Publications by Dr. Hamidreza Mahoozi

Discover the scientific papers and professional publications of Dr. Hamidreza Mahoozi, a leading expert in modern surgery. This page provides an overview of his most important publications and contributions to medical research and innovation.

Uniportal video-assisted thoracic surgery lobectomy: A consensus report from the Uniportal VATS Interest Group (UVIG) of the European Society of Thoracic Surgeons (ESTS)

August 2019

Abstract

Objectives: Our goal was to report the results of the first consensus paper among international experts in uniportal video-assisted thoracoscopic surgery (UniVATS) lobectomy obtained through a Delphi process, the objective of which was to define and standardize the main procedural steps, optimize its indications and perioperative management and identify elements to assist in future training.

Methods: The 40 members of the working group were convened and organized on a voluntary basis by the Uniportal VATS Interest Group (UVIG) of the European Society of Thoracic Surgeons (ESTS). An e-consensus finding exercise using the Delphi method was applied to require 75% agreement for reaching consensus on each question. Repeated iterations of anonymous voting continued for 3 rounds.

Results: Overall, 31 international experts from 18 countries completed all 3 rounds of questionnaires. Although a technical quorum was not achieved, most of the responders agreed that the maximum size of a UniVATS incision should be ≤4 cm. Agreement was reached on many points outlining the currently accepted definition of a UniVATS lobectomy, its indications and contraindications, perioperative clinical management and recommendations for training and future research directions.

Conclusions: The UVIG Consensus Report stated that UniVATS offers a valid alternative to standard VATS techniques. Only longer follow-up and randomized controlled studies will predict whether UniVATS represents a valid alternative approach to multiport VATS for major lung resections or whether it should be performed only in selected cases and by selected centres. The next step for the ESTS UVIG is the establishment of a UniVATS section inside the ESTS databases.

[Failure of Endo-VAC or Stenting Therapy after Oesophageal Anastomotic Insufficiency – How to Avoid Oesophagectomy]

January 2019

Abstract

Background: Anastomotic insufficiency after esophageal resection is a serious complication and is associated with a high mortality rate. A conservative approach, using stent implantation or endo-VAC therapy, is the initial therapeutic approach. This paper describes a combination of conservative and surgical management after an unsuccessful initial attempt to avoid esophagectomy.

Material and methods: All patients who were treated in our Clinic for Thoracic Surgery between May 2008 and December 2016 due to anastomotic insufficiency following esophageal resection were included. After initial treatment failure, the patients received conservative surgical combination therapy. An esophageal stent was implanted and fixed using transmural, absorbable sutures. Subsequently, a radical mediastinal and pleural debridement was performed and the defect was covered by muscle flap plasty. If germs were detected postoperatively, discontinuous irrigation therapy of the pleural cavity was also performed. We analyzed the factors that had an influence on mortality after treatment of anastomotic insufficiency following esophageal resection.

Results: 18 patients presented to our clinic after unsuccessful conservative treatment of anastomotic insufficiency following esophageal resection. 15 patients were referred within 20 days after detection of anastomotic insufficiency, 3 cases more than 20 days after the first symptoms of anastomotic insufficiency appeared. All patients presented with right-sided pleural empyema, pneumonia, mediastinitis and sepsis. In 3 cases, bilateral pleural empyema was present. Surgical treatment of anastomotic insufficiency was successful in 100% of cases. The 90-day mortality rate was 20% (3 patients).

Summary: Overall, the combined management of anastomotic insufficiency after esophageal resection has a very high success rate. Only the continuation of conservative treatment for more than 20 days has a significant impact on mortality.

Management of anastomotic insufficiency after esophageal resection in the event of conservative treatment failure

September 2017

Abstract

Background: Anastomotic insufficiency after esophageal resection is a serious complication and is associated with a high mortality rate. A conservative approach, using stent implantation or endo-sponge therapy, is the initial therapeutic approach. This paper describes a combination of conservative and surgical management in cases of unsuccessful initial treatment attempts and the evaluation of risk factors for increased mortality.

