Josip Figl1*, Suzana Figl2, Tomislav Meštrović1, Damir Halužan1, Dino Papeš1, Ivan Škorak1

1Josip Figl, Tomislav Meštrović1, Damir Halužan1, Dino Papeš1, Ivan Škorak, Department of Vascular surgery, University hospital centre Zagreb, Kišpatićeva 12, 10000 Zagreb, Croatia, EU

2Suzana Figl, Department of Plastic surgery, University hospital centre Zagreb, Kišpatićeva 12, 10000 Zagreb, Croatia, EU

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Josip Figl1*, Suzana Figl2

1Josip Figl, Department of Vascular surgery, University of Zagreb, Kišpatićeva 12, 10000 Zagreb, Croatia, EU

2Department of plastic surgery, University of Zagreb, Kišpatićeva 12, 10000 Zagreb, Croatia, EU

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Ujjwal K. Chowdhury, Niwin George, Sukhjeet Singh, Lakshmi Kumari Sankhyan, Suryalok Angadi, Chaitanya Chittimuri, Doniparthi Pradeep, Saidivya Yadavalli

Cardiothoracic Sciences Centre, All India Institute of Medical Sciences, India

Video File: www.jsurgery.com/articles/video/JSST-20-1111.mp4

The association of right ventricular outflow tract obstruction with complete atrioventricular septal defect is rare and poses surgical challenge at the time of intracardiac repair. We report here-in a 30-months-old female child diagnosed with severe right ventricular outflow tract obstruction, complete atrioventricular septal defect and severe left atrioventricular valvar regurgitation undergoing successful pulmonary valvotomy, resection of the right ventricular outflow tract with reconstruction of the complete atrioventricular septal defect by two-patch technique. The pulmonary valve ring was sutured directly. Postoperative period was uneventful.

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Timon Peter ter Braak1, Huu Chien Nguyen1, Lysanne van Silfhout2*, Albert Frederik Pull ter Gunne2, Edo Johan Hekma2

1University of Twente, Enschede, The Netherlands

2Department of Trauma Surgery at Rijnstate Hospital, Arnhem, The Netherlands

Background: Three-dimensional (3D) printed orthoses are being investigated as potential replacements for conventional casts for fracture treatment. 3D-printed casts could improve patient comfort and outcomes, as well as reduce complications like neuropraxia or cutaneous disease. Dimensions necessary to create such casts could be obtained in an easy, quick and non-invasive way with 3D surface scanner. The objective was to validate the Structure Sensor 3D scanner for forearm measurements.

Methods: The Structure Sensor 3D scanner was used to take scans of both forearms in 24 healthy volunteers. The measurements deducted from these scans were compared with the golden standard; direct circumference measurements with a measuring tape and volume measurements using water displacement volumetry. The interrater reliability and accuracy were calculated.

Results: The interrater reliability was 0.992 (p < 0.001) and 0.952 (p < 0.001) for circumference and volume measurements respectively. The dimensions obtained from with the 3D scanner were strongly correlated with their direct counterparts r = 0.977 (p < 0.001) and r = 0.893 (p < 0.001).

Conclusion: Based on the results from this study, the Structure Sensor 3D scanner has shown to be a reliable method for reproducible data on the forearm dimensions. Further research is necessary to investigate the use of these 3D scans in the process of creating 3D printed patient-specific orthoses in the treatment of DRF.

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Robert W. Ike1*, William J. Arnold2, Kenneth C. Kalunian3

1 Department of Internal Medicine, Division of Rheumatology, University of Michigan Health System

2 Rheumatologist, Orthopaedics and Rheumatology of the North Shore, Wilmette, IIlinois

3 Department of Medicine, Division of Rheumatology, Allergy and Immunology,University of California at San Diego

Rheumatology is defined by the many medical conditions that can affect joints, but rheumatologists have only been intermittently interested in looking into them. Rheumatologists were involved in the early development of arthroscopy, and most of the surgeons looking into joints were examining the sorts of conditions today’s rheumatologists would handle.

