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Sample records for advanced minimally invasive

  1. Minimally Invasive Dentistry

    Science.gov (United States)

    ... to your desktop! more... What Is Minimally Invasive Dentistry? Article Chapters What Is Minimally Invasive Dentistry? Minimally ... techniques. Reviewed: January 2012 Related Articles: Minimally Invasive Dentistry Minimally Invasive Veneers Dramatically Change Smiles What Patients ...

  2. Workshop on Advances in NASA-Relevant, Minimally Invasive Instrumentation

    Science.gov (United States)

    1985-01-01

    The purpose of this meeting is to highlight those advances in instrumentation and methodology that can be applied to the medical problems that will be encountered as the duration of manned space missions is extended. Information on work that is presently being done by NASA as well as other approaches in which NASA is not participating will be exchanged. The NASA-sponsored efforts that will be discussed are part of the overall Space Medicine Program that has been undertaken by NASA to address the medical problems of manned spaceflight. These problems include those that have been observed in the past as well as those which are anticipated as missions become longer, traverse different orbits, or are in any way different. This conference is arranged in order to address the types of instrumentation that might be used in several major medical problem areas. Instrumentation that will help in the cardiovascular, musculoskeletal, and psychological areas, among others will be presented. Interest lies in identifying instrumentation which will help in learning more about ourselves through experiments performed directly on humans. Great emphasis is placed on non-invasive approaches, although every substantial program basic to animal research will be needed in the foreseeable future. Space Medicine is a rather small affair in what is primarily an engineering organization. Space Medicine is conducted throughout NASA by a very small skeleton staff at the headquarters office in Washington and by our various field centers. These centers include the Johnson Space Center in Houston, Texas, the Ames Research Center in Moffett Field, California, the Jet Propulsion Laboratory in Pasadena, California, the Kennedy Space Center in Florida, and the Langley Research Center in Hampton, Virginia. Throughout these various centers, work is conducted in-house by NASA's own staff scientists, physicians, and engineers. In addition, various universities, industries, and other government laboratories

  3. Minimally Invasive Parathyroidectomy

    Directory of Open Access Journals (Sweden)

    Lee F. Starker

    2011-01-01

    Full Text Available Minimally invasive parathyroidectomy (MIP is an operative approach for the treatment of primary hyperparathyroidism (pHPT. Currently, routine use of improved preoperative localization studies, cervical block anesthesia in the conscious patient, and intraoperative parathyroid hormone analyses aid in guiding surgical therapy. MIP requires less surgical dissection causing decreased trauma to tissues, can be performed safely in the ambulatory setting, and is at least as effective as standard cervical exploration. This paper reviews advances in preoperative localization, anesthetic techniques, and intraoperative management of patients undergoing MIP for the treatment of pHPT.

  4. Minimally invasive surgery. Future developments.

    OpenAIRE

    1994-01-01

    The rapid development of minimally invasive surgery means that there will be fundamental changes in interventional treatment. Technological advances will allow new minimally invasive procedures to be developed. Application of robotics will allow some procedures to be done automatically, and coupling of slave robotic instruments with virtual reality images will allow surgeons to perform operations by remote control. Miniature motors and instruments designed by microengineering could be introdu...

  5. [Are there technological advances in minimally invasive surgery and who will pay them?].

    Science.gov (United States)

    Feussner, H; Wilhelm, D; Härtl, F; Schneider, A; Siess, M

    2007-06-01

    The successful development of minimally invasive surgery would have been inconceivable without continuous advances in medical technology. The users, i.e. the surgeons, however, only accepted innovations with a clear-cut positive impact on clinical care. Accordingly, the expected exponential rise in costs could be avoided. The imbalance in cost/benefit aspects between the deliverers of medical care on one hand, and the patients, the insurance companies and the employers on the other is critical. In addition, further innovations are to be expected. This will not be possible without increasing costs, but there are good reasons to assume that expenses will rise only moderately. Each modern society is able (and obliged) to afford a certain amount of medical progress in order to maintain a high level of medical care and economic strength.

  6. Prostate resection - minimally invasive

    Science.gov (United States)

    ... invasive URL of this page: //medlineplus.gov/ency/article/007415.htm Prostate resection - minimally invasive To use ... into your bladder instead of out through the urethra ( retrograde ... on New Developments in Prostate Cancer and Prostate Diseases. Evaluation and treatment of lower ...

  7. [Invasive and minimally invasive hemodynamic monitoring].

    Science.gov (United States)

    Hansen, Matthias

    2016-10-01

    Advanced hemodynamic monitoring is necessary for adequate management of high-risk patients or patients with derangement of circulation. Studies demonstrate a benefit of early goal directed therapy in unstable cardiopulmonary situations. In these days we have different possibilities of minimally invasive or invasive hemodynamic monitoring. Minimally invasive measurements like pulse conture analysis or pulse wave analysis being less accurate under some circumstances, however only an artery catheter is needed for cardiac output monitoring. Pulmonary artery, transpulmonary thermodilution and lithium dilution technology have acceptable accuracy in cardiac output measurement. For therapy of unstable circulation there are additionally parameters to obtain. The pulmonary artery catheter is the device with the largest rate of complications, used by a trained crew and with a correct indication, his use is unchained justified.

  8. Minimally invasive periodontal therapy.

    Science.gov (United States)

    Dannan, Aous

    2011-10-01

    Minimally invasive dentistry is a concept that preserves dentition and supporting structures. However, minimally invasive procedures in periodontal treatment are supposed to be limited within periodontal surgery, the aim of which is to represent alternative approaches developed to allow less extensive manipulation of surrounding tissues than conventional procedures, while accomplishing the same objectives. In this review, the concept of minimally invasive periodontal surgery (MIPS) is firstly explained. An electronic search for all studies regarding efficacy and effectiveness of MIPS between 2001 and 2009 was conducted. For this purpose, suitable key words from Medical Subject Headings on PubMed were used to extract the required studies. All studies are demonstrated and important results are concluded. Preliminary data from case cohorts and from many studies reveal that the microsurgical access flap, in terms of MIPS, has a high potential to seal the healing wound from the contaminated oral environment by achieving and maintaining primary closure. Soft tissues are mostly preserved and minimal gingival recession is observed, an important feature to meet the demands of the patient and the clinician in the esthetic zone. However, although the potential efficacy of MIPS in the treatment of deep intrabony defects has been proved, larger studies are required to confirm and extend the reported positive preliminary outcomes.

  9. Advances in Haptics, Tactile Sensing, and Manipulation for Robot-Assisted Minimally Invasive Surgery, Noninvasive Surgery, and Diagnosis

    Directory of Open Access Journals (Sweden)

    Abbi Hamed

    2012-01-01

    Full Text Available The developments of medical practices and medical technologies have always progressed concurrently. The relatively recent developments in endoscopic technologies have allowed the realization of the “minimally invasive” form of surgeries. The advancements in robotics facilitate precise surgeries that are often integrated with medical image guidance capability. This in turn has driven the further development of technology to compensate for the unique complexities engendered by this new format and to improve the performance and broaden the scope of the procedures that can be performed. Medical robotics has been a central component of this development due to the highly suitable characteristics that a robotic system can purport, including highly optimizable mechanical conformation and the ability to program assistive functions in medical robots for surgeons to perform safe and accurate minimally invasive surgeries. In addition, combining the robot-assisted interventions with touch-sensing and medical imaging technologies can greatly improve the available information and thus help to ensure that minimally invasive surgeries continue to gain popularity and stay at the focus of modern medical technology development. This paper presents a state-of-the-art review of robotic systems for minimally invasive and noninvasive surgeries, precise surgeries, diagnoses, and their corresponding technologies.

  10. Minimally Invasive Forefoot Surgery in France.

    Science.gov (United States)

    Meusnier, Tristan; Mukish, Prikesht

    2016-06-01

    Study groups have been formed in France to advance the use of minimally invasive surgery. These techniques are becoming more frequently used and the technique nuances are continuing to evolve. The objective of this article was to advance the awareness of the current trends in minimally invasive surgery for common diseases of the forefoot. The percutaneous surgery at the forefoot is less developed at this time, but also will be discussed.

  11. Minimally invasive PCNL-MIP.

    Science.gov (United States)

    Zanetti, Stefano Paolo; Boeri, Luca; Gallioli, Andrea; Talso, Michele; Montanari, Emanuele

    2017-01-01

    Miniaturized percutaneous nephrolithotomy (mini-PCNL) has increased in popularity in recent years and is now widely used to overcome the therapeutic gap between conventional PCNL and less-invasive procedures such as shock wave lithotripsy (SWL) or flexible ureterorenoscopy (URS) for the treatment of renal stones. However, despite its minimally invasive nature, the superiority in terms of safety, as well as the similar efficacy of mini-PCNL compared to conventional procedures, is still under debate. The aim of this chapter is to present one of the most recent advancements in terms of mini-PCNL: the Karl Storz "minimally invasive PCNL" (MIP). A literature search for original and review articles either published or e-published up to December 2016 was performed using Google and the PubMed database. Keywords included: minimally invasive PCNL; MIP. The retrieved articles were gathered and examined. The complete MIP set is composed of different sized rigid metallic fiber-optic nephroscopes and different sized metallic operating sheaths, according to which the MIP is categorized into extra-small (XS), small (S), medium (M) and large (L). Dilation can be performed either in one-step or with a progressive technique, as needed. The reusable devices of the MIP and vacuum cleaner efect make PCNL with this set a cheap procedure. The possibility to shift from a small to a larger instrument within the same set (Matrioska technique) makes MIP a very versatile technique suitable for the treatment of almost any stone. Studies in the literature have shown that MIP is equally effective, with comparable rates of post-operative complications, as conventional PCNL, independently from stone size. MIP does not represent a new technique, but rather a combination of the last ten years of PCNL improvements in a single system that can transversally cover all available techniques in the panorama of percutaneous stone treatment.

  12. Heart bypass surgery - minimally invasive

    Science.gov (United States)

    ... Names Minimally invasive direct coronary artery bypass; MIDCAB; Robot-assisted coronary artery bypass; RACAB; Keyhole heart surgery; ... M. is also a founding member of Hi-Ethics and subscribes to the principles of the Health ...

  13. Minimally legally invasive dentistry.

    Science.gov (United States)

    Lam, R

    2014-12-01

    One disadvantage of the rapid advances in modern dentistry is that treatment options have never been more varied or confusing. Compounded by a more educated population greatly assisted by online information in an increasingly litigious society, a major concern in recent times is increased litigation against health practitioners. The manner in which courts handle disputes is ambiguous and what is considered fair or just may not be reflected in the judicial process. Although legal decisions in Australia follow a doctrine of precedent, the law is not static and is often reflected by community sentiment. In medical litigation, this has seen the rejection of the Bolam principle with a preference towards greater patient rights. Recent court decisions may change the practice of dentistry and it is important that the clinician is not caught unaware. The aim of this article is to discuss legal issues that are pertinent to the practice of modern dentistry through an analysis of legal cases that have shaped health law. Through these discussions, the importance of continuing professional development, professional association and informed consent will be realized as a means to limit the legal complications of dental practice.

  14. Robotic assisted minimally invasive surgery

    Directory of Open Access Journals (Sweden)

    Palep Jaydeep

    2009-01-01

    Full Text Available The term "robot" was coined by the Czech playright Karel Capek in 1921 in his play Rossom′s Universal Robots. The word "robot" is from the check word robota which means forced labor.The era of robots in surgery commenced in 1994 when the first AESOP (voice controlled camera holder prototype robot was used clinically in 1993 and then marketed as the first surgical robot ever in 1994 by the US FDA. Since then many robot prototypes like the Endoassist (Armstrong Healthcare Ltd., High Wycombe, Buck, UK, FIPS endoarm (Karlsruhe Research Center, Karlsruhe, Germany have been developed to add to the functions of the robot and try and increase its utility. Integrated Surgical Systems (now Intuitive Surgery, Inc. redesigned the SRI Green Telepresence Surgery system and created the daVinci Surgical System ® classified as a master-slave surgical system. It uses true 3-D visualization and EndoWrist ® . It was approved by FDA in July 2000 for general laparoscopic surgery, in November 2002 for mitral valve repair surgery. The da Vinci robot is currently being used in various fields such as urology, general surgery, gynecology, cardio-thoracic, pediatric and ENT surgery. It provides several advantages to conventional laparoscopy such as 3D vision, motion scaling, intuitive movements, visual immersion and tremor filtration. The advent of robotics has increased the use of minimally invasive surgery among laparoscopically naοve surgeons and expanded the repertoire of experienced surgeons to include more advanced and complex reconstructions.

  15. What is minimally invasive dentistry?

    Science.gov (United States)

    Ericson, Dan

    2004-01-01

    Minimally Invasive Dentistry is the application of "a systematic respect for the original tissue." This implies that the dental profession recognizes that an artifact is of less biological value than the original healthy tissue. Minimally invasive dentistry is a concept that can embrace all aspects of the profession. The common delineator is tissue preservation, preferably by preventing disease from occurring and intercepting its progress, but also removing and replacing with as little tissue loss as possible. It does not suggest that we make small fillings to restore incipient lesions or surgically remove impacted third molars without symptoms as routine procedures. The introduction of predictable adhesive technologies has led to a giant leap in interest in minimally invasive dentistry. The concept bridges the traditional gap between prevention and surgical procedures, which is just what dentistry needs today. The evidence-base for survival of restorations clearly indicates that restoring teeth is a temporary palliative measure that is doomed to fail if the disease that caused the condition is not addressed properly. Today, the means, motives and opportunities for minimally invasive dentistry are at hand, but incentives are definitely lacking. Patients and third parties seem to be convinced that the only things that count are replacements. Namely, they are prepared to pay for a filling but not for a procedure that can help avoid having one.

  16. Acquiring minimally invasive surgical skills

    NARCIS (Netherlands)

    Hiemstra, Ellen

    2012-01-01

    Many topics in surgical skills education have been implemented without a solid scientific basis. For that reason we have tried to find this scientific basis. We have focused on training and evaluation of minimally invasive surgical skills in a training setting and in practice in the operating room.

  17. Minimally Invasive Video-Assisted versus Minimally Invasive Nonendoscopic Thyroidectomy

    Directory of Open Access Journals (Sweden)

    Zdeněk Fík

    2014-01-01

    Full Text Available Minimally invasive video-assisted thyroidectomy (MIVAT and minimally invasive nonendoscopic thyroidectomy (MINET represent well accepted and reproducible techniques developed with the main goal to improve cosmetic outcome, accelerate healing, and increase patient’s comfort following thyroid surgery. Between 2007 and 2011, a prospective nonrandomized study of patients undergoing minimally invasive thyroid surgery was performed to compare advantages and disadvantages of the two different techniques. There were no significant differences in the length of incision to perform surgical procedures. Mean duration of hemithyroidectomy was comparable in both groups, but it was more time consuming to perform total thyroidectomy by MIVAT. There were more patients undergoing MIVAT procedures without active drainage in the postoperative course and we also could see a trend for less pain in the same group. This was paralleled by statistically significant decreased administration of both opiates and nonopiate analgesics. We encountered two cases of recurrent laryngeal nerve palsies in the MIVAT group only. MIVAT and MINET represent safe and feasible alternative to conventional thyroid surgery in selected cases and this prospective study has shown minimal differences between these two techniques.

  18. Minimally invasive surgery for Achilles tendon pathologies

    Directory of Open Access Journals (Sweden)

    Nicola Maffulli

    2010-07-01

    Full Text Available Nicola Maffulli1, Umile Giuseppe Longo2, Filippo Spiezia2, Vincenzo Denaro21Centre for Sports and Exercise Medicine, Barts and The London School of Medicine and Dentistry, London, England; 2Department of Orthopedic and Trauma Surgery, Campus Bio-Medico University, Rome, ItalyAbstract: Minimally invasive trauma and orthopedic surgery is increasingly common, though technically demanding. Its use for pathologies of the Achilles tendon (AT hold the promise to allow faster recovery times, shorter hospital stays, and improved functional outcomes when compared to traditional open procedures, which can lead to difficulty with wound healing because of the tenuous blood supply and increased chance of wound breakdown and infection. We present the recent advances in the field of minimally invasive AT surgery for tendinopathy, acute ruptures, chronic tears, and chronic avulsions of the AT. In our hands, minimally invasive surgery has provided similar results to those obtained with open surgery, with decreased perioperative morbidity, decreased duration of hospital stay, and reduced costs. So far, the studies on minimally invasive orthopedic techniques are of moderate scientific quality with short follow-up periods. Multicenter studies with longer follow-up are needed to justify the long-term advantages of these techniques over traditional ones.Keywords: tendinopathy, rupture, percutanous repair, less invasive

  19. Outcomes After Minimally Invasive Esophagectomy

    Science.gov (United States)

    Luketich, James D.; Pennathur, Arjun; Awais, Omar; Levy, Ryan M.; Keeley, Samuel; Shende, Manisha; Christie, Neil A.; Weksler, Benny; Landreneau, Rodney J.; Abbas, Ghulam; Schuchert, Matthew J.; Nason, Katie S.

    2014-01-01

    Background Esophagectomy is a complex operation and is associated with significant morbidity and mortality. In an attempt to lower morbidity, we have adopted a minimally invasive approach to esophagectomy. Objectives Our primary objective was to evaluate the outcomes of minimally invasive esophagectomy (MIE) in a large group of patients. Our secondary objective was to compare the modified McKeown minimally invasive approach (videothoracoscopic surgery, laparoscopy, neck anastomosis [MIE-neck]) with our current approach, a modified Ivor Lewis approach (laparoscopy, videothoracoscopic surgery, chest anastomosis [MIE-chest]). Methods We reviewed 1033 consecutive patients undergoing MIE. Elective operation was performed on 1011 patients; 22 patients with nonelective operations were excluded. Patients were stratified by surgical approach and perioperative outcomes analyzed. The primary endpoint studied was 30-day mortality. Results The MIE-neck was performed in 481 (48%) and MIE-Ivor Lewis in 530 (52%). Patients undergoing MIE-Ivor Lewis were operated in the current era. The median number of lymph nodes resected was 21. The operative mortality was 1.68%. Median length of stay (8 days) and ICU stay (2 days) were similar between the 2 approaches. Mortality rate was 0.9%, and recurrent nerve injury was less frequent in the Ivor Lewis MIE group (P < 0.001). Conclusions MIE in our center resulted in acceptable lymph node resection, postoperative outcomes, and low mortality using either an MIE-neck or an MIE-chest approach. The MIE Ivor Lewis approach was associated with reduced recurrent laryngeal nerve injury and mortality of 0.9% and is now our preferred approach. Minimally invasive esophagectomy can be performed safely, with good results in an experienced center. PMID:22668811

  20. Minimally invasive procedures on the lumbar spine

    Science.gov (United States)

    Skovrlj, Branko; Gilligan, Jeffrey; Cutler, Holt S; Qureshi, Sheeraz A

    2015-01-01

    Degenerative disease of the lumbar spine is a common and increasingly prevalent condition that is often implicated as the primary reason for chronic low back pain and the leading cause of disability in the western world. Surgical management of lumbar degenerative disease has historically been approached by way of open surgical procedures aimed at decompressing and/or stabilizing the lumbar spine. Advances in technology and surgical instrumentation have led to minimally invasive surgical techniques being developed and increasingly used in the treatment of lumbar degenerative disease. Compared to the traditional open spine surgery, minimally invasive techniques require smaller incisions and decrease approach-related morbidity by avoiding muscle crush injury by self-retaining retractors, preventing the disruption of tendon attachment sites of important muscles at the spinous processes, using known anatomic neurovascular and muscle planes, and minimizing collateral soft-tissue injury by limiting the width of the surgical corridor. The theoretical benefits of minimally invasive surgery over traditional open surgery include reduced blood loss, decreased postoperative pain and narcotics use, shorter hospital length of stay, faster recover and quicker return to work and normal activity. This paper describes the different minimally invasive techniques that are currently available for the treatment of degenerative disease of the lumbar spine. PMID:25610845

  1. Esophageal surgery in minimally invasive era

    Institute of Scientific and Technical Information of China (English)

    2016-01-01

    The widespread popularity of new surgical technologiessuch as laparoscopy, thoracoscopy and robotics has ledmany surgeons to treat esophageal diseases with thesemethods. The expected benefits of minimally invasive surgery (MIS) mainly include reductions of postoperativecomplications, length of hospital stay, and pain andbetter cosmetic results. All of these benefits couldpotentially be of great interest when dealing with theesophagus due to the potentially severe complicationsthat can occur after conventional surgery. Moreover,robotic platforms are expected to reduce many of thedifficulties encountered during advanced laparoscopicand thoracoscopic procedures such as anastomoticreconstructions,accurate lymphadenectomies, andvascular sutures. Almost all esophageal diseases areapproachable in a minimally invasive way, includingdiverticula, gastro-esophageal reflux disease, achalasia,perforations and cancer. Nevertheless, while the limitsof MIS for benign esophageal diseases are mainlytechnical issues and costs, oncologic outcomes remainthe cornerstone of any procedure to cure malignancies,for which the long-term results are critical. Furthermore,many of the minimally invasive esophageal operationsshould be compared to pharmacologic interventionsand advanced pure endoscopic procedures; such acomparison requires a difficult literature analysis andleads to some confounding results of clinical trials. Thisreview aims to examine the evidence for the use of MISin both malignancies and more common benign diseaseof the esophagus, with a particular emphasis on futuredevelopments and ongoing areas of research.

  2. [MINIMALLY INVASIVE AORTIC VALVE REPLACEMENT].

    Science.gov (United States)

    Tabata, Minoru

    2016-03-01

    Minimally invasive aortic valve replacement (MIAVR) is defined as aortic valve replacement avoiding full sternotomy. Common approaches include a partial sternotomy right thoracotomy, and a parasternal approach. MIAVR has been shown to have advantages over conventional AVR such as shorter length of stay and smaller amount of blood transfusion and better cosmesis. However, it is also known to have disadvantages such as longer cardiopulmonary bypass and aortic cross-clamp times and potential complications related to peripheral cannulation. Appropriate patient selection is very important. Since the procedure is more complex than conventional AVR, more intensive teamwork in the operating room is essential. Additionally, a team approach during postoperative management is critical to maximize the benefits of MIAVR.

  3. A minimally invasive smile enhancement.

    Science.gov (United States)

    Peck, Fred H

    2014-01-01

    Minimally invasive dentistry refers to a wide variety of dental treatments. On the restorative aspect of dental procedures, direct resin bonding can be a very conservative treatment option for the patient. When tooth structure does not need to be removed, the patient benefits. Proper treatment planning is essential to determine how conservative the restorative treatment will be. This article describes the diagnosis, treatment options, and procedural techniques in the restoration of 4 maxillary anterior teeth with direct composite resin. The procedural steps are reviewed with regard to placing the composite and the variety of colors needed to ensure a natural result. Finishing and polishing of the composite are critical to ending with a natural looking dentition that the patient will be pleased with for many years.

  4. Minimally invasive aortic valve replacement

    DEFF Research Database (Denmark)

    Foghsgaard, Signe; Schmidt, Thomas Andersen; Kjaergard, Henrik K

    2009-01-01

    In this descriptive prospective study, we evaluate the outcomes of surgery in 98 patients who were scheduled to undergo minimally invasive aortic valve replacement. These patients were compared with a group of 50 patients who underwent scheduled aortic valve replacement through a full sternotomy....... The 30-day mortality rate for the 98 patients was zero, although 14 of the 98 mini-sternotomies had to be converted to complete sternotomies intraoperatively due to technical problems. Such conversion doubled the operative time over that of the planned full sternotomies. In the group of patients whose...... is an excellent operation in selected patients, but its true advantages over conventional aortic valve replacement (other than a smaller scar) await evaluation by means of randomized clinical trial. The "extended mini-aortic valve replacement" operation, on the other hand, is a risky procedure that should...

  5. Advances in bio-tactile sensors for minimally invasive surgery using the fibre Bragg grating force sensor technique: a survey.

    Science.gov (United States)

    Abushagur, Abdulfatah A G; Arsad, Norhana; Reaz, Mamun Ibne; Bakar, A Ashrif A

    2014-04-09

    The large interest in utilising fibre Bragg grating (FBG) strain sensors for minimally invasive surgery (MIS) applications to replace conventional electrical tactile sensors has grown in the past few years. FBG strain sensors offer the advantages of optical fibre sensors, such as high sensitivity, immunity to electromagnetic noise, electrical passivity and chemical inertness, but are not limited by phase discontinuity or intensity fluctuations. FBG sensors feature a wavelength-encoding sensing signal that enables distributed sensing that utilises fewer connections. In addition, their flexibility and lightness allow easy insertion into needles and catheters, thus enabling localised measurements inside tissues and blood. Two types of FBG tactile sensors have been emphasised in the literature: single-point and array FBG tactile sensors. This paper describes the current design, development and research of the optical fibre tactile techniques that are based on FBGs to enhance the performance of MIS procedures in general. Providing MIS or microsurgery surgeons with accurate and precise measurements and control of the contact forces during tissues manipulation will benefit both surgeons and patients.

  6. Minimally invasive pediatric surgery: Our experience

    Directory of Open Access Journals (Sweden)

    Saravanan K

    2008-01-01

    Full Text Available Aim: Departmental survey of the pediatric laparoscopic and thoracoscopic procedures. Materials and Methods: It is a retrospective study from January 1999 to December 2007. The various types of surgeries, number of patients, complications and conversions of laparoscopic and thoracoscopic procedures were analyzed. Results: The number of minimally invasive procedures that had been performed over the past 9 years is 734, out of which thoracoscopic procedures alone were 48. The majority of the surgeries were appendicectomy (31%, orchiopexy (19% and diagnostic laparoscopy (16%. The other advanced procedures include laparoscopic-assisted anorectoplasty, surgery for Hirschprung′s disease, thoracosocpic decortication, congenital diaphragmatic hernia repair, nephrectomy, fundoplication, etc. Our complications are postoperative fever, bleeding, bile leak following choledochal cyst excision and pneumothorax following bronchogenic cyst excision. A case of empyema thorax following thoracoscopic decortication succumbed due to disseminated tuberculosis. Our conversion rate was around 5% in the years 1999 to 2001, which has come down to 3% over the past few years. Conversions were for sliding hiatus hernia, nephrectomy, perforated adherent appendicitis, Meckel′s diverticulum, thoracoscopic decortication and ileal perforation. Conclusion: The minimally invasive pediatric surgical technique is increasingly accepted world wide and the need for laparoscopic training has become essential in every teaching hospital. It has a lot of advantages, such as less pain, early return to school and scarlessness. Our conversion rate has come down from 5% to 3% with experience and now we do more advanced procedures with a lower complication rate.

  7. Economic impact of minimally invasive lumbar surgery

    Science.gov (United States)

    Hofstetter, Christoph P; Hofer, Anna S; Wang, Michael Y

    2015-01-01

    Cost effectiveness has been demonstrated for traditional lumbar discectomy, lumbar laminectomy as well as for instrumented and noninstrumented arthrodesis. While emerging evidence suggests that minimally invasive spine surgery reduces morbidity, duration of hospitalization, and accelerates return to activites of daily living, data regarding cost effectiveness of these novel techniques is limited. The current study analyzes all available data on minimally invasive techniques for lumbar discectomy, decompression, short-segment fusion and deformity surgery. In general, minimally invasive spine procedures appear to hold promise in quicker patient recovery times and earlier return to work. Thus, minimally invasive lumbar spine surgery appears to have the potential to be a cost-effective intervention. Moreover, novel less invasive procedures are less destabilizing and may therefore be utilized in certain indications that traditionally required arthrodesis procedures. However, there is a lack of studies analyzing the economic impact of minimally invasive spine surgery. Future studies are necessary to confirm the durability and further define indications for minimally invasive lumbar spine procedures. PMID:25793159

  8. Minimally Invasive Transcatheter Aortic Valve Replacement (TAVR)

    Medline Plus

    Full Text Available Watch a Broward Health surgeon perform a minimally invasive Transcatheter Aortic Valve Replacement (TAVR) Click Here to view the BroadcastMed, Inc. Privacy Policy and Legal Notice © 2017 BroadcastMed, Inc. ...

  9. The advantages of minimally invasive dentistry.

    Science.gov (United States)

    Christensen, Gordon J

    2005-11-01

    Minimally invasive dentistry, in cases in which it is appropriate, is a concept that preserves dentitions and supporting structures. In this column, I have discussed several examples of minimally invasive dental techniques. This type of dentistry is gratifying for dentists and appreciated by patients. If more dentists would practice it, the dental profession could enhance the public's perception of its honesty and increase its professionalism as well.

  10. Invasive and minimally invasive surgical techniques for back pain conditions.

    Science.gov (United States)

    Lavelle, William; Carl, Allen; Lavelle, Elizabeth Demers

    2007-12-01

    This article summarizes current issues related to invasive and minimally invasive surgical techniques for back pain conditions. It describes pain generators and explains theories about how discs fail. The article discusses techniques for treating painful sciatica, painful motion segments, and spinal stenosis. Problems related to current imaging are also presented. The article concludes with a discussion about physical therapy.

  11. Minimally invasive surgical approach to pancreatic malignancies

    Institute of Scientific and Technical Information of China (English)

    Lapo; Bencini; Mario; Annecchiarico; Marco; Farsi; Ilenia; Bartolini; Vita; Mirasolo; Francesco; Guerra; Andrea; Coratti

    2015-01-01

    Pancreatic surgery for malignancy is recognized as challenging for the surgeons and risky for the patientsdue to consistent perioperative morbidity and mortality. Furthermore, the oncological long-term results are largely disappointing, even for those patients who experience an uneventfully hospital stay. Nevertheless, surgery still remains the cornerstone of a multidisciplinary treatment for pancreatic cancer. In order to maximize the benefits of surgery, the advent of both laparoscopy and robotics has led many surgeons to treat pancreatic cancers with these new methodologies. The reduction of postoperative complications, length of hospital stay and pain, together with a shorter interval between surgery and the beginning of adjuvant chemotherapy, represent the potential advantages over conventional surgery. Lastly, a better cosmetic result, although not crucial in any cancerous patient, could also play a role by improving overall well-being and patient self-perception. The laparoscopic approach to pancreatic surgery is, however, difficult in inexperienced hands and requires a dedicated training in both advanced laparoscopy and pancreatic surgery. The recent large diffusion of the da Vinci?? robotic platform seems to facilitate many of the technical maneuvers, such as anastomotic biliary and pancreatic reconstructions, accurate lymphadenectomy, and vascular sutures. The two main pancreatic operations, distal pancreatectomy and pancreaticoduodenectomy, are approachable by a minimally invasive path, but more limited interventions such as enucleation are also feasible. Nevertheless, a word of caution should be taken into account when considering the increasing costs of these newest technologies because the main concerns regarding these are the maintenance of all oncological standards and the lack of long-term follow-up. The purpose of this review is to examine the evidence for the use of minimally invasive surgery in pancreatic cancer(and less aggressive tumors), with

  12. Minimal Invasive Urologic Surgery and Postoperative Ileus

    Directory of Open Access Journals (Sweden)

    Fouad Aoun

    2015-07-01

    Full Text Available Postoperative ileus (POI is the most common cause of prolonged length of hospital stays (LOS and associated healthcare costs. The advent of minimal invasive technique was a major breakthrough in the urologic landscape with great potential to progress in the future. In the field of gastrointestinal surgery, several studies had reported lower incidence rates for POI following minimal invasive surgery compared to conventional open procedures. In contrast, little is known about the effect of minimal invasive approach on the recovery of bowel motility after urologic surgery. We performed an overview of the potential benefit of minimal invasive approach on POI for urologic procedures. The mechanisms and risk factors responsible for the onset of POI are discussed with emphasis on the advantages of minimal invasive approach. In the urologic field, POI is the main complication following radical cystectomy but it is rarely of clinical significance for other minimal invasive interventions. Laparoscopy or robotic assisted laparoscopic techniques when studied individually may reduce to their own the duration and prevent the onset of POI in a subset of procedures. The potential influence of age and urinary diversion type on postoperative ileus is contradictory in the literature. There is some evidence suggesting that BMI, blood loss, urinary extravasation, existence of a major complication, bowel resection, operative time and transperitoneal approach are independent risk factors for POI. Treatment of POI remains elusive. One of the most important and effective management strategies for patients undergoing radical cystectomy has been the development and use of enhanced recovery programs. An optimal rational strategy to shorten the duration of POI should incorporate minimal invasive approach when appropriate into multimodal fast track programs designed to reduce POI and shorten LOS.

  13. [Minimally invasive cardiac surgery for aortic valve disease].

    Science.gov (United States)

    Fujimura, Y; Katoh, T; Hamano, K; Gohra, H; Tsuboi, H; Esato, K

    1998-12-01

    Recent surgical advances leading to good operative results have contributed to the trend to useminimally invasive approaches, even in cardiac surgery. Smaller incisions are clearly more cosmetically acceptable to patients. When using a minimally invasive approach, it is most important to maintain surgical quality without jeopardizing patients. A good operative visual field leads to good surgical results. In the parasternal approach, we use a retractor to harvest an internal thoracic artery in coronary artery bypass surgery. Retracting the sternum upward allows for a good surgical view and permits the use of an arch cannula rather than femoral cannulation. When reoperating for aortic valve repair, the j-sternotomy approach requires less adhesiolysis compared with the traditional full sternotomy. No special technique is necessary to perform aortic valve surgery using the j-sternotomy approach. However, meticulous attention must be paid to avoiding left ventricular air embolisms to prevent postoperative stroke or neurocognitive deficits, especially when utilizing a minimally invasive approach. Transesophageal echo is useful not only for monitoring cardiac function but also for monitoring the persence of air in the left ventricle and atrium. This paper compare as the degree of invasion of minimally invasive cardiac surgery and the traditional full sternotomy. No differences were found in the occurrence of systemic inflammatory response syndrome between patients undergoing minimally invasive cardiac surgery and the traditional technique. Therefore it is concluded that minimally invasive surgery for patients with aortic valve disease may become the standard approach in the near future.

  14. Best practices for minimally invasive procedures.

    Science.gov (United States)

    Ulmer, Brenda C

    2010-05-01

    Techniques and instrumentation for minimally invasive surgical procedures originated in gynecologic surgery, but the benefits of surgery with small incisions or no incisions at all have prompted the expansion of these techniques into numerous specialties. Technologies such as robotic assistance, single-incision laparoscopic surgery, natural orifice transluminal endoscopic surgery, and video-assisted thoracoscopic surgery have led to the continued expansion of minimally invasive surgery into new specialties. With this expansion, perioperative nurses and other members of the surgical team are required to continue to learn about new technology and instrumentation, as well as the techniques and challenges involved in using new technology, to help ensure the safety of their patients. This article explores the development of minimally invasive procedures and offers suggestions for increasing patient safety.

  15. Minimally invasive (robotic assisted thoracic surgery and video-assisted thoracic surgery) lobectomy for the treatment of locally advanced non-small cell lung cancer

    Science.gov (United States)

    Yang, Hao-Xian; Woo, Kaitlin M.; Sima, Camelia S.

    2016-01-01

    Background Insufficient data exist on the results of minimally invasive surgery (MIS) for locally advanced non-small cell lung cancer (NSCLC) traditionally approached by thoracotomy. The use of telerobotic surgical systems may allow for greater utilization of MIS approaches to locally advanced disease. We will review the existing literature on MIS for locally advanced disease and briefly report on the results of a recent study conducted at our institution. Methods We performed a retrospective review of a prospective single institution database to identify patients with clinical stage II and IIIA NSCLC who underwent lobectomy following induction chemotherapy. The patients were classified into two groups (MIS and thoracotomy) and were compared for differences in outcomes and survival. Results From January 2002 to December 2013, 428 patients {397 thoracotomy, 31 MIS [17 robotic and 14 video-assisted thoracic surgery (VATS)]} underwent induction chemotherapy followed by lobectomy. The conversion rate in the MIS group was 26% (8/31) The R0 resection rate was similar between the groups (97% for MIS vs. 94% for thoracotomy; P=0.71), as was postoperative morbidity (32% for MIS vs. 33% for thoracotomy; P=0.99). The median length of hospital stay was shorter in the MIS group (4 vs. 5 days; P<0.001). The 3-year overall survival (OS) was 48.3% in the MIS group and 56.6% in the thoracotomy group (P=0.84); the corresponding 3-year DFS were 49.0% and 42.1% (P=0.19). Conclusions In appropriately selected patients with NSCLC, MIS approaches to lobectomy following induction therapy are feasible and associated with similar disease-free and OS to those following thoracotomy. PMID:27195138

  16. Minimally invasive restorative dentistry: a biomimetic approach.

    Science.gov (United States)

    Malterud, Mark I

    2006-08-01

    When providing dental treatment for a given patient, the practitioner should use a minimally invasive technique that conserves sound tooth structure as a clinical imperative. Biomimetics is a tenet that guides the author's practice and is generally described as the mimicking of natural life. This can be accomplished in many cases using contemporary composite resins and adhesive dental procedures. Both provide clinical benefits and support the biomimetic philosophy for treatment. This article illustrates a minimally invasive approach for the restoration of carious cervical defects created by poor hygiene exacerbated by the presence of orthodontic brackets.

  17. Minimally Invasive Osteotomies of the Calcaneus.

    Science.gov (United States)

    Guyton, Gregory P

    2016-09-01

    Osteotomies of the calcaneus are powerful surgical tools, representing a critical component of the surgical reconstruction of pes planus and pes cavus deformity. Modern minimally invasive calcaneal osteotomies can be performed safely with a burr through a lateral incision. Although greater kerf is generated with the burr, the effect is modest, can be minimized, and is compatible with many fixation techniques. A hinged jig renders the procedure more reproducible and accessible.

  18. Minimally invasive surgical techniques in periodontal regeneration.

    Science.gov (United States)

    Cortellini, Pierpaolo

    2012-09-01

    A review of the current scientific literature was undertaken to evaluate the efficacy of minimally invasive periodontal regenerative surgery in the treatment of periodontal defects. The impact on clinical outcomes, surgical chair-time, side effects and patient morbidity were evaluated. An electronic search of PUBMED database from January 1987 to December 2011 was undertaken on dental journals using the key-word "minimally invasive surgery". Cohort studies, retrospective studies and randomized controlled clinical trials referring to treatment of periodontal defects with at least 6 months of follow-up were selected. Quality assessment of the selected studies was done through the Strength of Recommendation Taxonomy Grading (SORT) System. Ten studies (1 retrospective, 5 cohorts and 4 RCTs) were included. All the studies consistently support the efficacy of minimally invasive surgery in the treatment of periodontal defects in terms of clinical attachment level gain, probing pocket depth reduction and minimal gingival recession. Six studies reporting on side effects and patient morbidity consistently indicate very low levels of pain and discomfort during and after surgery resulting in a reduced intake of pain-killers and very limited interference with daily activities in the post-operative period. Minimally invasive surgery might be considered a true reality in the field of periodontal regeneration. The observed clinical improvements are consistently associated with very limited morbidity to the patient during the surgical procedure as well as in the post-operative period. Minimally invasive surgery, however, cannot be applied at all cases. A stepwise decisional algorithm should support clinicians in choosing the treatment approach.

  19. Flexible Sensors for Minimally Invasive Medical Instruments

    NARCIS (Netherlands)

    Mimoun, B.A.Z.

    2013-01-01

    Being able to measure medical parameters directly inside the body in a minimally invasive way allows for a more accurate, faster, safer and cheaper diagnosis. A typical example can be found in the diagnosis of coronary artery diseases, where simultaneous measurement of intracoronary blood flow and p

  20. The concept of minimally invasive dentistry.

    Science.gov (United States)

    Ericson, Dan

    2007-01-01

    This paper reviews Minimally Invasive Dentistry (MID) from a day-to-day dentistry perspective, focusing mostly on cariology and restorative dentistry, even though it embraces many aspects of dentistry. The concept of MID supports a systematic respect for the original tissue, including diagnosis, risk assessment, preventive treatment, and minimal tissue removal upon restoration. The motivation for MID emerges from the fact that fillings are not permanent and that the main reasons for failure are secondary caries and filling fracture. To address these flaws, there is a need for economical re-routing so that practices can survive on maintaining dental health and not only by operative procedures.

  1. Mechatronic Feasibility of Minimally Invasive, Atraumatic Cochleostomy

    Directory of Open Access Journals (Sweden)

    Tom Williamson

    2014-01-01

    Full Text Available Robotic assistance in the context of lateral skull base surgery, particularly during cochlear implantation procedures, has been the subject of considerable research over the last decade. The use of robotics during these procedures has the potential to provide significant benefits to the patient by reducing invasiveness when gaining access to the cochlea, as well as reducing intracochlear trauma when performing a cochleostomy. Presented herein is preliminary work on the combination of two robotic systems for reducing invasiveness and trauma in cochlear implantation procedures. A robotic system for minimally invasive inner ear access was combined with a smart drilling tool for robust and safe cochleostomy; evaluation was completed on a single human cadaver specimen. Access to the middle ear was successfully achieved through the facial recess without damage to surrounding anatomical structures; cochleostomy was completed at the planned position with the endosteum remaining intact after drilling as confirmed by microscope evaluation.

  2. Robots for minimally invasive diagnosis and intervention

    OpenAIRE

    Huda, Nazmul; YU, Hongnian; Cang, Shuang

    2016-01-01

    Minimally invasive diagnosis and interventions provide many benefits such as higher efficiency, safer, minimum pain, quick recovery etc. over conventional way for many procedures. Large robots such as da-Vinci are being used in this purpose, whereas research of miniature robots for laparoscopic and endoscopic use, is growing in the recent years. A comprehensive literature search is performed using keywords’ laparoscopic robot, capsule endoscope, surgical medical robot etc. primarily for the t...

  3. Minimally Invasive Procedures for Nasal Aesthetics

    OpenAIRE

    Alessio Redaelli; Pietro Limardo

    2012-01-01

    Nose has an important role in the aesthetics of face. It is easy to understand the reason of the major interest that has revolved around the correction of its imperfections for several centuries, or even from the ancient times. In the last decade, all the surgical or medical minimal-invasive techniques evolved exponentially. The techniques of rejuvenation and corrections of nasal imperfections did not escape this development that is much widespread in the medicine of the third millennium. In ...

  4. Minimally invasive local therapies for liver cancer

    Institute of Scientific and Technical Information of China (English)

    David Li; Josephine Kang; Benjamin J Golas; Vincent W Yeung; David C Madoff

    2014-01-01

    Primary and metastatic liver tumors are an increasing global health problem, with hepatocellular carcinoma (HCC) now being the third leading cause of cancer-related mortality worldwide. Systemic treatment options for HCC remain limited, with Sorafenib as the only prospectively validated agent shown to increase overall survival. Surgical resection and/or transplantation, locally ablative therapies and regional or locoregional therapies have iflled the gap in liver tumor treatments, providing improved survival outcomes for both primary and metastatic tumors. Minimally invasive local therapies have an increasing role in the treatment of both primary and metastatic liver tumors. For patients with low volume disease, these therapies have now been established into consensus practice guidelines. This review highlights technical aspects and outcomes of commonly utilized, minimally invasive local therapies including laparoscopic liver resection (LLR), radiofrequency ablation (RFA), microwave ablation (MWA), high-intensity focused ultrasound (HIFU), irreversible electroporation (IRE), and stereotactic body radiation therapy (SBRT). In addition, the role of combination treatment strategies utilizing these minimally invasive techniques is reviewed.

  5. [Minimally Invasive Treatment of Esophageal Benign Diseases].

    Science.gov (United States)

    Inoue, Haruhiro

    2016-07-01

    As a minimally invasive treatment of esophageal achalasia per-oral endoscopic myotomy( POEM) was developed in 2008. More than 1,100 cases of achalasia-related diseases received POEM. Success rate of the procedure was more than 95%(Eckerdt score improvement 3 points and more). No serious( Clavian-Dindo classification III b and more) complication was experienced. These results suggest that POEM becomes a standard minimally invasive treatment for achalasia-related diseases. As an off-shoot of POEM submucosal tumor removal through submucosal tunnel (per-oral endoscopic tumor resection:POET) was developed and safely performed. Best indication of POET is less than 5 cm esophageal leiomyoma. A novel endoscopic treatment of gastroesophageal reflux disease (GERD) was developed. Anti-reflux mucosectomy( ARMS) is nearly circumferential mucosal reduction of gastric cardia mucosa. ARMS is performed in 56 consecutive cases of refractory GERD. No major complications were encountered and excellent clinical results. Best indication of ARMS is a refractory GERD without long sliding hernia. Longest follow-up case is more than 10 years. Minimally invasive treatments for esophageal benign diseases are currently performed by therapeutic endoscopy.

  6. Minimally invasive surgical treatment of valvular heart disease.

    Science.gov (United States)

    Goldstone, Andrew B; Joseph Woo, Y

    2014-01-01

    Cardiac surgery is in the midst of a practice revolution. Traditionally, surgery for valvular heart disease consisted of valve replacement via conventional sternotomy using cardiopulmonary bypass. However, over the past 20 years, the increasing popularity of less-invasive procedures, accompanied by advancements in imaging, surgical instrumentation, and robotic technology, has motivated and enabled surgeons to develop and perform complex cardiac surgical procedures through small incisions, often eliminating the need for sternotomy or cardiopulmonary bypass. In addition to the benefits of improved cosmesis, minimally invasive mitral valve surgery was pioneered with the intent of reducing morbidity, postoperative pain, blood loss, hospital length of stay, and time to return to normal activity. This article reviews the current state-of-the-art of minimally invasive approaches to the surgical treatment of valvular heart disease.

  7. Multiexpandable cage for minimally invasive posterior lumbar interbody fusion

    Science.gov (United States)

    Coe, Jeffrey D; Zucherman, James F; Kucharzyk, Donald W; Poelstra, Kornelis A; Miller, Larry E; Kunwar, Sandeep

    2016-01-01

    The increasing adoption of minimally invasive techniques for spine surgery in recent years has led to significant advancements in instrumentation for lumbar interbody fusion. Percutaneous pedicle screw fixation is now a mature technology, but the role of expandable cages is still evolving. The capability to deliver a multiexpandable interbody cage with a large footprint through a narrow surgical cannula represents a significant advancement in spinal surgery technology. The purpose of this report is to describe a multiexpandable lumbar interbody fusion cage, including implant characteristics, intended use, surgical technique, preclinical testing, and early clinical experience. Results to date suggest that the multiexpandable cage allows a less invasive approach to posterior/transforaminal lumbar interbody fusion surgery by minimizing iatrogenic risks associated with static or vertically expanding interbody prostheses while providing immediate vertebral height restoration, restoration of anatomic alignment, and excellent early-term clinical results. PMID:27729817

  8. Minimally invasive dentistry: a review and update.

    Science.gov (United States)

    Brostek, Andrew M; Bochenek, Andrew J; Walsh, Laurence J

    2006-06-01

    The term "Minimal Invasive (MI) Dentistry" can best be defined as the management of caries with a biological approach, rather than with a traditional (surgical) operative dentistry approach. Where operative dentistry is required, this is now carried out in the most conservative manner with minimal destruction of tooth structure. This new approach to caries management changes the emphasis from diagnosing carious lesions as cavities (and a repeating cycle of restorations), to one of diagnosing the oral ecological imbalance and effecting biological changes in the biofilm. The goal of MI is to stop the disease process and then to restore lost tooth structure and function, maximizing the healing potential of the tooth. The thought process which underpins this new minimal invasive approach can be organized into three main categories: (1) Recognize, which means identify patient caries risk, (2) Remineralize, which means prevent caries and reverse non-cavitated caries, and (3) Repair, which means control caries activity, maximize healing and repair the damage. The disease of dental caries is not just demineralization, but a process of repeated demineralization cycles caused by an imbalance in the ecological and chemical equilibrium of the biofilm /tooth interface (the ecological plaque hypothesis). Dietary and lifestyle patterns, especially carbohydrate frequency, water intake and smoking, play an important role in changing the biofilm ecology and pathogenicity. Tools for chairside assessment of saliva and plaque, allow risk to be assessed and patient compliance monitored. The remineralizing properties of saliva can be enhanced using materials which release biologically available calcium, phosphate and fluoride ions (CPP-ACP and CPP-ACFP). Use of biocides can also alter the pathogenic properties of plaque. Use of these MI treatment protocols, can repair early lesions and improve patient understanding and compliance. This review article introduces some of the key concepts

  9. Minimally invasive surgery for atrial fibrillation.

    Science.gov (United States)

    Zembala, Michael O; Suwalski, Piotr

    2013-11-01

    Atrial fibrillation (AF) remains the most common cardiac arrhythmia, affecting nearly 2% of the general population worldwide. Minimally invasive surgical ablation remains one of the most dynamically evolving fields of modern cardiac surgery. While there are more than a dozen issues driving this development, two seem to play the most important role: first, there is lack of evidence supporting percutaneous catheter based approach to treat patients with persistent and long-standing persistent AF. Paucity of this data offers surgical community unparalleled opportunity to challenge guidelines and change indications for surgical intervention. Large, multicenter prospective clinical studies are therefore of utmost importance, as well as honest, clear data reporting. Second, a collaborative methodology started a long-awaited debate on a Heart Team approach to AF, similar to the debate on coronary artery disease and transcatheter valves. Appropriate patient selection and tailored treatment options will most certainly result in better outcomes and patient satisfaction, coupled with appropriate use of always-limited institutional resources. The aim of this review, unlike other reviews of minimally invasive surgical ablation, is to present medical professionals with two distinctly different, approaches. The first one is purely surgical, Standalone surgical isolation of the pulmonary veins using bipolar energy source with concomitant amputation of the left atrial appendage-a method of choice in one of the most important clinical trials on AF-The Atrial Fibrillation Catheter Ablation Versus Surgical Ablation Treatment (FAST) Trial. The second one represents the most complex approach to this problem: a multidisciplinary, combined effort of a cardiac surgeon and electrophysiologist. The Convergent Procedure, which includes both endocardial and epicardial unipolar ablation bonds together minimally invasive endoscopic surgery with electroanatomical mapping, to deliver best of the

  10. Resin composites in minimally invasive dentistry.

    Science.gov (United States)

    Jacobsen, Thomas

    2004-01-01

    The concept of minimally invasive dentistry will provide favorable conditions for the use of composite resin. However, a number of factors must be considered when placing composite resins in conservatively prepared cavities, including: aspects on the adaptation of the composite resin to the cavity walls; the use of adhesives; and techniques for obtaining adequate proximal contacts. The clinician must also adopt an equally conservative approach when treating failed restorations. The quality of the composite resin restoration will not only be affected by the outline form of the preparation but also by the clinician's technique and understanding of the materials.

