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Файл:Ординатура / Хирургия / Библиотека им академика М.И. Перельмана / Книга_4110_Библиотеки_им_академика_М_И_Перельмана
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Essential Operative Steps
Potential Complications and Pitfalls
Template Dictation
25. Open Ivor-Lewis Esophagectomy
Essential Operative Steps
Potential Complications and Pitfalls
Template Dictation
26. Minimally Invasive Ivor-Lewis Esophagectomy
Essential Operative Steps
Laparoscopic Phase
Thoracoscopic Phase
Potential Complications and Pitfalls
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27. Lung Volume Reduction Surgery
Essential Operative Steps
Potential Complications and Pitfalls
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28. VATS Wedge Resection
Essential Operative Steps
Potential Complications and Pitfalls
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29. VATS Sympathectomy
Essential Operative Steps
Potential Complications and Pitfalls
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30. VATS Thymectomy
Essential Operative Steps
Potential Complications and Pitfalls
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31. Transcervical Thymectomy
Essential Operative Steps
Potential Complications and Pitfalls
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32. Trans-Sternal Thymectomy
Essential Operative Steps
Potential Complications and Pitfalls
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33. Open Lobectomies
Right Upper Lobectomy
Essential Operative Steps
Potential Complications and Pitfalls
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Right Middle Lobectomy
Essential Operative Steps
Potential Complications and Pitfalls
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Right Lower Lobectomy
Essential Operative Steps
Potential Complications and Pitfalls
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Left Upper Lobectomy
Essential Operative Steps
Potential Complications and Pitfalls
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Left Lower Lobectomy
Essential Operative Steps
Potential Complications and Pitfalls
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34. Segmentectomy
Essential Operative Steps
Potential Complications and Pitfalls
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Thoracotomy
Video-Assisted Thoracoscopic Surgery
35. Carinal Pneumonectomy
Essential Operative Steps
Potential Complications and Pitfalls
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36. Extrapleural Pneumonectomy for Mesothelioma
Essential Operative Steps
Potential Complications and Pitfalls
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37. Lung Procurement
Essential Operative Steps
Potential Complications and Pitfalls
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38. Lung Transplantation
Essential Operative Steps
Potential Complications and Pitfalls
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39. Bronchial and Arterial Sleeve Resection
Essential Operative Steps
Potential Complications and Pitfalls
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II. Adult Cardiac Surgery
1. Aortic Root Replacement for Ascending Aortic Aneurysm
Essential Operative Steps
Potential Complications and Pitfalls
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2. Aortic Root Replacement (Endocarditis)
Essential Operative Steps
Potential Complications and Pitfalls
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3. Total Arch/Hemiarch Replacement with DHCA – Dissection
Essential Operative Steps
Potential Complications and Pitfalls
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4. Elephant Trunk Part 1
Essential Operative Steps
Potential Complications and Pitfalls
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5. Elephant Trunk Part 2
Essential Operative Steps
Potential Complications and Pitfalls
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6. Endovascular Management of Acute Type B Dissection
Essential Operative Steps
Potential Complications and Pitfalls
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7. Aortic Valve Replacement for Aortic Insufficiency or Aortic Stenosis
Essential Operative Steps
Potential Complications and Pitfalls
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8. Aortic Valve Replacement with Aortic Root Enlargement
Essential Operative Steps
Potential Complications and Pitfalls
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9. Biatrial Cox-Maze Ablation for Atrial Fibrillation
Essential Operative Steps
Potential Complications and Pitfalls
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10. Coronary Artery Bypass Grafting with Cardiopulmonary Bypass
Essential Operative Steps
Potential Complications and Pitfalls
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11. Coronary Artery Bypass Grafting with Mammary and Vein Grafts - Off Pump
Essential Operative Steps
Potential Complications and Pitfalls
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12. Coronary Artery Bypass Grafting + Mitral Valve Repair VS Replacement
Essential Operative Steps
Potential Complications and Pitfalls
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13. Coronary Artery Bypass Grafting with Aortic Valve Replacement
Essential Operative Steps
Potential Complications and Pitfalls
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14. DeVega Tricuspid Valve Repair
Essential Operative Steps
Potential Complications and Pitfalls
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15. Donor Heart Procurement
Essential Operative Steps
Potential Complications and Pitfalls
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16. Hemiarch Replacement with DHCA – Aneurysm
Essential Operative Steps
