Resection of advanced stage XXXX with the cavitron ultrasonic surgical aspirator.

@entity1 @entity2362 @entity548 @entity5 @entity190 @entity530 @entity521
Current protocols for the treatment of @entity521 emphasize total or near total resection of @entity5 to improve survival. This is preferentially performed as a primary procedure, or is attempted at a second-look operation. Unfortunately, this @entity5 often grows to large size with invasion of the spinal canal, or encasement of major vascular or other retroperitoneal structures. A primary attempt at complete removal may result in difficult-to-control @entity548 or injury to, or loss of, vital organs. A second-look procedure carries other intrinsic risks. It often must be performed during a period of chemotherapeutically induced hematologic and immunologic suppression. The presence of adhesions and dense scar tissue increases the complexity of the dissection. The Cavitron Ultrasonic Surgical Aspirator (CUSA) combines continuous fragmentation, irrigation, and aspiration in one instrument. Tissues high in water content are selectively fragmented and aspirated, while tissues high in collagen and @entity2362 (such as blood vessels and pseudocapsular walls) are selectively spared. Five @entity1 , two with @entity530 , two with large @entity5 , and one with a seemingly unresectable large right @entity5 (crossing the midline with extensive aortocaval nodal involvement) had total or near-total resection accomplished using the CUSA. In these @entity1 , initial resection of the relatively soft inner part of the @entity5 left a collapsed pseudocapsule, which was then removed under greatly improved exposure in a relatively small field. The constant aspiration virtually eliminated @entity5 spillage. Since most vessels were skeletonized without penetration, @entity190 was minimized. There were no intraoperative or postoperative complications.
