-
Surgical and Radiologic Anatomy : SRA Jan 2022There is no systematic description of primary anatomical landmarks that allow a surgeon to reliably and safely navigate the superior and posterior mediastinum's fat...
PURPOSE
There is no systematic description of primary anatomical landmarks that allow a surgeon to reliably and safely navigate the superior and posterior mediastinum's fat tissue spaces near large vessels and nerves during video-assisted endothoracoscopic interventions in the prone position of a patient. Our aim was to develop an algorithm of sequential visual navigation during thoracoscopic extirpation of the esophagus and determine the most permanent topographic and anatomical landmarks allowing safe thoracoscopic dissection of the esophagus in the prone position.
METHODS
The anatomical study of the mediastinal structural features was carried out on 30 human cadavers before and after opening the right pleural cavity.
RESULTS
For thoracoscopic extirpation of the esophagus in the prone position, anatomical landmarks are defined, their variants are assessed, and an algorithm for their selection is developed, allowing their direct visualization before and after opening the mediastinal pleura.
CONCLUSION
The proposed algorithm for topographic and anatomical navigation based on the key anatomical landmarks in the posterior mediastinum provides safe performance of the video-assisted thoracoscopic extirpation of the esophagus in the prone position.
Topics: Esophagectomy; Humans; Lymph Node Excision; Mediastinum; Prone Position; Thoracic Surgery, Video-Assisted; Thoracoscopy
PubMed: 34426859
DOI: 10.1007/s00276-021-02820-8 -
Physics in Medicine and Biology Nov 2017In radiation treatment planning, the esophagus is an important organ-at-risk that should be spared in patients with head and neck cancer or thoracic cancer who undergo...
In radiation treatment planning, the esophagus is an important organ-at-risk that should be spared in patients with head and neck cancer or thoracic cancer who undergo intensity-modulated radiation therapy. However, automatic segmentation of the esophagus from CT scans is extremely challenging because of the structure's inconsistent intensity, low contrast against the surrounding tissues, complex and variable shape and location, and random air bubbles. The goal of this study is to develop an online atlas selection approach to choose a subset of optimal atlases for multi-atlas segmentation to the delineate esophagus automatically. We performed atlas selection in two phases. In the first phase, we used the correlation coefficient of the image content in a cubic region between each atlas and the new image to evaluate their similarity and to rank the atlases in an atlas pool. A subset of atlases based on this ranking was selected, and deformable image registration was performed to generate deformed contours and deformed images in the new image space. In the second phase of atlas selection, we used Kullback-Leibler divergence to measure the similarity of local-intensity histograms between the new image and each of the deformed images, and the measurements were used to rank the previously selected atlases. Deformed contours were overlapped sequentially, from the most to the least similar, and the overlap ratio was examined. We further identified a subset of optimal atlases by analyzing the variation of the overlap ratio versus the number of atlases. The deformed contours from these optimal atlases were fused together using a modified simultaneous truth and performance level estimation algorithm to produce the final segmentation. The approach was validated with promising results using both internal data sets (21 head and neck cancer patients and 15 thoracic cancer patients) and external data sets (30 thoracic patients).
Topics: Algorithms; Automation; Esophagus; Head and Neck Neoplasms; Humans; Image Processing, Computer-Assisted; Male; Radiotherapy Planning, Computer-Assisted; Radiotherapy, Intensity-Modulated; Tomography, X-Ray Computed
PubMed: 29049027
DOI: 10.1088/1361-6560/aa94ba -
Thoracic Organ Doses and Cancer Risk from Low Pitch Helical 4-Dimensional Computed Tomography Scans.BioMed Research International 2018To investigate the dose depositions to organs at risk (OARs) and associated cancer risk in cancer patients scanned with 4-dimensional computed tomography (4DCT) as... (Clinical Trial)
Clinical Trial
PURPOSE
To investigate the dose depositions to organs at risk (OARs) and associated cancer risk in cancer patients scanned with 4-dimensional computed tomography (4DCT) as compared with conventional 3DCT.
