Bu çalışma Helsinki Bildirgesi ve yerel klinik etik kuruluna (2018/09) uygun olarak yürütülmüştür.
1. Fizik Muayene
NOT: TOS tanısı için provokatif testler Şekil 1'de gösterilmektedir.
<ol><li>Adson testi için (skalen testi, Şekil 1A), hastanın omzunu hafif abdüksiyon ve biraz ekstansiyon ile dış rotasyona getirin ve radyal nabzı palpe edin. Hastanın başını geriye doğru uzatın ve test edilen omzuna doğru döndürün. Hastadan nefes almasını ve nefesini tutmasını isteyin.<ol><li>Semptomların çoğalması veya radyal nabzın ortadan kaldırılması durumunda, semptomlar başın tartışmalı tarafa dönmesiyle düzelirken testi pozitif olarak düşünün.</li>
	</ol></li>
	<li>Kostoklaviküler korse testi için (Şekil 1B), hastanın kolunu arkaya getirin, ipsilateral taraftaki hastanın kürek kemiğini bastırın ve geri çekin. Nabzı kontrol edin. Radyal nabız kaybolursa veya semptomlar tekrarlanırsa, test pozitif kabul edilir.</li>
	<li>Hiperabdüksiyon testi için (Şekil 1C), hastanın kolunu hafifçe uzatın ve radyal arteri palpe edin. Kolu 90-180° kaçırın. Pozitif bir test, radyal arterin nabzında başlangıçtan yeni pozisyona bir azalmadır.</li>
	<li>Roos (Doğu) testi için (Şekil 1D), testi oturma veya ayakta durma pozisyonunda gerçekleştirin. Hastanın omuzlarını 90° abdüksiyona götürün, dışarıdan döndürün ve dirsekleri 90°'ye kadar bükün. Dirsekler ön düzlemin biraz arkasında olmalıdır. Hastanın 3 dakika boyunca ellerini açıp kapatmasını sağlayın.<ol><li>Hasta ağırlık, iskemik ağrı veya kollarda güçsüzlük veya ellerde uyuşma ve karıncalanma yaşarsa testi pozitif olarak düşünün. Ellerdeki renk değişikliği de test için anlamlıdır. NOT: VTOS olgularında cerrahi tedavi ilk seçenek iken, NTOS olgularında 3 aylık konservatif tedaviden sonra günlük yaşamlarında, iş yaşamlarında ve uyku kalitelerinde düzelme olmadan cerrahi tedavi uygulanmaktadır.</li>
	</ol></li>
</ol>2. Preoperatif klinik ve elektrodiagnostik değerlendirme
<ol><li>Cerrahi tedavi ile klinik iyileşmenin değerlendirilmesi için fizik muayenede klinik bulgular, EMG bulguları ve QuickDASH (Kol, Omuz ve El Özürlülüğü: <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>) anketi ile günlük aktivitelerin semptomları ile ilgili sosyal ve psikolojik preoperatif dönemler gereklidir.</li>
	<li>Bileşik motor aksiyon potansiyeli (CMAP), duyusal sinir aksiyon potansiyeli (SNAP), sinir iletim hızı (NCV) ve F dalgası latansını ölçerek preoperatif EMG'leri belirleyin. Ticari bir EMG/NCV/EP ölçüm sistemi kullanarak kayıt yapın (örneğin, Nihon Kohden Neuropack 2).</li>
</ol>3. Transaksiller ilk kaburga rezeksiyonu kademeli olarak
<ol><li>0.6 mg / kg roküronyum bromür, 0.05 mg / kg midazolam ve 1-2 μg / kg fentanil içeren standart bir anestezik indüksiyon protokolü kullanarak anestezi uygulayın.</li>
	<li>Bakım için 6 mg / kg'da tiopental sodyum uygulayın.</li>
</ol>4. Hasta pozisyonu (Şekil 2)
<ol><li>Hastayı lateral dekübit pozisyonuna getirdikten sonra kolu sarın, kaldırın ve 90° abdüksiyon pozisyonunda asın. Gerekirse, postoperatif komplikasyonu önlemek için her 3-5 dakikada bir traksiyonu azaltın.</li>
	<li>Topikal sterilizasyon için% 10 steril povidon-iyot çözeltisi kullanın. Kolu, koltuk altını ve göğsü örtün. Kontaminasyonu önlemek için vücudun geri kalanına steril çarşaflar kullanın.</li>
</ol>5. İlk kaburgaya ulaşmak
<ol><li>Cerrahi aletlerin kullanımı Şekil 3'te ve Malzeme Tablosunda gösterilmiştir.</li>
	<li>Pektoralis kasından öne doğru uzanan aksiller saç çizgisinin altından, arkada latissimus dorsi kasından 5-7 cm uzunluğunda enine bir kesi yapın.</li>
	<li>Göğüs ön duvarına ulaşmak için cildi, deri altı dokusunu ve fasyayı çaprazlayın.</li>
	<li>İlk kaburgaya ulaşmak için künt diseksiyon kullanın.</li>
</ol>6. İlk kaburganın kaslardan ve fasyadan serbest bırakılması
<ol><li>İlk kaburganın üzerindeki fasyayı delin ve kaburganın üst kısmını kaplayan periosteumu inceleyin. Monopolar koter ve kaburga raspatory kullanarak kaburganın alt kenarını çevreleyen kaslardan künt bir şekilde inceleyin.</li>
	<li>İnterkostal kasları, sternokostal bileşkede kostoklaviküler ligamente ve posterior kosovertebral bileşkede açısal kostaya kadar ayırın.</li>
	<li>İlk kaburganın üst kenarında, anterior skalen kasını anteriorda ve medius skalen kasını arkada ortaya çıkarın. Kavisli forsepsleri ön ve orta skalen kasların altına yerleştirin ve kasları, nörovasküler demetten en uzak oldukları ilk kaburga üzerine yerleştirildikleri seviyede kesin.</li>
</ol>7. İlk kaburganın veya servikal kaburganın çıkarılması
<ol><li>İlk kaburganın rezeksiyonuna sternokostal bileşkede anteriordan başlayın. Sternumdan bir kaburga kesici kullanarak rezeke etmek için önce üst kenarından ve ardından alt kenarından çevirin. Nörovasküler yapıların korunduğundan emin olun.</li>
	<li>Daha sonra, kaburganın arka kısmını rezeke edin ve kaburga açısına distal olarak bulunan kısmı ayırın; Bu nedenle kaburga rezeksiyonunu tamamlayın.</li>
	<li>Servikal kaburgayı çevreleyen dokudan tamamen serbest bıraktıktan sonra, enine işlemin eklem yüzeyi görülene kadar kaburgayı rezeke edin ve parçalayın.</li>
</ol>8. Ameliyat Sonrası Dönem
<ol><li>Postoperatif dönemde, pnomotoraks gibi komplikasyonları ekarte etmek için göğüs röntgeni çekin.</li>
	<li>Sorunsuz vakalarda postoperatif 1. günde toraks drenini çıkarın.</li>
	<li>Postoperatif ağrı için steroid olmayan antienflamatuar ilaçlar, narkotik analjezikler ve kas gevşetici kullanın.</li>
	<li>Ameliyat sonrası erken dönemde, ameliyat edilen taraftaki kolun hareketini inceleyin. Ameliyat sonrası ilk iki ay fizik tedaviye devam edin.</li>
	<li>Hastaya ameliyat edilen tarafla herhangi bir yorucu aktivite yapmamasını tavsiye edin.</li>
</ol>9. Postoperatif klinik ve elektrodiagnostik değerlendirme
<ol><li>Cerrahi tedavi ile klinik iyileşmenin değerlendirilmesi için fizik muayenedeki klinik bulguları, EMG bulgularını ve QuickDASH (Kol, Omuz ve El Özürlülüğü: <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>) anketi ile günlük aktivite semptomları ile ameliyat öncesi ve sonrası (3 ay) dönemleri karşılaştırınız.</li>
	<li>Bileşik motor aksiyon potansiyeli (CMAP), duyusal sinir aksiyon potansiyeli (SNAP) ve sinir iletim hızı (NCV) ve F dalgası latansını ölçerek preoperatif ve postoperatif EMG'leri karşılaştırın. Ticari bir EMG/NCV/EP ölçüm sistemi kullanarak kayıt yapın (örneğin, Nihon Kohden Neuropack 2).</li>
	<li>Ağrı ve paresteziyi değerlendirmek için ameliyat sonrası fizik muayene yapın.</li>
</ol>

