Simultaneous Surgery Research Articles

An evaluation of the long-term patency of the aortocoronary bypass graft anastomosed to a vascular prosthesis.

Although concomitant surgery for coronary artery disease (CAD) and thoracic aortic aneurysm is performed often, the long-term patency of the coronary artery bypass grafting (CABG) anastomosed to a vascular prosthesis has not been fully investigated. Here, we explored the long-term patency of the graft in comparison with the proximal anastomosis site on the native ascending aorta or vascular prosthesis. A total of 84 patients with concomitant CABG who underwent surgery for thoracic aortic aneurysm at 3 Osaka Cardiovascular Research Group institutes were retrospectively investigated for this study. The patency of 109 aortocoronary bypasses using saphenous vein grafts was evaluated with computed tomography angiography or coronary angiography, comparing the grafts anastomosed on the vascular prosthesis (group P, n = 75) to those anastomosed on the native ascending aorta (group N, n = 34). During 45.9 ± 39.7 months follow-up, significantly worse patency of the grafts in group P was revealed when compared with those in group N (100% vs 77.6% in 12 months, 100% vs 52.7% in 36 months and 100% vs 31.6% in 57 months, log rank P < 0.001). The poor patency of the grafts was confirmed in each target lesions (left anterior descending artery: P = 0.050, right coronary artery: P = 0.045, left circumflex artery: P = 0.051) and regardless of the severities of the target coronary vessels (severe stenosis: P = 0.013, mild-to-moderate stenosis: P = 0.029). Furthermore, an analysis of graft occlusion risk factors using the univariate Cox proportional hazards model revealed that the proximal anastomosis site on the vascular prosthesis was the sole risk factor for graft occlusion (P < 0.001). In the simultaneous surgery for CAD and thoracic aortic aneurysm, CABG design from vascular prosthesis to coronary artery should be avoided if possible, although further studies are warranted.

Improving Surgical Results in Velopharyngeal Surgery: Our Experience in the Last Decade

Background and purposeThe surgical techniques used to treat velopharyngeal collapse in obstructive sleep apnoea patients have evolved over recent years. Our aim was to determine whether these new techniques have better surgical results. Materials and methodsThis is a retrospective study of moderate to severe obstructive sleep apnoea patients surgically treated from 2006 to 2018. Only adult patients with no compliance to positive airway pressure and without simultaneous multilevel surgery were included. During this period, 4 different techniques were performed: uvulopalatopharyngoplasty, lateral pharyngoplasty, expansion pharyngoplasty and barbed reposition pharyngoplasty. Success rates as defined by Sher, as well as postoperative AHI<10/h and mean relative AHI reduction (MRR) were compared. Results82 patients were included. AHI was significantly reduced from 43.4±24/h to 15.6±18.6/h. No significant changes in body mass index were observed. Hypoxaemia time, oxygen desaturation index, and Epworth sleepiness scale values improved after surgery. The best success rates were obtained performing barbed reposition pharyngoplasty (78.26% measured by Sher's criteria, 65.22% by AHI<10/h criteria and 74.1% by the MRR). The differences observed were statistically significant. ConclusionsBarbed reposition pharyngoplasty is a recently introduced technique that showed superiority over the other palatal surgery techniques in this cohort.