  11. Minimally invasive surgery for esophageal achalasia

    Institute of Scientific and Technical Information of China (English)

    Luigi Bonavina

    2006-01-01

    Esophageal achalasia is the most commonly diagnosed primary esophageal motor disorder and the second most common functional esophageal disorder. Current therapy of achalasia is directed toward elimination of the outflow resistance caused by failure of the lower esophageal sphincter to relax completely upon swallowing. The advent of minimally invasive surgery has nearly replaced endoscopic pneumatic dilation as the first-line therapeutic approach. In this editorial, the rationale and the evidence supporting the use of laparoscopic Heller myotomy combined with fundoplication as a primary treatment of achalasia are reviewed.

  12. Surgeons' musculoskeletal pain in minimally invasive surgery

    DEFF Research Database (Denmark)

    Dalager, Tina; Søgaard, Karen; Bech, Katrine Tholstrup

    Background: A large proportion of surgeons performing minimally invasive surgery (MIS) experience musculoskeletal pain in the upper body possibly due to awkward and long-term static positions. This can be detrimental for workability and health. The objective of the present review is to sum up...... in surgeons performing MIS is high and derives mainly from static postures. Positioning of monitor, adjustment of table height and instrument design also contribute substantially. Robotic assisted laparoscopy seems less physically demanding for the surgeon compared with conventional laparoscopy. However, some...

  13. Minimally Invasive Approach of a Retrocaval Ureter

    Science.gov (United States)

    Pinheiro, Hugo; Ferronha, Frederico; Morales, Jorge; Campos Pinheiro, Luís

    2016-01-01

    The retrocaval ureter is a rare congenital entity, classically managed with open pyeloplasty techniques. The experience obtained with the laparoscopic approach of other more frequent causes of ureteropelvic junction (UPJ) obstruction has opened the method for the minimally invasive approach of the retrocaval ureter. In our paper, we describe a clinical case of a right retrocaval ureter managed successfully with laparoscopic dismembered pyeloplasty. The main standpoints of the procedure are described. Our results were similar to others published by other urologic centers, which demonstrates the safety and feasibility of the procedure for this condition. PMID:27635277

  14. Minimal Invasive Decompression for Lumbar Spinal Stenosis

    Directory of Open Access Journals (Sweden)

    Victor Popov

    2012-01-01

    Full Text Available Lumbar spinal stenosis is a common condition in elderly patients and may lead to progressive back and leg pain, muscular weakness, sensory disturbance, and/or problems with ambulation. Multiple studies suggest that surgical decompression is an effective therapy for patients with symptomatic lumbar stenosis. Although traditional lumbar decompression is a time-honored procedure, minimally invasive procedures are now available which can achieve the goals of decompression with less bleeding, smaller incisions, and quicker patient recovery. This paper will review the technique of performing ipsilateral and bilateral decompressions using a tubular retractor system and microscope.

  15. Minimal Invasive Surgery for Esophageal Cancer

    Institute of Scientific and Technical Information of China (English)

    A.H.Hoelscher; Ch.Gutschow

    2004-01-01

    Thoracoscopic esophagectomy is only established in some centers and affords a cervical anastomosis because intrathoracic anastomosis as a routine is technically too difficult. Laparoscopic mobilisation of the stomach (gastrolysis) is an important contribution for minimal invasive surgery of esophageal cancer.This procedure reduces the stress of the two cavity operation for the patient and allows the construction of a comparable gastric conduit like by open surgery. The technique of laparoscopic gastrolysis as preparation for transthoracic en bloc esophagectomy is described in detail and preliminary results are briefly mentioned.

  16. Minimally invasive techniques in Acoustic Neurinoma Microneurosurgery

    Institute of Scientific and Technical Information of China (English)

    2001-01-01

    The present report should summarize our experience using minimally invasive techniques in acoustic neurinoma surgery at the Neurosurgical Department,University of Vienna,Austria .Based on the experience of about 687 cases ub a 20year time period our mostly used techniques will be presented. This is a minimal innvasive individual adapted approach,specified intraoperative strategy and dissection tech-niques (e.g.water jet dissection,ultrasonic aspirator CUSA),the use of neuronavigational systems and the use of endoscope assisted surgery.With respect to the Limited space of place precise citations to further textbooks of the authors handling with this topic will be given. Finally our results using these techniques are presented and further future perspectives in the treatment of these pathology(radiosurgery)will be dis-cussed.

  17. Minimally invasive colopexy for pediatric Chilaiditi syndrome.

    Science.gov (United States)

    Blevins, Wayne A; Cafasso, Danielle E; Fernandez, Minela; Edwards, Mary J

    2011-03-01

    Chilaiditi syndrome is a rare disorder characterized by abdominal pain, respiratory distress, constipation, and vomiting in association with Chilaiditi's sign. Chilaiditi's sign is the finding on plain roentgenogram of colonic interposition between the liver and diaphragm and is usually asymptomatic. Surgery is typically reserved for cases of catastrophic colonic volvulus or perforation because of the syndrome. We present a case of a 6-year-old boy who presented with Chilaiditi syndrome and resulting failure to thrive because of severe abdominal pain and vomiting, which did not improve with laxatives and dietary changes. He underwent a laparoscopic gastrostomy tube placement and laparoscopic colopexy of the transverse colon to the falciform ligament and anterior abdominal wall. Postoperatively, his symptoms resolved completely, as did his failure to thrive. His gastrostomy tube was removed 3 months after surgery and never required use. This is the first case of Chilaiditi syndrome in the pediatric literature we are aware of that was treated with an elective, minimally invasive colopexy. In cases of severe Chilaiditi syndrome refractory to medical treatment, a minimally invasive colopexy should be considered as a possible treatment option and potentially offered before development of life-threatening complications such as volvulus or perforation.

  18. [Theory and practice of minimally invasive endodontics].

    Science.gov (United States)

    Jiang, H W

    2016-08-01

    The primary goal of modern endodontic therapy is to achieve the long-term retention of a functional tooth by preventing or treating pulpitis or apical periodontitis is. The long-term retention of endodontically treated tooth is correlated with the remaining amount of tooth tissue and the quality of the restoration after root canal filling. In recent years, there has been rapid progress and development in the basic research of endodontic biology, instrument and applied materials, making treatment procedures safer, more accurate, and more efficient. Thus, minimally invasive endodontics(MIE)has received increasing attention at present. MIE aims to preserve the maximum of tooth structure during root canal therapy, and the concept covers the whole process of diagnosis and treatment of teeth. This review article focuses on describing the minimally invasive concepts and operating essentials in endodontics, from diagnosis and treatment planning to the access opening, pulp cavity finishing, root canal cleaning and shaping, 3-dimensional root canal filling and restoration after root canal treatment.

  19. Minimally invasive treatment options in fixed prosthodontics.

    Science.gov (United States)

    Edelhoff, Daniel; Liebermann, Anja; Beuer, Florian; Stimmelmayr, Michael; Güth, Jan-Frederik

    2016-03-01

    Minimally invasive treatment options have become increasingly feasible in restorative dentistry, due to the introduction of the adhesive technique in combination with restorative materials featuring translucent properties similar to those of natural teeth. Mechanical anchoring of restorations via conventional cementation represents a predominantly subtractive treatment approach that is gradually being superseded by a primarily defect-oriented additive method in prosthodontics. Modifications of conventional treatment procedures have led to the development of an economical approach to the removal of healthy tooth structure. This is possible because the planned treatment outcome is defined in a wax-up before the treatment is commenced and this wax-up is subsequently used as a reference during tooth preparation. Similarly, resin- bonded FDPs and implants have made it possible to preserve the natural tooth structure of potential abutment teeth. This report describes a number of clinical cases to demonstrate the principles of modern prosthetic treatment strategies and discusses these approaches in the context of minimally invasive prosthetic dentistry.

  20. Minimally invasive procedures for nasal aesthetics.

    Science.gov (United States)

    Redaelli, Alessio; Limardo, Pietro

    2012-04-01

    Nose has an important role in the aesthetics of face. It is easy to understand the reason of the major interest that has revolved around the correction of its imperfections for several centuries, or even from the ancient times. In the last decade, all the surgical or medical minimal-invasive techniques evolved exponentially. The techniques of rejuvenation and corrections of nasal imperfections did not escape this development that is much widespread in the medicine of the third millennium. In many cases, the techniques of surgical correction involve invasive procedure that necessitates, for the majority of cases, hospitalisation. The author, using a different approach, has developed mini-invasive techniques using botulinum toxin A (BTxA) and absorbable fillers for the correction of nasal imperfections. BTxA allows to reduce the imperfections due to hypertension of muscles, while the absorbable fillers allow to correct all the imperfections of the nasal profile from the root to the tip in total safety. The correction is based on the precise rules that allow avoiding the majority of side effects. Results are long lasting and well appreciated by patients.

  1. 结直肠手术中微创技术和理念的进展%Advances in technology and the concept of minimally invasive colorectal surgery

    Institute of Scientific and Technical Information of China (English)

    赵青川; 李纪鹏; 洪流

    2014-01-01

    近年来随着微创技术的发展,结直肠外科手术取得了重大进步。内镜技术最初作为一项诊查手段,现已越来越多地用于胃肠道疾病的治疗。其中内镜下粘膜切除术和内镜下粘膜剥离术可用于治疗早期结直肠癌,避免了开腹或腹腔镜手术,且体表不遗留手术疤痕。随着器械的完善和技术的进步,腹腔镜技术也已广泛用于结直肠癌的根治性切除,且大量的临床实践证明其具有良好的可行性和安全性。三维腹腔镜的应用改善了术中的视野,提升了腹腔镜操作的精细程度。机器人手术系统的出现则将外科手术引入一个新时代,远程手术得以成功实施,且更加精细灵活的操作可在腹腔镜下狭小的空间里完成。此外,功能学的微创理念日益受到重视。外科医生不仅仅追求更小的切口和创伤,更开始追求更小的应激反应和更快的术后恢复。本文回顾了近年来微创技术和理念的进展,并对微创外科在结直肠手术中的应用做出了展望。%With the development of minimally invasive techniques, colorectal surgery has made significant progress in recent years.Initially as a diagnostic tool,endoscopy has been used more and more often in the treatment of gastrointestinal disorders .Endoscopic Mucosal Resection ( EMR ) and Endoscopic Submucosal Dissection(ESD) are applied to the treatment of early-stage colorectal cancer,avoiding open or laparoscopic surgeries,and leaving no scar on the skin.With the improvement of operation skills,laparoscopy has been widely used in radical surgeries of colorectal cancer ,and its feasibility and safety have already been proven by abundant clinical practices.Three-dimensional laparoscopy improves the surgeon’s field of vision,enhances the precision of operations.The advent of robotic surgical system has led to a new era for surgical operations ,with remote surgeries performed successfully

  2. Minimally invasive aesthetic procedures in young adults

    Directory of Open Access Journals (Sweden)

    Wollina U

    2011-03-01

    Full Text Available Uwe Wollina1, Alberto Goldman21Department of Dermatology and Allergology, Academic Teaching Hospital Dresden-Friedrichstadt, Dresden, Germany; 2Clinica Goldman, Porto Alegre, Rio Grande du Sul, BrazilAbstract: Age is a significant factor in modifying specific needs when it comes to medical aesthetic procedures. In this review we will focus on young adults in their third decade of life and review minimally invasive aesthetic procedures other than cosmetics and cosmeceuticals. Correction of asymmetries, correction after body modifying procedures, and facial sculpturing are important issues for young adults. The implication of aesthetic medicine as part of preventive medicine is a major ethical challenge that differentiates aesthetic medicine from fashion.Keywords: acne scars, ice pick scars, boxcar scars, fillers 

  3. Minimally invasive surgery for esophageal cancer.

    Science.gov (United States)

    Santillan, Alfredo A; Farma, Jeffrey M; Meredith, Kenneth L; Shah, Nilay R; Kelley, Scott T

    2008-10-01

    Esophageal cancer represents a major public health problem worldwide. Several minimally invasive esophagectomy (MIE) techniques have been described and represent a safe alternative for the surgical management of esophageal cancer in selected centers with high volume and expertise in them. This article reviews the most recent and largest series evaluating MIE techniques. Recent larger series have shown MIE to be equivalent in postoperative morbidity and mortality rates to conventional surgery. MIE has been associated with less blood loss, less postoperative pain, and decreased intensive care unit and hospital length of stay compared with conventional surgery. Despite limited data, conventional surgery and MIE have shown no significant difference in survival, stage for stage. The myriad of MIE techniques complicates the debate of defining the optimal surgical approach for treating esophageal cancer. Randomized controlled trials comparing MIE with conventional open esophagectomy are needed to clarify the ideal procedure with the lowest postoperative morbidity, best quality of life after surgery, and long-term survival.

  4. Minimally invasive total hip arthroplasty: in opposition.

    Science.gov (United States)

    Hungerford, David S

    2004-06-01

    At the Knee Society Winter Meeting in 2003, Seth Greenwald and I debated about whether there should be new standards (ie, regulations) applied to the release of information to the public on "new developments." I argued for the public's "right to know" prior to the publication of peer-reviewed literature. He argued for regulatory constraint or "proving by peer-reviewed publication" before alerting the public. It is not a contradiction for me to currently argue against the public advertising of minimally invasive (MIS) total hip arthroplasty as not yet being in the best interest of the public. It is hard to remember a concept that has so captured both the public's and the surgical community's fancy as MIS. Patients are "demanding" MIS without knowing why. Surgeons are offering it as the next best, greatest thing without having developed the skill and experience to avoid the surgery's risks. If you put "minimally invasive hip replacement" into the Google search engine (http://www.google.com), you get 5,170 matches. If you put the same words in PubMed (http://www.ncbi.nlm.nih.gov/entrez/query.fcgi), referencing the National Library of Medicine database, you get SEVENTEEN; none is really a peer-reviewed article. Most are 1 page papers in orthopedics from medical education meetings. On the other hand, there are over 6,000 peer-reviewed articles on total hip arthroplasty. Dr. Thomas Sculco, my couterpart in this debate, wrote an insightful editorial in the American Journal of Orthopedic Surgery in which he stated: "Although these procedures have generated incredible interest and enthusiasm, I am concerned that they may be performed to the detriment of our patients." I couldn't agree with him more. Smaller is not necessarily better and, when it is worse, it will be the "smaller" that is held accountable.

  5. Transdermal Photopolymerization for Minimally Invasive Implantation

    Science.gov (United States)

    Elisseeff, J.; Anseth, K.; Sims, D.; McIntosh, W.; Randolph, M.; Langer, R.

    1999-03-01

    Photopolymerizations are widely used in medicine to create polymer networks for use in applications such as bone restorations and coatings for artificial implants. These photopolymerizations occur by directly exposing materials to light in "open" environments such as the oral cavity or during invasive procedures such as surgery. We hypothesized that light, which penetrates tissue including skin, could cause a photopolymerization indirectly. Liquid materials then could be injected s.c. and solidified by exposing the exterior surface of the skin to light. To test this hypothesis, the penetration of UVA and visible light through skin was studied. Modeling predicted the feasibility of transdermal polymerization with only 2 min of light exposure required to photopolymerize an implant underneath human skin. To establish the validity of these modeling studies, transdermal photopolymerization first was applied to tissue engineering by using "injectable" cartilage as a model system. Polymer/chondrocyte constructs were injected s.c. and transdermally photopolymerized. Implants harvested at 2, 4, and 7 weeks demonstrated collagen and proteoglycan production and histology with tissue structure comparable to native neocartilage. To further examine this phenomenon and test the applicability of transdermal photopolymerization for drug release devices, albumin, a model protein, was released for 1 week from photopolymerized hydrogels. With further study, transdermal photpolymerization potentially could be used to create a variety of new, minimally invasive surgical procedures in applications ranging from plastic and orthopedic surgery to tissue engineering and drug delivery.

  6. Surgical efficacy of minimally invasive thoracic discectomy.

    Science.gov (United States)

    Elhadi, Ali M; Zehri, Aqib H; Zaidi, Hasan A; Almefty, Kaith K; Preul, Mark C; Theodore, Nicholas; Dickman, Curtis A

    2015-11-01

    We aimed to determine the clinical indications and surgical outcomes for thoracoscopic discectomy. Thoracic disc disease is a rare degenerative process. Thoracoscopic approaches serve to minimize tissue injury during the approach, but critics argue that this comes at the cost of surgical efficacy. Current reports in the literature are limited to small institutional patient series. We systematically identified all English language articles on thoracoscopic discectomy with at least two patients, published from 1994 to 2013 on MEDLINE, Science Direct, and Google Scholar. We analyzed 12 articles that met the inclusion criteria, five prospective and seven retrospective studies comprising 545 surgical patients. The overall complication rate was 24% (n=129), with reported complications ranging from intercostal neuralgia (6.1%), atelectasis (2.8%), and pleural effusion (2.6%), to more severe complications such as pneumonia (0.8%), pneumothorax (1.3%), and venous thrombosis (0.2%). The average reported postoperative follow-up was 20.5 months. Complete resolution of symptoms was reported in 79% of patients, improvement with residual symptoms in 10.2%, no change in 9.6%, and worsening in 1.2%. The minimally invasive endoscopic approaches to the thoracic spine among selected patients demonstrate excellent clinical efficacy and acceptable complication rates, comparable to the open approaches. Disc herniations confined to a single level, with small or no calcifications, are ideal for such an approach, whereas patients with calcified discs adherent to the dura would benefit from an open approach.

  7. Prevailing Trends in Haptic Feedback Simulation for Minimally Invasive Surgery.

    Science.gov (United States)

    Pinzon, David; Byrns, Simon; Zheng, Bin

    2016-08-01

    Background The amount of direct hand-tool-tissue interaction and feedback in minimally invasive surgery varies from being attenuated in laparoscopy to being completely absent in robotic minimally invasive surgery. The role of haptic feedback during surgical skill acquisition and its emphasis in training have been a constant source of controversy. This review discusses the major developments in haptic simulation as they relate to surgical performance and the current research questions that remain unanswered. Search Strategy An in-depth review of the literature was performed using PubMed. Results A total of 198 abstracts were returned based on our search criteria. Three major areas of research were identified, including advancements in 1 of the 4 components of haptic systems, evaluating the effectiveness of haptic integration in simulators, and improvements to haptic feedback in robotic surgery. Conclusions Force feedback is the best method for tissue identification in minimally invasive surgery and haptic feedback provides the greatest benefit to surgical novices in the early stages of their training. New technology has improved our ability to capture, playback and enhance to utility of haptic cues in simulated surgery. Future research should focus on deciphering how haptic training in surgical education can increase performance, safety, and improve training efficiency.

  8. Monitoring high-risk patients: minimally invasive and non-invasive possibilities.

    Science.gov (United States)

    Renner, Jochen; Grünewald, Matthias; Bein, Berthold

    2016-06-01

    Over the past decades, there has been considerable progress in the field of less invasive haemodynamic monitoring technologies. Substantial evidence has accumulated, which supports the continuous measurement and optimization of flow-based variables such as stroke volume, that is, cardiac output, in order to prevent occult hypoperfusion and consequently to improve patients' outcome in the perioperative setting. However, there is a striking gap between the developments in haemodynamic monitoring and the increasing evidence to implement defined treatment protocols based on the measured variables, and daily clinical routine. Recent trials have shown that perioperative morbidity and mortality is higher than anticipated. This emphasizes the need for the anaesthesia community to address this issue and promotes the implementation of proven concepts into clinical practice in order to improve patients' outcome, especially in high-risk patients. The advances in minimally invasive and non-invasive monitoring techniques can be seen as a driving force in this respect, as the degree of invasiveness of any monitoring tool determines the frequency of its application, especially in the operating room (OR). From this point of view, we are very confident that some of these minimally invasive and non-invasive haemodynamic monitoring technologies will become an inherent part of our monitoring armamentarium in the OR and in the intensive care unit (ICU).

  9. Minimally invasive dentistry and the dental enterprise.

    Science.gov (United States)

    Rossomando, Edward F

    2007-03-01

    Improvements in understanding the process of remineralization have resulted in a reappraisal of repair of damaged tooth structure and call into question the principles of cavity preparation of GV Black and his principle of "extension for prevention." From this reappraisal has emerged the idea of minimally invasive dentistry (MID). The goal of MID is to remove as little of the sound tooth structure during the restoration phase as possible. This goal is in our reach in part because of availability of products that promote mineralization and of dental excavation instruments, like the dental laser, that can be managed to remove only damaged tooth structure. It is critical that the leaders of the dental enterprise endorse MID. Delay could allow new products to move from the dental profession to other health care providers. For example, a caries vaccine will soon enter the market place. Will dentists expand the scope of their practices to include the application of this vaccine, or will they ignore this new product and allow the new technology to enter the scope of practice of other health providers?

  10. Minimally invasive cardiac surgery and transesophageal echocardiography

    Directory of Open Access Journals (Sweden)

    Ajay Kumar Jha

    2014-01-01

    Full Text Available Improved cosmetic appearance, reduced pain and duration of post-operative stay have intensified the popularity of minimally invasive cardiac surgery (MICS; however, the increased risk of stroke remains a concern. In conventional cardiac surgery, surgeons can visualize and feel the cardiac structures directly, which is not possible with MICS. Transesophageal echocardiography (TEE is essential during MICS in detecting problems that require immediate correction. Comprehensive evaluation of the cardiac structures and function helps in the confirmation of not only the definitive diagnosis, but also the success of surgical treatment. Venous and aortic cannulations are not under the direct vision of the surgeon and appropriate positioning of the cannulae is not possible during MICS without the aid of TEE. Intra-operative TEE helps in the navigation of the guide wire and correct placement of the cannulae and allows real-time assessment of valvular pathologies, ventricular filling, ventricular function, intracardiac air, weaning from cardiopulmonary bypass and adequacy of the surgical procedure. Early detection of perioperative complications by TEE potentially enhances the post-operative outcome of patients managed with MICS.

  11. Process optimized minimally invasive total hip replacement

    Directory of Open Access Journals (Sweden)

    Philipp Gebel

    2012-02-01

    Full Text Available The purpose of this study was to analyse a new concept of using the the minimally invasive direct anterior approach (DAA in total hip replacement (THR in combination with the leg positioner (Rotex- Table and a modified retractor system (Condor. We evaluated retrospectively the first 100 primary THR operated with the new concept between 2009 and 2010, regarding operation data, radiological and clinical outcome (HOOS. All surgeries were perfomed in a standardized operation technique including navigation. The average age of the patients was 68 years (37 to 92 years, with a mean BMI of 26.5 (17 to 43. The mean time of surgery was 80 min. (55 to 130 min. The blood loss showed an average of 511.5 mL (200 to 1000 mL. No intra-operative complications occurred. The postoperative complication rate was 6%. The HOOS increased from 43 points pre-operatively to 90 (max 100 points 3 months after surgery. The radiological analysis showed an average cup inclination of 43° and a leg length discrepancy in a range of +/- 5 mm in 99%. The presented technique led to excellent clinic results, showed low complication rates and allowed correct implant positions although manpower was saved.

  12. Multiexpandable cage for minimally invasive posterior lumbar interbody fusion

    Directory of Open Access Journals (Sweden)

    Coe JD

    2016-09-01

    Full Text Available Jeffrey D Coe,1 James F Zucherman,2 Donald W Kucharzyk,3 Kornelis A Poelstra,4 Larry E Miller,5 Sandeep Kunwar,6 1Silicon Valley Spine Institute, Campbell, 2San Francisco Orthopaedic Surgeons, San Francisco, CA, 3Orthopaedic Pediatric and Spine, Crown Point, IN, 4Department of Surgery, Sacred Heart Hospital on the Emerald Coast, Miramar Beach, FL, 5Miller Scientific Consulting, Inc., Asheville, NC, 6Bell Neuroscience Institute, Washington Hospital Healthcare System, Fremont, CA, USA Abstract: The increasing adoption of minimally invasive techniques for spine surgery in recent years has led to significant advancements in instrumentation for lumbar interbody fusion. Percutaneous pedicle screw fixation is now a mature technology, but the role of expandable cages is still evolving. The capability to deliver a multiexpandable interbody cage with a large footprint through a narrow surgical cannula represents a significant advancement in spinal surgery technology. The purpose of this report is to describe a multiexpandable lumbar interbody fusion cage, including implant characteristics, intended use, surgical technique, preclinical testing, and early clinical experience. Results to date suggest that the multiexpandable cage allows a less invasive approach to posterior/transforaminal lumbar interbody fusion surgery by minimizing iatrogenic risks associated with static or vertically expanding interbody prostheses while providing immediate vertebral height restoration, restoration of anatomic alignment, and excellent early-term clinical results. Keywords: degenerative disc disease, expandable, low back pain, Luna

  13. Training minimal invasive approaches in hepatopancreatobilliary fellowship: the current status

    Science.gov (United States)

    Subhas, Gokulakkrishna; Mittal, Vijay K

    2011-01-01

    Background There has been an increasing role of advanced minimally invasive procedures in hepatopancreatobilliary (HPB) surgery. However, there are no set minimum laparoscopic case requirements. Methods A 14-question electronic survey was sent to 82 worldwide HPB fellowship programme directors. Results Forty-nine per cent (n = 40) of the programme directors responded. The programmes were predominantly university based (83%). Programmes had either one (55%) or two fellows (40%) each year. Programmes (35–48%) had average annual volumes of 51–100 hepatic, 51–100 pancreatic and 25–50 biliary cases. For many programmes, <10% of hepatic (48%), pancreatic (40%) and biliary (70%) cases were done laparoscopically. The average annual fellow case volumes for hepatic, pancreatic and biliary surgeries were 25–50 (62%), 25–50 (47%) and <25 (50%), respectively. The average annual number of hepatic, pancreatic and biliary cases done laparoscopically by a fellow was 9, 9 and 4, which constitutes 36%, 36% and 16%, respectively, of the International Hepato-Pancreato-Billiary Association (IHPBA) requirement. Conclusion We surmise that the low average number of surgeries performed by minimally-invasive techniques by HPB fellows is not sufficient in today's practice. Should there be an increase in the minimal number of hepatic, pancreatic and complex biliary cases to 50, 50, and 25, with at least 50% of these performed laparoscopically? PMID:21309929

  14. Minimally invasive surgery colloidal cystic thyroid nodules

    Directory of Open Access Journals (Sweden)

    V G Petrov

    2013-12-01

    Full Text Available An analysis of the use of minimally invasive interventions - laser-induced thermotherapy (LITT, ethanol destruction (ED under ultrasound guidance, a combination of these methods in the treatment of сystic-col- loidal nodes (CCN of thyroid nodules in 120 patients. ED carried out in 31 patients with cystic destruction of a site of more than 70%. Marked decrease in the average volume with 4.68 ± 2.25 cm3 to 1.15 ± 0.9 cm3. In 4 patients remained cystic cavity of small size, which required a combination of LITT (CombiLITT. Nine patients underwent LITT solid residue of more than 1 cm3. The average size of nodules within 6 months after the primary surgery was 0.9 ± 0.3 cm3. СombiLITT performed in 42 patients with cystic cavity from 20 to 70%. The volume of units decreased from 7.98 ± 4.56 to 1.87 ± 0.9 cm3. After 3 months, 11 patients with the size of a solid residue of more than 1 cm3 held LITT. All of them when viewed after 3 months observed decrease of more than 50%. LITT performed 23 patients with major nodes and cystic cavities less than 20% of the node. Marked decrease in the amount of nodes with 2.89 ± 1.25 cm3 to 1.42 ± 0.8 cm3. Retesting LITT took 2 patients. After 6 months, the average amount of units was 0.7 ± 0.2 cm3 LITT conducted in 24 patients with small cystic nodes to 1 cm3. Marked decrease in size from 0.69 ± 0.23 cm3 to 0.29 ± 0.12 cm3. Varied selection of minimally inva- sive treatment of CCN is effective and in most cases, to achieve reduction of the size of nodes.

  15. Minimally invasive treatment of multilevel spinal epidural abscess.

    Science.gov (United States)

    Safavi-Abbasi, Sam; Maurer, Adrian J; Rabb, Craig H

    2013-01-01

    The use of minimally invasive tubular retractor microsurgery for treatment of multilevel spinal epidural abscess is described. This technique was used in 3 cases, and excellent results were achieved. The authors conclude that multilevel spinal epidural abscesses can be safely and effectively managed using microsurgery via a minimally invasive tubular retractor system.

  16. Endoscopic Cystogastrostomy: Minimally Invasive Approach for Pancreatic Pseudocyst

    Directory of Open Access Journals (Sweden)

    Gull-Zareen Khan Sial

    2014-12-01

    Full Text Available Pancreatic pseudocysts in children are not uncommon. Non-resolving pseudocysts often require surgical intervention. Endoscopic cystogastrostomy is a minimally invasive procedure which is recommended for this condition. We report a large pancreatic pseudocyst in a 4-year old child, which developed following therapy with PEG-Asparaginase for acute lymphoblastic leukemia. It was managed with minimally invasive procedure.

  17. Endoscopic cystogastrostomy: minimally invasive approach for pancreatic pseudocyst.

    Science.gov (United States)

    Sial, Gull-Zareen Khan; Qazi, Abid Quddus; Yusuf, Mohammed Aasim

    2015-01-01

    Pancreatic pseudocysts in children are not uncommon. Non-resolving pseudocysts often require surgical intervention. Endoscopic cystogastrostomy is a minimally invasive procedure which is recommended for this condition. We report a large pancreatic pseudocyst in a 4-year old child, which developed following therapy with PEG-Asparaginase for acute lymphoblastic leukemia. It was managed with minimally invasive procedure.

  18. Heart bypass surgery - minimally invasive - discharge

    Science.gov (United States)

    ... invasive direct coronary artery bypass - discharge; MIDCAB - discharge; Robot assisted coronary artery bypass - discharge; RACAB - discharge; Keyhole ... M. is also a founding member of Hi-Ethics and subscribes to the principles of the Health ...

  19. Chances of cryosurgery in the minimal invasive therapy; Chancen der Kryochirurgie in der Minimal Invasiven Therapie

    Energy Technology Data Exchange (ETDEWEB)

    Haensgen, H. [Institut fuer Luft- und Kaeltetechnik GmbH, Dresden (Germany). Fachbereich Klimatechnik; Binneberg, A. [Institut fuer Luft- und Kaeltetechnik GmbH, Dresden (Germany). Fachbereich Klimatechnik; Herzog, R. [Institut fuer Luft- und Kaeltetechnik GmbH, Dresden (Germany). Fachbereich Klimatechnik; Schumann, B. [Institut fuer Luft- und Kaeltetechnik GmbH, Dresden (Germany). Fachbereich Klimatechnik

    1995-01-01

    Object in view of the minimal invasive therapy is to substitute the traditional open and therefore invasive surgically interventions through fewer invasive surgery. Additional to preponderantly in MIT used microsurgery and laser-therapy also cryotherapy may be used. Clinical results in therapy of trigeminalneuralgia are present. Application of endoscopic cryotip are possible. (orig.)

  20. Minimally invasive medicine:a new theoretical system of medicine

    Institute of Scientific and Technical Information of China (English)

    王永光; 裘法祖; 何兴图

    2004-01-01

    @@ For many diseases and surgical procedures, the method of choice has shifted from traditional means, or open surgery, to the use of less invasive means in the last few decades. These minimally invasive alternatives, such as laparoscopic, endoscopic, and interventional ultrasound procedures, usually result in less pain, scarring, recovery time and complication, as well as shorter hospitalization and reduced health-care costs. The trend is predicted to continue with these minimally invasive alternatives being used in clinics widely. In addition, these less invasive means will become one of the most important areas in the future of 21st century medicine.

  1. Minimal Invasive Percutaneous Fixation of Thoracic and Lumbar Spine Fractures

    Directory of Open Access Journals (Sweden)

    Federico De Iure

    2012-01-01

    Full Text Available We studied 122 patients with 163 fractures of the thoracic and lumbar spine undergoing the surgical treatment by percutaneous transpedicular fixation and stabilization with minimally invasive technique. Patient followup ranged from 6 to 72 months (mean 38 months, and the patients were assessed by clinical and radiographic evaluation. The results show that percutaneous transpedicular fixation and stabilization with minimally invasive technique is an adequate and satisfactory procedure to be used in specific type of the thoracolumbar and lumbar spine fractures.

  2. A minimally invasive approach for a compromised treatment plan.

    Science.gov (United States)

    Maibaum, Wayne W

    2016-01-01

    A primary goal in dentistry is the execution of appropriate treatment plans that are minimally invasive and maintainable. However, it is sometimes necessary to repair existing dental restorations or revise treatment plans to accommodate changes in a patient's condition. In the present case, a patient who was satisfied with a removable partial overdenture lost a critical abutment tooth. A creative, minimally invasive approach enabled the patient to keep his existing partial prosthesis and avoid the need for a full reconstruction or complete denture.

  3. Clinical application of keyhole techniques in minimally invasive neurosurgery

    Institute of Scientific and Technical Information of China (English)

    LAN Qing

    2006-01-01

    @@ With the development of modern neuroimaging and the improvement of surgical instruments or devices as well as operative skills, minimally invasive neurosurgery has been progressing rapidly with great changes in surgical concepts and methods.1 Based on these changes, anatomic research has been carried out to explore new surgical approaches dealing with anticipated microtrauma. These approaches have made or been making things possible. Keyhole microsurgery has evolved into an important subject of modern minimally invasive neurosurgery.

  4. Minimally Invasive Transaortic Mitral Decalcification During Aortic Valve Replacement.

    Science.gov (United States)

    Totsugawa, Toshinori; Sakaguchi, Taichi; Hiraoka, Arudo; Matsushita, Hiroshi; Hirai, Yuki; Yoshitaka, Hidenori

    2015-01-01

    Mitral annular calcification accompanied by aortic stenosis is hazardous for both double-valve replacement and transcatheter aortic valve implantation. Less invasive mitral procedure is required in this condition, and minimally invasive approach may further reduce the operative risk in high-risk patients. Here, we report minimally invasive transaortic mitral decalcification during aortic valve replacement through minithoracotomy. We believe that this option is feasible in patients who are at prohibitive risk for double-valve replacement or transcatheter aortic valve implantation because of severe mitral annular calcification.

  5. ACTIVE ROBOTIC ENDOSCOPE FOR MINIMALLY INVASIVE SURGERY

    Institute of Scientific and Technical Information of China (English)

    2002-01-01

    A robotic endoscope is mainly composed of a tactile array sensor, soft mobile mechanism for earthworm locomotion and turning mechanism based on shape memory effect. The tactile array sensor can provide the information about magnitude and orientation of interacting forces between the robotic endoscope and the wall of gastrointestinal tracts. The soft mobile mechanism contacts gastrointestinal tracts with air-in inflatable balloons, so it has better soft and non-invasive properties. The turning mechanism can be actively bent by shape memory alloy components and conform to the complex shape of gastrointestinal tracts. The working principle of robotic endoscope is dealt with.

  6. Minimally Invasive Surgical Treatment of Acute Epidural Hematoma: Case Series

    Directory of Open Access Journals (Sweden)

    Weijun Wang

    2016-01-01

    Full Text Available Background and Objective. Although minimally invasive surgical treatment of acute epidural hematoma attracts increasing attention, no generalized indications for the surgery have been adopted. This study aimed to evaluate the effects of minimally invasive surgery in acute epidural hematoma with various hematoma volumes. Methods. Minimally invasive puncture and aspiration surgery were performed in 59 cases of acute epidural hematoma with various hematoma volumes (13–145 mL; postoperative follow-up was 3 months. Clinical data, including surgical trauma, surgery time, complications, and outcome of hematoma drainage, recovery, and Barthel index scores, were assessed, as well as treatment outcome. Results. Surgical trauma was minimal and surgery time was short (10–20 minutes; no anesthesia accidents or surgical complications occurred. Two patients died. Drainage was completed within 7 days in the remaining 57 cases. Barthel index scores of ADL were ≤40 (n=1, 41–60 (n=1, and >60 (n=55; scores of 100 were obtained in 48 cases, with no dysfunctions. Conclusion. Satisfactory results can be achieved with minimally invasive surgery in treating acute epidural hematoma with hematoma volumes ranging from 13 to 145 mL. For patients with hematoma volume >50 mL and even cerebral herniation, flexible application of minimally invasive surgery would help improve treatment efficacy.

  7. Minimally invasive treatment of hepatic adenoma in special cases

    Energy Technology Data Exchange (ETDEWEB)

    Nasser, Felipe; Affonso, Breno Boueri; Galastri, Francisco Leonardo [Hospital Israelita Albert Einstein, São Paulo, SP (Brazil); Odisio, Bruno Calazans [MD Anderson Cancer Center, Houston (United States); Garcia, Rodrigo Gobbo [Hospital Israelita Albert Einstein, São Paulo, SP (Brazil)

    2013-07-01

    Hepatocellular adenoma is a rare benign tumor that was increasingly diagnosed in the 1980s and 1990s. This increase has been attributed to the widespread use of oral hormonal contraceptives and the broader availability and advances of radiological tests. We report two cases of patients with large hepatic adenomas who were subjected to minimally invasive treatment using arterial embolization. One case underwent elective embolization due to the presence of multiple adenomas and recent bleeding in one of the nodules. The second case was a victim of blunt abdominal trauma with rupture of a hepatic adenoma and clinical signs of hemodynamic shock secondary to intra-abdominal hemorrhage, which required urgent treatment. The development of minimally invasive locoregional treatments, such as arterial embolization, introduced novel approaches for the treatment of individuals with hepatic adenoma. The mortality rate of emergency resection of ruptured hepatic adenomas varies from 5 to 10%, but this rate decreases to 1% when resection is elective. Arterial embolization of hepatic adenomas in the presence of bleeding is a subject of debate. This observation suggests a role for transarterial embolization in the treatment of ruptured and non-ruptured adenomas, which might reduce the indication for surgery in selected cases and decrease morbidity and mortality. Magnetic resonance imaging showed a reduction of the embolized lesions and significant avascular component 30 days after treatment in the two cases in this report. No novel lesions were observed, and a reduction in the embolized lesions was demonstrated upon radiological assessment at a 12-month follow-up examination.

  8. Minimally Invasive Surgery——Future Perspectives

    Institute of Scientific and Technical Information of China (English)

    SC Sydney Chung

    2008-01-01

    @@ Following the advances in diagnostic endoscopy in the 1970's, therapeutic endoscopy in the 1980's and laparoscopic surgery in the 1990's the next break-through in endoscopic treatment is likely to be in the form of endoscopic surgery through natural orifices (NOTES).

  9. The material science of minimally invasive esthetic restorations.

    Science.gov (United States)

    Nový, Brian B; Fuller, Cameron E

    2008-01-01

    The term esthetic dentistry usually conjures up mental images of porcelain crowns and veneers. To some dentists, the term minimally invasive dentistry evokes thoughts of observing early lesions, and postponing treatment until lesions are closer to the pulp. (The World Congress of Minimally Invasive Dentistry defines minimally invasive dentistry as those techniques which respect health, function, and esthetics of oral tissue by preventing disease from occurring, or intercepting its progress with minimal tissue loss.) It would seem these two niches within dentistry are on opposite ends of the spectrum; however, composite resin and glass ionomer restorative materials unite these two ideologies. Understanding the limitations, benefits, and science behind each material allows clinicians to produce highly esthetic restorations that can resist future decay, internally remineralize the tooth, and help protect adjacent teeth from cariogenic attack.

  10. Appendicitis/diverticulitis: minimally invasive surgery.

    Science.gov (United States)

    Mutter, D; Marescaux, J

    2013-01-01

    Complicated intra-abdominal infections such as acute appendicitis and complicated diverticulitis represent both diagnostic and therapeutic challenges. Both diseases, although different in many ways, are caused by the obstruction of a blind pouch leading to inflammation, abscesses, and perforation of surrounding tissues. For many decades, acute appendicitis was managed through a conventional surgical incision in the right iliac fossa. As for other diseases, there is a significant tendency to propose less invasive treatments. For many teams, laparoscopy, which leads to less postoperative pain, a shorter hospital stay, and a quicker recovery, represents the standard of care for appendectomy. For selected cases, a medical approach can be proposed with satisfactory outcomes. Additionally, the management of complicated diverticulitis is also quickly moving towards less invasive procedures than the deleterious '3-phase surgery', which is Hartmann's procedure, followed by reversal protected with a stoma, and finally stoma closure. Benefiting from the evolution of antimicrobial therapy and interventional radiology, many complicated cases classified as Hinchey stage I and Hinchey stage II complicated diverticulitis are now treated medically. CT images allow the identification of patients requiring radiological drainage of localized abscesses or collections over 5 cm in size. Patients with Hinchey stage III sigmoiditis may benefit from an initial laparoscopic exploration allowing, in some cases, a conservative nonresective approach that will prevent laparotomy and stoma. Major resection leading to temporary or definitive stoma is usually indicated for stage IV complications and is required only in exceptional cases. Although a surgical intervention can be the definitive treatment for complicated intra-abdominal infections, multidisciplinary management including radiology, medical treatment, and laparoscopic surgery may limit the severe consequences of an acute surgical

  11. Minimally invasive maxillofacial vertical bone augmentation using brushite based cements.

    Science.gov (United States)

    Tamimi, Faleh; Torres, Jesus; Lopez-Cabarcos, Enrique; Bassett, David C; Habibovic, Pamela; Luceron, Elena; Barralet, Jake E

    2009-01-01

    An ideal material for maxillofacial vertical bone augmentation procedures should not only be osteoconductive, biocompatible and mechanically strong, but should also be applied using minimally invasive procedures and remain stable with respect to the original bone surfaces. This way, implant exposure and infection might be reduced and good mechanical stability may be achieved. Calcium phosphate cements are proven biocompatible and osteoconductive materials that can be injected using minimally invasive procedures. Among these cements, brushite based cements have the added advantage of being biodegradable in vivo. Therefore, this material has the potential for use in the aforementioned procedures. An in vivo study was performed in rabbits to evaluate the potential use of brushite cements in minimally invasive maxillofacial vertical bone augmentation procedures. In this study, we injected self-setting brushite cements on the subperiosteal bone surface using a minimally invasive tunnelling technique. The cement pastes were stable on the bone surface and hardened soon after they were injected thereby negating the need for additional supports such as membranes or meshes. The animals were sacrificed 8 weeks after the intervention and histological observations revealed signs of successful vertical bone augmentation. Therefore, we have demonstrated a minimally invasive vertical bone augmentation procedure that is an attractive alternative to current surgical procedures in terms of increased simplicity, reduced trauma, and lower cost of surgery.

  12. Minimally Invasive Cardiac Surgery: Transapical Aortic Valve Replacement

    Directory of Open Access Journals (Sweden)

    Ming Li

    2012-01-01

    Full Text Available Minimally invasive cardiac surgery is less traumatic and therefore leads to quicker recovery. With the assistance of engineering technologies on devices, imaging, and robotics, in conjunction with surgical technique, minimally invasive cardiac surgery will improve clinical outcomes and expand the cohort of patients that can be treated. We used transapical aortic valve implantation as an example to demonstrate that minimally invasive cardiac surgery can be implemented with the integration of surgical techniques and engineering technologies. Feasibility studies and long-term evaluation results prove that transapical aortic valve implantation under MRI guidance is feasible and practical. We are investigating an MRI compatible robotic surgical system to further assist the surgeon to precisely deliver aortic valve prostheses via a transapical approach. Ex vivo experimentation results indicate that a robotic system can also be employed in in vivo models.

  13. Early outcome of minimally invasive mitral valve surgery

    Directory of Open Access Journals (Sweden)

    Shawky Fareed

    2016-08-01

    Conclusion: Right anterolateral mini-thoracotomy minimally invasive technique provides excellent exposure of the mitral valve, even with a small atrium and offers a better cosmetic lateral scar which is less prone to keloid formation. In addition, minimally invasive right anterolateral mini-thoracotomy is as safe as median sternotomy for mitral valve surgery, with fewer complications and postoperative pain, less ICU and hospital stay, fast recovery to work with no movement restriction after surgery. It should be used as an initial approach for mitral valve surgery. Furthermore, it was believed that less spreading of the incision, no interference with the diaphragm and less tissue dissection might improve outcomes, particularly respiratory function.

  14. Minimally Invasive Spinal Surgery with Intraoperative Image-Guided Navigation

    Directory of Open Access Journals (Sweden)

    Terrence T. Kim

    2016-01-01

    Full Text Available We present our perioperative minimally invasive spine surgery technique using intraoperative computed tomography image-guided navigation for the treatment of various lumbar spine pathologies. We present an illustrative case of a patient undergoing minimally invasive percutaneous posterior spinal fusion assisted by the O-arm system with navigation. We discuss the literature and the advantages of the technique over fluoroscopic imaging methods: lower occupational radiation exposure for operative room personnel, reduced need for postoperative imaging, and decreased revision rates. Most importantly, we demonstrate that use of intraoperative cone beam CT image-guided navigation has been reported to increase accuracy.

  15. [Minimally invasive direct cardiac surgery with the jakoscope retractor].

    Science.gov (United States)

    Galajda, Zoltán; Jakó, Géza; von Jakó, Ronald; Péterffy, Arpád

    2008-01-20

    The authors present a surgical retractor named jakoscope, useful in the field of abdominal, urological, vascular, thoracic and cardiac surgery procedures. This multifunctional device offers the possibility to utilize Minimally Invasive Direct Access Surgical Technology (MIDAST) in the above mentioned surgical specialties. In their department the authors use the jakoscope retractor for aortic valve replacement, off-pump coronary bypass operations and radiofrequency pulmonary vein ablation by mini-thoracotomy approach. In this report they published for the first time their experience with jakoscope device in the field of cardiac surgery. In these operations the device assured adequate minimally invasive direct access, without complications.

