transaxillary approach
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2021 ◽  
pp. 000313482110611
Author(s):  
Ruhul Munshi ◽  
Nicholas Mankowski ◽  
Spenser Souza ◽  
Hosam Shalaby ◽  
Ahmed Elnahla ◽  
...  

Background Intraoperative neuromonitoring (IONM) has been accepted as a routine adjunct among surgeons who perform thyroid and parathyroid surgeries. Thyroid and parathyroid surgeries use various patient positioning strategies that have poorly understood effects on IONM. The aim of this study was to compare IONM signals between the transaxillary and transcervical approaches. Methods In this retrospective cohort study, we evaluated 463 adult patients who underwent a total of 502 procedures. The procedures performed included total thyroidectomy, right or left hemithyroidectomy, and parathyroidectomy. Vagus nerve and recurrent laryngeal nerve (RLN) latency and amplitude measurements were analyzed intra-operatively. The distances between the vagus nerve and the trachea were measured via ultrasound during transaxillary procedures. Results Compared to the transcervical approach, the right vagus nerve latency was significantly decreased in the transaxillary approach. Transaxillary surgery was not associated with increased latency or decreased amplitude on IONM. The distance between the vagus nerve and trachea was significantly decreased post-positioning during transaxillary approaches. Discussion Despite differences in patient positioning, a transaxillary approach was not associated with increased stress on the vagus nerve or RLN, according to IONM data. The decreased right vagus nerve latency associated with a transaxillary approach highlights the importance of considering patient positioning and laterality while interpreting IONM data.


Author(s):  
E.M.J. Cornips ◽  
B. Maesen ◽  
G. Geskes ◽  
J.G. Maessen ◽  
E.A.M. Beuls ◽  
...  

2021 ◽  
Author(s):  
François Simon ◽  
Romain Luscan ◽  
Thomas Blanc ◽  
Sabine Sarnacki ◽  
Françoise Denoyelle ◽  
...  

Author(s):  
Jerry Lorren Dominic ◽  
Paul Berry ◽  
Amudhan Kannan ◽  
Addisalem Hailu Wondafrash ◽  
Luis Reyes ◽  
...  

2021 ◽  
Vol 12 (3) ◽  
pp. 337-343
Author(s):  
Praveen Reddy Bayya ◽  
Brijesh Parayaru Kottayil ◽  
Balaji Srimurugan ◽  
Rakhi Balachandran ◽  
Jessin Puliparambil Jayashankar ◽  
...  

Background: In the treatment of simple congenital cardiac lesions, percutaneous and cosmetic surgical approaches have steadily gained prominence. Surgically, right vertical axillary approach is sparsely used despite superior cosmesis and less pain and blood product usage. Knowledge of potential pitfalls could lead to its more widespread acceptance. Methods: We retrospectively analyzed perioperative outcomes of 104 consecutive patients who underwent surgery by this technique between mid-2016 and December 2019, including ostium secundum (67), sinus venosus (34), coronary sinus (1), and ostium primum (1) atrial septal defects and hemianomalous pulmonary venous connection (1). Perioperative variables, surgical times, complications, and follow-up data were analyzed. Results: Patient weight ranged from 6.8 to 41 kg. Incision length ranged from 4 to 6 cm. There was no mortality. All cannulation was central. Difficulty in cannulation (inferior vena cava) was seen in two patients. Morbidity included pneumothorax in 2 (1.9%) patients and subcutaneous emphysema necessitating prolonged intercostal drain retention in 20 (19.2%) patients. Surgical time increased linearly (r = 0.567; P < .001) with increasing patient weight but cardiopulmonary bypass (CPB) time remained unaffected. No chest deformities or paresthesia were noted on follow-up. Scar size decreased in some patients. Conclusions: Right vertical axillary approach can be safely employed to treat simple congenital cardiac lesions with adequate awareness of potential pitfalls. Increasing patient weight increases the surgical time but does not affect CPB times. Incidence of pneumothorax and subcutaneous emphysema is similar to other thoracotomy approaches. It is cosmetically superior.


Gland Surgery ◽  
2021 ◽  
Vol 10 (3) ◽  
pp. 953-960
Author(s):  
Emad Kandil ◽  
Deena Hadedeya ◽  
Mahmoud Shalaby ◽  
Eman Toraih ◽  
David Aparício ◽  
...  

2021 ◽  
Vol 3 (1) ◽  
pp. e155-e162
Author(s):  
Kozo Furushima ◽  
Tadanao Funakoshi ◽  
Hiroshi Kusano ◽  
Azusa Miyamoto ◽  
Toru Takahashi ◽  
...  

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