이 연구는 헬싱키 선언 및 지역 임상 윤리 위원회(2018/09)에 따라 수행되었습니다.
1. 신체검사
알림: TOS 진단을 위한 도발적인 테스트는 그림 1에 나와 있습니다.
<ol><li>Adson 테스트(scalene 테스트, 그림 1A)의 경우 환자의 어깨를 약간의 외전과 약간의 확장으로 외부 회전으로 가져오고 요골 맥박을 촉진합니다. 환자의 머리를 뒤로 뻗고 테스트한 어깨 쪽으로 돌립니다. 환자에게 숨을 들이쉬고 숨을 참으라고 요청하십시오.<ol><li>증상이 재발하거나 요골 맥박이 소실되는 동안 머리를 외측으로 회전시켜 증상이 완화되는 경우 양성 판정을 고려하십시오.</li>
	</ol></li>
	<li>늑골쇄골 보조기 검사(그림 1B)의 경우 환자의 팔을 뒤쪽으로 가져오고 동측 쪽에 있는 환자의 견갑골 위로 눌렀다가 수축합니다. 맥박을 확인하십시오. 요골 맥박이 사라지거나 증상이 재발하면 검사는 양성으로 간주됩니다.</li>
	<li>과외전 검사(그림 1C)의 경우 환자의 팔을 약간 펴고 요골 동맥을 촉진합니다. 팔을 90-180° 외전합니다. 양성 검사는 기준선에서 새 위치까지 요골 동맥의 맥박이 감소하는 것입니다.</li>
	<li>Roos(East) 테스트(그림 1D)의 경우 앉은 자세 또는 서 있는 자세에서 테스트를 수행합니다. 환자의 어깨를 90° 외전으로 가져가고 바깥쪽으로 회전하고 팔꿈치를 90°로 구부립니다. 팔꿈치는 정면 평면보다 약간 뒤에 있어야 합니다. 환자가 3분 동안 손을 열었다 닫았다 합니다.<ol><li>환자가 무거움, 허혈성 통증 또는 팔의 약화 또는 손의 저림 및 따끔거림을 경험하는 경우 검사를 양성으로 간주합니다. 손의 변색도 시험에 의미가 있습니다. 참고: VTOS의 경우 수술적 치료가 첫 번째 옵션인 반면, NTOS의 경우 일상생활, 직장 생활 및 수면의 질이 개선되지 않은 상태에서 3개월의 보존적 치료 후 수술적 치료가 수행됩니다.</li>
	</ol></li>
</ol>2. 수술 전 임상 및 전기 진단 평가
<ol><li>수술적 치료에 의한 임상적 개선 평가를 위해 신체 검사, 근전도 소견 및 일상 활동 증상 및 수술 전 사회적, 심리적 기간과 관련된 QuickDASH(Disability of Arm, Shoulder, and Hand: <a href="https://www.hss.edu/physician-files/fufa/Fufa-quickdash-questionnaire.pdf">https://www.hss.edu/physician-files/fufa/Fufa-quickdash-questionnaire.pdf</a>) 설문지에서 임상 소견을 제시합니다.</li>
	<li>복합 운동 활동 전위(CMAP), 감각 신경 활동 전위(SNAP), 신경 전도 속도(NCV) 및 F파 잠복기를 측정하여 수술 전 EMG를 결정합니다. 상용 EMG/NCV/EP 측정 시스템(예: Nihon Kohden Neuropack 2)을 사용하여 기록합니다.</li>
</ol>3. 단계적 경겨드랑이 제1 갈비뼈 절제술
<ol><li>0.6mg/kg 로쿠로늄 브로마이드, 0.05mg/kg 미다졸람 및 1-2μg/kg 펜타닐을 포함하는 표준 마취 유도 프로토콜을 사용하여 마취를 수행합니다.</li>
	<li>유지를 위해 tiopenthal 나트륨을 6mg/kg으로 투여합니다.</li>
</ol>4. 환자 위치(그림 2)
<ol><li>환자를 측면 욕창 자세로 눕힌 후 팔을 감싸고 들어 올려 90° 외전 자세로 매달립니다. 필요한 경우 수술 후 합병증을 예방하기 위해 3-5분마다 견인력을 줄이십시오.</li>
