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Toselli L, Gigena C, Bellia-Munzon G, Sanjurjo D, Vallee M, Martinez-Ferro M. Lessons Learned after 176 Patients Treated with a Standardized Procedure of Thoracoscopic Cryoanalgesia during Minimally Invasive Repair of Pectus Excavatum. J Pediatr Surg 2024; 59:372-378. [PMID: 37973418 DOI: 10.1016/j.jpedsurg.2023.10.047] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2023] [Accepted: 10/14/2023] [Indexed: 11/19/2023]
Abstract
BACKGROUND Intrathoracic intercostal cryoanalgesia (Cryo) during minimally invasive repair of pectus excavatum (MIRPE) reports have been related to improved pain management, although its extent differs amongst studies. We aimed to report our experience using a standardized perioperative approach including Cryo during MIRPE, and compare our actual results with those of a previous thoracic epidural analgesia (TE) cohort. Lessons learned are summarized. METHODS Retrospective study including patients undergoing Cryo during MIRPE between October 2018 and May 2023. Results with a standardized perioperative approach were analyzed. We then compared our Cryo cohort with a previous cohort of 62 patients who underwent TE and MIRPE between 2013 and 2018. Continuous variables were reported as mean and standard deviation, and as median (interquartile range) for variables with non-uniform distribution. RESULTS We performed 176 Cryo during MIRPE (16.8 ± 4.6 years), with a mean postoperative length of stay (LOS) of 1.4 ± 0.8 days and a median total requirement of 7.5 (0.0; 15.0) oral morphine equivalents (OME) (mg). Patients with Cryo had a significantly lower mean LOS (1.4 ± 0.8 vs. 3.6 ± 1.0 days, p < 0.0001), and median total opioid requirement [7.5 (0.0; 15.0) vs. 77.4 (27.0; 115.5 OME (mg), p < 0.0001) compared to TE patients. Lessons learned included ensuring adequate contact of the cryoprobe with the target, proper exposition, and specialized multidisciplinary perioperative patient and family support, including psychology and physical therapy. CONCLUSIONS In this study, we reported lessons learned after performing a standardized protocol of perioperative care in patients undergoing Cryo during MIRPE. This protocol enabled the achievement of a short LOS and low postoperative opioid requirement. TYPE OF STUDY Retrospective comparative study. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Luzia Toselli
- Fundacion Hospitalaria Mother and Child Medical Center, Av. Crámer 4601. Buenos Aires, C1429AKL, Argentina; Clinica Mi Pectus, Buenos Aires, Argentina. Av. Crámer 4602, Capital Federal, Buenos Aires, C1429AKL, Argentina.
| | - Cecilia Gigena
- Fundacion Hospitalaria Mother and Child Medical Center, Av. Crámer 4601. Buenos Aires, C1429AKL, Argentina; Clinica Mi Pectus, Buenos Aires, Argentina. Av. Crámer 4602, Capital Federal, Buenos Aires, C1429AKL, Argentina
| | - Gaston Bellia-Munzon
- Fundacion Hospitalaria Mother and Child Medical Center, Av. Crámer 4601. Buenos Aires, C1429AKL, Argentina; Clinica Mi Pectus, Buenos Aires, Argentina. Av. Crámer 4602, Capital Federal, Buenos Aires, C1429AKL, Argentina
| | - Daniela Sanjurjo
- Fundacion Hospitalaria Mother and Child Medical Center, Av. Crámer 4601. Buenos Aires, C1429AKL, Argentina; Clinica Mi Pectus, Buenos Aires, Argentina. Av. Crámer 4602, Capital Federal, Buenos Aires, C1429AKL, Argentina
| | - Maxroxia Vallee
- Clinica Mi Pectus, Buenos Aires, Argentina. Av. Crámer 4602, Capital Federal, Buenos Aires, C1429AKL, Argentina
| | - Marcelo Martinez-Ferro
- Fundacion Hospitalaria Mother and Child Medical Center, Av. Crámer 4601. Buenos Aires, C1429AKL, Argentina; Clinica Mi Pectus, Buenos Aires, Argentina. Av. Crámer 4602, Capital Federal, Buenos Aires, C1429AKL, Argentina
