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Journal articles on the topic 'Transaxillary access'

Author: Grafiati

Published: 5 July 2023

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1

Semenov, D. Yu, M. E. Boriskova, P. A. Pankova, G. V. Volchkov, and M. A. Bykov. "TRANSAXILLARY ENDOVIDEOSURGICAL ACCESS IN THYROID SURGERY." VESTNIK KHIRURGII IMENI I.I.GREKOVA 177, no. 1 (March 10, 2018): 37–40. http://dx.doi.org/10.24884/0042-4625-2018-177-1-37-40.

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2

Marsillac, Alexandre Elmães de, Rossano Kepler Alvim Fiorelli, Henrique Neubarth Phillips, Pietro Novellino, André Lacerda Oliveira, and Ricardo Paiva A. Scheiba Zorron. "Transaxillary single-port subtotal parathyroidectomy: feasibility study in cadavers." Revista do Colégio Brasileiro de Cirurgiões 44, no. 2 (April 2017): 125–30. http://dx.doi.org/10.1590/0100-69912017002003.

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ABSTRACT Objective : to test the minimally invasive technique of single-port transaxillary subtotal parathyroidectomy in non-formalized cadavers to evaluate its viability and reproduction. Method : we performed ten subtotal parathyroidectomies through a transaxillary TriPort access in cadavers. The technique consisted of access through the axillary fossa, creating a subcutaneous tunnel to the anterior cervical region, for handling of the thyroid gland and dissection and resection of the parathyroid glands. Results : all surgeries were successful. The mean time of surgery was 65 minutes (57-79 min), with uncomplicated identification of all anatomical structures. There was no need for complementary incisions in the cervical region. Conclusion : the transaxillary single-port subtotal parathyroidectomy technique was feasible and reproducible, suggesting an alternative for minimally invasive cervical surgery.

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3

Wilbring, Manuel, Konstantin Alexiou, Torsten Schmidt, Asen Petrov, Ali Taghizadeh-Waghefi, Efstratios Charitos, Klaus Matschke, Sebastian Arzt, and Utz Kappert. "Safety and Efficacy of the Transaxillary Access for Minimally Invasive Aortic Valve Surgery." Medicina 59, no. 1 (January 13, 2023): 160. http://dx.doi.org/10.3390/medicina59010160.

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Background and Objectives: Transaxillary access is one of the latest innovations for minimally invasive aortic valve replacement (MICS-AVR). This study compares clinical performance in a large transaxillary MICS-AVR group to a propensity-matched sternotomy control group. Materials and Methods: This study enrolled 908 patients undergoing isolated AVR with a mean age of 69.4 ± 18.0 years, logistic EuroSCORE of 4.0 ± 3.9%, and body mass index (BMI) of 27.3 ± 6.1 kg/m2. The treatment group comprised 454 consecutive transaxillary MICS-AVR patients. The control group was 1:1 propensity-matched out of 3115 consecutive sternotomy aortic valve surgeries. Endocarditis, redo, and combined procedures were excluded. The multivariate matching model included age, left ventricular ejection fraction, logistic EuroSCORE, pulmonary hypertension, coronary artery disease, chronic lung disease, and BMI. Results: Propensity-matching was successful with subsequent comparable clinical baselines in both groups. MICS-AVR had longer skin-to-skin time (120.0 ± 31.5 min vs. 114.2 ± 28.7 min; p < 0.001) and more frequent bleeding requiring chest reopening (5.0% vs. 2.4%; p < 0.010), but significantly less packed red blood cell transfusions (0.57 ± 1.6 vs. 0.82 ± 1.6; p = 0.040). In addition, MICS-AVR patients had fewer access site wound abnormalities (1.5% vs. 3.7%; p = 0.038), shorter intensive care unit stays (p < 0.001), shorter ventilation times (p < 0.001), and shorter hospital stays (7.0 ± 5.1 days vs. 11.1 ± 6.5; p < 0.001). No significant differences were observed in stroke > Rankin 2 (0.9% vs. 1.1%; p = 0.791), renal replacement therapy (1.5% vs. 2.4%; p = 0.4762), and hospital mortality (0.9% vs. 1.5%; p = 0.546). Conclusions: Transaxillary MICS-AVR is at least as safe as AVR by sternotomy and can be performed in the same time frame. Its advantages are fewer transfusions and quicker postoperative recovery with a significantly shorter hospital stay. The cosmetic result and unrestricted physical abilities due to the untouched sternum and ribs are unique advantages of transaxillary access.

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Terzi, Alberto, Andrea Viti, and Luca Bertolaccini. "Transaxillary access to aortopulmonary window and paraaortic nodes." Asian Cardiovascular and Thoracic Annals 22, no. 9 (December 6, 2013): 1138–40. http://dx.doi.org/10.1177/0218492313516326.

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5

Taghizadeh-Waghefi, Ali, Sebastian Arzt, Veronica De Angelis, Jana Schiffarth, Asen Petrov, Matuš Tomko, Konstantin Alexiou, Klaus Matschke, Utz Kappert, and Manuel Wilbring. "Safety and Efficacy of the Transaxillary Access for Minimally Invasive Mitral Valve Surgery—A Propensity Matched Competitive Analysis." Medicina 58, no. 12 (December 15, 2022): 1850. http://dx.doi.org/10.3390/medicina58121850.

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Background and Objectives: Transaxillary access is a straightforward “single incision—direct vision” concept, based on a 5 cm skin incision in the right anterior axillary line. It is suitable for aortic, mitral and tricuspid surgery. The present study evaluates the hospital outcomes of the transaxillary access for isolated mitral valve surgery compared with full sternotomy. Patients and Methods: The final study group included 480 patients. A total of 160 consecutive transaxillary patients served as treatment group (MICS-MITRAL). Based on a multivariate logistic regression model including age, sex, body-mass-index, EuroScore II and LVEF, a 1:2 propensity matched control-group (n = 320) was generated out of 980 consecutive sternotomy patients. Redo surgeries, endocarditis or combined procedures were excluded. The mean age was 66.6 ± 10.6 years, 48.6% (n = 234) were female. EuroSCORE II averaged 1.98 ± 1.4%. Results: MICS-MITRAL had longer perfusion (88.7 ± 26.6 min vs. 68.7 ± 32.7 min; p < 0.01) and cross-clamp (64.4 ± 22.3 min vs. 49.7 ± 22.4 min; p < 0.01) times. This did not translate into longer procedure times (132 ± 31 min vs. 131 ± 46 min; p = 0.76). Both groups showed low rates of failed repair (MICS-MITRAL: n = 6/160; 3.75%; Sternotomy: n = 10/320; 3.1%; p = 0.31). MICS-MITRAL had lower transfusion rates (p ≤ 0.001), less re-exploration for bleeding (p = 0.04), shorter ventilation times (p = 0.02), shorter ICU-stay (p = 0.05), less postoperative hemofiltration (p < 0.01) compared to sternotomy patients. No difference was seen in the incidence of stroke (p = 0.47) and postoperative delirium (p = 0.89). Hospital mortality was significantly lower in MICS-MITRAL patients (0.0% vs. 3.4%; p = 0.02). Conclusions: The transaxillary access for MICS-MITRAL provides superior cosmetics and excellent clinical outcomes. It can be performed at least as safely and in the same time frame as conventional mitral surgery by sternotomy.

