Day 1 :
University of California, USA
Time : 10:00-10:30
Harry S Goldsmith is Clinical Professor of Neurological Surgery at the University of California in Sacramento. He has been a Full Professor of Surgery and Neurosurgery since 1970. He has written 260 published papers, has edited four surgical texts, and was the Editor of Goldsmith's Practice of Surgery in twelve volumes from 1976-1988. His main interest at present is in the treatment of Alzheimer's disease and in new treatment for acute and chronic spinal cord injuries using the omentum.
Background: In the late 1800's, Ramon y Cajal, Father of Neuropathology stated that the reason patients who suffered a spinal cord injury (SCI) do not improve is that a scar develops at the site of the SCI which prevents axons from penetrating through the scar barrier. The aim of the study was to learn if a scar following an SCI could be surgically removed, followed by reconstruction of the spinal cord which could lead to functional improvement following the injury.
Method: Studies were carried out in the laboratory to learn a technique to see if a piece of a spinal cord could be removed followed by subsequent functional improvement. It was found that when a section of the spinal cord in animals could be surgically excised with reconstruction of the spinal cord being successfully performed followed by functional success.
Results: It was learned in cats when a piece of spinal cord was removed, the spinal cord could be reconstructed by filling the spinal cord defect with collagen followed by the placement of an intact vascularized omentum directly on the underlying collagen connection. Not only was this possible, but a patient underwent excision of 1.6" of her spinal cord with subsequent ability to walk which was confirmed by video.
Conclusion: It appears that chronic spinal cord injured patients may have in the future the ability to have the scar which is present in a chronic injury removed with expectations following a spinal cord reconstruction that functional return can occur.
UKSH-Campus Kiel, Germany
Keynote: Complex hybrid procedure of a type 1 TAAA with retroperitoneal chimney approach for TEVAR and carotid-subclavian bypass
Time : 11:00-11:30
Justus Gross is Head of the Department of Vascular Unit, Clinic for Cardio-Vascular Surgery, University Hospital Schleswig-Holstein, Germany. The main focus is set at aortic treatments, such as complete open, complete endovascular and complex hybrid procedures. Approximately 250 aortic cases are treated per year. The entire research group develops novel technologies according to stent-graft designs and finding solutions for endovascular treatment of the aortic arch.
The 71-year-old patient with a symptomatic thoracic-abdominal aneurysm type 1 de Bakey (6.4 cm thoracic, 5.9 cm abdominal) and aneurysm of right iliac artery (4.2 cm) was admitted to our casualty department. Clinically she complained of chest as well as progressive back pain. The patient had an imperative will for treatment. A previously untreated pheochromocytoma and a mammary carcinoma (pT1 G2 pN0), also myocardial revascularization (LIMA/RIVA) are known as serious accompanying diagnoses. Furthermore, a pronounced PAD with bilateral subtotal occlusion of the external iliac artery existed, an interventional transfemoral approach was impossible. A supplemental blood supply of the liver by the superior mesentery artery was detected, which gave us a distal landing zone of 4 mm over stenting the coeliac trunk. We decided to perform a hybrid procedure including a left carotid-subclavian bypass essential according to the left mammarian bypass and a right aorto-profundal bypass with a side-to-side chimney functioning as sheath. Under rapid pacing the implantation of two TEVAR stent grafts with overstenting of the left subclavian artery as well as the coeliac trunk followed. Afterwards the trans-brachial subclavian plugs occlusion and controlling angiography showed successful treatment. At ICU initially stable circulatory conditions turned to increased lactic acidosis. Because of transfusion-dependent blood loss into the retroperitoneal drains, an angiography and a CT abdomen showed a pronounced retro peritoneal haematoma without an active bleeding. Only a small Type IIb endoleak was detected. In suspected of acute liver failure, due to the persistently compromised coagulation and strongly elevated liver values, upper abdomen sonography was immediately performed and showed a well perfused hepatic artery. A strongly reduced heart index of 1.5 l/m2 forced a highly dosed administration of inotropics. On the second postoperative day the patient underwent a ventricular fibrillation with maximum therapy, which rapidly degenerated into an asystole. Resuscitation measures were not enhanced because of actually limited prognosis.
University of Missouri, USA
Time : 11:30-12:00
John S Jarstad is an Associate Professor and Director of Cataract and Refractive (LASIK) surgery at University of Missouri School of Medicine Department of Ophthalmology. He is a Graduate of Brigham Young University (Provo, Utah), MD from University of Washington (Seattle), and completed his Internship, Residency and Clinical Fellowship in Ophthalmology at Mayo Clinic (Rochester, Minnesota). He was a Medical Student Research Fellow at National Institutes of Health (Bethesda, Maryland). He has lectured and taught cataract surgery at University of Washington in Seattle and as visiting professor in Indonesia, Austria, the Philippines, North Korea, Vietnam, Cambodia, Zimbabwe, Egypt, Angola, Nigeria, Madagascar and England, where he was elected to the Royal Society of Medicine in 2006. He was named by Consumer Research Council one of “America’s Top Ophthalmologists” and by Newsweek magazine as one of 15 Top Laser Eye Surgeons in the USA. He has performed over 1000 robotic femtosecond bladeless laser cataract procedures since 2012. He is the author of 60 publications or presentations and one book.
Statement of the Problem: Robotic Femtosecond Bladeless Laser Cataract Surgery is the newest and most controversial procedure in the world’s most common surgical procedure cataract surgery with intraocular lens implantation. First performed in England in 1949 by Sir Harold Ridley, the technology for both removing the cataractous lens and implanting a corrective intraocular replacement lens has reached new heights of precision and success with the introduction of the femtosecond laser, approved by the FDA for use in patients (2011). The purpose of this study is to describe the experience of one surgeon who has performed over 1000 robotic femtosecond bladeless laser-assisted cataract procedures and review common pearls that have led to excellent outcomes.
Methodology & Theoretical Orientation: 1000 patient procedures were reviewed to determine common complications and findings that would improve outcomes compared to early Femtosecond Laser-assisted Cataract Surgeries (FLACS).
Findings: Common complications included: difficulty docking the laser on Asian patients and those with small eyelid fissures, incomplete anterior capsulotomy with early interface attachments, posterior capsule blow-out, decentered Lens capsulotomy and small pupil and Floppy Iris Syndrome.
Conclusion & Significance: Whilst some conservative ophthalmologists have criticized Femtosecond Laser-assisted Cataract Surgery (FLACS) as an overhyped gimmick, its usefulness in patients with dense, mature and hyper- mature (Morgagnian) cataracts and in assuring the accurate centration of newer multi-focal intraocular lens implants is unquestioned in the authors opinion. Robotic Femtosecond Bladeless Laser-assisted Cataract Surgery is here to stay and will be the future of the most common surgical procedure performed throughout the world.