  16. Minimally invasive and surgical management strategies tailored to the severity of acute diverticulitis.

    LENUS (Irish Health Repository)

    McDermott, F D

    2014-01-01

    The severity of acute diverticulitis ranges from mild, simple inflammation to pericolic abscesses, or perforation with faeculent peritonitis. Treatment of diverticulitis has evolved towards more conservative and minimally invasive strategies. The aim of this review is to highlight recent concepts and advances in management.

  17. Voluntary autonomous simulator based training in minimally invasive surgery, residents' compliance and reflection

    NARCIS (Netherlands)

    van Empel, P.J.; Verdam, M.G.E.; Strypet, M.; van Rijssen, L.B.; Huirne, J. A.; Scheele, F.; Bonjer, H.J.; Meijerink, W.J.

    2012-01-01

    Background: Knot tying and suturing skills in minimally invasive surgery (MIS) differ markedly from those in open surgery. Appropriate MIS training is mandatory before implementation into practice. The Advanced Suturing Course (ASC) is a structured simulator based training course that includes a 6-w

  18. Diagnosis and minimally invasive treatment of early stage breast carcinoma

    NARCIS (Netherlands)

    van Esser, S.

    1979-01-01

    In this thesis the diagnostic work up and minimally invasive surgical treatment of early stage breast carcinoma is studied. Although the surgical treatment of breast carcinoma has improved significantly over the past decades, there is still room for improvement. On the one hand the focus is on early

  19. Manual Control for Medical Instruments in Minimally Invasive Surgery

    NARCIS (Netherlands)

    Fan, C.

    2014-01-01

    With the introduction of new technologies, surgical procedures have been varying from free access in open surgery towards limited access in minimal invasive surgery. During such procedures, surgeons have to manoeuver the instruments from outside the patient while looking at the monitor. Long and sle

  20. Minimally invasive maxillofacial vertical bone augmentation using brushite based cements

    NARCIS (Netherlands)

    Tamimi, Faleh; Torres, Jesus; Lopez-Cabarcos, Enrique; Bassett, David C.; Habibovic, Pamela; Luceron, Elena; Barralet, Jake E.

    2009-01-01

    An ideal material for maxillofacial vertical bone augmentation procedures should not only be osteoconductive, biocompatible and mechanically strong, but should also be applied using minimally invasive procedures and remain stable with respect to the original bone surfaces. This way, implant exposure

  1. Minimally Invasive Surgical Treatments for Benign Prostatic Hyperplasia

    NARCIS (Netherlands)

    V. Tzortzis; S. Gravas; J.J.M.C.H. de la Rosette

    2009-01-01

    Although transurethral resection of the prostate (TURP) is considered to be the reference standard for minimally invasive surgical treatment (MIST) of lower urinary tract symptoms (LUTS) due to benign prostatic obstruction (BPO), it is associated with a noteworthy rate of complication. Transurethral

  2. Perspectives of Nanotechnology in Minimally Invasive Therapy of Breast Cancer

    Directory of Open Access Journals (Sweden)

    Yamin Yang

    2013-01-01

    Full Text Available Breast cancer, the most common type of cancer among women in the western world, affects approximately one out of every eight women over their lifetime. In recognition of the high invasiveness of surgical excision and severe side effects of chemical and radiation therapies, increasing efforts are made to seek minimally invasive modalities with fewer side effects. Nanoparticles (<100 nm in size have shown promising capabilities for delivering targeted therapeutic drugs to cancer cells and confining the treatment mainly within tumors. Additionally, some nanoparticles exhibit distinct properties, such as conversion of photonic energy into heat, and these properties enable eradication of cancer cells. In this review, current utilization of nanostructures for cancer therapy, especially in minimally invasive therapy, is summarized with a particular interest in breast cancer.

  3. Aortic Valve Replacement: Treatment by Sternotomy versus Minimally Invasive Approach

    Directory of Open Access Journals (Sweden)

    Renata Tosoni Rodrigues Ferreira

    Full Text Available Abstract Objective: To compare the results of aortic valve replacement with access by sternotomy or minimally invasive approach. Methods: Retrospective analysis of medical records of 37 patients undergoing aortic valve replacement by sternotomy or minimally invasive approach, with emphasis on the comparison of time of cardiopulmonary bypass and aortic clamping, volume of surgical bleeding, time of mechanical ventilation, need for blood transfusion, incidence of atrial fibrillation, length of stay in intensive care unit, time of hospital discharge, short-term mortality and presence of surgical wound infection. Results: Sternotomy was used in 22 patients and minimally invasive surgery in 15 patients. The minimally invasive approach had significantly higher time values of cardiopulmonary bypass (114.3±23.9 versus 86.7±19.8min.; P=0.003, aortic clamping (87.4±19.2 versus 61.4±12.9 min.; P<0.001 and mechanical ventilation (287.3±138.9 versus 153.9±118.6 min.; P=0.003. No difference was found in outcomes surgical bleeding volume, need for blood transfusion, incidence of atrial fibrillation, length of stay in intensive care unit and time of hospital discharge. No cases of short-term mortality or surgical wound infection were documented. Conclusion: The less invasive approach presented with longer times of cardiopulmonary bypass, aortic clamping and mechanical ventilation than sternotomy, however without prejudice to the length of stay in intensive care unit, time of hospital discharge and morbidity.

  4. Advances of imaging-guided interventional minimally invasive techniques for the treatment of lumbar disc herniation%影像导引腰椎间盘突出症微创治疗技术进展

    Institute of Scientific and Technical Information of China (English)

    李福元; 许文哲

    2012-01-01

    Lumbar disc herniation (LDH) is a common disease, which leads to the most common cause of low back pain. Imaging-guided interventional minimally invasive treatment of lumbar disc herniation. which was performed with minimal invasion, less pain, quicker recovery and less complications, has been widely used in clinic, and become the preferred method for the treatment of mild to moderate lumbar disc herniation.%腰椎间盘突出症(lumbar disc herniation,LDH)是一种常见病、多发病,是导致腰腿痛最常见的原因.影像导引微创治疗腰椎间盘突出症创伤小、痛苦少、恢复快、并发症少现已广泛应用于临床,成为治疗轻、中度腰椎间盘突出症的首选方法.

  5. MINIMALLY INVASIVE LOW-COLLAR INCISION IN THYROID LOBECTOMY

    Institute of Scientific and Technical Information of China (English)

    刘宝国; 王成学; 张乃嵩

    2003-01-01

    Objective: To report the development of a technique for minimally invasive thyroid lobectomy. Method: The procedure was accepted by 200 patients with a nodule of the lobe of the thyroid. We performed hemithyroidectomys through a 2-4 cm low-collar horizontal skin incision by conventional instrumentation. Results: The recurrent laryngeal nerve and the parathyroid glands were easily identified and preserved. The amount of bleeding ranged from 5 to 50 ml (mean 15 ml). Mean Operation time was 52.2 minutes (ranged 32 to 80 minutes). No complication occurred. Mean postoperative stay was 5.5 days (ranged 4 to 7 days). The incision provided excellent cometic results because the small and lower incisions were completely hidden by clothing collar. Conclusion: The above technique is feasible, safe, minimally invasive, less time and cost consuming and cosmetical.

  6. Nonsurgical, image-guided, minimally invasive therapy for thyroid nodules

    DEFF Research Database (Denmark)

    Gharib, Hossein; Hegedüs, Laszlo; Pacella, Claudio Maurizio

    2013-01-01

    evaluation. These techniques have also been applied to recurrent locoregional cervical thyroid cancer with encouraging initial results, although still limited data. Conclusions: Surgery and radioiodine remain as conventional and established treatments for nodular goiters. However, the new image......Context: Nodular thyroid disease is very common. Most nodules are asymptomatic, are benign by fine-needle aspiration, remain stable, and can be followed by observation alone in the majority of the patients. Occasionally, nodules grow or cause symptoms requiring treatment. So far, surgery has been...... our main option for treatment. Objective: In this review, we discuss nonsurgical, minimally invasive approaches for small thyroid masses, including indications, efficacy, side effects, and costs. Evidence Acquisition: We selected recent publications related to minimally invasive thyroid techniques...

  7. Minimally Invasive Thoracic Surgery in Pediatric Patients: The Taiwan Experience

    Directory of Open Access Journals (Sweden)

    Yu-Kai Huang

    2013-01-01

    Full Text Available Minimally invasive technology or laparoscopic surgery underwent a major breakthrough over the past two decades. The first experience of thoracoscopy in children was reported around 1980 for diagnosis of intrathoracic pathology and neoplasia. Up until the middle of the 1990s, the surgical community in Taiwan was still not well prepared to accept the coming era of minimally invasive surgery. In the beginning, laparoscopy was performed in only a few specialties and only relatively short or simple surgeries were considered. But now, the Taiwan’s experiences over the several different clinical scenarios were dramatically increased. Therefore, we elaborated on the experience about pectus excavatum: Nuss procedure, primary spontaneous hemopneumothorax, thoracoscopic thymectomy, and empyema in Taiwan.

  8. Surgical technique for minimally invasive fibula fracture fixation.

    Science.gov (United States)

    Carlile, G S; Giles, N C L

    2011-09-01

    This paper describes a minimally invasive percutaneous technique for reduction and fixation of distal fibula fractures using plate osteosynthesis. We believe this technique benefits patients with poor quality soft tissue envelopes. So far a total of 25 patients have undergone percutaneous fixation, 22 females and 3 males. At no stage yet has a minimally invasive procedure been abandoned intra-operatively in favour of conversion to an open procedure. The mean age was 61.6 years (range 25-80 years). The mean time to surgery was 2.00 days (range 0-5) and mean time to discharge was 4.20 days (range 1-9). At a minimum of over 1 year's follow-up all fractures have healed, with no delayed unions or complications so far experienced.

  9. Minimally Invasive Liver Surgery for Hepatic Colorectal Metastases.

    Science.gov (United States)

    Nassour, Ibrahim; Polanco, Patricio M

    2016-04-01

    Minimally invasive surgery has been cautiously introduced in surgical oncology over the last two decades due to a concern of compromised oncological outcomes. Recently, it has been adopted in liver surgery for colorectal metastases. Colorectal cancer is a major cause of cancer-related death in the USA. In addition, liver metastasis is the most common site of distant disease and its resection improves survival. While open resection was the standard of care, laparoscopic liver surgery has become the standard of care for minor liver resections. Laparoscopic liver surgery provides equivalent oncological outcomes with better perioperative results compared to open liver surgery. Robotic liver surgery has been introduced as it is believed to overcome some of the limitations of laparoscopy. Finally, laparoscopic radio-frequency ablation and microwave coagulation can be used as adjuncts in minimally invasive surgery to complement or replace surgical resection when not possible.

  10. MICROSURGICAL LANDMARKS IN MINIMALLY INVASIVE TRANSFORAMINAL LUMBAR INTERBODY FUSION

    Directory of Open Access Journals (Sweden)

    Javier Quillo-Olvera

    2015-12-01

    Full Text Available Microsurgical landmarks of the facet joint complex were defined to provide guidance and security within the tubular retractor during transforaminal surgery. A retrospective observational study was performed in segments L4-L5 by the left side approach. Microsurgical relevant photos, anatomical models and drawing were used to expose the suggested landmarks. The MI-TLIF technique has advantages compared with conventional open TLIF technique, however minimally invasive technique implies lack of security for the surgeon due to the lack of defined microanatomical landmarks compared to open spine surgery, and disorientation within the tubular retractor, the reason why to have precise microsurgical references and its recognition within the surgical field provide speed and safety when performing minimally invasive technique.

  11. Application of minimally invasive surgery in traumatic brain injury

    Directory of Open Access Journals (Sweden)

    Liu Baiyun

    2014-12-01

    Full Text Available This article aims to expound the essence of minimally invasive surgery as well as when and how to use it in craniocerebral trauma surgery according to the characteristics of the disease. In neurosurgery, the importance of tissue protection should be from the inside to the outside, i.e. brain→dura→skull→scalp. In this article, I want to share my opinion and our team’s experience in terms of selecting surgical approaches and incision, surgical treatment of the skull, dura handling, intracranial operation and placement of drainage based on the above theory. I hope this will be helpful for trauma surgeons. Key words: Traumatic brain injuries; Large craniectomy; Surgical procedures, minimally invasive

  12. Microleakage resistance of minimally invasive Class I flowable composite restorations.

    Science.gov (United States)

    Bonilla, Esteban D; Stevenson, Richard G; Caputo, Angelo A; White, Shane N

    2012-01-01

    Minimally invasive flowable composite Class I restorations are widely used. However, flowable composites are characterized by low filler contents, modified resin formulations, low moduli of elasticity, low viscosity, generally poor mechanical properties, and decreased long-term stability. The purpose of this study was to compare the microleakage resistance of a wide variety of flowable composites used with their manufacturers' recommended bonding systems to that of a long-used and widely studied microhybrid composite when placed as minimally invasive occlusal restorations. Molar teeth were prepared in a standardized manner, restored, artificially aged, stained, sectioned, evaluated, and analyzed. Microleakage varied substantially, by a whole order of magnitude, among the material groups tested. The control group, a conventional microhybrid composite material, leaked significantly less than all the flowable composite groups. Microleakage varied very slightly among measurement site locations. Tiny microscopic bubbles were seen within many of the flowable composite specimens, as were a few voids.

  13. [Minimally invasive surgery and robotic surgery: surgery 4.0?].

    Science.gov (United States)

    Feußner, H; Wilhelm, D

    2016-03-01

    Surgery can only maintain its role in a highly competitive environment if results are continuously improved, accompanied by further reduction of the interventional trauma for patients and with justifiable costs. Significant impulse to achieve this goal was expected from minimally invasive surgery and, in particular, robotic surgery; however, a real breakthrough has not yet been achieved. Accordingly, the new strategic approach of cognitive surgery is required to optimize the provision of surgical treatment. A full scale integration of all modules utilized in the operating room (OR) into a comprehensive network and the development of systems with technical cognition are needed to upgrade the current technical environment passively controlled by the surgeon into an active collaborative support system (surgery 4.0). Only then can the true potential of minimally invasive surgery and robotic surgery be exploited.

  14. Minimally invasive plate internal fixation for calcaneal fractures

    Institute of Scientific and Technical Information of China (English)

    SHAN Shu-lan; XU Jun-ling; YAO Shu-zhang; YU Guo-sheng; LIU Yu-qin

    2010-01-01

    Objective: To assess the clinical efficacy of minimally invasive plate internal fixation for the treatment of calcaneal fractures.Methods: Manual reduction, rectification of deformity,and cold compress with traditional Chinese medicine were used preoperatively to relieve swelling and pain. A small incision was made to expose the articular facet and to perform anatomic reduction and plate fixation. Self-made traditional Chinese pharmaceutics were applied postoperatively on the surface of the wound to accelerate bony union.Results: All the 40 patients were followed up for at least 1 year postoperatively. According to the Maryland scoring system, the excellent and good rate was 87.5%.Conclusion: Minimally invasive plate internal fixation has the advantages of relatively mild injury, reliable fixation,good recovery, and rare complications in the treatment of intraarticular fractures.

  15. Current status of minimally invasive endoscopicmanagement for Zenker diverticulum

    Institute of Scientific and Technical Information of China (English)

    Alberto Aiolfi; Federica Scolari; Greta Saino; Luigi Bonavina

    2015-01-01

    Surgical resection has been the mainstay of treatment ofpharyngoesophageal (Zenker) diverticula over the pastcentury. Developments in minimally invasive surgeryand new endoscopic devices have led to a paradigmchange. The concept of dividing the septum betweenthe esophagus and the pouch rather than resecting thepouch itself has been revisited during the last threedecades and new technologies have been investigatedto make the transoral operation safe and effective. Theinternal pharyngoesophageal myotomy accomplished through the transoral stapling approach has been shown to effectively relieve outflow obstruction and restore physiological bolus transit in patients with medium size diverticula. Transoral techniques, either through a rigid device or by flexible endoscopy, are gaining popularity over the open surgical approach due the low morbidity, the fast recovery time and the fact that the procedure can be safely repeated. We provide an analysis of the the current status of minimally invasive endoscopic management of Zenker diverticulum.

  16. Minimally invasive approach for redo mitral valve surgery.

    Science.gov (United States)

    Botta, Luca; Cannata, Aldo; Bruschi, Giuseppe; Fratto, Pasquale; Taglieri, Corrado; Russo, Claudio Francesco; Martinelli, Luigi

    2013-11-01

    Redo cardiac surgery represents a clinical challenge due to a higher rate of peri-operative morbidity and mortality. Mitral valve re-operations can be particularly demanding in patients with patent coronary artery bypass grafts, previous aortic valve replacement, calcified aorta or complications following a previous operation (abscesses, perivalvular leaks, or thrombosis). Risk of graft injuries, hemorrhage, the presence of dense adhesions and complex valve exposure can make redo valve operations challenging through a median sternotomy. In this review article we provide an overview of minimally invasive approaches for redo mitral valve surgery discussing indications, techniques, outcomes, concerns and controversies. Scientific literature about minimally invasive approach for redo mitral surgery was reviewed with a MEDLINE search strategy combining "mitral valve" with the following terms: 'minimally invasive', 'reoperation', and 'alternative approach'. The search was limited to the last ten years. A total of 168 papers were found using the reported search. From these, ten papers were identified to provide the best evidence on the subject. Mitral valve reoperations can be safely and effectively performed through a smaller right thoracotomy in the fourth intercostal space termed "mini" thoracotomy or "port access". The greatest potential benefit of a right mini-thoracotomy is the avoidance of sternal re-entry and limited dissection of adhesions, avoiding the risk of injury to cardiac structures or patent grafts. Good percentages of valve repair can be achieved. Mortality is low as well as major complications. Minimally invasive procedures with an unclamped aorta have the potential to combine the benefits of minimally invasive access and continuous myocardial perfusion. Less invasive trans-catheter techniques could be considered as the natural future evolution for management of structural heart disease and mitral reoperations. The safety and efficacy of these

  17. Minimally invasive rehabilitation of a patient with amelogenesis imperfecta

    OpenAIRE

    Büchi, Dominik; Fehmer, Vincent; Sailer, Irena; Wolleb, Karin; Jung, Ronald

    2014-01-01

    This case report describes a minimally invasive step-by-step approach to treat a patient with amelogenesis imperfecta. This is a genetic developmental disorder of the dental enamel, which clinically manifests as white and dark discolorations of the teeth. The clinical examination did not reveal the true depth of the staining. Therefore, a step-wise treatment approach was chosen. The first step consisted of a home bleaching procedure, which led to a slight improvement of the esthetic appearanc...

  18. A minimally invasive treatment of severe dental fluorosis

    OpenAIRE

    Ardu, Stefano; Stavridakis, Minos; Krejci, Ivo

    2007-01-01

    This article describes a minimally invasive technique to treat a severe case of enamel fluorosis using microabrasion to eliminate the hypermineralized, white-colored, superficial enamel layer, followed by home bleaching treatment and chairside re-creation of superficial enamel microstructure. The proposed technique may improve the esthetics of fluorotic teeth without requiring other restorative procedures. Microabrasion followed by home bleaching may be an interesting alternative for the rest...

  19. Minimally invasive dentistry: paradigm shifts in preparation design.

    Science.gov (United States)

    LeSage, Brian P

    2009-01-01

    While the concept of minimally invasive dentistry has long been considered a rational, viable approach to restorative care, preparation design, material science, and long-term evidentiary support have only recently begun to provide the foundation necessary to support such treatment in the everyday practice. This article reviews the fundamental paradigm shift evidenced in contemporary prosthodontics as required to facilitate the emerging interest in delivering conservative restorative alternatives.

  20. Anaesthesia for minimally invasive gastric and bowel surgery

    DEFF Research Database (Denmark)

    Lund, Claus

    2002-01-01

    eliminated anaesthetic drugs are, by virtue of their pharmacodynamic and pharmacokinetic profiles, optimal for use; combined with continuous thoracic epidurals with local anaesthetics and low-dose opioids, these drugs may permit reduction of various post-operative complications. Minimally invasive surgical...... and whether or not different anaesthetic regimens influence relevant morbidity parameters. In future documentation it is important that controlled, well-designed clinical studies evaluate how the advantages from multimodal anaesthetic techniques improve relevant surgical outcome....

  1. Biliary peritonitis following percutaneous nephrolithotomy: Minimally invasive management

    OpenAIRE

    Yadav, Siddharth; Singh, Animesh; Singh, Prabhjot

    2015-01-01

    Percutaneous nephrolithotomy (PCNL) is a standard procedure for large renal calculi but has potential for complications. Rarely, biliary tract injury can occur during PCNL that can lead to biliary peritonitis with sepsis. Such cases are usually managed by emergent cholecystectomy. We present a case of biliary peritonitis resulting from gall bladder injury during PCNL, managed minimally invasively with an abdominal drain and endoscopic retrograde cholangiography with common bile duct stenting.

  2. Biliary peritonitis following percutaneous nephrolithotomy: Minimally invasive management.

    Science.gov (United States)

    Yadav, Siddharth; Singh, Animesh; Singh, Prabhjot

    2015-01-01

    Percutaneous nephrolithotomy (PCNL) is a standard procedure for large renal calculi but has potential for complications. Rarely, biliary tract injury can occur during PCNL that can lead to biliary peritonitis with sepsis. Such cases are usually managed by emergent cholecystectomy. We present a case of biliary peritonitis resulting from gall bladder injury during PCNL, managed minimally invasively with an abdominal drain and endoscopic retrograde cholangiography with common bile duct stenting.

  3. The peripheral cannulation technique in minimally invasive congenital cardiac surgery.

    Science.gov (United States)

    Vida, Vladimiro L; Tessari, Chiara; Putzu, Alessandro; Tiberio, Ivo; Guariento, Alvise; Gallo, Michele; Stellin, Giovanni

    2016-08-19

    Congenital minimally invasive cardiac surgery has gained wide acceptance thanks to its favorable outcomes. The introduction of peripheral cannulation for cardiopulmonary bypass further reduces surgical trauma by decreasing surgical access and allowing the spectrum of surgical access for the correction of simple congenital heart defects to be widened. Right internal jugular vein percutaneous cannulation, together with the direct surgical cannulation of femoral vessels, proves to be a safe and effective tool in patients with body weight above 15 kg.

  4. CHANGES IN RADIOGRAPHIC PARAMETERS AFTER MINIMALLY INVASIVE LUMBAR INTERBODY FUSION

    Directory of Open Access Journals (Sweden)

    Emiliano Vialle

    2015-12-01

    Full Text Available Objective : This study aims to evaluate changes in lumbosacral parameters after minimally invasive lumbar interbody fusion. The secondary aim was to evaluate whether interbody cage shape (crescent shaped or rectangular would influence the results. Method : Retrospective analysis of 70 patients who underwent one or two level lumbar interbody fusion through a minimally invasive posterolateral approach. This included midline preservation and unilateral facetectomy. Pre- and postoperative (three to six months postoperative radiographs were used for measuring lumbar lordosis (LL, segmental lordosis (SL at the level of interbody fusion, and sacral slope (SS. Further analyses divided the patients into Roussouly lumbar subgroups. Results : LL was significantly reduced after surgery (59o:39o, p=0.001 as well as the SS (33.8o:31.2o, p=0.05. SL did not change significantly (11.4:11.06, p=0.85. There were no significant differences when comparing patients who received crescent shaped cage (n=27 and rectangular cage (n=43. Hypolordotic patients (Roussouly types 1 and 2 had radiographic improvement in comparison to normolordotic and hyperlordotic groups (types 3 and 4. Conclusion : Minimally invasive lumbar interbody fusion caused reduction in lumbosacral parameters. Cage shape had no influence on the results.

  5. Minimally Invasive Dentistry--concepts and techniques in cariology.

    Science.gov (United States)

    Ericson, Dan; Kidd, Edwina; McComb, Dorothy; Mjör, Ivar; Noack, Michael J

    2003-01-01

    The concept 'Minimally Invasive Dentistry' can be defined as maximal preservation of healthy dental structures. Within cariology, this concept includes the use of all available information and techniques ranging from accurate diagnosis of caries, caries risk assessment and prevention, to technical procedures in repairing restorations. Dentists are currently spending more than half their time replacing old restorations. The main reasons for restoration failures are secondary caries and fractures, factors that are generally not addressed in the technical process of replacing a restoration. Prevailing concepts on minimally invasive dentistry seem to be 'product or technique-motivated', challenging one technique or product with another, rather than focusing on a general concept. New knowledge of caries progression rates has also led to substantial modification of restorative intervention thresholds and further handling of the disease. New diagnostic tools for caries lesion detection, caries risk assessment and focused preventive treatments have decreased the need for early restorative interventions. In parallel to this, new techniques for cutting teeth and removing decay have evolved. This paper focuses on describing minimally invasive dentistry in cariology from a conceptual perspective, relating to clinical caries diagnosis, restorative intervention thresholds and operative procedures, with special reference to survival of tunnel and slot restorations and to repair vs. replacement of defective restorations.

  6. Minimally invasive approaches for the treatment of inflammatory bowel disease

    Institute of Scientific and Technical Information of China (English)

    Marco Zoccali; Alessandro Fichera

    2012-01-01

    Despite significant improvements in medical management of inflammatory bowel disease,many of these patients still require surgery at some point in the course of their disease.Their young age and poor general conditions,worsened by the aggressive medical treatments,make minimally invasive approaches particularly enticing to this patient population.However,the typical inflammatory changes that characterize these diseases have hindered wide diffusion of laparoscopy in this setting,currently mostly pursued in high-volume referral centers,despite accumulating evidences in the literature supporting the benefits of minimally invasive surgery.The largest body of evidence currently available for terminal ileal Crohn's disease shows improved short term outcomes after laparoscopic surgery,with prolonged operative times.For Crohn's colitis,high quality evidence supporting laparoscopic surgery is lacking.Encouraging preliminary results have been obtained with the adoption of laparoscopic restorative total proctocolectomy for the treatment of ulcerative colitis.A consensus about patients' selection and the need for staging has not been reached yet.Despite the lack of conclusive evidence,a wave of enthusiasm is pushing towards less invasive strategies,to further minimize surgical trauma,with single incision laparoscopic surgery being the most realistic future development.

  7. Complications of minimally invasive cosmetic procedures: Prevention and management

    Directory of Open Access Journals (Sweden)

    Lauren L Levy

    2012-01-01

    Full Text Available Over the past decade, facial rejuvenation procedures to circumvent traditional surgery have become increasingly popular. Office-based, minimally invasive procedures can promote a youthful appearance with minimal downtime and low risk of complications. Injectable botulinum toxin (BoNT, soft-tissue fillers, and chemical peels are among the most popular non-invasive rejuvenation procedures, and each has unique applications for improving facial aesthetics. Despite the simplicity and reliability of office-based procedures, complications can occur even with an astute and experienced injector. The goal of any procedure is to perform it properly and safely; thus, early recognition of complications when they do occur is paramount in dictating prevention of long-term sequelae. The most common complications from BoNT and soft-tissue filler injection are bruising, erythema and pain. With chemical peels, it is not uncommon to have erythema, irritation and burning. Fortunately, these side effects are normally transient and have simple remedies. More serious complications include muscle paralysis from BoNT, granuloma formation from soft-tissue filler placement and scarring from chemical peels. Thankfully, these complications are rare and can be avoided with excellent procedure technique, knowledge of facial anatomy, proper patient selection, and appropriate pre- and post-skin care. This article reviews complications of office-based, minimally invasive procedures, with emphasis on prevention and management. Practitioners providing these treatments should be well versed in this subject matter in order to deliver the highest quality care.

  8. Primary Dural Repair in Minimally Invasive Spine Surgery

    Directory of Open Access Journals (Sweden)

    Raqeeb M. Haque

    2013-01-01

    Full Text Available We describe an effective surgical technique in primary repair of the spinal dura during minimally invasive spine surgery (MISS. Objective. Minimally invasive spine surgery includes the treatment of intradural lesions, and proper closure of the dura is necessary. However, primary dural closure can be difficult due to the restricted space of MIS retractors and the availability of appropriate surgical instrumentation. Methods. We describe the use of a needle already used in the pediatric neurosurgical arena that can facilitate easier and safer closure of spinal dura through MISS retractors in two illustrative intradural cases. Results and Discussion. The primary dural closure technique is described and patient demographics are included. The instruments specifically used for the intradural closure through MIS retractor systems include (1 4-0 Surgilon braided nylon (Covidien, Dublin, Ireland with a CV-20 taper 1/2 circle, 10 mm diameter needle; (2 Scanlan (Saint Paul, MN, USA dura closure set. Conclusion. Successful primary dural repair can be performed on primary and incidental durotomies during minimally invasive spinal surgery. We describe the novel use of a 10 mm diameter needle to help surgeons safely and efficiently close the dura with more ease than previously described.

  9. Minimally invasive cardiac surgery-coronary artery bypass graft.

    Science.gov (United States)

    Lemma, Massimo; Atanasiou, Thanos; Contino, Monica

    2013-01-01

    Coronary artery bypass graft (CABG) is among the most common operations performed in the world. Different surgical strategies can be used with different invasiveness. This paper describes a recent development of the technique that merges the advantages resulting from both the adoption of an 'off-pump no-touch aorta operation' and a 'complete arterial revascularization through a left minithoracotomy' in a single procedure. This operation is currently known with the acronym MICS (minimally invasive cardiac surgery)-CABG (minimally invasive cardiac surgery). It is an off-pump operation performed through a minithoracotomy in the fourth or fifth left intercostal space across the midclavicular line. The left internal thoracic artery (LITA) is harvested under direct vision using a special rib-retractor with multiple interchangeable thoracotomy blades, including blades to use with lift systems for proximal artery harvesting, while the right radial artery (RA) is harvested endoscopically. A Y-connection is made between the two arteries. The LITA is used to bypass the left anterior descending coronary artery, while the right RA is used on the obtuse marginal branches and/or the posterior descending coronary artery. A special coronary stabilizer and a heart positioner with a shaft for remote thoracic insertion are needed.

  10. Minimally Invasive Surgery for Pectus Excavatum: Park Technique

    Directory of Open Access Journals (Sweden)

    Hyung Park

    2011-09-01

    Full Text Available Pectus excavatum (PE is the most commonly encountered chest wall deformity which comprises one out of 1,000 live births. Depression of the anterior chest wall due to posterior angulation of the sternum and costal cartilages results in compression of internal thoracic organs as well as aesthetically unpleasant appearance. Multiple surgical techniques have been developed to correct this condition. Ravitch procedure, the technique including the excision of all deformed costal cartilages, division of intercostals bundles from the sternum, and transverse sternal osteotomy, was proposed in 1949 and most widely applied until recently. The Wada technique, principally sternal turnover, has been an alternative procedure. Those invasive techniques involve tedious and bloody operations resulted in a permanent defect of costal cartilages or contracture of the chest wall. Most importantly, a large, unsightly operative scar at the anterior chest is aesthetically dissatisfying. In this study “Minimally Invasive Surgery for Pectus Excavatum: Park Technique” was explained.

  11. Minimally invasive prostate cancer detection test using FISH probes

    Directory of Open Access Journals (Sweden)

    Tinawi-Aljundi R

    2016-07-01

    Full Text Available Rima Tinawi-Aljundi,1 Shannon T Knuth,2 Michael Gildea,2 Joshua Khal,2 Jason Hafron,1 Kenneth Kernen,1 Robert Di Loreto,1 Joan Aurich-Costa2 1Pathology and Research Department, Michigan Institute of Urology, St Clair Shores, MI, USA; 2Research and Development, Cellay, Inc., Cambridge, MA, USA Purpose: The ability to test for and detect prostate cancer with minimal invasiveness has the potential to reduce unnecessary prostate biopsies. This study was conducted as part of a clinical investigation for the development of an OligoFISH® probe panel for more accurate detection of prostate cancer.Materials and methods: One hundred eligible male patients undergoing transrectal ultrasound biopsies were enrolled in the study. After undergoing digital rectal examination with pressure, voided urine was collected in sufficient volume to prepare at least two slides using ThinPrep. Probe panels were tested on the slides, and 500 cells were scored when possible. From the 100 patients recruited, 85 had more than 300 cells scored and were included in the clinical performance calculations.Results: Chromosomes Y, 7, 10, 20, 6, 8, 16, and 18 were polysomic in most prostate carcinoma cases. Of these eight chromosomes, chromosomes 7, 16, 18, and 20 were identified as having the highest clinical performance as a fluorescence in situ hybridization test and used to manufacture the fluorescence in situ hybridization probe panels. The OligoFISH® probes performed with 100% analytical specificity. When the OligoFISH® probes were compared with the biopsy results for each individual, the test results highly correlated with positive and negative prostate biopsy pathology findings, supporting their high specificity and accuracy. Probes for chromosomes 7, 16, 18, and 20 showed in the receiver operator characteristics analysis an area under the curve of 0.83, with an accuracy of 81% in predicting the biopsy result.Conclusion: This investigation demonstrates the ease of use

  12. Minimally Invasive Surfactant Therapy and Noninvasive Respiratory Support.

    Science.gov (United States)

    Kribs, Angela

    2016-12-01

    Respiratory distress syndrome (RDS) caused by surfactant deficiency is major cause for neonatal mortality and short- and long-term morbidity of preterm infants. Continuous positive airway pressure and other modes of noninvasive respiratory support and intubation and positive pressure ventilation with surfactant therapy are efficient therapies for RDS. Because continuous positive airway pressure can fail in severe surfactant deficiency, and because traditional surfactant therapy requires intubation and positive pressure ventilation, this entails a risk of lung injury. Several strategies to combine noninvasive respiratory therapy with minimally invasive surfactant therapy have been described. Available data suggest that those strategies may improve outcome of premature infants with RDS.

  13. Ergonomic T-Handle for Minimally Invasive Surgical Instruments.

    Science.gov (United States)

    Parekh, J; Shepherd, Det; Hukins, Dwl; Maffulli, N

    2016-05-01

    A T-handle has been designed to be used for minimally invasive implantation of a dynamic hip screw to repair fractures of the proximal femur. It is capable of being used in two actions: (i) push and hold (while using an angle guide) and (ii) application of torque when using the insertion wrench and lag screw tap. The T-handle can be held in a power or precision grip. It is suitable for either single (sterilised by γ-irradiation) or multiple (sterilised by autoclaving) use. The principles developed here are applicable to handles for a wide range of surgical instruments.

  14. Anaesthesia for minimally invasive gastric and bowel surgery

    DEFF Research Database (Denmark)

    Lund, Claus

    2002-01-01

    It is of great importance that anaesthetic regimens match surgical procedures in regard to surgical time, in reducing organ dysfunction elicited by the anaesthesia and surgical trauma and by providing optimal post-operative pain treatment, leaving the possibility of early mobilization. New, rapidly...... eliminated anaesthetic drugs are, by virtue of their pharmacodynamic and pharmacokinetic profiles, optimal for use; combined with continuous thoracic epidurals with local anaesthetics and low-dose opioids, these drugs may permit reduction of various post-operative complications. Minimally invasive surgical...

  15. [Possibilities of minimal invasive cardiac catheter interventions in the dog].

    Science.gov (United States)

    Glaus, T M; Unterer, S; Tomsa, K; Baumgartner, C; Geissbühler, U; Gardelle, O; Reusch, C

    2003-09-01

    The therapeutic possibilities in veterinary cardiology have developed rapidly in the past few years. Whereas until recently cardiac intervention in dogs could only be performed by thoracotomy, new minimally invasive techniques are adopted. Procedures like balloondilatation of pulmonic stenosis, coil embolisation of patent ductus arteriosus, pacemaker implantation in symptomatic bradyarrhyhtmia, and palliative balloon pericardiotomy are becoming more and more established. These alternative interventional methods are attractive, because no postsurgical pain and no complications potentially associated with thoracotomy ensue. The knowledge of such new treatment modalities and particularly the indications for an intervention are prerequisites to apply them optimally and broadly.

  16. Cost-effectiveness of minimally invasive sacroiliac joint fusion

    Directory of Open Access Journals (Sweden)

    Cher DJ

    2015-12-01

    Full Text Available Daniel J Cher,1 Melissa A Frasco,2 Renée JG Arnold,2,3 David W Polly4,5 1Clinical Affairs, SI-BONE, Inc., San Jose, CA, USA; 2Division of Health Economics and Outcomes Research, Quorum Consulting, Inc., San Francisco, CA, USA; 3Department of Preventive Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA; 4Department of Orthopaedic Surgery, University of Minnesota, Minneapolis, MN, USA; 5Department of Neurosurgery, University of Minnesota, Minneapolis, MN, USA Background: Sacroiliac joint (SIJ disorders are common in patients with chronic lower back pain. Minimally invasive surgical options have been shown to be effective for the treatment of chronic SIJ dysfunction. Objective: To determine the cost-effectiveness of minimally invasive SIJ fusion. Methods: Data from two prospective, multicenter, clinical trials were used to inform a Markov process cost-utility model to evaluate cumulative 5-year health quality and costs after minimally invasive SIJ fusion using triangular titanium implants or non-surgical treatment. The analysis was performed from a third-party perspective. The model specifically incorporated variation in resource utilization observed in the randomized trial. Multiple one-way and probabilistic sensitivity analyses were performed. Results: SIJ fusion was associated with a gain of approximately 0.74 quality-adjusted life years (QALYs at a cost of US$13,313 per QALY gained. In multiple one-way sensitivity analyses all scenarios resulted in an incremental cost-effectiveness ratio (ICER <$26,000/QALY. Probabilistic analyses showed a high degree of certainty that the maximum ICER for SIJ fusion was less than commonly selected thresholds for acceptability (mean ICER =$13,687, 95% confidence interval $5,162–$28,085. SIJ fusion provided potential cost savings per QALY gained compared to non-surgical treatment after a treatment horizon of greater than 13 years. Conclusion: Compared to traditional non-surgical treatments

  17. Removal of Invisalign retention attachments: a new minimally invasive method.

    Science.gov (United States)

    Ruiz, Jose Luis; Finger, Werner J; Sasazaki, Hiromi; Komatsu, Masahi

    2009-01-01

    Removal of Invisalign resin retention buttons without damaging underlying enamel is a major challenge. To date, the use of tungsten carbide burs is the most common and fastest--yet a risky-ablation method. Stainbuster, a fiber-reinforced resin bur, has been introduced for removal of surface stains and resin remnants from tooth surfaces. This comparative in vitro and in vivo study proved that a combined technique, using multifluted tungsten carbide burs for fast removal of the bulk of resin followed by Stainbuster grinding for gentle removal of the final resin layer, is a safe and minimally invasive procedure for removing composite buttons from enamel.

  18. Radiation oncology: physics advances that minimize morbidity.

    Science.gov (United States)

    Allison, Ron R; Patel, Rajen M; McLawhorn, Robert A

    2014-12-01

    Radiation therapy has become an ever more successful treatment for many cancer patients. This is due in large part from advances in physics including the expanded use of imaging protocols combined with ever more precise therapy devices such as linear and particle beam accelerators, all contributing to treatments with far fewer side effects. This paper will review current state-of-the-art physics maneuvers that minimize morbidity, such as intensity-modulated radiation therapy, volummetric arc therapy, image-guided radiation, radiosurgery and particle beam treatment. We will also highlight future physics enhancements on the horizon such as MRI during treatment and intensity-modulated hadron therapy, all with the continued goal of improved clinical outcomes.

  19. Minimally invasive neurosurgery: the technical platform for translational medicine

    Institute of Scientific and Technical Information of China (English)

    ZHAO Ji-zong

    2009-01-01

    @@ Translational medicine, normally refers to a process for transitioning from the initial lab discovery to the patient's bedside with minimal disconnect and offers a comprehensive review of statistical design and methodology. It has been advocated repeatedly by worldwide medical scientists as the new prospect highlighting the transition for scientific achievements from laboratory results to clinical application in recent years. As for neurosurgery, it is generally acknowledged that it has been improving in basic research and clinical practice by bounds and leaps; however, the achievements in basic and clinical neurosurgical studies seem to be parallel with no intersection for mutual interaction.Minimally invasive neurosurgery is aimed at serving as the intersection platform for translational medicine.

  20. Intraoperative augmented reality for minimally invasive liver interventions

    Science.gov (United States)

    Scheuering, Michael; Schenk, Andrea; Schneider, Armin; Preim, Bernhard; Greiner, Guenther

    2003-05-01

    Minimally invasive liver interventions demand a lot of experience due to the limited access to the field of operation. In particular, the correct placement of the trocar and the navigation within the patient's body are hampered. In this work, we present an intraoperative augmented reality system (IARS) that directly projects preoperatively planned information and structures extracted from CT data, onto the real laparoscopic video images. Our system consists of a preoperative planning tool for liver surgery and an intraoperative real time visualization component. The planning software takes into account the individual anatomy of the intrahepatic vessels and determines the vascular territories. Methods for fast segmentation of the liver parenchyma, of the intrahepatic vessels and of liver lesions are provided. In addition, very efficient algorithms for skeletonization and vascular analysis allowing the approximation of patient-individual liver vascular territories are included. The intraoperative visualization is based on a standard graphics adapter for hardware accelerated high performance direct volume rendering. The preoperative CT data is rigidly registered to the patient position by the use of fiducials that are attached to the patient's body, and anatomical landmarks in combination with an electro-magnetic navigation system. Our system was evaluated in vivo during a minimally invasive intervention simulation in a swine under anesthesia.

  1. Minimally invasive ventriculo-atrial shunt for hydrocephalus

    Institute of Scientific and Technical Information of China (English)

    李江山; 江勇豪; 程成; 张世凯

    2005-01-01

    Objective: To study the therapeutic effect of mini-traumatic ventriculo-atrial shunt on hydrocephalus. Methods: Seventeen patients were treated with right internal jugular venepuncture intubation to finish minimally invasive ventriculo-atrial shunt for hydrocephalus. The patients were evaluated by CT/MRI. The catheters were deployed at the proper position in the right atrium under X-ray fluoroscopy.Results: The hydrocephalus in all the 17 patients eliminated with this surgical procedure with a 100% success rate technically. The operational duration ranged from 0.75 to 1.5 h (average: 1 h). Mistaken puncture into the internal carotid artery as a complication occurred on 1 case.Conclusions: The mini-traumatic ventriculo-atrial shunt, as a novel minimal invasion technique, has the advantages of small trauma, no influence on local blood circulation, short time and simplicity at operation, rapid healing, and good short-term effect. Moreover, it is suitable for those patients with organic dysfunction.

  2. Bioinspired Nanoparticulate Medical Glues for Minimally Invasive Tissue Repair.

    Science.gov (United States)

    Lee, Yuhan; Xu, Chenjie; Sebastin, Monisha; Lee, Albert; Holwell, Nathan; Xu, Calvin; Miranda Nieves, David; Mu, Luye; Langer, Robert S; Lin, Charles; Karp, Jeffrey M

    2015-11-18

    Delivery of tissue glues through small-bore needles or trocars is critical for sealing holes, affixing medical devices, or attaching tissues together during minimally invasive surgeries. Inspired by the granule-packaged glue delivery system of sandcastle worms, a nanoparticulate formulation of a viscous hydrophobic light-activated adhesive based on poly(glycerol sebacate)-acrylate is developed. Negatively charged alginate is used to stabilize the nanoparticulate surface to significantly reduce its viscosity and to maximize injectability through small-bore needles. The nanoparticulate glues can be concentrated to ≈30 w/v% dispersions in water that remain localized following injection. With the trigger of a positively charged polymer (e.g., protamine), the nanoparticulate glues can quickly assemble into a viscous glue that exhibits rheological, mechanical, and adhesive properties resembling the native poly(glycerol sebacate)-acrylate based glues. This platform should be useful to enable the delivery of viscous glues to augment or replace sutures and staples during minimally invasive procedures.

  3. Minimal Invasive Circumferential Management of Thoracolumbar Spine Fractures

    Directory of Open Access Journals (Sweden)

    S. Pesenti

    2015-01-01

    Full Text Available Introduction. While thoracolumbar fractures are common lesions, no strong consensus is available at the moment. Objectives. The aim of this study was to evaluate the results of a minimal invasive strategy using percutaneous instrumentation and anterior approach in the management of thoracolumbar unstable fractures. Methods. 39 patients were included in this retrospective study. Radiologic evaluation was based on vertebral and regional kyphosis, vertebral body height restoration, and fusion rate. Clinical evaluation was based on Visual Analogic Score (VAS. All evaluations were done preoperatively and at 1-year follow-up. Results. Both vertebral and regional kyphoses were significantly improved on postoperative evaluation (13° and 7° versus −1° and −9°  P<0.05, resp. as well as vertebral body height (0.92 versus 1.16, P<0.05. At 1-year follow-up, mean loss of correction was 1°. A solid fusion was visible in all the cases, and mean VAS was significantly reduced form 8/10 preoperatively to 1/10 at the last follow-up. Conclusion. Management of thoracolumbar fractures using percutaneous osteosynthesis and minimal invasive anterior approach (telescopic vertebral body prosthesis is a valuable strategy. Results of this strategy offer satisfactory and stable results in time.

  4. Minimally invasive rehabilitation of a patient with amelogenesis imperfecta.

    Science.gov (United States)

    Büchi, Dominik; Fehmer, Vincent; Sailer, Irene; Wolleb, Karin; Jung, Ronald

    2014-01-01

    This case report describes a minimally invasive step-by-step approach to treat a patient with amelogenesis imperfecta. This is a genetic developmental disorder of the dental enamel, which clinically manifests as white and dark discolorations of the teeth. The clinical examination did not reveal the true depth of the staining. Therefore, a step-wise treatment approach was chosen. The first step consisted of a home bleaching procedure, which led to a slight improvement of the esthetic appearance, but the stains were still clearly visible. The next step was the application of a microabrasion technique. This led to further improvement, but not to a satisfactory result for this patient who had high esthetic expectations. Thus, the third step was undertaken: it was planned to restore the maxillary incisors and canines with ceramic veneers. The dental technician prepared a wax-up, which served as a basis for a clinical mock-up. After discussing the mock-up and the treatment plan with the patient, crown lengthening was performed on teeth 11 and 23 to improve the pink esthetics. Subsequently, the teeth were prepared in a minimally invasive way and a final impression was taken. Following try-in, the six veneers were inserted with resin cement.

  5. Thermotolerance of human myometrium: implications for minimally invasive uterine therapies

    Science.gov (United States)

    Thomas, Aaron C.; Grisez, Brian T.; McMillan, Kathleen; Chill, Nicholas; Harclerode, Tyler P.; Radabaugh, Rebecca; Jones, Ryan M.; Coad, James E.

    2013-02-01

    Endometrial ablation has gained significant clinical acceptance over the last decade as a minimally invasive treatment for abnormal uterine bleeding. To improve upon current thermal injury modeling, it is important to better characterize the myometrium's thermotolerance. The extent of myometrial thermal injury was determined across a spectrum of thermal histories/doses (time-temperature combinations). Fresh extirpated human myometrium was obtained from 13 subjects who underwent a previous scheduled benign hysterectomy. Within two hours of hysterectomy, the unfixed myometrium was treated in a stabilized saline bath with temperatures ranging from 45-70 °C and time intervals from 30- 150 seconds. The time-temperature combinations were selected to simulate treatment times under 2.5 minutes. A total of six such thermal matrices, each comprised of 45 time-temperature combinations, were prepared for evaluation. The treated myometrium was cryosectioned for nitro blue tetrazolium (NBT) staining to assess for thermal respiratory enzyme inactivation. Image analysis was subsequently used to quantitatively assess the stained myometrium's capacity to metabolize the tetrazolium at each time-temperature combination. This colorimetric data was then used as marker of cellular viability and determine survival parameters with implications for developing minimally invasive uterine therapies.

  6. Minimally invasive treatment of oral ranula with a mucosal tunnel.

    Science.gov (United States)

    Jia, T; Xing, L; Zhu, F; Jin, X; Liu, L; Tao, J; Chen, Y; Gao, Z; Zhang, H

    2015-02-01

    We have developed a new method for minimally-invasive treatment of uncomplicated oral ranulas using a mucosal tunnel, and we report the clinical outcome. We constructed a mucosal tunnel for each of 35 patients who presented with an oral ranula, by making 2 parallel incisions across the top of the protruding ranula 2-3mm apart, and dissected the soft tissue along the incisions to its wall. The fluid was removed and the cavity irrigated with normal saline. The wall of the ranula was not treated. The first mucosal tunnel was made by suturing the base of the mucosal strip to the deepest part of the wall of the ranula. The mucosal base of the tunnel and the deepest part of the base of the ranula were fixed with absorbable sutures. The two external edges of the incisions were sutured together to form the second mucosal tunnel, and apposing sutures were inserted between the two parallel incisions to form two natural mucosal tunnels. The duration of follow-up ranged from 1 to 5 years. One patient was lost to follow-up and 34 patients were cured. Outcomes were satisfactory without relapse during the follow-up period and the patients were satisfied with the outcome. The mucosal tunnel is a safe, effective, simple, and minimally-invasive treatment for oral ranula.

