No abstract

Objective Robotic-assisted techniques are continuing to cement their role in coronary surgery, particularly in facilitating the endoscopic harvesting of the left internal mammary artery (LIMA), regardless of how the subsequent bypass grafting is performed. As more surgeons attempt to become trained in robotic-assisted procedures, we sought to better define the learning curve associated with robotic-assisted endoscopic LIMA harvest. Methods Between January 2011 and July 2012, a total of 77 patients underwent robotic-assisted minimally invasive direct coronary artery bypass surgery at our institution. The LIMA was harvested endoscopically in all patients, using standard robotic instruments, followed by direct grafting to anterior wall myocardial vessels via a small thoracotomy. Intraoperative times for various components of the procedure were collated and analyzed. Results The mean ± SD time taken to insert and position the ports for the robotic instruments was 3.9 ± 1.4 minutes. The mean ± SD LIMA harvest time was 31.8 ± 10.1 minutes, and the mean ± SD total robotic time was 44.2 ± 12.9 minutes. All time variables consistently continued to decrease as the experience of the operating surgeon increased, with the greatest magnitude of improvement being evident within the first 20 cases. The logarithmic learning curves for LIMA harvest time and total robot time during our entire experience were both calculated as 90%, correlating to an expected 10% improvement in performance for each doubling of cases completed. Conclusions Coronary surgeons can rapidly become proficient in robotic-assisted endoscopic LIMA harvest, with significant improvement in operative times evident within the first 20 cases completed. These data may be useful in designing appropriate training programs for newer surgeons seeking to gain experience in robotic-assisted coronary surgery.

Congenital pulmonary airway malformation (CPAM), previously known as congenital cystic adenomatoid malformation (CCAM), is an inborn abnormality of the lower respiratory system. Most often diagnosed in the perinatal period, these anomalies usually present with tachypnea, cyanosis, and respiratory distress. However, rare cases are asymptomatic and undiagnosed until adulthood.

Background There is limited literature of venovenous extracorporeal membrane oxygenation use in a community, non-university, setting in the trauma population. Methods We reviewed our cases over 2 years from March 2018 to March 2020. This study was conducted in a community hospital with a General Surgery residency with no direct affiliation to a medical school. Primary outcome reviewed was survival to discharge. Secondary outcomes included duration of extracorporeal membranous oxygenation (ECMO) support, blood transfusion requirement, complications, and disposition. Results Five patients were cannulated during this time period. All patients survived to discharge. Mean time on ECMO was 153.4 h or 6.4 days (range 60–216 h). All patients required a transfusion while cannulated, with a mean of 10 units PRBC transfused (range 3–24). One patient required CPR, one required cessation of heparin drip for bleeding, and one had clinical signs of a stroke. Three patients were discharged to long-term acute care facilities and the other two to acute rehab. Conclusions Community level I trauma centers are capable of handling trauma patients requiring ECMO. It does require a multi-disciplinary team of surgical intensivists and cardiothoracic surgeons along with the support of nursing, respiratory therapists, and perfusionists. The outcomes in this limited series show that ECMO can be a tool utilized in the community setting.