Physicians and surgeons first began adapting endoscopes to peer into joints mainly to assess the sort of synovial conditions that would concern today’s rheumatologists. Rheumatologists were among the pre-World War II pioneers developing and documenting arthroscopy. Post-war father of modern arthroscopy Watanabe found rheumatologists among his early students, who took back the technique to their home countries, teaching others. Rheumatologists described and analyzed the intraarticular features of their common diseases in the 60s and 70s. Improvements in instrumentation and dogged efforts by a few orthopedists made several common joint surgical procedures feasible under arthroscopic guidance. A groundswell of interest from academic rheumatologists adapting arthroscopy grew considerably in the 90s with the development of “needle scopes” that could be used in an office setting. Rheumatologists had a hand in their downfall, conducting the first prospective trial questioning the efficacy of arthroscopic debridement in OA and developing biological compounds that greatly reduced the call for any resective intervention in inflammatory arthropathies. The arthroscope has proven an excellent tool for viewing and sampling synovium and continues to serve this purpose at several international research centers. While cartilage is imaged mainly by MRI now, some OA features – such as a high prevalence of visible calcinosis – beg further arthroscopy-directed investigation.

A new generation of “needle scopes” with far superior optics awaits for future investigators, should they develop interest.

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Ujjwal K. Chowdhury, Niwin George, Sukhjeet Singh, Lakshmi Kumari Sankhyan, Suryalok Angadi, Chaitanya Chittimuri, Doniparthi Pradeep, Sai Divya Yadavalli

Department of Cardiothoracic and Vascular Surgery, All India Institute of Medical Sciences, New Delhi-110029, India

Video File: www.jsurgery.com/review/technical-details-of-dacron-patch-closure-of-ostium-secundum-atrial-septal-defect-via-limited-right-anterolateral-thoracotomy.pdf

A 23-year-old female patient with a large ostium secundum atrial septal defect not amenable for device closure underwent surgical closure of atrial septal defect via a limited right anterolateral thoracotomy approach under normothermic cardiopulmonary bypass and St. Thomas (II) based cold blood cardioplegia. Postoperative recovery was uneventful. The safeguards and pitfalls of limited right anterolateral thoracotomy have been highlighted.

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Ujjwal K. Chowdhury1*, Niwin George1, Sukhjeet Singh1, Suruchi Hasija2, Lakshmikumari Sankhyan1, Srikant Sharma1, Niraj Nirmal Pandey3, Sanjoy Sengupta1, Mani Kalaivani4

1Departments of Cardiothoracic and Vascular Surgery, All India Institute of Medical Sciences, New Delhi, India.

2Department of Cardiac Anaesthesia, All India Institute of Medical Sciences, New Delhi, India.

3Department of Cardiac Radiology ,All India Institute of Medical Sciences, New Delhi, India.

4Department of Biostatistics, All India Institute of Medical Sciences, New Delhi, India.

JSST-20-1113-Fig-Fig

Graphic display (n=140) showing widely patent left and right coronary arterial systems, intact proximal and distal anastomoses without coronary ostial kinking/narrowing/aneurysm or pseudo-aneurysm formation

Objectives: To ascertain the influence of technique of coronary button implantation in patients undergoing Bentall’s procedure with respect to survival, re-exploration for bleeding, anastomotic complications of proximal and distal aortic suture lines, formation of coronary aneurysm and pseudo-aneurysm, kinking and coronary ostial narrowing.

Methods: We reviewed 140 patients (75 males) aged between 22 and 66 years (mean±SD 48.21±1.36 years) receiving a composite aortic conduit from January 1998 to December 2019 for annulo-aortic ectasia (n=98), aortic dissection (n=41), and repaired tetralogy of Fallot (n=1), 24 of whom had Marfan’s syndrome. All patients underwent modified “button technique” by interposing a glutaraldehyde-treated pericardial strip at the graft-coronary anastomoses and proximal aortic conduit suturing using interlocking, interrupted, pledgeted mattress sutures. To detect anastomotic complications of the coronary ostia, proximal and distal aortic anastomoses, survivors underwent echocardiography every 6 months and computed tomographic angiography at 12 months or whenever indicated.