<ol>
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M. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Thoracic+outlet+syndrome:+evaluation+of+a+therapeutic+exercise+program.">Thoracic outlet syndrome: evaluation of a therapeutic exercise program.</a> InProc Mayo Clinic. 31, 281-287 (1956).</li><li>Han, S., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Transaxillary+approach+in+thoracic+outlet+syndrome:+the+importance+of+resection+of+the+first-rib.">Transaxillary approach in thoracic outlet syndrome: the importance of resection of the first-rib.</a> European Journal of Cardio-Thoracic Surgery. 24 (3), 428-433 (2003).</li><li>Yavuzer, &. #. 3. 5. 0. ;., Atinkaya, C., Tokat, O. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Clinical+predictors+of+surgical+outcome+in+patients+with+thoracic+outlet+syndrome+operated+on+via+transaxillary+approach.">Clinical predictors of surgical outcome in patients with thoracic outlet syndrome operated on via transaxillary approach.</a> European Journal of Cardio-Thoracic Surgery. 25 (2), 173-178 (2004).</li><li>Roos, D. 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S., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Outcomes+of+surgical+paraclavicular+thoracic+outlet+decompression.">Outcomes of surgical paraclavicular thoracic outlet decompression.</a> Annals of vascular surgery. 28 (2), 457-464 (2014).</li><li>Peek, J., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Long-term+functional+outcome+of+surgical+treatment+for+thoracic+outlet+syndrome.">Long-term functional outcome of surgical treatment for thoracic outlet syndrome.</a> Diagnostics. 8 (1), 7 (2018).</li><li>Urschel, H. C. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Transaxillary+first+rib+resection+for+thoracic+outlet+syndrome.">Transaxillary first rib resection for thoracic outlet syndrome.</a> Operative Techniques in Thoracic and Cardiovascular Surgery. 10 (4), 313-317 (2005).</li><li>Sheth, R. N., Campbell, J. N. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Surgical+treatment+of+thoracic+outlet+syndrome:+a+randomized+trial+comparing+two+operations.">Surgical treatment of thoracic outlet syndrome: a randomized trial comparing two operations.</a> Journal of Neurosurgery: Spine. 3 (5), 355-363 (2005).</li><li>Urschel, H. C., Razzuk, M. 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TFRR, TOS 9,10,11 tedavisinde en çok kullanılan cerrahi tekniktir. TFRR'nin avantajı, cerrahi alana ulaşmak için kasların kesilmesine gerek kalmadan koltuk altında gizli bir kesi ile daha iyi bir kozmetik sonuç sağlamasıdır. Dezavantajı nispeten dar ve derin çalışma alanıdır. Arteriyel TOS tedavisi için tercih edilen supraklaviküler yaklaşım, subklavyen arteri daha az hasar riskine sokar12<...