Potential Complications and Pitfalls
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17. Aortic Root Replacement with Homograft for Aortic Root Abscess (Native And Or Prior Bentall)
Essential Operative Steps
Potential Complications and Pitfalls
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18. Unexpected Intraoperative Complications
Massive Air Embolism
Essential Operative Steps
Potential Complications and Pitfalls
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Intraoperative Aortic Dissection
Essential Operative Steps
Potential Complications and Pitfalls
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19. LVAD – Heartware
Essential Operative Steps
Potential Complications and Pitfalls
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20. LVAD – Heart Mate II
Essential Operative Steps
Potential Complications and Pitfalls
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21. Minimally Invasive Directed Coronary Artery Bypass
Essential Operative Steps
Potential Complications and Pitfalls
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22. Aortic Valve Surgery with Upper Hemisternotomy Approach
Essential Operative Steps
Potential Complications and Pitfalls
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23. Mitral Valve Replacement
Essential Operative Steps
Potential Complications and Pitfalls
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24. Minimally Invasive Mitral Surgery
Essential Operative Steps
Potential Complications and Pitfalls
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25. Mitral Valve Repair for Bileaflet Prolapse
Essential Operative Steps
Potential Complications and Pitfalls
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26. Orthotopic Heart Transplantation
Essential Operative Steps
Potential Complications and Pitfalls
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27. Thoracoabdominal Aneurysm Repair
Essential Operative Steps
Potenital Complications and Pitfalls
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28. Permanent Pacemaker Insertion
Essential Operative Steps
Potential Complications and Pitfalls
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29. Repair of Post-Infarction Ventricular Septal Defect
Essential Operative Steps
Potential Complications and Pitfalls
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30. Repair of Post-Infarction Ventricular Aneurysm (DOR Endoventricular Circular Patch Plasty (EVCPP))
Essential Operative Steps
Potential Complications and Pitfalls
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31. Pulmonary Embolectomy
Essential Operative Steps
Potential Complications and Pitfalls
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32. Redo Sternotomy and Difficult Sternal Closure
Essential Operative Steps
Redo Sternotomy:
Sternal Closure
Potential Complications and Pitfalls
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33. Resection of Atrial Myxoma
Essential Operative Steps
Potential Complications and Pitfalls
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34. Septal Myectomy
Essential Operative Steps
Potential Complications and Pitfalls
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35. Endovascular Repair of Descending Thoracic Aortic Aneurysm (TEVAR)
Essential Operative Steps
Potential Complications and Pitfalls
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36. Total Arch Replacement with Deep Hypothermic Circulatory Arrest for Aneurysm
Essential Operative Steps
Potential Complications and Pitfalls
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37. Total Artificial Heart
Essential Operative Steps
Potential Complications and Pitfalls
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38. Transcatheter Aortic Valve Implantation (TAVI): (Transfemoral-Transapical Approach)
Essential Operative Steps
Potential Complications and Pitfalls
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39. Valve Sparing Root Replacement
Essential Operative Steps
Potential Complications and Pitfalls
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III. Congenital Cardiac Surgery
1. Repair of Atrial Septal Defect- Secundum Atrial Septal Defect
Essential Operative Steps
Potential Complications and Pitfalls
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2. Ventricular Septal Defect: Perimembranous
Essential Operative Steps
Potential Complications and Pitfalls
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3. Partial AV Canal Repair
Essential Operative Steps
Potential Complications and Pitfalls
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4. Complete Atrioventricular Canal Repair
Essential Operative Steps
Potential Complications and Pitfalls
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5. Repair of Partial Anomalous Pulmonary Venous Return
Essential Operative Steps
Potential Complications and Pitfalls
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6. Supra-Cardiac Total Anomalous Pulmonary Venous Return (TAPVR)
Essential Operative Steps
Potential Complications and Pitfalls
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7. Total Anomalous Pulmonary Venous Return (TAPVR) - Cardiac Type
Essential Operative Steps
Potential Complications and Pitfalls
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8. Infra-Cardiac Total Anomalous Pulmonary Venous Return (TAPVR)
Essential Operative Steps
Potential Complications and Pitfalls
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9. Patent Ductus Arteriosus Ligation
Essential Operative Steps
Potential Complications and Pitfalls
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10. Aortic Coarctation Repair with Extended End-to-End Anastomosis
Essential Operative Steps
Potential Complications and Pitfalls
