Sleeve Anastomosis Research Articles

Validation of Novel Microsurgical Vessel Anastomosis Techniques: A Systematic Review.

Thorough validation of novel microsurgical techniques is deemed essential before their integration into clinical practice. To achieve proper validation, the design of randomized controlled trials (RCTs) should be undertaken, accompanied by the execution of comprehensive statistical analyses, including confounder adjustment and power analysis. This systematic review aims to provide an encompassing overview of the validation methodologies employed in microsurgical studies, with a specific focus on innovative vessel anastomosis techniques. A literature search was conducted in PubMed for articles describing the validation of novel microsurgical vessel anastomosis techniques in animal or human subjects. The literature search yielded 6,658 articles. A total of 6,564 articles were excluded based on title and abstract. Ninety-four articles were assessed for full-text eligibility. Forty-eight articles were included in this systematic review. Out of 30 comparative studies, 9 studies validated novel modified interrupted suture techniques, 6 studies modified continuous techniques, 6 studies modified sleeve anastomosis techniques, 1 study a modified vesselotomy technique, 7 studies sutureless techniques, and 1 study a modified lymphaticovenular anastomosis technique. Twenty-eight studies contained animals (n = 1,998). Fifteen animal studies were RCTs. Two studies contained human/cadaveric subjects (n = 29). Statistical power analysis and confounder adjustment were performed in one animal study. Out of 18 noncomparative studies, 5 studies validated novel modified interrupted suture techniques, 1 study a modified continuous technique, 2 studies modified sleeve anastomosis techniques, 4 studies modified vesselotomy techniques, 4 studies sutureless techniques, and 2 studies modified lymphaticovenular anastomosis techniques. Ten studies contained animal subjects (n = 320), with two RCTs. Eight studies contained human subjects (n = 173). Statistical power analysis and confounder adjustment were performed in none of the animal or human studies. The current methods of microsurgical technique validation should be reconsidered due to poor study design. Statistical analysis including confounder adjustment and power analysis should be performed as a standard method of novel technique validation.

Effect of SASI procedure (Single Anastomosis Sleeve Ileal) on the symptoms of gastroesophageal reflux disease in bariatric patients - a review of the literature.

The problem of gastroesophageal reflux disease among bariatric patients is constantly growing. While bariatric surgery is the most effective method of treating obesity and related diseases, not all surgical procedures lead to improvement or resolution of gastroesophageal reflux disease. The search for the "ideal" surgical procedure for this group of patients is ongoing. The relatively recently introduced SASI procedure seems to have a beneficial effect on GERD symptoms and may be an alternative anti-reflux procedure in obese patients. The presented paper is a review of the latest literature on the impact of SASI procedure on the symptoms of gastroesophageal reflux disease.

Video-assisted thoracic surgery sleeve resection and bronchoplasty using 3D imaging system: its safety and efficacy

BackgroundVideo-assisted thoracic surgery sleeve resection with bronchial anastomosis or bronchoplasty is a technically demanding procedure. Three-dimensional endoscopic surgery has been reported to be helpful in decreasing operation time and improving spatial perception with less surgical errors, but there have been rare reports about relatively difficult thoracoscopic procedures utilizing 3D thoracoscope. We performed this study to evaluate early clinical outcomes of thoracoscopic sleeve resection and bronchoplasty utilizing 3D thoracoscope.MethodsData from a total of 36 patients who underwent thoracoscopic sleeve lobectomy or bronchoplasty at our institution from December 2015 to October 2017 were retrospectively reviewed. Three-port approach with one utility incision was used with a 10 mm, 30° three-dimensional thoracoscope. Twenty-three patients (81%) were male, and mean age was 65.9 ± 9.4 years. Fourteen patients (38.9%) underwent sleeve resection with bronchial anastomosis, 22 (61.1%) underwent wedge or simple bronchoplasty, and one patient received concomitant PA procedure. Bronchial anastomosis sites were not covered with viable tissue flaps.ResultsThere was no (0%) suture needle injury from spatial misperception during bronchoplasty or sleeve anastomosis. There was no (0%) operative mortality. The pathologic report revealed squamous cell carcinoma (63.9%), adenocarcinoma (19.4%), carcinoid (6.9%), adenosquamous carcinoma (3.4%), and sarcomatoid carcinoma (2.8%). One (2.8%) late mortality was due to systemic recurrence of sarcomatoid carcinoma. There was no (0.0%) anastomotic failure. The mean number of dissected lymph nodes were 27.4 ± 13.2, and mean operation time was 216.8 ± 60.0 min. Median postoperative 24-h drain amount was 315 mL. Median chest tube days and hospital days were 4 and 6, respectively. Two patients (5.6%) had complications greater than Clavien-Dindo grade II—one case of ARDS, and the other case of a delayed bronchopleural fistula.ConclusionsThoracoscopic sleeve resection and bronchoplasty utilizing HD 3D thoracoscope is a safe and effective procedure with excellent early clinical outcomes. Further investigation for long-term outcomes will be needed.

