Uniportal fully robotic-assisted bronchovascular sleeve bilobectomy

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Uniportal robotic-assisted thoracic surgery for mediastinal tumors

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Uniportal pure robotic-assisted thoracic surgery—technical aspects, tips and tricks

The uniportal access for robotic thoracic surgery presents itself as a natural evolution of minimally invasive thoracic surgery (MITS). It was developed by surgeons who pioneered the uniportal video-assisted thoracic surgery (U-VATS) in all its aspects following the same principles of a single incision by using robotic technology. The robotic surgery was initially started as a hybrid procedure with the use of thoracoscopic staplers by the assistant. However, due to the evolution of robotic modern platforms, the staplers can be nowadays controlled by the main surgeon from the console. The pure uniportal robotic-assisted thoracic surgery (U-RATS) is defined as the robotic thoracic surgery performed through a single intercostal (ic) incision, without rib spreading, using the robotic camera, robotic dissecting instruments and robotic staplers. There are presented the advantages, difficulties, the general aspects and specific considerations for U-RATS. For safety reasons, the authors recommend the transition from multiportal-RATS through biportal-RATS to U-RATS. The use of robotic dissection and staplers through a single incision and the rapid undocking with easy emergent conversion when needed (either to U-VATS or to thoracotomy) are safety advantages over multi-port RATS that cannot be overlooked, offering great comfort to the surgeon and quick and smooth recovery to the patient.info:eu-repo/semantics/publishedVersio

Three embeddings of the Klein simple group into the Cremona group of rank three

We study the action of the Klein simple group G consisting of 168 elements on two rational threefolds: the three-dimensional projective space and a smooth Fano threefold X of anticanonical degree 22 and index 1. We show that the Cremona group of rank three has at least three non-conjugate subgroups isomorphic to G. As a by-product, we prove that X admits a Kahler-Einstein metric, and we construct a smooth polarized K3 surface of degree 22 with an action of the group G.Comment: 43 page

Papillary muscle approximation combined with ventriculoplasty in patients with ischemic cardiomyopathy and functional mitral regurgitation: effects on mitral valve and left ventricul shape

IMSP Spitalul Clinic RepublicanStudiile recente definesc regurgitarea mitrală funcțională şi înrautățirea indicelui sistolic a venericului stâng, drept ca o lărgire a dimensiunii dintre marginile muşchilor papilari, prin urmare, micşorarea acestei distante poate îmbunătăţi funcţia valvei mitrale şi ventriculului stâng. Pentru acest studiu au fost selectaţi 33 de pacienţi cu cardiomiopatie ischemică la care s-a efectuat aproximarea muşchilor papilari.Recent studies define functional mitral regurgitation and worsened left ventricular systolic indices as the widening of the dimension between papillary muscle heads; consequently, narrowing this distance may improve the mitral valve and left ventricle function. The study included 33 patients with ischemic cardiomyopathy undergoing papillary muscle approximation