Osteochondroma of the mandibular condyle: an algorithm for treatment

Purpose Osteochondroma (OC) or osteocartilaginous exostosis is considered to be the most common benign tumor of the axial skeleton; however, due to its endochondral origin, this pathology is rarely seen in the maxillofacial skeleton aside in the head of the mandibular condyle.1,2 Condylar OCs can lead to various structural and functional disturbances which include facial asymmetries, malocclusion, prognathic deviation of chin, crossbite of the contralateral side, mouth opening disturbances, temporomandibular joint (TMJ) dysfunctions, and hearing loss, and pain in some cases.2-8 The types of surgical treatments for osteochondroma vary from resection without reconstruction (low-condylectomy), resection (total condylectomy) with TMJ reconstruction (autogenous/alloplastic), combined surgery, including orthognathic correction and low-condylectomy or TMJ reconstruction. Although previous studies have reviewed various modes of treatments and have supported the efficacy of each of them, none address the indications of such treatments in an algorithmic fashion. In this study, we reviewed a series of cases which were surgically treated and proposed a treatment algorithm based on initial presentation, age, location of the mass, morphology of the mass, and the degree of dentofacial deformity created. Methods We reviewed a total of 6 patients with a mean age of 33.6 years at the time of surgery. Three of those 6 patients presented as a pedunculated condylar mass located on the superior surface of the condyle, resulting in mild occlusal discrepancies and facial asymmetry. Two of these patients were treated successfully with proportional condylectomy and postoperative orthodontic correction of dental malocclusion with stable results. No orthognathic surgery was required until the last follow-up. The third patient elected not to undergo postoperative orthodontic correction of persistent malocclusion due to financial reasons but had no sign of recurrence with stable functional mild malocclusion. One of the 6 patients presented with superior located condylar mass, which was slightly larger in size, with significant cant of the maxilla and the mandible. This patient underwent a low condylectomy with simultaneous orthognathic surgery. The final 2 patients presented with a significantly larger mass, with medial extension toward the cranial base. One of these patients had preoperative facial dysesthesia, presumed to be due to impingement on cranial nerve V. These patients were both treated with complete condylectomy and total joint replacement due to size of the mass, patient age, and medial extension and location of the mass on the condyle. Results All 6 patients who received treatment at Virginia Commonwealth University by the same surgeon from years 2015–2019 were found to show no sign of tumor recurrence at their most recent follow-up (mean follow-up length 10.8 months; range 3–30 months). Conclusions Based upon these surgical outcomes, we propose the algorithm shown in Figure 2, which can help guide practitioners in choosing the correct surgical procedure based upon preoperative clinical and radiographic findings.

Simultaneous Laparoscopic Surgery during Deep Inferior Epigastric Artery Perforator Flap Elevation: A Case Report

As deep inferior epigastric artery perforator (DIEP) flap surgery is gaining popularity, more patients including BRCA-positive patients need simultaneous laparoscopic surgery. We share our experience on a patient who underwent concurrent laparoscopic hysterectomy during flap elevation with a novel method. A patient diagnosed with a right breast cancer also required laparoscopic hysterectomy due to multiple uterine myoma. After perforator mapping was performed, flap elevation through external oblique fascia level was carried out first, sparing the periumbilical perforator and superficial inferior epigastric vein. Three ports were inserted for laparoscopy on posterior fascia level in the periumbilical area, left upper quadrant area and suprapubic area. The surgery was completed without any complication, gas leaks or vascular injury with the advantage of reduced risk of vascular damage and less surgical incision.

Long-term results of augmented unilateral lateral rectus muscle recession for dissociated horizontal deviation.

We report the long-term surgical results of augmented lateral rectus muscle (LR) recession for dissociated horizontal deviation (DHD) without concomitant exotropia (XT) or esotropia (ET). This retrospective review included patients with DHD without XT or ET who underwent augmented LR recession and were followed-up for ≥12 months. Each patient’s medical records were evaluated to identify their demographics, preoperative angle of deviation, surgical procedure, success rate, and reoperation rate. A total of 11 patients with DHD were included (median patient age at surgery, 6 years; interquartile range [IQR], 5 to 10 years). Four patients (36.4%) had a history of infantile ET while three patients (27.3%) had a history of unilateral cataract surgery for congenital cataract. The median preoperative angle of DHD in the unilateral eye was 20 prism diopters (PD) (IQR, 15 to 25 PD). The median amount of LR recession was 8.0 mm (IQR, 7.5 to 8.0 mm). Three patients (27.3%) underwent simultaneous surgery for dissociated vertical deviation. At the final examination after a median follow-up period of 32 months (IQR, 24 to 58 months), 10 patients (91%) showed successful alignment. The long-term successful alignment rate after augmented LR recession for DHD was good; thus, application of this technique is appropriate in patients with DHD.