  7. Minimally invasive spine surgery in spinal infections. An up-date.

    Science.gov (United States)

    Verdú López, Francisco; Vanaclocha Vanaclocha, Vicente; Mayorga-Villa, Juan D

    2016-10-27

    Although spinal infections have always been present recently their incidence has increased, in partly fostered by the advances in medicine (i.e. compromised 10 immunity, chronic diseases, increasingly complex spinal procedures...) and increased life expectancy. Using PubMed for this systematic review, the main spine infections types will be addressed focusing in the minimally invasive surgical techniques that can be used in their treatment. Spontaneous and iatrogenic pyogenic and non-pyogenic spine infections can be treated in many different ways depending on their extension and 15 location as well as on their causative microorganisms. The indications of percutaneous image-guided, endoscopic and microsurgical treatment techniques will be updated. In spine infections minimally invasive surgical techniques show a great potential as to be safe, effective, with low surgical morbidity and fast patients' recovery.

  8. Minimally invasive percutaneous plate fixation of distal tibia fractures.

    LENUS (Irish Health Repository)

    Bahari, Syah

    2007-10-01

    We report a series of 42 patients reviewed at a mean of 19.6 months after treatment of distal tibial and pilon fractures using the AO distal tibia locking plate with a minimally invasive percutaneous plate osteosynthesis (MIPPO) technique. Mean time to union was 22.4 weeks. All fractures united with acceptable alignment and angulation. Two cases of superficial infection were noted, with one case of deep infection. Mean SF36 score was 85 and mean AOFAS score was 90 at a mean of 19 months follow-up. We report satisfactory outcomes with the use of the AO distal tibia locking plate in treatment of unstable distal tibial fractures. Eighty-nine percent of the patients felt that they were back to their pre injury status and 95% back to their previous employment.

  9. [Haptic tracking control for minimally invasive robotic surgery].

    Science.gov (United States)

    Xu, Zhaohong; Song, Chengli; Wu, Wenwu

    2012-06-01

    Haptic feedback plays a significant role in minimally invasive robotic surgery (MIRS). A major deficiency of the current MIRS is the lack of haptic perception for the surgeon, including the commercially available robot da Vinci surgical system. In this paper, a dynamics model of a haptic robot is established based on Newton-Euler method. Because it took some period of time in exact dynamics solution, we used a digital PID arithmetic dependent on robot dynamics to ensure real-time bilateral control, and it could improve tracking precision and real-time control efficiency. To prove the proposed method, an experimental system in which two Novint Falcon haptic devices acting as master-slave system has been developed. Simulations and experiments showed proposed methods could give instrument force feedbacks to operator, and bilateral control strategy is an effective method to master-slave MIRS. The proposed methods could be used to tele-robotic system.

  10. Surgical approaches for minimally invasive plate osteosynthesis in dogs.

    Science.gov (United States)

    Pozzi, A; Lewis, D

    2009-01-01

    Fracture stabilisation techniques continue to evolve and to provide approaches which minimise the iatrogenic trauma associated with surgery. Minimally invasive plate osteosynthesis (MIPO) is a recently described method of biological internal fixation performed by introducing a bone plate via small insertional incisions that are made remote to the fracture site. The plate is slid adjacent to the bone in an epiperiosteal tunnel connecting the two insertional incisions. Screws are placed in the plate through the insertional incisions or via additional stab incisions made over the holes in the plate. In this paper we describe the surgical approaches used to perform MIPO in humeral, radial, femoral and tibial fractures in dogs. We found that these approaches allowed safe insertion of the plate without grossly damaging neuro-vascular structures. Further studies are needed to evaluate the clinical outcome of MIPO in dogs.

  11. Non-technical skills in minimally invasive surgery teams

    DEFF Research Database (Denmark)

    Gjeraa, Kirsten; Spanager, Lene; Konge, Lars

    2016-01-01

    BACKGROUND: Root cause analyses show that up to 70 % of adverse events are caused by human error. Strong non-technical skills (NTS) can prevent or reduce these errors, considerable numbers of which occur in the operating theatre. Minimally invasive surgery (MIS) requires manipulation of more...... were included. All were observational studies without blinding, and they differed in aims, types of evaluation, and outcomes. Only two studies evaluated patient outcomes other than operative time, and overall, the studies' quality of evidence was low. Different communication types were encountered...... towards NTS. CONCLUSIONS: MIS teams' NTS are important for workflow and prevention of errors and can be enhanced by working in fixed teams. In the technological complex sphere of MIS, communication revolves around equipment- and patient-related topics, much more so than in open surgery. In all, only a few...

  12. Endoskopie, minimal invasive chirurgische und navigierte Verfahren in der Urologie

    Science.gov (United States)

    Grosse, Joachim; von Walter, Matthias; Jakse, Gerhard

    Betrachtet man die letzten 100 Jahre der Urologie in Deutschland seit Gründung ihrer Fachgesellschaft 1906 in Stuttgart, so sind sicherlich die letzten 25 Jahre von umfassenden Entwicklungen mit z. T. vollständigen Umwälzungen bisheriger Therapien und Methoden auf urologischen Fachgebiet gekennzeichnet. In erster Linie handelte es sich dabei um minimal invasive endoskopische Techniken wie perkutane Nierenchirurgie, Ureterorenoskopie, videoendoskopisch unterstütze transurethrale Elektroresektionen der Prostata und von Blasentumore sowie die Laparoskopie. Sie führten zu besseren operativen Ergebnissen und einer deutlichen Senkung der Morbidität der entsprechenden Behandlung urologischer Krankheitsbilder, mit der Konsequenz, dass einige bisher als Standard gültige offene Operationsverfahren abgelöst wurden.

  13. Minimally invasive surgery for inflammatory bowel disease: Current perspectives

    Institute of Scientific and Technical Information of China (English)

    Badri Shrestha

    2016-01-01

    The surgical management of complicated and recurrent inflammatory bowel disease(IBD),has remained a challenge.Minimally invasive surgery(MIS),in the form of laparoscopic resections,single port approach and robotic-assisted dissections in the management of IBD,have been examined in several prospective studies.All of them have shown advantages over open surgeryin terms of reduction of physical trauma of surgery,recovery time,better cosmetic outcomes and shorter hospitalization.However,it is important to appreciate that not all patients with IBD are suitable for MIS,so a combination of both open and MIS should be adopted to achieve optimum outcomes.A review on this subject performed by Neumann et al in this issue of World Journal of Gastrointestinal Pharmacology and Therapeutics have provided evidence in support of the contemporary practice of MIS in the management of IBD and the accompanying commentary further critically evaluates their application in clinical practice.

  14. Interventional MRI of the breast: minimally invasive therapy

    Energy Technology Data Exchange (ETDEWEB)

    Hall-Craggs, M.A. [MR Unit, Middlesex Hospital, London (United Kingdom)

    2000-01-01

    In recent years a variety of minimally invasive therapies have been applied to the treatment of breast lesions. These therapies include thermal treatments (interstitial laser coagulation, focused ultrasound, radiofrequency and cryotherapy), percutaneous excision, and interstitial radiotherapy. Magnetic resonance has been used in these treatments to visualize lesions before, during and after therapy and to guide interventions. ''Temperature-sensitive'' sequences have shown changes with thermal ablation which broadly correlate with areas of tumour necrosis. Consequently, MR has the potential to monitor treatment at the time of therapy. To date, experience in the treatment of breast cancer has been restricted to small studies. Large controlled studies are required to validate the efficacy and safety of these therapies in malignant disease. (orig.)

  15. [Minimally Invasive Mitral Valve Plasty;My Technique].

    Science.gov (United States)

    Ito, Toshiaki

    2016-07-01

    We perform minimally invasive mitral valve plasty under totally endoscopic view. Skin incisions are composed of a 3 to 5 cm of main wound along the right 4th intercostal space, 1 trocar port in the 3rd intercostal space, and a camera port in the 5th intercostal space. Matal rib spreader is not used. A 3-dimensional endoscope was recently introduced. Forceps controlled by the left hand are inserted through the independent trocar port in the 3rd intercostal space. Left atrial retractor, aortic clamp, and all the cannulae are inserted through the main incision. Cardio-pulmonary bypass is established through the right femoral artery and vein cannulation. No additional venous cannula through the right jugular vein is used. Posterior leaflet lesions are repaired by resection and suture technique. Anterior leaflet prolapse is repaired mainly using the loop technique. Bleeding from the chest wall is meticulously checked before closing the chest.

  16. Impact of minimally invasive surgery on the pediatric surgical profession.

    Science.gov (United States)

    Jones, Vinci S; Biesheuvel, Cornelis J; Cohen, Ralph C

    2008-12-01

    We conducted a survey among pediatric surgeons to examine the impact of the advent of minimally invasive surgery (MIS) on the pediatric surgical profession with respect to job satisfaction and training challenges. An invitation to participate in a web-based questionnaire was sent out to 306 pediatric surgeons. Apart from demographic details and training recommendations, parameters relevant to job satisfaction, including patient interaction, peer pressure, ethical considerations, academic progress, ability to train residents, and financial remuneration, were studied. The response rate was 38.2%. Working in a unit performing MIS was identified by 71% of respondents as the most effective and feasible modality of training in MIS. Inability to get away from a busy practice was the most common reason cited for inability to acquire MIS training. The overall responses to the job satisfaction parameters showed a positive trend in the current MIS era for patient interaction, ethical considerations, academic progress, and training residents, with a negative trend for peer pressure and financial remuneration. The enthusiastic minimally invasive surgeons (EMIS) were defined as those having more than 5 years of MIS experience and also performing more than 10% of their work using MIS. Of the 113 responses analyzed, 67 belonged to the EMIS category. Those belonging to the EMIS group were less likely to feel inadequate in training their residents, in meeting the felt needs of the patients, or to complain about peer pressure. They were more likely to consider MIS to be as relevant and beneficial in children as in adults. Embracing MIS, as represented by the EMIS group, correlated with an overall greater job satisfaction.

  17. New minimally invasive approaches for cholecystectomy: Review of literature

    Institute of Scientific and Technical Information of China (English)

    Martin; Gaillard; Hadrien; Tranchart; Panagiotis; Lainas; Ibrahim; Dagher

    2015-01-01

    Laparoscopic cholecystectomy is the most commonlyperformed abdominal intervention in Western countries. In an attempt to reduce the invasiveness of the procedure, surgeons have developed single-incision laparoscopic cholecystectomy(SILC), minilaparoscopic cholecystectomy(MLC) and natural orifice transluminal endoscopic surgery(NOTES). The aim of this review was to determine the role of these new minimally invasive approaches for elective laparoscopic cholecystectomy in the treatment of gallstone related disease. Current literature remains insufficient for the correct assessment of emerging techniques for laparoscopic cholecystectomy. None of these procedures has demonstrated clear benefits over conventional laparoscopic cholecystectomy. SILC cannot be currently recommended as it can be associated with an increased risk of bile duct injury and incisional hernia incidence. NOTES cholecystectomy is still experimental, although hybrid transvaginal cholecystectomy is gaining popularity in clinical practice. As it is standardized and almost identical to the standard laparoscopic technique, MLC could lead to limited benefits without exposing patients to increased postoperative complications, being therefore adoptable for routine elective cholecystectomy. Technical challenges of SILC and NOTES cholecystectomy could be addressed with the evolution of new surgical tools that need to catch up with the innovative minds of surgeons. Regardless the place of these approaches in the future, robotization may be necessary to impose them as standard treatment.

  18. Craniocervical junction diseases treatment with a minimally invasive approach

    Directory of Open Access Journals (Sweden)

    Roberto Carlos Díaz

    2014-01-01

    Full Text Available Objective: To introduce a new minimally invasive surgical approach to anterior and lateral craniocervical junction diseases, preserving the midline posterior cervical spine stabilizing elements and reducing the inherent morbidity risk associated with traditional approaches. Methods: We describe a novel surgical technique in four cases of extra-medullary anterolateral compressive lesions located in the occipito-cervical junction, including infections and intra- and/or extradural tumor lesions. We used a paramedian trasmuscular approach through an anatomical muscle corridor using a micro MaXcess(r surgical expandable retractor, with the purpose of reducing morbidity and preserving the posterior muscle and ligamentous tension band. Results: This type of surgical approach provides adequate visualization and microsurgical resection of lesions and reduces muscle manipulation and devascularisation, preserving the tension of the ligament complex. There was minimal blood loss and a decrease in postoperative pain, with rapid start of rehabilitation and shorter hospitalization times. There were no intraoperative complications, and all patients recovered from their pre-operative symptoms. Conclusions: This novel surgical technique is feasible and adequate for the occipito-atlanto-axial complex, with better results than traditional procedures.

  19. Sialendoscopy and Combined Minimally Invasive Treatment for Large Parotid Stones

    Science.gov (United States)

    Zavázalová, Šárka; Vorobiov, Olexii; Astl, Jaromír

    2016-01-01

    Sialendoscopy (SE) represents nowadays one of the standard diagnostic and therapeutic procedures in the treatment of major salivary glands lithiasis. We know from experience that it is successful only in small percentage of patients, when used in monotherapy. However, it represents an indispensable part of all of the combined minimally invasive gland-preserving treatment techniques, the success rate of which is around 90%. In this work, we focused on the role of sialendoscopy in the treatment of patients with larger inflamed fixed stones in glandula parotis. We conducted a total of 364 sialendoscopy procedures in 332 patients on our site. We have confirmed lithiasis as a cause of salivary gland obstruction in 246 (74%) patients. In 9 patients there was larger, single, or multiple inflamed fixed lithiasis of glandula parotis. In this subgroup of patients endoscopically assisted sialolithectomy from external mini-incision has become the method of choice. In 9 of the 9 (100%) cases we have achieved complete elimination of stones, and in 8 of the 9 (89%) cases we have achieved complete elimination of complaints. Sialoendoscopically assisted sialolithectomy of glandula parotis from external mini-incision has proved to be highly effective technique to eliminate stones with minimal complications. PMID:27882318

  20. Crystalloid-based cardioplegia for minimally invasive cardiac surgery.

    Science.gov (United States)

    Misfeld, Martin; Davierwala, Piroze

    2012-01-01

    With the ever-increasing popularity of minimally invasive (MI) cardiac surgery, procedures like aortic valve replacement, with or without concomitant aortic surgery, and mitral and tricuspid valve procedures are now routinely performed through a minimal-access partial upper sternotomy and right anterolateral small thoracotomy, respectively, in our institution. To have optimal visualization through a small incision, it is extremely important to reduce the number of instruments, retractors, and cannulae passing through the incision to a bare minimum and to avoid repeated manipulation of the operative field. Repeated use of blood cardioplegia to maintain myocardial protection can sometimes prevent the surgeon from executing the aforementioned measures. However, if adequate myocardial protection can be achieved and maintained by administering a single dose of crystalloid cardioplegia, it would help expedite the operation with greater ease. At our institution, myocardial protection during aortic valve surgery is achieved using either blood or crystalloid cardioplegia according to surgeon preference. However, crystalloid cardioplegia has become the standard myocardial protection strategy for performing MI mitral valve surgery. Our experience with crystalloid cardioplegia for MI mitral valve surgery is the focus of this article.

  1. Minimally invasive surgery for inflammatory bowel disease: Review of current developments and future perspectives

    Institute of Scientific and Technical Information of China (English)

    Philipp--Alexander Neumann; Emile Rijcken

    2016-01-01

    Patients with inflammatory bowel disease(IBD)com-prise a population of patients that have a high likelihood of both surgical treatment at a young age and repetitive operative interventions.Therefore surgical procedures need to aim at minimizing operative trauma with bestpostoperative recovery.Minimally invasive techniques have been one of the major advancements in surgery in the last decades and are nowadays almost routinely performed in colorectal resections irrespective of underlying disease.However due to special disease related characteristics such as bowel stenosis,interen-teric fistula,abscesses,malnutrition,repetitive sur-geries,or immunosuppressive medications,patients with IBD represent a special cohort with specific needs for surgery.This review summarizes current evidence of minimally invasive surgery for patients with Crohn’s disease or ulcerative colitis and gives an outlook on the future perspective of technical advances in this highly moving field with its latest developments in single port surgery,robotics and trans-anal techniques.

  2. Minimally invasive strabismus surgery versus paralimbal approach: A randomized, parallel design study is minimally invasive strabismus surgery worth the effort?

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    Richa Sharma

    2014-01-01

    Full Text Available Introduction : Minimal access surgery is common in all fields of medicine. We compared a new minimally invasive strabismus surgery (MISS approach with a standard paralimbal strabismus surgery (SPSS approach in terms of post-operative course. Materials and Methods: This parallel design study was done on 28 eyes of 14 patients, in which one eye was randomized to MISS and the other to SPSS. MISS was performed by giving two conjunctival incisions parallel to the horizontal rectus muscles; performing recession or resection below the conjunctival strip so obtained. We compared post-operative redness, congestion, chemosis, foreign body sensation (FBS, and drop intolerance (DI on a graded scale of 0 to 3 on post-operative day 1, at 2-3 weeks, and 6 weeks. In addition, all scores were added to obtain a total inflammatory score (TIS. Statistical Analysis: Inflammatory scores were analyzed using Wilcoxon′s signed rank test. Results: On the first post-operative day, only FBS (P = 0.01 and TIS (P = 0.04 showed significant difference favoring MISS. At 2-3 weeks, redness (P = 0.04, congestion (P = 0.04, FBS (P = 0.02, and TIS (P = 0.04 were significantly less in MISS eye. At 6 weeks, only redness (P = 0.04 and TIS (P = 0.05 were significantly less. Conclusion: MISS is more comfortable in the immediate post-operative period and provides better cosmesis in the intermediate period.

  3. Minimally invasive approaches in pancreatic pseudocyst: a Case report

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    Rohollah Y

    2009-09-01

    Full Text Available "n Normal 0 false false false EN-US X-NONE AR-SA MicrosoftInternetExplorer4 /* Style Definitions */ table.MsoNormalTable {mso-style-name:"Table Normal"; mso-tstyle-rowband-size:0; mso-tstyle-colband-size:0; mso-style-noshow:yes; mso-style-priority:99; mso-style-qformat:yes; mso-style-parent:""; mso-padding-alt:0in 5.4pt 0in 5.4pt; mso-para-margin:0in; mso-para-margin-bottom:.0001pt; mso-pagination:widow-orphan; font-size:11.0pt; font-family:"Calibri","sans-serif"; mso-ascii-font-family:Calibri; mso-ascii-theme-font:minor-latin; mso-fareast-font-family:"Times New Roman"; mso-fareast-theme-font:minor-fareast; mso-hansi-font-family:Calibri; mso-hansi-theme-font:minor-latin; mso-bidi-font-family:Arial; mso-bidi-theme-font:minor-bidi;} Background: According to importance of post operative period, admission duration, post operative pain, and acceptable rate of complications, minimally invasive approaches with endoscope in pancreatic pseudocyst management becomes more popular, but the best choice of procedure and patient selection is currently not completely established. During past decade endoscopic procedures are become first choice in most authors' therapeutic plans, however, open surgery remains gold standard in pancreatic pseudocyst treatment."n"nMethods: we present here a patient with pancreatic pseudocyst unresponsive to conservative management that is intervened endoscopically before 6th week, and review current literatures to depict a schema to management navigation."n"nResults: A 16 year old male patient presented with two episodes of acute pancreatitis with abdominal pain, nausea and vomiting. Hyperamilasemia, pancreatic ascites and a pseudocyst were found in our preliminary investigation. Despite optimal conservative management, including NPO (nil per os and total parentral nutrition, after four weeks, clinical and para-clinical findings deteriorated. Therefore, ERCP and trans-papillary cannulation with placement of 7Fr stent was

  4. "Fast-track" and "Minimally Invasive" Surgery for Gastric Cancer

    Institute of Scientific and Technical Information of China (English)

    Xin-Xin Liu; Hua-Feng Pan; Zhi-Wei Jiang; Shu Zhang; Zhi-Ming Wang; Ping Chen; Yan Zhao

    2016-01-01

    Background:Enhanced recovery after surgery (ERAS) protocols or fast-track (FT) programs enable a shorter hospital stay and lower complication rate.Minimally invasive surgery (MIS) is associated with a lesser trauma and a quicker recovery in many elective abdominal surgeries.However,little is known of the safety and effectiveness made by ERAS protocols combined with MIS for gastric cancer.The purpose of this study was to evaluate the safety and effectiveness made by FT programs and MIS in combination or alone.Methods:We summarized an 11-year experience on gastric cancer patients undergoing elective laparotomy or minimally invasive gastric resection in standard cares (SC) or FT programs during January 2004 to December 2014.A total of 984 patients were enrolled and assigned into four groups:open gastrectomies (OG) with SC (OG + SC group,n =167);OG with FT programs (OG + FT group,n =277);laparoscopic gastrectomies (LG) with FT programs (LG + FT group,n =248);and robot-assisted gastrectomies (RG) with FT programs (RG + FT group,n =292).Patients' data were collected to evaluate the clinical outcome.The primary end point was the length of postoperative hospital stay.Results:The OG + SC group showed the longest postoperative hospital stay (mean:12.3 days,median:11 days,interquartile range [IQR]:6-16 days),while OG + FT,LG + FT,and RG + FT groups recovered faster (mean:7.4,6.4,and 6.6 days,median:6,6,and 6 days,IQR:3-9,4-8,and 3-9 days,respectively,all P < 0.001).The postoperative rehabilitation parameters such as flatus time after surgery (4.7 ± 0.9,3.1 ± 0.8,3.0± 0.9,and 3.1 ± 0.9 days) followed the same manner.After 30 postoperative days' follow-up,the total incidence of complications was 9.6% in OG + SC group,10.1% in OG + FT group,8.1% in LG + FT group,and 10.3% in RG + FT group.The complications showed no significant differences between the four groups (all P > 0.05).Conclusions:ERAS protocols alone could significantly bring fast recovery after surgery

  5. Outcome of minimally invasive surgery in the management of tuberculous spondylitis

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    Pankaj Kandwal

    2012-01-01

    Full Text Available Introduction: With the advancement of instrumentation and minimally access techniques in the field of spine surgery, good surgical decompression and instrumentation can be done for tuberculous spondylitis with known advantage of MIS (minimally invasive surgery. The aim of this study was to assess the outcome of the minimally invasive techniques in the surgical treatment of patients with tuberculous spondylodiscitis. Materials and Methods: 23 patients (Group A with a mean age 38.2 years with single-level spondylodiscitis between T4-T11 treated with video-assisted thoracoscopic surgery (VATS involving anterior debridement and fusion and 15 patients (Group B with a mean age of 32.5 years who underwent minimally invasive posterior pedicle screw instrumentation and mini open posterolateral debridement and fusion were included in study. The study was conducted from Mar 2003 to Dec 2009 duration. The indication of surgery was progressive neurological deficit and/or instability. The patients were evaluated for blood loss, duration of surgery, VAS scores, improvement in kyphosis, and fusion status. Improvement in neurology was documented and functional outcome was judged by oswestry disability index (ODI. Results: The mean blood loss in Group A (VATS category was 780 ml (330-1180 ml and the operative time averaged was 228 min (102-330 min. The average preoperative kyphosis in Group A was 38° which was corrected to 30°. Twenty-two patients who underwent VATS had good fusion (Grade I and Grade II with failure of fusion in one. Complications occurred in seven patients who underwent VATS. The mean blood loss was 625 ml (350-800 ml with an average duration of surgery of 255 min (180-345 min in the percutaneous posterior instrumentation group (Group B. The average preoperative segmental (kyphosis Cobb′s angle of three patients with thoracic TB in Group B was 41.25° (28-48°, improved to 14.5°(11°- 21° in the immediate postoperative period (71

  6. Minimally invasive tethered cord release in children: A technical note

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    S. Kağan Başarslan

    2014-03-01

    Full Text Available Tethered cord release is commonly performed in pediatric neurosurgery. Nowadays, minimally invasive procedures are created growing interest due to its highly tolerable nature for surgery. It has been main purpose a minimal damaging on access route and maximum protection of normal structures in surgery. We present a surgical treatment of tethered cord syndrome, by which is provided the cord releasing unlike the many methods being applied with tissue removal. The main advantage of performing this surgery through 2 cm hole is to avoid removing ligamentum flavum and bony structure like lamina in addition to reduce the length of the incision and the related scar tissue. J Clin Exp Invest 2014; 5 (1: 115-117 Technical note: the patient was taken on the operating table in the sitting-prone position, and L5-S1 distance was determined by fluoroscopy. The skin and subcutaneous tissues was passed via a 2 cm vertical incision settled in 0.5 cm laterally from midline. L5-S1 distance and its covering ligamentum flavum are displayed by the guidance of L5 lamina. Williams’s retractor was placed in the distance after fetching microscope. The foregoing procedures are the same with microdiscectomic surgery. By a vertical incision made on the flavum, its both layer was lifted up and hanged with simple suture on the back tissue for a comfortable exposure of the Dura. Thecal sac was opened by 0.5 cm long vertical incision on the Dura after obtaining secure CSF drainage with the help of yellow-tipped syringe needle. With finding by a nerve hook, the phylum was burned and released securely. Then the Dura was sutured primarily for the closure by means of microsurgery instruments, and flavum was laid on it again.

  7. Minimally invasive repair of Morgagni hernia - A multicenter case series.

    Science.gov (United States)

    Lamas-Pinheiro, R; Pereira, J; Carvalho, F; Horta, P; Ochoa, A; Knoblich, M; Henriques, J; Henriques-Coelho, T; Correia-Pinto, J; Casella, P; Estevão-Costa, J

    2016-01-01

    Children may benefit from minimally invasive surgery (MIS) in the correction of Morgagni hernia (MH). The present study aims to evaluate the outcome of MIS through a multicenter study. National institutions that use MIS in the treatment of MH were included. Demographic, clinical and operative data were analyzed. Thirteen patients with MH (6 males) were operated using similar MIS technique (percutaneous stitches) at a mean age of 22.2±18.3 months. Six patients had chromosomopathies (46%), five with Down syndrome (39%). Respiratory complaints were the most common presentation (54%). Surgery lasted 95±23min. In none of the patients was the hernia sac removed; prosthesis was never used. In the immediate post-operative period, 4 patients (36%) were admitted to intensive care unit (all with Down syndrome); all patients started enteral feeds within the first 24h. With a mean follow-up of 56±16.6 months, there were two recurrences (18%) at the same institution, one of which was repaired with an absorbable suture; both with Down syndrome. The application of MIS in the MH repair is effective even in the presence of comorbidities such as Down syndrome; the latter influences the immediate postoperative recovery and possibly the recurrence rate. Removal of hernia sac does not seem necessary. Non-absorbable sutures may be more appropriate.

  8. Multiple video sequences synchronization during minimally invasive surgery

    Science.gov (United States)

    Belhaoua, Abdelkrim; Moreau, Johan; Krebs, Alexandre; Waechter, Julien; Radoux, Jean-Pierre; Marescaux, Jacques

    2016-03-01

    Hybrid operating rooms are an important development in the medical ecosystem. They allow integrating, in the same procedure, the advantages of radiological imaging and surgical tools. However, one of the challenges faced by clinical engineers is to support the connectivity and interoperability of medical-electrical point-of-care devices. A system that could enable plug-and-play connectivity and interoperability for medical devices would improve patient safety, save hospitals time and money, and provide data for electronic medical records. In this paper, we propose a hardware platform dedicated to collect and synchronize multiple videos captured from medical equipment in real-time. The final objective is to integrate augmented reality technology into an operation room (OR) in order to assist the surgeon during a minimally invasive operation. To the best of our knowledge, there is no prior work dealing with hardware based video synchronization for augmented reality applications on OR. Whilst hardware synchronization methods can embed temporal value, so called timestamp, into each sequence on-the-y and require no post-processing, they require specialized hardware. However the design of our hardware is simple and generic. This approach was adopted and implemented in this work and its performance is evaluated by comparison to the start-of-the-art methods.

  9. Evaluation of robotic minimally invasive surgical skills using motion studies.

    Science.gov (United States)

    Jun, Seung-Kook; Sathia Narayanan, Madusudanan; Singhal, Pankaj; Garimella, Sudha; Krovi, Venkat

    2013-09-01

    Robotic Minimally Invasive Surgery, and the engendered computer-integration, offers unique opportunities for quantitative computer-based surgical-performance evaluation. In this work, we examine extension of traditional manipulative skill assessment, having deep roots in performance evaluation in manufacturing industries, for applicability to robotic surgical skill evaluation. This method relies on: defining task-level segmentation of modular sub-tasks/micro-motions called 'Therbligs' that can be combined to perform a given task; and analyzing intra- and inter-user performance variance by studying surgeons' performance over each 'Therbligs'. Any of the performance metrics of macro-motions-from motion-economy, tool motion measurements to handed-symmetry-can now be extended over the micro-motion temporal segments. Evaluation studies were based on video recordings of surgical tasks in two settings: first, we examined performance of two representative manipulation exercises (peg board and pick-and-place) on a da Vinci surgical SKILLS simulator. This affords a relatively-controlled and standardized test-scenarios for surgeons with varied experience-levels. Second, task-sequences from real surgical videos were analyzed with a list of predefined 'Therbligs' in order to investigate its overall usefulness.

  10. Minimally-invasive transepidermal potentiometry with microneedle salt bridge.

    Science.gov (United States)

    Abe, Yuina; Nagamine, Kuniaki; Nakabayashi, Mayu; Kai, Hiroyuki; Kaji, Hirokazu; Yamauchi, Takeshi; Yamasaki, Kenshi; Nishizawa, Matsuhiko

    2016-08-01

    A commercial painless microneedle was filled with physiological saline agar, and this needle-based salt bridge was inserted into the skin (a piece of porcine skin and a flank skin of a live mouse) to make an electrical contact with its subepidermal region. The transepidermal potential (TEP), the potential difference between the skin surface and the subepidermal region, was measured using this inner electrode and a conventional agar electrode on the surface of the skin. Control of penetration depth of the inner electrode with a spacer and hydrophilic pretreatment with ozone plasma were found to be necessary for stable measurement. The TEP was reduced upon damages on the skin surface by tape stripping and acetone defatting, which indicated the fabricated needle electrode is useful for the minimally-invasive measurement of TEP and evaluation of skin barrier functions. Furthermore, we showed that the device integrating two electrodes into a single compact probe was useful to evaluate the local barrier functions and their mapping on a skin. This device could be a personal diagnostic tool in the fields of medicine and cosmetics in future.

  11. Design of Micro Robot for Minimally Invasive Surgery

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    Deiva Ganesh A

    2012-09-01

    Full Text Available Micro robots for medical applications need to be compatible with human body, remotely controllable, smooth in movement, less painful to the patients and capable of performing the designated functions. In this paper, state of the art in the design, fabrication and control of micro robots are presented. First the benefits of micro robots in medical applications are listed out. Second, the predominantly used micro robot designs are discussed. Third, the various fabrication process used in micro robot construction are presented. Fourth, the different approaches used for its operation and control in micro robot technology are narrated. Next based on the review we have designed a swimming micro robot driven by external magnetic fields for minimally invasive surgery. The advantage of EMA is that it can generate a wireless driving force. Then, the locomotive mechanism of the micro robot using EMA is presented. Using the EMA system setup various experiments have been conducted. Finally, the performance of the swimming micro robot is evaluated.  

  12. Depth Perception of Surgeons in Minimally Invasive Surgery.

    Science.gov (United States)

    Bogdanova, Rositsa; Boulanger, Pierre; Zheng, Bin

    2016-10-01

    Minimally invasive surgery (MIS) poses visual challenges to the surgeons. In MIS, binocular disparity is not freely available for surgeons, who are required to mentally rebuild the 3-dimensional (3D) patient anatomy from a limited number of monoscopic visual cues. The insufficient depth cues from the MIS environment could cause surgeons to misjudge spatial depth, which could lead to performance errors thus jeopardizing patient safety. In this article, we will first discuss the natural human depth perception by exploring the main depth cues available for surgeons in open procedures. Subsequently, we will reveal what depth cues are lost in MIS and how surgeons compensate for the incomplete depth presentation. Next, we will further expand our knowledge by exploring some of the available solutions for improving depth presentation to surgeons. Here we will review the innovative approaches (multiple 2D camera assembly, shadow introduction) and devices (3D monitors, head-mounted devices, and auto-stereoscopic monitors) for 3D image presentation from the past few years.

  13. A Novel Approach to Minimally Invasive Management of Sigmoid Volvulus

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    Alireza Tavassoli

    2016-11-01

    Full Text Available Resection is the most common treatment choice for sigmoid volvulus, a common complication in our region. A new minimally invasive technique for sigmoid resection with local anesthesia was done in this study. This method is invented to avoid general on regional anesthesia in high-risk patients. Nineteen patients were evaluated and then 14 were enrolled in this study. Sigmoidectomy with a left lower quadrant incision was performed and demographic data, the length of hospital stay, complications and procedure time were recorded. The mean age of participants was 65.68, and the male to female ratio was 1:2.7. The mean duration of the operation was 91.42 min. Complications include one case each of wound hematoma and wound infection. The intraoperative pain score was 1.2/10 and postoperative pain score was 2.35/10. The mean hospital staying was 8.3 days. By meticulous patient selection, sigmoidectomy under local anesthesia for sigmoid volvulus could be a surgeons’ armamentarium in special situations.

  14. Augmented Reality Image Guidance in Minimally Invasive Prostatectomy

    Science.gov (United States)

    Cohen, Daniel; Mayer, Erik; Chen, Dongbin; Anstee, Ann; Vale, Justin; Yang, Guang-Zhong; Darzi, Ara; Edwards, Philip'eddie'

    This paper presents our work aimed at providing augmented reality (AR) guidance of robot-assisted laparoscopic surgery (RALP) using the da Vinci system. There is a good clinical case for guidance due to the significant rate of complications and steep learning curve for this procedure. Patients who were due to undergo robotic prostatectomy for organ-confined prostate cancer underwent preoperative 3T MRI scans of the pelvis. These were segmented and reconstructed to form 3D images of pelvic anatomy. The reconstructed image was successfully overlaid onto screenshots of the recorded surgery post-procedure. Surgeons who perform minimally-invasive prostatectomy took part in a user-needs analysis to determine the potential benefits of an image guidance system after viewing the overlaid images. All surgeons stated that the development would be useful at key stages of the surgery and could help to improve the learning curve of the procedure and improve functional and oncological outcomes. Establishing the clinical need in this way is a vital early step in development of an AR guidance system. We have also identified relevant anatomy from preoperative MRI. Further work will be aimed at automated registration to account for tissue deformation during the procedure, using a combination of transrectal ultrasound and stereoendoscopic video.

  15. Percutaneous Iliac Screws for Minimally Invasive Spinal Deformity Surgery

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    Michael Y. Wang

    2012-01-01

    Full Text Available Introduction. Adult spinal deformity (ASD surgeries carry significant morbidity, and this has led many surgeons to apply minimally invasive surgery (MIS techniques to reduce the blood loss, infections, and other peri-operative complications. A spectrum of techniques for MIS correction of ASD has thus evolved, most recently the application of percutaneous iliac screws. Methods. Over an 18 months 10 patients with thoracolumbar scoliosis underwent MIS surgery. The mean age was 73 years (70% females. Patients were treated with multi-level facet osteotomies and interbody fusion using expandable cages followed by percutaneous screw fixation. Percutaneous iliac screws were placed bilaterally using the obturator outlet view to target the ischial body. Results. All patients were successfully instrumented without conversion to an open technique. Mean operative time was 302 minutes and the mean blood loss was 480 cc, with no intraoperative complications. A total of 20 screws were placed successfully as judged by CT scanning to confirm no bony violations. Complications included: two asymptomatic medial breaches at T10 and L5, and one patient requiring delayed epidural hematoma evacuation. Conclusions. Percutaneous iliac screws can be placed safely in patients with ASD. This MIS technique allows for successful caudal anchoring to stress-shield the sacrum and L5-S1 fusion site in long-segment constructs.

  16. Canaloplasty: A Minimally Invasive and Maximally Effective Glaucoma Treatment

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    Mahmoud A. Khaimi

    2015-01-01

    Full Text Available Canaloplasty is a highly effective, minimally invasive, surgical technique indicated for the treatment of open-angle glaucoma that works by restoring the function of the eye’s natural outflow system. The procedure’s excellent safety profile and long-term efficacy make it a viable option for the majority of glaucoma patient types. It can be used in conjunction with existing drug based glaucoma treatments, after laser or other types of incisional surgery, and does not preclude or affect the outcome of future surgery. Numerous scientific studies have shown Canaloplasty to be safe and effective in lowering IOP whilst reducing medication dependence. A recent refinement of Canaloplasty, known as ab-interno Canaloplasty (ABiC, maintains the IOP-lowering and safety benefits of traditional (ab-externo Canaloplasty using a more efficient, simplified surgical approach. This paper presents a review of Canaloplasty indications, clinical data, and complications, as well as comparisons with traditional incisional glaucoma techniques. It also addresses the early clinical evidence for ABiC.

  17. Instruments for minimally invasive surgery: principles of ergonomic handles.

    Science.gov (United States)

    Matern, U; Waller, P

    1999-02-01

    Although the advantages of minimally invasive surgery (MIS) have been clearly established for the patient, the surgeon must cope with disadvantages caused by unergonomic instrument handles. Pressure areas and persisting nerve lesions have been described in the literature. The shape of the instrument handles has been identified as the reason for these disorders. To prevent these, it is necessary to use ergonomically designed handles for MIS instruments. Anatomic, physiologic, and ergonomic facts as well as the results of the authors' own experiences and tests are presented. On this basis, an ideal ergonomic working posture for the laparoscopic surgeon and an optimal grasp for manipulating the instruments' functional elements are recommended. To enable the surgeon to evaluate ergonomic handles for MIS instruments according to his own needs, 14 criteria for genuine "ergonomic handles" are established. On the basis of these criteria, deficiencies of handles currently available (ring and shank handles at an angle or with axial extension to the instrument shaft, and pistol handles) are discussed. Furthermore, new handles, developed by the authors according to the criteria for genuine ergonomic handles, are presented.

  18. Minimally invasive glaucoma surgery: current status and future prospects

    Directory of Open Access Journals (Sweden)

    Richter GM

    2016-01-01

    Full Text Available Grace M Richter,1,2 Anne L Coleman11UCLA Stein Eye Institute, Department of Ophthalmology, University of California, Los Angeles, CA, USA; 2USC Eye Institute, Department of Ophthalmology, Keck School of Medicine of University of Southern California, Los Angeles, CA, USAAbstract: Minimally invasive glaucoma surgery aims to provide a medication-sparing, conjunctival-sparing, ab interno approach to intraocular pressure reduction for patients with mild-to-moderate glaucoma that is safer than traditional incisional glaucoma surgery. The current approaches include: increasing trabecular outflow (Trabectome, iStent, Hydrus stent, gonioscopy-assisted transluminal trabeculotomy, excimer laser trabeculotomy; suprachoroidal shunts (Cypass micro-stent; reducing aqueous production (endocyclophotocoagulation; and subconjunctival filtration (XEN gel stent. The data on each surgical procedure for each of these approaches are reviewed in this article, patient selection pearls learned to date are discussed, and expectations for the future are examined. Keywords: MIGS, microincisional glaucoma surgery, trabecular stent, Schlemm’s canal, suprachoroidal shunt, ab interno

  19. Ongoing deficits in resident training for minimally invasive surgery.

    Science.gov (United States)

    Park, Adrian; Witzke, Donald; Donnelly, Michael

    2002-01-01

    Patient preference has driven the adoption of minimally invasive surgery (MIS) techniques and altered surgical practice. MIS training in surgical residency programs must teach new skill sets with steep learning curves to enable residents to master key procedures. Because no nationally recognized MIS curriculum exists, this study asked experts in MIS which laparoscopic procedures should be taught and how many cases are required for competency. Expert recommendations were compared to the number of cases actually performed by residents (Residency Review Committee [RRC] data). A detailed survey was sent nationwide to all surgical residency programs (academic and private) known to offer training in MIS and/or have a leader in the field. The response rate was approximately 52%. RRC data were obtained from the resident statistics summary report for 1998-1999. Experts identified core procedures for MIS training and consistently voiced the opinion that to become competent, residents need to perform these procedures many more times than the RRC data indicate they currently do. At present, American surgical residency programs do not meet the suggested MIS case range or volume required for competency. Residency programs need to be restructured to incorporate sufficient exposure to core MIS procedures. More expert faculty must be recruited to train residents to meet the increasing demand for laparoscopy.

  20. Peroral endoscopic myotomy: An emerging minimally invasive procedure for achalasia.

    Science.gov (United States)

    Vigneswaran, Yalini; Ujiki, Michael B

    2015-10-10

    Peroral endoscopic myotomy (POEM) is an emerging minimally invasive procedure for the treatment of achalasia. Due to the improvements in endoscopic technology and techniques, this procedure allows for submucosal tunneling to safely endoscopically create a myotomy across the hypertensive lower esophageal sphincter. In the hands of skilled operators and experienced centers, the most common complications of this procedure are related to insufflation and accumulation of gas in the chest and abdominal cavities with relatively low risks of devastating complications such as perforation or delayed bleeding. Several centers worldwide have demonstrated the feasibility of this procedure in not only early achalasia but also other indications such as redo myotomy, sigmoid esophagus and spastic esophagus. Short-term outcomes have showed great clinical efficacy comparable to laparoscopic Heller myotomy (LHM). Concerns related to postoperative gastroesophageal reflux remain, however several groups have demonstrated comparable clinical and objective measures of reflux to LHM. Although long-term outcomes are necessary to better understand durability of the procedure, POEM appears to be a promising new procedure.

  1. Cyclodialysis Cleft Treatment Using a Minimally Invasive Technique

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    João Pinheiro-Costa

    2015-02-01

    Full Text Available Purpose: To report a case of a cyclodialysis cleft that was successfully managed with gas endotamponade and cyclocryotherapy. Methods: A 37-year-old male victim of a severe blunt ocular trauma was referred to our service for evaluation and treatment of a left eye hypotony. Clinical examination revealed an intraocular pressure of 2 mm Hg, a cyclodialysis cleft extending from the 11 to 1 o'clock positions and a hypotonic maculopathy. Left eye best corrected visual acuity (BCVA was 3/10. The patient failed to respond to conservative treatment with atropine 1%, so a single bubble of 16% C2F6 was injected into the vitreous cavity, followed by superior quadrant transconjunctival cyclocryotherapy. Results: After gas absorption, the intraocular pressure increased to 11 mm Hg and became steady during the 24 months of follow-up. His hypotonic maculopathy resolved, and the BCVA improved to 9/10. Complete closure of the cyclodialysis cleft was documented with ultrasound biomicroscopy. Conclusion: Cryotherapy associated with gas endotamponade is a minimally invasive technique that could be considered for patients with cyclodialysis clefts that fail to respond to medical therapy.

  2. MINIMALLY INVASIVE OPEN THYROIDECTOMY IN THYROID CANCER WITH COEXISTENT HASHIMOTO THYROIDITIS

    Directory of Open Access Journals (Sweden)

    Rumen Nenkov

    2013-06-01

    Full Text Available One of the minimally invasive thyroidectomy challenges is the application of this technique in the surgical treatment of thyroid cancer. The use of minimally invasive open approach in co-existence of thyroid cancer with Hashimoto thyroiditis is well known provocation to the skills of the surgeon working in the field of thyroid surgery.Aim: To report our results and to present the possibilities of minimally invasive open approach in the surgical treatment of thyroid carcinoma and coexistent Hashimoto thyroiditis. Patients and methods: For the period from 2008 to 2011, 641 patients were operated on in our clinic using minimally invasive open approach. In 32 of these patients presence of Hashimoto thyroiditis was found in combination with thyroid cancer. All patients were females, 26 to 46 years age. Patients were selected according to designed and accepted for our institution criteria. The procedures were performed using ultrasound (harmonic shears (Harmonic Focus® and Harmonic Ace®, Ethicon Endo-Surgery. The operative time, incidence, type and severity of complications, length of hospital stay, safety and reliability of the surgical procedure were analyzed. Results: The operative incision length in all cases was between 2.0-2.5 cm. In 27 patients papillary thyroid carcinoma and in 5 patients – follicular variant of the neoplasm were found. The tumor size ranged between 0.5 and 1.5 cm. In all patients total thyroidectomy using harmonic scalpel was performed. Lymph node metastases in the central neck compartment were not found in any of the cases. The rate, type and severity of complications did not exceed those for patients who underwent conventional thyroidectomy. All patients leaved the hospital in the first 24 postoperative hours. The follow-up did not reveal remnant thyroid tissue in thyroid gland bed or recurrence of the disease.Conclusions: Our results demonstrate the feasibility and reliability of minimally invasive open approach with

  3. Development of magnetic anchoring and guidance systems for minimally invasive surgery.

    Science.gov (United States)

    Best, Sara L; Cadeddu, Jeffery A

    2010-07-01

    Recent advances in urology have included natural orifice translumenal endoscopic surgery (NOTES) and laparoendoscopic single-site surgery (LESS). These techniques seek to minimize morbidity by reducing the number of transabdominal port sites, but this comes at a cost of decreased instrument agility and other technical challenges that have prevented LESS and NOTES from entering mainstream urologic practice. Magnetic anchoring and guidance systems (MAGS) consist of instruments that are inserted laparoscopically through an entry in the peritoneal cavity at one point and then driven into position elsewhere and controlled with magnets. These instruments improve the ergonomics of minimally invasive surgery and may help make LESS and NOTES more accessible to urologists across experience levels.

  4. Laparoendoscopic single-site surgery in gynaecology: A new frontier in minimally invasive surgery

    Directory of Open Access Journals (Sweden)

    Fader Amanda

    2011-01-01

    Full Text Available Review Objective: To review the recent developments and published literature on laparoendoscopic single-site (LESS surgery in gynaecology. Recent Findings: Minimally invasive surgery has become a standard of care for the treatment of many benign and malignant gynaecological conditions. Recent advances in conventional laparoscopy and robotic-assisted surgery have favorably impacted the entire spectrum of gynaecological surgery. With the goal of improving morbidity and cosmesis, continued efforts towards refinement of laparoscopic techniques have lead to minimization of size and number of ports required for these procedures. LESS surgery is a recently proposed surgical term used to describe various techniques that aim at performing laparoscopic surgery through a single, small-skin incision concealed within the umbilicus. In the last 5 years, there has been a surge in the developments in surgical technology and techniques for LESS surgery, which have resulted in a significant increase in utilisation of LESS across many surgical subspecialties. Recently published outcomes data demonstrate feasibility, safety and reproducibility for LESS in gynaecology. The contemporary LESS literature, extent of gynaecological procedures utilising these techniques and limitations of current technology will be reviewed in this manuscript. Conclusions: LESS surgery represents the newest frontier in minimally invasive surgery. Comparative data and prospective trials are necessary in order to determine the clinical impact of LESS in treatment of gynaecological conditions.