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Bellía-Munzón G, Sanjurjo D, Toselli L, Vallee M, Elmo G, Martínez-Ferro M. Novel index to estimate the cephalocaudal extent of the excavation in pectus excavatum: The Titanic index. J Pediatr Surg 2023; 58:605-607. [PMID: 36681535 DOI: 10.1016/j.jpedsurg.2022.12.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Accepted: 12/12/2022] [Indexed: 12/24/2022]
Abstract
BACKGROUND/PURPOSE Quantification of the severity of pectus excavatum deformities is currently performed using the Haller index (HI) and the Correction index (CI), amongst others. However, most indexes characterize the severity at the point of maximum excavation. We present a new index, the Titanic index (TI), aimed at the appraisal of the cephalocaudal extent of the excavation and its potential clinical use. MATERIALS AND METHODS Retrospective analysis of a cohort of patients who underwent a minimally invasive repair of pectus excavatum (MIRPE) between July 2020 and April 2022 at a single center. We defined TI as the percentage of the sternum that lied behind the anterior costal line observed in the CT. Demographics, HI, CI, and TI calculated based on computed tomography images (CT) were analyzed. Also, we compared the severity indexes of two groups of patients divided by the number of implants introduced per patient (group A: two implants, and group B: more than two). RESULTS Seventy-eight patients (92% male) were included, with a mean age of 17.2 ± 4.8 years. The mean TI was 37%. Albeit weak, we identified significant correlations between the TI and the HI and, more closely, to the CI. Two implants were introduced in 37 (47%) patients, and more than two in 41 (53%) patients. Compared to patients with two implants, the group of patients who received more than two implants were older and showed worse thoracic indexes. Using receiver operating characteristic curve analysis, we identified the TI as a better predictor of the need for more than two implants than HI and CI. In this regard, a TI larger than 66.5% had a sensitivity of 93% and a specificity of 92%. CONCLUSION We propose a novel index for the categorization of the severity of pectus excavatum. This index might be useful in planning the number of implants required for complete thoracic remodeling during MIRPE. LEVEL OF EVIDENCE Level III. TYPE OF STUDY Retrospective Comparative Study.
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Affiliation(s)
- Gastón Bellía-Munzón
- Fundación Hospitalaria Mother and Child Medical Center. Av. Crámer 4602. Capital Federal, Buenos Aires, Argentina, C1429AKL
| | - Daniela Sanjurjo
- Fundación Hospitalaria Mother and Child Medical Center. Av. Crámer 4602. Capital Federal, Buenos Aires, Argentina, C1429AKL
| | - Luzía Toselli
- Fundación Hospitalaria Mother and Child Medical Center. Av. Crámer 4602. Capital Federal, Buenos Aires, Argentina, C1429AKL.
| | - Maxroxia Vallee
- Fundación Hospitalaria Mother and Child Medical Center. Av. Crámer 4602. Capital Federal, Buenos Aires, Argentina, C1429AKL
| | - Gastón Elmo
- Fundación Hospitalaria Mother and Child Medical Center. Av. Crámer 4602. Capital Federal, Buenos Aires, Argentina, C1429AKL
| | - Marcelo Martínez-Ferro
- Fundación Hospitalaria Mother and Child Medical Center. Av. Crámer 4602. Capital Federal, Buenos Aires, Argentina, C1429AKL
