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Kawahara I, Shiozaki E, Ogawa Y, Morofuji Y, Haraguchi W, Ono T, Tsutsumi K, Honda K, Ito T. Carotid Endarterectomy Using Lone Star Retractor System. J Stroke Cerebrovasc Dis 2021; 30:105684. [PMID: 33652346 DOI: 10.1016/j.jstrokecerebrovasdis.2021.105684] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2020] [Revised: 11/09/2020] [Accepted: 02/13/2021] [Indexed: 10/22/2022] Open
Abstract
Cervical carotid disease is typical atherosclerosis, which is responsible for ischemic stroke. The effectiveness of carotid endarterectomy (CEA) for advanced carotid stenosis has been established in many large studies, and CEA is the gold standard in surgical treatment. On the other hand, endovascular carotid artery stenting (CAS) has become increasingly popular recently. It is very important to avoid any complications to maintain the effectiveness of CEA. The retractor device is important for the exposure of carotid arteries and for the safe surgical manipulation. We have started to use lone star retractor system (LSRS) to deploy the surgical field. LSRS provides the usability to handle and a shallower surgical field without the disturbance of surgical manipulation. And it can facilitate exposure of the distal internal carotid artery because surgeon can retract freely in whole circumference by towing with moderate strength. LSRS may bring the smoother and easier surgical manipulations in CEA.
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Affiliation(s)
- Ichiro Kawahara
- Department of Neurosurgery, National Hospital Organization Nagasaki Medical Center.
| | - Eri Shiozaki
- Department of Neurosurgery, National Hospital Organization Nagasaki Medical Center.
| | - Yuka Ogawa
- Department of Neurosurgery, National Hospital Organization Nagasaki Medical Center.
| | - Yoichi Morofuji
- Department of Neurosurgery, National Hospital Organization Nagasaki Medical Center.
| | - Wataru Haraguchi
- Department of Neurosurgery, National Hospital Organization Nagasaki Medical Center.
| | - Tomonori Ono
- Department of Neurosurgery, National Hospital Organization Nagasaki Medical Center.
| | - Keisuke Tsutsumi
- Department of Neurosurgery, National Hospital Organization Nagasaki Medical Center.
| | - Kazuya Honda
- Department of Neurosurgery, National Hospital Organization Nagasaki Medical Center.
| | - Takehiro Ito
- Department of Neurosurgery, National Hospital Organization Nagasaki Medical Center.
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Uno M, Takai H, Yagi K, Matsubara S. Surgical Technique for Carotid Endarterectomy: Current Methods and Problems. Neurol Med Chir (Tokyo) 2020; 60:419-428. [PMID: 32801277 PMCID: PMC7490601 DOI: 10.2176/nmc.ra.2020-0111] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Over the last 60 years, many reports have investigated carotid endarterectomy (CEA) and techniques have thus changed and improved. In this paper, we review the recent literature regarding operational maneuvers for CEA and discuss future problems for CEA. Longitudinal skin incision is common, but the transverse incision has been reported to offer minimal invasiveness and better cosmetic effects for CEA. Most surgeons currently use microscopy for dissection of the artery and plaque. Although no monitoring technique during CEA has been proven superior, multiple monitors offer better sensitivity for predicting postoperative neurological deficit. To date, data are lacking regarding whether routine shunt or selective shunt is better. Individual surgeons thus need to select the method with which they are more comfortable. Many surgical techniques have been reported to obtain distal control of the internal carotid artery in patients with high cervical carotid bifurcation or high plaque, and minimally invasive techniques should be considered. Multiple studies have shown that patch angioplasty reduces the risks of stroke and restenosis compared with primary closure, but few surgeons in Japan have been performing patch angioplasty. Most surgeons thus experience only a small volume of CEAs in Japan, so training programs and development of in vivo training models are important.
