ABSTRACT
The treatment of primary lung cancer of the left upper lobe in those patients with prior coronary artery bypass graft is difficult to plan and execute due to the potential for invasion into coronary grafts, particularly the left internal mammary artery. We present a patient with squamous cell carcinoma invading into coronary artery bypass grafts, but which is successfully treated by a combination of percutaneous coronary intervention followed by video-assisted thoracoscopic surgery.
Subject(s)
Carcinoma, Squamous Cell/surgery , Coronary Artery Bypass/adverse effects , Coronary Stenosis/surgery , Lung Neoplasms/surgery , Percutaneous Coronary Intervention/methods , Thoracic Surgery, Video-Assisted/methods , Aged , Carcinoma, Squamous Cell/pathology , Coronary Angiography/methods , Coronary Artery Bypass/methods , Coronary Stenosis/diagnostic imaging , Follow-Up Studies , Graft Survival , Humans , Lung Neoplasms/pathology , Male , Neoplasm Invasiveness/pathology , Neoplasm Staging , Treatment OutcomeABSTRACT
Recurrent spontaneous esophageal ruptures are rare, found in only a few case reports. They are treated mostly by thoracotomy and repair, but none through stenting alone. We present a patient with recurrent spontaneous esophageal rupture who was successfully treated through stenting and made a speedy and complete recovery.
Subject(s)
Esophageal Diseases/surgery , Esophagus/surgery , Stents , Esophageal Diseases/diagnosis , Humans , Male , Middle Aged , Recurrence , Rupture, Spontaneous , Tomography, X-Ray ComputedABSTRACT
BACKGROUND: The advantages of internal thoracic artery skeletonization include early high blood flow, a longer conduit, and less bleeding than pedicle internal thoracic artery grafts. Longer conduits are needed for complete endoscopic arterial revascularization. Therefore this study was designed to determine the feasibility and safety of internal thoracic artery skeletonization using the da Vinci robotic system (Intuitive Surgical, Sunnyvale, CA). METHODS: Nine dogs underwent bilateral robotic internal thoracic artery harvesting through three ports placed in the left chest. One internal thoracic artery was harvested as a pedicle in each dog, and the other was skeletonized. Internal thoracic artery blood flow was measured in each graft, and comparative endothelial histologic studies were performed. Data are mean +/- the standard error of the mean. RESULTS: All 18 internal thoracic arteries were harvested successfully. Skeletonized internal thoracic artery harvests required more time (48.0 minutes +/- 1.8) than pedicle internal thoracic artery harvests (39.0 minutes +/- 1.4; p < 0.05). Internal thoracic artery flows during the final intervals were similar (skeletonized = 30.0 mL/min +/- 2.4 vs pedicle = 31.5 mL/min +/- 1.8; p = 0.9). Free internal thoracic artery bleeding flow was similar in both groups (skeletonized = 162.0 mL/min +/- 3.0 vs pedicle = 189.0 mL/min +/- 2.4; p = 0.4). Histologically, both groups were similar with minimal endothelial damage. CONCLUSIONS: Robotically skeletonized harvesting is safe, but it requires more time (48.0 minutes +/- 1.8) than pedicle internal thoracic artery harvesting. Despite muted tactile feedback with robotics, neither technique was associated with histologic or functional damage. These encouraging results may represent an advantage for complete arterial revascularization in robotic coronary bypass patients.