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Toselli L, Chinni E, Nazar-Peirano M, Vallee M, Sanjurjo D, Martinez J, Bellia-Munzon G. Determinants of success associated with vacuum bell treatment of pectus excavatum. J Pediatr Surg 2022; 57:550-554. [PMID: 35525808 DOI: 10.1016/j.jpedsurg.2022.04.010] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2021] [Revised: 04/01/2022] [Accepted: 04/14/2022] [Indexed: 01/09/2023]
Abstract
BACKGROUND/PURPOSE We explored determinants of success in a large cohort of patients with pectus excavatum submitted to vacuum bell treatment and compared groups with satisfactory versus unsatisfactory outcomes. METHODS Retrospective case-control study in a single center between May 2013 and January 2020, including patients with pectus excavatum treated with vacuum bell. We classified patients according to their status at closure of data registry (surveillance; withdrawal; complete correction; failure) and according to Obermeyer's classification of degrees of pectus excavatum correction. Determinants of success were calculated using receiver operating characteristic curves. RESULTS Overall, 186 patients were included. Complete correction was achieved by 17% of the cases, while 45% remained under surveillance. Failure rates were low (n = 9; 5%), whereas withdrawal rates were 34%. Based on Obermeyer's classification of degree of excavation correction, 35% had excellent/good, 25% fair, and 40% poor/worse results. When comparing patients with good/excellent results with those with unsatisfactory results, patients with good/excellent results had a longer treatment duration [19.0 (13.0; 28) months vs. 13.0 (6.5; 22.5) months, p<0.0001], and lower initial pectus depth [1.6 (1.2; 2.0) cm, vs. 2.0 (1.5; 2.6) cm, p = 0.001]. Using ROC curves, the best determinants of success were an initial pectus depth ≤ 1.8 cm and a length of treatment > 12 months. CONCLUSION One-third of patients in treatment with a vacuum bell achieved excellent or good outcomes in our cohort. Determinants of success included an initial pectus depth of 1.8 cm or less and a minimum length of treatment of 12 months. TYPE OF STUDY retrospective comparative study LEVEL OF EVIDENCE: III.
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Affiliation(s)
- Luzia Toselli
- Fundación Hospitalaria Mother and Child Medical Center, Av. Crámer 4602. Capital Federal, Buenos Aires, Argentina C1429AKL.
| | - Emilio Chinni
- Fundación Hospitalaria Mother and Child Medical Center, Av. Crámer 4602. Capital Federal, Buenos Aires, Argentina C1429AKL
| | - Maximiliano Nazar-Peirano
- Fundación Hospitalaria Mother and Child Medical Center, Av. Crámer 4602. Capital Federal, Buenos Aires, Argentina C1429AKL
| | - Maxroxia Vallee
- Fundación Hospitalaria Mother and Child Medical Center, Av. Crámer 4602. Capital Federal, Buenos Aires, Argentina C1429AKL
| | - Daniela Sanjurjo
- Fundación Hospitalaria Mother and Child Medical Center, Av. Crámer 4602. Capital Federal, Buenos Aires, Argentina C1429AKL
| | - Jorge Martinez
- Fundación Hospitalaria Mother and Child Medical Center, Av. Crámer 4602. Capital Federal, Buenos Aires, Argentina C1429AKL
| | - Gaston Bellia-Munzon
- Fundación Hospitalaria Mother and Child Medical Center, Av. Crámer 4602. Capital Federal, Buenos Aires, Argentina C1429AKL
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Toselli L, Chinni E, Nazar-Peirano M, Vallee M, Sanjurjo D, Martinez J, Bellía-Munzón G. Reply to Letter to the Editor by Tedde M. J Pediatr Surg 2022; 57:747. [PMID: 35931557 DOI: 10.1016/j.jpedsurg.2022.07.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2022] [Accepted: 07/18/2022] [Indexed: 11/27/2022]
Affiliation(s)
- Luzia Toselli
- Fundación Hospitalaria Mother and Child Medical Center. Av. Crámer 4602. Capital Federal. Argentina. C1429AKL.