Brakiyal pleksus, subklavyen arter veya venin skalen üçgeninde sıkışması klinik olarak torasik çıkış sendromu (TOS) olarak bilinir ve ilk olarak Peet ve ark.1 tarafından tanımlanır. Torasik outlet sendromu, altta yatan etiyolojiye göre nörojenik (NTOS), arteriyel TOS ve venöz TOS olarak alt bölümlere ayrılır1. NTOS'lu hastalar (TOS vakalarının% 93-95'i) ağrı, uyuşukluk ve ipsilateral güçsüzlük ile başvururlar. Venöz TOS'lu hastalar (%3-5) venöz tromboz, arteriyel TOS'lu hastalar (%1-2) arteriyel tromboembolik olay ve iskemi ile başvururlar. TOS'un konservatif yönetimi, ilaçları ve fizyoterapiyi içerir ve TOS vakaları için ilk tercihtir. Cerrahi tedavi yöntemleri dekompresyon prosedürlerini içerir ve konservatif tedavi başarısız olduktan sonra uygulanır2. Dekompresyon teknikleri arasında transaksiller birinci kaburga rezeksiyonu (TFRR), supraklaviküler birinci kaburga rezeksiyonu skalenektomi (SFRRS), skalektomi (supraklaviküler veya transaksiller yoluyla ilk kaburga rezeksiyonu olmadan) ve posterior yaklaşım ilk kaburga rezeksiyonu (PA-FRR) bulunur3. Roos ve arkadaşları tarafından 1966 yılında tanımlanan bir teknik olan transaksiller ilk kaburga rezeksiyonu, TOS 4,5'in tedavisinde etkili bir yöntemdir. TFRR'nin temel amacı son servikal ve birinci torasik kaburgaların tamamen çıkarılması ve alttaki nörovasküler demeti dekompresyona uğratılmasıdır.
Vasküler TOS (VTOS) tanısı BT anjiyografi, renkli dupleks USG ve arteriyografi veya venografi ile konurken, NTOS tanısı X-ışını, elektrodiagnostik çalışmalar (iğne elektromiyelografisi), renkli dupleks Doppler USG ve servikal MRG ile konur. Ameliyat öncesi diğer bozuklukların dışlanması için fizyoterapist ve psikiyatrist konsültasyonları alınmalıdır. Anterior skalen kasına lidokain enjeksiyonu ile semptomların giderilmesi de NTOS hastalarında tanı ve cerrahi yararın öngörücüsü için iyi bir göstergedir6.

