The Annals of thoracic surgery
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Comparative Study
Robotic anatomic segmentectomy of the lung: technical aspects and initial results.
Robotic lobectomy with radical lymph node dissection is a new frontier of minimally invasive thoracic surgery. Series of sublobar anatomic resection for primary initial lung cancers or for metastasis using video-assisted thoracic surgery have been reported but no cases have been so far reported using the robot-assisted approach. We present the technique and surgical outcome of our initial experience. ⋯ Robotic anatomic lung segmentectomy is feasible and safe procedure. Robotic system, by improving ergonomic, surgeon view and precise movements, may make minimally invasive segmentectomy easier to adopt and perform.
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Comparative Study
Open, hybrid, and endovascular treatment for aortic coarctation and postrepair aneurysm in adolescents and adults.
Open, hybrid, and endovascular procedures are used for grown-up patients with aortic coarctation and complications after repair, an expanding population. We sought to characterize patients and procedures, assess early and late outcomes, and describe indications to guide treatment of these complex patients. ⋯ Coarctation, recurrent coarctation, and postrepair aneurysm/pseudoaneurysm in adolescent and adult patients can be safely and effectively managed with open, hybrid, or endovascular techniques. Optimal results are achievable in this complex population of patients with a multimodality approach tailored to surgical indication and anatomy. All survivors of coarctation repair require lifelong surveillance.
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Comparative Study
Characteristics associated with the use of nonanatomic resections among Medicare patients undergoing resections of early-stage lung cancer.
Racial disparities in access to surgical resection for treatment of early-stage non-small-cell lung cancer (NSCLC) are well documented. However it is unclear how race, clinical, and hospital characteristics affect the surgical approach among patients undergoing resection. ⋯ Since 2000, the use of nonanatomic resections in stage I NSCLC has increased, most significantly among patients with larger tumors. After adjusting for clinical factors, there was no relation between race and type of surgical resection.
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Comparative Study
Contrast-induced nephropathy and risk of acute kidney injury and mortality after cardiac operations.
Contrast-induced nephropathy (CIN) is a predictor of long-term morbidity and mortality. We assessed whether patients in whom CIN developed at diagnostic coronary angiography also had an increased risk of acute kidney injury (AKI) and higher mortality after cardiac operations. ⋯ The development of CIN at diagnostic angiography is an independent predictor of postoperative AKI and mortality after cardiac procedures.
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Approximately 10% to 20% of children are readmitted congenital heart surgery. Readmissions are now being viewed by payers as preventable complications of the original surgery or hospitalization, and there have been proposals by insurance agencies to deny coverage of the additional expenses incurred by the readmission. With hopes to reduce the potential impact, we analyzed patients undergoing congenital heart surgery at our institution in order to identify risk factors for readmission. ⋯ Potential risk factors for readmission after congenital heart surgery have been identified. Hopefully, altering the discharge process and the early postoperative care in these high-risk patients can minimize the impact of hospital readmissions after congenital heart surgery.