| | - Emilio Chinni
- Fundación Hospitalaria Mother and Child Medical Center. Av. Crámer 4602. Capital Federal. Argentina. C1429AKL
| | - Maximiliano Nazar-Peirano
- Fundación Hospitalaria Mother and Child Medical Center. Av. Crámer 4602. Capital Federal. Argentina. C1429AKL
| | - Maxroxia Vallee
- Fundación Hospitalaria Mother and Child Medical Center. Av. Crámer 4602. Capital Federal. Argentina. C1429AKL
| | - Daniela Sanjurjo
- Fundación Hospitalaria Mother and Child Medical Center. Av. Crámer 4602. Capital Federal. Argentina. C1429AKL
| | - Jorge Martinez
- Fundación Hospitalaria Mother and Child Medical Center. Av. Crámer 4602. Capital Federal. Argentina. C1429AKL
| | - Gastón Bellía-Munzón
- Fundación Hospitalaria Mother and Child Medical Center. Av. Crámer 4602. Capital Federal. Argentina. C1429AKL
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Toselli L, Vallee M, Elmo G, Martinez J, Sanjurjo D, Nazar M, Bellia-Munzon G. Implementation and acceptance rates of a specially designed vacuometer for the vacuum bell treatment of pectus excavatum. J Pediatr Surg 2021; 56:2235-2238. [PMID: 33789800 DOI: 10.1016/j.jpedsurg.2021.03.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2020] [Revised: 02/24/2021] [Accepted: 03/12/2021] [Indexed: 11/19/2022]
Abstract
BACKGROUND / PURPOSE To report the implementation of a specially designed vacuometer for the ambulatory measurement of the exact negative pressure self-applied by the patient when using the vacuum bell for the treatment of pectus excavatum and to analyze patient satisfaction with the device, by conducting a survey. METHODS Between October 2018 and June 2020, all patients with pectus excavatum who received a vacuum bell at our Pectus Clinic were provided with a specially designed pectus vacuometer for their personal use. We described the vacuometer, the fundamentals of its development, and the utilization protocol. A survey was conducted evaluating comfort, clarity of instructions, usefulness, simplicity of connection, and likeability. The level of satisfaction was assessed using a Likert scale ranging from 1 (very negative experience) to 5 (very positive experience). The occurrence of skin lesions provoked by the application of the vacuum bell was registered. RESULTS From 72 submitted surveys, 54 patients answered. Patient demographics comprised 44 (81.5%) males and a mean age of 12.6 ± 6.0 years. The mean initial external pectus depth was 2.0 ± 0.7 cm and the mean duration of treatment was 13.2 ± 8.6 months. No skin lesions were detected while using the vacuum bell and the vacuometer. The mean general satisfaction score was 4.4 ± 0.7 and 83.3% of the respondents did not have any inconvenience with the vacuometer. A patient who considered himself cured was the only dropout during the study. CONCLUSIONS In this study, we described the feasibility and fundamentals of the application of a specifically designed vacuometer for ambulatory use as an adjunct to the treatment of pectus excavatum with a vacuum bell, and demonstrated a high satisfaction level with the device. In addition, the vacuometer might help avoid skin lesions secondary to the vacuum bell and foster adhesion to treatment. TYPE OF STUDY Treatment study. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Luzia Toselli
- Fundación Hospitalaria Mother and Child Medical Center, Av. Crámer 4602. Capital Federal, Buenos Aires, Argentina, C1429AKL. dra.luzia.toselli@gmail
| | - Maxroxia Vallee
- Fundación Hospitalaria Mother and Child Medical Center, Av. Crámer 4602. Capital Federal, Buenos Aires, Argentina, C1429AKL
| | - Gaston Elmo
- Hospital Italiano de Buenos Aires, Gascon 450. Capital Federal, Buenos Aires, Argentina. C1181ACH
| | - Jorge Martinez
- Fundación Hospitalaria Mother and Child Medical Center, Av. Crámer 4602. Capital Federal, Buenos Aires, Argentina, C1429AKL
| | - Daniela Sanjurjo
- Fundación Hospitalaria Mother and Child Medical Center, Av. Crámer 4602. Capital Federal, Buenos Aires, Argentina, C1429AKL
| | - Maximiliano Nazar
- Fundación Hospitalaria Mother and Child Medical Center, Av. Crámer 4602. Capital Federal, Buenos Aires, Argentina, C1429AKL
| | - Gaston Bellia-Munzon
- Fundación Hospitalaria Mother and Child Medical Center, Av. Crámer 4602. Capital Federal, Buenos Aires, Argentina, C1429AKL
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Martinez J, Toselli L, Aleixandre CG, Bellia-Munzon G, Sanjurjo D, Peirano MN, Vallee M, Martinez-Ferro M. Surgical Planning, Simulation, and Prosthesis Customization for Complex Chest Wall Malformations. Ann Thorac Surg 2021; 112:e295-e298. [PMID: 33741326 DOI: 10.1016/j.athoracsur.2021.01.084] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2020] [Revised: 01/29/2021] [Accepted: 01/30/2021] [Indexed: 10/21/2022]
Abstract
Despite the emergent application of 3-dimensional technology for thoracic reconstructions, reports regarding its use for the resolution of the heterogeneous subgroup of complex chest wall malformations are lacking. We aim to report a novel, standardized process of personalized repair of complex chest wall malformations comprising multidisciplinary, comprehensive surgical planning; surgical simulation on a 3-dimensionally printed scale model of the area of interest; manufacturing of customized prostheses; and surgical repair according to plan. We propose this therapeutic strategy for the resolution of such a wide variety of chest wall deformities to reduce improvisation and enhance outcomes.