METHODS AND MATERIALS
The radiotherapy treatment planning CT image and structure sets of 102 patients were converted to CT phantoms. The effective diameters of those patients were computed. Thoracic scan protocols in 4DCT and 3DCT were simulated and verified with a validated Monte Carlo code. The doses to OARs (heart, lungs, esophagus, trachea, spinal cord, and skin) were calculated and their correlations with patient effective diameter were investigated. The associated cancer risk was calculated using the published models in BEIR VII reports.
RESULTS
The average of mean dose to thoracic organs was in the range of 7.82-11.84 cGy per 4DCT scan and 0.64-0.85 cGy per 3DCT scan. The average dose delivered per 4DCT scan was 12.8-fold higher than that of 3DCT scan. The organ dose was linearly decreased as the function of patients' effective diameter. The ranges of intercept and slope of the linear function were 17.17-30.95 and -0.0278--0.0576 among patients' 4DCT scans, and 1.63-2.43 and -0.003--0.0045 among patients' 3DCT scans. Relative risk of cancer increased (with a ratio of 15.68:1) resulting from 4DCT scans as compared to 3DCT scans.
CONCLUSIONS
As compared to 3DCT, 4DCT scans deliver more organ doses, especially for pediatric patients. Substantial increase in lung cancer risk is associated with higher radiation dose from 4DCT and smaller patients' size as well as younger age.
Topics: Adolescent; Adult; Aged; Aged, 80 and over; Child; Female; Humans; Male; Middle Aged; Neoplasms, Radiation-Induced; Radiation Dosage; Risk Factors; Thoracic Neoplasms; Thorax; Tomography, X-Ray Computed
PubMed: 30345309
DOI: 10.1155/2018/8927290 -
Computational and Mathematical Methods... 2013We managed to establish three-dimensional digitized visible model of human thoracic structures and to provide morphological data for imaging diagnosis and thoracic and...
We managed to establish three-dimensional digitized visible model of human thoracic structures and to provide morphological data for imaging diagnosis and thoracic and cardiovascular surgery. With Photoshop software, the contour line of lungs and mediastinal structures including heart, aorta and its ramus, azygos vein, superior vena cava, inferior vena cava, thymus, esophagus, diaphragm, phrenic nerve, vagus nerve, sympathetic trunk, thoracic vertebrae, sternum, thoracic duct, and so forth were segmented from the Chinese Visible Human (CVH)-1 data set. The contour data set of segmented thoracic structures was imported to Amira software and 3D thorax models were reconstructed via surface rendering and volume rendering. With Amira software, surface rendering reconstructed model of thoracic organs and its volume rendering reconstructed model were 3D reconstructed and can be displayed together clearly and accurately. It provides a learning tool of interpreting human thoracic anatomy and virtual thoracic and cardiovascular surgery for medical students and junior surgeons.
Topics: Adult; Algorithms; Anatomy, Cross-Sectional; Cadaver; China; Diagnostic Imaging; Humans; Image Processing, Computer-Assisted; Imaging, Three-Dimensional; Male; Models, Theoretical; Reproducibility of Results; Software; Thorax; Visible Human Projects
PubMed: 24369489
DOI: 10.1155/2013/795650 -
Journal of Cellular and Molecular... Nov 2013Telocytes (TCs), a new type of interstitial cells, were identified in many different organs and tissues of mammalians and humans. In this study, we show the presence, in...
Telocytes (TCs), a new type of interstitial cells, were identified in many different organs and tissues of mammalians and humans. In this study, we show the presence, in human oesophagus, of cells having the typical features of TCs in lamina propria of the mucosa, as well as in muscular layers. We used transmission electron microscopy (TEM), immunohistochemistry (IHC) and primary cell culture. Human oesophageal TCs present a small cell body with 2-3 very long Telopodes (Tps). Tps consist of an alternation of thin segments (podomers) and thick segments (podoms) and have a labyrinthine spatial arrangement. Tps establish close contacts ('stromal synapses') with other neighbouring cells (e.g. lymphocytes, macrophages). The ELISA testing of the supernatant of primary culture of TCs indicated that the concentrations of VEGF and EGF increased progressively. In conclusion, our study shows the existence of typical TCs at the level of oesophagus (mucosa, submucosa and muscular layer) and suggests their possible role in tissue repair.