<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&#039;&#039;</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

Torasik outlet sendromu (TOS), önemli bir üretkenlik kaybına neden olan yaygın bir hastalıktır. TOS'da sıkışan nörovasküler yapıların dekompresyonu için transaksiller birinci kaburga rezeksiyonu (TFRR) protokolü kullanılmıştır. Diğer cerrahi prosedürler arasında TFRR'nin avantajı, en düşük nüks oranına ve daha iyi kozmetik sonuçlara sahip olmasıdır. TFRR'nin dezavantajı, vasküler kontrolün sağlanmasını zorlaştıran dar ve derin bir çalışma koridoru sağlamasıdır.

Klinik Sonuçlar Bu çalışmaya toplam 15 hasta dahil edildi. Hastaların üçü (%20) erkek, 12'si (%80) kadındı. Hastaların yaş ortalaması 30.6 ± 8.98 idi. Erkek katılımcıların tamamı ve kadın katılımcıların 5'i beden işçisiydi. NTOS grubunun en sık şikayeti kol-önkol ağrısı ve uyuşma, kavrama güçsüzlüğü ve hipotenar atrofi idi. Postoperatif klinik takipte hastalara parestezi ve ağrı şiddeti, genel memnuniyet, aktivite ve iş durumları soruldu. QuickDASH skorları...

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

Burada, brakiyal pleksus, subklavyen ven ve arterin basısı sonucu oluşan torasik outlet sendromunun tedavisi için birinci kaburganın transaksiller rezeksiyonu protokolü sunulmaktadır.

Torasik Outlet Sendromunun Tedavisi için Transaksiller Birinci Kaburga Rezeksiyonu

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

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JoVE Journal

Medicine

2.8K Görüntüleme.  Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Research Hospital. Burada, brakiyal pleksus, subklavyen ven ve arterin basısı sonucu oluşan torasik outlet sendromunun tedavisi için birinci kaburganın transaksiller rezeksiyonu protokolü sunulmaktadır.

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

Technique and Patient Selection Criteria of Right Anterior Mini-Thoracotomy for Minimal Access Aortic Valve Replacement

Aortic valve stenosis has become the most prevalent valvular heart disease in developed countries, and is due to the aging of these populations. The incidence of the pathology increases with growing age after 65 years. Conventional surgical aortic valve replacement through median sternotomy has been the gold standard of patient care for symptomatic aortic valve stenosis. However, as the risk profile of patients worsens, other therapeutic strategies have been introduced in an attempt to maintain the excellent results obtained by the established surgical treatment. One of these approaches is represented by transcatheter aortic valve implantation. Although the outcomes of high-risk patients undergoing treatment for symptomatic aortic valve stenosis have improved with transcatheter aortic valve replacement, many patients with this condition remain candidates for surgical aortic valve replacement. In order to reduce the surgical trauma in patients who are candidates for surgical aortic valve replacement, minimally invasive approaches have garnered interest during the past decade. Since the introduction of right anterior thoracotomy for aortic valve replacement in 1993, right anterior mini-thoracotomy and upper hemi-sternotomy have become the predominant incisional approaches among cardiac surgeons performing minimal access aortic valve replacement. Beside the location of the incision, the arterial cannulation site represents the second major landmark of minimal access techniques for aortic valve replacement. The two most frequently used arterial cannulation sites include central aortic and peripheral femoral approaches. With the purpose of reducing surgical trauma in these patients, we have opted for a right anterior mini-thoracotomy approach with a central aortic cannulation site. This protocol describes in detail a technique for minimally invasive aortic valve replacement and provides recommendations for patient selection criteria, including cardiac computer tomography measurements. The indications and limitations of this technique, as well as its alternatives, are discussed.