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Affiliation(s)
- Jorge Martinez
- Fundación Hospitalaria Mother and Child Medical Center, Buenos Aires, Argentina
| | - Luzia Toselli
- Fundación Hospitalaria Mother and Child Medical Center, Buenos Aires, Argentina.
| | | | | | - Daniela Sanjurjo
- Fundación Hospitalaria Mother and Child Medical Center, Buenos Aires, Argentina
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Bellia-Munzon G, Martinez J, Toselli L, Nazar Peirano M, Sanjurjo D, Vallee M, Martinez-Ferro M. From bench to bedside: 3D reconstruction and printing as a valuable tool for the chest wall surgeon. J Pediatr Surg 2020; 55:2703-2709. [PMID: 32811684 DOI: 10.1016/j.jpedsurg.2020.07.010] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2020] [Revised: 06/14/2020] [Accepted: 07/08/2020] [Indexed: 11/30/2022]
Abstract
BACKGROUND/PURPOSE The development of computer-aided design/manufacturing and digital image technology shows promise to revolutionize several medical and surgical fields. In this context, we propose a different approach for minimally invasive repair of pectus excavatum (MIRPE) including preoperative planning, ambulatory template fitting, and implant customization. METHODS We prospectively collected data on 130 consecutive patients who underwent a novel process of implant customization for MIRPE between November 2015 and September 2019 at our institution. This process consisted of: 1) preoperative planning using 3D computed tomography scan reconstruction and 3D printing of the implant template, 2) an ambulatory fitting session with the template, and 3) manufacture of a custom made, prebent, metallic implant based on the 3D printed templates. We described the process in detail and analyzed the "implant-deformity" match, need for rebending, modification of the curvature or shape of the pectus implant intraoperatively, and accuracy of the number of bars planned preoperatively. RESULTS Preoperative planning including 3D reconstruction and printing resulted in a 92.3% optimal "implant-deformity" anatomic match. Minimal rebending without flipping of the implants was required in 5.4% of the patients. In two cases (1.5%), the implants were too short, and they tended to sink into the intercostal space, and in one case (0.8%), the patient's chest was extremely asymmetric, and the implant had to be removed and rebent intraoperatively. The number of implants planned preoperatively was precise in 100%. CONCLUSIONS In this study, we demonstrated that minimally invasive repair of pectus excavatum assisted by preoperative planning, ambulatory template fitting, and implant customization enables an excellent anatomic match, leading to minimal rebending, and avoiding implant flipping or removal after retrosternal passage as well as accuracy in the number of bars programmed preoperatively. TYPE OF STUDY Prospective registry. LEVEL OF EVIDENCE III.
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Affiliation(s)
| | - Jorge Martinez
- Fundación Hospitalaria Mother and Child Medical Center, Buenos Aires, Argentina
| | - Luzia Toselli
- Fundación Hospitalaria Mother and Child Medical Center, Buenos Aires, Argentina.