Removal of foveal hard exudates by subretinal balanced salt solution injection using 38-gauge needle in diabetic patients

To examine the anatomic and visual outcomes after removal of foveal hard exudates through a macular hole created by subretinal balanced salt solution (BSS) injection. This was a retrospective, consecutive, case series. Six patients (7 eyes) underwent vitrectomy with removal of foveal hard exudates. All patients were women and the mean age was 65years (range from 55 to 71). All patients had a history of panretinal photocoagulation. Previous treatments included intravitreal anti-vascular endothelial growth factor injection in one eye and vitrectomy in both eyes of one patient. The geometric mean preoperative decimal visual acuity was 0.11 (range from 0.08 to 0.3). The mean postoperative follow-up period was 12months (range from 6 to 19). The status of lens was two phakic and five pseudophakic. Surgical procedures included simultaneous cataract surgery if phakic, creation of posterior vitreous detachment if not present, internal limiting membrane (ILM) peeling and a gas or air tamponade. Manual subretinal BSS injection using 38-gauge needle was performed at ILM-peeled area. Removal of foveal hard exudates was conducted by the water flow through the macular hole created during subretinal BSS injection. Foveal hard exudates decreased in all cases early after surgery. The geometric mean final decimal visual acuity was 0.31 (range from 0.1 to 0.9). Visual acuity improved more than 0.2 LogMAR units in six eyes and unchanged in one eye. There was no severe complication and recurrence of macular edema. This procedure may be effective for foveal hard exudates in diabetic patients.

Simultaneous Axillary–Carotid and Carotid–Axillary Bypass

We here report a case of a 52-year-old man who underwent simultaneous bypass grafting surgery on his carotid–axillary arteries bilaterally (axillary–carotid and carotid–axillary bypasses) after a failed endovascular treatment. This has rarely been reported. Imaging follow-up at 5 days showed bypass graft patency, and he developed no complications. At 1-month follow-up, the patient had no discomfort or recurrence of vertigo and ataxia and his blood pressure was steady and normal bilaterally. The results in this patient indicate that axillary–carotid and carotid–axillary bypasses using expanded polytetrafluoroethylene grafts are a safe and valuable techniques for revascularizing common carotid artery and subclavian artery occlusive diseases, achieving patency and freedom from stroke in the short term. Long-term outcomes are yet to be determined.

Clinical Experience with Thymic Cystectomy: A Single-Institution Study of 117 Cases from 2013 to 2019.

BackgroundThe aim of this study was to summarize the clinical experience of thymic cysts treatment from a single center.Material/MethodsClinical data, imaging, pathological results, and follow-up results of thymic cyst patients who underwent surgery from January 2013 to September 2019 were retrospectively reviewed.ResultsA total of 117 patients were enrolled, including 76 asymptomatic patients and 41 symptomatic patients. The average diameter of thymic cysts, the cysts in asymptomatic patients, and those in symptomatic patients were 31.93±19.92 mm, 29.28±17.97 mm, and 36.85±22.50 mm, respectively. The number of cysts ranged from 1 to 3 cm, 3 to 6 cm, and >6 cm in 73 cases (62.4%), 32 cases (27.3%), and 12 cases (10.3%), respectively. There was no correlation between the size of thymic cysts and the presence or absence of symptoms. Only 20 cases (17.1%) were correctly diagnosed as thymic cysts before surgery. There were 67 patients (57.3%) who underwent video-assisted thoracic surgery (VATS) and 50 cases (42.7%) underwent open surgery. Cystectomy was performed in 93 cases (79.5%) and 24 cases (20.5%) underwent simultaneous resection of thymic cysts and other thoracic tumors. Compared with the thoracotomy group, the VATS group had shorter hospital stay and chest tube indwelling time. No serious complications occurred after surgery. The median follow-up time was 45.0 months (range 4.0–84.0 months) and there was no recurrence.ConclusionsAttention should be paid to the accuracy of preoperative diagnosis of thymic cysts and the reduction of asymptomatic thymic cystectomy. For patients who have both thymic cysts and other thoracic tumors, simultaneous surgery is safe and feasible.