Material and methods: The study includes 18 patients who underwent esophageal resection with gastric anastomosis between May 2008 and December 2016 and subsequently developed anastomotic insufficiency. After conservative treatment failure, the patients were treated by a surgical approach with a combination of esophageal stent implantation, transmural stent fixation, defect coverage by flap plasty, radical mediastinal debridement and discontinuous irrigation therapy of the pleural cavity.

We evaluated factors that influence the mortality rate after surgical therapy for anastomotic insufficiency after esophagectomy. Results: All patients presented to our clinic after unsuccessful conservative therapy for anastomotic insufficiency after esophagectomy. 15 patients were referred within 20 days after anastomotic insufficiency, 3 cases more than 20 days after anastomotic insufficiency. All patients presented with right-sided pleural empyema, pneumonia, mediastinitis and sepsis. Three cases had bilateral pleural empyema.

Successful surgical treatment of anastomotic insufficiency was achieved in 100% of cases. The 90-day mortality rate was 20% (3 patients). Conclusion: Overall, the combined management of anastomotic insufficiency after esophageal resection has a very high success rate. The only independent influencing factor regarding an increased mortality rate is a prolonged conservative treatment approach of more than 20 days.

Indication and operative technique for acquired posterior hernias of the diaphragm

January 2017

Abstract

Diaphragmatic hernias are divided into congenital (CDH) and acquired (ADH) hernias. The incidence of CDH is 1:2.000- 1: 5.000. In 80-90 % CDH is localized on the left side (Bochdalek hernia). Acquired diaphragmatic hernia (ADH) will be distinct between the frequent i traumatic (approximately 75.1 % – 85.3 % of patients of ADH), the rarer spontaneous and i secondary pathological ADH (e.g. thoracic wall abscess or neoplasia).
The most common symptoms for CDH are dyspnea, cyanosis, tachypnea, decreased or absence of breath sounds and thoracic peristaltic sounds. The first diagnostic step after the physical I examination at CDH and ADH is a Chest-X-ray. A thin-layered CT thorax is the most effective diagnostic method. The right-sided hernias are often overlooked in conventional Chest-X-ray, due to this a CT-Thorax or MRI-Thorax will be recommended in case of any suspicion.
Therapeutically, patients should first be stabilized and then evaluated for a surgical therapy (Late repair). After the stabilization, surgical treatment should be carried out within 24 h. For the unstable patients an implantation of ECMO should be pursued and carried out a surgical treatment to remove the ECMO during the next 7 days.

Modern Management of Traumatic Hemothorax

January 2016

Abstract

Hemothorax is defined as a bleeding into pleural cavity. Hemothorax is a frequent manifestation of blunt chest trauma. Some authors suggested a hematocrit value more than 50% for differentiation of a hemothorax from a sanguineous pleural effusion.
Hemothorax is also often associated with penetrating chest injury or chest wall blunt trauma with skeletal injury. Much less common, it may be related to pleural diseases, induced iatrogenic or develop spontaneously. In the vast majority of blunt and penetrating trauma cases, hemothoraces can be managed by relatively simple means in the course of care.

Erdheim-Chester disease in a female cardiac surgery patient

May 2011

Abstract

We report a case of Erdheim-Chester disease (ECD) with isolated cardiac involvement in a 74-year-old female patient. The patient initially presented with superior vena cava syndrome and PET-CT imaging demonstrating an obstructing hypermetabolic lesion in the right atrium, and a distinct nonobstructing hypermetabolic lesion in the left atrium, expected to be malignant. There was no evidence of extracardiac disease.

At surgical exploration, consistent with malignancy, the right atrial tumor was found to have grown into the pericardium and was resected to address symptoms and for histological diagnosis which revealed ECD on immunohistochemistry. We conclude that isolated cardiac ECD should be included in the surgical strategy for cardiac tumors showing infiltrative growth.