	<li>국소 살균을 위해 10% 멸균 포비돈-요오드 용액을 사용하십시오. 팔, 겨드랑이, 가슴을 드레이프합니다. 오염을 방지하기 위해 신체의 나머지 부분에 멸균 시트를 사용하십시오.</li>
</ol>5. 첫 번째 갈비뼈에 도달
<ol><li>그림 3과 재료 표에 표시된 수술 기구를 사용하십시오.</li>
	<li>가슴 근육에서 앞쪽으로, 광배근에서 뒤쪽으로 뻗어 있는 겨드랑이 헤어라인 아래를 5-7cm 길이로 가로로 절개합니다.</li>
	<li>피부, 피하 조직, 근막을 가로질러 전방 흉벽에 도달합니다.</li>
	<li>뭉툭한 해부를 사용하여 첫 번째 갈비뼈에 도달합니다.</li>
</ol>6. 근육과 근막에서 첫 번째 갈비뼈 풀기
<ol><li>첫 번째 갈비뼈 위에 있는 근막을 뚫고 갈비뼈 윗부분에 있는 골막을 절개합니다. 단극 소작과 갈비뼈 raspatory를 사용하여 주변 근육에서 갈비뼈의 아래쪽 가장자리를 뭉툭하게 해부합니다.</li>
	<li>흉골 접합부의 늑골 쇄골 인대와 후방 늑골 접합부의 각늑골까지 늑간 근육을 나눕니다.</li>
	<li>첫 번째 갈비뼈의 위쪽 가장자리에서 전방 비늘 근육을 전방으로 노출시키고 중골 비늘 근육을 후방으로 노출시킵니다. 구부러진 겸자를 전방 및 중간 비늘 근육 아래에 배치하여 신경 혈관 다발에서 가장 멀리 떨어진 첫 번째 갈비뼈 위에 삽입 된 수준에서 근육을 자릅니다.</li>
</ol>7. 첫 번째 갈비뼈 또는 경추 갈비뼈 제거
<ol><li>흉골 접합부 앞쪽에서 첫 번째 갈비뼈 절제를 시작합니다. 먼저 위쪽 가장자리에서 돌린 다음 아래쪽 가장자리를 돌려 흉골에서 갈비뼈 절단기를 사용하여 절제합니다. 신경 혈관 구조가 보존되어 있는지 확인하십시오.</li>
	<li>그 후, 갈비뼈의 뒤쪽 부분을 절제하고 갈비뼈의 각도에 원위부에 위치한 부분을 분절합니다. 따라서 갈비뼈 절제술을 완료합니다.</li>
	<li>주변 조직에서 경추 갈비뼈를 완전히 분리한 후 횡돌기의 관절면이 보일 때까지 갈비뼈를 절제하고 관절을 제거합니다.</li>
</ol>8. 수술 후 기간
<ol><li>수술 후 흉부 X선 촬영을 통해 기흉과 같은 합병증을 배제합니다.</li>
	<li>특별한 일이 없는 경우 수술 후 1일째에 흉부 배액관을 제거합니다.</li>
	<li>수술 후 통증에는 비스테로이드성 항염증제, 마약성 진통제, 근육이완제를 사용하십시오.</li>
	<li>수술 후 초기에 수술 쪽에서 팔의 움직임을 검사합니다. 수술 후 처음 두 달 동안은 물리 치료를 계속하십시오.</li>
	<li>환자에게 수술한 쪽에서 피곤한 활동을 하지 않도록 조언하십시오.</li>
</ol>9. 수술 후 임상 및 전기 진단 평가
<ol><li>수술적 치료에 의한 임상적 개선 평가를 위해 신체 검사, 근전도 소견 및 일상 활동 증상과 관련된 QuickDASH(팔, 어깨, 손 장애: <a href="https://www.hss.edu/physician-files/fufa/Fufa-quickdash-questionnaire.pdf">https://www.hss.edu/physician-files/fufa/Fufa-quickdash-questionnaire.pdf</a>) 설문지의 임상 소견과 수술 전후 및 수술 후(3개월) 기간을 비교합니다.</li>
	<li>복합 운동 활동 전위(CMAP), 감각 신경 활동 전위(SNAP), 신경 전도 속도(NCV) 및 F파 잠복기를 측정하여 수술 전과 수술 후 EMG를 비교합니다. 상용 EMG/NCV/EP 측정 시스템(예: Nihon Kohden Neuropack 2)을 사용하여 기록합니다.</li>
	<li>수술 후 통증과 감각 이상을 평가하기 위해 신체 검사를 실시합니다.</li>
</ol>