Facedown Positioning Following Surgery for Large Full-Thickness Macular Hole

The value of facedown positioning following surgery for large full-thickness macular holes is unknown. To determine whether advice to position facedown postoperatively improves the outcome for large macular holes. This randomized, parallel group superiority trial with 1:1 randomization stratified by site with 3 months' follow-up was conducted at 9 sites across the United Kingdom and included participants with an idiopathic full-thickness macular hole of at least 400 μm minimum linear diameter and a duration of fewer than 12 months. All participants had vitrectomy surgery with peeling of the internal limiting membrane and injection of perfluoropropane (14%) gas, with or without simultaneous surgery for cataract. Following surgery, participants were randomly advised to position either facedown or face forward for 8 hours daily for 5 days. The primary outcome was closure of the macular hole determined 3 months following surgery by masked optical coherence tomography evaluation. Secondary outcome measures at 3 months were visual acuity, participant-reported experience of positioning, and quality of life measured by the National Eye Institute Visual Function Questionnaire 25. A total of 185 participants (45 men [24.3%]; 156 white [84.3%]; 9 black [4.9%]; 10 Asian [5.4%]; median age, 69 years [interquartile range, 64-73 years]) were randomized. Macular hole closure was observed in 90 (85.6%) who were advised to position face forward and 88 (95.5%) advised to position facedown (adjusted odds ratio, 3.15; 95% CI, 0.87-11.41; P = .08). The mean (SD) improvement in best-corrected visual acuity at 3 months was 0.34 (0.69) logMAR (equivalent to 1 Snellen line) in the face-forward group and 0.57 (0.42) logMAR (equivalent to 3 Snellen lines) in the facedown group (adjusted mean difference, 0.22 [95 % CI, 0.05-0.38]; equivalent to 2 Snellen lines); 95% CI, 0.05-0.38; P = .01). The median National Eye Institute Visual Function Questionnaire 25 score was 89 (interquartile range, 76-94) in the facedown group and 87 (interquartile range, 73-93) in the face-forward group (mean [SD] change on a logistic scale, 0.08 [0.26] face forward and 0.11 [0.25] facedown; adjusted mean [SD] difference on a logistic scale, 0.02; 95% CI, -0.03 to 0.07; P = .41). The results do not prove that facedown positioning following surgery is more likely to close large macular holes compared with facing forward but do support the possibility that visual acuity outcomes may be superior. Isrctn.org Identifier: 12410596.

Simultaneous bilateral hallux valgus surgery: Percutaneous or conventional? Early results of a matched study from a tertiary institution

BackgroundHallux valgus is bilateral in up to 84 % of cases. In the setting of simultaneous bilateral correction, we aim to evaluate if minimally invasive percutaneous surgery (MIS) provides any advantage compared to conventional open surgery. Methods52 feet (26 patients) undergoing simultaneous bilateral MIS surgery were matched by severity of deformity to 52 feet (26 patients) undergoing simultaneous conventional open surgery. Patients were followed for a minimum of six months. Pre- and post-operative radiographs and clinical records were reviewed. ResultsThere were no significant differences in pre-operative function or pain between both groups. Post-operatively, the mean hallux valgus angle (HVA) was significantly lower in the MIS group. (HVA MIS – 8.6; Open – 11.8, P = 0.013). There were no significant differences in post-operative outcome and patient satisfaction between both groups. ConclusionThis study demonstrates that simultaneous bilateral MIS hallux valgus surgery can be considered for patients with bilateral symptomatic hallux valgus.

Day-Case Admission for External Dacryocystorhinostomy in Preschool Children.