The Initial Experience on Thoracoscopic Sleeve Lobectomy: Continuous Suturing Technique of the Bronchial Anastomosis in 12 Cases.

Sleeve resection is a widely performed type of operation in the surgical treatment of non-small cell lung cancer. Video-assisted thoracoscopic surgery (VATS) is now used even in central tumor surgeries of the lung with the increasing technology and experience. Sleeve resection cases performed through VATS in our clinic in recent years were presented with demographic, surgical, pathologic, and survey characteristics. Twelve patients who underwent sleeve resection with VATS in our clinic between November 2015 and August 2019 were included in the study. Operative, pathologic, and postoperative characteristics of the patients were examined. A total of 12 patients, 3 female and 9 male individuals, were included in the study. The mean age of the patients was 61.7±12.9 years. According to the localization of the tumors, left upper lobectomy was performed in 4 patients and 8 patients underwent right upper lobectomy. During the sleeve anastomosis of the patients, 3/0 prolene sutures were used in 5 patients (36%) and 4/0 prolene sutures in 4 patients (36%), whereas 3/0 polydioxanone suture (PDS) was used in 3 patients (28%). The mean operation time was 288.2±77.1 (205 to 460) minutes and the mean anastomosis time was 70±18.5 (55 to 110) minutes. In the postoperative period, 1 patient who had acute myocardial infarction died on the fourth postoperative day. The mean postoperative drainage duration of the patients was 5.5±1.9 (3 to 10) days and the mean length of hospital stay was 6.4±1.9 (4 to 11) days. When the pathologic features were examined, the mean tumor diameter was found to be 2.5±1.2 (1 to 5.5) cm. The mean follow-up period was calculated as 26.1±15.6 months (2 to 47). Other than 1 patient who died, the follow-up of 11 patients still proceeds. VATS approach of sleeve resections, which is performed cautiously even by thoracotomy, is becoming more common. These operations, which could be performed in experienced centers, offer a postoperative period of less morbidity to the patients with the advantage of reduced postoperative pain, drainage time, and hospital stay.

Factors influencing the recurrence of arterial involvement after surgical repair in Behçet disease

ObjectiveArterial involvement in Behçet disease (BD) is rare, and its surgical management is a major concern because of its high recurrence rate. This study evaluated the influence of the surgical technique, device, and immunosuppressive treatment used on the postoperative recurrence in patients with non-pulmonary arterial BD. MethodsA single-center, retrospective study was conducted of 23 patients meeting the international criteria for BD who underwent surgery for arterial involvement between May 1996 and September 2015. Recurrence was defined as the occurrence of arterial aneurysm or thrombosis during follow-up. Perioperative medical treatment and surgical technique used were reported. ResultsThere were 47 surgical procedures performed in 23 patients. Mean follow-up was 8.4 ± 7.5 years. Initial arterial lesions were aneurysms and thrombosis in 85% and 15% of cases, respectively. Arterial lesions were aortic and peripheral in 48% and 52% of cases. Recurrence rate was 51%. Recurrences developed within <1 year in 24% of cases and at the same anatomic site in 92% of cases. Among the 24 recurrences, 17 were false aneurysms, 6 were thrombosis, and 1 was a true aneurysm in a different arterial site. To treat the arterial lesion, direct anastomosis was performed in 6 cases; bypass using the saphenous vein, graft, or allograft was performed in 6, 27, and 5 cases, respectively; and stent graft was used in 3 cases. Vascular lesions involved the aorta in 19 cases and a peripheral artery in 28 cases.Preoperative medical treatments, including colchicine, steroids, and immunosuppressants, significantly decreased recurrence rate: 28% (7/25) vs 75% (15/20) in untreated patients (P = .002). The recurrence rate was 42.5% (17/40) in patients treated postoperatively vs 80% (4/5) in untreated patients. The nature of the device used (vein, prosthetic graft, allograft, stent graft, or direct anastomosis) did not change the risk of recurrence. When anastomoses were protected using the prosthetic sleeving technique, the recurrence rate was three times lower (P = .08). ConclusionsRelapse is a main concern after surgical repair of arterial BD. This study suggests the need for targeted perioperative medical management to reduce the risk of arterial recurrence in BD patients. To this end, a multidisciplinary approach is mandatory. The use of sleeve anastomosis is associated with a numerically lower risk of recurrence. However, further studies are needed to confirm this efficacy.