| | | | - Daniela Sanjurjo
- Fundación Hospitalaria Mother and Child Medical Center, Buenos Aires, Argentina
| | - Maxroxia Vallee
- Fundación Hospitalaria Mother and Child Medical Center, Buenos Aires, Argentina; Fundación INICIAR, Buenos Aires, Argentina
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Toselli L, Bellía Munzón G, Martinez J, Vallee M, Sanjurjo D, Nazar Peirano M, Martínez-Ferro M. Safety-string: A handy maneuver to control pectus bar removal bleeding complications. J Pediatr Surg 2020; 55:1162-1164. [PMID: 32143902 DOI: 10.1016/j.jpedsurg.2020.01.058] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2019] [Revised: 12/10/2019] [Accepted: 01/29/2020] [Indexed: 11/19/2022]
Abstract
The pectus bar removal procedure is often considered a simple, straightforward surgery with a low incidence of complications. However, life-threatening bleeding complications have been reported requiring major measures for hemostatic control. Our objective is to share a simple maneuver that our group has systematically included in the bar removal procedure to facilitate bleeding control in case hemorrhage occurs.
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Affiliation(s)
- Luzia Toselli
- Fundación Hospitalaria Mother and Child Medical Center, Av. Crámer 4602, Capital Federal, Buenos Aires, Argentina, C1429AKL.
| | - Gastón Bellía Munzón
- Fundación Hospitalaria Mother and Child Medical Center, Av. Crámer 4602, Capital Federal, Buenos Aires, Argentina, C1429AKL
| | - Jorge Martinez
- Fundación Hospitalaria Mother and Child Medical Center, Av. Crámer 4602, Capital Federal, Buenos Aires, Argentina, C1429AKL
| | - Maxroxia Vallee
- Fundación Hospitalaria Mother and Child Medical Center, Av. Crámer 4602, Capital Federal, Buenos Aires, Argentina, C1429AKL
| | - Daniela Sanjurjo
- Fundación Hospitalaria Mother and Child Medical Center, Av. Crámer 4602, Capital Federal, Buenos Aires, Argentina, C1429AKL
| | - Maximiliano Nazar Peirano
- Fundación Hospitalaria Mother and Child Medical Center, Av. Crámer 4602, Capital Federal, Buenos Aires, Argentina, C1429AKL
| | - Marcelo Martínez-Ferro
- Fundación Hospitalaria Mother and Child Medical Center, Av. Crámer 4602, Capital Federal, Buenos Aires, Argentina, C1429AKL
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Cadaval Gallardo C, Martínez J, Bellía-Munzon G, Nazar M, Sanjurjo D, Toselli L, Martínez-Ferro M. Thoracoscopic cryoanalgesia: A new strategy for postoperative pain control in minimally invasive pectus excavatum repair. Cir Pediatr 2020; 33:11-15. [PMID: 32166917] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
OBJECTIVE Recent publications report early discharge and low opioid requirements after minimally invasive pectus excavatum repair treated with bilateral intercostal nerve cryoablation. Our aim is to report our initial experience with this technique. MATERIAL AND METHODS Retrospective analysis of medical records of patients undergoing bilateral thoracoscopic cryoanalgesia during minimally invasive pectus excavatum repair within our institution from September 2018 to March 2019. TECHNIQUE A cryoprobe was applied at -70 ºC for 2 minutes each from the 3rd to the 7th intercostal nerves bilaterally under thoracoscopic control. Postoperative pain was assessed using a visual analogue scale (VAS). RESULTS Twenty-one patients were included. Ninety percent were male, the mean age being 15.2 ± 4.29 years, and the mean weight being 53.6 ± 15.33 kg. The average Haller index was 5.1 ± 2.97, and the mean repair index was 37.6 ± 13.77%. The mean number of implants introduced was 2.55 ± 0.74. The mean duration of cryoanalgesia was 39.9 ± 21.1. No patients received epidural anesthesia. Mean postoperative stay was 1.64 ± 0.73 days. Seventy-one percent of the patients required 1 dose of opioids at the most for postoperative pain control. According to the VAS, the average pain score on postoperative days 1, 3, 7, and 21 was 2.55, 2.01, 0.5, and 0.06, respectively. CONCLUSIONS Bilateral thoracoscopic cryoanalgesia during minimally invasive pectus excavatum repair leads to early discharge and good postoperative pain control in all cases. Cryoanalgesia has become our treatment of choice for pain control in the thoracoscopic repair of pectus excavatum.