Epistaxis during or after dacryocystorhinostomy may present a risk of circulatory compromise, particularly in young children. In view of this concern, we reviewed the outcome and complications of external dacryocystorhinostomy in preschool children, aged less than 4½ years. Retrospective noncomparative series. A case-note review for a series of preschool children undergoing external dacryocystorhinostomy as a day-case admission at Moorfields Eye Hospital between 1992 and 2018; all surgery was consultant-led. Details were taken of the type of surgery, any intraoperative or postoperative complications (surgical or anesthetic), any unplanned admissions after surgery, and the functional outcome. To assess the veracity of the medical records, the parents for a sample of 67 children were contacted to check whether there had been any unrecorded events or concerns. Anesthetic or surgical complications, unplanned admissions, and postoperative events. One-hundred and eighty-seven children (117 boys; 63%) underwent 228 external dacryocystorhinostomies during 201 admissions, the average admission age being 36.8 months (median, 37.5; range, 5.5-53.5 months). Forty-one children (20%) underwent bilateral dacryocystorhinostomy: the 27 having simultaneous bilateral surgery dacryocystorhinostomy were operated at a mean age of 38.2 months (median, 37.5; range, 15.5-53.5 months), this being significantly different from the average age at first operation in 14 children undergoing sequential admission for bilateral dacryocystorhinostomy (mean, 24.9 months; median, 27.0; range, 5.5-42.5) (p = 0.0023). No adverse anesthetic events were recorded, 2 children (2 dacryocystorhinostomies) required temporary nasal packing at the end of surgery for epistaxis, and one further child was admitted for overnight observation because of persistent mild epistaxis after bilateral dacryocystorhinostomy. Three children (3 dacryocystorhinostomies) had a mild, self-limiting secondary epistaxis, and there were no unplanned emergency admissions. The telephone survey did not reveal any disparity in the medical records. With experienced surgeons and anesthetists in a suitable specialist hospital, external dacryocystorhinostomy in preschool children would appear to be a safe and effective procedure, with few and minor complications. Although facilities for overnight observation should be available, the surgery can typically be planned as a day-case admission, and simultaneous bilateral surgery is also possible in this age-group.

Simultaneous totally robotic rectal resection and partial nephrectomy: case report and review of literature

IntroductionThe incidence of synchronous RCC and colorectal cancer is heterogeneous ranging from 0.03 to 4.85%. Instead, only one case of huge colon carcinoma and renal angiomyolipoma was reported. The treatment of synchronous kidney and colorectal neoplasm is, preferably, synchronous resection. Currently, laparoscopic approach has shown to be feasible and safe, and it has become the gold standard of synchronous resection due to advantages of minimally invasive surgery. We presented a case synchronous renal neoplasm and colorectal cancer undergone simultaneous totally robotic renal enucleation and rectal resection with primary intracorporeal anastomosis. As our knowledge, this is the first case in literature of simultaneous robotic surgery for renal and colorectal tumor.Case presentationA 53-year-old woman was affected by recto-sigmoid junction cancer and a solid 5 cm left renal mass. We performed a simultaneous robotic low anterior rectal resection and renal enucleation. Total operative time was 260 min with robotic time of 220 min; estimated blood loss was 150 ml; time to flatus was 72 h, and oral diet was administered 4 days after surgery. The patient was discharged on the eighth post-operative day without peri- and post-operative complication. The definitive histological examination showed a neuroendocrine tumor pT2N1 G2, with negative circumferential and distal resection margins. Renal tumor was angiomyolipoma. At 23 months follow-up, the patient is recurrence free.Discussion and conclusionAs our knowledge, we described the first case in literature of simultaneous robotic anterior rectal resection and partial nephrectomy for treatment of colorectal tumor and renal mass. Robotic rectal resection with intracorporeal anastomosis surgery seems to be feasible and safe even when it is associated with simultaneous partial nephrectomy. Many features of robotic technology could be useful in combined surgery. This strategy is recommended only when patients’ medical conditions allow for longer anesthesia exposure. The advantages are to avoid a delay treatment of second tumor, to reduce the time to start the post-operative adjuvant chemotherapy, to avoid a second anesthetic procedure, and to reduce the patient discomfort. However, further studies are needed to evaluate robotic approach as standard surgical strategy for simultaneous treatment of colorectal and renal neoplasm.