The diagnostic and surgical treatment of heart tumors

Spitalul Clinic Republican, departament cardiochirurgie, Al XI-lea Congres al Asociației Chirurgilor „Nicolae Anestiadi” din Republica Moldova și cea de-a XXXIII-a Reuniune a Chirurgilor din Moldova „Iacomi-Răzeșu” 27-30 septembrie 2011Tumorile cardiace, primare sau secundare, se pot dezvolta la nivelul oricărei structuri ale cordului: miocard, endocard sau pericard. Incidența tumorilor cardiace este foarte mică şi se explică probabil, prin particularitățile metabolismului în miocard, circuitului sanguin coronarian şi sistemului de legături limfatice redus. Scopul stuliului: Determinarea prioritară a metodelor de diagnostic preoperator şi aprecierea tacticii tratamentului chirurgical în dependență de forma clinico-morfologică a neoplasmului cardiac. Materiale şi metode: Au fost supuse analizei 72 depacienți operați cu tumori cardiace, care s-au tratat pe parcursul anilor 1983-2010. Vârsta bolnavilor a variat între 15–73 ani (media 55,3 ani) dintre care 20 (27.8%) barbați şi 52 (72,2%) femei. La 66 (91,7%) pacienți tumorile au fost benigne şi la 6(8,3%) maligne. Rezultate: Toți pacienții diagnosticați cu tumori cardiace au fost supuşi inrevenției chirurgicale în condiții de circulație extracorporală. Cel mai des a fost depistat mixomul cardiac care a alcătuit 58 (80,6%) cu localizarea mai fregventă în atriu stîng- 91,4%, urmat de rabdomiom în 2 (2,8%), mezoteliom 2 (2,8%) , hemangiom 1 (1,4%) cazuri, leiomiom 2 (2,8%), fibrom 1 (1,4%) şi sarcom 6 (8,3%). La 10 (7,2%) pacienți s-a efectuat concomitent corecție valvulară mitrală şi tricuspidiană. În 2 cazuri s-a efectuat şi by-passul coronarian. Letalitatea postoperatorie a constituit 6 (8,3%) pacienți (1 caz de tromboembolia arterei pulmonară, 1-de hemoragie postoperatorie, ceilalți 4 pacienți operați cu tumori maligne au decedat de insuficiență cardiacă progresivă). Concluzii: Tumorile cardiace primare, odată identificate, trebuie înlăturate chirurgical. Vârsta pacienților şi severitatea insuficienței cardiace nu poate servi ca contraindicație către operație. Tumorile cardiace maligne au un prognostic nefavorabil. În speranța prelungirii vieții pacientului tratamentul chirurgical este combinat cu tratamentul medicamentos specific.Primary and secondary heart tumors can develop within any level of heart structure: myocardium, endocardium or pericardium.The incidence of cardiac tumors is very low and can be probably explained based on the particularities of metabolism within the myocardium, the coronary blood circuit and the reduced system of lymphatic connections. Data and methods: Records on surgical interventions in 72 patients with cardiac tumors subjected to treatment during 1983-2010 were analyzed. The age of patients ranged 15-73 years (the average age was 55.3 years) including 20 (27.8%) men and 52 (72,2%) women. In 66 (91.7%) patients tumors were benign and 6 (8.3%) malignant. All the patients have been operated upon in conditions of cardiopulmonary bypass with radical removal of benign cardiac tumor. The left atrial mixom has been most frequently met in 58 (80.6%). The morphological site of the looks like: myxomas (58 cases), rhabdomiomas (2 cases), leiomiomas (2 cases), hemangiomas (1 case), fibromas (1 case), mesoepitheliomas (2 cases), various sarcomas (6 cases). Postoperative mortality consisted 8,3% (6 patiens) followed by rabdomiomas in 2 (2.8%), mesothelioma 2 (2.8% ), a hemangiomas (1.4%) cases, leiomiomas 2 (2.8%), fibromas 1 (1.4%) and sarcomas 6 (8.3%) cases. In 10 (7.2%) patients concomitant receiving tricuspid and mitral valve correction, 2 cases was also performed and coronary artery bypass. The post operative lethality has constitued 6 (8,3%) cases (1 case of pulmonary artery thromboembolism, 1 postoperative bleeding, the other four patients operated with malignant tumors died of progressive heart failure). Coclusions: Once identified, primary cardiac tumors must be surgically removed. Patients age and the severity of heart failure cannot be regarded as a counter-indication to surgery. Since malignant cardiac tumors are given an unfavorable forecast, the surgical treatment is combined with the specific treatment