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S., Milton, R., Chaudhuri, N., Kefaloyannis, E., Papagiannopoulos, K. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Totally+endoscopic+(VATS)+first+rib+resection+for+thoracic+outlet+syndrome.">Totally endoscopic (VATS) first rib resection for thoracic outlet syndrome.</a> The Annals of Thoracic Surgery. 103 (1), 241-245 (2017).</li><li>Strother, E., Margolis, M. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Robotic+first+rib+resection.">Robotic first rib resection.</a> Operative Techniques in Thoracic and Cardiovascular Surgery. 20 (2), 176-188 (2015).</li></ol>

TFRR은 TOS 9,10,11의 치료에 가장 많이 사용되는 수술 기법입니다. TFRR의 장점은 수술 부위에 도달하기 위해 근육을 절단할 필요 없이 겨드랑이에 숨겨진 절개로 더 나은 미용 결과를 제공한다는 것입니다. 단점은 상대적으로 좁고 깊은 작업 공간입니다. 동맥 TOS 치료에 선호되는 쇄골상 접근법은 쇄골하 동맥의 손상 위험을 낮춘?...

비늘 삼각형의 상완신경총, 쇄골하 동맥 또는 정맥의 압박은 임상적으로 흉곽출구증후군(TOS)으로 알려져 있으며, Peet et al.1에 의해 처음 설명되었습니다. 흉곽출구증후군은 기저 원인에 따라 신경인성(NTOS), 동맥성 TOS, 정맥성 TOS로 나뉜다1. NTOS 환자(TOS 사례의 93-95%)는 통증, 무감각 및 동측 약화를 나타냅니다. 정맥 TOS 환자(3-5%)는 정맥 혈전증을 나타내고, 동맥 TOS 환자(1-2%)는 동맥 혈전 색전증 및 허혈을 나타냅니다. TOS의 보존적 관리에는 약물 및 물리 치료가 포함되며 TOS 사례의 첫 번째 선택입니다. 수술적 치료에는 감압술이 포함되며 보존적 관리가 실패한 후에 시행한다2. 감압술에는 경겨드랑이 제1 늑골 절제술(TFRR), 쇄골 상부 제1 늑골 절제술(SFRRS), 종아리 절제술(쇄골상 또는 경겨드랑이를 통한 제1 늑골 절제술 없이) 및 후방 접근 제1 늑골 절제술(PA-FRR)이 포함됩니다3. 1966년 Roos et al.에 의해 기술된 기술인 경겨드랑이 제1 갈비뼈 절제술은 TOS 4,5의 치료에 효과적인 방법이다. TFRR의 주요 목표는 마지막 경추 및 첫 번째 흉부 갈비뼈를 완전히 제거하고 기저 신경 혈관 다발을 감압하는 것입니다.
혈관 TOS(VTOS)는 CT 혈관 조영술, 색이중 USG, 동맥 조영술 또는 정맥 조영술로 진단되는 반면, NTOS는 X선, 전기 진단 검사(바늘 전기 척수염 조영술), 색 이중 도플러 USG 및 자궁 경부 MRI로 진단됩니다. 물리치료사와 정신과 의사의 상담을 통해 수술 전에 다른 장애를 배제해야 합니다. 전방 비늘근에 리도카인 주사를 투여했을 때 증상이 완화되는 것은 NTOS 환자의 수술 효과를 진단하고 예측할 수 있는 좋은 지표이기도 하다6.