Successful repair of the rectovaginal fistula with gracilis muscle interposition

Introduction: Rectovaginal fistulas represent an often devastating condition in patients and a challenge for surgeons. Successful management of this condition must take into account a variety of variables including the etiology, size, and location of the fistula. We retrospectively evaluated our experience with the gracilis interposition procedure to assess its efficacy in repairing rectovaginal fistulas. Materials and Methods: We performed a retrospective study of all patients who underwent gracillis muscle interposition flap in our institution from January 2015 to November 2018 for the repair of fistulas between the rectum and vagina arising from diverse etiologies. Results: Rectovaginal fistula repair with gracilis muscle interposition was done in twelve patients. The etiologies were obstetric trauma (n=7), trauma (n=3), post arteriovenous malformation excision (n=1) and one patient had fistula after excision of squamous papilloma of rectum. Overall all the patients with gracilis interposition flap resulted in complete healing, a success rate of 100 percent. Discussion: Various surgical procedures have been suggested for the repair of these fistulas, including fecal diversion, primary repair, endorectal advancement flap, transvaginal repair, coloanal sleeve anastomosis, and interposition flaps. The reported success rate for the repair of rectovaginal or rectourethral fistulas using the gracilis muscle interposition technique is generally much higher than that reported for other repair techniques. Conclusion: Given the high success rate and low complication rate, repair with gracilis muscle interposition is recommended for fistulas with unfavorable local conditions, such as those present after radiation or subsequent to long-term, persistent infection, and especially after failed previous repairs. Keywords: Rectovaginal fistula, Gracilis muscle, Interposition.

Factors Influencing the Recurrence of Arterial Involvement After Surgical Repair In Behçet'S Disease

Introduction: Arterial involvement in Behçet's disease (BD) is rare and its surgical management is a major concern because of the high rate of recurrence as thrombosis or false aneurysm. The aim of this study was to identify factors influencing the postoperative recurrence of arterial lesions in patients with non-pulmonary arterial BD. Methods: Single centre retrospective study conducted in 23 patients meeting the International Study Group of BD criteria, who underwent surgery for arterial involvement between May 1996 and September 2015. Recurrence was defined as the occurrence of arterial aneurysm or thrombosis confirmed by ultrasound or CT-scan during follow-up. The nature of perioperative medical treatment and the surgical technique were reported. Results: Forty-seven surgical procedures were performed with a mean number of 2.4 ± 0.6 procedures in 16 patients with recurrences. Mean follow-up was 8.4±7.5 years. Initial arterial lesions were aneurysms and thrombosis in 85% and 15% of cases respectively. Arterial lesions were aortic in 48% of cases and peripheral in 52%. Recurrence rate was 51%. Recurrences occurred within less than one year in 24%, at the same anatomical site in 92% of cases. Preoperative medical treatment consisting in colchicine or steroids or immunosupressants significantly decreased recurrence rate of arterial lesions: 28% (7/25) versus 75% (15/20) in untreated patients (P = 0.002). The recurrence rate was 42.5% (17/40) in patients treated postoperatively versus 80% (4/5) in untreated patients. The nature of the device used did not change the risk of recurrence (vein, prosthetic graft allograft, stentgraft or direct anastomosis). When anastomosis where protected using prosthetic sleeving technique during surgery, the risk of recurrence was decreased by three (P = 0.034). Conclusion: Relapse is a main concern after surgical repair of arterial BD. But the risk seems to be reduced when a medical treatment is applied with vascular procedure. This study suggests the need for targeted perioperative medical management to reduce the risk of arterial recurrence in BD patients. To this end, a multidisciplinary approach combining rheumatologists and vascular surgeons is mandatory. The use of sleeve anastomosis is associated with a decrease in risk of recurrence in the form of anastomotic pseudo aneurysms and should be generalized when technically feasible. Disclosure: Nothing to disclose