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6

Trani, Carlo, Cristina Aurigemma, Enrico Romagnoli, and Francesco Burzotta. "Percu-Ax aortic valve implantation with a double arm approach: a case report." European Heart Journal - Case Reports 4, no. 5 (October 1, 2020): 1–5. http://dx.doi.org/10.1093/ehjcr/ytaa225.

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Abstract Background Transaxillary route for structural and coronary percutaneous interventions represents a valid alternative access in patients with obstructive peripheral disease. Nevertheless, its widespread use is limited by a less manageable haemostasis procedure. Case summary In this case, we describe a minimalistic high-risk transcatheter aortic valve implantation (TAVI) procedure (TAVI Score 6.42%) conducted with a double arm approach (radial and axillary accesses) in an 88-year-old patient with severe aortic stenosis and multiple co-morbidities preventing both surgical (Society of Thoracic Surgeons mortality 7.9%) and percutaneous transfemoral approach (extensive peripheral artery disease). We also described the successful management of a complicated transaxillary haemostasis with this technique. Discussion In our cases, a minimalist double-arm approach was successfully used for TAVI procedure as an alternative to transfemoral approach assuring effective and safe management of vascular access haemostasis.

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Liu, Yang, Jiazhong Wang, Shuo Chen, and Gang Cao. "Endoscopic total thyroidectomy using a unilateral transaxillary approach: A case report." Journal of International Medical Research 51, no. 3 (March 2023): 030006052311589. http://dx.doi.org/10.1177/03000605231158962.

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Endoscopic transaxillary thyroidectomy is a common method for remote-access thyroidectomy. The approach typically uses a gasless method, and a long incision to insert a special retractor. In addition, it is considered only suitable for unilateral lobectomy because of problems accessing contralateral parts of the thyroid gland. We describe here, a case of a young woman who had a total thyroidectomy performed using an endoscopic approach. We reduced the non-inflated 4–6 cm incision that is usually required, into three holes, and performed unilateral transaxillary thyroidectomy; this was verified by radioactive iodine uptake and thyroglobulin levels during follow-up. The approach was clinically successful and resulted in minimal scarring. More studies are required to optimize this promising technique.

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Arru, M., L. Aldrighetti, F. Gremmo, M. Ronzoni, E. Angeli, R. Caterini, and G. Ferla. "Arterial Devices for Regional Hepatic Chemotherapy: Transaxillary versus Laparotomic Access." Journal of Vascular Access 1, no. 3 (July 2000): 93–99. http://dx.doi.org/10.1177/112972980000100305.

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Schäfer, Ulrich, Yen Ho, Christian Frerker, Dimitry Schewel, Damian Sanchez-Quintana, Joachim Schofer, Klaudija Bijuklic, et al. "Direct Percutaneous Access Technique for Transaxillary Transcatheter Aortic Valve Implantation." JACC: Cardiovascular Interventions 5, no. 5 (May 2012): 477–86. http://dx.doi.org/10.1016/j.jcin.2011.11.014.

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10

Wang, Huan, James L. Swischuk, Kenneth Fraser, Jorge Alvernia, and Giuseppe Lanzino. "Transaxillary Carotid Stenting: Technical Case Report." Operative Neurosurgery 56, suppl_4 (April 1, 2005): ONS—E441—ONS—E441. http://dx.doi.org/10.1227/01.neu.0000156847.28054.66.

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Abstract OBJECTIVE AND IMPORTANCE: As endovascular neurointerventions continue to evolve rapidly, angioplasty and stenting of both the extracranial and intracranial vessels have become more routine procedures. When the transfemoral approach is contraindicated or technically difficult, familiarity with alternative access techniques becomes essential. We report a successful transaxillary carotid stenting in a patient with an axillary bifemoral bypass graft. CLINICAL PRESENTATION: A 77-year-old man presented with a symptomatic high-grade stenosis (80%) of the left internal carotid artery. Because of the increased risk of general anesthesia related to his advanced age and severe comorbidities, stenting of the left internal carotid artery was considered. A left transaxillary approach was chosen because of the presence of an axillary bifemoral bypass graft. TECHNIQUE: Under ultrasound guidance, the left axillary artery was successfully punctured and cannulated. After a 0.038 Magic Torque wire (Boston Scientific/Medi-Tech, Watertown, MA) was anchored with the tip of the wire in the distal left occipital artery, a 7-French (outer diameter) Vista Bright guiding sheath (Cordis, Miami, FL) was successfully positioned in the mid left common carotid artery, with an MPA catheter (Cordis) used as guiding support. Subsequently, two Precise stents (Cordis) were successfully deployed across the stenosis, yielding a satisfactory angiographic result. CONCLUSION: With proper patient selection and the use of ultrasound guidance during the initial puncture, the transaxillary approach is a safe and technically feasible alternative to the transfemoral approach when performing carotid stenting.

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Bondarenko, Yu S., D. M. Salikhov, and A. N. Petrovsky. "Transaxillary hemithyroidectomy and parathyroidectomy: mastering the technique." Endocrine Surgery 15, no. 4 (December 14, 2022): 20–21. http://dx.doi.org/10.14341/serg12768.

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Background. The relevance of endoscopic interventions on the thyroid and parathyroid glands is beyond doubt, and this explains the interest in this promising choice of surgical approach both among surgeons and patients who want to avoid a scar on the neck.Aim. To evaluate the first results of own endoscopic interventions in patients with diseases of the thyroid and parathyroid glands.Materials and methods. In the Research Institute of KCH N 1 named after prof. S.V. Ochapovsky from December 2020 to April 2022, 23 hemithyroidectomies and 8 paraadenomectomies were performed using endoscopic techniques for benign neoplasms of the thyroid and parathyroid glands. All patients in the preoperative period underwent ultrasound, TAPB + CI (for thyroid pathology), and the hormonal background was studied. Indications for endoscopic hemithyroidectomy in 18 cases were colloid goiter, in 5 cases — follicular adenoma. The indication for endoscopic paraadenomectomy in all cases was primary hyperparathyroidism. We used endoscopic three-port axillary-mammary gas access. Under the ETN, an incision was made along the outer edge of the pectoralis major muscle (m. pectoralis major). Carbon dioxide was injected into the pancreas using a Verish needle. A 5 mm port was inserted along the edge of the areola. Another 10 mm trocar was installed at the attachment points (m. pectoralis major).Results. The average operation time was 190.4 minutes for endoscopic hemithyroidectomy and 78.6 minutes for endoscopic paraadenomectomy. With the increase in the number of performed operations, there was a decrease in the duration of surgical interventions. In two cases in patients after hemithyroidectomy, seromas up to 20 ml in volume were noted in the postoperative period, which required puncture interventions (once).Conclusion. Endoscopic interventions on the thyroid and parathyroid glands from axillary access are a safe method of surgical intervention, and the cosmetic result is an indisputable advantage of this method.