<table>
	<tbody>
		<tr>
			<td>Ag Debakey vascular forceps 24 cm, 3.5 mm</td>
			<td>Lawton medizintechnik</td>
			<td>30-0032</td>
			<td>Check the hemorrhage</td>
		</tr>
		<tr>
			<td>Bone chisels curved 13x9.1/2&#39;&#39;</td>
			<td>Aesculap Inc.</td>
			<td>MB-992R</td>
			<td>Dissect the periost of the first rib</td>
		</tr>
		<tr>
			<td>Doyen-stille retractor 24 cm</td>
			<td>Lawton medizintechnik</td>
			<td>20-0650</td>
			<td>Skin- muscle retraction</td>
		</tr>
		<tr>
			<td>Foerster sponge forceps straight</td>
			<td>Lawton medizintechnik</td>
			<td>07-0156</td>
			<td>For swabbing</td>
		</tr>
		<tr>
			<td>Luer stille bone rongeur curved 27 cm</td>
			<td>Lawton medizintechnik</td>
			<td>38-0703</td>
			<td>Bone punches</td>
		</tr>
		<tr>
			<td>Luer stille rongeur straight 22 cm</td>
			<td>Lawton medizintechnik</td>
			<td>38-0400</td>
			<td>Rib cutter</td>
		</tr>
		<tr>
			<td>Mayo hegar needle holder 20.5 cm</td>
			<td>Lawton medizintechnik</td>
			<td>08-0184</td>
			<td>Suturing</td>
		</tr>
		<tr>
			<td>Metzenbaum scissors curved delicate 23 cm</td>
			<td>Lawton medizintechnik</td>
			<td>05-0665</td>
			<td>Dissection</td>
		</tr>
		<tr>
			<td>Overholt curved forceps delicate 30.5 cm</td>
			<td>Lawton medizintechnik</td>
			<td>06-0807</td>
			<td>Split the scalen muscles from the rib</td>
		</tr>
		<tr>
			<td>Roberts art forceps straight 24 cm</td>
			<td>Lawton medizintechnik</td>
			<td>06-0370</td>
			<td>For sponge and remove remain bone</td>
		</tr>
		<tr>
			<td>Roux retractor medium size 15.5 cm</td>
			<td>Lawton medizintechnik</td>
			<td>20-0402</td>
			<td>Wound retraction</td>
		</tr>
		<tr>
			<td>Semb rasparotry 22,5 cm, 12mm</td>
			<td>Lawton medizintechnik</td>
			<td>39-0252</td>
			<td>Dissect the muscle of the first rib</td>
		</tr>
		<tr>
			<td>Smith peterson model curved osteotome 13x205 mm</td>
			<td>Lawton medizintechnik</td>
			<td>46-0783</td>
			<td>Dissect the muscle of the first rib</td>
		</tr>
		<tr>
			<td>Stille -giertz rib shears 27 cm</td>
			<td>Lawton medizintechnik</td>
			<td>38-0200</td>
			<td>First rib cutting</td>
		</tr>
		<tr>
			<td>Stille osteotome 8x205 mm</td>
			<td>Lawton medizintechnik</td>
			<td>46-0248</td>
			<td>Dissect the periost of the first rib</td>
		</tr>
		<tr>
			<td>Wagner rongeur 5.5x210 mm</td>
			<td>Lawton medizintechnik</td>
			<td>53-0703</td>
			<td>Punches</td>
		</tr>
	</tbody>
</table>

transaxillary first rib resection for treatment of the thoracic outlet syndrome

흉곽출구증후군(TOS)은 심각한 생산성 저하를 유발하는 흔한 질환입니다. 경겨드랑이 제1 늑골 절제술(TFRR) 프로토콜은 TOS에서 갇힌 신경 혈관 구조의 감압에 사용되었습니다. 다른 수술 절차 중에서 TFRR의 장점은 재발률이 가장 낮고 미용적 결과가 더 좋다는 것입니다. TFRR의 단점은 혈관 조절을 어렵게 만드는 좁고 깊은 작업 통로를 제공한다는 것입니다.

임상적 결과 이 연구에는 총 15명의 환자가 포함되었습니다. 3명(20%)은 남성이었고 12명(80%)은 여성이었다. 환자의 평균 연령은 30.6세± 8.98세였다. 모든 남성 참가자와 여성 참가자 중 5명은 육체 노동자였습니다. NTOS 그룹의 가장 흔한 불만은 팔-팔뚝 통증과 무감각, 악력 약화 및 하부 위축이었습니다. 수술 후 임상 추적에서 환자는 감각 이상 및 통증 중증도, 전반적인 만족도, 활동 ?...

Watch this Scientific Journal Video about Transaxillary First Rib Resection for Treatment of the Thoracic Outlet Syndrome at JoVE.com

Transaxillary First Rib Resection for Treatment of the Thoracic Outlet Syndrome

여기에서는 상완신경총, 쇄골하정맥 및 동맥의 압박으로 인한 흉곽출구증후군의 치료를 위한 첫 번째 갈비뼈의 경겨드랑이 절제술 프로토콜을 제시합니다.

흉곽출구증후군 치료를 위한 경겨드랑이 제1갈비뼈 절제술

Thoracic outlet syndrome (TOS) is a common disorder that causes a significant loss of productivity. The transaxillary first rib resection (TFRR) protocol ...

transaxillary-first-rib-resection-for-treatment-thoracic-outlet

Research

JoVE Journal

Medicine

2.7K 조회수.  Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Research Hospital. 여기에서는 상완신경총, 쇄골하정맥 및 동맥의 압박으로 인한 흉곽출구증후군의 치료를 위한 첫 번째 갈비뼈의 경겨드랑이 절제술 프로토콜을 제시합니다.