Long term outcomes from lymphatic venous anastomosis after total hysterectomy to prevent postoperative lymphedema in lower limb

BackgroundLymphedema in lower limb is one of major postoperative complications followed by a total hysterectomy with lymph node dissection. The objective of this report is to examine a long-term result of lymphaticovenous anastomosis procedure as a preventive surgery.MethodsSixteen patients with endometrial cancer underwent an abdominal hysterectomy with a bilateral salpingo-oophorectomy. Just after pelvic lymph node dissection, either end-to-end or sleeve anastomosis utilizing venules and suprainguinal lymph vessels was performed. During the observation period from 4 to 13 years, the symptom of lymphedema in lower extremities has been assessed.ResultsAmong 16 patients, 1 presented postoperative lymphedema grade 3 (CTCAE (Common Terminology Criteria for Adverse Events) Ver. 4.0, 10025233) in lower limb, and a second surgery at 7 years after the first one was required. Other 6 patients showed non-severe symptoms of lymphedema, diagnosed as grade 1. The rest 9 patients did not show any symptoms of postoperative lymphedema in a long term (up to 13 years).ConclusionFrom the long term outcomes of our 16 cases, we propose that a direct lymphaticovenous microsurgery immediately after a hysterectomy with lymphadenectomy of external inguinal lymph node is one of the appropriate therapeutic choices to prevent severe lymphedema in lower limb.

How to do a simplified Dacron sleeve technique of aortic anastomosis.

Step-by-step diagram demonstrating technique of Dacron sleeve anastomosis for thoracic aorta.

An antiquated contraindication for minimally invasive lung surgery: No place to staple the bronchus.

This study aims to evaluate the feasibility and outcomes of lobectomy operations without using a stapler for bronchial closure. Between December 2014 and August 2018, a total of 108 patients (72 males, 36 females; mean age 62.1±9.8 years; range, 19 to 83 years) with primary lung cancer who underwent lobar resection with robot-assisted thoracoscopic surgery were included in this study. Primary bronchial closure (n=7) and sleeve anastomosis (n=9) were performed in some cases. These 16 patients were compared with other lobectomy cases (n=92) who had bronchial stapling for bronchial closure. There was no statistically significant difference in the mean duration of operation, amount of intraoperative bleeding, length of postoperative stay in the hospital, and morbidity and readmission rates between the two groups (p=0.3, p=0.5, p=0.06, p=0.4, and p=0.63, respectively). No bronchial fistula developed in any of the patients. Primary bronchial closure and sleeve anastomosis can be safely performed with robot-assisted thoracoscopic surgery without conversion to thoracotomy, or a larger assistance incision with a similar success rate of the stapled bronchus.

Orthotopic Kidney Transplantation in the Rat With the Use of a Sleeve Arterial Anastomosis Method and a Modified Stenting Technique for Renal Veins

