Cardiac Surgery in Patients With Liver Cirrhosis (CASTER) Study: Early and Long-Term Outcomes

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Laparoendoscopic Single-site Surgery for Comprehensive Staging of Early Ovarian Cancer

Study ObjectiveTo demonstrate the procedure and suspension skills of laparoendoscopic single-site (LESS) staging surgery with infrarenal para-aortic lymphadenectomy for early-stage ovarian cancer.DesignA presentation of the surgery through this technical video.SettingA hospital.Patient and InterventionsA 45-year-old woman presented with a pelvic mass on gynecologic examination and a serum cancer antigen 125 level of 5910 U/mL (normal = <35 U/mL). A computed tomographic scan revealed a mixture of solid and cystic components (70 × 77 × 71 mm) arising from the right ovary and characterized by the “ovarian vascular pelvic” sign. Clinically early-stage ovarian cancer was suspected. Subsequently, LESS staging surgery was performed by an experienced surgeon in our department.ResultsThe surgery lasted 280 minutes, and the volume of blood loss was 50 mL; there were no intra- or postoperative complications. We “hid” the incision perfectly for cosmetic purposes. The histopathologic findings supported high-grade serous ovarian cancer of the right ovary with the left fallopian tube involved as well. In addition, a total of 34 negative pelvic and 18 negative para-aortic lymph nodes were identified, and a stage of IIA was diagnosed as a result.ConclusionWe performed an LESS staging surgery for early-stage ovarian cancer successfully. Our video shows that the LESS approach provided feasible, cosmetic, and safe access among the selected malignant gynecologic surgery. Therefore, we have experienced that the effective suspension was an auxiliary measure for LESS lymphadenectomy. In addition, compared with multiport laparoscopy, the LESS approach could provide easier access to infrarenal para-aortic regions; furthermore, it was safe and quick to extract an unknown sample.     

Pump Speed Optimization in Patients Implanted With the HeartMate 3 Device

Background

Pump speed optimization in patients implanted with a ventricular assist device represents a major challenge during the follow-up period. We present our findings on whether combined invasive hemodynamic ramp tests and cardiopulmonary exercise testing (CPX) can help optimize patient management.