Carrie Bush

New technology applications: Knotless barbed suture for tracheal resection anastomosis.

Tracheal resection anastomoses are often under tension and can be technically challenging. New suture materials such as V‐loc (barbed, knotless wound closure device) may offer advantages over conventional methods. The objective of this study is to determine if a running V‐loc suture is of comparable tensile strength to conventional closure.

To preserve or not to preserve the orbit in paranasal sinus neoplasms: a meta-analysis.

Context The effect on survival of orbital evisceration on patients with paranasal sinus neoplasms has not been well established. Objective To review systematically the available literature concerning survival in patients who undergo surgery for paranasal sinus neoplasm with and without preservation of the eye. Data Source A retrospective meta-analysis of English and non-English articles using Medline and the Cochrane database. Eligibility Criteria Studies analyzing 5-year survival rates in patients who had orbital evisceration compared with orbital preservation for the treatment of paranasal sinus neoplasms were included in the final analysis. Data Extraction Independent review by two authors using predefined data fields. Data Synthesis A meta-analysis of four articles involving 443 patients was performed using the DerSimonian-Laird random-effects method. Results Our analysis revealed a total effect size of 0.964 in favor of preservation of the eye; however, these results are not robust, having a true effect size anywhere from 0.785 to 1.142 with a 95% confidence interval. Limitations Only retrospective observational studies were included because a prospective randomized study cannot be performed in this population. Conclusion Our study supports the notion that in select patients preservation of the eye may yield a different outcome when compared with orbital evisceration.

Defining the biomechanical properties of the rabbit trachea

Surgical advancements rely heavily on validated animal models. The New Zealand White (NZW) rabbit is a widely used model for airway research, including regenerative medicine applications. Currently, the biomechanical properties of the normal rabbit trachea are not known. Our objective was to define these properties to assist in the standardization and understanding of future airway research using this model.

Minimally invasive access to the posterior cranial fossa: An anatomical study comparing a retrosigmoidal endoscopic approach to a microscopic approach

OBJECTIVES The central location and complex neurovascular structures of the posterior cranial fossa make tumor resection in this region challenging. The traditional surgical approach is a suboccipital craniotomy using a microscope for visualization. This approach necessitates a large surgical window and cerebellar retraction, which can result in patient morbidity. With the advances in endoscopic technology, minimally invasive access to the cerebellopontine angle can be achieved with minimal manipulation of uninvolved structures, reducing the complications associated with the suboccipital approach. METHODS An endoscopic and microscopic approach was completed on anatomic specimens. To access the central structures of the posterior cranial fossa, a retrosigmoidal approach was undertaken. A keyhole craniotomy was made in the occipital bone posterior to the junction of the transverse and sigmoid sinuses. The endoscope was advanced and photographs were obtained for review. The exposure was compared with that obtained with a microscope. RESULTS The endoscopic retrosigmoidal approach to the posterior cranial fossa provided increased exposure to the midline structures while minimizing the surgical window. The relevant anatomy was identified without difficulty. CONCLUSION An endoscopic retrosigmoidal approach to the midline structures of the posterior cranial fossa is anatomically feasible. The morbidity associated with retraction of the cerebellum could possibly be avoided, improving patient outcomes. Retrosigmoidal endoscopy provides access to anatomical structures that is not possible using a microscope in a suboccipital approach. Further understanding of the endoscopic anatomy of the posterior fossa can allow for advances in cranial base surgery with improved safety and efficacy.

Incision planning in thyroid compartment surgery: Getting it perfect

OBJECTIVE This study evaluated changes in thyroid compartment incision site locations with patient positioning to define a reliable method for placing the scar in the optimal vertical location. METHODS The optimal incision location was marked with the patient sitting upright before surgery. The distance from the sternal notch to this mark was measured with the patient in the upright, supine, and final surgical positions. RESULTS Complete data were available for 104 procedures. The mean distances from the sternal notch to the incision site were 4.8, 21.5, and 31.9 mm in the sitting, supine, and surgical positions, respectively. Each of these distances were significantly different from one another (P<.0001) and were independent of patient age, sex, body mass index (BMI), or height. CONCLUSIONS Cutaneous cervical landmarks migrate significantly during patient positioning. Marking the thyroid compartment incision site while the patient is in an upright position results in a more predictable final scar location.