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12

Clark, Shane, Olgert Bardhi, Ankur Jain, and Siddharth Wayangankar. "A NEW APPROACH - UTILIZING PERCUTANEOUS TRANSAXILLARY ACCESS FOR AORTIC VALVE REPLACEMENT." Journal of the American College of Cardiology 77, no. 18 (May 2021): 985. http://dx.doi.org/10.1016/s0735-1097(21)02344-5.

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13

Thawabi, Mohammad, Rajiv Tayal, Amer Hawatmeh, Marc Cohen, and Najam Wasty. "UTILITY OF PERCUTANEOUS TRANSAXILLARY ACCESS FOR PERIPHERAL VASCULAR PROCEDURES AND INTERVENTIONS." Journal of the American College of Cardiology 71, no. 11 (March 2018): A1436. http://dx.doi.org/10.1016/s0735-1097(18)31977-6.

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14

Roebuck, Derek J., Kani Vendhan, Alex M. Barnacle, Stefan Brew, and Clare A. McLaren. "Ultrasound-guided Transaxillary Access for Diagnostic and Interventional Arteriography in Children." Journal of Vascular and Interventional Radiology 21, no. 6 (June 2010): 842–47. http://dx.doi.org/10.1016/j.jvir.2010.02.025.

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15

Dralle, Henning. "Robot-Assisted Transaxillary Thyroid Surgery: As Safe as Conventional-Access Thyroid Surgery?" European Thyroid Journal 2, no. 2 (2013): 71–75. http://dx.doi.org/10.1159/000350856.

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16

Bertoglio, Luca, Lenard Conradi, Dominic P. J. Howard, Amir Kaki, Wouter Van den Eynde, Javier Rio, Matteo Montorfano, et al. "Percutaneous transaxillary access for endovascular aortic procedures in the multicenter international PAXA registry." Journal of Vascular Surgery 75, no. 3 (March 2022): 868–76. http://dx.doi.org/10.1016/j.jvs.2021.08.089.

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17

Rogers, Toby, and Robert J. Lederman. "Percutaneous transaxillary access for TAVR: Another opportunity to stay out of the chest." Catheterization and Cardiovascular Interventions 91, no. 1 (January 1, 2018): 157–58. http://dx.doi.org/10.1002/ccd.27458.

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18

Zanon, C., and M. Grosso. "Transaxillary access to perform hepatic artery infusion (HAI) for secondary or primitive hepatic tumours." European Journal of Cancer 32, no. 10 (September 1996): 1824–25. http://dx.doi.org/10.1016/0959-8049(96)00179-7.

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19

Kanei, Yumiko, Waqas Qureshi, Nirmal Kaur, Jennifer Walker, and Nikolaos Kakouros. "CRT-600.11 Percutaneous Transaxillary Transcatheter Aortic Valve Replacement (TAVR) With Minimalist Approach as Primary Alternative Access to Transfemoral Access." JACC: Cardiovascular Interventions 13, no. 4 (February 2020): S49—S50. http://dx.doi.org/10.1016/j.jcin.2020.01.157.

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20

Coughlan, JJ, Thomas J. Kiernan, and Samer Arnous. "Alternative Access for Transcatheter Aortic Valve Implantation: Current Evidence and Future Directions." Vascular and Endovascular Review 2, no. 1 (April 15, 2019): 23–27. http://dx.doi.org/10.15420/ver.2019.4.2.

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Transcatheter aortic valve implantation (TAVI) is the usual technique for patients with severe aortic stenosis who are at high risk for surgical aortic valve replacement. The transfemoral (TF) route is the most commonly used access type, and significant progress in this procedure has greatly increased the proportion of patients who can undergo it. Not all patients are suitable for TF TAVI, however, so other routes, including transapical, transaortic, subclavian, trans-subclavian/transaxillary, transcarotid and transcaval, may need to be used. Evidence on these routes shows promising results but the majority of this is registry data rather than randomised controlled trials, so TF TAVI remains the safest access route and should be considered for most patients. However, in patients who are unsuitable for TF TAVI, alternative access routes are safe and feasible. The challenges concern choosing the best route, the valve to use and skill of the specialist centre. This article provides a overview of options for alternative vascular access in TAVI, the clinical rationale for using them, current evidence and areas for clinical investigation.

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Mach, Markus, Sercan Okutucu, Tillmann Kerbel, Aref Arjomand, Sefik Gorkem Fatihoglu, Paul Werner, Paul Simon, and Martin Andreas. "Vascular Complications in TAVR: Incidence, Clinical Impact, and Management." Journal of Clinical Medicine 10, no. 21 (October 28, 2021): 5046. http://dx.doi.org/10.3390/jcm10215046.

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Transcatheter aortic valve replacement (TAVR) has replaced surgical aortic valve replacement as the new gold standard in elderly patients with severe aortic valve stenosis. However, alongside this novel approach, new complications emerged that require swift diagnosis and adequate management. Vascular access marks the first step in a TAVR procedure. There are several possible access sites available for TAVR, including the transfemoral approach as well as transaxillary/subclavian, transcarotid, transapical, and transcaval. Most cases are primarily performed through a transfemoral approach, while other access routes are mainly conducted in patients not suitable for transfemoral TAVR. As vascular access is achieved primarily by large bore sheaths, vascular complications are one of the major concerns during TAVR. With rising numbers of TAVR being performed, the focus on prevention and successful management of vascular complications will be of paramount importance to lower morbidity and mortality of the procedures. Herein, we aimed to review the most common vascular complications associated with TAVR and summarize their diagnosis, management, and prevention of vascular complications in TAVR.

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Sardone, Andrea, Luca Franchin, Diego Moniaci, Salvatore Colangelo, Francesco Colombo, Giacomo Boccuzzi, and Mario Iannaccone. "Management of Vascular Access in the Setting of Percutaneous Mechanical Circulatory Support (pMCS): Sheaths, Vascular Access and Closure Systems." Journal of Personalized Medicine 13, no. 2 (February 6, 2023): 293. http://dx.doi.org/10.3390/jpm13020293.