The goal of this protocol is to describe in detail the technique of minimally invasive aortic valve replacement through a right anterior mini-thoracotomy and central aortic cannulation. This technique can potentially enhance patients&#39; comfort and, by reducing post-operative morbidity, promote lowering the length of stay and global costs.

Teknik ve en az düzeyde erişim aort kapak replasmanı için hemen ön Mini Torakotomi hasta seçimi kriterleri

Aortic valve stenosis has become the most prevalent valvular heart disease in developed countries, and is due to the aging of these populations. The ...

Tıp

Low-Cost Single-Port (LoCoSP) Device for a Transcervical Approach in Minimally Invasive Transhiatal Esophagectomy

Esophagectomy remains the preferred option to achieve curative treatment in advanced esophageal cancer, but the choice of surgical approach remains controversial. A transthoracic approach may improve lymph node dissection, but it has considerable morbidity and respiratory complications. Transhiatal access has been demonstrated as an efficient means of minimizing post-operative complications. Minimally invasive transhiatal esophagectomy may reduce operative trauma and morbidity as well as enhance postoperative recovery with no compromise in cancer recurrence or survival. Nevertheless, it has a technical limitation in terms of cervical esophagus dissection. Thus, a low-cost single-port device was developed to complete upper mediastinal dissection by a transcervical approach during minimally invasive transhiatal esophagectomy. This device uses a nasogastric tube, a number-eight sterile glove, a sterile sponge, and 3 permanent 5-mm trocars. The step-by-step process of transhiatal esophagectomy and the development of this device are described. This technique allows for the dissection of the upper mediastinum, as well as the esophagus over the aortic arch and behind the superior portion of the trachea. The harvesting of lymph nodes along the left recurrent laryngeal nerve and paratracheals was improved.

Low-Cost Single-Port LoCoSP Device for a Transcervical Approach in Minimally Invasive Transhiatal Esophagectomy

Here, we describe a step-by-step description of transhiatal esophagectomy and the development of a low-cost single-port device for a transcervical approach in a minimally invasive transhiatal esophagectomy.

Minimal İnvaziv Transhiatal Özofagtomide Transerviziv Yaklaşım için Düşük Maliyetli Tek Bağlantı Noktalı (LoCoSP) Cihaz

Esophagectomy remains the preferred option to achieve curative treatment in advanced esophageal cancer, but the choice of surgical approach remains ...

Laminectomy for the Removal of Thoracic Ossification of the Ligamentum Flavum (TOLF) Using Ultrasonic and Conventional Osteotomes

Thoracic ossification of the ligamentum flavum (TOLF) is a common cause of progressive thoracic myelopathy. TOLF is typically treated with surgical decompression. A variety of surgical techniques, including laminoplasty, laminectomy, and lamina fenestration, are used for the effective treatment of TOLF. However, traditional methods are associated with a substantial risk of perioperative complications, including dural laceration and/or iatrogenic spinal cord injury. Therefore, it is important to develop an efficient and secure surgical technique for TOLF. Herein, we describe a method for laminectomyperformed at the thoracic spine using an ultrasonic osteotome combined with a conventional osteotome. This technique can reduce intraoperative complications. This is a relatively safe and easy-to-learn method that should be recommended for the treatment of TOLF.

Laminectomy for the Removal of Thoracic Ossification of the Ligamentum Flavum TOLF Using Ultrasonic and Conventional Osteotomes

We present a methodology for using an ultrasonic osteotome combined with a conventional osteotome for laminectomy in thoracic ossification of the ligamentum flavum. This is a relatively safe and easy-to-learn method that avoids the perioperative complications associated with the conventional method.

Ultrasonik ve Konvansiyonel Osteotomlar Kullanılarak Ligamentum Flavum'un (TOLF) Torasik Ossifikasyonunun Giderilmesi için Laminektomi

Thoracic ossification of the ligamentum flavum (TOLF) is a common cause of progressive thoracic myelopathy. TOLF is typically treated with surgical ...