Anatomic analysis specific for the endoscopic approach to the inferior, medial and lateral orbit

Abstract Introduction: The endoscopic approaches to the medial and inferior orbital walls have continued to grow in popularity. The ability to provide a safe approach to the orbit through this technique has been described in a handful of studies. Even though metric analyses have been conducted on orbital anatomy, few have outlined the anatomical relations pertinent to endoscopic surgery. The goal is to provide improved understanding of the complex anatomy encountered through anatomical dissections and metric analysis of the orbit. This information could assist in approach selection during preoperative planning. Methods: Anatomical dissections via transantral and endonasal approaches were used to define the limits with current endoscopic sinus surgery instrumentation. The surface area was then calculated of the floor and medial wall to assess access created by the approaches. The path of the infraorbital canal was conducted to assess its placement within the orbital floor. Results: The transantral and endonasal approaches to the orbit provided an adequate surgical window inferiorly and medially. This was confirmed by the surface area calculations. Access laterally was also possible, however, it became limited as dissection advanced superior to the lateral rectus muscle. The infraorbital canal was located consistently at midline on the orbital floor. Conclusion: Endoscopic access to the medial and inferior parts of the orbit is feasible and creates adequate access with current instrumentation. Knowing the surgical boundaries and the amount of exposure created can assist the surgeon in deciding a minimally invasive approach.

Epidemiologic Factors and Surgical Outcomes in Patients with Nasal Polyposis and Asthma

Background/Aim: To evaluate the role of epidemiologic factors in surgical outcomes for patients with nasal polyposis (NP) and asthma. Methods: Data was prospectively collected on patients who underwent endoscopic sinus surgery over a 7-year period. Among patients with chronic rhinosinusitis (CRS) with NP and asthma, surgical outcomes were analyzed according to gender and race. Results: Patients with NP and asthma had significantly higher Lund-Kennedy and SNOT-20 scores - pre- and postoperatively - compared to CRS patients without NP or asthma. Both Caucasians and African-Americans in the CRS with NP/asthma group showed a statistically significant improvement at 6 months. Caucasians continued to have a significant improvement at 12 months, whereas African-Americans did not. There were no differences according to gender. Conclusion: In our patient population, African-Americans with NP and asthma had poorer outcomes following functional endoscopic sinus surgery.

What is the Best Route to the Meckel Cave? Anatomical Comparison between the Endoscopic Endonasal Approach and a Lateral Approach

Background Traditionally, a pterional approach is utilized to access the Meckel cave. Depending on the tumor location, extradural dissection of the Gasserian ganglion can be performed. An endoscopic endonasal access could potentially avoid a craniotomy in these cases. Methods We performed an endoscopic endonasal approach as well as a lateral approach to the Meckel cave on six anatomic specimens. To access the Meckel cave endoscopically, a complete sphenoethmoidectomy and maxillary antrostomy followed by a transpterygoid approach was performed. For lateral access, a pterional craniotomy with extradural dissection was performed. Results The endoscopic endonasal approach allowed adequate access to the Gasserian ganglion. All the relevant anatomy was identified without difficulty. Both approaches allowed for a similar exposure, but the endonasal approach avoided brain retraction and improved anteromedial exposure of the Gasserian ganglion. The lateral approach provided improved access posterolaterally and to the superior portion. Conclusion The endoscopic endonasal approach to the Meckel cave is anatomically feasible. The morbidity associated with brain retraction from the open approaches can be avoided. Further understanding of the endoscopic anatomy within this region can facilitate continued advancement in endoscopic endonasal surgery and improvement in the safety and efficacy of these procedures.

Trans-oral robotic submandibular gland removal

Submandibular gland excision is traditionally performed via a trans-cervical approach. While generally regarded as a relatively simple surgical procedure, several complications are possible, including injury to the marginal mandibular branch of the facial nerve, lingual nerve, hypoglossal nerve, facial artery and a visible unsightly neck scar or keloid. The trans-oral route has the ability to eliminate a cervical scar and decrease risk of injury to several structures. Coincident with the development of the trans-oral approach, robotic surgery has been gaining popularity in the operative management of early oral cavity, tonsil, and tongue base malignancies. A 51-year-old female presented to our institution with a 15-year history of recurrent left submandibular gland sialoadenitis. She previously underwent a rhytidectomy with cervicoplasty and was interested in a trans-oral approach to avoid a neck incision. Here we present a novel application of the da Vinci Surgical Robot for trans-oral removal of the submandibular gland.

Minimal Access Neck Dissection

Since the description of the systematic en bloc neck dissection by Crile in 1906, neck dissections have evolved to include functional and minimally invasive techniques. Evidence-based medicine has allowed for the adoption of the selective neck dissection in a number of circumstances. Furthermore, as the primary disease becomes better understood and life expectancies increase, cosmetic outcomes have become an increasing concern in patient care. While this remains secondary to oncologic outcomes, reducing the morbidity of neck dissections has become of great interest. When the primary operative purpose is as a staging procedure, the minimally invasive approach is particularly desirable.