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The use of percutaneous mechanical circulatory support (pMCS), such as intra-aortic balloon pump, Impella, TandemHeart and VA-ECMO, in the setting of cardiogenic shock or in protect percutaneous coronary intervention (protect-PCI) is rapidly increasing in clinical practice. The major problem related to the use of pMCS is the management of all the device-related complications and of any vascular injury. MCS often requires large-bore access, if compared with common PCI, and for this reason the correct management of vascular access is a crucial point. The correct use of these devices in catheterization laboratories requires specific knowledge such as the correct evaluation of the vascular access performed, when possible, with advance imaging techniques in order to choose a percutaneous or a surgical approach. In addition to conventional transfemoral access, other types of access, such as transaxillary/subclavial access and the transcaval approach, have emerged over the years. These other approaches require advanced skills of the operators and a multidisciplinary team with dedicated physicians. Another important part of the management of vascular access is the closure systems used for hemostasis. Currently, two types of devices are typically used in the lab: suture-based or plug-based ones. In this review we want to describe all these aspects related to the management of vascular access in pMCS and describe, finally, a case report from our center’s experience.

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23

Fan, Ying, Shuo-Dong Wu, and Jing Kong. "Single-Port Access Transaxillary Totally Endoscopic Thyroidectomy: A New Approach for Minimally Invasive Thyroid Operation." Journal of Laparoendoscopic & Advanced Surgical Techniques 21, no. 3 (April 2011): 243–47. http://dx.doi.org/10.1089/lap.2010.0547.

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24

Alharbi, Anas A., Fahad S. Alqahtani, Peter Farjo, and Jason A. Moreland. "Axillary Artery Pseudoaneurysm Following Percutaneous Transaxillary Access for Impella Device Placement During Percutaneous Coronary Intervention." JACC: Case Reports 2, no. 6 (June 2020): 907–10. http://dx.doi.org/10.1016/j.jaccas.2020.05.005.

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25

Muscoli, Saverio, Valeria Cammalleri, Michela Bonanni, Francesca Romana Prandi, Angela Sanseviero, Gianluca Massaro, Marco Di Luozzo, et al. "The Transaxillary Route as a Second Access Option in TAVI Procedures: Experience of a Single Centre." International Journal of Environmental Research and Public Health 19, no. 14 (July 16, 2022): 8649. http://dx.doi.org/10.3390/ijerph19148649.

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Background: The aim of our study was to determine the feasibility and efficacy of transaxillary (TAX) TAVI in patients not eligible for the transfemoral route. Methods: This is a retrospective study of a single center. We analysed 262 patients treated with TAVI. In 17 patients (6.5%), the procedure was performed with the TAX approach. Procedural and hospital data, 30-day safety, and clinical efficacy were assessed and compared between the transfemoral and TAX groups. Results: In the TAX groups, we found a higher prevalence of men (p = 0.001), smokers (p = 0.033), and previous strokes (p = 0.02). The EUROSCORE II was higher in the TAX group (p = 0.014). The success rate of the device was 100%. TAX was associated with a longer procedure time (p = 0.001) and shorter median device time (p = 0.034) in minutes. Patients treated with TAX had a longer hospital stay (p = 0.005) and higher overall bleeding rate (p = 0.001). Peripheral neurological complications were more frequent with TAX (p = 0.001), which almost completely resolved by 30 days. Conclusions: TAX TAVI is safe and effective and should be considered as a second choice when transfemoral TAVI is not feasible due to severe comorbidities.

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Huang, Georgeanna J., Julian L. Wichmann, and Dan C. Mills. "Transaxillary Subpectoral Augmentation Mammaplasty: A Single Surgeon’s 20-Year Experience." Aesthetic Surgery Journal 31, no. 7 (September 1, 2011): 781–801. http://dx.doi.org/10.1177/1090820x11416936.

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Abstract Background Transaxillary subpectoral augmentation mammaplasty (TASPA) is not widely accepted due to perceived limitations in pocket access, visualization, control, and subsequent risk for postoperative complications. Current published data do little to substantiate or refute those claims. Objective A retrospective chart review of a single surgeon’s 20-year experience with the TASPA technique was undertaken to assess the incidence of total secondary procedures, implant-related revisions, and reoperations unrelated to the implant. Methods The senior author (DCM) performed 1776 primary TASPA procedures from January 1989 through December 2008. Of those, 94 patients did not meet inclusion criteria, leaving a total of 1682 records for analysis. Data reviewed included age, date of surgery, race, implant size and type, manufacturer, and reasons for reoperation. Results Average age was 32.7 ± 8.1 years (range, 16-62). Average implant size was 438.5 ± 51.5 cc (range, 270-630). Implants from Allergan/Inamed/McGhan (Irvine, CA), Dow-Corning (Midland, MI), Mentor (Santa Barbara, CA), and Surgitek (Racine, PA) were inserted (n = 2094 saline, n = 1270 silicone). Mean follow-up time was 37.9 ± 45.4 months (range, one month to 19.8 years). Excluding staged mastopexies and treatment for breast cancer, total secondary procedures were required in 225 patients (13.4%). Implant-related revisions included malposition (2.97%), size change (2.5%), and capsular contracture (1.9%). Perioperatively, no infections occurred, and two patients (0.12%) experienced hematoma. Most reoperations (62.8%) were performed through the axilla. Comparison to published data showed an equal or lower rate of capsular contracture, hematoma, and infection with the TASPA approach. Conclusions Given its advantages of an inconspicuous scar, decreased infection, and decreased capsular contracture, TASPA can be safely offered to patients as an option in breast augmentation.

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Abraham, Bishoy, Mina Sous, Ramy Sedhom, Sherif Roman, Michael Megaly, and F. David Fortuin. "A META-ANALYSIS COMPARING TRANSCAROTID VERSUS TRANSAXILLARY/TRANSUBCLAVIAN AND TRANSAPICAL ACCESS IN TRANSCATHETER AORTIC VALVE REPLACEMENT." Journal of the American College of Cardiology 79, no. 9 (March 2022): 708. http://dx.doi.org/10.1016/s0735-1097(22)01699-0.

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Mahmood, Shazil, Mohamed Almajed, Paul Nona, and Pedro Arturo Villablanca. "NEUROLOGIC COMPLICATIONS OF TRANSAXILLARY ACCESS IN TAVR - A CASE OF POSTPROCEDURAL ULNAR AND MEDIAN NERVE INJURY." Journal of the American College of Cardiology 79, no. 9 (March 2022): 2952. http://dx.doi.org/10.1016/s0735-1097(22)03943-2.