Strategies of the treatment of cardiac prosthetic valve thrombosis

Department of Cardiac Surgery, Republican Hospital, Chisinau, the Republic of MoldovaBackground: The article deals with the analysis of principal causes of valve prosthesis thrombosis and “pannus” thrombosis. The diagnosis and contemporary treatment strategy of prosthesis dysfunction have been considered. Material and methods: In our department 1670 patients with extracorporeal circulation were operated on, among them 1260 had valve pathology that made up 74.2%. 1164 heart valves were replaced, 145 of them were biological prostheses and 1019 were mechanical ones of different types. Prosthesis thrombosis took place in 28 patients that represented 60% of the number of patients with prothesis disfunction and 2.2% of the total number of operated patients from which 21 patients, their age ranged from 35 to 63 years old. The surgical treatment was performed to 9 patients, thrombolysis – to 19 patients. Results: During last 6-7 years the thrombolysis treatment with ateplasum and reteplasse has been successfully implemented in the therapy of thrombosis valve prothesis. Thrombolysis was performed to 19 patients. The results are the following: in 17 cases good outcomes (a complete recovery of the prosthesis function with transprosthetic gradient and the normalization of systolic pressure in right ventricle) have been registered, one case has been complicated with transitory ischemic ictus. Out of 19 patients who underwent the thrombolysis treatment, there were 2 lethal cases. Conclusions: The patients that are in a critical state with prosthesis thrombosis (acute pulmonary edema, hypotension, heart insufficiency NYHA IV) should immediately receive EchoCG confirmation of the need of intravenous thrombolitic therapy. The thrombolysis efficacy in prosthesis thrombosis is high; the rate of embolic complications is low, which can be used as the first line treatment for all patients with prothesis thrombosis (in the absence of contraindications). In the case of partial response to the thrombolysis treatment, the patient can be operated on in good hemodynamic conditions and with low surgical risk

Reconstructive possibilities of surgical treatment in cusps flail syndrome of mitral valve

IMSP Spitalul Clinic RepublicanFenomenul de flail al cuspelor de valvă mitrală are un substrat morfologic bine determinat şi un mecanism complex de incompetenţă valvulară. Rupturile spontane de cordaje se implică cu o evoluţie hemodinamică agresivă şi necesită tratament chirurgical de urgenţă. Ele au fost caracteristice pentru scalopul P2 (55% de cazuri), cu apariţie predominant izolată, în altele 15% - în combinaţie cu afectarea altor componente. Tehnicile chirurgical reconstructive au fost posibile în 53 de cazuri, 47 de pacienţi au beneficiat de protezări valvulare. Procedeele reconstructive de valvă mitrală au cuprins tehnici rezecţionale (15 cazuri), aplicarea de neocordaje (12), combinarea acestora (26). Analiza geometriei valvei mitrale pune în evidenţă cîteva repere, care urmăresc restabilirea aşa numitului triunghi de coaptare, ca rezultat final al tehnicilor reconstructive efectuate.The flail of the mitral valve has a morphologic substrate well determined and complex mechanism of valve incompetence. Spontaneous cordage rupture involves an aggressive hemodynamic evolution and requires urgent surgical treatment, characteristic for P2 scallop (55% of cases), with predominant isolated appearance, in other 15% - combined with other component affectation. Reconstructive surgical techniques regarding the mitral valve include resection techniques (15 cases), neo-cordage applying (12), and combined (26). Geometry analysis of the mitral valve reveals reestablishment of the coaptation triangle as a result of the performed reconstructive technique

Reconstructive possibilities of surgical treatment in cusps flail syndrome of mitral valve

IMSP Spitalul Clinic RepublicanFenomenul de flail al cuspelor de valvă mitrală are un substrat morfologic bine determinat şi un mecanism complex de incompetenţă valvulară. Rupturile spontane de cordaje se implică cu o evoluţie hemodinamică agresivă şi necesită tratament chirurgical de urgenţă. Ele au fost caracteristice pentru scalopul P2 (55% de cazuri), cu apariţie predominant izolată, în altele 15% - în combinaţie cu afectarea altor componente. Tehnicile chirurgical reconstructive au fost posibile în 53 de cazuri, 47 de pacienţi au beneficiat de protezări valvulare. Procedeele reconstructive de valvă mitrală au cuprins tehnici rezecţionale (15 cazuri), aplicarea de neocordaje (12), combinarea acestora (26). Analiza geometriei valvei mitrale pune în evidenţă câteva repere, care urmăresc restabilirea aşa numitului triunghi de coaptare, ca rezultat final al tehnicilor reconstructive efectuate.The flail of the mitral valve has a morphologic substrate well determined and complex mechanism of valve incompetence. Spontaneous cordage rupture involves an aggressive hemodynamic evolution and requires urgent surgical treatment, characteristic for P2 scallop (55% of cases), with predominant isolated appearance, in other 15% - combined with other component affectation. Reconstructive surgical techniques regarding the mitral valve include resection techniques (15 cases), neo-cordage applying (12), and combined (26). Geometry analysis of the mitral valve reveals reestablishment of the coaptation triangle as a result of the performed reconstructive technique