  5. Comparative effectiveness of open versus minimally invasive sacroiliac joint fusion

    Directory of Open Access Journals (Sweden)

    Ledonio CGT

    2014-06-01

    Full Text Available Charles GT Ledonio,1 David W Polly Jr,1 Marc F Swiontkowski,1 John T Cummings Jr2 1Department of Orthopaedic Surgery, University of Minnesota, Twin Cities, MN, 2Community Neurosurgical Care, Indianapolis, IN, USA Background: The mainstay of sacroiliac joint disruption/degenerative sacroiliitis therapy has been nonoperative management. This nonoperative management often includes a regimen of physical therapy, chiropractic treatment, therapeutic injections, and possibly radiofrequency ablation at the discretion of the treating physician. When these clinical treatments fail, sacroiliac joint fusion has been recommended as the standard treatment. Open and minimally invasive (MIS surgical techniques are typical procedures. This study aims to compare the perioperative measures and Oswestry Disability Index (ODI outcomes associated with each of these techniques. Methods: A comparative retrospective chart review of patients with sacroiliac joint fusion and a minimum of 1 year of follow-up was performed. Perioperative measures and ODI scores were compared using the Fisher's exact test and two nonparametric tests, ie, the Mann–Whitney U test and the Wilcoxon signed-rank test. The results are presented as percent or median with range, as appropriate. Results: Forty-nine patients from two institutions underwent sacroiliac joint fusion between 2006 and 2012. Ten patients were excluded because of incomplete data, leaving 39 evaluable patients, of whom 22 underwent open and 17 underwent MIS sacroiliac joint fusion. The MIS group was significantly older (median age 66 [39–82] years than the open group (median age 51 [34–74] years. Surgical time and hospital stay were significantly shorter in the MIS group than in the open group. Preoperative ODI was significantly greater in the open group (median 64 [44–78] than in the MIS group (median 53 [14–84]. Postoperative improvement in ODI was statistically significant within and between groups, with MIS

  6. Medicolegal Corner: When minimally invasive thoracic surgery leads to paraplegia

    Directory of Open Access Journals (Sweden)

    Nancy E Epstein

    2014-01-01

    Full Text Available A patient with mild cervical myelopathy due to multilevel ossification of the posterior longitudinal ligament (OPLL initially underwent a cervical C3-T1 laminectomy with C2-T2 fusion utilizing lateral mass screws. The patient′s new postoperative right upper extremity paresis largely resolved within several postoperative months. However, approximately 6 months later, the patient developed increased paraparesis attributed to thoracic OPLL and Ossification of the yellow ligament (OYL at the T2-T5 and T10-T11 levels. The patient underwent simultaneous minimally invasive (MIS unilateral MetRx approaches to both regions. Postoperatively, the patient was paraplegic and never recovered function. Multiple mistakes led to permanent paraplegia due to MIS MetRx decompressions for T2-T5 and T10-11 OPLL/OYL in this patient. First, both thoracic procedures should have been performed "open" utilizing a full laminectomy rather than MIS; adequate visualization would have likely averted inadvertent cord injury, and the resultant CSF leak. Second, the surgeon should have used an operating microscope. Third, the operation should have been monitored with somatosensory evoked potentials (SEP, motor evoked potentials (MEP, and EMG (electromyography. Fourth, preoperatively the patient should have received a 1-gram dose of Solumedrol for cord "protection". Fifth, applying Gelfoam as part of the CSF leak repair is contraindicated (e.g. due to swelling in confined spaces- see insert. Sixth, if the patient had not stopped Excedrin prior to the surgery, the surgery should have been delayed to avoid the increased perioperative risk of bleeding/hematoma.

  7. Minimally Invasive Robotic Laser Corpus Callosotomy: A Proof of Concept

    Science.gov (United States)

    Essayed, Walid I; Deb, Sayantan; Hoffman, Caitlin; Schwartz, Theodore H

    2017-01-01

    Introduction We describe the feasibility of using minimally invasive robotic laser interstitial thermotherapy (LITT) for achieving an anterior two-thirds as well as a complete corpus callosotomy. Methods Ten probe trajectories were plotted on normal magentic resonance imaging (MRI) scans using the Brainlab Stereotactic Planning Software (Brainlab, Munich, Germany). The NeuroBlate® System (Monteris Medical, MN, USA) was used to conform the thermal burn to the corpus callosum along the trajectory of the probe. The distance of the ideal entry site from either the coronal suture and the torcula or nasion and the midline was calculated. The distance of the probe tip from the dorsal and ventral limits of the callosotomy in the sagittal plane were also calculated. Results Anterior two-thirds callosotomy was possible in all patients using a posterior parieto-occipital paramedian trajectory through the non-dominant lobe. The average entry point was 3.64 cm from the midline, 10.6 cm behind the coronal suture, and 9.2 cm above the torcula. The probe tip was an average of 1.4 cm from the anterior commissure. For a total callosotomy, an additional contralaterally placed frontal probe was used to target the posterior one-third of the corpus callosum. The average entry site was 3.3 cm from the midline and 9.1 cm above the nasion. The average distance of the probe tip from the base of the splenium was 0.94 cm. Conclusion The directional thermoablation capability of the NeuroBlate® system allows for targeted lesioning of the corpus callosum, to achieve a two-thirds or complete corpus callosotomy. A laser distance of < 2 cm is sufficient to reach the entire corpus callosum through one trajectory for an anterior two-thirds callosotomy and two trajectories for a complete callosotomy.

  8. PARASURG hybrid parallel robot for minimally invasive surgery.

    Science.gov (United States)

    Pisla, D; Gherman, B; Plitea, N; Gyurka, B; Vaida, C; Vlad, L; Graur, F; Radu, C; Suciu, M; Szilaghi, A; Stoica, A

    2011-01-01

    This paper presents the parallel hybrid robot, PARASURG 9M, for robotically assisted surgery, a robot which was entirely designed and produced in Romania. It is a versatile robot, being composed of a positioning and orientation module, PARASURG 5M with five degrees of freedom, having the possibility of attaching at its end either a laparoscope or an active surgical instrument for cutting/grasping, PARASIM, with four degrees of freedom. Based on its mathematical modelling, the first low-cost experimental model of the surgical robot has been built. The robot is part of the surgical robotic system, PARAMIS, with three arms, one used as a laparoscope holder, and other two for manipulating active instruments. When it is used as a manipulator of the camera, the user has the possibility to give commands in a large area for the positioning of the laparoscope using different interfaces: joystick, microphone, keyboard & mouse and haptic device. If the active surgical instrument, PARASIM, is attached, the robot commands are given through a haptic device. The main features that make the PARASURG 9M surgical robot suited for minimally invasive surgery are: precision, the elimination of the natural tremor of the surgeon, direct control over a smooth, precise, stable view of the internal surgical field for the surgeon. It also eliminates the need of a second surgeon to be present for the entire procedure (in the case of using the robot as a camera holder). In addition, there is improvement of surgeon dexterity in the case of using the PARASIM active instrument and better ergonomics in using the robot (in the case of the classic laparoscopy, the surgeon must adopt a difficult position for a long period of time, while the robot never gets tired). Having a relatively easy to understand, intuitive commanding system, the surgeons can rapidly adapt to the use of the PARASURG 9M robot in surgical procedures.

  9. Postoperative metabolic acidosis following the minimally invasive radiofrequency maze procedure

    Directory of Open Access Journals (Sweden)

    Raymond Patrick Hom

    2016-01-01

    Full Text Available Purpose: Atrial fibrillation (AF is the most common arrhythmia treated in the world. While medical treatment with antiarrhythmic drugs remains the primary treatment modality, symptomatic refractory AF often requires treatment with a catheter or surgical ablation. One minimally invasive therapy is the Mini-Maze procedure, which utilizes epicardial radiofrequency ablation via a subxiphoid approach to rid the heart of arrhythmogenic atrial foci without a median sternotomy or cardiopulmonary bypass. The goal of this retrospective cohort study was to identify clinical factors associated with metabolic acidosis following the Mini-Maze procedure. Materials and Methods: After Institutional Review Board approval, we studied patients undergoing the Mini-Maze procedure, off-pump coronary artery bypass grafting or patients conventional Cox-Maze on cardiopulmonary bypass. The first base deficit value obtained in the Intensive Care Unit was used as a measure of metabolic acidosis. Using logistic regression with Akaike information criteria, we analyzed preoperative, intraoperative, and postoperative data to determine the factors associated with changes in base deficit. Results: A multivariable model using stepwise selection demonstrated that diabetes mellitus and weight were associated with a decrease in the base deficit by 2.87 mEq/L (95% CI: −5.55-−0.19 and 0.04 mEq/L (95%CI: −0.08, 0.004, respectively. Furthermore, creatinine was associated with a 1.57 mEq/L (95% CI: 0.14, 2.99 increase in the base deficit. Conclusion: The Mini-Maze procedure was not associated with postoperative metabolic acidosis. Instead, nondiabetic patients and patients with higher creatinine were associated with greater base deficits after undergoing cardiac surgery.

  10. Minimally invasive plate osteosynthesis for distal radius fractures

    Directory of Open Access Journals (Sweden)

    Xu-ming Wei

    2014-01-01

    Full Text Available Background: Fractures of distal radius are common injury in all age groups. Cast treatment with or without close reduction is a viable option. However, the results are often unsatisfactory with restricted function. The open reduction and internal fixation often results in extensive soft tissue dissection and associated high rates of infection and delayed/nonunion. The distractor/external fixator have reported good functional and anatomical results but the incidence of pin traction infection nerve injury and cosmedic deformity are high. We introduced a modified operative technique for minimally invasive plate osteosynthesis (MIPO for distal radial fracture and evaluated the functional outcomes and complications. Materials and Methods: 22 distal radial fractures (10 left, 12 right were treated using the MIPO technique and two small incisions with a palmar locking plate from August 2009 to August 2010. The wrist function was assessed according to Dienst wrist rating system, and postoperative complications were recorded. Results: According to Dienst wrist rating system, 13 patients showed excellent results, 6 cases showed good results and 3 patients had moderate results. No patient had poor results. Thus, the excellent and good rate was 86.4%. One patient had anesthesia in the thenar eminence and this symptom disappeared after 3 months. One patient had delayed healing in the proximal wrist crease. Two patients had mild pain on the ulnar side of the wrist and two patients had limited wrist joint function. Conclusion: The MIPO technique by using two small palmar incisions is safe and effective for treatment of distal radial fractures.

  11. Intrasulcal electrocorticography in macaque monkeys with minimally invasive neurosurgical protocols

    Directory of Open Access Journals (Sweden)

    Takeshi eMatsuo

    2011-05-01

    Full Text Available Electrocorticography (ECoG, multichannel brain-surface recording and stimulation with probe electrode arrays, has become a potent methodology not only for clinical neurosurgery but also for basic neuroscience using animal models. The highly evolved primate’s brain has deep cerebral sulci, and both gyral and intrasulcal cortical regions have been implicated in important functional processes. However, direct experimental access is typically limited to gyral regions, since placing probes into sulci is difficult without damaging the surrounding tissues. Here we describe a novel methodology for intrasulcal ECoG in macaque monkeys. We designed and fabricated ultra-thin flexible probes for macaques with micro-electro-mechanical systems (MEMS technology. We developed minimally invasive operative protocols to implant the probes by introducing cutting edge devices for human neurosurgery. To evaluate the feasibility of intrasulcal ECoG, we conducted electrophysiological recording and stimulation experiments. First, we inserted parts of the Parylene-C-based probe into the superior temporal sulcus to compare visually evoked ECoG responses from the ventral bank of the sulcus with those from the surface of the inferior temporal cortex. Analyses of power spectral density and signal-to-noise ratio revealed that the quality of the ECoG signal was comparable inside and outside of the sulcus. Histological examination revealed no obvious physical damage in the implanted areas. Second, we placed a modified silicone ECoG probe into the central sulcus and also on the surface of the precentral gyrus for stimulation. Thresholds for muscle twitching were significantly lower during intrasulcal stimulation compared to gyral stimulation. These results demonstrate the feasibility of intrasulcal ECoG in macaques. The novel methodology proposed here opens up a new frontier in neuroscience research, enabling the direct measurement and manipulation of electrical activity in the

  12. Intrasulcal electrocorticography in macaque monkeys with minimally invasive neurosurgical protocols.

    Science.gov (United States)

    Matsuo, Takeshi; Kawasaki, Keisuke; Osada, Takahiro; Sawahata, Hirohito; Suzuki, Takafumi; Shibata, Masahiro; Miyakawa, Naohisa; Nakahara, Kiyoshi; Iijima, Atsuhiko; Sato, Noboru; Kawai, Kensuke; Saito, Nobuhito; Hasegawa, Isao

    2011-01-01

    Electrocorticography (ECoG), multichannel brain-surface recording and stimulation with probe electrode arrays, has become a potent methodology not only for clinical neurosurgery but also for basic neuroscience using animal models. The highly evolved primate's brain has deep cerebral sulci, and both gyral and intrasulcal cortical regions have been implicated in important functional processes. However, direct experimental access is typically limited to gyral regions, since placing probes into sulci is difficult without damaging the surrounding tissues. Here we describe a novel methodology for intrasulcal ECoG in macaque monkeys. We designed and fabricated ultra-thin flexible probes for macaques with micro-electro-mechanical systems technology. We developed minimally invasive operative protocols to implant the probes by introducing cutting-edge devices for human neurosurgery. To evaluate the feasibility of intrasulcal ECoG, we conducted electrophysiological recording and stimulation experiments. First, we inserted parts of the Parylene-C-based probe into the superior temporal sulcus to compare visually evoked ECoG responses from the ventral bank of the sulcus with those from the surface of the inferior temporal cortex. Analyses of power spectral density and signal-to-noise ratio revealed that the quality of the ECoG signal was comparable inside and outside of the sulcus. Histological examination revealed no obvious physical damage in the implanted areas. Second, we placed a modified silicone ECoG probe into the central sulcus and also on the surface of the precentral gyrus for stimulation. Thresholds for muscle twitching were significantly lower during intrasulcal stimulation compared to gyral stimulation. These results demonstrate the feasibility of intrasulcal ECoG in macaques. The novel methodology proposed here opens up a new frontier in neuroscience research, enabling the direct measurement and manipulation of electrical activity in the whole brain.

  13. Nonablative minimally invasive thermal therapies in the treatment of symptomatic benign prostatic hyperplasia.

    NARCIS (Netherlands)

    Ancona, F.C.H. d'

    2008-01-01

    PURPOSE OF REVIEW: As all new treatment modalities nonablative thermal therapy for minimal invasive treatment of benign prostatic hyperplasia should be critically analyzed. This review discusses the literature to identify the merits of these so-called minimally invasive treatments and the place they

  14. Pointing with a One-Eyed Cursor for Supervised Training in Minimally Invasive Robotic Surgery

    DEFF Research Database (Denmark)

    Kibsgaard, Martin; Kraus, Martin

    2016-01-01

    Pointing in the endoscopic view of a surgical robot is a natural and effcient way for instructors to communicate with trainees in robot-assisted minimally invasive surgery. However, pointing in a stereo-endoscopic view can be limited by problems such as video delay, double vision, arm fatigue......-day training units in robot- assisted minimally invasive surgery on anaesthetised pigs....

  15. Comparison of minimally invasive parathyroidectomy under local anaesthesia and minimally invasive video-assisted parathyroidectomy for primary hyperparathyroidism: a cost analysis

    Science.gov (United States)

    MELFA, G.I.; RASPANTI, C.; ATTARD, M.; COCORULLO, G.; ATTARD, A.; MAZZOLA, S.; SALAMONE, G.; GULOTTA, G.; SCERRINO, G.

    2016-01-01

    Background Primary hyperparathyroidism (PHPT) origins from a solitary adenoma in 70–95% of cases. Moreover, the advances in methods for localizing an abnormal parathyroid gland made minimally invasive techniques more prominent. This study presents a micro-cost analysis of two parathyroidectomy techniques. Patients and methods 72 consecutive patients who underwent minimally invasive parathyroidectomy, video-assisted (MIVAP, group A, 52 patients) or “open” under local anaesthesia (OMIP, group B, 20 patients) for PHPT were reviewed. Operating room, consumable, anaesthesia, maintenance costs, equipment depreciation and surgeons/anaesthesiologists fees were evaluated. The patient’s satisfaction and the rate of conversion to conventional parathyroidectomy were investigated. T-Student’s, Kolmogorov-Smirnov tests and Odds Ratio were used for statistical analysis. Results 1 patient of the group A and 2 of the group B were excluded from the cost analysis because of the conversion to the conventional technique. Concerning the remnant patients, the overall average costs were: for Operative Room, 1186,69 € for the MIVAP group (51 patients) and 836,11 € for the OMIP group (p<0,001); for the Team, 122,93 € (group A) and 90,02 € (group B) (p<0,001); the other operative costs were 1388,32 € (group A) and 928,23 € (group B) (p<0,001). The patient’s satisfaction was very strongly in favour of the group B (Odds Ratio 20,5 with a 95% confidence interval). Conclusions MIVAP is more expensive compared to the “open” parathyroidectomy under local anaesthesia due to the costs of general anaesthesia and the longer operative time. Moreover, the patients generally prefer the local anaesthesia. Nevertheless, the rate of conversion to the conventional parathyroidectomy was relevant in the group of the local anaesthesia compared to the MIVAP, since the latter allows a four-gland exploration. PMID:27381690

  16. Minimally Invasive Procedures - Direct and Video-Assisted Forms in the Treatment of Heart Diseases

    Energy Technology Data Exchange (ETDEWEB)

    Castro, Josué Viana Neto, E-mail: jvcn@uol.com.br [Instituto do Coração do Nordeste (INCONE), Fortaleza, CE (Brazil); Universidade de Fortaleza (UNIFOR), Fortaleza, CE (Brazil); Melo, Emanuel Carvalho; Silva, Juliana Fernandes [Instituto do Coração do Nordeste (INCONE), Fortaleza, CE (Brazil); Rebouças, Leonardo Lemos; Corrêa, Larissa Chagas; Germano, Amanda de Queiroz [Universidade de Fortaleza (UNIFOR), Fortaleza, CE (Brazil); Machado, João José Aquino [Instituto do Coração do Nordeste (INCONE), Fortaleza, CE (Brazil)

    2014-03-15

    Minimally invasive cardiovascular procedures have been progressively used in heart surgery. To describe the techniques and immediate results of minimally invasive procedures in 5 years. Prospective and descriptive study in which 102 patients were submitted to minimally invasive procedures in direct and video-assisted forms. Clinical and surgical variables were evaluated as well as the in hospital follow-up of the patients. Fourteen patients were operated through the direct form and 88 through the video-assisted form. Between minimally invasive procedures in direct form, 13 had aortic valve disease. Between minimally invasive procedures in video-assisted forms, 43 had mitral valve disease, 41 atrial septal defect and four tumors. In relation to mitral valve disease, we replaced 26 and reconstructed 17 valves. Aortic clamp, extracorporeal and procedure times were, respectively, 91,6 ± 21,8, 112,7 ± 27,9 e 247,1 ± 20,3 minutes in minimally invasive procedures in direct form. Between minimally invasive procedures in video-assisted forms, 71,6 ± 29, 99,7 ± 32,6 e 226,1 ± 42,7 minutes. Considering intensive care and hospitalization times, these were 41,1 ± 14,7 hours and 4,6 ± 2 days in minimally invasive procedures in direct and 36,8 ± 16,3 hours and 4,3 ± 1,9 days in minimally invasive procedures in video-assisted forms procedures. Minimally invasive procedures were used in two forms - direct and video-assisted - with safety in the surgical treatment of video-assisted, atrial septal defect and tumors of the heart. These procedures seem to result in longer surgical variables. However, hospital recuperation was faster, independent of the access or pathology.

  17. Minimal intervention dentistry: part 7. Minimally invasive operative caries management: rationale and techniques.

    Science.gov (United States)

    Banerjee, A

    2013-02-01

    When patients present with cavities causing pain, poor aesthetics and/or functional problems restorations will need to be placed. Minimally invasive caries excavation strategies can be deployed depending on the patient's caries risk, lesion-pulp proximity and vitality, the extent of remaining supra-gingival tooth structure and clinical factors (for example, moisture control, access). Excavation instruments, including burs/handpieces, hand excavators, chemo-mechanical agents and/or air-abrasives limiting caries removal selectively to the more superficial caries-infected dentine and partial removal of caries-affected dentine when required, help create smaller cavities with healthy enamel/dentine margins. Using adhesive restorative materials the operator can, if handling with care, optimise the histological substrate coupled with the applied chemistry of the material so helping to form a durable peripheral seal and bond to aid retention of the restoration as well as arresting the carious process within the remaining tooth structure. Achieving a smooth tooth-restoration interface clinically to aid the cooperative, motivated patient in biofilm removal is an essential pre-requisite to prevent further secondary caries.

  18. [Minimally invasive approaches to hip and knee joints for total joint replacement].

    Science.gov (United States)

    Rittmeister, M; König, D P; Eysel, P; Kerschbaumer, F

    2004-11-01

    The manuscript features the different minimally invasive approaches to the hip for joint replacement. These include medial, anterior, anterolateral, and posterior approaches. The concept of minimally invasive hip arthroplasty makes sense if it is an integral part of a larger concept to lower postoperative morbidity. Besides minimal soft tissue trauma, this concept involves preoperative patient education, preemptive analgesia, and postoperative physiotherapy. It is our belief that minimal incision techniques for the hip are not suited for all patients and all surgeons. The different minimally invasive approaches to the knee joint for implantation of a knee arthroplasty are described and discussed. There have been no studies published yet that fulfill EBM criteria. The data so far show that minimally invasive approaches and implantation techniques for total knee replacements lead to quicker rehabilitation of patients.

  19. Minimally invasive plate osteosynthesis for humerus diaphyseal fractures

    Directory of Open Access Journals (Sweden)

    M Shantharam Shetty

    2011-01-01

    Full Text Available Background: Minimally invasive plate osteosynthesis (MIPO technique is reported as a satisfactory procedure for the treatment of humeral shaft fractures by the anterior approach by several authors. However, none of the published reports had a significant follow-up nor have they reported patient outcomes. We evaluated the clinical, radiographic, and functional outcome over a minimum follow-up of 2 years using the same MIPO technique to humeral shaft fracture. Materials and Methods: 32 adult patients with diaphyseal fractures of the humerus treated with MIPO between June 2007 and October 2008 were included in the study. Patients with metabolic bone disease, polytrauma, and Gustilo and Anderson type 3 open fractures with injury severity score >16 were excluded from the study. All cases were treated with closed indirect reduction and locking plate fixation using the MIPO technique. The surgery time, radiation exposure, and time for union was noted. The shoulder and elbow function was assessed using the UCLA shoulder and Mayo elbow performance scores, respectively. Results: Of the 32 patients in the study, 19 were males and 13 were females. The mean age was 39 years (range: 22-70 years. Twenty-seven of the thirty-two patients (84.3% had the dominant side fractured. We had eight cases of C2 type; five cases of C1 and A2 type; four cases of B2 type; three cases each of B3, B1, and A1 type; and one case of A3 type of fracture. The mean surgical time was 91.5 minutes (range: 70-120 minutes and mean radiation exposure was 160.3 seconds (range: 100-220 seconds. The mean radiological fracture union time was 12.9 weeks (range: 10-20 weeks. Shoulder function was excellent in 27 cases (84.3% and good in remaining 5 cases (15.6% on the UCLA score. Elbow function was excellent in 26 cases (81.2%, good in 5 cases (15.6%, and fair in 1 case (3.1% who had an associated olecranon fracture that was fixed by tension band wire in the same sitting. Conclusion: MIPO of

  20. Minimally invasive approaches for histological diagnosis of anterior mediastinal masses

    Institute of Scientific and Technical Information of China (English)

    FANG Wen-tao; XU Mei-ying; CHEN Gang; CHEN Yong; CHEN Wen-hu

    2007-01-01

    diagnostic yield in mediastinal mass is rather low. Superior to core needle biopsy, biopsy through a mini-mediastinotomy under local anesthesia is highly effective in the histological diagnosis of anterior mediastinal mass, and has a satisfactory diagnostic yield. The method is safe, minimally invasive, cost-effective, and useful in therapeutic decision making for anterior mediastinal masses.

  1. Neuroendocrine tumors (carcinoids of the stomach and intestines - early diagnosis and minimally invasive endoscopic procedures

    Directory of Open Access Journals (Sweden)

    Kuryk O.G.

    2014-03-01

    Full Text Available Background. Neuroendocrine tumors of the stomach and intestines are rare diseases. Increasing incidence and complexity of diagnosis of these diseases cause acuteness of the problem. Objective. To evaluate the effectiveness of morphological examination of endoscopic biopsy material for diagnostics of neuroendocrine tumors and for evaluation of completeness of minimally invasive endoscopic surgical interventions (endoscopic mucosal resection and endoscopic submucosal dissection at neuroendocrine tumors. Methods. On the basis of Medical center "Oberig" in 2009 - 2013 in eight cases neuroendocrine tumors were diagnosed: 2 (25 % in the stomach, 2 (25% – in the duodenum, 2 (25% - in the small intestine, 1 (12.5 % - in the ascending colon, 1 (12.5% - in the rectum. Neuroendocrine tumors of stomach and ileum were removed by endoscopic mucosal resection, duodenal bulb and rectum neuroendocrine tumors – by endoscopic submucosal dissection, papillary duodenum, colon and jejunum neuroendocrine tumors – by surgical resection. Results. It was shown, that morphological evaluation of endoscopic mucosal biopsies is effective way to diagnose the neuroendocrine tumors. Conclusion. Endoscopic mucosal resection and endoscopic submucosal dissection allows to get advanced material for morphological diagnosis of neuroendocrine tumors and an adequate method of their removing Citation: Kuryk OG, Yakovenko VO, Bazdyrev VV, Bodnar LV. [Neuroendocrine tumors (carcinoids of the stomach and intestines - early diagnosis and minimally invasive endoscopic procedures]. Morphologia. 2014;8(1:58-64. Ukrainian.

  2. New real-time MR image-guided surgical robotic system for minimally invasive precision surgery

    Energy Technology Data Exchange (ETDEWEB)

    Hashizume, M.; Yasunaga, T.; Konishi, K. [Kyushu University, Department of Advanced Medical Initiatives, Faculty of Medical Sciences, Fukuoka (Japan); Tanoue, K.; Ieiri, S. [Kyushu University Hospital, Department of Advanced Medicine and Innovative Technology, Fukuoka (Japan); Kishi, K. [Hitachi Ltd, Mechanical Engineering Research Laboratory, Hitachinaka-Shi, Ibaraki (Japan); Nakamoto, H. [Hitachi Medical Corporation, Application Development Office, Kashiwa-Shi, Chiba (Japan); Ikeda, D. [Mizuho Ikakogyo Co. Ltd, Tokyo (Japan); Sakuma, I. [The University of Tokyo, Graduate School of Engineering, Bunkyo-Ku, Tokyo (Japan); Fujie, M. [Waseda University, Graduate School of Science and Engineering, Shinjuku-Ku, Tokyo (Japan); Dohi, T. [The University of Tokyo, Graduate School of Information Science and Technology, Bunkyo-Ku, Tokyo (Japan)

    2008-04-15

    To investigate the usefulness of a newly developed magnetic resonance (MR) image-guided surgical robotic system for minimally invasive laparoscopic surgery. The system consists of MR image guidance [interactive scan control (ISC) imaging, three-dimensional (3-D) navigation, and preoperative planning], an MR-compatible operating table, and an MR-compatible master-slave surgical manipulator that can enter the MR gantry. Using this system, we performed in vivo experiments with MR image-guided laparoscopic puncture on three pigs. We used a mimic tumor made of agarose gel and with a diameter of approximately 2 cm. All procedures were successfully performed. The operator only advanced the probe along the guidance device of the manipulator, which was adjusted on the basis of the preoperative plan, and punctured the target while maintaining the operative field using robotic forceps. The position of the probe was monitored continuously with 3-D navigation and 2-D ISC images, as well as the MR-compatible laparoscope. The ISC image was updated every 4 s; no artifact was detected. A newly developed MR image-guided surgical robotic system is feasible for an operator to perform safe and precise minimally invasive procedures. (orig.)

  3. Esthetic Smile Design: Limited Orthodontic Therapy to Position Teeth for Minimally Invasive Veneer Preparation.

    Science.gov (United States)

    Miro, Andi-Jean; Shalman, Alex; Morales, Ramiro; Giannuzzi, Nicholas J

    2015-07-01

    The standards of dentistry are being elevated, with a greater emphasis being placed on esthetics along with functionality. Minimally invasive dentistry has become an essential component in creating restorations that are functional and have increased longevity. In the case discussed in this article, the patient underwent 9 months of orthodontic therapy to correct her improper overbite and overjet, and the spacing of her dentition so the teeth could be positioned for future minimally invasive restorations. Orthodontic therapy was paramount in positioning the teeth so that the future restorations would have ideal axial inclinations and be as minimally invasive as possible.

  4. Open radical retropubic prostatectomy 2007: the true minimally invasive surgery for localized prostate cancer?

    Science.gov (United States)

    Nosnik, Israel P; Gan, Tong J; Moul, Judd W

    2007-09-01

    The introduction of robotic laparoscopic assisted prostatectomy at our institution and nationwide has been a great advancement and has caused us to focus and fine-tune our goal for improvements in prostate cancer outcomes whether the patient elects for robotic laparoscopic assisted prostatectomy or open minimally invasive radical retropubic prostatectomy. While these authors favor the open technique performed by highly skilled urologic surgical oncologists, the lessons we have learned to date suggest that it is the skill of the surgeon that determines outcome, regardless of whether or not the operation is performed by an open or robotic laparoscopic technique. The concepts we have articulated here are related to resection and avoidance of positive margins, limited intraoperative blood loss and pain control, which allow equivalence in these outcome areas, regardless of technique.

  5. Steering and Harvesting Technology for Minimally Invasive Biopsy

    NARCIS (Netherlands)

    Jelínek, F.

    2015-01-01

    Contemporary medical imaging technologies, such as computed tomography or magnetic resonance imaging, play a pivotal role in medical diagnosis, allowing for a relatively fast and non-invasive examination of the human body. In the field of cancer surgery they allow for preoperative detection of tumor

  6. Patient recollection of airway suctioning in the ICU : routine versus a minimally invasive procedure

    NARCIS (Netherlands)

    Van de Leur, JP; Zwaveling, JH; Loef, BG; Van der Schans, CP

    2003-01-01

    Objective: Many patients have an unpleasant recollection of routine endotracheal suctioning after discharge from the Intensive Care Unit (ICU). We hypothesized that through minimally invasive airway suctioning discomfort and stress may be prevented, resulting in less recollection. Design: A prospect

  7. Minimally invasive transforaminal lumbar interbody fusion Results of 23 consecutive cases

    Directory of Open Access Journals (Sweden)

    Amit Jhala

    2014-01-01

    Conclusion: The study demonstrates a good clinicoradiological outcome of minimally invasive TLIF. It is also superior in terms of postoperative back pain, blood loss, hospital stay, recovery time as well as medication use.

  8. Minimally invasive oesophagectomy: preliminary results after introduction of an intrathoracic anastomosis

    NARCIS (Netherlands)

    Workum, F. van; Wildenberg, F.J. van den; Polat, F.; Wilt, J.H.W. de; Rosman, C.

    2014-01-01

    BACKGROUND: Intrathoracic anastomosis after oesophagectomy has recently been associated with reduced functional morbidity compared to a cervical anastomosis. METHODS: From January 2011 until August 2012, all operable patients were scheduled to undergo minimally invasive oesophagectomy (MIE) with int

  9. Minimizing Risks of Invasive Alien Plant Species in Tropical Production Forest Management

    Directory of Open Access Journals (Sweden)

    Michael Padmanaba

    2014-08-01

    Full Text Available Timber production is the most pervasive human impact on tropical forests, but studies of logging impacts have largely focused on timber species and vertebrates. This review focuses on the risk from invasive alien plant species, which has been frequently neglected in production forest management in the tropics. Our literature search resulted in 114 publications with relevant information, including books, book chapters, reports and papers. Examples of both invasions by aliens into tropical production forests and plantation forests as sources of invasions are presented. We discuss species traits and processes affecting spread and invasion, and silvicultural practices that favor invasions. We also highlight potential impacts of invasive plant species and discuss options for managing them in production forests. We suggest that future forestry practices need to reduce the risks of plant invasions by conducting surveillance for invasive species; minimizing canopy opening during harvesting; encouraging rapid canopy closure in plantations; minimizing the width of access roads; and ensuring that vehicles and other equipment are not transporting seeds of invasive species. Potential invasive species should not be planted within dispersal range of production forests. In invasive species management, forewarned is forearmed.

  10. Intra-operative tumour localisation in robot-assisted minimally invasive surgery:A review

    OpenAIRE

    Li, Min; Liu, Hongbin; Jiang, Allen; Seneviratne, Lakmal D.; Dasgupta, Prokar; Althoefer, Kaspar; Wurdemann, Helge

    2014-01-01

    Robot-assisted minimally invasive surgery has many advantages compared to conventional open surgery and also certain drawbacks: it causes less operative trauma and faster recovery times but does not allow for direct tumour palpation as is the case in open surgery. This article reviews state-of-the-art intra-operative tumour localisation methods used in robot-assisted minimally invasive surgery and in particular methods that employ force-based sensing, tactile-based sensing, and medical imagin...

  11. Minimally invasive aortic valve replacement – pros and cons of keyhole aortic surgery

    OpenAIRE

    Kaczmarczyk, Marcin; Szałański, Przemysław; Zembala, Michał; Filipiak, Krzysztof; Karolak, Wojciech; Wojarski, Jacek; Garbacz, Marcin; Kaczmarczyk, Aleksandra; Kwiecień, Anna; Zembala, Marian

    2015-01-01

    Over the last twenty years, minimally invasive aortic valve replacement (MIAVR) has evolved into a safe, well-tolerated and efficient surgical treatment option for aortic valve disease. It has been shown to reduce postoperative morbidity, providing faster recovery and rehabilitation, shorter hospital stay and better cosmetic results compared with conventional surgery. A variety of minimally invasive accesses have been developed and utilized to date. This concise review demonstrates and discus...

  12. Minimally invasive scoliosis surgery: an innovative technique in patients with adolescent idiopathic scoliosis

    Directory of Open Access Journals (Sweden)

    Gambassi Melanie

    2011-08-01

    Full Text Available Abstract Minimally invasive spine surgery is becoming more common in the treatment of adult lumbar degenerative disorders. Minimally invasive techniques have been utilized for multilevel pathology, including adult lumbar degenerative scoliosis. The next logical step is to apply minimally invasive surgical techniques to the treatment of adolescent idiopathic scoliosis (AIS. However, there are significant technical challenges of performing minimally invasive surgery on this patient population. For more than two years, we have been utilizing minimally invasive spine surgery techniques in patients with adolescent idiopathic scoliosis. We have developed the present technique to allow for utilization of all standard reduction maneuvers through three small midline skin incisions. Our technique allows easy passage of contoured rods, placement of pedicle screws without image guidance, and allows adequate facet osteotomy to enable fusion. There are multiple potential advantages of this technique, including: less blood loss, shorter hospital stay, earlier mobilization, and relatively less pain and need for pain medication. The operative time needed to complete this surgery is longer. We feel that a minimally invasive approach, although technically challenging, is a feasible option in patients with adolescent idiopathic scoliosis. Although there are multiple perceived benefits, long term data is needed before it can be recommended for routine use.

  13. Conceptual frameworks and methods for advancing invasion ecology.

    Science.gov (United States)

    Heger, Tina; Pahl, Anna T; Botta-Dukát, Zoltan; Gherardi, Francesca; Hoppe, Christina; Hoste, Ivan; Jax, Kurt; Lindström, Leena; Boets, Pieter; Haider, Sylvia; Kollmann, Johannes; Wittmann, Meike J; Jeschke, Jonathan M

    2013-09-01

    Invasion ecology has much advanced since its early beginnings. Nevertheless, explanation, prediction, and management of biological invasions remain difficult. We argue that progress in invasion research can be accelerated by, first, pointing out difficulties this field is currently facing and, second, looking for measures to overcome them. We see basic and applied research in invasion ecology confronted with difficulties arising from (A) societal issues, e.g., disparate perceptions of invasive species; (B) the peculiarity of the invasion process, e.g., its complexity and context dependency; and (C) the scientific methodology, e.g., imprecise hypotheses. To overcome these difficulties, we propose three key measures: (1) a checklist for definitions to encourage explicit definitions; (2) implementation of a hierarchy of hypotheses (HoH), where general hypotheses branch into specific and precisely testable hypotheses; and (3) platforms for improved communication. These measures may significantly increase conceptual clarity and enhance communication, thus advancing invasion ecology.

  14. [Planning and simulation of minimally-invasive robotic heart surgery].

    Science.gov (United States)

    Coste-Manière, Eve; Adhami, Louaï; Severac-Bastide, Renault; Boissonnat, Jean-Daniel; Carpentier, Alain

    2002-04-01

    Due to their numerous advantages, mainly in terms of patient benefit, mini-invasive robotically assisted interventions are gaining in importance in various surgical fields. However, this conversion has its own challenges that stem from both its novelty and complexity. In this paper we propose to accompany the surgeons in their transition, by offering an integrated environment that enables them to make better use of this new technology. The proposed system is patient-dependent, and enables the planning, validation, simulation, teaching and archiving of robotically assisted interventions. The approach is illustrated for a coronary bypass graft using the daVinci tele-operated robot.

  15. Minimally invasive surgical procedures for the treatment of lumbar disc herniation

    Directory of Open Access Journals (Sweden)

    Raspe, Heiner

    2005-11-01

    Full Text Available Introduction: In up to 30% of patients undergoing lumbar disc surgery for herniated or protruded discs outcomes are judged unfavourable. Over the last decades this problem has stimulated the development of a number of minimally-invasive operative procedures. The aim is to relieve pressure from compromised nerve roots by mechanically removing, dissolving or evaporating disc material while leaving bony structures and surrounding tissues as intact as possible. In Germany, there is hardly any utilisation data for these new procedures – data files from the statutory health insurances demonstrate that about 5% of all lumbar disc surgeries are performed using minimally-invasive techniques. Their real proportion is thought to be much higher because many procedures are offered by private hospitals and surgeries and are paid by private health insurers or patients themselves. So far no comprehensive assessment comparing efficacy, safety, effectiveness and cost-effectiveness of minimally-invasive lumbar disc surgery to standard procedures (microdiscectomy, open discectomy which could serve as a basis for coverage decisions, has been published in Germany. Objective: Against this background the aim of the following assessment is: * Based on published scientific literature assess safety, efficacy and effectiveness of minimally-invasive lumbar disc surgery compared to standard procedures. * To identify and critically appraise studies comparing costs and cost-effectiveness of minimally-invasive procedures to that of standard procedures. * If necessary identify research and evaluation needs and point out regulative needs within the German health care system. The assessment focusses on procedures that are used in elective lumbar disc surgery as alternative treatment options to microdiscectomy or open discectomy. Chemonucleolysis, percutaneous manual discectomy, automated percutaneous lumbar discectomy, laserdiscectomy and endoscopic procedures accessing the disc

  16. Resection of an Occipital-Cervical Junction Schwannoma through a modified minimally invasive approach: Technical Note

    Directory of Open Access Journals (Sweden)

    Michael Feldman

    2015-01-01

    Conclusion: In properly selected patients, minimally invasive approaches to the OCJ for resection of mass lesions are feasible, provide adequate visualization of tumor and surrounding structures, and may even be preferable given the lower morbidity of a smaller incision and minimal soft tissue dissection.

  17. Editor’s Pick: Recent Developments in Minimally Invasive Radical Prostatectomy

    Directory of Open Access Journals (Sweden)

    Jarno Riikonen

    2015-01-01

    Full Text Available Minimally invasive surgery has gained a dominant status in prostate cancer surgery during the last decade. The benefits of minimally invasive prostatectomy were demonstrated by pioneers of conventional laparoscopic prostatectomy, however, the real domination of laparoscopy in radical prostatectomy (RP started after the dissemination of robotic surgery. Robot-assisted surgery still remains the most widespread method to perform minimally invasive RP, although the recent evolution of laparoscopic technology and instruments has evoked interest in conventional laparoscopy again. The recent developments in the technique of RP are focused on decreasing invasiveness and complications. The recent methods to improve postoperative functional outcome of RP can be utilised without compromising the oncological results.

  18. INTERLAMINAR ENDOSCOPIC DISCECTOMY: MINIMALLY INVASIVE PROCEDURE, A SERIES REPORT

    Directory of Open Access Journals (Sweden)

    Somashekar

    2014-04-01

    Full Text Available BACKGROUND: The upright posture of humans throws enormous stress on spine, particularly during flexion and is responsible for many structural causes of backache such as lumbar disc prolapsed. Various modalities of surgical management are available for intervertebral disc prolapsed, but posterior interlaminar endoscopic approach has minimal stripping of paraspinal muscles, enhanced visualization due to better magnification and illumination, shorter hospital stay, and faster recovery time. METHODS: Total of 64 patients with lumbar intervertebral disc herniation were operated between 2008and 2013with endoscopic discectomy after localization of symptomatic level. The results were evaluated by Oswestry Disability index score. RESULTS: At final follow-up results were, excellent 60%, Good20%, Fair 16.7% and Poor in 3.3%. CONCLUSION: Open discectomy has been standard procedure of choice. Interlaminar endoscopic discectomy is a safe supplement for open discectomy which offers minimal trauma, better visualization intra operatively with less hospital stay and early mobilization and early return to work.

  19. Minimally invasive cosmetic dentistry: smile reconstruction using direct resin bonding.

    Science.gov (United States)

    Prieto, Lucia Trazzi; Araujo, Cintia Tereza Pimenta; de Oliveira, Dayane Carvalho Ramos Salles; de Azevedo Vaz, Sergio Lins; D'Arce, Maria Beatriz Freitas; Paulillo, Luis Alexandre Maffei Sartini

    2014-01-01

    Discrepancies in tooth size and shape can interfere with smile harmony. Composite resin can be used to improve the esthetics of the smile at a low cost while offering good clinical performance. This article presents an approach for restoring and correcting functional, anatomic, and esthetic discrepancies with minimal intervention, using composites and a direct adhesive technique. This conservative restorative procedure provided the patient with maximum personal esthetic satisfaction.

  20. A Computational Investigation Of Minimal Invasive Spine Surgery

    DEFF Research Database (Denmark)

    Rasmussen, Sten; Rasmussen, John

    Introduction: MISS has been used for more than a decade. The reasoning is the perception that a gentle surgery is more beneficial for the patient. Especially since traditional open spine surgery (TOSS) has several reported limitations including blood loss, muscle pain and infection. Minimal...... functionality compared with TOSS. The investigation has only considered the muscular effect of the two approaches, while remaining parameters such as joint forces or loads on the fused joint remain for future investigation....

  1. Minimally Invasive Cardiac Surgery Using a 3D High-Definition Endoscopic System.

    Science.gov (United States)

    Ruttkay, Tamas; Götte, Julia; Walle, Ulrike; Doll, Nicolas

    2015-01-01

    We describe a minimally invasive heart surgery application of the EinsteinVision 2.0 3D high-definition endoscopic system (Aesculap AG, Tuttlingen, Germany) in an 81-year-old man with severe tricuspid valve insufficiency. Fourteen years ago, he underwent a Ross procedure followed by a DDD pacemaker implantation 4 years later for tachy-brady-syndrome. His biventricular function was normal. We recommended minimally invasive tricuspid valve repair. The application of the aformentioned endoscopic system was simple, and the impressive 3D depth view offered an easy and precise manipulation through a minimal thoracotomy incision, avoiding the need for a rib spreading retractor.

  2. Minimally invasive atlantoaxial fusion: cadaveric study and report of 5 clinical cases.

    Science.gov (United States)

    Srikantha, Umesh; Khanapure, Kiran S; Jagannatha, Aniruddha T; Joshi, Krishna C; Varma, Ravi G; Hegde, Alangar S

    2016-12-01

    OBJECTIVE Minimally invasive techniques are being increasingly used to treat disorders of the cervical spine. They have a potential to reduce the postoperative neck discomfort subsequent to extensive muscle dissection associated with conventional atlantoaxial fusion procedures. The aim of this paper was to elaborate on the technique and results of minimally invasive atlantoaxial fusion. MATERIALS Minimally invasive atlantoaxial fusion was done initially in 4 fresh-frozen cadavers and subsequently in 5 clinical cases. Clinical cases included patients with reducible atlantoaxial instability and undisplaced or minimally displaced odontoid fractures. The surgical technique is illustrated in detail. RESULTS Among the cadaveric specimens, all C-1 lateral mass screws were in the correct position and 2 of the 8 C-2 screws had a vertebral canal breach. Among clinical cases, all C-1 lateral mass screws were in the correct position. Only one C-2 screw had a Grade 2 vertebral canal breach, which was clinically insignificant. None of the patients experienced neurological worsening or implant-related complications at follow-up. Evidence of rib graft fusion or C1-2 joint fusion was successfully demonstrated in 4 cases, and flexion-extension radiographs done at follow-up did not show mobility in any case. CONCLUSIONS Minimally invasive atlantoaxial fusion is a safe and effective alternative to the conventional approach in selected cases. Larger series with direct comparison to the conventional approach will be required to demonstrate clinical benefit presumed to be associated with a minimally invasive approach.

  3. A minimally invasive method for induction of myocardial infarction in an animal model using tungsten spirals.

    Science.gov (United States)

    Peukert, Daniel; Laule, Michael; Kaufels, Nicola; Schnorr, Jörg; Taupitz, Matthias; Hamm, Bernd; Dewey, Marc

    2009-06-01

    Most animal models use surgical thoracotomy with ligation of a coronary artery to induce myocardial infarction. Incision of the chest wall and myocardium affect remodeling after myocardial infarction. The aim of our study was to evaluate a new minimally invasive technique for inducing acute myocardial infarction in pigs. To this end, coronary angiography using a 6-F cardiac catheter was performed in 20 pigs. The cardiac catheter was advanced into the left circumflex artery (LCX) under electrocardiographic monitoring and small tungsten spirals were deployed in the vessel. LCX occlusion was verified by coronary angiography. Two days later, magnetic resonance imaging (MRI) was performed to estimate the extent of infarction. Thereafter, all animals were euthanized and the hearts stained with 2,3,5-triphenyltetrazolium chloride for histologic measurement of infarct size. Tungsten spirals were successfully placed in the LCX in all 20 pigs. About 13 of the 20 animals survived until the end of the experiment. The mean infarct size in the area supplied by the LCX was 4.4 +/- 2.3 cm(3) at MRI and 4.3 +/- 2.2 cm(3) at histology (r = 0.99, P < 0.001). No other myocardial regions showed infarction in any of the 13 pigs. Five of nine pigs requiring defibrillation due to ventricular fibrillation died because defibrillation was unsuccessful. One animal each died from pericarditis and pneumonia. Our results show that the minimally invasive method presented here enables reliable induction of myocardial infarction in a fairly straightforward manner. The 25% mortality rate associated with induction of myocardial infarction in our study is comparable to that reported by other investigators.

  4. ENDOSCOPIC SLEEVE GASTROPLASTY - MINIMALLY INVASIVE THERAPY FOR PRIMARY OBESITY TREATMENT

    Science.gov (United States)

    GALVÃO-NETO, Manoel dos Passos; GRECCO, Eduardo; de SOUZA, Thiago Ferreira; de QUADROS, Luiz Gustavo; SILVA, Lyz Bezerra; CAMPOS, Josemberg Marins

    2016-01-01

    ABSTRACT Background: Less invasive and complex procedures have been developed to treat obesity. The successful use of Endoscopic Sleeve Gastroplasty using OverStitch(r) (Apollo Endosurgery, Austin, Texas, USA) has been reported in the literature. Aim: Present technical details of the procedure and its surgical/ endoscopic preliminary outcome. Method: The device was used to perform plications along the greater curvature of the stomach, creating a tubulization similar to a sleeve gastrectomy. Result: A male patient with a BMI of 35.17 kg/m2 underwent the procedure, with successful achievement of four plications, and preservation of gastric fundus. The procedure was successfully performed in 50 minutes, time without bleeding or other complications. The patient presented mild abdominal pain and good acceptance of liquid diet. Conclusions: The endoscopic gastroplasty procedure was safe, with acceptable technical viability, short in duration and without early complications. PMID:27683786

  5. Hepatic artery pseudoaneurysm after surgical treatment for pancreatic cancer: Minimally invasive angiographic techniques as the preferred treatment

    Directory of Open Access Journals (Sweden)

    Sucandy Iswanto

    2014-01-01

    Full Text Available Background: Delayed intra-abdominal bleeding related to hepatic artery pseudoaneurysm is a potentially lethal complication after pancreaticoduodenectomy for pancreatic cancer. Locally advanced tumors, which result in vessel erosion or extensive operative skeletonization, may contribute to weakness of the arterial wall. Reoperation is often technically difficult with high rate of mortality; therefore, alternative less invasive options are ideal. Aims: The study was to present an alternative endovascular treatment of a large hepatic artery pseudoaneurysm after pancreatic resection for locally advanced multicystic adenocarcinoma. Materials and Methods: Transcatheteric mesenteric angiography with deployment of detachable coils in the pseudoaneurysm sac was utilized to manage the hepatic artery pseudoaneurysm. Results: Completion angiography confirmed cessation of contrast enhancement in the pseudoaneurysm sac with preservation of normal antegrade hepatic artery flow. Conclusion: Minimally invasive angiographic technique is the preferred treatment for hepatic artery pseudoaneurysm after pancreatic resections.