Experience in Obstructive Hyperthrophic Myocardiopathy Surgery at a National Reference Center

To identify the clinical characteristics, analyze the results and show the efficacy of surgical treatment of hypertrophic obstructive cardiomyopathy (HOC), in a national reference institute. A descriptive, retrospective, case series of patients with the diagnosis of HOC operated at the National Cardiovascular Institute, was performed between December 2016 and January 2019. We analyzed the postoperative evolution of symptomatology, functional class (FC), left ventricular outflow tract gradient (LVOTG) and mitral regurgitation (MR). Thirteen cases with HOC undergoing extended septal myectomy were evaluated. 31% were women and the average age was 39.6 years. Before surgical treatment, 85% were in functional class (FC) III-IV, 85% of patients had severe MR, the mean septum thickness was 27 mm (range from 19 to 39 mm), and mean LVOTG was 111 mmHg (range from 60 to 150 mmHg). After surgical treatment we found improvement of the functional class (69% in FC I) and the degree of MR (92% with zero or minimal), and reduction of mean LVOTG to 16 mmHg (range from 6 to 35 mmHg). Simultaneous surgery of the mitral valve was performed in 7 patients (54%). Our experience in HOC surgery is good. The treatment of both myocardial and valve components allows reducing LVOTG and correcting MR.

Differential time-course tear film quantitative changes following limbal relaxing incisions

BackgroundThe study aims at evaluating the time-course changes of pre-corneal tear film after simultaneous phacoemulsification and limbal relaxing incisions (LRIs) performed in 2 groups of patients; group-A had vertical and group-B had horizontal LRIs.MethodsFourty-two eyes of 28 patients with co-existing cataract and corneal astigmatism were studied before and after simultaneous cataract surgery and LRIs (at weeks 1, 4 and 12), patients were classified into 2 groups according to the orientation of LRIs; vertical (A) and horizontal (B) groups. Pre-corneal tear film stability was assessed by measuring the tear break-up time (TBUT) and the tear volume was determined using Schirmer’s I test (Basic Schirmer’s test; BST), both preoperatively and postoperatively.ResultsTBUT was significantly reduced in both the study groups (P = 0.001) without significant reduction regarding basic Schirmer’s test values except for the first postoperative week in the horizontal LRI group-B (P = 0.04).ConclusionsPrecorneal tear film stability is altered in the early postoperative period after simultaneous cataract and LRI incisions shown by TBUT measurement values. These changes do not appear to differ significantly depending on the orientation of LRI incisions.

Chronic maxillary sinusitis of dental origin and oroantral fistula: The results of combined surgical approach in an Italian university hospital.

Unilateral chronic maxillary sinusitis is a possible complication of odontogenic disease or dental treatment and is mainly due to the development of an oroantral fistula (OAF). The management of chronic maxillary sinusitis of dental origin (CMSDO) requires a combined treatment via endoscopic sinus surgery (ESS) and intraoral surgical treatment of the odontogenic source. The aim of this study is to present the results of our university hospital unit in the treatment and follow-up of a case series of 34 patients treated with a combined surgical approach for CMSDO due to OAF. All patients were treated with ESS combined with an intraoral approach. No intraoperative or immediate postoperative complications were observed; nasal synechia was found in 3 patients (8.82%). The overall success rate after the primary intervention was 94.12%; recurrence was observed in 2 cases (5.88%), both were suffering from diabetes mellitus and were tobacco smokers. Our results confirm that simultaneous surgery with a combination of an intraoral and endoscopic approach can be considered the best strategy for the long-term restoration of normal sinonasal homeostasis in selected patients with chronic odontogenic sinusitis and OAF, guaranteeing an effective treatment with minimal complications in the short and long term.