Korunmuş Otonomik Solunum ile Video Yardımlı Torakoskopik Cerrahi için Entübasyon Dışı Protokol

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.

Yazar Spotlight: Multimodal Analjezi ve Sevofluran İnhalasyon Anestezisi ile Entübe Edilmemiş Video Yardımlı Torakoskopik Cerrahi 

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

Entübe Olmayan Video Yardımlı Torakoskopik Cerrahi

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

Transoral Robotic Total Thyroidectomy and Bilateral Central Regional Lymph Node Dissection for Papillary Thyroid Carcinoma

Currently, the common approaches to thyroid surgery include conventional thyroidectomy, bilateral axillo-breast, axillary, retroauricular, and oral vestibule approaches. Essentially, various approaches to thyroid surgery only move the traditional surgical incision to a more concealed position but still leave scars on the body surface. Among them, thyroid surgery via the oral vestibule approach can obtain the best cosmetic outcome through the shortest natural cavity. However, in the early time, thyroid surgery via the oral vestibule approach usually requires three incisions in the mouth and one axillary incision. We have introduced a robotic surgical system into thyroidectomy via the oral vestibule approach and successfully completed total thyroidectomy and bilateral central lymph node dissection. During the operation, only three incisions were made at the oral vestibule without an axillary incision. This article aims to present the unique three-port method of robotic thyroidectomy via oral vestibule for the treatment of patients with papillary thyroid cancer.

The transoral robotic total thyroidectomy and bilateral central regional lymph node dissection using three ports without axillary incision are feasible and safe for early-stage papillary thyroid carcinoma. Here we present the operative techniques of this operation.

Papiller Tiroid Karsinomu için Transoral Robotik Total Tiroidektomi ve Bilateral Santral Bölgesel Lenf Nodu Diseksiyonu

Currently, the common approaches to thyroid surgery include conventional thyroidectomy, bilateral axillo-breast, axillary, retroauricular, and oral ...

Gasless Endoscopic Thyroidectomy via the Trans-Axillary Approach

For patients with early, low-risk papillary thyroid carcinoma, an increasing number are opting for endoscopic thyroid surgery due to its ability to achieve favorable therapeutic outcomes while maintaining excellent cosmetic results. Among the available endoscopic procedures, the Gasless Endoscopic Thyroidectomy Trans-axillary Approach (GETTA) has gained popularity among surgeons. This is attributed to its straightforward cavity construction, spacious operating area, precise visual field exposure, and manageable learning curve. However, few studies have provided detailed descriptions of the specific surgical steps involved in GETTA. Drawing from a synthesis of existing literature and our own clinical expertise, we present a comprehensive outline of the GETTA procedure. This process can be categorized into five distinct stages: positioning and incision planning; establishment of surgical cavities; identification and protection of the recurrent laryngeal nerve, inferior parathyroid gland, and central neck dissection; localization and preservation of the superior laryngeal nerve, superior parathyroid gland, and dissection of the thyroid's superior pole; transection of the thyroid isthmus followed by en bloc resection of the thyroid gland and central neck lymph nodes. The five-step approach of GETTA is easy to learn and can be adapted for resecting both benign and malignant thyroid and parathyroid diseases.

Gasless Endoscopic Thyroidectomy via the Trans-Axillary Approach

This protocol presents the procedure for conducting thyroidectomy using the gasless endoscopic thyroidectomy trans-axillary approach (GETTA).

Transaksiller yaklaşımla gazsız endoskopik tiroidektomi

For patients with early, low-risk papillary thyroid carcinoma, an increasing number are opting for endoscopic thyroid surgery due to its ability to ...