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11. Division of Vascular Ring
Essential Operative Steps
Potential Complications and Pitfalls
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12. Pulmonary Artery Banding
Essential Operative Steps
Potential Complications and Pitfalls
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13. Modified Blalock-Taussig Shunt (Using Interposition Gore-Tex Tube Graft)
Essential Operative Steps
Potential Complications and Pitfalls
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14. Norwood Procedure
Essential Operative Steps
Potential Complications and Pitfalls
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15. Bidirectional Glenn Procedure
Essential Operative Steps
Potential Complications and Pitfalls
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16. Completion Lateral Tunnel Fontan
Essential Operative Steps
Potential Complications and Pitfalls
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17. Extra-Cardiac (Non-Fenestrated) Completion Fontan Procedure
Essential Operative Steps
Potential Complications and Pitfalls
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18. Repair of Supravalvular Aortic Stenosis
Essential Operative Steps
Potential Complications and Pitfalls
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19. Ross Procedure for the Correction of Congenital Aortic Stenosis
Essential Operative Steps
Potential Complications and Pitfalls
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20. Repair of Obstructive Hypertrophic Cardiomyopathy: (Septal Myomectomy)
Essential Operative Steps
Potential Complications and Pitfalls
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21. Arterial Switch Procedure
Essential Operative Steps
Potential Complications and Pitfalls
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22. Tetralogy of Fallot: Transventricular Repair
Essential Operative Steps
Potential Complications and Pitfalls
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23. Tetralogy of Fallot Repair - Infundibular Sparing (Transatrial Repair)
Essential Operative Steps
Potential Complications and Pitfalls
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24. Pulmonary Valve Replacement and Reconstruction of Right Ventricle Outflow Tract
Essential Operative Steps
Potential Complications and Pitfalls
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25. Repair of Truncus Arteriousus (TA)
Essential Operative Steps
Potential Complications and Pitfalls
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26. Cone Repair for Ebstein Malformation
Essential Operative Steps
Potential Complications and Pitfalls
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27. Pediatric Lung Transplantation: Bilateral Sequential Lung Transplantation
Essential Operative Steps
Potential Complications and Pitfalls
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28. Pediatric Heart Transplantation
Essential Operative Steps
Potential Complications and Pitfalls
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I. General Thoracic Surgery
1. Flexible Bronchoscopy
Bharat Pancholy MD, and William H Warren MD
Rush University Medical Center, Chicago IL
Essential Operative Steps
Flexible bronchoscopy in a non-intubated patient
1. Monitoring = continuous pulse oximetry, non-invasive blood pressure monitoring, electrocardiographic monitoring.
2. IV access – peripheral or central IV access.
3. Apply supplemental oxygen either via nasal cannula or non-rebreather mask.
4. Sedation for comfort and cooperation:
5. Intravenous opiates (analgesic and antitussive)
6. Benzodiazepines (anxiolysis and antegrade amnesia)
7. Topical anesthetic – spraying hypopharynx with 1% or 2% lidocaine using atomizer
8. If inserting through nares –ask patient to plug one nare and inhale through other nostril. Then reverse. Whichever
nare appears to be able to ventilate better, plan to introduce bronchoscopy through that nare. Place cotton tip
applicator through the nare with lidocaine gel to anesthetize. Leave cotton tip applicator in place for 1 minute and
then remove.
9. Introduce bronchoscope through the nose or mouth
10. Once true vocal cords visualized, inject 5 ml of 4% lidocaine – this will anesthetize the larynx and allow for easier
advancement of the bronchoscope.
11. Visualization and inspection of the larynx, and vocal cords.
12. Assess vocal cord mobility
13. All lobar and segmental bronchi must be examined.
14. Tracheobronchial tree remote from the area in question is assessed first.
15. Bronchus leading to the known area of disease is examined.
16. Perform bronchoscopic procedure as indicated – biopsy, brushing, bronchoalveolar lavage, transbronchial needle
aspiration.
17. Remove bronchoscope at termination of procedure
Flexible bronchoscopy in an intubated patient
1. Apply swivel adapter to endotracheal tube
2. Maintain ventilation through side arm of adapter
3. Bronchoscope is passed through tight fitting diaphragm on the adapter
4. Perform bronchoscopy and any associated procedures
5. Remove bronchoscopy, remove adapter.
Potential Complications and Pitfalls
1. Hypoxemia
2. Hypercapnia pre procedure/during/post procedure
3. Respiratory depression
4. Aspiration
5. Analgesic in elderly and debilitated patients should be minimized
6. Liver failure patients should not receive any benzodiazepines
7. Bleeding (risk is increased in following)
8. Increased with PT >40% of normal
9. Platelet count < 50,000
10. Uremia
11. Pulmonary hypertension
12. Pneumothorax after patient undergoing transbronchial biopsy
13. Bronchospasm
14. Increase in patients with asthma and severe chronic obstructive disease
15. Laryngospasm
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