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Affiliation(s)
- C Cadaval Gallardo
- Pediatric Surgery Department. Hospital Universitario Infantil Virgen del Rocío. Sevilla (Spain)
| | - J Martínez
- Pediatric Surgery Group (PSG). Fundación Hospitalaria, Centro de Salud Materno Infanto Juvenil. Buenos Aires (CABA), Argentina
| | - G Bellía-Munzon
- Pediatric Surgery Group (PSG). Fundación Hospitalaria, Centro de Salud Materno Infanto Juvenil. Buenos Aires (CABA), Argentina
| | - M Nazar
- Pediatric Surgery Group (PSG). Fundación Hospitalaria, Centro de Salud Materno Infanto Juvenil. Buenos Aires (CABA), Argentina
| | - D Sanjurjo
- Pediatric Surgery Group (PSG). Fundación Hospitalaria, Centro de Salud Materno Infanto Juvenil. Buenos Aires (CABA), Argentina
| | - L Toselli
- Pediatric Surgery Group (PSG). Fundación Hospitalaria, Centro de Salud Materno Infanto Juvenil. Buenos Aires (CABA), Argentina
| | - M Martínez-Ferro
- Pediatric Surgery Group (PSG). Fundación Hospitalaria, Centro de Salud Materno Infanto Juvenil. Buenos Aires (CABA), Argentina
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Bianchi HF, Algieri RD, Sanjurjo D, Ottone NE, Fuentes R. Multiple Anatomical Variations of the Hepatic Pedicle: Case Report and Clinical Application. INT J MORPHOL 2014. [DOI: 10.4067/s0717-95022014000300006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Richard-Kowalski D, Termeulen D, Reed M, Reyes R, Kuliga M, Sanjurjo D, Hirsch AE. Implementation of a direct patient callback system improves compliance for additional breast imaging and early breast cancer detection. J Clin Oncol 2006. [DOI: 10.1200/jco.2006.24.18_suppl.6073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
6073 Background: Existing patient recall systems usually involve contacting the referring physician who then notifies the patient to schedule a return visit for further imaging. We set out to determine whether a direct patient callback system would improve patient compliance in returning for additional imaging including magnification, spot compression, and ultrasound, and whether that would translate to an improvement in early breast cancer detection. Methods: Beginning on 4/1/2004, we prospectively identified all patients whose screening mammograms were read as having an incomplete assessment that required additional imaging (ACR BIRADS 0). Those patients were contacted directly via telephone to return for additional views. Results: Between 11/1/2002 and 3/31/3004, 1142 patients with incomplete screening mammography were identified and the referring physicians were contacted. 956 of 1142 (84%) patients returned and underwent additional breast imaging. Between 4/1/2004 and 12/31/2005, 1,336 patients with incomplete screening mammography were contacted directly to return for additional imaging. 1,307 of 1,336 (98%) patients returned and underwent additional breast imaging. (p < 0.0001, Fisher’s exact test). 125 of the 1,307 (8.5%) of the subsequent exams were found to be suspicious and biopsy was recommended (ACR BIRADS 4 or 5). Conclusions: Our new system of contacting patients with incomplete mammography has significantly increased our recall rate. Implementation of this system has enabled us to identify those patients whose mammograms are suspicious and ultimately diagnose breast cancer earlier. Direct patient callback has become standard policy and we are recommending this system for all radiology recall examinations. No significant financial relationships to disclose.
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Affiliation(s)
- D. Richard-Kowalski
- Cancer Care Quality Improvement Committee; Boston University Medical Center, Boston, MA
| | - D. Termeulen
- Cancer Care Quality Improvement Committee; Boston University Medical Center, Boston, MA
| | - M. Reed
- Cancer Care Quality Improvement Committee; Boston University Medical Center, Boston, MA
| | - R. Reyes
- Cancer Care Quality Improvement Committee; Boston University Medical Center, Boston, MA
| | - M. Kuliga
- Cancer Care Quality Improvement Committee; Boston University Medical Center, Boston, MA
| | - D. Sanjurjo
- Cancer Care Quality Improvement Committee; Boston University Medical Center, Boston, MA
| | - A. E. Hirsch
- Cancer Care Quality Improvement Committee; Boston University Medical Center, Boston, MA
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