Outcomes of bilateral simultaneous hallux MTPJ fusion

BackgroundArthrodesis of the first metatarsophalangeal joint (MTPJ) is a frequently performed surgical procedure. Many patients have bilateral hallux MTPJ pathology requiring bilateral arthrodesis. There are concerns that bilateral simultaneous hallux surgery, under one anaesthetic, results in the patient being severely incapacitated in the early post-operative period. We hypothesize that bilateral simultaneous hallux MTPJ fusions does not compromise outcomes or the patients’ post-operative comfort and rehabilitation and is cost and time effective. MethodsIn this retrospective study, 16 patients who underwent bilateral simultaneous first MTPJ arthrodesis were compared to 16 patients who had unilateral MTPJ arthrodesis with regards to outcome, tolerance, cost and time effectiveness. Outcome measures were evaluated using the American Orthopaedic Foot and Ankle Society (AOFAS) hallux score and the Self-Reported Foot and Ankle questionnaire (SEFAS). ResultsThere was a significant improvement in the AOFAS scores post surgery in the bilateral group and according to the SEFAS grading, 14 patients (87.5%) had good or excellent outcome scores with 13 (81.25%) of these patients having excellent scores. This was comparable to the outcome scores in the unilateral group. Two patients developed non-unions bilaterally compared to one in the unilateral group. There is also a notable general cost saving and less time off work when bilateral fusions are done at the same setting. ConclusionBilateral simultaneous hallux MTPJ arthrodesis is an effective, convenient and cost effective option for patients requiring MTPJ fusions for bilateral hallux pathology. Level of evidenceLevel 4

Single-center experience of simultaneous bilateral uni-portal video-assisted thoracoscopic surgery for multiple ground-glass opacities

BackgroundThere is an increasing incidence rate of ground-glass opacity (GGO), especially for multiple GGOs (≥2). Whether it is safe and feasible to have bilateral simultaneous surgical resection remains unknown. The purpose of this study is to summarize the experience of surgical resection of patients with multiple GGOs in our Hospital in recent years, and to discuss the above questions.MethodsClinical datas of patients who underwent one-stage bilateral uni-portal VATS resections of multiple pulmonary ground glass opacities and had routine pathological examination were collected from May 2016 to May 2019 in our hospital.ResultsA total of 34 patients underwent simultaneous bilateral surgical resection of multiple GGO lesions, 28 were women,6 were men, the average age of total patients was 57.9 ± 6.7 years. All patients underwent bilateral uni-portal video-assisted thoracoscopic surgery (Uni-portal VATS), the average intraoperative blood loss was 100.9 ± 67.7 ml, the average operation time was 140 ± 74.8 min, the average thoracic drainage time was 2.8 ± 3.1 days, and the average postoperative hospital stay was 4.2 ± 4.3 days. Postoperative complications including: 2 cases of infection, 3 cases of atrial fibrillation, and 5 cases of persistent air leakage for more than 3 days. All of them improved after treatment, and there were no serious complications and deaths in perioperative period. A total of 76 GGO lesions were resected, with a total malignancy rate of 81.6%, including 40 were pure GGO, of which 28 were malignant (70%), and the average diameter of them were 9.6 ± 3.8 mm; 36 were mixed GGO, of which 34 were malignant (94.4%), the average diameter of them were 15.6 ± 6.6 mm.Mean postoperative follow-up was 28.4 (range, 3–39) months. There was neither recurrence nor deaths at final follow-up.ConclusionThe malignancy rate of multiple GGOs is high. Therefore, when the lung function is allowed,one-stage bilateral uni-portal VATS can be considered. According to experience of main surgeon and the frozen biopsy, either sub-lobar resection or lobectomy was acceptable. The risk of postoperative complications and the prognosis were optimal.

Evaluation of Mandibular Symmetry in Patients With Condylar Osteochondroma Who Underwent Intro-Oral Condylar Resection and Simultaneous Bimaxillary Orthognathic Surgery.