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Rück, Andreas, Daniel Eriksson, Dinos Verouhis, Nawzad Saleh, Rickard Linder, Matthias Corbascio, and Magnus Settergren. "Percutaneous access and closure using the MANTA vascular closure device in transaxillary transcatheter aortic valve implantation." EuroIntervention 16, no. 3 (June 2020): 266–68. http://dx.doi.org/10.4244/eij-d-19-00809.

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30

Debry, Nicolas, Talel Raouf Trimech, Thomas Gandet, Flavien Vincent, Ilir Hysi, Cédric Delhaye, Guillaume Cayla, et al. "Transaxillary compared with transcarotid access for TAVR: a propensity-matched comparison from a French multicentre registry." EuroIntervention 16, no. 10 (November 2020): 842–49. http://dx.doi.org/10.4244/eij-d-20-00117.

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31

Ben Ali, W., R. Cartier, and T. Modine. "TRANSAXILLARY COMPARED WITH TRANSCAROTID ACCESS FOR TAVR: A PROPENSITY-MATCHED COMPARISON FROM A FRENCH MULTICENTER REGISTRY." Canadian Journal of Cardiology 36, no. 10 (October 2020): S108—S109. http://dx.doi.org/10.1016/j.cjca.2020.07.207.

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32

Fenchel, Sabine, Christian Wisianowsky, Silvia Schams, Karin Nuessle, Stefan C. Krämer, Johannes Görich, and Elmar M. Merkle. "Contrast-Enhanced 3D MRA of the Aortoiliac and Infrainguinal Arteries When Conventional Transfemoral Arteriography is Not Feasible." Journal of Endovascular Therapy 9, no. 4 (August 2002): 511–19. http://dx.doi.org/10.1177/152660280200900421.

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Purpose: To evaluate whether contrast-enhanced 3-dimensional (3D) magnetic resonance angiography (MRA) can substitute for transaxillary or transbrachial catheter access when angiography via the transfemoral route is not possible. Methods: Contrast-enhanced 3D MRA was performed in 14 patients (12 men; mean 66.1 ± 12.4 years, range 48–98) with atherosclerotic disease of the aorta or lower extremities in whom conventional transfemoral arteriography was not feasible. The images were evaluated for their ability to identify and characterize lesions directly responsible for the patient's symptoms, adequately depict the vascular anatomy for therapy planning, and identify additional lesions not directly responsible for the patient's symptoms. The arterial system was divided into 15 segments, and image quality and the presence of occlusive disease were determined. Results: MRA adequately depicted 387 (95%) of 406 arterial segments in 14 patients. Nineteen (5%) arterial segments were inadequately delineated because of low signal intensity distal from severe stenoses (n = 11), venous overlap (n = 6), or metallic clip—induced signal voids (n = 2). The lesions directly responsible for the patients' symptoms were identified in all 14 patients (2 aortic occlusions [Leriche's syndrome] and 12 iliac occlusions or severe stenoses). Visualization of the vascular anatomy was adequate for therapy planning in 13 of 14 patients, and 3D MRA satisfactorily identified other lesions not directly responsible for the current symptoms. Conclusions: When transfemoral catheter angiography of the aortoiliac and lower extremities is not feasible, contrast-enhanced 3D MRA is suitable for determining and planning therapy and can be used instead of angiography via the transaxillary or transbrachial routes.

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Allen, Keith, Daniel Watson, Amit Vora, Paul Mahoney, Adnan Chhatriwalla, Jonathan Schwartz, Antoine Keller, Nishtha Sodhi, Ruth Eisenberg, and Michael Caskey. "TCT-606 Transcarotid vs Transaxillary Access for Transcatheter Aortic Valve Replacement With a Self-Expanding, Supra-Annular Valve." Journal of the American College of Cardiology 80, no. 12 (September 2022): B249. http://dx.doi.org/10.1016/j.jacc.2022.08.790.

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Jadhav, Sfurti, Reeta Varyani, Prayaag Kini, Banajit Barooah, and Shambhavi Raju. "“All roads lead to rome” - Dilatation of coarctation in infant presenting with heart failure done via transaxillary access." Indian Heart Journal 73 (December 2021): S43—S44. http://dx.doi.org/10.1016/j.ihj.2021.11.084.

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Abusnina, Waiel, Akshay Machanahalli Balakrishna, Mahmoud Ismayl, Azka Latif, Mostafa Reda Mostafa, Ahmad Al-abdouh, Muhammad Junaid Ahsan, et al. "Comparison of Transfemoral versus Transsubclavian/Transaxillary access for transcatheter aortic valve replacement: A systematic review and meta-analysis." IJC Heart & Vasculature 43 (December 2022): 101156. http://dx.doi.org/10.1016/j.ijcha.2022.101156.

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Russell, Jonathon O., Christopher R. Razavi, Meghan E. Garstka, Lena W. Chen, Elya Vasiliou, Sang-Wook Kang, Ralph P. Tufano, and Emad Kandil. "Remote-Access Thyroidectomy: A Multi-Institutional North American Experience with Transaxillary, Robotic Facelift, and Transoral Endoscopic Vestibular Approaches." Journal of the American College of Surgeons 228, no. 4 (April 2019): 516–22. http://dx.doi.org/10.1016/j.jamcollsurg.2018.12.005.

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Herremans, Andries, Dylan Thomas Stevesyns, Hicham El Jattari, Michaël Rosseel, and Liesbeth Rosseel. "The Place of Transaxillary Access in Transcatheter Aortic Valve Implantation (TAVI) Compared to Alternative Routes—A Systematic Review Article." Reviews in Cardiovascular Medicine 24, no. 5 (May 19, 2023): 150. http://dx.doi.org/10.31083/j.rcm2405150.

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Buzzatti, Nicola, Alessandra Sala, and Ottavio Alfieri. "Comparing traditional aortic valve surgery and transapical approach to transcatheter aortic valve implant." European Heart Journal Supplements 22, Supplement_E (March 23, 2020): E7—E12. http://dx.doi.org/10.1093/eurheartj/suaa050.

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Abstract During the last 15 years, transcatheter aortic valve implant (TAVI) has become a valid alternative to surgical aortic valve replacement in symptomatic patients with severe aortic stenosis, and high or intermediate operative risk. Transcatheter aortic valve implant could be approached through various access sites, among which the transapical has long been one of the most popular. Through the years, this procedure has shown results similar to the standard surgical approach, but not as good as the same procedure via the transfemoral approach. For this reason, along with continuous technological advances, the transfemoral approach is used, presently, in 90% of the patient, while the transapical route has been limited, progressively, to a minority of patients. Currently the Heart Team should decide, in every single patient, between conventional surgery and TAVI. In clinical practice, TAVI is favoured in high-risk patients, and in the elderly at intermediate surgical risk with favourable anatomical features. In patients in whom TAVI is preferable to surgery, but have ‘non-usable’ femoral approach, alternative routes, such as transaxillary or transapical, could be considered.