Removal of Subcostal Specimen After Complete Portal Robotic Lobectomy

Subcostal Specimen Removal in Completely Portal Robotic Lobectomy

The Completely Portal Robotic Lobectomy (CPRL-4) technique is increasingly favored for lobectomy procedures due to its advancements over traditional robot-assisted lobectomy (RAL). CPRL-4 integrates a fourth robotic arm and CO2 insufflation, resulting in superior visualization within the intrathoracic cavity owing to enhanced lung deflation. While CPRL-4 effectively achieves pulmonary resection, extracting specimens typically necessitates an intercostal utility thoracotomy, which may pose risks. To address potential damage associated with this method, we introduced a subcostal trans-diaphragmatic access port during resection, later enlarging it for specimen removal post-lobectomy. This study evaluated the efficacy and feasibility of this subcostal trans-diaphragmatic specimen removal approach following CPRL-4 procedures for pulmonary malignancies, all performed by a single surgical team. The findings suggest that subcostal specimen removal post-CPRL-4 offers several advantages, including reduced risk of thoracotomy-related complications, making it a practical, feasible, and safe method. This innovation has the potential to improve outcomes and patient care in pulmonary malignancy surgeries significantly.

This protocol describes the removal of lung specimens following a completely portal robotic lobectomy. Determining the optimal location for specimen extraction is a pertinent question, as both intercostal and subcostal routes can serve as potential extraction paths following robotic or video-thoracoscopic lobectomy. We choose subcostal lung specimen removal over intercostal removal.

The Completely Portal Robotic Lobectomy (CPRL-4) technique is increasingly favored for lobectomy procedures due to its advancements over traditional ...

Improved Thoracoscopic-Assisted Surgery for the Treatment of Metastatic Thoracic Vertebral Tumors

The significant progress made in the diagnosis and treatment of malignant tumors has led to improved patient survival rates. However, the metastatic spread of these tumors to the thoracic vertebrae remains a significant challenge, often resulting in bone-related adverse events, such as pathological fractures and severe complications. To address this issue, a refined multidisciplinary approach has been explored, which utilizes thoracoscopic techniques for tumor resection and spinal interventions. Thoracoscopic techniques offer a minimally invasive alternative to traditional open surgical methods, aiming to reduce the overall trauma experienced by patients. By leveraging the advantages of thoracoscopy, clinicians can effectively resect metastatic tumors within the thoracic vertebrae while minimizing the impact on surrounding tissues and structures. This approach, combined with targeted spinal interventions, has the potential to improve patient outcomes and quality of life by mitigating the debilitating effects of pathological fractures and other complications associated with metastatic bone disease. The implementation of this multidisciplinary strategy, incorporating thoracoscopic tumor resection and spinal interventions, represents a promising avenue for the management of metastatic tumors within the thoracic vertebrae. Further research and clinical evaluation are necessary to fully elucidate the long-term benefits and establish the optimal treatment protocols for this patient population, ultimately enhancing the care and outcomes for individuals afflicted by this challenging condition.

Here, we present a protocol to demonstrate an improved thoracoscopic-assisted surgery for the treatment of metastatic thoracic vertebral tumors.

Metastatik Torasik Vertebra Tümörlerinin Tedavisi için Geliştirilmiş Torakoskopik Yardımlı Cerrahi

The significant progress made in the diagnosis and treatment of malignant tumors has led to improved patient survival rates. However, the metastatic ...

Torasik Outlet Sendromunun Tedavisi için Transaksiller Birinci Kaburga Rezeksiyonu

Özet

Daha Fazla Video Keşfet

Teknik ve en az düzeyde erişim aort kapak replasmanı için hemen ön Mini Torakotomi hasta seçimi kriterleri

Minimal İnvaziv Transhiatal Özofagtomide Transerviziv Yaklaşım için Düşük Maliyetli Tek Bağlantı Noktalı (LoCoSP) Cihaz

Ultrasonik ve Konvansiyonel Osteotomlar Kullanılarak Ligamentum Flavum'un (TOLF) Torasik Ossifikasyonunun Giderilmesi için Laminektomi

Entübe Olmayan Video Yardımlı Torakoskopik Cerrahi

Entübe Olmayan Video Yardımlı Torakoskopik Cerrahi

Entübe Olmayan Video Yardımlı Torakoskopik Cerrahi

Papiller Tiroid Karsinomu için Transoral Robotik Total Tiroidektomi ve Bilateral Santral Bölgesel Lenf Nodu Diseksiyonu

Transaksiller yaklaşımla gazsız endoskopik tiroidektomi

Subcostal Specimen Removal in Completely Portal Robotic Lobectomy

Metastatik Torasik Vertebra Tümörlerinin Tedavisi için Geliştirilmiş Torakoskopik Yardımlı Cerrahi