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Affiliation(s)
- Masaaki Uno
- Department of Neurosurgery, Kawasaki Medical School
| | - Hiroki Takai
- Department of Neurosurgery, Kawasaki Medical School
| | - Kenji Yagi
- Department of Neurosurgery, Kawasaki Medical School
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Ryu B, Sato S, Inoue T, Kawamata T, Okada Y. A novel omnidirectional tin-alloyed ring retractor for craniotomy in neurosurgery: technical note. Neurosurg Rev 2020; 44:619-624. [PMID: 31927700 DOI: 10.1007/s10143-020-01237-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2019] [Revised: 11/16/2019] [Accepted: 01/02/2020] [Indexed: 11/30/2022]
Abstract
In neurosurgical operations, proper craniotomy using retractors is necessary. Various surgical instruments are used for this purpose, including standard retractors and multipurpose head frame retractor systems. However, the conventional multipurpose head frame system is often not optimal for use in some craniotomies and postures because of its size and complexity of setting. We have invented a new omnidirectional tin-alloyed (ODT) ring retractor for craniotomy with malleability and shape memory characteristics to resolve these issues. It is principally elliptical in shape, approximately 30 × 20 cm in diameter, and sufficiently firm. Accordingly, this ODT ring can retract the surgical field in all directions. Here, we report our experiences of 281 neurosurgical craniotomies using this ODT ring retractor system in various craniotomy sites and postures. Our novel ODT ring retractor is useful because of its low profile, multidirectional retractability, and less obstructiveness with its malleability. It could be used with pediatric patients where strong traction is not desirable.
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Affiliation(s)
- Bikei Ryu
- Department of Neurosurgery, St Luke's International Hospital, 9-1 Akashi-cho, Chuo-ku, Tokyo, 104-8560, Japan. .,Department of Neuroendovascular Therapy, St Luke's International Hospital, 9-1 Akashi-cho, Chuo-ku, Tokyo, 104-8560, Japan. .,Department of Neurosurgery, Tokyo Women's Medical University, 8-1 Kawada-cho, Shinjuku-ku, Tokyo, 162-8666, Japan.
| | - Shinsuke Sato
- Department of Neurosurgery, St Luke's International Hospital, 9-1 Akashi-cho, Chuo-ku, Tokyo, 104-8560, Japan.,Department of Neuroendovascular Therapy, St Luke's International Hospital, 9-1 Akashi-cho, Chuo-ku, Tokyo, 104-8560, Japan
| | - Tatsuya Inoue
- Department of Neuroendovascular Therapy, St Luke's International Hospital, 9-1 Akashi-cho, Chuo-ku, Tokyo, 104-8560, Japan
| | - Takakazu Kawamata
- Department of Neurosurgery, Tokyo Women's Medical University, 8-1 Kawada-cho, Shinjuku-ku, Tokyo, 162-8666, Japan
| | - Yoshikazu Okada
- Department of Neurosurgery, St Luke's International Hospital, 9-1 Akashi-cho, Chuo-ku, Tokyo, 104-8560, Japan
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Hosoyama H, Hanaya R, Otsubo T, Sato M, Kashida Y, Sugata S, Katagiri M, Iida K, Arita K. Application of Rubber Band with Hooks on Both Ends for Vagus Nerve Stimulator Implantation. World Neurosurg 2018; 111:258-260. [DOI: 10.1016/j.wneu.2017.12.133] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2017] [Revised: 12/19/2017] [Accepted: 12/20/2017] [Indexed: 12/01/2022]
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Moteki Y, Okada Y, Inoue T, Sato S, Kuwamoto K, Shima S, Niimi Y. The Availability of a Tin-Alloyed Omnidirectional Retractor-Supporting Ring for Ventriculoperitoneal Shunt Laparotomy. World Neurosurg 2017; 109:110-114. [PMID: 28943418 DOI: 10.1016/j.wneu.2017.09.085] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2017] [Revised: 09/11/2017] [Accepted: 09/13/2017] [Indexed: 11/29/2022]
Abstract
OBJECTIVE We report the availability of a newly developed, malleable, tin-alloyed omnidirectional retractor-supporting (OD) ring for steady and safe ventriculoperitoneal (VP) shunt laparotomy. METHODS The OD ring is principally circular in shape, 15 cm in diameter, and is sufficiently malleable to be fitted to the abdominal wall. There are 22 outward protrusions 12 mm in length that are welded to the outside of the ring at regular intervals. The OD ring with twisted rubber bands attached around the protrusions is placed on the abdominal wall surrounding the skin incision. Then the edge is omnidirectionally retracted with blunt minihooks attached to the rubber bands. In our hospital from January 2016 to February 2017, 15 consecutive patients underwent a VP shunt procedure using the OD ring. RESULTS In a VP shunt procedure, our malleable, tin-alloyed OD ring could be smoothly placed on various types of abdominal walls. Moreover, our OD ring system provided a wider and shallower operative field allowing omnidirectional retraction during small laparotomy. Additionally, the OD ring system did not interfere with our surgical manipulations. CONCLUSIONS Our newly developed retraction system with a malleable, tin-alloyed OD ring and minihooks may allow safe and steady small laparotomy for VP shunt.
