Technical considerations in robotic aberrant right subclavian artery resection for dysphagia lusoria.

Dysphagia lusoria occurs due to compression of the esophagus as an aberrant right subclavian artery (ARSA) crosses the mediastinum. Surgical management includes open, hybrid, and endovascular techniques, with no consensus gold standard. There are few reports of robotic-assisted ARSA resection. We describe the innovative technique and outcomes for two patients who successfully underwent robotic-assisted transthoracic resection of an ARSA after right carotid-subclavian bypass for dysphagia lusoria. Both patients experienced improvement or resolution of their dysphagia and no major complications. In select patients with a noncalcified origin of the ARSA without aneurysmal degeneration, the robotic-assisted approach represents a viable option.

Streamlining Iliac Bone Harvest for Maxillary Reconstruction With Novel Use of Arthrex Osteochondral Autograft Transfer System.

This study introduces a novel application of the Osteochondral Autograft Transfer System (OATS) for autologous bone grafting during alveolar cleft repair. Approximately 75% of patients with cleft lip and palate have an alveolar cleft, which often necessitates secondary bone grafting from common donor sites such as the iliac crest. Traditional harvesting techniques, although effective, can be labor-intensive and increase the risk of donor site injury. Here the authors describe the use of OATS, which has primarily been used in orthopedic procedures like anterior cruciate ligament reconstruction, for the first time in alveolar cleft repair. It involves a minimally invasive, single-use transfer system for harvesting osteochondral autografts from the anterior iliac crest, and thereby reduces harvest time compared with traditional open approaches. The procedure is detailed from pre-operative evaluation through long-term follow-up and highlights the technique's benefits related to surgical time, ease of use, and maintenance of sizable autograft volumes. Similarly, the authors discuss other advantages of OATS, including its single-use and cordless nature, which is believed to contribute to a lower contamination risk and better intraoperative ergonomics.

Primary Pancreatic Signet Ring Cell Carcinoma: A Case Report and Review of the Literature.

Background: Primary pancreatic signet ring cell carcinoma (PPSRCC) is a rare (<1%) poorly reported histopathological variant of pancreatic cancer with ill-defined treatment guidelines. Herein, we describe a case of nonmetastatic PPSRCC in a 45-year-old female. Presentation: A 45-year-old female presented with 3 weeks of abdominal pain radiating to her back. Other pertinent positives included a 20-pound (9.1-kilogram) weight loss and jaundice, with a known 30-pack-year smoking history. CT scan revealed a 4.6 × 3.6 cm hypoattenuating mass in the head of the pancreas (HOP) with dilatation of the common bile duct. Total bilirubin at presentation was elevated, and a biliary stent was placed endoscopically. Subsequent endoscopic ultrasonography revealed a periampullary ulcerated mass involving the HOP and second portion of the duodenum, with pathology revealing poorly differentiated adenocarcinoma with mucinous background and focal signet ring cells. A classic pancreatoduodenectomy (Whipple procedure) was performed. Final pathology revealed a poorly differentiated (G3) pT3/pN2/pM0 PPSRCC with 11 of 16 positive specimen lymph nodes. The tumor had evidence of both KRAS and TP53 mutations and expressed an MUC1+/MUC2-/MUC5AC+ immunophenotype. Medical oncology recommended a 6-month course of adjuvant modified-dose FOLFIRINOX therapy. Conclusion: This report highlights the need for further research into the pathogenesis of gastrointestinal signet ring cell carcinoma to identify and study therapeutic targets that can eventually be translated to PPSRCC treatment. Given the paucity of PPSRCC, adjuvant therapy candidates follow the current literature on more common pancreatic cancer subtypes to guide treatment.