Results: Seven (5%) patients died of cardiac-related cause, 45% had transient hemodynamic instability, 55% had low cardiac output and 87.1% had spontaneous return of sinus rhythm. At a mean follow-up of 161.6±69.9 months, the actuarial survival was 92.6±0.02% (95% CI: 86.9%-96.1) and there were no anastomotic aneurysm or pseudo-aneurysm formation, no kinking of the coronary ostia or ostial narrowing.

Conclusion: The modified open button technique and proximal aortic conduit suturing is associated with reduced perioperative bleeding, no aneurysm or pseudo-aneurysm formation at the coronary and distal aortic anastomoses. We recommend more extensive use of pericardial strip reinforcement of coronary button and new imaging techniques.

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K. Karavdic*, N. Dziho, A. Jonuzi, A. Firdus, E. Milisic, A. Karamustafic

Clinic for Pediatric Surgery, Clinic Center of University Sarajevo, Bosnia and Herzegovina

Introduction: There are several methods of creating pneumoperitoneum in patients who are planned to be subjected under laparoscopy procedure. The most commonly used method is generally a Veress needle insertion. In pediatric population treatment, the popular method is open blunt trocar insertion technique.

Objective: To describe the safety and efficacy of open laparoscopic access for the primary trocar using Hasson’s technique for pediatric laparoscopic surgery.

Methods: All 229 laparoscopic procedures that were performed at the Clinic for Pediatric Surgery Clinical Center of University Sarajevo between 2015.-2020. With Hasson’s technique were evaluated. Patients were aged from 6 months to 18 years.

Results: Most patients who had open laparoscopic access during the study period had diagnosis of acute appendicitis (n=165), impalpable undescended testicles (n=18), gallstones (n=17), varicocele (n=4), hernias (n=4) and other reasons (n=18). Three children had minor operative complications (2 cases of pre-peritoneal placement of trocar, which were recognized and corrected immediately and the other had omental bleeding). Two children had post-operative complications related to primary access (one port infection and other port site hematoma). Access to the abdominal cavity was generally accomplished in 3-12 minutes (average 4+2). Clinic follow-up ranged from 3-14 months.

Conclusion: Open laparoscopic access using modified Hasson’s technique was associated with no major or life-threatening complications. Hasson’s technique for the primary trocar for accessing the abdominal cavity is a safe and effective method and is recommended for all laparoscopic procedures in children.

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Ujjwal K. Chowdhury*, Sukhjeet Singh, Niwin George, Lakshmi Kumari Sankhyan, Sanjoy Sengupta, Sushamagayatri B, Parag Gharde, Vishwas Malik, Sreenita Chowdhury

Cardiothoracic Sciences Centre, All India Institute of Medical Sciences, India

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Ujjwal K. Chowdhury*, Niwin George, Lakshmi Kumari Sankhyan, Sukhjeet Singh, Abhinavsingh Chauhan, SushamaGayatri B, Parag Gharde, Vishwas Malik, Priyanka Chowdhury

Cardiothoracic Sciences Centre, All India Institute of Medical Sciences, India

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Ujjwal K. Chowdhury*, Lakshmi Kumari Sankhyan, Sukhjeet Singh, Niwin George, Abhinavsingh Chauhan, Sushamagayatri B, Parag Gharde, Sanjoy Sengupta, Sreenita Chowdhury

Cardiothoracic Sciences Centre, All India Institute of Medical Sciences, India

Video File: https://www.jsurgery.com/articles/video/JSST-20-1112.mp4

A 23-year-old female patient with a large ostium secundum atrial septal defect not amenable for device closure underwent surgical closure of atrial septal defect via a limited right anterolateral thoracotomy approach under normothermic cardiopulmonary bypass and St. Thomas (II) based cold blood cardioplegia. Postoperative recovery was uneventful. The safeguards and pitfalls of limited right anterolateral thoracotomy have been highlighted.

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Davide Pertile*, Chiara Giannotti, Stefano Scabini, Domenico Soriero

General and Oncologic Surgery Unit, “Policlinico San Martino” Hospital, Italy

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