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Affiliation(s)
- Yosuke Moteki
- Department of Neurosurgery, St. Luke's International Hospital, Tokyo, Japan; Department of Neuroendovascular Therapy, St. Luke's International Hospital, Tokyo, Japan.
| | - Yoshikazu Okada
- Department of Neurosurgery, St. Luke's International Hospital, Tokyo, Japan
| | - Tatsuya Inoue
- Department of Neurosurgery, St. Luke's International Hospital, Tokyo, Japan; Department of Neuroendovascular Therapy, St. Luke's International Hospital, Tokyo, Japan
| | - Shinsuke Sato
- Department of Neurosurgery, St. Luke's International Hospital, Tokyo, Japan; Department of Neuroendovascular Therapy, St. Luke's International Hospital, Tokyo, Japan
| | - Kentaro Kuwamoto
- Department of Neurosurgery, St. Luke's International Hospital, Tokyo, Japan
| | - Shogo Shima
- Department of Neurosurgery, St. Luke's International Hospital, Tokyo, Japan
| | - Yasunari Niimi
- Department of Neuroendovascular Therapy, St. Luke's International Hospital, Tokyo, Japan
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Toyota S, Kumagai T, Goto T, Mori K, Taki T. Utility of the Lone Star Retractor System in Microsurgical Carotid Endarterectomy. World Neurosurg 2017; 101:509-513. [DOI: 10.1016/j.wneu.2017.02.067] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2016] [Revised: 12/13/2016] [Accepted: 02/12/2017] [Indexed: 11/15/2022]
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Ishiguro T, Yoneyama T, Ishikawa T, Yamaguchi K, Kawashima A, Kawamata T, Okada Y. Perioperative and Long-term Outcomes of Carotid Endarterectomy for Japanese Asymptomatic Cervical Carotid Artery Stenosis: A Single Institution Study. Neurol Med Chir (Tokyo) 2015; 55:830-7. [PMID: 26458845 PMCID: PMC4663021 DOI: 10.2176/nmc.oa.2014-0398] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
As the recently developed medical treatments for asymptomatic cervical carotid artery stenosis (ACCAS) have shown excellent stroke prevention, carotid endarterectomy (CEA) should be carried out for more selected patients and with lower complication rates and better long-term outcomes. We have performed CEA for Japanese ACCAS patients with a uniform surgical technique and strict perioperative management. In this study, we retrospectively investigated the perioperative complications and long-term outcomes of our CEA series. A total of 147 CEAs were carried out in 139 Japanese ACCAS patients. All patients were routinely checked for their cardiac function and high risk coronary lesions were preferentially treated before CEA. All CEAs were performed under general anesthesia using a shunt system. The postoperative cerebral blood flow was routinely measured under continued sedation to prevent postoperative hyperperfusion. The 30-day perioperative morbidity rate was 2.04%, including a perioperative stroke rate of 0.68%. There were no perioperative deaths. With regard to the long-term outcomes of the 134 followed-up patients, 9 patients were dead and 5 patients suffered from strokes, including 2 patients with ipsilateral hemispheric ischemia. The annual rates of death, all stroke and ipsilateral ischemic stroke were 1.15%, 0.64%, and 0.25%, respectively. These results showed that the perioperative morbidity and mortality rates of our CEAs were lower than those in the previous large trials. Furthermore, the long-term outcomes of this series were favorable to those reported in the latest medical treatment trials for ACCAS patients. CEA may be useful for preventing ischemic stroke in Japanese ACCAS patients.
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Affiliation(s)
- Taichi Ishiguro
- Department of Neurosurgery, Tokyo Women's Medical University
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