Esophageal cancer is a growing problem in the United States. Surgical resection, often in combination with chemoradiotherapy, provides the only approach to offer a cure for these patients. Traditional open approaches are burdened by high levels of morbidity and mortality. Minimally invasive esophagectomy (MIE) has been proposed as an alternative approach. Although MIE is complex and perhaps more time-consuming, perioperative results are encouraging and generally trend toward fewer pulmonary complications, lower blood loss, shorter ICU stays, and shorter overall hospitalization durations.
Minimally invasive direct coronary artery bypass (MIDCAB) utilizes a small (4–5 cm) left anterior thoracotomy incision for direct visualization of the diseased coronary artery on the anterior wall of the left ventricle without the use of cardiopulmonary bypass (CPB).
This article describes the basics of the MIDCAB surgery, emphasizing both the left anterior thoracotomy for the harvest of LIMA and direct anastomosis on a beating heart without CPB. This procedure is done on a 72-year-old patient who had significant long LAD stenosis and presented with effort angina. Following a multidisciplinary “heart team” conference, he underwent a successful MIDCAB and was discharged home on postoperative day 4.
With improvement in both preoperative parathyroid tumor identification and the use of intraoperative parathyroid hormone assay, minimally invasive parathyroidectomy (MIP) is now performed more frequently in patients with primary hyperparathyroidism (pHPT). Still, many institutions are not familiar with performing MIP under regional or local anesthesia. Here, Dr. Tobias Carling presents an MIP performed under local cervical block anesthesia on a patient with pHPT and parathryoid adenoma.
In this case, Dr. Tobias Carling and Dr. Courtney Gibson at Smilow Cancer Hospital at Yale New Haven perform a TOETVA on a 45-year-old patient who presented with a growing thyroid nodule that was shown to be a Hurthle cell neoplasm on fine-needle aspiration.
Numerous minimally-invasive approaches to thyroidectomy have been developed over the years to minimize the neck surgical scar, many of which are performed using endoscopic or robotic assistance. However, a more diminutive anterior cervical scar still remains a problem for some patients, as well as more extensive dissections for remote access operations. Therefore, natural orifice surgery was adopted at select institutions in an effort to perform a truly scarless thyroidectomy. Trans-oral endoscopic thyroidectomy has been the latest approach developed, known as the natural orifice transluminal endoscopic thyroidectomy, which is categorized as a natural orifice transluminal endoscopic surgery (NOTES) procedure. There are several ways to perform the natural orifice transluminal endoscopic thyroidectomy. Here, the authors present the TOETVA under general anesthesia.
After experiencing chest pressure while exercising, a 72-year-old patient tested positive in both a stress test and nuclear medicine study, triggering a left heart catheterization that revealed a high grade lesion of the proximal left anterior descending coronary artery. His cardiologist determined the lesion would not be amenable to angioplasty or stenting, so Dr. Marco Zenati performs a minimally invasive coronary artery bypass (MIDCAB).