비디오: Transaxillary First Rib Resection for Treatment of the Thoracic Outlet Syndrome

Isolated Hepatic Perfusion as a Treatment for Liver Metastases of Uveal Melanoma

Isolated hepatic perfusion (IHP) is a procedure where the liver is surgically isolated and perfused with a high concentration of the chemotherapeutic agent melphalan. Briefly, the procedure starts with the setup of a percutaneous veno-venous bypass from the femoral vein to the external jugular vein. Via a laparotomy, catheters are then inserted into the proper hepatic artery and the caval vein. The portal vein and the caval vein, both supra- and infrahepatically, are then clamped. The arterial and venous catheters are connected to a heart lung machine and the liver is perfused with melphalan (1 mg/kg body weight) for 60 min. This way it is possible to locally perfuse the liver with a high dose of a chemotherapeutic agent, without leakage to the systemic circulation.
In previous studies including patients with isolated liver metastases of uveal melanoma, an overall response rate of 33-100% and a median survival between 9 and 13 months, have been reported. The aim of this protocol is to give a clear description of how to perform the procedure and to discuss IHP as a treatment option for liver metastases of uveal melanoma.

Here, we present a protocol how to perform an isolated liver perfusion (IHP) with melphalan and we also discuss IHP as a treatment option for liver metastases of uveal melanoma.

포도막 흑색 종의 간전이에 대한 치료로 고립 간 관류

Isolated hepatic perfusion (IHP) is a procedure where the liver is surgically isolated and perfused with a high concentration of the chemotherapeutic ...

연구

의학

Surgical Models of Gastroesophageal Reflux with Mice

Multiple surgical procedures have been reported to induce gastroesophageal reflux in animals. Herein, we report three surgical models with mice aiming to induce reflux of gastric contents, duodenal contents or mixed contents. Surgical procedures and general principles have been described in detail. A researcher with surgical experience should be able to grasp the technique after a short period of practice. After surgery, most mice can survive and develop reflux esophagitis similar to that in humans. However, it should be noted that histological differences between mouse and human esophagus are the inherent limitations of these surgical models. If used for research on Barrett&#8217;s esophagus and adenocarcinoma, these procedures may need to be combined with genetic modifications.

This article demonstrates surgical procedures of gastroesophageal reflux with mice. These models are useful tools for research on mechanisms and treatment of gastroesophageal reflux disease and potentially Barrett&#8217;s esophagus and esophageal adenocarcinoma.

마우스와 위식도 역류의 외과 모델

Multiple surgical procedures have been reported to induce gastroesophageal reflux in animals. Herein, we report three surgical models with mice aiming to ...

Network Analysis of Foramen Ovale Electrode Recordings in Drug-resistant Temporal Lobe Epilepsy Patients

Approximately 30% of epilepsy patients are refractory to antiepileptic drugs. In these cases, surgery is the only alternative to eliminate/control seizures. However, a significant minority of patients continues to exhibit post-operative seizures, even in those cases in which the suspected source of seizures has been correctly localized and resected. The protocol presented here combines a clinical procedure routinely employed during the pre-operative evaluation of temporal lobe epilepsy (TLE) patients with a novel technique for network analysis. The method allows for the evaluation of the temporal evolution of mesial network parameters. The bilateral insertion of foramen ovale electrodes (FOE) into the ambient cistern simultaneously records electrocortical activity at several mesial areas in the temporal lobe. Furthermore, network methodology applied to the recorded time series tracks the temporal evolution of the mesial networks both interictally and during the seizures. In this way, the presented protocol offers a unique way to visualize and quantify measures that considers the relationships between several mesial areas instead of a single area.

This protocol describes a procedure to track the evolution of mesial network measures in temporal lobe epilepsy (TLE) patients. It is based on the combination of intracranial recordings with a novel numerical technique for data analysis. Specifically, we present a protocol for network analyses of foramen ovale recordings.

Approximately 30% of epilepsy patients are refractory to antiepileptic drugs. In these cases, surgery is the only alternative to eliminate/control ...

