS are the same as in any open anterior spinal surgery. This article reviews the outcomes of VATS treatments in thoracic disc diseases, fractures, tumors and vertebral osteomyelitis. In addition, we have described our `learning curve ′ and surgical techniques using video-assisted thoracoscopic spinal releases and instrumentation in the treatment of 50 patients with adolescent idiopathic scoliosis.
Video endoscopic inguinal lymphadenectomy (VEIL): minimally invasive resection of inguinal lymph nodes
Tobias-Machado, M.;Tavares, Alessandro;Molina Jr, Wilson R.;Forseto Jr, Pedro H.;Juliano, Roberto V.;Wroclawski, Eric R.;
International braz j urol , 2006, DOI: 10.1590/S1677-55382006000300012
Abstract: objectives: describe and illustrate a new minimally invasive approach for the radical resection of inguinal lymph nodes. surgical technique: from the experience acquired in 7 operated cases, the video endoscopic inguinal lymphadenectomy (veil) technique was standardized in the following surgical steps: 1) positioning of the inferior member extended in abduction, 2) introduction of 3 work ports distal to the femoral triangle, 3) expansion of the working space with gas, 4) retrograde separation of the skin flap with a harmonic scalpel, 5) identification and dissection of the long saphenous vein until the oval fossa, 6) identification of the femoral artery, 7) distal ligature of the lymph node block at the femoral triangle vertex, 8) liberation of the lymph node tissue up to the great vessels above the femoral floor, 9) distal ligature of the long saphenous vein, 10) control of the saphenofemoral junction, 11) final liberation of the surgical specimen and endoscopic view showing that all the tissue of the region was resected, 12) removal of the surgical specimen through the initial orifice, 13) vacuum drainage and synthesis of the incisions. comments: the veil technique is feasible and allows the radical removal of inguinal lymph nodes in the same limits of conventional surgery dissection. the main anatomic repairs of open surgery can be identified by the endoscopic view, confirming the complete removal of the lymphatic tissue within the pre-established limits. preliminary results suggest that this technique can potentially reduce surgical morbidity. oncologic follow-up is yet premature to demonstrate equivalence on the oncologic point of view.
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