Our experience with robotic-assisted thymic surgery.

Thoracic surgery is increasingly influenced by the development of minimally invasive approaches which have also influenced surgery in the area of the anterior mediastinum. The previously standard approach to the thymus via partial sternotomy was gradually replaced by the videothoracoscopic approach in most cases. In recent years, robotically assisted surgery has been gaining ground worldwide in this area, as well. The aim of our paper is to provide a comprehensive overview of procedures in the field of the thymus, including their indications, and to share our first experience with robot-assisted thymus surgery. At the 3rd Department of Surgery, since the start of the robot-assisted thymus surgery program, 23 thymectomies have been performed using this approach, of which 17 were performed for thymoma, 3 for myasthenia gravis, and 3 for parathyroid adenoma localized in thymus tissue. From our experience and the available data, it follows that the length of hospitalization, the rate of complications and the resulting effect of robot-assisted procedures is comparable to VTS procedures; however, the robot-assisted surgery also allows for mini-invasive treatment even in significantly obese patients and in patients with advanced thymic tumors who would otherwise be indicated for open thymectomy.

Surgical treatment of hyperparathyroidism with a pathologically changed parathyroid gland found in the mediastinum.

The most common indication for surgical treatment of parathyroid gland pathology is primary hyperparathyroidism where extirpation of the pathologically changed parathyroid gland is the first-choice treatment. Embryonic development of the lower pair of parathyroid glands is quite complex and is closely related to the tissue of the thymus; for this reason it is not uncommon for a parathyroid adenoma to be located in the mediastinum or directly in the tissue of the thymus. The treatment of primary hyperparathyroidism is becoming a multidisciplinary issue in which radiodiagnostics and nuclear medicine methods play a significant role as they are needed to accurately localize the affected gland and to plan an adequate surgery. In case of intrathoracic localization of parathyroid adenoma, the therapy belongs in the hands of thoracic surgery. At our department, the endocrine surgery program, including parathyroid gland surgery, has a long tradition, and complicated patients are concentrated here, often patients with refractory hyperparathyroidism after a previous procedure. In the last 10 years, almost 2,300 procedures for parathyroid pathology have been performed at the IIIrd Department of Surgery of the 1st Faculty of Medicine, Charles University and University Hospital in Motol, of which some pathologies with mediastinal localization were managed using minimally invasive methods, i.e. videothoracoscopy or robotic-assisted surgery.

Robotic distal pancreatectomy - the first experience.

INTRODUCTION: Minimally invasive distal pancreatectomy (MIDP) includes both laparoscopic and robotic distal pancreatectomy (RDP). MIDP is often adopted first due to the absence of the requirement of a complex reconstruction. In recent years, an increase in the use of robotic surgery has been noted. METHODS: The authors present initial experience with RDP and retrospective analysis of data from prospectively collected database. RESULTS: Between September 2021 and October 2022 five patients undergoing RDP with splenectomy performed in the 3rd Department of Surgery, 1st Faculty of Medicine, Charles University and Motol University Hospital were included from a prospectively maintained database. The age was from 20 to 70 years. No conversion was required. One patient underwent reoperation due to staple-line hemorrhage. Postoperative hospital stay was from 4 to 14 days. The follow-up period was from 2 to 14 months. CONCLUSION: Our first experience demonstrates RDP is a safe and efficacious approach for tumors of pancreatic body and tail in selected patients. A larger number of patients is needed to obtain more accurate results.

Volvulus 8 years after bariatric surgery.

INTRODUCTION: Bariatric surgery is a widespread branch of surgery because of the increase in obesity in population. It is one way to achieve long-term weight loss effect in obese patients. Like other surgeries, bariatric surgery has many complications including ileus and volvulus in small intestine. It is an acute state in surgery and usually leads to a revision surgery. CASE REPORT: 58 years old woman who underwent mini-gastric bypass in 2014. She was admitted to our department because of manifestation of ileus on the second day after TEP of the hip joint. There was a typical sign of volvulus on the CT scan. She was operated on the same day. The reinsertion of enteroenteroanastomosis and denotation of the small intestine, desufflation of the large intestine, and reconstruction of new enteroenteroanastomosis was needed. After the surgery, the patient was without any complications. The bowel function recovery was slower postoperatively. CONCLUSION: Diagnosis of volvulus is not easy because of non-specific clinical symptoms. In this case report, the volvulus occurred 8 years after the primary surgery. Symptoms developed because of paralytic ileus after hip replacement.

Anatomy of the dens and its implications for fracture treatment: an anatomical and radiological study.

PURPOSE: The most common injuries to the upper cervical spine are fractures of the dens axis. Therefore, the purpose of our study was to answer three questions, namely (1) whether the size of the dens is adequate at all levels to accommodate two screws, (2) what the angle of the posterior tilt of the dens is in a healthy individual and (3) compare the measured variables between the sexes. METHODS: The cohort comprised 50 males and 50 females CT examination of the craniocervical junction. We measured the five diameters of the dens and posterior dens angulation angle (PDAA) and screw insertion angle (SIA). The same dimensions were measured in a control group, consisting of 40 non-pathological second cervical vertebrae specimens. RESULTS: On CT scans, the mean PDAA was 162.7 degrees in males and 160.26 degrees in females; the mean SIA was 62.0 degrees in males and 60.2 degrees in females. On specimens, the mean PDAA was 169.47 degrees in males and 166.95 degrees in females; the mean SIA was 65.42 degrees in males and 64.47 degrees in females. All obtained values were higher in males; regardless of their measuring on either CT scans or specimens, differences between males and females were statistically significant (p < 0.05) in a, c, d and e values. CONCLUSIONS: The values of our measurements correlate with the dimensions identified previously in other studies. Based on our clinical experience and measurements, we presume that two 3.5-mm screws can be inserted into the dens of all adult patients, except for those with pronounced anatomical anomalies. Posterior dens angulation angle is slightly larger than we expected. The dens is significantly larger in males almost in all measurement. These slides can be retrieved under Electronic Supplementary Material.