  6. Peroral endoscopic myotomy: An emerging minimally invasive procedure for achalasia

    Institute of Scientific and Technical Information of China (English)

    Yalini; Vigneswaran; Michael; B; Ujiki

    2015-01-01

    Peroral endoscopic myotomy(POEM) is an emergingminimally invasive procedure for the treatment of achalasia. Due to the improvements in endoscopic technology and techniques, this procedure allows for submucosal tunneling to safely endoscopically create a myotomy across the hypertensive lower esophageal sphincter. In the hands of skilled operators and experienced centers, the most common complications of this procedure are related to insufflation and accumulation of gas in the chest and abdominal cavities with relatively low risks of devastating complications such as perforation or delayed bleeding. Several centers worldwide have demonstrated the feasibility of this procedure in not only early achalasia but also other indications such as redo myotomy, sigmoid esophagus and spastic esophagus. Short-term outcomes have showed great clinical efficacy comparable to laparoscopic Heller myotomy(LHM). Concerns related to postoperative gastroesophageal reflux remain, however several groups have demonstrated comparable clinical and objective measures of reflux to LHM. Although long-term outcomes are necessary to better understand durability of the procedure, POEM appears to be a promising new procedure.

  7. Minimally invasive technique for curettage of chondroblastoma using endoscopic technique.

    Science.gov (United States)

    Errani, C; Traina, F; Chehrassan, M; Donati, D; Faldini, C

    2014-11-01

    Chondroblastoma is a rare benign bone tumor. The treatment for chondroblastoma usually consists of curettage of the lesion and packing the tumor cavity with bone grafts or bone cement. However, chondroblastomas are known to recur in 10% to 20% of cases after excision, possibly because the incomplete removal of pathological tissue at surgery. We present a case of chondroblastoma in the distal femur treated by endoscopic curettage, which allowed a complete resection of tumor tissue and a minimal damage of the bone. The patient had relief of symptoms, rapid function restoration and no local recurrence. Endoscopic curettage is a promising new treatment for chondroblastoma. In fact, the extra-articular technique enters the tumor cavity via a tunnel drilled through the medullary canal, allowing to visualize possible residual tumor tissue or defects of the articular surface, without violating the joint and without taking away a much bigger cortical window.

  8. Hybrid minimally invasive esophagectomy for cancer: impact on postoperative inflammatory and nutritional status.

    Science.gov (United States)

    Scarpa, M; Cavallin, F; Saadeh, L M; Pinto, E; Alfieri, R; Cagol, M; Da Roit, A; Pizzolato, E; Noaro, G; Pozza, G; Castoro, C

    2016-11-01

    The purpose of this case-control study was to evaluate the impact of hybrid minimally invasive esophagectomy for cancer on surgical stress response and nutritional status. All 34 consecutive patients undergoing hybrid minimally invasive esophagectomy for cancer at our surgical unit between 2008 and 2013 were retrospectively compared with 34 patients undergoing esophagectomy with open gastric tubulization (open), matched for neoadjuvant therapy, pathological stage, gender and age. Demographic data, tumor features and postoperative course (including quality of life and systemic inflammatory and nutritional status) were compared. Postoperative course was similar in terms of complication rate. Length of stay in intensive care unit was shorter in patients undergoing hybrid minimally invasive esophagectomy (P = 0.002). In the first postoperative day, patients undergoing hybrid minimally invasive esophagectomy had lower C-reactive protein levels (P = 0.001) and white cell blood count (P = 0.05), and higher albumin serum level (P = 0.001). In this group, albumin remained higher also at third (P = 0.06) and seventh (P = 0.008) postoperative day, and C-reactive protein resulted lower at third post day (P = 0.04). Hybrid minimally invasive esophagectomy significantly improved the systemic inflammatory and catabolic response to surgical trauma, contributing to a shorter length of stay in intensive care unit.

  9. Utility of Intraoperative Neuromonitoring during Minimally Invasive Fusion of the Sacroiliac Joint.

    Science.gov (United States)

    Woods, Michael; Birkholz, Denise; MacBarb, Regina; Capobianco, Robyn; Woods, Adam

    2014-01-01

    Study Design. Retrospective case series. Objective. To document the clinical utility of intraoperative neuromonitoring during minimally invasive surgical sacroiliac joint fusion for patients diagnosed with sacroiliac joint dysfunction (as a direct result of sacroiliac joint disruptions or degenerative sacroiliitis) and determine stimulated electromyography thresholds reflective of favorable implant position. Summary of Background Data. Intraoperative neuromonitoring is a well-accepted adjunct to minimally invasive pedicle screw placement. The utility of intraoperative neuromonitoring during minimally invasive surgical sacroiliac joint fusion using a series of triangular, titanium porous plasma coated implants has not been evaluated. Methods. A medical chart review of consecutive patients treated with minimally invasive surgical sacroiliac joint fusion was undertaken at a single center. Baseline patient demographics and medical history, intraoperative electromyography thresholds, and perioperative adverse events were collected after obtaining IRB approval. Results. 111 implants were placed in 37 patients. Sensitivity of EMG was 80% and specificity was 97%. Intraoperative neuromonitoring potentially avoided neurologic sequelae as a result of improper positioning in 7% of implants. Conclusions. The results of this study suggest that intraoperative neuromonitoring may be a useful adjunct to minimally invasive surgical sacroiliac joint fusion in avoiding nerve injury during implant placement.

  10. Utility of Intraoperative Neuromonitoring during Minimally Invasive Fusion of the Sacroiliac Joint

    Directory of Open Access Journals (Sweden)

    Michael Woods

    2014-01-01

    Full Text Available Study Design. Retrospective case series. Objective. To document the clinical utility of intraoperative neuromonitoring during minimally invasive surgical sacroiliac joint fusion for patients diagnosed with sacroiliac joint dysfunction (as a direct result of sacroiliac joint disruptions or degenerative sacroiliitis and determine stimulated electromyography thresholds reflective of favorable implant position. Summary of Background Data. Intraoperative neuromonitoring is a well-accepted adjunct to minimally invasive pedicle screw placement. The utility of intraoperative neuromonitoring during minimally invasive surgical sacroiliac joint fusion using a series of triangular, titanium porous plasma coated implants has not been evaluated. Methods. A medical chart review of consecutive patients treated with minimally invasive surgical sacroiliac joint fusion was undertaken at a single center. Baseline patient demographics and medical history, intraoperative electromyography thresholds, and perioperative adverse events were collected after obtaining IRB approval. Results. 111 implants were placed in 37 patients. Sensitivity of EMG was 80% and specificity was 97%. Intraoperative neuromonitoring potentially avoided neurologic sequelae as a result of improper positioning in 7% of implants. Conclusions. The results of this study suggest that intraoperative neuromonitoring may be a useful adjunct to minimally invasive surgical sacroiliac joint fusion in avoiding nerve injury during implant placement.

  11. PORCELAIN LAMINATE VENEERS: A MINIMALLY INVASIVE ESTHETIC PROCEDURE

    Directory of Open Access Journals (Sweden)

    Tajammul

    2013-11-01

    Full Text Available ABSTRACT: With the advancement in the area of cosmetic dentistry, the dental profession has been offered new opportunities in conservative and esthetic restorative procedures. Multiple options are available to treat problems arising in the zone of high esthetic sensitivity. The use of porcelain laminate veneers to solve esthetic and/or functional problems has shown to be a valid treatment option especially in the anterior esthetic zone. The techniques and the materials employed to fabricate porcelain laminate veneers offer satisfactory, predictable and lasting results. The current porcelain veneers are esthetically superior, conservative and durable treatment modality

  12. Doppler-Guided Hemorrhoid Artery Ligation with Recto-Anal-Repair Modification: Functional Evaluation and Safety Assessment of a New Minimally Invasive Method of Treatment of Advanced Hemorrhoidal Disease

    Directory of Open Access Journals (Sweden)

    Piotr Walega

    2012-01-01

    Full Text Available Purpose: We present 12-month followup results of functional evaluation and safety assessment of a modification of hemorrhoidal artery ligation (DGHAL called Recto-Anal-Repair (RAR in treatment of advanced hemorrhoidal disease (HD. Methods: Patients with grade III and IV HD underwent the RAR procedure (DGHAL combined with restoration of prolapsed hemorrhoids to their anatomical position with longitudinal sutures. Each patient had rectal examination, anorectal manometry, and QoL questionnaire performed before 3 months, and 12 months after RAR procedure. Results: 20 patients completed 12-month followup. There were no major complications. 3 months after RAR, 5 cases of residual mucosal prolapse were detected (25%, while only 3 patients (15% reported persistence of symptoms. 12 months after RAR, another 3 HD recurrences were detected, to a total of 8 patients (40% with HD recurrence. Anal pressures after RAR were significantly lower than before (P<0.05, and the effect was persistent 12 months after RAR. One patient (5% reported occasional soiling 3 months after RAR. Conclusions: RAR seems to be a safe method of treatment of advanced HD with no major complications. The procedure has a significant influence on anal pressures, with no evidence of risk of fecal incontinence after the operation.

  13. 妇科医师的微创理念与技艺%Gynaecologists Minimally Invasive Concept and Skills

    Institute of Scientific and Technical Information of China (English)

    凌斌

    2013-01-01

    The concept of minimally invasive belongs to the category of philosophy.It is the essence of advanced active subjective thought,embodies the integrity,loyalty and kindness to patients and medicine.Minimally invasive technology is the original passive clinical technological means,requires highly skilled and wonderful artistry excelling nature.Minimally invasive concept determines minimally invasive techniques,predicts the future of clinical medicine,accepts critical thinking,challenges traditional medicine behavior and promotes accurate treatment.Minimally invasive concept advocated to retain organs and functions,both to resist excessive treatment,also don't agree with insufficient treatment.Clinical minimally invasive wise decision lies in the proper definition of degree of removal of organs.In the face of the change of disease,if taking constant strategy of treatments for various diseases,the degree of treatment is unavoidably biased.%微创理念属于哲学范畴,是先进主动的主观思想的精髓,体现对医学与患者的忠诚、笃信和仁爱;微创技术是原始被动使用的临床手段,要求技艺精湛,巧夺天工.微创理念决定微创技术,促进建立批判性思维,挑战传统医学行为,推崇精准化治疗,预示临床医学的未来.微创理念倡导保留器官和功能,既抵触过度治疗,也不苟同治疗不足,临床微创决策在于恰到好处地界定器官取舍之度,面对复杂多变之病,秉承以不变应万变之策,治疗之度则难免有失偏颇.

  14. Humane accomplishment of physicians and the philosophy of minimally-invasive and noninvasive medicine: A perspective.

    Science.gov (United States)

    Ling, Bin; Lang, Jinghe

    2015-11-01

    The highest realm in clinical medicine is the harmonious unity of medical sciences and the humanistic spirit. Given that the beauty of human nature resides in humanity, a competent medical practitioner should be a sage that personifies the rigorous scientific spirit and the humanity. It is essential for a medical practitioner to learn to seek answers to medical inquiries at the philosophical level. Important as it is to study the organs, the cells and the functions of the body, medical practitioners need to be well-versed in the utmost beauty of mankind. The central tenet of minimally-invasive therapeutic medicine is to minimize harm to patients while effectively managing the lesion. The radical changes brought about by minimally-invasive technologies, exemplified by the non-invasive high intensity focused ultrasound (HIFU) surgery, are to change the face of traditional surgery.

  15. Minimally-invasive treatment of high velocity intra-articular fractures of the distal tibia.

    LENUS (Irish Health Repository)

    Leonard, M

    2012-02-01

    The pilon fracture is a complex injury. The purpose of this study was to evaluate the outcome of minimally invasive techniques in management of these injuries. This was a prospective study of closed AO type C2 and C3 fractures managed by early (<36 hours) minimally invasive surgical intervention and physiotherapist led rehabilitation. Thirty patients with 32 intra-articular distal tibial fractures were treated by the senior surgeon (GK). Our aim was to record the outcome and all complications with a minimum two year follow-up. There were two superficial wound infections. One patient developed a non-union which required a formal open procedure. Another patient was symptomatic from a palpable plate inferiorly. An excellent AOFAS result was obtained in 83% (20\\/24) of the patients. Early minimally invasive reduction and fixation of complex high velocity pilon fractures gave very satisfactory results at a minimum of two years follow-up.

  16. 微创拔牙理念及技术操作%Concept of minimally invasive extraction and technical operations

    Institute of Scientific and Technical Information of China (English)

    胡开进; 杨擎天

    2011-01-01

    随着科技的进步、医学的发展及新型拔牙器械的推出,微创拔牙理念及技术得以产生和发展.但微创拔牙理念和技术在我国还没有得到广泛的推广和应用,远远达不到医患的需求.本文以复杂牙、阻生牙的微创拔除为例,对微创拔牙理念和技巧作一阐述,为进一步推广微创拔牙的理念和技术应用提供参考.%With the advances in technology, development of medical science and the introduction of new extraction instruments, the concepts and techniques of minimally invasive in tooth extraction emerged and developed. In China, however, the concept and technology has not been widely promoted and applied currently, far below patients and doctors' needs. In our article, we will introduce the concepts and techniques of minimally invasive in tooth extraction in detail by using the removal of complicated teeth and impacted teeth for example. We hope that could help to promote and spread the concepts and techniques of minimally invasive in tooth extraction.

  17. Minimally invasive per-catheter occlusion and dilation procedures for congenital cardiovascular abnormalities in dogs.

    Science.gov (United States)

    Tobias, Anthony H; Stauthammer, Christopher D

    2010-07-01

    With ever-increasing sophistication of veterinary cardiology, minimally invasive per-catheter occlusion and dilation procedures for the treatment of various congenital cardiovascular abnormalities in dogs have become not only available, but mainstream. Much new information about minimally invasive per-catheter patent ductus arteriosus occlusion has been published and presented during the past few years. Consequently, patent ductus arteriosus occlusion is the primary focus of this article. Occlusion of other less common congenital cardiac defects is also briefly reviewed. Balloon dilation of pulmonic stenosis, as well as other congenital obstructive cardiovascular abnormalities is discussed in the latter part of the article.

  18. Developing neonatal minimally invasive surgery: Innovation, techniques, and helping an industry to change.

    Science.gov (United States)

    Rothenberg, Steven S

    2015-02-01

    The field of minimally invasive surgery (MIS) in neonates and infants is a relatively new field, evolving over the last 20years. This has required the development of not only new techniques but new instruments. The process has resulted in a unique partnership between pediatric minimally invasive surgeons and industry, as both groups have struggled to find the right mix of need, technical viability, and economic sustainability. The results have spawned a new generation of MIS instrumentation that not only enables the neonatal MIS surgeon but also leads the way in the field of mini-laparoscopy in children and adults.

  19. Intra-operative tumour localisation in robot-assisted minimally invasive surgery: A review.

    Science.gov (United States)

    Li, Min; Liu, Hongbin; Jiang, Allen; Seneviratne, Lakmal D; Dasgupta, Prokar; Althoefer, Kaspar; Wurdemann, Helge

    2014-05-01

    Robot-assisted minimally invasive surgery has many advantages compared to conventional open surgery and also certain drawbacks: it causes less operative trauma and faster recovery times but does not allow for direct tumour palpation as is the case in open surgery. This article reviews state-of-the-art intra-operative tumour localisation methods used in robot-assisted minimally invasive surgery and in particular methods that employ force-based sensing, tactile-based sensing, and medical imaging techniques. The limitations and challenges of these methods are discussed and future research directions are proposed.

  20. Pointing with a One-Eyed Cursor for Supervised Training in Minimally Invasive Robotic Surgery

    DEFF Research Database (Denmark)

    Kibsgaard, Martin; Kraus, Martin

    2016-01-01

    Pointing in the endoscopic view of a surgical robot is a natural and effcient way for instructors to communicate with trainees in robot-assisted minimally invasive surgery. However, pointing in a stereo-endoscopic view can be limited by problems such as video delay, double vision, arm fatigue......, and reachability of the pointer controls. We address these problems by hardware-based overlaying the stereo-endoscopic view with a one-eyed cursor, which can be comfortably controlled by a wireless, gyroscopic air mouse. The proposed system was positively evaluated by five experienced instructors in four full......-day training units in robot- assisted minimally invasive surgery on anaesthetised pigs....

  1. [Design of minimally invasive surgery wrist institution actuated by shape memory alloy].

    Science.gov (United States)

    Zhang, Zhenhua; Cao, Tong; Chen, Hua; Liu, Da; Shi, Zhenyun; Ma, Chen

    2013-06-01

    The rapid development of minimally invasive surgery technology requires higher flexibility of surgical treatment and small volume of medical instrument. This paper proposed a new type of minimally invasive surgery wrist institution actuated by TiNi shape memory alloy (SMA) wire. The wrist institution has some advantages such as compact structure, flexible function, light weight, big movement space, and high output position precision. The paper briefly introduces the properties of TiNi SMA and describes the configuration of wrist institution. We also carried out mechanism simulation analysis to the mechanics model and set up kinematics equations, and finally presented the workspace of the institution.

  2. Minimally invasive aortic valve replacement - pros and cons of keyhole aortic surgery.

    Science.gov (United States)

    Kaczmarczyk, Marcin; Szałański, Przemysław; Zembala, Michał; Filipiak, Krzysztof; Karolak, Wojciech; Wojarski, Jacek; Garbacz, Marcin; Kaczmarczyk, Aleksandra; Kwiecień, Anna; Zembala, Marian

    2015-06-01

    Over the last twenty years, minimally invasive aortic valve replacement (MIAVR) has evolved into a safe, well-tolerated and efficient surgical treatment option for aortic valve disease. It has been shown to reduce postoperative morbidity, providing faster recovery and rehabilitation, shorter hospital stay and better cosmetic results compared with conventional surgery. A variety of minimally invasive accesses have been developed and utilized to date. This concise review demonstrates and discusses surgical techniques used in contemporary approaches to MIAVR and presents the most important results of MIAVR procedures.

  3. Minimally invasive aortic valve replacement – pros and cons of keyhole aortic surgery

    Science.gov (United States)

    Szałański, Przemysław; Zembala, Michał; Filipiak, Krzysztof; Karolak, Wojciech; Wojarski, Jacek; Garbacz, Marcin; Kaczmarczyk, Aleksandra; Kwiecień, Anna; Zembala, Marian

    2015-01-01

    Over the last twenty years, minimally invasive aortic valve replacement (MIAVR) has evolved into a safe, well-tolerated and efficient surgical treatment option for aortic valve disease. It has been shown to reduce postoperative morbidity, providing faster recovery and rehabilitation, shorter hospital stay and better cosmetic results compared with conventional surgery. A variety of minimally invasive accesses have been developed and utilized to date. This concise review demonstrates and discusses surgical techniques used in contemporary approaches to MIAVR and presents the most important results of MIAVR procedures. PMID:26336491

  4. Full Mouth Rehabilitation by Minimally Invasive Cosmetic Dentistry Coupled with Computer Guided Occlusal Analysis: A Case Report.

    Science.gov (United States)

    Sarita; Thumati, Prafulla

    2014-12-01

    Evidence of dentistry dates back to 7000 B.C. and since then has come, indeed a long sophisticated way in treatment management of our dental patients. There have been admirable advances in the field of prosthodontics by the way of techniques and materials; enabling production of artificial teeth that feel, function and appear nothing but natural. The following case report describes the management of maxillary edentulousness with removable complete denture and mandibular attrition and missing teeth with onlays and FPD by the concept of minimally invasive cosmetic dentistry. Computer guided occlusal analysis was used to guide sequential occlusal adjustments to obtain measurable bilateral occlusal contacts simultaneously.

  5. Minimally invasive proximal interphalangeal joint arthrodesis using a locking compression plate and tissue engineering in horses: A pilot study

    OpenAIRE

    SEO, Jong-Pil; Yamaga, Takashi; TSUZUKI, Nao; YAMADA, Kazutaka; HANEDA, Shingo; Furuoka, Hidefumi; Tabata, Yasuhiko; SASAKI, Naoki

    2014-01-01

    This pilot study assessed the efficacy of 2 minimally invasive techniques for proximal interphalangeal (PIP) joint arthrodesis in horses. The PIP joints of both forelimbs (n = 6) were stabilized with locking compression plates (LCP) using a minimally invasive technique (LCP technique). Subsequently, for 1 randomly selected PIP joint of each horse, surgical drilling (SurD) was performed and tissue engineering (TE) was applied (LCP/SurD/TE technique). Minimally invasive PIP joint arthrodesis wi...

  6. Transanal minimally invasive surgery (TAMIS) approach for large juxta-anal gastrointestinal stromal tumour.

    Science.gov (United States)

    Wachter, Nicolas; Wörns, Marcus-Alexander; Dos Santos, Daniel Pinto; Lang, Hauke; Huber, Tobias; Kneist, Werner

    2016-01-01

    Gastrointestinal stromal tumours (GISTs) are rarely found in the rectum. Large rectal GISTs in the narrow pelvis sometimes require extended abdominal surgery to obtain free resection margins, and it is a challenge to preserve sufficient anal sphincter and urogenital function. Here we present a 56-year-old male with a locally advanced juxta-anal non-metastatic GIST of approximately 10 cm in diameter. Therapy with imatinib reduced the tumour size and allowed partial intersphincteric resection (pISR). The patient underwent an electrophysiology-controlled nerve-sparing hybrid of laparoscopic and transanal minimally invasive surgery (TAMIS) in a multimodal setting. The down-to-up approach provided sufficient dissection plane visualisation and allowed the confirmed nerve-sparing. Lateroterminal coloanal anastomosis was performed. Follow-up showed preserved urogenital function and good anorectal function, and the patient remains disease-free under adjuvant chemotherapy as of 12 months after surgery. This report suggests that the TAMIS approach enables extraluminal high-quality oncological and function-preserving excision of high-risk GISTs.

  7. Transanal minimally invasive surgery (TAMIS approach for large juxta-anal gastrointestinal stromal tumour

    Directory of Open Access Journals (Sweden)

    Nicolas Wachter

    2016-01-01

    Full Text Available Gastrointestinal stromal tumours (GISTs are rarely found in the rectum. Large rectal GISTs in the narrow pelvis sometimes require extended abdominal surgery to obtain free resection margins, and it is a challenge to preserve sufficient anal sphincter and urogenital function. Here we present a 56-year-old male with a locally advanced juxta-anal non-metastatic GIST of approximately 10 cm in diameter. Therapy with imatinib reduced the tumour size and allowed partial intersphincteric resection (pISR. The patient underwent an electrophysiology-controlled nerve-sparing hybrid of laparoscopic and transanal minimally invasive surgery (TAMIS in a multimodal setting. The down-to-up approach provided sufficient dissection plane visualisation and allowed the confirmed nerve-sparing. Lateroterminal coloanal anastomosis was performed. Follow-up showed preserved urogenital function and good anorectal function, and the patient remains disease-free under adjuvant chemotherapy as of 12 months after surgery. This report suggests that the TAMIS approach enables extraluminal high-quality oncological and function-preserving excision of high-risk GISTs.

  8. Minimally invasive surgery of diabetic foot – review of current techniques

    Science.gov (United States)

    I, Botezatu; D, Laptoiu

    2016-01-01

    The term diabetic foot is usually used to indicate advanced foot pathology (complex clinical situations correlating diabetic foot ulcers, diabetic foot infections, Charcot foot, and critical limb ischemia). The early recognition of the etiology of these foot lesions is essential for the therapeutic decision in order to achieve a good functional result. Several surgical procedures involving the foot have been developed in order to promote healing and avoid complications. Traditionally, surgery has been performed in an open way. The literature regarding the performance and efficacy of classical osteotomies and arthrodesis is inconsistent. This can be attributed to several variables, such as differences in patient clinical aspects and the panel of surgical techniques utilized. As with other surgical specialties, fluoroscopic imaging and minimally invasive tools are now being incorporated in these procedures. The use of high speed burrs associated with specialized osteosynthesis implants, offers several advantages over classical techniques. The ability to associate these gestures to complex protocols is beginning to be currently developed. The respect for the soft tissues is considered one of the first advantages. Despite the limited time since they were introduced in clinical practice, functional results seemed to be consistent, supporting the use of this technology. PMID:27974928

  9. Flexible and stretchable electronics for wearable healthcare devices and minimally invasive surgical tools

    Science.gov (United States)

    Kim, Dae-Hyeong; Lee, Mincheol; Lee, Hyunjae

    2016-05-01

    Recent advances in soft electronics have attracted great attention, largely due to their potential applications in personalized, bio-integrated healthcare devices. The mechanical mismatch between conventional electronic/optoelectronic devices and soft human tissues/organs have presented many challenges, such as the low signalto- noise ratio of biosensors because of the incomplete integration of rigid devices with the body, inflammation and excessive immune responses of implanted stiff devices originated from friction and their foreign nature to biotic systems, and the considerable discomfort and consequent stress experienced by users when wearing/implanting these devices. Ultra-flexible and stretchable electronic devices are being highlighted due to their low system modulus and the intrinsic system-level softness that are important to solve these issues. Here, we describe our unique strategies for the nanomaterial synthesis and fabrication, their seamless assembly and integration, and the design and development of corresponding wearable healthcare devices and minimally invasive surgical tools. These bioelectronic systems fully utilize recent breakthroughs in unconventional soft electronics based on nanomaterials to address unsolved issues in clinical medicine and to provide new opportunities in the personalized healthcare.

  10. Minimally invasive diagnosis of sarcoidosis by EBUS when conventional diagnostics fail

    DEFF Research Database (Denmark)

    Eckardt, J; Olsen, K E; Jørgensen, O D;

    2010-01-01

    Endobronchial ultrasound-guided transbronchial fine-needle aspiration (EBUS) is a minimally invasive method used routinely for mediastinal staging of patients with lung cancer. EBUS has also proved to be a valuable diagnostic tool for patients with different intrathoracic lesions who remain...

  11. Implementation of simulation in surgical practice: Minimally invasive surgery has taken the lead: The Dutch experience

    NARCIS (Netherlands)

    H.W.R. Schreuder; G. Oei; M. Maas; J.C.C. Borleffs; M.P. Schijven

    2011-01-01

    Minimal invasive techniques are rapidly becoming standard surgical techniques for many surgical procedures. To develop the skills necessary to apply these techniques, box trainers and/or inanimate models may be used, but these trainers lack the possibility of inherent objective classification of res

  12. Implementation of simulation in surgical practice : Minimally invasive surgery has taken the lead: The Dutch experience

    NARCIS (Netherlands)

    Schreuder, Henk W. R.; Oei, Guid; Maas, Mario; Borleffs, Jan C. C.; Schijven, Marlies P.

    2011-01-01

    Minimal invasive techniques are rapidly becoming standard surgical techniques for many surgical procedures. To develop the skills necessary to apply these techniques, box trainers and/or inanimate models may be used, but these trainers lack the possibility of inherent objective classification of res

  13. Utility of Intraoperative Neuromonitoring during Minimally Invasive Fusion of the Sacroiliac Joint

    OpenAIRE

    Michael Woods; Denise Birkholz; Regina MacBarb; Robyn Capobianco; Adam Woods

    2014-01-01

    Study Design. Retrospective case series. Objective. To document the clinical utility of intraoperative neuromonitoring during minimally invasive surgical sacroiliac joint fusion for patients diagnosed with sacroiliac joint dysfunction (as a direct result of sacroiliac joint disruptions or degenerative sacroiliitis) and determine stimulated electromyography thresholds reflective of favorable implant position. Summary of Background Data. Intraoperative neuromonitoring is a well-accepted adjunct...

  14. Minimally Invasive Techniques to Accelerate the Orthodontic Tooth Movement: A Systematic Review of Animal Studies

    Directory of Open Access Journals (Sweden)

    Irfan Qamruddin

    2015-01-01

    Full Text Available Objective. To evaluate various noninvasive and minimally invasive procedures for the enhancement of orthodontic tooth movement in animals. Materials and Methods. Literature was searched using NCBI (PubMed, PubMed Central, and PubMed Health, MedPilot (Medline, Catalogue ZB MED, Catalogue Medicine Health, and Excerpta Medica Database (EMBASE, and Google Scholar from January 2009 till 31 December 2014. We included original articles related to noninvasive and minimally invasive procedures to enhance orthodontic tooth movement in animals. Extraction of data and quality assessments were carried out by two observers independently. Results. The total number of hits was 9195 out of which just 11 fulfilled the inclusion criteria. Nine articles were good and 5 articles were moderate in quality. Low level laser therapy (LLLT was among the most common noninvasive techniques whereas flapless corticision using various instruments was among the commonest minimally invasive procedures to enhance velocity of tooth movement. Conclusions. LLLT, low intensity pulsed ultrasound (LIPUS, mechanical vibration, and flapless corticision are emerging noninvasive and minimally invasive techniques which need further researches to establish protocols to use them clinically with conviction.

  15. Minimally invasive non-thermal laser technology using laser-induced optical breakdown for skin rejuvenation

    NARCIS (Netherlands)

    Habbema, L.; Verhagen, R.; Van Hal, R.; Liu, Y.; Varghese, B.

    2011-01-01

    We describe a novel, minimally invasive laser technology for skin rejuvenation by creating isolated microscopic lesions within tissue below the epidermis using laser induced optical breakdown. Using an in-house built prototype device, tightly focused near-infrared laser pulses are used to create opt

  16. Minimally invasive aortic valve replacement reduces atelectasis in cardiac intensive care

    DEFF Research Database (Denmark)

    Foghsgaard, Signe; Gazi, Dunia; Bach, Karen;

    2009-01-01

    OBJECTIVE: Respiratory failure is a major complication after cardiac surgery. The purpose was to evaluate the impact of minimally invasive aortic valve replacement (mini AVR) on the occurrence of left lower lobe atelectasis (LLLA) in the cardiac intensive care unit (ICU). PATIENTS AND METHODS: 98...

  17. Minimally Invasive Molecular Staging (MIMS) RT-PCR Breast Cancer Study

    Science.gov (United States)

    2007-03-31

    31-03-2007 Final Report 19990426 - 20061231 4. TITLE AND SUBTITLE 5a. CONTRACT NUMBER Minimally Invasive Molecular Staging (MIMS) N00014-99-1-0784 RT...carcinoma micrometastases in axillary lymph nodes by means of reverse-transcriptase Polymerase chain reaction: comparison between mucl mRNA and keratin-19

  18. Automatic image processing solutions for MRI-guided minimally invasive intervention planning

    NARCIS (Netherlands)

    Noorda, YH

    2016-01-01

    In this thesis, automatic image processing methods are discussed for the purpose of improving treatment planning of MRI-guided minimally invasive interventions. Specifically, the following topics are addressed: rib detection in MRI, liver motion modeling in MRI and MR-CT registration of planning ima

  19. Automatic image processing solutions for MRI-guided minimally invasive intervention planning

    OpenAIRE

    Noorda, YH

    2016-01-01

    In this thesis, automatic image processing methods are discussed for the purpose of improving treatment planning of MRI-guided minimally invasive interventions. Specifically, the following topics are addressed: rib detection in MRI, liver motion modeling in MRI and MR-CT registration of planning image for HIFU treatment.

  20. NHI program for introducing thoracoscopic minimally invasive mitral and tricuspid valve surgery

    Directory of Open Access Journals (Sweden)

    Tamer El Banna

    2014-03-01

    Conclusions: Thoracoscopic minimally invasive mitral valve surgery can be performed safely but definitely requires a learning curve. Good results and a high patient satisfaction are guaranteed. We now utilize this approach for isolated atrioventricular valve disease and our plan is to make this exclusive by the end of this year for all the patients except Redo Cases.

  1. Minimally invasive plating osteosynthesis for mid-distal third humeral shaft fractures.

    Science.gov (United States)

    Lian, Kejian; Wang, Lei; Lin, Dasheng; Chen, Zhiwen

    2013-08-01

    Mid-distal third humeral shaft fractures can be effectively treated with minimally invasive plating osteosynthesis and intramedullary nailing (IMN). However, these 2 treatments have not been adequately compared. Forty-seven patients (47 fractures) with mid-distal third humeral shaft fractures were randomly allocated to undergo either minimally invasive plating osteosynthesis (n=24) or IMN (n=23). The 2 groups were similar in terms of fracture patterns, fracture location, age, and associated injuries. Intraoperative measurements included blood loss and operative time. Clinical outcome measurements included fracture healing, radial nerve recovery, and elbow and shoulder discomfort. Radiographic measurements included fracture alignment, time to healing, delayed union, and nonunion. Functional outcome was satisfactory in both groups. Mean American Shoulder and Elbow Surgeons score and Mayo score were both better for the minimally invasive plating osteosynthesis group than for the IMN group (98.2 vs 97.6, respectively, and 93.5 vs 94.1, respectively; Pshaft fractures. Minimally invasive plating osteosynthesis is more suitable for complex fractures, especially for radial protection and motion recovery of adjacent joints, compared with IMN for simple fractures.

  2. Tools for precision enhancement in minimally invasive cardiac surgery: three dimensional visualization, computer enhancement and robotics.

    Science.gov (United States)

    Shennib, H

    1999-11-01

    This article is a current update of the rationale for development of new enabling technologies in minimally invasive cardiac surgery. Specifically the potential advantages of three dimensional visualization, computer enhancement technology and robotics in performance of totally endoscopic coronary artery bypass grafts will be addressed.

  3. Endotracheal suctioning versus minimally invasive airway suctioning in intubated patients : a prospective randomised controlled trial

    NARCIS (Netherlands)

    Van de Leur, JP; Zwaveling, JH; Loef, BG; Van der Schans, CP

    2003-01-01

    Study objective: Endotracheal suctioning in intubated patients is routinely applied in most ICUs but may have negative side effects. We hypothesised that on-demand minimally invasive suctioning would have fewer side effects than routine deep endotracheal suctioning, and would be comparable in durati

  4. Ergonomic assessment of neck posture in the minimally invasive surgery suite during laparoscopic cholecystectomy

    NARCIS (Netherlands)

    Van Det, M.J.; Meijerink, W.J.H.J.; Hoff, C.; Van Veelen, M.A.; Pierie, J.P.E.N.

    2008-01-01

    Background With the expanding implementation of minimally invasive surgery, the operating team is confronted with challenges in the field of ergonomics. Visual feedback is derived from a monitor placed outside the operating field. This crossover trial was conducted to evaluate and compare neck post

  5. Cubital tunnel syndrome : A comparison of an endoscopic technique with a minimal invasive open technique

    NARCIS (Netherlands)

    Bolster, M. A. J.; Zophel, O. T.; van den Heuvel, E. R.; Ruettermann, M.

    2014-01-01

    Both open and endoscopic methods for ulnar nerve decompression have been described. The purpose of this study is to compare the 6-month results of a minimal invasive open technique with an endoscopic technique. We treated 60 patients with unilateral ulnar neuropathy at the elbow, employing both tech

  6. Effects of Camera Arrangement on Perceptual-Motor Performance in Minimally Invasive Surgery

    Science.gov (United States)

    Delucia, Patricia R.; Griswold, John A.

    2011-01-01

    Minimally invasive surgery (MIS) is performed for a growing number of treatments. Whereas open surgery requires large incisions, MIS relies on small incisions through which instruments are inserted and tissues are visualized with a camera. MIS results in benefits for patients compared with open surgery, but degrades the surgeon's perceptual-motor…

  7. Minimally invasive posterior cervical decompression using tubular retractor: The technical note and early clinical outcome

    Directory of Open Access Journals (Sweden)

    Jung-Woo Hur

    2014-01-01

    Full Text Available Background: The aim of this work is to present a novel decompression technique that approaches cervical spine posteriorly, but through minimal invasive method using tubular retractor avoiding detachment of posterior musculature. Methods: Six patients underwent minimally invasive posterior cervical decompression using the tubular retractor system and surgical microscope. Minimally invasive access to the posterior cervical spine was performed with exposure through a paramedian muscle-splitting approach. With the assistance of a specialized tubular retraction system and deep soft tissue expansion mechanism, multilevel posterior cervical decompression could be accomplished. This approach also allows safe docking of the retractor system on the lateral mass, thus avoiding the cervical spinal canal during exposure. A standard operating microscope was used with ×10 magnification and 400 mm focal length. The hospital charts, magnetic resonance imaging studies, and follow-up records of all the patients were reviewed. Outcome was assessed by neurological status and visual analog scale (VAS for neck and arm pain. Results: There was no significant complication related to operation. The follow-up time was 4-12 months (mean, 9 months. Muscle weakness improved in all patients; sensory deficits resolved in four patients and improved in two patients. Analysis of the mean VAS for radicular pain and VAS for neck pain showed significant improvement. Conclusions: The preliminary experiences with good clinical outcome seem to promise that this minimally invasive technique is a valid alternative option for the treatment of cervical spondylotic myelopathy.

  8. Reduction of the inflammatory response in patients undergoing minimally invasive coronary artery bypass grafting

    NARCIS (Netherlands)

    Gu, YJ; Mariani, MA; van Oeveren, W; Grandjean, JG; Boonstra, PW

    1998-01-01

    Background. The aim of this prospective study was to determine whether the inflammation-associated clinical morbidity as well as the subclinical markers of the inflammatory response are reduced in patients who undergo minimally invasive coronary artery bypass grafting without cardiopulmonary bypass.

  9. [Modern minimal invasive combine surgical approach in varicose disease of lower limbs patients].

    Science.gov (United States)

    Berehovyĭ, O V; Hur'iev, A M; Kisel'ov, V O; Hrepachevs'kyĭ, V Ie; Sholokh, V M; Bon', D O

    2012-07-01

    The analysis of combine endovenous laser coagulations in 167 patients, treated from 2007 to 2011 with different types of chronic venous insufficiency of superficial veins of lower limbs varicous disease were analysed. The high efficiency of minimal invasive combine surgical treatment, using high energetic diode laser Dornier Medilas Fibertom with wave length of 940 nm was done.

  10. Renal cellcarcinoma: advances in minimally invasive treatments and outcome prediction

    NARCIS (Netherlands)

    Kroeze, S.G.C.

    2012-01-01

    With a worldwide incidence of approximately 200,000 new cases and a mortality of 102,000 patients each year renal cell carcinoma (RCC) accounts for approximately 4% of cancer incidence and 2% of cancer mortality. Over the last decades the incidence of RCC has risen, largely due to the widespread use

  11. Minimally invasive esophagectomy for cancer: Single center experience after 44 consecutive cases

    Directory of Open Access Journals (Sweden)

    Bjelović Miloš

    2015-01-01

    Full Text Available Introduction. At the Department of Minimally Invasive Upper Digestive Surgery of the Hospital for Digestive Surgery in Belgrade, hybrid minimally invasive esophagectomy (hMIE has been a standard of care for patients with resectable esophageal cancer since 2009. As a next and final step in the change management, from January 2015 we utilized total minimally invasive esophagectomy (tMIE as a standard of care. Objective. The aim of the study was to report initial experiences in hMIE (laparoscopic approach for cancer and analyze surgical technique, major morbidity and 30-day mortality. Methods. A retrospective cohort study included 44 patients who underwent elective hMIE for esophageal cancer at the Department for Minimally Invasive Upper Digestive Surgery, Hospital for Digestive Surgery, Clinical Center of Serbia in Belgrade from April 2009 to December 2014. Results. There were 16 (36% middle thoracic esophagus tumors and 28 (64% tumors of distal thoracic esophagus. Mean duration of the operation was 319 minutes (approximately five hours and 20 minutes. The average blood loss was 173.6 ml. A total of 12 (27% of patients had postoperative complications and mean intensive care unit stay was 2.8 days. Mean hospital stay after surgery was 16 days. The average number of harvested lymph nodes during surgery was 31.9. The overall 30-day mortality rate within 30 days after surgery was 2%. Conclusion. As long as MIE is an oncological equivalent to open esophagectomy (OE, better relation between cost savings and potentially increased effectiveness will make MIE the preferred approach in high-volume esophageal centers that are experienced in minimally invasive procedures.

  12. Outcome of Minimal Invasive Percutaneous Plate Osteosynthesis in closed fractures of distal tibia

    Directory of Open Access Journals (Sweden)

    Anil K Mishra

    2014-01-01

    Full Text Available Background: The limited soft tissue, subcutaneous location and poor vascularity render the dista tibial fractures very challenging. Treatment of distal tibial fractures using minimally invasive percutaneous plate osteosynthesis technique may minimise damage to soft tissues and vascular integrity of bony fragments, leaving comminuted fragments out of the mechanical construct, preserving soft tissues with limited operative exposure. Objective: To assess the outcome of patients treated with minimally invasive percutaneous plate osteosynthesis technique for closed distal tibial fractures. Methods: The study included total of 30 patients (24males and 6females with close distal tibia fracture, which were treated with distal tibia locking plate using minimally invasive percutaneous plate osteosynthesis technique. Results: The mean ages of the patient were 44.23 years (30 to58 years. Patients were followed up at 2 weeks, 6weeks, 12weeks, 24weeks and 1 year after the operation and evaluated clinically and radiologically. Among 30 pateints, all fractures went to union. The mean American orthopaedic foot and ankle score was 89.23% (SD-3.92. There was 2case of superficial infection and 3 case of plate impingement with no intraoperative complication and mortality rates. Conclusion: Minimally invasive percutaneous plate osteosynthesis is an effective technique for the management of distal tibial fractures. It is minimally invasive, though technically demanding, but preserves the biological environment by preserving the soft tissue with better outcome in terms of radiological union and functional outcome. Journal of College of Medical Sciences-Nepal, 2013, Vol-9, No-2, 38-44 DOI: http://dx.doi.org/10.3126/jcmsn.v9i2.9686

  13. Minimally invasive esthetic therapy: a case report describing the advantages of a multidisciplinary approach.

    Science.gov (United States)

    Pinto, Rodrigo Carlos; Chambrone, Leandro; Colombini, Bella Luna; Ishikiriama, Sérgio Kiyoshi; Britto, Isabella Maria; Romito, Giuseppe Alexandre

    2013-05-01

    The decision-making process for the treatment of esthetic areas is based on the achievement of a healthy, harmonious, and pleasant smile. These conditions are directly associated with a solid knowledge of tooth anatomy and proportions, as well as the smile line, soft tissue morphology, and osseous architecture. To achieve these objectives, a multidisciplinary approach may be necessary to create long-term harmony between the final restoration and the adjacent teeth, and the health of the surrounding soft and hard tissues. This case report describes the application of a minimally invasive therapy on a 33-year-old woman seeking esthetic treatment. Minimally invasive periodontal plastic surgery associated with porcelain laminate veneers yielded satisfactory esthetics and minimal trauma to dental and periodontal tissues. Such a combined approach may be considered a viable option for the improvement of "white" and "red" esthetics.

  14. Complications of Minimally Invasive, Tubular Access Surgery for Cervical, Thoracic, and Lumbar Surgery

    Directory of Open Access Journals (Sweden)

    Donald A. Ross

    2014-01-01

    Full Text Available The object of the study was to review the author’s large series of minimally invasive spine surgeries for complication rates. The author reviewed a personal operative database for minimally access spine surgeries done through nonexpandable tubular retractors for extradural, nonfusion procedures. Consecutive cases (n=1231 were reviewed for complications. There were no wound infections. Durotomy occurred in 33 cases (2.7% overall or 3.4% of lumbar cases. There were no external or symptomatic internal cerebrospinal fluid leaks or pseudomeningoceles requiring additional treatment. The only motor injuries were 3 C5 root palsies, 2 of which resolved. Minimally invasive spine surgery performed through tubular retractors can result in a low wound infection rate when compared to open surgery. Durotomy is no more common than open procedures and does not often result in the need for secondary procedures. New neurologic deficits are uncommon, with most observed at the C5 root. Minimally invasive spine surgery, even without benefits such as less pain or shorter hospital stays, can result in considerably lower complication rates than open surgery.

  15. Del Nido cardioplegia in the setting of minimally invasive aortic valve surgery.

    Science.gov (United States)

    Vistarini, Nicola; Laliberté, Eric; Beauchamp, Philippe; Bouhout, Ismail; Lamarche, Yoan; Cartier, Raymond; Carrier, Michel; Perrault, Louis; Bouchard, Denis; El-Hamamsy, Ismaïl; Pellerin, Michel; Demers, Philippe

    2017-03-01

    The purpose of this study is to report our experience with del Nido cardioplegia (DNC) in the setting of minimally invasive aortic valve surgery. Forty-six consecutive patients underwent minimally invasive aortic valve replacement (AVR) through a "J" ministernotomy: twenty-five patients received the DNC (Group 1) and 21 patients received standard blood cardioplegia (SBC) (Group 2). The rate of ventricular fibrillation at unclamping was significantly lower in the DNC group (12% vs 52%, p=0.004), as well as postoperative creatinine kinase-MB (CK-MB) values (11.4±5.2 vs 17.7±6.9 µg/L, p=0.004). There were no deaths, myocardial infarctions or major complications in either group. Less postoperative use of intravenous insulin (28% vs 81%, pDNC group. In conclusion, the DNC is easy to use and safe during minimally invasive AVR, providing a myocardial protection at least equivalent to our SBC, improved surgical efficiency, minimal cost and less blood glucose perturbations.

  16. Early post-operative pulmonary function tests after mitral valve replacement: Minimally invasive versus conventional approach. Which is better?

    Directory of Open Access Journals (Sweden)

    Magdy Gomaa

    2016-12-01

    Conclusion: Minimally invasive right anterolateral mini-thoracotomy is as safe as median sternotomy for mitral valve surgery, with fewer complications and postoperative pain, less ICU and hospital stay, fast recovery to work with no movement restriction after surgery. There was a highly significant difference denoting better post operative pulmonary function of the minimally invasive approach.

  17. A predictive model of suitability for minimally invasive parathyroid surgery in the treatment of primary hyperparathyroidism [corrected].

    LENUS (Irish Health Repository)

    Kavanagh, Dara O

    2012-05-01

    Improved preoperative localizing studies have facilitated minimally invasive approaches in the treatment of primary hyperparathyroidism (PHPT). Success depends on the ability to reliably select patients who have PHPT due to single-gland disease. We propose a model encompassing preoperative clinical, biochemical, and imaging studies to predict a patient\\'s suitability for minimally invasive surgery.

  18. Experimental myocardial hypertrophy induced by a minimally invasive ascending aorta coarctation

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    Martins A.S.

    2001-01-01

    Full Text Available Ascending aorta coarctation was produced by a minimally invasive technique in rabbits. Animal mortality was 5%. Morphometric and hemodynamic parameters were evaluated. A parabiotically isolated heart model was used to assess the hemodynamic parameters. Left ventricular weight/body weight ratio and muscle area showed clear evidence of hypertrophy when compared to control. The hemodynamic changes in the isolated heart model suggested decreased diastolic and systolic function in the coarcted group. The present model produced hypertrophy with low mortality rates as a result of its less invasive nature.