Topics: Cell Size; Cells, Cultured; Epidermal Growth Factor; Esophagus; Humans; Microscopy, Electron, Transmission; Mucous Membrane; Myocytes, Smooth Muscle; Primary Cell Culture; Vascular Endothelial Growth Factor A
PubMed: 24188731
DOI: 10.1111/jcmm.12149 -
The Journal of Thoracic and... Aug 2019Esophageal dysmotility and gastroesophageal reflux disease are common in patients with advanced lung disease and can potentially affect outcomes of lung transplant;...
BACKGROUND
Esophageal dysmotility and gastroesophageal reflux disease are common in patients with advanced lung disease and can potentially affect outcomes of lung transplant; however, the effects of lung transplant on foregut function remain unknown. We assessed foregut function before and after bilateral lung transplant.
METHODS
We attempted complete foregut function testing before and after lung transplant. We compared patients with obstructive lung disease and patients with restrictive lung disease who underwent lung transplant between 2015 and 2016.
RESULTS
In total, 112 patients met inclusion criteria. The mean age of patients was 62.2 years, and 62 patients were men. A total of 51 patients (45.5%) were diagnosed with obstructive lung disease, and 56 patients (50.0%) were diagnosed with restrictive lung disease. Approximately half of these patients had a change in manometric diagnosis before and after lung transplant, with most achieving increased peristaltic vigor. Pre-lung transplant gastroesophageal reflux disease was more prevalent in the restrictive lung disease cohort than in the obstructive lung disease cohort (42.9% vs 19.6%, P = .010). Thoracoabdominal pressure gradient before lung transplantation was greater in the restrictive lung disease group than in the obstructive lung disease group (23.4 vs 14.7 mm Hg, P < .001), which may explain the mechanism of increased reflux in patients with restrictive lung disease. No differences were seen in the post-lung transplant prevalence of pathological reflux and thoracoabdominal pressure gradient between groups.
CONCLUSIONS
Esophageal motility and reflux parameters vary significantly between patients with obstructive lung disease and patients with restrictive lung disease, and can be explained by differences in underlying pulmonary dynamics. Restoring pulmonary physiology after lung transplant ameliorates the effects of esophageal dysmotility and reflux. Improved peristaltic vigor after lung transplant in patients with hypomotility is important, which may make them eligible for antireflux surgery if gastroesophageal reflux disease persists after lung transplant.
Topics: Aged; Endoscopy, Digestive System; Esophageal Motility Disorders; Esophagus; Female; Gastric Emptying; Gastroesophageal Reflux; Humans; Lung Transplantation; Male; Manometry; Middle Aged
PubMed: 31084982
DOI: 10.1016/j.jtcvs.2019.02.128 -
The Journal of Thoracic and... Sep 2017
Topics: Endoscopy; Esophagectomy; Esophagus; Metals; Stents
PubMed: 28645825
DOI: 10.1016/j.jtcvs.2017.05.026 -
American Journal of Physiology.... Jun 2013We studied the digestive and respiratory tract motor responses in 10 chronically instrumented dogs during eructation activated after feeding. Muscles were recorded from...