BackgroundWe describe a simple and reliable orthotopic kidney transplantation method in rats with the use of sleeve arterial anastomosis and a modified stenting technique for anastomosis of the renal vein (RV). MethodsMale Fischer and Lewis rats were used as kidney donors and recipients, respectively, and their left kidneys were harvested in situ. In the control rats (n = 30), the renal artery (RA) and RV anastomoses were performed end-to-end with interrupted sutures by means of the conventional technique. In the experimental animals (n = 30), revascularization of the RA was fashioned end-in-end with the use of a modified sleeve anastomosis, the RV was anastomosed end-to-end with the use of a modified stenting technique and interrupted sutures, and the ureter was anastomosed with the use of the end-to-end interrupted suture technique. ResultsThe arterial anastomosis time in the control group was 8.52 ± 1.1 minutes, and that in the experimental group was 4.7 ± 0.6 minutes (P < .05). The venous anastomosis time in the experimental group was 9.2 ± 1.3 minutes, which also was less than in the control group (11.19 ± 0.78 minutes; P < .05). The warm ischemia time decreased from 26.8 ± 1.3 minutes in the control group to 20.7 ± 0.5 minutes in the experimental group (P < .05). The success rate of 93% at 21 days after grafting was identical in the experimental and control groups. ConclusionsWe developed a modified model of orthotopic kidney transplantation that can significantly reduce the warm ischemia time.

Bronchial sleeve anastomosis and primary closures with the da Vinci system: an advanced minimally invasive technique

Background: Bronchial division using a stapler may lead to a positive or suboptimal bronchial margin during anatomical resections if the tumour is close to the lobar orifice. Primary suture closure of the bronchus, instead of stapling, or bronchial sleeve anastomosis may provide a better marginal distance in such cases. One of the advantages of minimally invasive robotic surgery (da Vinci System Intuitive Surgical, Sunnyvale, CA, USA) is the complete transfer of surgeon’s capability inside the thoracic cavity. In this study, we analysed primary bronchial closure or bronchial anastomosis techniques performed using robot-assisted thoracoscopic surgery (RATS). Methods: In total, 296 patients underwent robot-assisted thoracoscopy in our centre between January 2012 and June 2017. Among these, 203 underwent anatomical lung resections. Surgical bronchial closure techniques were performed on nine patients. The indications for bronchial closure, details of surgery and peri- and postoperative characteristics were analysed in this study. Results: We performed primary suture closure in three patients, sleeve lobectomy in five and isolated partial bronchotomy and bronchial closure in one. Although we used prolene sutures in the first three patients, we preferred to use V-loc sutures (barbed sutures; Medtronic, Covidien New Haven, CT, USA) in the more recent patients. The mean docking time was 16.3±5.8 min (range, 10–25 min), and the mean operation duration was 101.1±24.2 min. The duration of drainage was 3.6±1 days, and the mean length of postoperative stay in hospital was 6.2±1.6 days. All patients underwent R0 resections. Conclusions: Bronchial closure without staplers is a safe method in experienced hands in robotic surgery. Negative surgical margins of the bronchus can be achieved in lung tumours that are close or extending over the lobar bronchus by higher technical capabilities of robotic surgery. We believe V-loc sutures have a potential place in bronchial closure in minimally invasive surgery.

Alternativas quirúrgicas en el manejo de la fístula rectovaginal: experiencia de 25 años

BackgroundRectovaginal fistula (RVF) is a distressing condition with no generally accepted standard surgical management. AimTo assess results of surgery for RVF. Material and methodThis is a descriptive retrospective analysis of 63 patients operated on consecutively for RVF in a period of 25 years. ResultsHalve of the cases were secondary to a pelvic malignancy and 27% due to radiotherapy of pelvic tumors. RVFs were associated with local (obstetrical) trauma and postsurgical complications in 28% of the cases. High RVFs were approached through abdominal procedures in 26 patients (41%), including radical resection of the primary tumor in 11 cases and coloanal sleeve anastomosis procedure in 15 patients with a RVF due to pelvic radiation. Seventeen patients with persistent pelvic tumors after radiotherapy and/or surgery were handled with a colostomy or ileostomy to improve quality of life. Four of five cases with postsurgical RVF closed spontaneously with a proximal colostomy and, in seven patients with obstetrical RVF, an advancement flaps were performed, with success in 6. ConclusionsIn this study local repair of RVF was employed in 12 cases, one third of the cases needed a permanent ostomy, and 40% of the complex cases of RVF were successfully repaired with sphincter preservation. Comparisons with other studies are precluded because of heterogeneity of published RVF series, probably due to different patterns of reference.