Laparoscopy-endoscopy Cooperative Surgery for the Treatment of Gastric Gastrointestinal Stromal Tumors

In view of the shortcomings of endoscopic or laparoscopic surgeries alone in the treatment of gastric gastrointestinal stromal tumors (G-GISTs), this approach makes an innovative improvement in the treatment of G-GISTs that are less than 5 cm in size. Laparoscopy-endoscopy cooperative surgery (LECS) is used to combine endoscopic and laparoscopic surgeries, fully realizing their respective advantages and avoiding their drawbacks. The main steps are as follows. First, gastroscopy and laparoscopy are combined to confirm the location and boundary of the tumor. Tumor resection is carried out laparoscopically, guided by a gastroscope. The specimen is removed orally and the gastric wound closed laparoscopically. Then, gastroscopy and laparoscopy are combined to determine whether there is wound bleeding, if the suture is satisfactory, and if the gastric cavity is deformed.
LECS has natural advantages in the treatment of G-GISTs that are less than 5 cm in size. The accurate estimation of tumor location and boundary greatly improves the complete resection rate of tumors. The risk of tumor rupture is substantially reduced, and the long-term prognosis of patients is significantly improved. The process allows for accurate resection of the tumor, maximum preservation of normal gastric tissue and organ function, and avoids postoperative gastric deformation. The patient's postoperative rehabilitation is greatly accelerated, and oral feeding can resume on the day of the operation. The specimen is taken out through the mouth to avoid the need for an extended abdominal incision. This greatly reduces the patient's postoperative pain and scarring. The method greatly shortens the postoperative hospital stay (i.e., discharge is possible on the day after the operation), increasing the turnover of hospital beds.

Laparoscopy-endoscopy cooperative surgery is appropriate for the treatment of gastric gastrointestinal stromal tumors less than 5 cm in size. It can achieve the respective advantages of endoscopic and laparoscopic surgeries while avoiding their drawbacks.

위장 기질 종양의 치료를위한 복강경 내시경 검사 협동 수술

In view of the shortcomings of endoscopic or laparoscopic surgeries alone in the treatment of gastric gastrointestinal stromal tumors (G-GISTs), this ...

Laparoscopic Oocyte Retrieval and Cryopreservation during Vaginoplasty for Treatment of Mayer-Rokitansky-Kuster-Hauser Syndrome

In Mayer-Rokitansky-Kuster-Hauser Syndrome (MRKHS) patients who are scheduled for laparoscopic vaginoplasty and have a desire for biological motherhood, we propose that a concomitant laparoscopic oocyte retrieval for cryopreservation is performed. Oocyte retrieval is pursued at the beginning of the laparoscopy. Right and left 5 mm trocars are positioned, through which a 17 G ovum aspiration needle is used for puncture of the right and left ovaries, respectively. To facilitate exposure of the follicles, the ovaries are mobilized and held with laparoscopic forceps.
When aspirating multiple follicles near each other, the needle tip is retained in the ovary to reduce the number of times that the ovarian cortex is transfixed and due to the inherent risk of bleeding. Subsequent steps are unchanged compared to the Davydov laparoscopic modified technique for vaginoplasty. Prior to surgery, controlled ovarian stimulation is performed with a gonadotropin hormone-releasing hormone (Gn-RH) antagonist protocol, and the concomitant procedure of oocyte retrieval and vaginoplasty is scheduled 36 h after the final follicular maturation trigger. Follicular fluid is collected in the same 10 mL sterile tubes used during transvaginal oocyte retrieval and transferred in a warming block (37 &#176;C) to the assisted reproduction laboratory, where mature (metaphase II) oocytes are vitrified.
In this case, a series of 23 women with MRKH, oocytes were successfully retrieved and cryopreserved in all patients; vaginoplasty was subsequently conducted without modifications, and the inpatient and outpatient postoperative care (day of urinary catheter removal, day of hospital discharge, dilator use, and comfort at follow-up) remained unaffected. One postoperative complication occurred in one patient (fever developing on day 5 post surgery and intraperitoneal fluid detection on transabdominal ultrasound) and resolved after conservative treatment. Rather than performing surgical vaginoplasty and delaying oocyte retrieval in MRKH patients, this approach combines both procedures in a single laparoscopy, thereby minimizing surgical invasiveness and anesthesiologic risks.

A dedicated team can offer Mayer-Rokitansky-Kuster-Hauser patients the option to perform controlled ovarian stimulation and oocyte cryopreservation at the time of laparoscopic vaginoplasty.

Mayer-Rokitansky-Kuster-Hauser 증후군 치료를위한 질 성형술 중 복강경 난 모세포 검색 및 냉동 보존

In Mayer-Rokitansky-Kuster-Hauser Syndrome (MRKHS) patients who are scheduled for laparoscopic vaginoplasty and have a desire for biological motherhood, ...