We studied the digestive and respiratory tract motor responses in 10 chronically instrumented dogs during eructation activated after feeding. Muscles were recorded from the cervical area, thorax, and abdomen. The striated muscles were recorded using EMG and the smooth muscles using strain gauges. We found eructation in three distinct functional phases that were composed of different sets of motor responses: gas escape, barrier elimination, and gas transport. The gas escape phase, activated by gastric distension, consists of relaxation of the lower esophageal sphincter and diaphragmatic hiatus and contraction of the longitudinal muscle of the thoracic esophagus and rectus abdominis. All these motor events promote gas escape from the stomach. The barrier elimination phase, probably activated by rapid gas distension of the thoracic esophagus, consists of relaxation of the pharyngeal constrictors and excitation of dorsal and ventral upper esophageal sphincter distracting muscles, as well as rapid contraction of the diaphragmatic dome fibers. These motor events allow esophagopharyngeal air movement by promoting retrograde airflow and opening of the upper esophageal sphincter. The transport phase, possibly activated secondary to diaphragmatic contraction, consists of a retrograde contraction of the striated muscle esophagus that transports the air from the thoracic esophagus to the pharynx. We hypothesize that the esophageal reverse peristalsis is mediated by elementary reflexes, rather than a coordinated peristaltic response like secondary peristalsis. The phases of eructation can be activated independently of one another or in a different manner to participate in physiological events other than eructation that cause gastroesophageal or esophagogastric reflux.
Topics: Animals; Diaphragm; Dogs; Electromyography; Eructation; Esophageal Sphincter, Upper; Esophagus; Larynx; Muscle Contraction; Muscle, Smooth; Peristalsis; Pharynx; Rectus Abdominis; Stomach
PubMed: 23578784
DOI: 10.1152/ajpgi.00043.2013 -
Annals of the New York Academy of... Dec 2018Despite improvements in operative strategies for esophageal resection, anastomotic leaks, fistula, postoperative pulmonary complications, and chylothorax can occur. Our... (Review)
Review
Despite improvements in operative strategies for esophageal resection, anastomotic leaks, fistula, postoperative pulmonary complications, and chylothorax can occur. Our review seeks to identify potential risk factors, modalities for early diagnosis, and novel interventions that may ameliorate the potential adverse effects of these surgical complications following esophagectomy.
Topics: Anastomotic Leak; Esophagectomy; Esophagus; Humans; Lung Diseases
PubMed: 29984413
DOI: 10.1111/nyas.13920 -
Surgical Endoscopy Apr 2017During esophageal dissection and lymphadenectomy of the upper mediastinum by thoracoscopy in prone position, we observed a complex anatomy in which we had to resect the...
BACKGROUND
During esophageal dissection and lymphadenectomy of the upper mediastinum by thoracoscopy in prone position, we observed a complex anatomy in which we had to resect the esophagus, dissect vessels and nerves, and take down some of these in order to perform a complete lymphadenectomy. In order to improve the quality of the dissection and standardization of the procedure, we describe the surgical anatomy and steps involved in this procedure.
METHODS
We retrospectively evaluated twenty consecutive and unedited videos of thoracoscopic esophageal resections. We recorded the vascular anatomy of the supracarinal esophagus, lymph node stations and the steps taken in this procedure. The resulting concept was validated in a prospective study including five patients.
RESULTS
Seventy percent of patients in the retrospective study had one right bronchial artery (RBA) and two left bronchial arteries (LBA). The RBA was divided at both sides of the esophagus in 18 patients, with preservation of one LBA or at least one esophageal branch in all cases. Both recurrent laryngeal nerves were identified in 18 patients. All patients in the prospective study had one RBA and two LBA, and in four patients the RBA was divided at both sides of the esophagus and preserved one of the LBA. Lymphadenectomy was performed of stations 4R, 4L, 2R and 2L, with a median of 11 resected lymph nodes. Both recurrent laryngeal nerves were identified in four patients. In three patients, only the left recurrent nerve could be identified. Two patients showed palsy of the left recurrent laryngeal nerve, and one showed neuropraxia of the left vocal cord.
CONCLUSIONS
Knowledge of the surgical anatomy of the upper mediastinum and its anatomical variations is important for standardization of an adequate esophageal resection and paratracheal lymphadenectomy with preservation of any vascularization of the trachea, bronchi and the recurrent laryngeal nerves.
Topics: Adenocarcinoma; Carcinoma, Squamous Cell; Dissection; Esophageal Neoplasms; Esophagectomy; Esophagus; Humans; Lymph Node Excision; Mediastinum; Prospective Studies; Retrospective Studies; Thoracoscopy; Treatment Outcome; Video Recording
PubMed: 27553798
DOI: 10.1007/s00464-016-5186-1