Left lower lobe sleeve resection and anastomosis

Left lower lobe sleeve resection and anastomosis

A new rat model of auxiliary partial heterotopic liver transplantation with liver dual arterial blood supply.

Auxiliary partial heterotopic liver transplantation (APHLT) with portal vein arterialization is a valuable procedure to be considered in the treatment of patients with acute liver failure and metabolic liver diseases. The aim of this study was to develop a new rat model of APHLT with liver dual arterial blood supply (LDABS). A total of 20 rats were used. The donor liver was resected, and the celiac trunk was reserved. Left and medial hepatic lobes accounting for 70% of the liver mass were removed en bloc and the suprahepatic caval vein was ligated simultaneously. Thus, 30% of the donor liver was obtained as the graft. Sleeve anastomosis of the graft portal vein and splenic artery were performed after narrowing the portal vein lumen through suturing. The right kidney of the recipient was removed, and sleeve anastomosis was performed between the celiac trunk of the graft and the right renal artery of the recipient. In addition, end-to-end anastomosis was performed between the infrahepatic caval vein of the graft and the right renal vein of the recipient. Following the reperfusion of the graft, the blood flow of the arterialized portal vein was controlled within the physiological range through suturing and narrowing under monitoring with an ultrasonic flowmeter. The bile duct of the graft was implanted into the duodenum of the recipient through an internal stent catheter. A 70% section of the native liver (left and medial hepatic lobes) was resected using bloodless hepatectomy. The mean operative duration was 154.5±16.4 min, and the warm and cold ischemia times of the graft were 8.1±1.1 min and 64.5±6.6 min, respectively. The blood flow of the arterialized portal vein to the graft was 1.8±0.3 ml/min/g liver weight. The success rate of model establishment (waking with post-surgical survival of >24 h) was 70% (7/10). Following successful model establishment, all rats survived 7 days post-surgery (100%; 7/7). The graft was found to be soft in texture and bright red in color following exploratory laparotomy. In conclusion, a new rat model of APHLT with LDABS without stent for vascular reconstruction was developed. This is a feasible and reliable rat model for liver transplantation study.

Clinical outcomes of colo‐anal pull‐through procedure for complex rectal conditions

Pull-through with colo-anal sleeve anastomosis may be used as a last resort to avoid permanent diversion in patients with complex rectal conditions. This procedure allows the preservation of intestinal continuity by minimizing the hazards of deep dissection in an inflamed and fibrosed pelvis. A retrospective study was performed of colo-anal pull-through procedures carried out between January 1998 and December 2012 at St Mark's Hospital by one surgeon. Patients were identified from operative logbooks and their case notes were reviewed. Thirty-four patients (21 women) with a median age of 54 (21-75) years underwent the pull-through operation for complex rectal conditions involving fistulae and/or a hostile pelvis as a final attempt to restore intestinal continuity. The median length of hospital stay was 7.5 (5-45) days. Median follow-up was 23 (3-71) months. There was no peri-operative mortality. There were two (6%) outright failures. Early complications occurred in 14 (41%) patients and late complications in 10 (29%). Fistulae recurred in seven (25%) of 28 patients but with further treatment four healed, giving an overall healing rate of 89%. Normal continence was achieved in 19 (79%) of 24 patients who were evaluated. In clinically difficult rectal situations the colo-anal pull-through procedure is a suitable salvage procedure to restore intestinal continuity before considering a permanent stoma.

A novel model for orthotopic liver transplantation in rats using hepatic rearterialization and biliary extradrainage system