Modified Posterior Vertebral Column Resection for Patients with Thoracolumbar Kyphotic Deformity

Old compression vertebrae fracture or congenital kyphoscoliosis with abnormal vertebral body development and other diseases that invade the spine may cause severe thoracolumbar kyphotic deformity, often accompanied by intractable low back pain or compression of the spinal cord, leading to severe neurological symptoms or even paralysis. If conservative treatment cannot relieve the symptoms or correct the deformities, surgical treatment is usually needed. For severe kyphotic deformity, reconstruction of the physiological curvature and rigid fixation determine the prognosis of the patients. Osteotomy and orthopedics are the standard procedure for deformities with severe compression of the front and middle column, but the trauma to the patients is high, with a long operation time and massive blood loss. To avoid these disadvantages, we have developed a modified technique to remove the diseased vertebra unilaterally. In this technique, we use a modified trephine to resect the vertebral columns like in the pedicle screw technique by adding a locking instrument that can restrict the trephine to lower the risk of osteotomy and shorten the surgery time and blood loss.

We describe a modified technique for resecting the posterior vertebral column unilaterally based on a modified trephine for patients with thoracolumbar kyphotic deformity.

흉요추 후만 기형 환자를 위한 수정된 후방 척추 기둥 절제술

Old compression vertebrae fracture or congenital kyphoscoliosis with abnormal vertebral body development and other diseases that invade the spine may ...

Use of the Scissor-Type Knife During the Peroral Endoscopy Myotomy Procedure for the Treatment of Achalasia

Peroral endoscopic myotomy (POEM) is one of the first-line treatment modalities along with pneumatic dilation and Heller myotomy for patients with achalasia. Endoscopists, especially trainees during the learning phase, commonly face difficulty in tissue plane dissection and selective myotomy while working near the esophagogastric junction, with increased risks of inadvertent injury, unexpected bleeding, and inadequate myotomy. To minimize the technical difficulty and improve the safety of POEM, we describe a protocol for using a scissor-type knife for the main steps of POEM, including mucosal incision, submucosal tunneling, myotomy, and hemostasis. The standard techniques used with the scissor-type knife involve grasping the target tissue, and then dissection or coagulation. The confirmation of the cutting line after grasping improves the accuracy and reliability of dissection, which is particularly useful for the selective myotomy of the internal circular muscle. Meanwhile, the scissor-type knife provides enhanced hemostatic capability and enables hemostasis and pre-coagulation without the device exchange for hemostatic forceps. Evaluation of the clinical outcomes in three patients who successfully received POEM using the scissor-type knife revealed no perioperative adverse events. At the 3-month follow-up, all patients achieved clinical success with postoperative Eckardt scores ranging from 0 to 1. In conclusion, the use of a scissor-type knife could minimize the technical difficulty and improve the safety of the POEM procedures, which may be suitable for trainees during the learning phase.

To minimize the technical difficulty and improve the safety of peroral endoscopic myotomy (POEM), we describe a protocol for using a scissor-type knife for the main steps of POEM, including mucosal incision, submucosal tunneling, myotomy, and hemostasis.

이완불능증 치료를위한 구강 내시경 근절개술 절차 중 가위 형 칼 사용

Peroral endoscopic myotomy (POEM) is one of the first-line treatment modalities along with pneumatic dilation and Heller myotomy for patients with ...

Clinical Application of Single-Surgeon, Three-Port, Laparoscopic Resection for Colorectal Cancer with Natural Orifice Specimen Extraction

Reduced-port laparoscopic surgery (RPLS) has been widely used for the radical resection of gastrointestinal tumors. Single-surgeon, three-port, laparoscopic radical resection for sigmoid colon or high rectal cancer with natural orifice specimen extraction surgery (NOSES) has the advantage of a small incision, quick postoperative recovery, and short hospital stay. Yet, there are still only a few reports on NOSES. This paper describes the indications, preoperative preparations, surgical steps, and precautions for single-surgeon, three-port, laparoscopic radical resection of the sigmoid colon and high rectal cancer, and intraoperative specimen collection through the natural orifice. 
The protocol focuses on the steps of radical dissection and the main technical points of resection and reconstruction. At the same time, a procedure for fixing an anvil seat by self-traction of extracorporeal silk thread, used for purse-string suture fixation after the proximal anvil was placed in the abdominal cavity, was creatively improved. This operation could effectively avoid problems such as an insufficient proximal intestinal tube, shaking off the anvil seat, and weak purse-string suture during a single operation. The surgical care had less variability and was easy to perform, effectively avoiding postoperative anastomotic leakage and bleeding due to excessive intraoperative anastomotic tissue. This surgery could be widely promoted in primary hospitals.

Here, we present a protocol to successfully perform single-surgeon, three-port, laparoscopic resection for colorectal cancer with natural orifice specimen extraction.