  19. Simultaneous Minimally Invasive Treatment of Colorectal Neoplasm with Synchronous Liver Metastasis

    Directory of Open Access Journals (Sweden)

    Stefano Garritano

    2016-01-01

    Full Text Available Purpose. To analyse perioperative and oncological outcomes of minimally invasive simultaneous resection of primary colorectal neoplasm with synchronous liver metastases. Methods. A Medline revision of the current published literature on laparoscopic and robotic-assisted combined colectomy with hepatectomy for synchronous liver metastatic colorectal neoplasm was performed until February 2015. The specific search terms were “liver metastases”, “hepatic metastases”, “colorectal”, “colon”, “rectal”, “minimally invasive”, “laparoscopy”, “robotic-assisted”, “robotic colorectal and liver resection”, “synchronous”, and “simultaneous”. Results. 20 clinical reports including 150 patients who underwent minimally invasive one-stage procedure were retrospectively analysed. No randomized trials were found. The approach was laparoscopic in 139 patients (92.7% and robotic in 11 cases (7.3%. The rectum was the most resected site of primary neoplasm (52.7% and combined liver procedure was in 89% of cases a minor liver resection. One patient (0.7% required conversion to open surgery. The overall morbidity and mortality rate were 18% and 1.3%, respectively. The most common complication was colorectal anastomotic leakage. Data concerning oncologic outcomes were too heterogeneous in order to gather definitive results. Conclusion. Although no prospective randomized trials are available, one-stage minimally invasive approach seems to show advantages over conventional surgery in terms of postoperative short-term course. On the contrary, more studies are required to define the oncologic values of the minimally invasive combined treatment.

  20. 2. Minimally invasive mitral valve surgery why do you take the risks?

    Directory of Open Access Journals (Sweden)

    A. Attia

    2016-07-01

    Full Text Available During recent years, minimally invasive mitral valve surgery (MIMVS become the preferred method of mitral valve repair and replacement in many institutions worldwide with excellent results, in spite of there is no clear difinition of minimally invasive surgery and we do not have efficient studies about the risks of MIMVS comparing to conventional mitral valve surgery. Many studies are needed to clarify the need for either conventional or minimally invasive mitral valve surgery instead of personal preference. The patient’s demographic profile, intraoperative data and postoperative outcomes of patients undergoing minimally invasive mitral valve surgery were retrospectively collected from our database from May 2011 to April 2014. We will present early and mid-term outcomes of patients undergoing minimally invasive mitral valve surgery in our institution. Seventy consecutive patients (45 male and 25 female, age 35 ± 12 years, underwent MIMVS surgery. Mean preoperative New York Heart Association function class was 2.6 ± 0.7. Mean ejection fraction was 50 ± 8. Cardiopulmonary bypass was instituted through femoral cannulation (28 of 70, 40%, or direct aortic cannulation (42 of 70, 25%. Aortic cross-clamp used in (66 of 70, 94.2%. Without aortic cross-clamp in (4 of 70, 5.7%, mitral valve repair has been done in (52 of 70, 74.2%, mitral valve replacement (18 of 70, 25.7%. Concomitant procedures included AF ablation (24 of 70, 34.2%, and tricuspid valve repair (33 of 70, 47.1%. No mortality recorded, residual mitral regurge was found in (6 of 70, 8.5% during 1 year follow up. Cardiopulmonary bypass, and “skin to skin” surgery were 95 ± 35 and 250 ± 74 min, respectively. 4 patients (5.7% underwent reexploration for bleeding and (57 of 70, 81.4% did not receive any blood transfusions. Six patients (8.5% sustained face oedema. Mean length of hospital stay was 7 ± 3.8 days. 18 patients (25.7% did not feel any interest regarding

  1. Intraoperative laparoscope augmentation for port placement and resection planning in minimally invasive liver resection.

    Science.gov (United States)

    Feuerstein, Marco; Mussack, Thomas; Heining, Sandro M; Navab, Nassir

    2008-03-01

    In recent years, an increasing number of liver tumor indications were treated by minimally invasive laparoscopic resection. Besides the restricted view, two major intraoperative issues in laparoscopic liver resection are the optimal planning of ports as well as the enhanced visualization of (hidden) vessels, which supply the tumorous liver segment and thus need to be divided (e.g., clipped) prior to the resection. We propose an intuitive and precise method to plan the placement of ports. Preoperatively, self-adhesive fiducials are affixed to the patient's skin and a computed tomography (CT) data set is acquired while contrasting the liver vessels. Immediately prior to the intervention, the laparoscope is moved around these fiducials, which are automatically reconstructed to register the patient to its preoperative imaging data set. This enables the simulation of a camera flight through the patient's interior along the laparoscope's or instruments' axes to easily validate potential ports. Intraoperatively, surgeons need to update their surgical planning based on actual patient data after organ deformations mainly caused by application of carbon dioxide pneumoperitoneum. Therefore, preoperative imaging data can hardly be used. Instead, we propose to use an optically tracked mobile C-arm providing cone-beam CT imaging capability intraoperatively. After patient positioning, port placement, and carbon dioxide insufflation, the liver vessels are contrasted and a 3-D volume is reconstructed during patient exhalation. Without any further need for patient registration, the reconstructed volume can be directly augmented on the live laparoscope video, since prior calibration enables both the volume and the laparoscope to be positioned and oriented in the tracking coordinate frame. The augmentation provides the surgeon with advanced visual aid for the localization of veins, arteries, and bile ducts to be divided or sealed.

  2. Anesthetic challenges in minimally invasive cardiac surgery: Are we moving in a right direction?

    Directory of Open Access Journals (Sweden)

    Vishwas Malik

    2016-01-01

    Full Text Available Continuously growing patient′s demand, technological innovation, and surgical expertise have led to the widespread popularity of minimally invasive cardiac surgery (MICS. Patient′s demand is being driven by less surgical trauma, reduced scarring, lesser pain, substantially lesser duration of hospital stay, and early return to normal activity. In addition, MICS decreases the incidence of postoperative respiratory dysfunction, chronic pain, chest instability, deep sternal wound infection, bleeding, and atrial fibrillation. Widespread media coverage, competition among surgeons and hospitals, and their associated brand values have further contributed in raising awareness among patients. In this process, surgeons and anesthesiologist have moved from the comfort of traditional wide incision surgeries to more challenging and intensively skilled MICS. A wide variety of cardiac lesions, techniques, and approaches coupled with a significant learning curve have made the anesthesiologist′s job a challenging one. Anesthesiologists facilitate in providing optimal surgical settings beginning with lung isolation, confirmation of diagnosis, cannula placement, and cardioplegia delivery. However, the concern remains and it mainly relates to patient safety, prolonged intraoperative duration, and reduced surgical exposure leading to suboptimal treatment. The risk of neurological complications, aortic injury, phrenic nerve palsy, and peripheral vascular thromboembolism can be reduced by proper preoperative evaluation and patient selection. Nevertheless, advancement in surgical instruments, perfusion practices, increasing use of transesophageal echocardiography, and accumulating experience of surgeons and anesthesiologist have somewhat helped in amelioration of these valid concerns. A patient-centric approach and clear communication between the surgeon, anesthesiologist, and perfusionist are vital for the success of MICS.

  3. Minimally Invasive Pyeloplasty in Horseshoe Kidneys with Ureteropelvic Junction obstruction: A case series

    Directory of Open Access Journals (Sweden)

    Stephen Faddegon

    2013-04-01

    Full Text Available Background and Purpose Horseshoe kidney is an uncommon renal anomaly often associated with ureteropelvic junction (UPJ obstruction. Advanced minimally invasive surgical (MIS reconstructive techniques including laparoscopic and robotic surgery are now being utilized in this population. However, fewer than 30 cases of MIS UPJ reconstruction in horseshoe kidneys have been reported. We herein report our experience with these techniques in the largest series to date. Materials and Methods We performed a retrospective chart review of nine patients with UPJ obstruction in horseshoe kidneys who underwent MIS repair at our institution between March 2000 and January 2012. Four underwent laparoscopic, two robotic, and one laparoendoscopic single-site (LESS dismembered pyeloplasty. An additional two pediatric patients underwent robotic Hellstrom repair. Perioperative outcomes and treatment success were evaluated. Results Median patient age was 18 years (range 2.5-62 years. Median operative time was 136 minutes (range 109-230 min. and there were no perioperative complications. After a median follow-up of 11 months, clinical (symptomatic success was 100%, while radiographic success based on MAG-3 renogram was 78%. The two failures were defined by prolonged t1/2 drainage, but neither patient has required salvage therapy as they remain asymptomatic with stable differential renal function. Conclusions MIS repair of UPJ obstruction in horseshoe kidneys is feasible and safe. Although excellent short-term clinical success is achieved, radiographic success may be lower than MIS pyeloplasty in heterotopic kidneys, possibly due to inherent differences in anatomy. Larger studies are needed to evaluate MIS pyeloplasty in this population.

  4. Biostatistical analysis of treatment results of bacterial liver abscesses using minimally invasive techniques and open surgery

    Directory of Open Access Journals (Sweden)

    Кipshidze A.A.

    2013-12-01

    Full Text Available Today bacterial abscesses remain one of the most difficult complications in surgical hepatology, both traditional and minimally invasive methods of their treatment are used. Bio-statistical analysis is used due to the fact that strong evidences are required for the effectiveness of one or another method of surgical intervention. The estimation of statistical significance of differences between the control and the main group of patients with liver abscesses is given in this paper. Depending on the treatment method patients were divided into two groups: 1 - minimally invasive surgery (89 cases; 2 – laporatomy surgery (74 patients. Data compa¬ri¬son was performed by means of Stjudent's criterion. The effectiveness of method of abscesses drainage using inter¬ventional sonography, outer nazobiliar drainage with reorganization of ductal liver system and abscess cavity with the help of modern antiseptics was considered. The percentage of cured patients was also estimated.

  5. Novel wireless-communicating textiles made from multi-material and minimally-invasive fibers.

    Science.gov (United States)

    Gorgutsa, Stepan; Bélanger-Garnier, Victor; Ung, Bora; Viens, Jeff; Gosselin, Benoit; LaRochelle, Sophie; Messaddeq, Younes

    2014-10-16

    The ability to integrate multiple materials into miniaturized fiber structures enables the realization of novel biomedical textile devices with higher-level functionalities and minimally-invasive attributes. In this work, we present novel textile fabrics integrating unobtrusive multi-material fibers that communicate through 2.4 GHz wireless networks with excellent signal quality. The conductor elements of the textiles are embedded within the fibers themselves, providing electrical and chemical shielding against the environment, while preserving the mechanical and cosmetic properties of the garments. These multi-material fibers combine insulating and conducting materials into a well-defined geometry, and represent a cost-effective and minimally-invasive approach to sensor fabrics and bio-sensing textiles connected in real time to mobile communications infrastructures, suitable for a variety of health and life science applications.

  6. Novel Wireless-Communicating Textiles Made from Multi-Material and Minimally-Invasive Fibers

    Directory of Open Access Journals (Sweden)

    Stepan Gorgutsa

    2014-10-01

    Full Text Available The ability to integrate multiple materials into miniaturized fiber structures enables the realization of novel biomedical textile devices with higher-level functionalities and minimally-invasive attributes. In this work, we present novel textile fabrics integrating unobtrusive multi-material fibers that communicate through 2.4 GHz wireless networks with excellent signal quality. The conductor elements of the textiles are embedded within the fibers themselves, providing electrical and chemical shielding against the environment, while preserving the mechanical and cosmetic properties of the garments. These multi-material fibers combine insulating and conducting materials into a well-defined geometry, and represent a cost-effective and minimally-invasive approach to sensor fabrics and bio-sensing textiles connected in real time to mobile communications infrastructures, suitable for a variety of health and life science applications.

  7. Vascular thoracic outlet syndrome developed after minimally invasive repair of pectus excavatum.

    Science.gov (United States)

    Kılıç, Burcu; Demirkaya, Ahmet; Turna, Akif; Kaynak, Kamil

    2013-09-01

    The Nuss procedure is a minimally invasive surgical repair technique for pectus excavatum with fewer delayed complications compared to open procedures. We report the case of a 22-year-old man with deep pectus excavatum who developed vascular thoracic outlet syndrome after the Nuss procedure. Further evaluation demonstrated that the first rib was causing severe obstruction of the right subclavian artery. The patient showed clinical features of subclavian artery compression. A first rib resection, division of the anterior scalene muscle and fibrous bands provided complete relief of the complaints. The forced structural and spatial changes produced by the elevation of the depressed upper chest might have caused this complication. Vascular thoracic outlet syndrome should be kept in mind as a possible complication in patients who have undergone minimally invasive repair of pectus excavatum, and this complication can be treated by first rib resection.

  8. Minimally invasive space shuttle laminotomy for degenerative lumbar spinal canal stenosis

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    Shunji Asamoto

    2016-01-01

    Full Text Available Study Design: Technical note. Objectives: To show microsurgical technique, considering the meticulous anatomy of the ligamentum flavum (LF. Background: Different methods are available for treating lumbar spinal canal stenosis (LSCS. A minimally invasive surgery, namely, space shuttle laminotomy, has recently been proposed. Here, we describe the surgical method for this novel technique. To conduct this surgery accurately, surgeons must have perfect knowledge of anatomy, especially regarding the LF. Materials and Methods and Results: We use this interlaminectomy technique for all cases of LSCS. All patients with LSCS recovered from their neurological deficits in shorter hoslital stays than regular laminectomy. Conclusion: Minimally invasive space shuttle laminotomy (MISSL, which involves a microsurgical technique, is a safe, complication-free procedure.

  9. Minimally invasive porcelain veneers: indications for a conservative esthetic dentistry treatment modality.

    Science.gov (United States)

    Strassler, Howard E

    2007-11-01

    Patients have many restorative options for changing the appearance of their teeth. The most conservative restorative treatments for changing the appearance of teeth include tooth bleaching, direct composite resin veneers, and porcelain veneers. Patients seeking esthetic treatment should undergo a comprehensive clinical examination that includes an esthetic evaluation. When selecting a conservative treatment modality, the use of minimally invasive or no-preparation porcelain veneers should be considered. As with any treatment decision, the indications and contraindications must be considered before a definitive treatment plan is made. Long-term research has demonstrated a 94% survival rate for minimally invasive porcelain veneers. While conservation of tooth structure is important, so is selecting the right treatment modality for each patient based on clinical findings.

  10. Esthetic rehabilitation of a worn dentition with a minimally invasive prosthetic procedure (MIPP).

    Science.gov (United States)

    Fradeani, Mauro; Barducci, Giancarlo; Bacherini, Leonardo

    2016-01-01

    A minimally invasive prosthetic procedure (MIPP) for the esthetic rehabilitation of the complete arch advocates the preservation of enamel to optimize the adhesive bond of the luting agent to both the tooth surface and the etchable ceramic restoration. When esthetic rehabilitation of a worn dentition is required, a MIPP can be selected to reduce the biological cost of removing additional enamel tooth structure. The fundamental steps to achieve this goal are to: (1) increase the vertical dimension of occlusion (VDO); (2) reduce the thickness of the monolithic ceramic material; (3) preserve the enamel during tooth preparation; and (4) adhesively bond the etchable ceramic restorations. This article presents a comprehensive, minimally invasive prosthetic treatment approach for the esthetic rehabilitation of a severely worn dentition using a lithium disilicate all-ceramic material with partial and complete coverage restorations.

  11. Minimally Invasive Long-Term Management of Direct Restorations: the '5 Rs'.

    Science.gov (United States)

    Green, David; Mackenzie, Louis; Banerjee, Avijit

    2015-06-01

    The assessment and operative long-term management of direct restorations is a complex and controversial subject in conservative dentistry. Employing a minimally invasive (MI) approach helps preserve natural tooth structure and maintain endodontic health for as long as possible during the restorative cycle. This paper discusses how minimally invasive techniques may be applied practically to reviewing, resealing, refurbishing, repairing or replacing deteriorating/failed direct coronal restorations (the'5 Rs') and provides an update of contemporary MI clinical procedures. CPD/CLINICAL RELEVANCE: The assessment and long-term clinical management of deteriorating/failing direct restorations is a major component of the general dental practice workload and NHS UK budget expenditure for operative dentistry.

  12. Minimally invasive arthrodesis for chronic sacroiliac joint dysfunction using the SImmetry SI Joint Fusion system.

    Science.gov (United States)

    Miller, Larry E; Block, Jon E

    2014-01-01

    Chronic sacroiliac (SI) joint-related low back pain (LBP) is a common, yet under-diagnosed and undertreated condition due to difficulties in accurate diagnosis and highly variable treatment practices. In patients with debilitating SI-related LBP for at least 6 months duration who have failed conservative management, arthrodesis is a viable option. The SImmetry(®) SI Joint Fusion System is a novel therapy for SI joint fusion, not just fixation, which utilizes a minimally invasive surgical approach, instrumented fixation for immediate stability, and joint preparation with bone grafting for a secure construct in the long term. The purpose of this report is to describe the minimally invasive SI Joint Fusion System, including patient selection criteria, implant characteristics, surgical technique, postoperative recovery, and biomechanical testing results. Advantages and limitations of this system will be discussed.

  13. Novel wireless-communicating textiles made from multi-material and minimally-invasive fibers.

    Science.gov (United States)

    Bélanger-Garnier, Victor; Gorgutsa, Stephan; Ung, Bora; Viens, Jeff; Gosselin, Benoit; LaRochelle, Sophie; Messaddeq, Younes

    2014-01-01

    The ability to integrate multiple materials into miniaturized fiber structures enables the realization of novel biomedical textile devices with higher-level functionalities and minimally-invasive attributes. In this work, we present novel textile fabrics integrating unobtrusive multi-material fibers that communicate through 2.4 GHz wireless networks with excellent signal quality. The conductor elements of the textiles are embedded within the fibers themselves, providing electrical and chemical shielding against the environment, while preserving the mechanical and cosmetic properties of the garments. These multi-material fibers combine insulating and conducting materials into a well-defined geometry, and represent a cost-effective and minimally-invasive approach to sensor fabrics and bio-sensing textiles connected in real time to mobile communications infrastructures, suitable for a variety of health and life science applications.

  14. Laser radiation in tennis elbow treatment: a new minimally invasive alternative

    Science.gov (United States)

    Paganini, Stefan; Thal, Dietmar R.; Werkmann, Klaus

    1998-01-01

    The epicondylitis humeri radialis (EHR) (tennis elbow), is a common disease in elbow joint pain syndromes. We treated patients with chronic pain for at least one year and no improvement with conservative or operative therapies with a new minimal invasive method, the EHR-Laser radiation (EHR- LR). With this method periepicondylar coagulations were applied to the trigger points of the patients. For this the previously established technique of facet joint coagulation with the Nd:Yag-laser was modified. In a follow-up study of between 6 weeks and 2 years all patients reported either a significant pain reduction or were symptom free. EHR-LR is a new method situated between conservative and surgical treatments for minimal invasive therapy of EHR. Several therapeutic rationales were discussed for the resulting pain reduction.

  15. Artificial muscles for a novel simulator in minimally invasive spine surgery.

    Science.gov (United States)

    Hollensteiner, Marianne; Fuerst, David; Schrempf, Andreas

    2014-01-01

    Vertebroplasty and kyphoplasty are commonly used minimally invasive methods to treat vertebral compression fractures. Novice surgeons gather surgical skills in different ways, mainly by "learning by doing" or training on models, specimens or simulators. Currently, a new training modality, an augmented reality simulator for minimally invasive spine surgeries, is going to be developed. An important step in investigating this simulator is the accurate establishment of artificial tissues. Especially vertebrae and muscles, reproducing a comparable haptical feedback during tool insertion, are necessary. Two artificial tissues were developed to imitate natural muscle tissue. The axial insertion force was used as validation parameter. It appropriates the mechanical properties of artificial and natural muscles. Validation was performed on insertion measurement data from fifteen artificial muscle tissues compared to human muscles measurement data. Based on the resulting forces during needle insertion into human muscles, a suitable material composition for manufacturing artificial muscles was found.

  16. Minimal change nephrotic syndrome associated with invasive thymoma: a case report with literature review.

    Science.gov (United States)

    Long, Quan; Wu, Ping; Jiang, Gengru; Zhu, Chun

    2014-04-01

    The present report describes a case of nephrotic syndrome (NS) with invasive thymoma. A male patient was hospitalized for severe edema with reduced urine output. He had a history of thymectomy and radiotherapy because of invasive thymoma 4 years before the development of NS. Renal biopsy displayed minimal change disease (MCD). Although imaging study showed probably recurrent sign of invasive thymoma, the patient still received steroid monotherapy for ~ 9 months and he got partial remission of NS at the 8th week. Therefore, we suggest that MCD should be taken into account as a pathological lesion type in old NS patients with thymoma. In spite of longer remission time, steroid monotherapy and combination therapy with immunosuppressant are effective for thymoma-associated MCD.

  17. Quantification of Femoral Neck Exposure Through a Minimally Invasive Smith-Petersen Approach

    Science.gov (United States)

    2010-06-01

    2004; 429:248 255. 9. Jacobs MA, Goytia RN, Bhargava T. Hip resurfacing through an anterolateral approach: surgical description and early review. J...neck blood supply than the posterior approach during hip resurfacing . J Bone Joint Surg (Br). 2007;89-B: 1293 1298. 11. Swiontkowski MF, Thorpe M, Seiler...approach to the hip . Methods: Ten fresh frozen hemipelves were dissected using a minimally invasive Smith Petersen approach. Upon completion of the

  18. Minimally Invasive Antral Membrane Balloon Elevation (MIAMBE): A 3 cases report

    OpenAIRE

    Roberto Arroyo; Diego Cabrera

    2013-01-01

    ABSTRACT Long-standing partial edentulism in the posterior segment of an atrophic maxilla is a challenging treatment. Sinus elevation via Cadwell Luc has several anatomical restrictions, post-operative discomfort and the need of complex surgical techniques. The osteotome approach is a significantly safe and efficient tecnique, as a variation of this technique the "minimal invasive antral membrane balloon elevation" (MIAMBE) has been developed, which use a hydraulic system. We present three c...

  19. Complex esthetic and functional rehabilitation with an additive, minimally invasive restorative approach.

    Science.gov (United States)

    Ho, Christopher Ck

    2014-06-01

    Historically, the management of patients presenting with extensive tooth wear comprised the use of conventional fixed prosthodontics, an approach that often entailed invasive dentistry and increased biomechanical risk. With the development of adhesive bonding, a dentition can be restored in a much more conservative manner using an additive approach. This case report describes the concepts employed in a complex rehabilitation involving tooth erosion, applying both direct and indirect restorations with minimal biological risk to the patient.

  20. Minimally invasive dentistry combining orthodontic therapy and single-unit restoration.

    Science.gov (United States)

    Lowe, Edward; Rego, Juan; Rego, Nelson

    2008-06-01

    Today's restorative materials enable dental professionals to deliver predictable aesthetic enhancement, particularly for compromised teeth in the anterior region. Treating a single compromised tooth, however, requires a thorough understanding of the restorative material's optical properties, experience in its clinical performance, and awareness of therapeutic modalities that conserve sound tooth structure. In this presentation, the authors demonstrate the use of orthodontic therapy and careful treatment planning to restore a single central incisor using a minimally invasive approach.

  1. "NIMS technique" for minimally invasive spinal fixation using non-fenestrated pedicle screws: A technical note

    Directory of Open Access Journals (Sweden)

    Alugolu Rajesh

    2015-01-01

    Full Text Available Study Design: Case series. Objective: To reduce the cost of minimally invasive spinal fixation. Background: Minimally invasive spine (MIS surgery is an upcoming modality of managing a multitude of spinal pathologies. However, in a resource-limited situations, using fenestrated screws (FSs may prove very costly for patients with poor affordability. We here in describe the Nizam′s Institute of Medical Sciences (NIMS experience of using routine non-FSs (NFSs for transpedicular fixation by the minimally invasive way to bridge the economic gap. Materials and Methods: A total of 7 patients underwent NFS-minimally invasive spine (MIS surgery. Male to female distribution was 6:1. The average blood loss was 50 ml and the mean operating time was 2 and 1/2 h. All patients were mobilized the very next day after confirming the position of implants on X-ray/computed tomography. Results: All 7 patients are doing well in follow-up with no complaints of a backache or fresh neurological deficits. There was no case with pedicle breach or screw pullout. The average cost of a single level fixation by FS and NFS was `1, 30,000/patient and `32,000/patient respectively ($2166 and $530, respectively. At the end of 1-year follow-up, we had two cases of screw cap loosening and with a displacement of the rod cranio-caudally in one case which was revised through the same incisions. Conclusions: Transpedicular fixation by using NFS for thoracolumbar spinal pathologies is a cost-effective extension of MIS surgery. This may extend the benefits to a lower socioeconomic group who cannot afford the cost of fenestrated screw (FS.

  2. Screw in the aorta: minimally invasive graft replacement for chronic aortic erosion by spinal instrument.

    Science.gov (United States)

    Fukuda, Wakako; Aoki, Chikashi; Daitoku, Kazuyuki; Taniguchi, Satoshi; Fukuda, Ikuo

    2013-01-01

    Intra-and early post-operative aortic injury by pedicle screw is not a rare complication in orthopedic surgery, but aortic penetration by a screw head over a long time period is considered as an uncommon case. There are various surgical management options for thoracic aortic injury caused by malpositioned spinal instruments. We report a case of a patient who underwent minimally invasive graft replacement of the descending thoracic artery for pedicle screw penetration.

  3. 3T MR-guided minimally-invasive penile fracture repair

    Directory of Open Access Journals (Sweden)

    Giovanni Rosi

    2016-03-01

    Full Text Available We present the case of a 21 year old patient with an incomplete tear of the tunica albuginea occurred after violent masturbation. The diagnostic assessment was performed first clinically, then with ultrasound and with 3 Tesla MRI. 3 Tesla MRI, owing to its high resolution, allowed to exactly detect the tear location leading to precise preoperative planning. After adequate diagnosis through imaging and proper planning, we were able to perform a selective minimally invasive surgical approach to repair the lesion.

  4. Minimally invasive intervention in a case of a noncarious lesion and severe loss of tooth structure.

    Science.gov (United States)

    Reston, Eduardo G; Corba, Vanessa D; Broliato, Gustavo; Saldini, Bruno P; Stefanello Busato, Adair L

    2012-01-01

    The present article describes a minimally invasive technique used for the restoration of loss of tooth structure caused by erosion of intrinsic etiology. First, the cause of erosion was treated and controlled. Subsequently, taking into consideration patient characteristics, especially a young age, a more conservative technique was chosen for dental rehabilitation with the use of composite resin. The advantages and disadvantages of the technique employed are discussed.

  5. Survey of minimally invasive general surgery fellows training in robotic surgery.

    Science.gov (United States)

    Shaligram, Abhijit; Meyer, Avishai; Simorov, Anton; Pallati, Pradeep; Oleynikov, Dmitry

    2013-06-01

    Minimally invasive surgery fellowships offer experience in robotic surgery, the nature of which is poorly defined. The objective of this survey was to determine the current status and opportunities for robotic surgery training available to fellows training in the United States and Canada. Sixty-five minimally invasive surgery fellows, attending a fundamentals of fellowship conference, were asked to complete a questionnaire regarding their demographics and experiences with robotic surgery and training. Fifty-one of the surveyed fellows completed the questionnaire (83 % response). Seventy-two percent of respondents had staff surgeons trained in performing robotic procedures, with 55 % of respondents having general surgery procedures performed robotically at their institution. Just over half (53 %) had access to a simulation facility for robotic training. Thirty-three percent offered mechanisms for certification and 11 % offered fellowships in robotic surgery. One-third of the minimally invasive surgery fellows felt they had been trained in robotic surgery and would consider making it part of their practice after fellowship. However, most (80 %) had no plans to pursue robotic surgery fellowships. Although a large group (63 %) felt optimistic about the future of robotic surgery, most respondents (72.5 %) felt their current experience with robotic surgery training was poor or below average. There is wide variation in exposure to and training in robotic surgery in minimally invasive surgery fellowship programs in the United States and Canada. Although a third of trainees felt adequately trained for performing robotic procedures, most fellows felt that their current experience with training was not adequate.

  6. Anastomosis in minimally invasive Ivor lewis esophagectomy via two ports provides equivalent perioperative outcomes to open

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    Y Zhao

    2014-01-01

    Full Text Available Objective: Minimally invasive esophagectomy (MIE is becoming a selective treatment of esophageal cancer; however, it′s a complex and technically demanding surgical operation. MIE can be performed in high volume centers in a variety of ways using different techniques. Transthoracic staplers have traditionally been used in open transthoracic Ivor Lewis Esophagectomy (ILE with good success. An investigation of the safety and utility of transthoracic stapler via two ports on thorax for esophageal anastomosis in minimally invasive ILE is reviewed. Methods: Patients of esophageal cancer were selected between November 2012 and July 2014. All the patients received minimally invasive (MIE or open transthoracic ILE. Transthoracic stapler for MIE anastomosis was performed through the major port located at subaxillary region. Patients′ demographics, indications for esophagectomy, perioperative treatments, intraoperative data, postoperative complications, hospital length of stay, 7 and in-hospital mortality were evaluated. Results: Totally, 63 consecutive patients underwent MIE or ILE. All the patients were Han with a mean age of 60 years (52-74. The indication of surgery is esophageal cancer, and squamous cell carcinoma was defined by pathologist before operation. None of the patients had neoadjuvant chemotherapy or radiation. All the MIE patients were no conversions to open thoracotomy or laparotomy. Mean operative time was 4.5 h. One patient (3.03% suffered postoperative pneumonia, no leak from the gastric conduit staple line or esophageal anastomoses, no postoperative complication required surgical intervention was observed. The median hospital length of stay was 13 days (range 7-18. There were no in-hospital mortalities. Conclusions: In our study, transthoracic stapler through the major port at subaxillary seems technically feasible and safe for minimally invasive ILE with comparable morbidity and oncologic data to open.

  7. Bilateral neurological deficits following unilateral minimally invasive TLIF: A review of four patients

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    Nixon, Alexander T.; Smith, Zachary A.; Lawton, Cort D.; Albert P. Wong; Dahdaleh, Nader S; Antoun Koht; Fessler, Richard G.

    2014-01-01

    Background: Minimally invasive transforaminal lumbar interbody fusion (MI-TLIF) is commonly used for the treatment of degenerative lumbar spinal disorders. The rate of postoperative neurological deficits is traditionally low. New neurological postoperative complications may be underreported. We report our infrequent rate of MI-TLIF procedures complicated by postoperative weakness. Methods: A database of 340 patients was evaluated, all of whom underwent MI-TLIF procedures performed between...

  8. Intraprostatic ozone therapy: A minimally invasive approach in benign prostatic hyperplasia

    OpenAIRE

    Shabbir Hussain; Sharma, Deepti B.; Fanindra S Solanki; Ajay Pathak; Dhananjay Sharma

    2017-01-01

    Introduction: Transurethral resection of prostate (TURP) remains the golden standard therapy since decades. There are various minimally invasive therapies (MITs) for the treatment of benign prostatic hyperplasia (BPH). Still, there is a need for therapy with lesser side effects and better outcome. We had studied the effect of intraprostatic ozone injection (IPOI) as an MIT for patients with BPH who have failed trial without catheter (TWOC). Materials and Methods: Thirty elderly patients wi...

  9. Minimally invasive treatment for esthetic enhancement of white spot lesion in adjacent tooth.

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    Lee, Ji-Hye; Kim, Dae-Gon; Park, Chan-Jin; Cho, Lee-Ra

    2013-08-01

    This article describes the treatment provided to a patient with the maxillary anterior teeth exhibiting severe secondary caries beneath the previous restoration and a white spot lesion on the adjacent incisor. Two implants were placed after extraction of hopeless teeth with the guided bone regeneration technique. A white spot lesion of the adjacent incisor was treated with minimally invasive treatment. This clinical report describes the multidisciplinary treatment for the white spot lesion and esthetic restoration of missing anterior teeth.

  10. Implementation of simulation in surgical practice: minimally invasive surgery has taken the lead: the Dutch experience.

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    Schreuder, Henk W R; Oei, Guid; Maas, Mario; Borleffs, Jan C C; Schijven, Marlies P

    2011-01-01

    Minimal invasive techniques are rapidly becoming standard surgical techniques for many surgical procedures. To develop the skills necessary to apply these techniques, box trainers and/or inanimate models may be used, but these trainers lack the possibility of inherent objective classification of results. In the past decade, virtual reality (VR) trainers were introduced for training minimal invasive techniques. Minimally invasive surgery (MIS) is, by nature, very suitable for this type of training. The specific psychomotor skills and eye-hand coordination needed for MIS can be mastered largely using VR simulation techniques. It is also possible to transfer skills learned on a simulator to real operations, resulting in error reduction and shortening of procedural operating time. The authors aim to enlighten the process of gaining acceptance in the Netherlands for novel training techniques. The Dutch Societies of Surgery, Obstetrics and Gynecology, and Urology each developed individual training curricula for MIS using simulation techniques, to be implemented in daily practice. The ultimate goal is to improve patient safety. The authors outline the opinions of actors involved, such as different simulators, surgical trainees, surgeons, surgical societies, hospital boards, government, and the public. The actual implementation of nationwide training curricula for MIS is, however, a challenging step.

  11. Lumbar Spinal Stenosis Minimally Invasive Treatment with Bilateral Transpedicular Facet Augmentation System

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    Masala, Salvatore, E-mail: salva.masala@tiscali.it [Interventional Radiology and Radiotherapy, University of Rome ' Tor Vergata' , Department of Diagnostic and Molecular Imaging (Italy); Tarantino, Umberto [University of Rome ' Tor Vergata' , Department of Orthopaedics and Traumatology (Italy); Nano, Giovanni, E-mail: gionano@gmail.com [Interventional Radiology and Radiotherapy, University of Rome ' Tor Vergata' , Department of Diagnostic and Molecular Imaging (Italy); Iundusi, Riccardo [University of Rome ' Tor Vergata' , Department of Orthopaedics and Traumatology (Italy); Fiori, Roberto, E-mail: fiori.r@libero.it; Da Ros, Valerio, E-mail: valeriodaros@hotmail.com; Simonetti, Giovanni [Interventional Radiology and Radiotherapy, University of Rome ' Tor Vergata' , Department of Diagnostic and Molecular Imaging (Italy)

    2013-06-15

    Purpose. The purpose of this study was to evaluate the effectiveness of a new pedicle screw-based posterior dynamic stabilization device PDS Percudyn System Trade-Mark-Sign Anchor and Stabilizer (Interventional Spine Inc., Irvine, CA) as alternative minimally invasive treatment for patients with lumbar spine stenosis. Methods. Twenty-four consecutive patients (8 women, 16 men; mean age 61.8 yr) with lumbar spinal stenosis underwent implantation of the minimally invasive pedicle screw-based device for posterior dynamic stabilization. Inclusion criteria were lumbar stenosis without signs of instability, resistant to conservative treatment, and eligible to traditional surgical posterior decompression. Results. Twenty patients (83 %) progressively improved during the 1-year follow-up. Four (17 %) patients did not show any improvement and opted for surgical posterior decompression. For both responder and nonresponder patients, no device-related complications were reported. Conclusions. Minimally invasive PDS Percudyn System Trade-Mark-Sign has effectively improved the clinical setting of 83 % of highly selected patients treated, delaying the need for traditional surgical therapy.

  12. Natural and Controlled Demineralization for Study Purposes in Minimally Invasive Dentistry.

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    Skucha-Nowak, Małgorzata; Gibas, Mirosław; Tanasiewicz, Marta; Twardawa, Henryk; Szklarski, Tomasz

    2015-01-01

    Artificially induced demineralization of enamel is frequently used during laboratory tests, particularly in minimally invasive dentistry. The aim of this study was to analyze demineralization techniques of hard tooth tissue applicable in the research of materials in minimally invasive dentistry. The most important factor taken into consideration when designing a method is to make a model as closely similar to the natural environment of the human oral cavity as it is possible. In vitro models allow us to maintain stability and control over the environment and guarantee repeatability of the results. There are main models to produce dental caries outside of the body. The first model is chemical and it uses acids. It is simplified and reflects the actual environment of the oral cavity to a lesser degree. The second model is biological and it is more accurate as it uses microorganisms which build the dental plaque. Among in vitro protocols are also used pH-cycling models. Based on the available literature, it was found that bovine teeth and human teeth with demineralization diagnosed while still inside the oral cavity are the most frequently used kind of specimens in research conducted with use of the chemical model. Not a single case of use of the biological and pH-cycling models were found in the available literature related to the research of infiltrants in minimally invasive dentistry.

  13. Application of Minimally Invasive Treatment of Locking Compression Plate in SchatzkerⅠ~Ⅲ Tibial Plateau Fracture

    Institute of Scientific and Technical Information of China (English)

    Zhao Guohui

    2014-01-01

    Objective:To investigate the clinical effect of minimally invasive treatment of locking compression plate (LCP) in SchatzkerⅠ~Ⅲ tibial plateau fracture. Methods: Thirty-eight patients with SchatzkerⅠ~Ⅲtibial plateau fracture in our hospital were given minimally invasive treatment of LCP, and the artificial bone was transplanted to the depressed bone. Adverse responses, wound healing time and clinical efifcacy were observed. Results:All patients were followed-up for 14~20 months, and the mean duration was 16 months. Within 1 week after operation, 1 patient suffered from short-term rejection reaction to artiifcial bone, but he healed after corresponding measures were taken. There were no complications like skin necrosis and externally-exposed steel plate among the patients. In addition, all fractures were recovered, and the recovery time was 2.6~4.1 months, with the mean duration being 3.4 months. The recovery of knee function was favorable, in which 20 cases were excellent, 14 were good, and 4 were general. The excellent and good rate was 89.5%. Conclusion: Minimally invasive treatment of LCP for SchatzkerⅠ~Ⅲ tibial plateau fracture can reduce the postoperative relocation loss, and has small trauma and stable ifxation.

  14. Minimally invasive strategies and options for far-lateral Iumbar disc herniation

    Institute of Scientific and Technical Information of China (English)

    ZHOU Yue; ZHANG Chao; WANG Jian; CHU Tong-wei; LI Chang-qing; ZHANG Zheng-feng; ZHENG wen-jie

    2008-01-01

    Objective: To investigate the surgical procedlures,options and surgical indications for far-lateral lumbar disc herniation between three different minimally invasive procedures.Methods: From January 2000 to October 2006, 52 patients with far-lateral lumbar disc herniation (29 males and 23 females, with the average age of 41.5 years) were treated with minimally invasive procedures. All the patients were assessed by X-ray and CT. Some were given additional myeography, discography, Computerized tomography myelography (CTM) and MRI examination. Yeung Endoscopy Spine System (YESS), METRx and X-tube procedures were performed in 25, 13 and 14 cases, respectively. All patients were followed up for a mean period of 13.5 months. Clinical outcomes were assessed by visual analog score (VAS) and Nakai criteria. Results: The results indicated that the three procedures could significantly improve the radiating leg symptoms (PO.05). The YESS procedure had several advantages including shortest operation time, simplest anesthesia and least trauma as compared with the other two procedures, especially for simple type I far-lateral lumbar disc herniation. METRx procedure was specially suitable for simple type II. And the procedure of posterior endoscopic facetectomy, posterior lumbar interbody fusion and unilateral pedicle screw instrumentation with X-tube was designed for far-lateral disc herniation combined with degenerative lumbar instability. Conclusion: Minimally invasive strategies and options should be determined by different types of far-lateral lumbar disc herniation.

  15. Minimally invasive arthrodesis for chronic sacroiliac joint dysfunction using the SImmetry SI Joint Fusion system

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    Miller LE

    2014-05-01

    Full Text Available Larry E Miller,1,2 Jon E Block21Miller Scientific Consulting, Inc., Asheville, NC, USA; 2The Jon Block Group, San Francisco, CA, USA Abstract: Chronic sacroiliac (SI joint-related low back pain (LBP is a common, yet under-diagnosed and undertreated condition due to difficulties in accurate diagnosis and highly variable treatment practices. In patients with debilitating SI-related LBP for at least 6 months duration who have failed conservative management, arthrodesis is a viable option. The SImmetry® SI Joint Fusion System is a novel therapy for SI joint fusion, not just fixation, which utilizes a minimally invasive surgical approach, instrumented fixation for immediate stability, and joint preparation with bone grafting for a secure construct in the long term. The purpose of this report is to describe the minimally invasive SI Joint Fusion System, including patient selection criteria, implant characteristics, surgical technique, postoperative recovery, and biomechanical testing results. Advantages and limitations of this system will be discussed. Keywords: arthrodesis, fusion, minimally invasive, sacroiliac, SImmetry

  16. Minimally invasive surgical treatment for unstable fractures of the proximal phalanx: intramedullary screw

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    Marcio Aurélio Aita

    2016-02-01

    Full Text Available ABSTRACT OBJECTIVE: To analyze the clinical-functional parameters and quality of life of patients undergoing minimally invasive surgical treatment for extra-articular fractures of the proximal phalanx, using an intramedullary screw (Acutrak(r. METHODS: Between January 2011 and September 2014, a prospective study was conducted on 41 patients (48 fingers with unstable extra-articular fractures of the proximal phalanx, who underwent minimally invasive surgical treatment using an intramedullary screw (Acutrak(r. These patients were evaluated 12 months after the surgery by means of the DASH quality-of-life questionnaire, VAS pain scale, measurement of range of motion (ROM, in degrees and radiographic assessment. RESULTS: All the patients achieved adequate reduction and consolidation of their fractures. There were statistically significant improvements in quality of life on the DASH scale, pain on the VAS scale and range of motion. CONCLUSION: The minimally invasive technique for treating unstable extra-articular fractures of the proximal phalanx using an intramedullary screw (Acutrak(r is effective and safe, and it presents satisfactory clinical-functional results.

  17. Micro/nanostructured surface modification using femtosecond laser pulses on minimally invasive electrosurgical devices.

    Science.gov (United States)

    Lin, Chia-Cheng; Lin, Hao-Jan; Lin, Yun-Ho; Sugiatno, Erwan; Ruslin, Muhammad; Su, Chen-Yao; Ou, Keng-Liang; Cheng, Han-Yi

    2016-01-29

    The purpose of the present study was to examine thermal damage and a sticking problem in the tissue after the use of a minimally invasive electrosurgical device with a nanostructured surface treatment that uses a femtosecond laser pulse (FLP) technique. To safely use an electrosurgical device in clinical surgery, it is important to decrease thermal damage to surrounding tissues. The surface characteristics and morphology of the FLP layer were evaluated using optical microscopy, scanning electron microscopy, and transmission electron microscopy; element analysis was performed using energy-dispersive X-ray spectroscopy, grazing incidence X-ray diffraction, and X-ray photoelectron spectroscopy. In the animal model, monopolar electrosurgical devices were used to create lesions in the legs of 30 adult rats. Animals were sacrificed for investigations at 0, 3, 7, 14, and 28 days postoperatively. Results indicated that the thermal damage and sticking situations were reduced significantly when a minimally invasive electrosurgical instrument with an FLP layer was used. Temperatures decreased while film thickness increased. Thermographic data revealed that surgical temperatures in an animal model were significantly lower in the FLP electrosurgical device compared with that in the untreated one. Furthermore, the FLP device created a relatively small area of thermal damage. As already mentioned, the biomedical nanostructured layer reduced thermal damage and promoted the antisticking property with the use of a minimally invasive electrosurgical device. © 2016 Wiley Periodicals, Inc. J Biomed Mater Res Part B: Appl Biomater, 2016.

  18. Effect of Anti-Sticking Nanostructured Surface Coating on Minimally Invasive Electrosurgical Device in Brain.

    Science.gov (United States)

    Cheng, Han-Yi; Ou, Keng-Liang; Chiang, Hsi-Jen; Lin, Li-Hsiang

    2015-10-01

    The purpose of the present study was to examine the extent of thermal injury in the brain after the use of a minimally invasive electrosurgical device with a nanostructured copper-doped diamond-like carbon (DLC-Cu) surface coating. To effectively utilize an electrosurgical device in clinical surgery, it is important to decrease the thermal injury to the adjacent tissues. The surface characteristics and morphology of DLC-Cu thin film was evaluated using a contact angle goniometer, scanning electron microscopy, and atomic force microscopy. Three-dimensional biomedical brain models were reconstructed using magnetic resonance images to simulate the electrosurgical procedure. Results indicated that the temperature was reduced significantly when a minimally invasive electrosurgical device with a DLC-Cu thin film coating (DLC-Cu-SS) was used. Temperatures decreased with the use of devices with increasing film thickness. Thermographic data revealed that surgical temperatures in an animal model were significantly lower with the DLC-Cu-SS electrosurgical device compared to an untreated device. Furthermore, the DLC-Cu-SS device created a relatively small region of injury and lateral thermal range. As described above, the biomedical nanostructured film reduced excessive thermal injury with the use of a minimally invasive electrosurgical device in the brain.

  19. Minimally Invasive Transforaminal Lumbar Interbody Fusion: A Perspective on Current Evidence and Clinical Knowledge

    Directory of Open Access Journals (Sweden)

    Ali Habib

    2012-01-01

    Full Text Available This paper reviews the current published data regarding open transforaminal lumbar interbody fusion (TLIF in relation to minimally invasive transforaminal lumbar interbody fusion (MI-TLIF. Introduction. MI-TLIF, a modern method for lumbar interbody arthrodesis, has allowed for a minimally invasive method to treat degenerative spinal pathologies. Currently, there is limited literature that compares TLIF directly to MI-TLIF. Thus, we seek to discuss the current literature on these techniques. Methods. Using a PubMed search, we reviewed recent publications of open and MI-TLIF, dating from 2002 to 2012. We discussed these studies and their findings in this paper, focusing on patient-reported outcomes as well as complications. Results. Data found in 14 articles of the literature was analyzed. Using these reports, we found mean follow-up was 20 months. The mean patient study size was 52. Seven of the articles directly compared outcomes of open TLIF with MI-TLIF, such as mean duration of surgery, length of post-operative stay, blood loss, and complications. Conclusion. Although high-class data comparing these two techniques is lacking, the current evidence supports MI-TLIF with outcomes comparable to that of the traditional, open technique. Further prospective, randomized studies will help to further our understanding of this minimally invasive technique.

  20. Minimally Invasive Stabilisation with Posterior Transiliac Plate of Pelvic Ring Fractures

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    Ferhat Say

    2013-11-01

    Full Text Available Aim: Transiliac posterior plate osteosynthesis is one of the surgical option for treating instable pelvic fractures. In this report, we aimed to evaluate clinical results of patients with pelvic fractures treated with transiliac plate osteosynthesis by minimally invasive methods. Material and Method: Patients with instable pelvic fractures treated with minimally invasive transiliac plate osteosynthesis were evaluated retrospectively. Radiographic assessments were made on pelvic x-rays using Tornetta and Matta methods. Functional results were evaluated using Hannover pelvic outcome score. Results: This study included 21 patients with a mean age of 37.8 years (range 17-62yrs. The mean follow-up period was 21.2 (6-38 months. According to AO classification, 14 patients had a C1 and 6 patients had a C2 and 1 patients had a C3 type pelvic fractures. Clinical results were excellent (4 point in 12 patients, good (3 point in 4 patients, fair (2 point in 5 patients according to Hannover pelvic outcome score. According to radiological assessments, the results were excellent (< 5 mm in 13 patients, good (5-10 mm dislocation in 6 patients and fair (10-20 mm dislocation in 2 patients. Superficial infection was detected in two patients. Loss of reduction occurred in two patients. Discussion: Minimally invasive transiliac plate osteosynthesis for treating pelvic fractures is a method with good clinical results and low neurovascular complication risks.

  1. Intrathoracic migration of a breast implant after minimally invasive cardiac surgery.

    Science.gov (United States)

    Songcharoen, Somjade Jay; McClure, Michael; Aru, Roberto G; Songcharoen, Somprasong

    2015-03-01

    The aging population, in combination with the popularity of breast augmentation with implants, presents surgeons with a growing number of cases involving women undergoing minimally invasive cardiac surgery (MICS) who have breast implants. We present an unusual complication involving the delayed migration of a subpectoral implant into the chest cavity through an iatrogenic defect after a minimally invasive mitral valve repair. This chest wall defect was ultimately repaired with a latissimus dorsi flap. Although MICS has been described in women with breast implants, the documented experience remains limited. Most authors classically recommend explantation of the prosthesis to provide access to the chest wall; however, some have later suggested preserving the implant capsule in situ while performing the cardiac procedure with gentle retraction. From our literature review and experience, we recommend that the posterior capsule should remain intact. If this is not possible, then the chest wall closure should be reinforced with either mesh, soft tissue, or both. Soft tissue options include the conversion from a subpectoral to a subglandular position to use the pectoralis major, or a latissimus dorsi muscle flap. With the increasing number of these cases along with the complexities of minimally invasive procedures, close communication and planning should be undertaken between both cardiothoracic and plastic surgeons when taking care of these patients. Above all, when faced with postoperative complications after MICS, the plastic surgeon must maintain a high index of clinical suspicion and consider the possibility of intrathoracic migration of an implant so that proper workup and planning may be initiated.