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Chan, Edward Y., Dennis M. Lumbao, Alexander Iribarne, Rachel Easterwood, Jonathan Y. Yang, Faisal H. Cheema, Craig R. Smith, and Michael Argenziano. "Evolution of Cannulation Techniques for Minimally Invasive Cardiac Surgery a 10-Year Journey." Innovations: Technology and Techniques in Cardiothoracic and Vascular Surgery 7, no. 1 (January 2012): 9–14. http://dx.doi.org/10.1097/imi.0b013e318253369a.

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Objective For minimally invasive cardiac surgery (MICS) procedures requiring cardiopulmonary bypass (CPB), cannulation techniques vary and seem to be important determinants of technical difficulty and clinical outcomes. Over 10 years of MICS, we have modified our techniques substantially, and the present report outlines the evolution of our current cannulation platform. Methods From October 2000 to November 2010, 1087 minimally invasive cardiac procedures were performed at our institution; of these, 165 were done without CPB and were excluded. Methods of arterial and venous cannulation and aortic occlusion were retrospectively reviewed. Outcomes of interest included CPB and aortic cross-clamp time, as well as rates of in-hospital stroke, myocardial infarction, and short- and long-term mortality. Results The mean age of the study population was 57 ± 15 years, with 50% being men. The MICS procedures included mitral valve surgery, atrial septal defect repair, atrial fibrillation ablation, and cardiac tumor resections. Over the study period, peripheral arterial cannulation was replaced by central aortic cannulation, which was used in 33% of patients in 2000–2001 and 93% in 2008–2010. Venous cannulation strategies also evolved over time, from percutaneous neck and femoral (78% of cases from 2000–2005), to direct superior vena cava and percutaneous femoral (67% in 2006–2007), to percutaneous dual-stage femoral (51% in 2008–2010). Aortic occlusion was achieved by endoaortic balloon in 33% of cases in 2000–2001 but, by 2002, was replaced by transaxillary clamp occlusion and direct antegrade/retrograde cardioplegia. In the post-endoballoon era, CPB and cross-clamp times have remained consistent. Overall, there were nine strokes (<1.0%), no myocardial infarctions, and 18 deaths (2.0%) within 30 days of surgery, and the incidence of these outcomes has not changed over time. Conclusions Over 10 years, our cannulation strategy for MICS has evolved to favor central aortic over femoral arterial cannulation, percutaneous femoral dual-stage bicaval venous drainage over percutaneous neck access, and transaxillary clamping over endoaortic balloon occlusion of the aorta. In our experience, this approach has resulted in low complication rates and a reliable platform for a variety of MICS procedures.

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Malvindi, P., P. Berretta, M. Wilbring, O. Bifulco, V. De Angelis, M. Cefarelli, C. Zingaro, U. Kappert, and M. Di Eusanio. "P46 TRANSAXILLARY MITRAL VALVE SURGERY IS ASSOCIATED WITH EARLY RECOVERY AND SHORTER ICU AND HOSPITAL STAY." European Heart Journal Supplements 25, Supplement_D (May 2023): D57—D58. http://dx.doi.org/10.1093/eurheartjsupp/suad111.132.

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Abstract Background and Aim Several thoracic incisions have been described and different techniques used for cardiopulmonary bypass, myocardial protection and valve exposure in minimally invasive mitral valve surgery (MIMVS). Aim of this study is to compare the early outcomes of patients operated through a right trans–axillary (TAxA) approach with those achieved in conventional full sternotomy (FS) operations. Methods Prospectively collected data of patients who underwent mitral valve surgery between 2017 and 2022 at two academic centres were reviewed. Among them, 454 patients underwent MIMVS through TAxA access and 667 patients through FS (associated aortic and CABG procedures, infective endocarditis and urgent operations were excluded). A propensity match analysis was performed using seventeen preoperative and intraoperative variables. Results There was no difference in preoperative characteristics in matched populations. The rate of mitral valve repair was similar in both groups. Patients in TAxA group had a higher rate of repair using artificial chordae. Operative times were shorter in FS group but in patients operated in minimally invasive approach there was a trend towards decreasing CPB and cross–clamp time over the study period. Hospital mortality in TAxA group was 0.25%, postoperative cerebral stroke rate was 0.7%. TAxA mitral surgery was associated with shorter intubation time (p<0.001) and ICU stay (p<0.001). After a median hospital stay of 8 days, 30% of patients who had TAxA surgery were discharged home vs. 5% in the FS group (p<0.001). Conclusions TAxA approach is safe and effective. Compared to FS, it allows shorter mechanical ventilation, ICU and postoperative hospital stay with a higher rate of patients able to be discharged home without any further period of cardiopulmonary rehabilitation.

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Schäfer, U., F. Deuschl, N. Schofer, C. Frerker, T. Schmidt, K. H. Kuck, F. Kreidel, et al. "Safety and efficacy of the percutaneous transaxillary access for transcatheter aortic valve implantation using various transcatheter heart valves in 100 consecutive patients." International Journal of Cardiology 232 (April 2017): 247–54. http://dx.doi.org/10.1016/j.ijcard.2017.01.010.

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Ruge, Hendrik, Marcus-André Deutsch, Magdalena Erlebach, Melchior Burri, Sabine Bleiziffer, and Ruediger Lange. "TAVR in Patients on Hemodialysis: Outcome of A High-Risk Patient Group." Heart Surgery Forum 23, no. 5 (August 28, 2020): E611—E616. http://dx.doi.org/10.1532/hsf.3129.

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Background: Perioperative mortality is high and long-term survival is poor for patients on hemodialysis undergoing surgical aortic valve replacement (SAVR). Transcatheter aortic valve replacement (TAVR) offers a safe and effective therapy for high-risk patients suffering from aortic valve stenosis. However, in patients on hemodialysis only limited information is available on the outcome following TAVR. Methods: Of the 2613 consecutive patients in our single-center TAVR registry, all hemodialysis patients, were identified. Demographics, procedural details, clinical outcomes, mortality, and complications were evaluated. Results: Forty-two hemodialysis patients with a mean age of 75.2±8.2 years, a mean STS predicted risk of mortality of 11.1±9.5% and a mean logEuroScore of 27.9±18.8% underwent TAVR. Mean duration on hemodialysis prior to intervention was 62.8±49.6 months. A transfemoral access was chosen in 24 patients, a transapical in 16, and a transaxillary and a transaortic in one patient, respectively. Estimated survival at 30 days, one, three and five years was 83.3%, 68.3%, 37.7% and 18.9%, respectively. Estimated median survival was 1.8±0.4 years. VARC-2 defined perioperative complications included stroke in 7.1% (3/42), major bleeding in 16.7% (7/42), and vascular complications in 7.1% (3/42). In two patients, echocardiographic examination at three and four years, respectively, showed evidence for structural valve deterioration. Conclusion: A high number of patients with ESRD undergoing TAVR require a non-transfemoral access. Predominantly, bleeding events contribute to the perioperative morbidity. An estimated median survival of less than two years after TAVR allows only limited assessment of valve prosthesis durability. Cardiovascular and non-cardiovascular mortality contribute equally to the causes of death beyond the first year after TAVR.