자연 오리피스 표본 추출을 통한 대장암에 대한 단일 외과의, 3포트, 복강경 절제술의 임상 적용

Reduced-port laparoscopic surgery (RPLS) has been widely used for the radical resection of gastrointestinal tumors. Single-surgeon, three-port, ...

Microscopic Cyst Resection for the Treatment of Patients Diagnosed with Epididymal Cyst

Epididymal cysts mostly occur in men aged 20-40 years old. Previous reports have covered concerns about postoperative complexes, including postoperative asoedema, hematoma, sustaining pain, and seminal tract obstruction in patients who have undertaken nonmicroscopic epididymal cyst resection or epididymal resection. Nonmicroscopic epididymal cyst surgery is suggested for patients with childbirth plans as a precaution. The treatment of male epididymal cysts via microtechnology is obviously a beneficial option; we took the lead in carrying out microscopic epididymal exploration and cyst resection surgery in China. From September 2017 to April 2021, 41 young and middle-aged male patients diagnosed with epididymal cysts underwent microtechnology treatment in a program titled &#34;microscopic epididymal exploration and cystectomy&#34;. The postoperative follow-up lasted for 3-50 months. The results confirmed that, as microscopic manipulation largely improved visualization of the subtle tissue structures of the epididymis, the cyst could be clearly dissected apart and completely removed intact under the microscope. Bleeding during the operation was significantly reduced (2-3 mL) and wound drainage was not required. According to follow-up data, microscopic treatment significantly reduced the incidence of postoperative scrotal hematoma, edema, and long-term postoperative pain, thereby promising a higher surgical success rate as well as recurrence prevention. Besides, preliminary experience and reflection suggest that microscopic epididymal exploration and cystectomy provide efficient preservation of the epididymal patency through refined treatment, while a better prognosis can be achieved. We recommend that surgery be carried out before the epididymal cyst develops to 0.8 cm in diameter, for fear that a larger epididymal cyst (&#62;0.9 cm in diameter) could cause the complete destruction of all tubules of the ipsilateral epididymis - a more severe case with damage to the testicular output network.

Here, we present a protocol to treat patients diagnosed with an epididymal cyst using microscopic cyst resection. Based on microscopic manipulation, a largely improved visualization of the subtle tissue structures of the epididymis was obtained, so the cyst could be clearly dissected apart and completely removed intact.

부고환 낭종으로 진단된 환자의 치료를 위한 현미경적 낭종 절제술

Epididymal cysts mostly occur in men aged 20-40 years old. Previous reports have covered concerns about postoperative complexes, including postoperative ...

자율 호흡이 보존된 비디오 보조 흉강경 수술을 위한 비삽관 프로토콜

Non-Intubated Video-Assisted Thoracoscopic Surgery

Double-lumen intubation under general anesthesia is currently the most commonly performed intubation technique for pneumonectomy, wedge resection of the lung, and lobectomy. However, there is a high incidence of pulmonary complications arising from general anesthesia with tracheal intubation. Non-intubation with the preservation of voluntary breathing is an alternative to anesthesia. Non-intubation procedures minimize the adverse effects of tracheal intubation and general anesthesia, such as intubation-related airway trauma, ventilation-induced lung injury, residual neuromuscular blockade, and post-operative nausea and vomiting. However, the steps for non-intubation procedures are not detailed in many studies. Here, we present a concise non-intubated protocol for the performance of video-assisted thoracoscopic surgery with preserved autonomic breathing. This article identifies the conditions necessary to convert from non-intubated to intubated anesthesia and also discusses the advantages and limitations of non-intubated anesthesia. In this work, this intervention was performed on 58 patients. In addition, the results of a retrospective study are presented. Compared with intubated general anesthesia, patients in the non-intubated video-assisted thoracic surgery group had lower rates of post-operative pulmonary complications, shorter operative times, less intraoperative blood loss, shorter PACU stays, a lower number of days to chest drain removal, less post-operative drainage, and shorter hospital stays.

저자 스포트라이트: Multimodal Analgesia and Sevoflurane Inhalation Anesthesia를 이용한 Non-Intubated Video-Assisted Thoracoscopic Surgery with Multimodal Analgesia and Sevoflurane Inhalation Anesthesia(다중 모드 진통 및

Here, we present a non-intubated protocol for performing video-assisted thoracoscopic surgery with preserved autonomic breathing.

삽관되지 않은 비디오 보조 흉강경 수술

Double-lumen intubation under general anesthesia is currently the most commonly performed intubation technique for pneumonectomy, wedge resection of the ...