BackgroundAlthough the rat orthotopic liver transplantation (OLT) model has existed for many years, only a few models can be applied for dynamic bile collection. The aim of this study was to introduce a dependent rat OLT model with hepatic rearterialization and an expediently dynamic bile collection system. MethodsForty-five male Sprague–Dawley rats were divided into the following three groups (n = 15 each): group A, OLT without hepatic rearterialization; group B, OLT with hepatic rearterialization; group C, OLT with hepatic rearterialization and a biliary extradrainage system. In groups B and C, a modified sleeve anastomosis between the donor common hepatic artery and the recipient proper hepatic artery was performed to restore the hepatic artery blood flow. In group C, after hepatic rearterialization, biliary extradrainage and jejunum stoma were performed to reestablish the bile flow, and a waistcoat-like external fixator was introduced to protect this system. ResultsThe surgical success rates in groups A, B, and C were 100% (15/15), 93% (14/15), and 93% (14/15), respectively. In groups B and C, the hepatic artery patency rates were 93% and 86% on postoperative day 3 and postoperative day 21, respectively. Also, the liver function and bile duct integrity were preserved better than that in group A. In group C, the biliary extradrainage system was well preserved and bile collection was easily performed. ConclusionsThe rat OLT model with hepatic rearterialization and a convenient biliary extradrainage system was satisfactory in maintaining the survival rate, hepatic artery patency rate, and recovery of graft function, so it can be applied in various studies after transplantation.

Left lower sleeve lobectomy by uniportal video-assisted thoracoscopic approach

Endobronchial tumours requiring sleeve resection have been usually considered a contraindication for video-assisted thoracoscopic surgery (VATS). However, with new technical advances and the experience gained in VATS, sleeve lobectomy has been performed by thoracoscopy in experienced VATS centres. Right-sided sleeve anastomoses are easier to perform by VATS than left-sided ones because of the presence of the pulmonary artery and aortic arch on the left side. Most surgeons use a 3 to 4 incision VATS technique for sleeve anastomosis but the surgery can be performed by using only one incision. This is the first report of a left-sided sleeve lobectomy by uniportal approach.

Hybrid Video-Assisted Thoracic Surgery With Segmental–Main Bronchial Sleeve Resection for Non–Small Cell Lung Cancer

The purpose of the current study is to present the clinical and surgical results in patients who underwent hybrid video-assisted thoracic surgery with segmental-main bronchial sleeve resection. Thirty-one patients, 27 men and 4 women, underwent segmental-main bronchial sleeve anastomoses for non-small cell lung cancer between May 2004 and May 2011. Twenty-six (83.9%) patients had squamous cell carcinoma, and 5 patients had adenocarcinoma. Six patients were at stage IIB, 24 patients at stage IIIA, and 1 patient at stage IIIB. Secondary sleeve anastomosis was performed in 18 patients, and Y-shaped multiple sleeve anastomosis was performed in 8 patients. Single segmental bronchiole anastomosis was performed in 5 cases. The average time for chest tube removal was 5.6 days. The average length of hospital stay was 11.8 days. No anastomosis fistula developed in any of the patients. The 1-, 2-, and 3-year survival rates were 83.9%, 71.0%, and 41.9%, respectively. Hybrid video-assisted thoracic surgery with segmental-main bronchial sleeve resection is a complex technique that requires training and experience, but it is an effective and safe operation for selected patients.

Effect of tissue engineering small vessel scaffolds in experimental animals

Acellular xenogeneic small vessel scaffolds preliminarily eliminate the xenogeneic antigen that could induce an immune rejection. We transplanted the Wistar rat caudal artery scaffolds into Japanese white rabbit ear central arteries, and observed the changes of blood flow and vessel wall. We acquired 30 caudal arteries from 15 Wistar rats, some were directly assigned as caudal artery group, the others were disposed by 1% p-octyl polyethelene glycol phenyl ether, and were assigned as the group of tissue engineered small vessel scaffold. We collected 15 Japanese white rabbits, and utilized a pair of ear central arteries per rabbit as hosts. Through microscopic surgery, the proximal broken end of central artery was overlapped into the donor’s proximal vessel lumen by sleeve anastomosis, while the distal broken end was sutured by classical end-to-end anastomosis. The maximum patency time of small vessel scaffold was 46 hours and 47 minutes, and which of caudal vessel was 14 hours. The poor blood flow primarily was occurred in distal broken end, while proximal end was connected in pedicle graft structure. On the 10th day, tunica intima fibers in vessel scaffold were still arranged in cylindrical conformation regularly without cell adherence. On the 100th day, tunica intima fibers were still preserved completely in proximal end. The results showed that xenogeneic acellular small vessel scaffold can be transplanted into the host, and the sleeve anastomosis was significantly superior to the classical end-to-end anastomosis.