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Schafer, Ulrich, Florian Deuschl, Niklas Schofer, Christian Frerker, Daniel Reichart, Johannes Schirmer, Tobias Schmidt, et al. "TCT-708 Safety and Efficacy of the Percutaneous Transaxillary Access for Transcatheter Aortic Valve Implantation using various Transcatheter Heart Valves in 100 Consecutive Patients." Journal of the American College of Cardiology 68, no. 18 (November 2016): B287. http://dx.doi.org/10.1016/j.jacc.2016.09.121.

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Kasprzak, Piotr M., Karin Pfister, Waclaw Kuczmik, Wilma Schierling, Georgios Sachsamanis, and Kyriakos Oikonomou. "Novel Technique for the Treatment of Type Ia Endoleak After Endovascular Abdominal Aortic Aneurysm Repair." Journal of Endovascular Therapy 28, no. 4 (April 26, 2021): 519–23. http://dx.doi.org/10.1177/15266028211010469.

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Purpose Open surgical repair of type Ia endoleak after endovascular aortic aneurysm repair/sealing (EVAR/EVAS) is associated with significant perioperative mortality and morbidity. Current endovascular redo techniques face limitations, especially when the infrarenal landing zone is inadequate and the previous endograft is rigid and features a short or no main body. We present a novel concept for the treatment of type Ia endoleak using a custom-made branched device. Technique The 5-branch-device (Cook Medical, Bloomington, IN, USA) consists of a nitinol skeleton with branches, covered with a low-profile polyester fabric loaded in an 18F sheath. The device features a minimum of 2 proximal sealing stents and includes branches for renovisceral vessels as well as an additional 8 mm branch for the contralateral iliac limb. Implantation and sealing in the renovisceral vessels is carried out in standard fashion, using transfemoral and transaxillary access. Distal sealing is achieved by tapering the branched component into the ipsilateral iliac limb and using a bridging balloon-expandable or self-expandable stent-graft through the additional branch to the preexisting contralateral iliac limb. Conclusion Treatment of type Ia endoleak with a new custom-made device enables sufficient proximal seal while minimizing suprarenal aortic coverage and facilitates adequate component overlap. The low profile branched design accommodates implantation through the preexisting endograft and catheterization of target vessels.

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Egu, Obiloh Enyinnaya, and Fardad Forouzanpour. "Mild Nipple Asymmetry: Using a Supra-Areola Incision With Crescent Nipple-Areola Complex Lift to Address This Problem in Primary Breast Augmentations." American Journal of Cosmetic Surgery 34, no. 2 (January 16, 2017): 97–102. http://dx.doi.org/10.1177/0748806816685067.

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Breast augmentation mammoplasty is one of the most commonly performed cosmetic procedures in the United States. Currently, the common access incisions employed to perform the procedure are periareolar, inframammary, transaxillary, (TUBA) transumbilical, and (TABA) transabdominal (a technique that places breast prosthesis through existing abdominal scars or during the performance of an abdominoplasty). Asymmetries of the breast and chest wall are a common occurrence that is faced by aesthetic surgeons who perform breast augmentations. We aim to describe how our experience with using the supra-areola incision, for a primary breast augmentation procedure, has the added advantage of allowing us to address this problem. This article is a retrospective review of primary breast augmentation cases that were performed in our General Cosmetic Surgical Group and Fellowship Training Program from January 1, 2007, to June 30, 2015. The review addresses the incidence of nipple asymmetry in our primary breast augmentation patients and how we are able to address this problem by performing a crescent nipple-areola complex (NAC) lift via a supra-areola incision. From January 1, 2007, to June 30, 2015, 281 primary breast augmentations were performed, of which 184 (65.8%) had an NAC lift to address subjective and objective mild nipple asymmetry (~1 cm). There were no intraoperative complications. At follow-up, more than 92% of patients report satisfaction with their aesthetic outcome, 98% admitted to resolution or improvement of nipple asymmetry, 99% admitted to adequate postoperative nipple sensation, while 8% had secondary/revision breast surgery in the form of capsulectomies, scar revisions, and implant change revisions. Supra-areola incision approach should be strongly considered as a first-line approach in patients undergoing a primary breast augmentation procedure with adequately sized NAC and have evidence of mild (maximum study average = 0.95 cm) nipple asymmetry.

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Kolvenbach, Ralf, Ron Karmeli, Assaf Rabin, and Raluca Lica. "Endovascular Hybrid Repair of True Ascending Aortic Aneurysms Using Double Graft Wrapping to Prepare a Landing Zone for Ascending Aortic Stent-Graft Placement: A Cohort Study." Journal of Endovascular Therapy 26, no. 5 (June 14, 2019): 658–64. http://dx.doi.org/10.1177/1526602819856075.

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Purpose: To describe a hybrid procedure that avoids cardiopulmonary bypass to treat patients with true ascending aortic aneurysms without a suitable proximal landing zone for endovascular repair. Material and Methods: Thirteen consecutive patients (mean age 75.9±6.5 years; 8 women) with true ascending aortic aneurysms were treated with the endovascular hybrid repair of true aortic aneurysms (EHTA) approach, which consists of a conventional sternotomy with double wrapping of the ascending aorta followed by staged stent-graft placement. Via sternotomy, a polypropylene mesh trimmed to downsize the aneurysm is placed around the dilated ascending aorta and sutured to the adventitia. A similarly trimmed polytetrafluoroethylene graft is placed loosely around the first wrap to avoid adhesions and secure the proximal landing zone. There is no need for cardiopulmonary bypass. A few days later, a standard thoracic stent-graft is deployed via either a transaxillary or transfemoral access; chimney or bypass grafts are used as needed to revascularize the supra-aortic vessels. Results: The ascending aortic diameter was reduced from a mean 5.7 cm (range 4.8–6.5) to 3.9 cm (range 3.2–4.3) after wrapping. The mean interval between surgery and stent-graft placement was 5 days. In this interval, 2 patients with significant reduction in the diameter of the ascending aorta elected to forego placement of a stent-graft. Of the 11 patients who underwent the full hybrid EHTA procedure, the ascending aortic stent-graft was combined with a chimney graft in the innominate artery in 4 cases. In 1 patient, a supra-aortic debranching procedure using a bifurcated Dacron graft to the innominate and left common carotid arteries was performed after wrapping with the polypropylene mesh. There was no mortality or neurological complication. A sternal wound infection required a prolonged hospital stay. At a mean follow-up of 13.8 months (range 3–24), there has been no death, type I endoleak, or sign of aneurysm enlargement on imaging. Conclusion: This technique permits complete endovascular exclusion of an ascending aortic aneurysm in a less invasive approach than standard open repair. Although this is only a small cohort of patients without long-term follow-up, it seems that this hybrid procedure is associated with low morbidity and mortality. It offers a beating-heart approach to treat true ascending aortic aneurysms in selected high-risk patients.