Mandibular condylar osteochondroma (OC) can result in facial asymmetry, malocclusion, and temporomandibular joint dysfunction. The authors have previously demonstrated a novel method for conservative condylectomy and simultaneous orthognathic surgery for treatment of mandibular condylar OC. The purpose of this study was to evaluate the immediate improvement and long-term stability of mandibular symmetry in the treatment of condylar OC. Fifty-six patients with unilateral mandibular condylar OC combined with secondary facial asymmetry and malocclusion were enrolled in this retrospective study. The computerized tomography (CT) scans were acquired with the mandible in centric relation (CR) before surgery, 1 week and 12 to 18 months after surgery. The images were reconstructed and processed for the analysis with ProPlan CMF 2.1 software. After defining the skeletal landmarks and the reference planes, the chin deviation, chin rotation and mandibular asymmetry index were calculated. The operations and healing were uneventful and the patients showed no signs of recurrence or temporomandibular joint ankylosis during the follow-up. Facial symmetry was greatly improved right after the surgery in the chin deviation (from 9.2 to 1.7 mm, P < 0.01), chin rotation (from 11.2 to 2.3, P < 0.01) and the asymmetry index of three mandibular landmarks (Go, MF and Sg, all P < 0.01). It also showed a stable result after 12 to 18 months follow-up. We also established a novel measurement method, which showed that the combination of conservative condylectomy via the intraoral approach based on intraoperative navigation and simultaneous orthognathic surgery is effective for improving the facial symmetry when treat the mandibular condylar OC.

Simultaneous Orthognathic Surgery and Mandibular Contour Osteoplasty for Treating Mandibular Protrusion With High Gonial Angle.

The purpose of this study was to confirm the effectiveness and feasibility of simultaneous orthognathic surgery and mandibular contour osteoplasty with the help of the accurate surgical templates to treat mandibular protrusion with high gonial angle. Ten patients diagnosed as mandibular protrusion with high gonial angle were included in this study. Besides the traditional orthognathic surgery, mandibular contour osteoplasty was performed simultaneously. Models of the mandible were fabricated via 3D printing technology. Accurate surgical templates were produced on the 3D printing model according to preoperative design. Radiographs and medical photographs preoperatively and postoperatively were taken to compare the effectiveness of the operation. Measurement items include gonial angle (Ar-Go-Me), midlines of maxilla and mandible. The clinical manifestation of the temporomandibular joint and condylar process were observed. Radiographs and photographs of the face were taken after surgery showed satisfactory esthetic outcomes. The right gonial angle improved from 128.20° ± 5.67° to 120.35° ± 0.46°, and the left gonial angle improved from 129.91° ± 2.78° to 120.74° ± 0.59°. The midlines of the maxilla and mandibular basically consisted of the facial midline. After surgery, patients' clinical manifestation of the temporomandibular joint was no significant difference compared with the preoperative and the condylar process had no absorption. The results of this study showed it was possible to perform orthognathic surgery and mandibular contour osteoplasty simultaneously with the help of surgical templates in the treatment of mandibular protrusion with high gonial angle.

Experience and outcome of simultaneous bilateral endoscopic surgery (SBES) for patients with bilateral upper tract urolithiasis

Introduction: 15% of Urolithiasis patients presents with bilateral renal stones. Management of patients with renal stones along with ureteric stones commonly requires staged approach. Simultaneous bilateral endoscopic surgery (SBES) has emerged as more efficient treatment option which allows management of renal and ureteric stone in a simultaneous manner. We report our experience with SBES for patients with bilateral Urolithiasis. Patients and Methods: From May 2018 to February 2020, 12 patients who would otherwise have been treated in staged or in consecutive manner were planned for Simultaneous Bilateral Endoscopic surgery. Procedures were performed in the FOSML position to achieve both antegrade and retrograde access. Management of renal stones by supine approach and retrograde uretroscopic lithotripsy for ureteric stones under general anesthesia. Results: A total of 12 patients underwent simultaneous bilateral endoscopic surgery. Among these 12 patients, 2 patients had contra lateral upper ureteric calculus, 4 had mid ureteric calculus and remaining 6 had lower ureteric calculus. 11 patients were discharged on second postoperative day and remaining 1 patient was discharged on 3rd postoperative day due to procedure related complication. Conclusion: Simultaneous bilateral endoscopic surgery can be performed in FOSML position and is safe and effective procedure with shorter operative time and anesthesia. Procedure is beneficial for patient, healthcare system and surgeon.