Christopher B. Komanapalli

Minimally Invasive Management of the Mediastinal Parathyroid Adenoma

Introduction/Methods: Traditional surgical management of mediastinal parathyroid adenomas has required mediastinal exploration via sternotomy or thoracotomy. By contrast minimal access approaches to the mediastinum via videoscopic transthoracic or transcervical approaches can offer equivalent visualization, patient safety and decreased patient morbidity. The availability of sternal retractor systems, the rapid parathyroid hormone (PTH) assay for intraoperative confirmation of cure, recurrent laryngeal nerve monitoring technique and video‐assisted thoracic surgery (VATS) instrumentation have made this possible. The purpose of this article is to discuss these approaches and the results with their application in five consecutive patients.

Recurrent Pulmonary Artery Sarcoma

Abstract  Pulmonary artery sarcomas are a diagnostic and therapeutic challenge. Most patients are initially thought to have pulmonary emboli, and during embolectomy, a sarcoma is found. Given the significant morbidity and mortality of cardiac sarcomas, an aggressive strategy for resection is indicated, as this leads to benefits in disease‐free and overall survival. Imaging tests and clinical signs and symptoms may assist in accurate preoperative determination of pulmonary artery sarcoma. We present an interesting case of a patient with pulmonary artery sarcoma who underwent successful re‐resection, along with a brief discussion regarding preoperative imaging and the surgical resection of these tumors.

Extended transcervical video-assisted thymectomy.

This article describes surgery using a transcervical approach with thoracoscopic visualization. The video-assisted extended approach is well suited for patients undergoing thymectomy for myasthenia gravis, thymic cysts, small thymoma, or mediastinal parathyroid adenoma. It incorporates the minimally invasive nature of the transcervical method with the extensive anterior mediastinal dissection, while allowing for complete removal of the thymus and anterior mediastinal fat and avoiding the morbidity of a sternotomy.

Patient-specific insulin-resistance-guided infusion improves glycemic control in cardiac surgery.

BACKGROUND Maintenance of appropriate capillary blood glucose in cardiovascular surgery patients has been associated with improved outcomes, including lower mortality. Interpatient variability in insulin resistance can make management difficult, leading to unexpected episodes of hypoglycemia and hyperglycemia. To improve postoperative glucose control at our institution, a patient-specific insulin-resistance-guided (IRG) protocol was developed. METHODS Prospective data were gathered on 100 consecutive cardiovascular surgery patients managed with our standard insulin infusion protocol and 100 patients managed using the IRG protocol. Clinical characteristics and glycemic indices were analyzed for the two groups. Primary endpoints included (1) percentage of time spent in the target range, (2) number of hypoglycemic and hyperglycemic episodes, (3) time to achievement of target blood glucose, and (4) the total daily dose of insulin required. RESULTS The IRG protocol resulted in significant improvements, including increased percentage of time spent in the normoglycemic range (82.5% versus 65.8%, p < 0.001), reduced rate of hypoglycemic episodes (0.12 versus 0.99, p < 0.01), reduced rate of hyperglycemic episodes (capillary blood glucose >126 mg/dL: 4.8 versus 8.2, p < 0.01), and a reduced time to the first measurement in the target range. Total daily dose of insulin was mildly increased, but failed to reach statistical significance (92.48 versus 82.64 units, p = 0.32). CONCLUSIONS Use of the IRG protocol led to improved glycemic indices while reducing episodes of hypoglycemia in both diabetic and nondiabetic patients. The ability to adjust a patients insulin dosing based upon factors related to their insulin resistance results in improved blood glucose control and safety in cardiovascular surgery patients.

Advances in congenital heart surgery.

Purpose of review We provide an overview of the past years literature on congenital heart surgery. Recent findings This review focuses on selected disease entities, operative techniques, perioperative management strategies, and quality of care. Summary Congenital heart surgery is an evolving field.

Computer assisted surgical stapling

Computer assisted surgical stapling is the application of new technology to conventional staplers. The components of the system, their use in open thoracic surgery and a review of the literature to date are presented.