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Allen, Keith, Adnan Chhatriwalla, and Eric Kirker. "Transcarotid Access is Preferred to Transaxillary Access for Nonfemoral TAVR." Annals of Thoracic Surgery, February 2022. http://dx.doi.org/10.1016/j.athoracsur.2022.01.048.

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Prendes, Carlota F., Paolo Spath, Jan Stana, Tarek Hamwi, Sven Peterss, Konstantinos Stavroulakis, Maximilian Pichlmaier, and Nikolaos Tsilimparis. "Transaxillary Branch-to-Branch-to-Branch Carotid Catheterization Technique for Triple-Branch Arch Repair." Journal of Endovascular Therapy, May 24, 2023, 152660282311691. http://dx.doi.org/10.1177/15266028231169169.

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Purpose: To describe the transaxillary branch-to-branch-to-branch carotid catheterization technique (tranaxillary 3BRA-CCE IT) for cannulation of all supra-aortic vessels using only 1 femoral and 1 axillary access during triple-branch arch repair. Technique: After deployment of the triple-branch arch device, catheterization and bridging of the innominate artery (IA) should be performed through a right axillary access (cutdown or percutaneous). Then, the retrograde left subclavian (LSA) branch should be catheterized (if not preloaded) from a percutaneous femoral access, and a 12×90Fr sheath should be advanced to the outside of the endograft. Subsequently, catheterization of the left common carotid artery (LCCA) antegrade branch should be performed, followed by snaring of a wire in the ascending aorta which was inserted through the axillary access, creating a branch-to-branch-to-branch through-and-through guidewire. Over the axillary access, a 12×45Fr sheath should be inserted into the IA branch and looped in the ascending aorta using a push-and-pull technique so that it faces the LCCA branch, allowing for stable catheterization of the LCCA. The retrograde LSA branch should then be bridged following the standard fashion. Conclusions: This series of 5 patients demonstrates that triple-branch arch repair can be performed with the transaxillary 3BRA-CCE IT, allowing catheterization of the supra-aortic vessels without manipulation of the carotid arteries. Clinical Impact The transaxillary 3BRA-CCE IT allows catheterization and bridging of all supra-aortic vessels in triple-branch arch repair through only 2 vascular access points, the femoral artery and the right axillary artery. This technique avoids carotid surgical cutdown and manipulation during these procedures, reducing the risk of access site complications, including bleeding and reintervention, reintubation, cranial nerve lesions, increased operating time, and so on, and has the potential to change the current vascular access standard used during triple-branch arch repair.

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Kandil, Emad, Mounika Akkera, Hosam Shalaby, Ruhul Munshi, Abdallah Attia, Ahmed Elnahla, Mahmoud Shalaby, Mohamed Abdelgawad, Lee Grace, and Sang W. Kang. "A Single Surgeon’s 10-Year Experience in Remote-Access Thyroid and Parathyroid Surgery." American Surgeon, November 3, 2020, 000313482095030. http://dx.doi.org/10.1177/0003134820950300.

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Background Remote-access thyroid and parathyroid surgery has gained popularity recently due to its benefit of avoiding visible neck scars. Most of these techniques were described and performed in Asia, on patients with different body habitus compared to American patients. We aim to analyze the learning curve in performing these operations in North America. Methods This is a retrospective cohort study of a 10-year experience by a single surgeon at a North American institute. Patients who underwent thyroid or parathyroid procedures by a transaxillary, retroauricular, or transoral endoscopic thyroidectomy vestibular approach (TOETVA) were included. Cumulative sum (CUSUM) was used to analyze learning curves based on intraoperative blood loss and total operative times and learning phases were divided accordingly. Results Three hundred seventy-two remote-access thyroid and parathyroid procedures were performed during the study period. Total operative time for transaxillary procedures was initially reduced after the 69th procedure and then again after the 134th case. For retroauricular procedures, marked reduction in the operative time was observed after 21 procedures. Most patients (57.02%) were discharged home on the same day during the mastering phase. In the transaxillary procedures, only 1 case of brachial plexus injury occurred prior to the routine use of somatosensory evoked potential (SSEP) monitoring. Discussion Remote-access thyroid and parathyroid surgeries can be performed safely with minimal complications in a select group of patients. Analysis of the learning curve in performing these operations aids in structuring a safe and effective learning period for endocrine surgeons seeking to venture into this modality of treatment.

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Rossi, Leonardo, Andrea De Palma, Lorenzo Fregoli, Piermarco Papini, Carlo Enrico Ambrosini, Chiara Becucci, Benard Gjeloshi, Riccardo Morganti, Puccini Marco, and Gabriele Materazzi. "Robotic transaxillary thyroidectomy: time to expand indications?" Journal of Robotic Surgery, April 17, 2023. http://dx.doi.org/10.1007/s11701-023-01594-y.

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AbstractIn 2016, the American Thyroid Association published a statement on remote-access thyroid surgery claiming that it should be reserved to patients with thyroid nodule ≤ 3 cm, thyroid lobe < 6 cm and without thyroiditis. We retrospectively enrolled all patients who underwent robotic transaxillary thyroidectomy between February 2012 and March 2022. We compared surgical outcomes between patients who presented a thyroid gland with a nodule ≤ 3 cm, thyroid lobe < 6 cm and without thyroiditis (Group A) and patients without these features (Group B). The rate of overall complications resulted comparable (p = 0.399), as well as the operative time (p = 0.477) and the hospital stay (p = 0.305). Moreover, bleeding resulted associated to thyroid nodule > 3 cm (p = 0.015), although all bleedings but one occurred in the remote-access site from the axilla to the neck. In experienced hands, robotic transaxillary thyroidectomy is feasible and safe even in patients with large thyroid nodules or thyroiditis.

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