  2. Minimally invasive surgery for lumbar synovial cysts with coexisting degenerative spondylolisthesis

    Science.gov (United States)

    Hirt, Daniel; Shah, Saumya; Lu, Daniel C.; Holly, Langston T.

    2016-01-01

    Background About one third of lumbar synovial cysts are associated with degenerative spondylolisthesis. Segmental instability is thought to contribute to the pathogenesis and recurrence of synovial cysts and lumbar fusion has been advocated as a treatment of choice in the presence of spondylolisthesis. In patients with spondylolisthesis, minimally invasive resection of lumbar synovial cysts, without fusion, could minimize surgically induced segmental instability while providing good pain relief. Methods Clinical and radiological outcomes of lumbar synovial cyst patients with and without spondylolisthesis were retrospectively compared. Pain outcomes were assessed with modified Macnab criteria. Results Fifty-three patients (18 with grade 1 spondylolisthesis) underwent minimally invasive synovial cyst resection and all had either excellent or good pain outcome at ≤ 8 post- operative weeks (P = 1.000, n = 53). At > 8 post-operative weeks (mean (SD) follow-up of 200 (175) weeks), excellent or good outcomes were noted in 89% of patients without spondylolisthesis and in 75% of patients with spondylolisthesis (P = 0.425, n = 40). Four patients developed a new grade 1 spondylolisthesis at a mean follow-up of 2.6 ± 2.1 years. Nine patients were assessed for spondylolisthesis measurements at 1.2 ± 1.3 years of follow up and no significant difference was observed (5 ± 0 vs 5 ± 1 mm; P = 0.791). Two patients without spondylolisthesis and none of the patients with spondylolisthesis had a synovial cyst recurrence. Conclusion Patients with concomitant lumbar degenerative spondylolisthesis and synovial cyst can have good short- and long-term clinical outcomes with minimally invasive surgery without fusion. Post-operative segmental instability does not appear to be significant in patients with spondylolisthesis. All patients included in this article signed an informed consent for the use of their medical information for research. PMID:27909658

  3. Comparative study of minimally invasive versus open esophagectomy for esophageal cancer in a single cancer center

    Institute of Scientific and Technical Information of China (English)

    Mu Juwei; Yuan Zuyang; Zhang Baihua; Li Ning; Lyu Fang; Mao Yousheng; Xue Qi

    2014-01-01

    Background In order to minimize the injury reaction during the surgery and reduce the morbidity rate,hence reducing the mortality rate of esophagectomy,minimally invasive esophagectomy (MIE) was introduced.The aim of this study was to compare the postoperative outcomes in patients with esophageal squamous cell carcinoma undergoing minimally invasive or open esophagectomy (OE).Methods The medical records of 176 consecutive patients,who underwent minimally invasive esophagectomy (MIE) between January 2009 and August 2013 in Cancer Institute & Hospital,Chinese Academy of Medical Sciences,were retrospectively reviewed.In the same period,142 patients who underwent OE,either Ivor Lewis or McKeown approach,were selected randomly as controls.The clinical variables of paired groups were compared,including age,sex,Charlson score,tumor location,duration of surgery,number of harvested lymph nodes,morbidity rate,the rate of leak,pulmonary morbidity rate,mortality rate,and hospital length of stay (LOS).Results The number of harvested lymph nodes was not significantly different between MIE group and OE group (median 20 vs.16,P=0.740).However,patients who underwent MIE had longer operation time than the OE group (375 vs.300 minutes,P <0.001).Overall morbidity,pulmonary morbidity,the rate of leak,in-hospital death,and hospital LOS were not significantly different between MIE and OE groups.Morbidities including anastomotic leak and pulmonary morbidity,inhospital death,hospital LOS,and hospital expenses were not significantly different between MIE and OE groups as well.Conclusions MIE and OE appear equivalent with regard to early oncological outcomes.There is a trend that hospital LOS and hospital expenses are reduced in the MIE group than the OE group.

  4. Minimally invasive neurosurgery with interventional magnetic resonance. Its present and future

    Energy Technology Data Exchange (ETDEWEB)

    Hashimoto, Takuo [Jikei Univ., Tokyo (Japan). School of Medicine

    2000-01-01

    We have used X-ray fluoroscopy, ultrasonography, and computed tomography in treatment. However, these methods do not provide precise image. Since magnetic resonance (MR) provides high-resolution images, it is more suitable in treatment. Recently open-type MR has been introduced for clinical diagnosis and treatment. Interventional MR provides a real-time images, high-resolutional images, and thermal distribution. Open MR can be used for minimally invasive neurosurgery. Interventional MR (I-MR) can be used in treatment and is extremely useful for minimally invasive surgery of the brain and spinal cord. We have used an open-type permanent MR scanner (Airis, Hitachi), for minimally invasive neurosurgery. Stereotactic brain tumor biopsy, aspiration of intracerebral hematoma, and percutaneous laser disc hernia ablation under MR guidance has been performed in our department. I-MR provided precise, and less-invasive treatment. Stereotactic biopsy was done in 12 patients with brain tumors. Precise, accurate biopsy is possible with MR fluoroscopic guidance. Hematomas were also aspirated safely and precisely by monitoring real-time image. Percutaneous laser disc hernia ablation (PLDA) was done in 201 patients with lumbar disc herniation (127 at L4/5 and 48 at L5/S1). Patients ranged in age from 17 to 72 years. A MR-compatible 18-gauge 15-cm-long titanium needle was clearly visualized and safety and accurately inserted into the disc herniation from multiple directions. Laser ablation was done (mean, 1,000 J). Signs and symptoms improved immediately after ablation. The overall success rate was 90.5% (MacNab's criteria). Two patients (1.0%) had discitis after PLDA. I-MR and fluoroscopy provide near-real-time images for treatment of brain tumors and hematoma. Precise treatment can be performed with the Patil MR-compatible stereotactic system. PLDA was performed safety and accurately with I-MR. The results were satisfactory. I-MR-PLDA is a safe, precise, and minimally

  5. Minimally invasive treatment of the thoracic spine disease: completely percutaneous and hybrid approaches.

    Science.gov (United States)

    Tamburrelli, Francesco Ciro; Francesco Ciro, Tamburrelli; Scaramuzzo, Laura; Laura, Scaramuzzo; Genitiempo, Maurizio; Maurizio, Genitiempo; Proietti, Luca; Luca, Proietti

    2013-01-01

    The aim of the study was to evaluate the feasibility of a limited invasive approach for the treatment of upper thoracic spine disease. Seven patients with type-A thoracic fractures and three with tumors underwent long thoracic stabilization through a minimally invasive approach. Four patients underwent a completely percutaneous approach while the other three underwent a modified hybrid technique, a combination of percutaneous and open approach. The hybrid constructs were realized using a percutaneous approach to the spine distally to the spinal lesion and by open approach proximally. In two patients, the stabilization was extended proximally up to the cervical spine. Clinical and radiographic assessment was performed during the first year after the operation at 3, 6, and 12 months. No technically related complications were seen. The postoperative recovery was rapid even in the tumor patients with neurologic impairment. Blood loss was irrelevant. At one-year follow-up there was no loosening or breakage of the screws or failure of the implants. When technically feasible a completely percutaneous approach has to be taken in consideration; otherwise, a combined open-percutaneous approach could be planned to minimize the invasivity of a completely open approach to the thoracic spine.

  6. Anterior Spinal Artery Syndrome: Reversible Paraplegia after Minimally Invasive Spine Surgery

    Directory of Open Access Journals (Sweden)

    J. Bredow

    2014-01-01

    Full Text Available Background Context. Percutaneous balloon kyphoplasty is an established minimally invasive technique to treat painful vertebral compression fractures, especially in the context of osteoporosis with a minor complication rate. Purpose. To describe the heparin anticoagulation treatment of paraplegia following balloon kyphoplasty. Study Design. We report the first case of an anterior spinal artery syndrome with a postoperative reversible paraplegia following a minimally invasive spine surgery (balloon kyphoplasty without cement leakage. Methods. A 75-year-old female patient underwent balloon kyphoplasty for a fresh fracture of the first vertebra. Results. Postoperatively, the patient developed an acute anterior spinal artery syndrome with motor paraplegia of the lower extremities as well as loss of pain and temperature sensation with retained proprioception and vibratory sensation. Complete recovery occurred six hours after bolus therapy with 15.000 IU low-molecular heparin. Conclusion. Spine surgeons should consider vascular complications in patients with incomplete spinal cord syndromes after balloon kyphoplasty, not only after more invasive spine surgery. High-dose low-molecular heparin might help to reperfuse the Adamkiewicz artery.

  7. Analysis and Management of Complications in a Cohort of 1,065 Minimally Invasive Cochlear Implantations

    Science.gov (United States)

    Jiang, Yi; Gu, Ping; Li, Beicheng; Gao, Xue; Sun, Baochun; Song, Yueshuai; Wang, Guojian; Yuan, Yongyi; Wang, Cuicui; Liu, Miao; Han, Dongyi; Dai, Pu

    2017-01-01

    Objectives: To analyze complications associated with minimally invasive cochlear implantation by comparing data from different centers, to discuss major reasons for complications, and to refine implantation techniques to decrease them. Patients: Patients who underwent cochlear implantation at our center by the same surgeon (the corresponding author of this article) from March 2006 to March 2015 were enrolled. Intervention: First, a retrospective analysis of the complications associated with minimally invasive cochlear implantation at our center was performed. Second, published reports from other centers that describe complications were reviewed. Differences between complications in our cohort and other studies were evaluated. Main Outcome Measure: Strategies for reducing complications were assessed and modifications in surgical protocol proposed accordingly. Results: In total, 1,014 patients underwent 1,065 cochlear implantations. There were 28 complications (7 major, 21 minor) and only 2 reimplantations for the entire cohort, with no case of severe infection, flap necrosis, or device extrusion. The major complications were electrode misplacement, magnet displacement, implant failure secondary to trauma, and temporary cerebrospinal fluid leakage. The rates of major complications in our cohort were very low (0.6%) compared with those in the literature. Conclusion: Preoperative surgical planning based on individual patient anatomy and employment of soft surgical techniques can minimize surgical complications. PMID:28192378

  8. A Potential Solution to Minimally Invasive Device for Oral Surgery: Evaluation of Surgical Outcomes in Rat

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    Keng-Liang Ou

    2015-01-01

    Full Text Available The objective of the present research was to investigate the thermal injury in the brain after minimally invasive electrosurgery using instruments with copper-doped diamond-like carbon (DLC-Cu surface coating. The surface morphologies of DLC-Cu thin films were characterized using scanning electron microscopy and atomic force microscopy. Three-dimensional brain models were reconstructed using magnetic resonance imaging to simulate the electrosurgical operation. In adult rats, a monopolar electrosurgical instrument coated with the DLC-Cu thin film was used to generate lesions in the brain. Animals were sacrificed for evaluations on postoperative days 0, 2, 7, and 28. Data indicated that the temperature decreased significantly when minimally invasive electrosurgical instruments with nanostructure DLC-Cu thin films were used and continued to decrease with increasing film thickness. On the other hand, the DLC-Cu-treated device created a relatively small thermal injury area and lateral thermal effect in the brain tissues. These results indicated that the DLC-Cu thin film minimized excessive thermal injury and uniformly distributed the temperature in the brain. Taken together, our study results suggest that the DLC-Cu film on copper electrode substrates is an effective means for improving the performance of electrosurgical instruments.

  9. A modified minimally invasive technique for the surgical management of large trichobezoars

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    Amit Javed

    2013-01-01

    Full Text Available Background: Trichobezoar which were traditionally managed by open surgical retrieval are now often managed by minimally invasive surgical approach. Removal of a large trichobezoar by laparoscopy, however, needs an incision (usually 4-5 cm in size for specimen removal and has the risk of intra-peritoneal spillage of hair and inspissated secretions. Materials and Methods : The present paper describes a modified laparoscopy-assisted technique with temporary gastrocutaneopexy for the effective removal of a large trichobezoar using a camera port and a 4-5 cm incision (which is similar to that needed for specimen removal during laparoscopy. Results: Three patients with large trichobezoar were managed with the described technique. The average duration of surgery was 45 (30-60 min and the intraoperative blood loss was minimal. There was no peritoneal spillage and the trichobezoar could be retrieved through a 4-5 cm incision in all patients. All had an uneventful recovery and at a median followup of 6 months had excellent cosmetic and functional results. Conclusion: The described technique is a minimally invasive alternative for trichobezoar removal. There is no risk of peritoneal contamination and the technical ease and short operative time in addition to an incision limited to size required for the specimen removal, makes it an attractive option.

  10. Prostatic urethral lift: A minimally invasive treatment for benign prostatic hyperplasia.

    Science.gov (United States)

    Garcia, Cindy; Chin, Peter; Rashid, Prem; Woo, Henry H

    2015-03-01

    Prostatic urethral lift (PUL) is a minimally invasive procedure for the treatment of lower urinary tract symptoms (LUTS) secondary to benign prostatic hyperplasia. The procedure may be performed under local, spinal, or general anesthesia. The PUL procedure involves the delivery of implants that retract obstructing prostate lobes. Unlike other benign prostatic hyperplasia treatment options including pharmacological therapy, and the current invasive gold-standard transurethral resection of the prostate, the PUL procedure achieves quantifiable improvements in functional outcomes and quality of life, in the absence of major adverse events. Furthermore, improvement in LUTS may be attained while preserving erectile and ejaculatory function. Adverse effects associated with the PUL procedure are mild to moderate, and are transient in nature. The PUL procedure provides an alternative for men seeking treatment for bothersome LUTS, with fewer side-effects.

  11. Minimal invasive stabilization of osteoporotic vertebral compression fractures. Methods and preinterventional diagnostics; Minimal-invasive Stabilisierung osteoporotischer Wirbelkoerpereinbrueche. Methodik und praeinterventionelle Diagnostik

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    Grohs, J.G.; Krepler, P. [Orthopaedische Klinik, Universitaet Wien (Austria)

    2004-03-01

    Minimal invasive stabilizations represent a new alternative for the treatment of osteoporotic compression fractures. Vertebroplasty and balloon kyphoplasty are two methods to enhance the strength of osteoporotic vertebral bodies by the means of cement application. Vertebroplasty is the older and technically easier method. The balloon kyphoplasty is the newer and more expensive method which does not only improve pain but also restores the sagittal profile of the spine. By balloon kyphoplasty the height of 101 fractured vertebral bodies could be increased up to 90% and the wedge decreased from 12 to 7 degrees. Pain was reduced from 7,2 to 2,5 points. The Oswestry disability index decreased from 60 to 26 points. This effects persisted over a period of two years. Cement leakage occurred in only 2% of vertebral bodies. Fractures of adjacent vertebral bodies were found in 11%. Good preinterventional diagnostics and intraoperative imaging are necessary to make the balloon kyphoplasty a successful application. (orig.) [German] Minimal-invasive Stabilisierungen stellen eine Alternative zur bisherigen Behandlung osteoporotischer Wirbelfrakturen dar. Die Vertebroplastie und die Ballonkyphoplastik sind 2 Verfahren, um die Festigkeit der Wirbelkoerper nach osteoporotischen Kompressionsfrakturen durch Einbringen von Knochenzement wieder herzustellen. Die Vertebroplastie ist die aeltere, technisch einfachere und kostenguenstigere Technik, geht allerdings regelmaessig mit Zementaustritt einher. Die Ballonkyphoplastik ist die neuere kostenintensivere Technologie, mit der abgesehen von der Schmerzreduktion auch die Wiederherstellung des sagittalen Profils der Wirbelsaeule angestrebt werden kann. Mit der Ballonkyphoplastik konnten bei 101 frakturierten Wirbelkoerpern die Hoehe auf fast 90% des Sollwertes angehoben und die lokale Kyphose von 12 auf 7 vermindert werden. Die Schmerzen wurden - gemessen anhand einer 10-teiligen Skala - von 7,2 auf 2,5 reduziert. Der Oswestry disability

  12. To ventilate or not after minimally invasive direct coronary artery bypass surgery : The role of epidural anesthesia

    NARCIS (Netherlands)

    de Vries, AJ; Mariani, MA; van der Maaten, JMAA; Loef, BG; Lip, H

    2002-01-01

    Objective: To evaluate the effect of immediate postoperative extubation and postoperative ventilation after minimally invasive direct coronary artery bypass (MIDCAB) surgery and to assess the role of epidural anesthesia. Design: Randomized prospective study. Setting: University hospital, single inst

  13. Minimally invasive treatment of the KobyGard system for plantar fasciitis:a retrospective study

    Institute of Scientific and Technical Information of China (English)

    XU Hai-lin; XU Lei; ZHANG Dian-ying; FU Zhong-guo; WANG Tian-bing; ZHANG Pei-xun; JIANG Bao-guo

    2012-01-01

    Background Calcodynia is a persistent condition that podiatric surgeons frequently see among their patients,and plantar fasciitis is the main reason for pain.When systematic conservative treatments fail to alleviate these conditions,it requires surgical intervention,mainly plantar fascia release surgery,which used to be an open heel release surgery.This study aimed to investigate whether minimally invasive treatment of the KobyGard system is more safe and effective for plantar fasciitis.Methods From May 2009 to May 2012,a total of nine patients,three males and six females with plantar fasciitis,were treated in the Peking University People's Hospital with minimally invasive instruments,the KobyGard system,for the release of plantar fascia.Three patients,experiencing bilateral calcaneodynia,underwent bilateral surgery.One patient had bilateral calcaneodynia with enthesiopathy of Achilles tendon,and underwent Achilles tendon surgery.Preoperative and postoperative Visual Analogue Scale(VAS),American Orthopaedic Foot and Ankle Society(AOFAS)ankle and hindfoot scores,Roles and Maudsley scores and SF-36 questionnaires were evaluated.Results The nine patients were successfully followed up.The average postoperative follow-up time was 13.2 months and it varied from 2.0 months to 21.0 months.Pre-and postoperative average scores of VAS was 9.3 and 1.9(P<0.001),respectively.Pre-and postoperative average scores of AOFAS hind foot was 36.0 and 82.0(P<0.001),respectively.There was also a statistically significant amelioration in SF-36 scores and the Roles and Maudlesy scores.Eight patients were satisfied with the surgery outcome.Conclusion Minimally invasive surgery treatment of the KobyGard system for plantar fasciitis has the advantages of shorter operation time,ease of operation,and similar satisfaction rates with open surgery,but with smaller surgical incision.

  14. Minimal invasive surgical correction of pectus excavatum deformities in adolescents: Our institutional experience

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    Jokić Radoica

    2013-01-01

    Full Text Available Introduction. Nuss procedure is a minimal invasive surgical technique based on retrosternal placement of a metal plate to correct pectus excavatum chest deformity. We are presenting our five­year (2006­2011 institutional experience of 21 patients. Objective. The aim of this study was to determine characteristics and advantages of minimal invasive surgical approach in correcting deformities of the chest. Methods. Surgical procedure, named after its author Nuss, involves the surgical placement of a molded metal plate, the so­called pectus bar, behind the sternum under thoracoscopic view whereby immediate controlled intraoperative corrections and stabilizations of the depression can be made. The great advantage of this method is reflected in a significant shortening of operative time, usually without indications for compensation in blood volume, and with a significantly shortened postoperative recovery that allows patients to quickly return to their normal activities. Results. In the period 2006­2011, 21 patients were operated by the Nuss procedure. The pectus bar was set in front or behind the muscles of the chest. Among the complications listed were inflammation of wounds in three patients, dislocation (shifting of the bar requiring a reoperation in two patients, an occurrence of a pericardial effusion in one patient, and allergic response to foreign body in one patient. Five patients required extraction of the bar two years later, and three patients after three years, all with excellent results. Conclusion. Minimally invasive Nuss procedure is safe and effective. It currently represents the primary method of choice for solving the chest deformity pectus excavatum for patients of all ages. Modification of thoracoscopic control allows a safe field of operation. Postoperative results are excellent with very few complications that can be attributed to the learning curve.

  15. Minimally-invasive posterior lumbar stabilization for degenerative low back pain and sciatica. A review.

    Science.gov (United States)

    Bonaldi, G; Brembilla, C; Cianfoni, A

    2015-05-01

    The most diffused surgical techniques for stabilization of the painful degenerated and instable lumbar spine, represented by transpedicular screws and rods instrumentation with or without interbody cages or disk replacements, require widely open and/or difficult and poorly anatomical accesses. However, such surgical techniques and approaches, although still considered "standard of care", are burdened by high costs, long recovery times and several potential complications. Hence the effort to open new minimally-invasive surgical approaches to eliminate painful abnormal motion. The surgical and radiological communities are exploring, since more than a decade, alternative, minimally-invasive or even percutaneous techniques to fuse and lock an instable lumbar segment. Another promising line of research is represented by the so-called dynamic stabilization (non-fusion or motion preservation back surgery), which aims to provide stabilization to the lumbar spinal units (SUs), while maintaining their mobility and function. Risk of potential complications of traditional fusion methods (infection, CSF leaks, harvest site pain, instrumentation failure) are reduced, particularly transitional disease (i.e., the biomechanical stresses imposed on the adjacent segments, resulting in delayed degenerative changes in adjacent facet joints and discs). Dynamic stabilization modifies the distribution of loads within the SU, moving them away from sensitive (painful) areas of the SU. Basic biomechanics of the SU will be discussed, to clarify the mode of action of the different posterior stabilization devices. Most devices are minimally invasive or percutaneous, thus accessible to radiologists' interventional practice. Devices will be described, together with indications for patient selection, surgical approaches and possible complications.

  16. Minimally-invasive posterior lumbar stabilization for degenerative low back pain and sciatica. A review

    Energy Technology Data Exchange (ETDEWEB)

    Bonaldi, G., E-mail: bbonaldi@yahoo.com [Neuroradiology Department, Ospedale Papa Giovanni XXIII, Bergamo (Italy); Brembilla, C. [Department of neurosurgery, Ospedale Papa Giovanni XXIII, Bergamo (Italy); Cianfoni, A. [Neuroradiology of Neurocenter of Italian Switzerland, Lugano, CH (Switzerland)

    2015-05-15

    The most diffused surgical techniques for stabilization of the painful degenerated and instable lumbar spine, represented by transpedicular screws and rods instrumentation with or without interbody cages or disk replacements, require widely open and/or difficult and poorly anatomical accesses. However, such surgical techniques and approaches, although still considered “standard of care”, are burdened by high costs, long recovery times and several potential complications. Hence the effort to open new minimally-invasive surgical approaches to eliminate painful abnormal motion. The surgical and radiological communities are exploring, since more than a decade, alternative, minimally-invasive or even percutaneous techniques to fuse and lock an instable lumbar segment. Another promising line of research is represented by the so-called dynamic stabilization (non-fusion or motion preservation back surgery), which aims to provide stabilization to the lumbar spinal units (SUs), while maintaining their mobility and function. Risk of potential complications of traditional fusion methods (infection, CSF leaks, harvest site pain, instrumentation failure) are reduced, particularly transitional disease (i.e., the biomechanical stresses imposed on the adjacent segments, resulting in delayed degenerative changes in adjacent facet joints and discs). Dynamic stabilization modifies the distribution of loads within the SU, moving them away from sensitive (painful) areas of the SU. Basic biomechanics of the SU will be discussed, to clarify the mode of action of the different posterior stabilization devices. Most devices are minimally invasive or percutaneous, thus accessible to radiologists’ interventional practice. Devices will be described, together with indications for patient selection, surgical approaches and possible complications.

  17. Clinical efficacy of three different minimally invasive procedures for far lateral lumbar disc herniation

    Institute of Scientific and Technical Information of China (English)

    LIU Tao; ZHOU Yue; WANG Jian; CHU Tong-wei; LI Chang-qing; ZHANG Zheng-feng; ZHANG Chad; ZHENG Wen-jie

    2012-01-01

    Background Far lateral lumbar disc hemiation (FLLDH) accounts for 2.6% to 11.7% of all lumbar herniated discs.Numerous surgical approaches have been described for treating this condition.The purpose of this study was to evaluate minimally invasive surgical techniques for the treatment of FLLDH.Methoda From June 2000 to March 2006,52 patients with FLLDH were treated with minimally invasive procedures.All patients were assessed by anteroposterior and lateral roentgenography and computed tomography (CT).Some patients underwent myelography,discography,and magnetic resonance imaging.Procedures performed included Yeung Endoscopy Spine System (YESS) (n=25),METRx MicroDiscectomy System (n=13),and X-tube (n=14).Patients were followed up for a mean of 13.5 months.Clinical outcomes were assessed using a visual analog scale (VAS) and Nakai criteria.Results All 3 procedures significantly improved radiating leg symptoms (P <0.005).After surgery,84.0%,84.6%,and 92.8% of patients in the YESS,METRx,and X-tube groups had excellent or good outcomes.There were no statistically significant differences of VAS scores between the groups.The YESS procedure was associated with the shortest operation time,simplest anesthesia,and least trauma compared with the other 2 procedures,especially for type Ⅰherniations.The METRx procedure was the most suitable for type Ⅱ herniations and posterior endoscopic facetectomy.Posterior lumbar interbody fusion and unilateral pedicle screw instrumentation with X-tube was the most suitable for herniations combined with degenerative lumbar instability (type Ⅲ).Conclusion Minimally invasive strategies and options should be determined with reference to the type of FLLDH.

  18. Minimally invasive keyhole approaches for removal of tumors of the third ventricle

    Institute of Scientific and Technical Information of China (English)

    LAN Qing; DONG Jun; HUANG Qiang

    2006-01-01

    Background In recent years, keyhole microsurgery has become an important subject of modem minimally invasive neurosurgery. In this study, minimally invasive techniques avoiding unnecessary tissue injuries were applied to refine traditional approaches for the removal of third ventricular tumors within a limited operative filed.Methods Individualized keyhole approaches were designed according to the characteristics of third ventricular tumors and their growth patterns. A series of keyhole approaches such as supraorbital subfrontal approach,infratentorial supracerebellar approach, interhemispheric transcallosal approach, pterional approach were taken to enter the third ventricle anteriorly, posteriorly, superiorly or laterally, respectively. A total of 34 removed tumors in or extended into the third ventricle included 11 craniopharyngiomas, 10 pituitary adenomas, 2 pinealomas, 1cholesteatoma, 3 germinomas, and 7 gliomas.Results Total tumor resection was done in 27 (79.4%) of the patients, and subtotal resection in 7 patients (20.6%). Residual tumor was due to tight adherence of germinoma to the vein of Galen (1 patient),craniopharyngioma to the pituitary stalk (3), supratentorial extension of pineal region gliomas (1), suprasellar extension of gliomas (1) and giant pituitary adenoma (1). Complications such as brain contusion, postoperative hemorrhage and infection were not associated with keyhole approaches. Extended incision or enlarged bone flap was not made because of episode during operation or inadequate exposure.Conclusions Keyhole approaches are safe, effective and minimally invasive in the surgical treatment of tumors deeply seated in the third ventricle. Individualized keyhole approach ensures a successful treatment. Tumors in the upper middle part of the third ventricle can be exposed by the interhemispheric transcallosal keyhole approach. Tumors of the posterior third ventricle may be well exposed by the infratentorial supracerebellar keyhole approach

  19. Percutaneous, Minimally Invasive Repair of Traumatic and Simultaneous Rupture of Both Achilles Tendons: A Case Report.

    Science.gov (United States)

    Zietek, Pawel; Karaczun, Maciej; Kruk, Bartosz; Szczypior, Karina

    2016-01-01

    Achilles injury is a common musculoskeletal disorder. Bilateral rupture of the Achilles tendon, however, is much less common and usually occurs spontaneously. Complete, traumatic, and bilateral ruptures are rare and typically require long periods of immobilization before the patient can return to full weightbearing. A 52-year-old male was hospitalized for bilateral traumatic rupture to both Achilles tendons. No risk factors for tendon rupture were found. Blood samples revealed no peripheral blood pathologic features. Both tendons were repaired with percutaneous, minimally invasive surgery using the Achillon(®) tendon suture system. Rehabilitation was begun 4 weeks later. An ankle-foot orthosis was prescribed to provide ankle support with an adjustable range of movement, and active plantar flexion was set at 0° to 30°. The patient remained non-weightbearing with the ankle-foot orthosis device and performed active range-of-motion exercises. At 8 weeks after surgery, we recommended that he begin walking with partial weightbearing using a foot-tibial orthosis with the range of motion set to 45° plantar flexion and 15° dorsiflexion. At 10 weeks postoperatively, he was encouraged to return to full weightbearing on both feet. Beginning rehabilitation as soon as possible after minimally invasive surgery, compared with 6 weeks of immobilization after surgery, provided a rapid resumption to full weightbearing. We emphasize the clinical importance of a safe, simple treatment program that can be followed for a patient with damage to the Achilles tendons. To our knowledge, ours is the first report of minimally invasive repair of bilateral simultaneous traumatic rupture of the Achilles tendon.

  20. Mast Quadrant-assisted Minimally Invasive Modified Transforaminal Lumbar Interbody Fusion: Single Incision Versus Double Incision

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    Xin-Lei Xia

    2015-01-01

    Full Text Available Background: The concept of minimally invasive techniques is to make every effort to reduce tissue damage. Certainly, reducing skin incision is an important part of these techniques. This study aimed to investigate the clinical feasibility of Mast Quadrant-assisted modified transforaminal lumbar interbody fusion (TLIF with a small single posterior median incision. Methods: During the period of March 2011 to March 2012, 34 patients with single-segment degenerative lumbar disease underwent the minimally invasive modified TLIF assisted by Mast Quadrant with a small single posterior median incision (single incision group. The cases in this group were compared to 37 patients with single-segment degenerative lumbar disease in the double incision group. The perioperative conditions of patients in these two groups were statistically analyzed and compared. The Oswestry Disability Index (ODI scores, Visual Analog Scale (VAS scores, and sacrospinalis muscle damage evaluation indicators before operation and 3, 12 months postoperation were compared. Results: A total of 31 and 35 cases in the single incision and double incision groups, respectively, completed at least 12 months of systemic follow-up. The differences in perioperative conditions between the two groups were not statistically significant. The incision length of the single incision group was significantly shorter than that of the double incision group (P < 0.01. The ODI and VAS scores of patients in both groups improved significantly at 3 and 12 months postoperation. However, these two indicators at 3 and 12 months postoperation and the sacrospinalis muscle damage evaluation indicators at 3 months postoperation did not differ significantly between the two groups (P ≥ 0.05. Conclusions: Mast Quadrant-assisted modified TLIF with a small single posterior median incision has excellent clinical feasibility compared to minimally invasive TLIF with a double paramedian incision.

  1. Mast Quadrant-assisted Minimally Invasive Modified Transforaminal Lumbar Interbody Fusion: Single Incision Versus Double Incision

    Institute of Scientific and Technical Information of China (English)

    Xin-Lei Xia; Hong-Li Wang; Fei-Zhou Lyu; Li-Xun Wang; Xiao-Sheng Ma; Jian-Yuan Jiang

    2015-01-01

    Background:The concept of minimally invasive techniques is to make every effort to reduce tissue damage.Certainly,reducing skin incision is an important part of these techniques.This study aimed to investigate the clinical feasibility of Mast Quadrant-assisted modified transforaminal lumbar interbody fusion (TLIF) with a small single posterior median incision.Methods:During the period of March 2011 to March 2012,34 patients with single-segment degenerative lumbar disease underwent the minimally invasive modified TLIF assisted by Mast Quadrant with a small single posterior median incision (single incision group).The cases in this group were compared to 37 patients with single-segment degenerative lumbar disease in the double incision group.The perioperative conditions of patients in these two groups were statistically analyzed and compared.The Oswestry Disability Index (ODI) scores,Visual Analog Scale (VAS) scores,and sacrospinalis muscle damage evaluation indicators before operation and 3,12 months postoperation were compared.Results:A total of 31 and 35 cases in the single incision and double incision groups,respectively,completed at least 12 months of systemic follow-up.The differences in perioperative conditions between the two groups were not statistically significant.The incision length of the single incision group was significantly shorter than that of the double incision group (P < 0.01).The ODI and VAS scores of patients in both groups improved significantly at 3 and 12 months postoperation.However,these two indicators at 3 and 12 months postoperation and the sacrospinalis muscle damage evaluation indicators at 3 months postoperation did not differ significantly between the two groups (P ≥ 0.05).Conclusions:Mast Quadrant-assisted modified TLIF with a small single posterior median incision has excellent clinical feasibility compared to minimally invasive TLIF with a double paramedian incision.

  2. Comparative study between open and minimally invasive approach in the surgical management of esophageal leiomyoma

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    Diego Ramos

    2016-01-01

    Full Text Available Introduction: Leiomyomas are the most common benign tumors of the esophagus. Although classically surgical enucleation through thoracotomy or laparotomy has been widely accepted as treatment of choice, development of endoscopic and minimally invasive procedures has completely changed the surgical management of these tumors. Material and methods: We performed a retrospective review of all esophageal leiomyoma operated at Hospital Universitario Ramón y Cajal (Madrid, Spain between January 1986 and December 2014, analyzing patients' demographic data, symptomatology, tumor size and location, diagnostic tests, surgical data, complications and postoperative stay. Results: Thirteen patients were found within that period, 8 men and 5 women, with a mean age of 53.62 years (range 35-70 years. Surgical enucleation was achieved in all patients. In 8 cases (61.54% a thoracic approach was performed (4 thoracotomies and 4 thoracoscopies, and in 5 cases (38.56% an abdominal approach was performed (3 laparotomies and 2 laparoscopies; enucleation was carried out through a minimally invasive approach in 6 patients (46.15%. There were no cases of endoscopic resection alone. Surgery mean length was 174.38 minutes (range 70-270 minutes and median postoperative stay was 6.5 days (range 2-27 days. There was neither mortality nor cases of intraoperative complications were described. No postoperative major complications were reported; however one patient presented important pain in his right hemithorax that required management and long term follow-up by the Pain Management Unit. With a mean follow-up of 165.57 months (median 170; range 29-336 months no recurrences were reported. Conclusion: Enucleation is the treatment of choice for the majority of esophageal leiomyomas. In our experience, duration of the surgical procedure through minimally invasive approach was longer than surgery through open approach; however, postoperative stay was shorter in the first group

  3. Value of transesophageal echocardiography (TEE) guidance in minimally invasive mitral valve surgery.

    Science.gov (United States)

    Ender, Jörg; Sgouropoulou, Sophia

    2013-11-01

    The role of intraoperative transesophageal echocardiography (TEE) has increased tremendously since its first use in 1979. Today intraoperative TEE is a class I indication for surgical mitral valve reconstruction for evaluation of mitral valve pathology, graduation of mitral regurgitation and detection of potential risk factors as well as post-repair assessment. Real-time three-dimensional TEE offers anatomical visualization of the mitral valve apparatus, fundamental for virtual surgical planning of proper annuloplasty ring size. As minimally invasive and even off-pump techniques for mitral valve repair become more popular, image guidance by intraoperative TEE will play an essential role.

  4. Minimally invasive surgery for rectal cancer:Are we there yet?

    Institute of Scientific and Technical Information of China (English)

    Bradley J Champagne; Rohit Makhija

    2011-01-01

    Laparoscopic colon surgery for select cancers is slowly evolving as the standard of care but minimally invasive approaches for rectal cancer have been viewed with significant skepticism.This procedure has been performed by select surgeons at specialized centers and concerns over local recurrence,sexual dysfunction and appropriate training measures have further hindered widespread acceptance.Data for laparoscopic rectal resection now supports its continued implementation and widespread usage by expeienced surgeons for select patients.The current controversies regarding technical approaches have created ambiguity amongst opinion leaders and are also addressed in this review.

  5. HE NEW METHOD OF MINIMALLY INVASIVE OSTEOSYTHESIS OF HUMERAL SHAFT FRACTURES WITH HELICAL PLATES

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    A. Y. Kochish

    2016-01-01

    Full Text Available The purpose of investigation is to approve the new method of minimally invasive plate osteosynthesis in cases of diaphyseal humeral shaft fractures with helical plate.Materials and methods. During experimental cadaveric part of the study implantation of long helical plate on humerus using minimally invasive technique on 14 fresh cadaveric shoulders was done. plate was inserted from two incisions 3-5 cm long in the upper part of the shoulder on the lateral side and in the lower part on the anterior side. Clinical part of the study included 31 patients with isolated humeral shaft fractures and humeral shaft fractures associated with fractures of proximal humerus and treated by minimally invasive fixation with helical plate.Results. Cadaveric study included preparation and special measuring and showed that implantation of the helical plate in proposed way gives safe distances between plate and axial, radial, musculocutaneous, median nerves, main humeral vessels and tendon of the long head of the biceps.Results of the clinical part of the study: radiological evidence of bone healing were observed on the 12 weeks in 10 from 28 cases (36%, on the 18 weeks in 18 from 25 (72%, on the 24 weeks in all 25 cases (100%. On the 24 weeks after surgery results on the DASH scale in average were 13±3,6 (from 3 to 36. Where in good results were in 17 (68% cases, satisfactory in 8 (32% cases. On the Constant Shoulder Score at the same time averege results were 80±4,63 (from 60 to 91. Exellent result was in 7 (28% cases, good in 12 (48%, satisfactory in 5 (20% cases and bad in one (4% case with subacromial impidgement after wrong plate positioning. There were no any cases of vascular and neurological complications and nonunions.Conclusion. Minimally invasive fixation of humeral shaft fractures with helical plates is safe and effective method of surgical treatment with good dynamic of functional rehabilitation and can be recommended for clinical use.

  6. Epiglottis reshaping using CO2 laser: a minimally invasive technique and its potent applications.

    Science.gov (United States)

    Bourolias, Constantinos; Hajiioannou, Jiannis; Sobol, Emil; Velegrakis, George; Helidonis, Emmanuel

    2008-07-25

    Laryngomalacia (LRM), is the most common laryngeal abnormality of the newborn, caused by a long curled epiglottis, which prolapses posteriorly. Epiglottis prolapse during inspiration (acquired laryngomalacia) is an unusual cause of airway obstruction and a rare cause of obstructive sleep apnea syndrome (OSAS). We present a minimally invasive technique where epiglottis on cadaveric larynx specimens was treated with CO2 laser. The cartilage reshaping effect induced by laser irradiation was capable of exposing the glottis opening widely. This technique could be used in selected cases of LRM and OSAS due to epiglottis prolapse as an alternative, less morbid approach.

  7. Epiglottis reshaping using CO2 laser: A minimally invasive technique and its potent applications

    Directory of Open Access Journals (Sweden)

    Velegrakis George

    2008-07-01

    Full Text Available Abstract Laryngomalacia (LRM, is the most common laryngeal abnormality of the newborn, caused by a long curled epiglottis, which prolapses posteriorly. Epiglottis prolapse during inspiration (acquired laryngomalacia is an unusual cause of airway obstruction and a rare cause of obstructive sleep apnea syndrome (OSAS. We present a minimally invasive technique where epiglottis on cadaveric larynx specimens was treated with CO2 laser. The cartilage reshaping effect induced by laser irradiation was capable of exposing the glottis opening widely. This technique could be used in selected cases of LRM and OSAS due to epiglottis prolapse as an alternative, less morbid approach.

  8. Occlusion of atrial septal defect utilizing occluder devise via minimally invasive right chest approach

    Institute of Scientific and Technical Information of China (English)

    励峰; 李伟; 康宁; 龚宝生; 吴东进; 徐方杰; 邱兆昆; 吴卫华

    2011-01-01

    Objective To evaluate atrial septal defect (ASD) occlusion employing a small right anterior thoracotomy approach. Methods A total of 21 patients with ASD underwent general anesthesia and 2 -3 cm incision was made in the fourth right intercostal space. Utilizing transesophageal or transthoracic echocardiography, the occluder was released using a monotube unit. Results All patients were occluded successfully. No patient required open surgery utilizing extracorporeal circulation. There were no major complications and no evidence of residual atrial shunt. Conclusion ASD occlusion via a minimal surgical incision is safe, less invasive, and has excellent outcomes.

  9. Minimal invasive transforaminal lumbar interbody fusion versus open transforaminal lumbar interbody fusion

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    Arvind G Kulkarni

    2016-01-01

    Conclusion: The results in MI TLIF are comparable with O-TLIF in terms of outcomes. The advantages of MI-TLIF are lesser blood loss, shorter hospital stay, lesser tissue trauma, and early mobilization. The challenges of MI-TLIF lie in the steep learning curve and significant radiation exposure. The ultimate success of TLIF lies in the execution of the procedure, and in this respect the ability to achieve similar results using a minimally invasive technique makes MI-TLIF an attractive alternative.

  10. Minimally invasive corticotomy in orthodontics: a new technique using a CAD/CAM surgical template.

    Science.gov (United States)

    Cassetta, M; Pandolfi, S; Giansanti, M

    2015-07-01

    Accelerating orthodontic tooth movement is a topical issue. Despite the different techniques described in the literature, the corticotomy is the only effective and safe means of accelerating orthodontic tooth movement. Although effective, the corticotomy presents significant postoperative discomfort. The aggressive nature of these particular methods, related to the elevation of mucoperiosteal flaps and to the length of the surgery, has resulted in reluctance to proceed with this technique among both patients and the dental community. To overcome the disadvantages of the corticotomy, this technical note describes an innovative, minimally invasive, flapless procedure combining piezoelectric surgical cortical micro-incisions with the use of a 3D Printed CAD/CAM surgical guide.

  11. Minimal-invasive posterior approach for total hip arthroplasty versus standard lateral approach.

    Science.gov (United States)

    Schleicher, Iris; Haas, Holger; Adams, Tim S; Szalay, Gabor; Klein, Heiko; Kordelle, Jens

    2011-08-01

    In this prospective study we compared clinical and radiological results and rehabilitation progress of 64 patients who underwent total hip arthroplasty using the standard lateral approach with 64 patients operated with a minimal-invasive (MIS) posterior approach. The outcome of our study did not show any significant differences with regard to patient's safety such as complication rate and radiological assessment of the cup position. There was no difference in the duration of surgery, blood loss, hospital stay and postoperative leg length discrepancy. Rehabilitation milestones were achieved earlier by MIS patients and three and six months postoperatively, the Harris Hip Score of the MIS group was significantly higher.

  12. Optimization Algorithm for Operation Comfortability of Master Manipulator of Minimally Invasive Surgery Robot

    Institute of Scientific and Technical Information of China (English)

    李进华; 王雪生; 邢元; 王树新; 李建民; 梁科

    2016-01-01

    To evaluate the operation comfortability in the master-slave robotic minimally invasive surgery (MIS), an optimal function was built with two operation comfortability decided indices, i.e., the center distance and volume contact ratio. Two verifying experiments on Phantom Desktop and MicroHand S were conducted. Experimental results show that the operation effect at the optimal relative location is better than that at the random location, which means that the optimal function constructed in this paper is effective in optimizing the operation comfortability.

  13. Real-time stereo generation for surgical vision during minimal invasive robotic surgery

    Science.gov (United States)

    Laddi, Amit; Bhardwaj, Vijay; Mahapatra, Prasant; Pankaj, Dinesh; Kumar, Amod

    2016-03-01

    This paper proposes a framework for 3D surgical vision for minimal invasive robotic surgery. It presents an approach for generating the three dimensional view of the in-vivo live surgical procedures from two images captured by very small sized, full resolution camera sensor rig. A pre-processing scheme is employed to enhance the image quality and equalizing the color profile of two images. Polarized Projection using interlacing two images give a smooth and strain free three dimensional view. The algorithm runs in real time with good speed at full HD resolution.

  14. Minimally invasive management of metastases from gastrointestinal stromal tumors; Minimalinvasive Therapieoptionen bei Metastasen gastrointestinaler Stromatumoren

    Energy Technology Data Exchange (ETDEWEB)

    Kamusella, P.C.; Bethke, A.; Platzek, I.; Wiggermann, P.; Wissgott, C.; Stroszczynski, C. [Universitaetsklinikum Dresden, Radiologisches Institut, Dresden (Germany)

    2009-12-15

    Minimally invasive radiological procedures can lead to an improvement in the prognosis and the clinical symptoms in cases of metastases of gastro-intestinal stromal tumors (GIST) in the context of multimodal therapy concepts. In the context of interdisciplinary therapy decision-making radiofrequency ablation (RFA) and transarterial tumor embolization should be considered. (orig.) [German] Minimalinvasive radiologische Verfahren koennen bei Metastasierung eines gastrointestinalen Stromatumors (GIST) im Rahmen multimodaler Therapiekonzepte zu einer Verbesserung der Prognose und klinischen Symptomatik fuehren. Im Rahmen des interdisziplinaeren Therapienentscheids sollten die Radiofrequenzablation (RFA) und die transarterielle Tumorembolisation in Betracht gezogen werden. (orig.)

  15. [Minimally invasive technique for harvesting a saphenous vein via one small incision].

    Science.gov (United States)

    Sato, M; Suenaga, E; Koga, S; Matsuyama, S

    2007-08-01

    We report a minimally invasive technique for harvesting a saphenous vein graft (SVG) via 1 small skin incision. The expected advantages of this technique are better cosmetic results and fewer wound complications than the conventional open technique or the bridging technique. The SVG, 10-15 cm in length, can be harvested by about 3 cm-long single small skin incision. SaphLITE Retractor System (Genzyme Srugical Products, Cambridge), SLS Hematostatic Clip System (Vitalitec International, Plymouth), and curved scissors were necessary instruments for this technique. It is feasible for cases that require a shorter length of SVG.

  16. 食管癌的微创术%Minimal Invasive Surgery for Esophageal Cancer

    Institute of Scientific and Technical Information of China (English)

    A.H.H(o)lscher; Ch.Gutschow

    2004-01-01

    Thoracoscopic esophagectomy is only established in some centers and affords a cervical anastomosis because intrathoracic anastomosis as a routine is technically too difficult. Laparoscopic mobilisation of the stomach (gastrolysis) is an important contribution for minimal invasive surgery of esophageal cancer.This procedure reduces the stress of the two cavity operation for the patient and allows the construction of a comparable gastric conduit like by open surgery. The technique of laparoscopic gastrolysis as preparation for transthoracic en bloc esophagectomy is described in detail and preliminary results are briefly mentioned.

  17. Experimental study on treatment of acetabular anterior column fractures: applyment of a minimally invasive percutaneous lag screw guide apparatus

    OpenAIRE

    Zhang, Li-hai; Zhang, Li-cheng; Si, Qing-hua; Gao, Yuan; Su, Xiu-Yun; Zhao, Zhe; Tang, Pei-Fu

    2016-01-01

    Background The aim of this study was to design a new minimally invasive percutaneous lag screw guide apparatus and to verify its adjuvant treatment of acetabular anterior column fracture on pelvis specimens. Methods This guide apparatus was self-developed based on the principles of “two points form a line” and “Rectangle”. Using C-arm fluoroscopy, this guide apparatus was used to conduct minimally invasive percutaneous lag screw internal fixation of acetabular anterior column fractures. Ten h...

  18. How I do it: self-retaining atrial retractors for robotic and minimally invasive mitral valve surgery.

    Science.gov (United States)

    Ishikawa, Norihiko; Sun, You Su; Nifong, L Wiley; Watanabe, Go; Chitwood, W Randolph

    2007-01-01

    Successful surgery, particularly on the heart valves, is dependent on excellent and consistent exposure of the operative field. In this report, we describe 2 types of new atrial retractors designed for robotic and minimally invasive mitral valve surgery. These simple and easy-to-handle atrial retractors provide exceptional and consistent exposure of the left atrium in robotic and minimally invasive mitral valve surgery and prevent traumatic injury.

  19. Minimally invasive blood sampling method for genetic studies on Gopherus tortoises

    Directory of Open Access Journals (Sweden)

    García–Feria, L. M.

    2015-04-01

    Full Text Available Obtaining good quality tissue samples is the first hurdle in any molecular study. This is especially true for studies involving management and conservation of wild fauna. In the case of tortoises, the most common sources of DNA are blood samples. However, only a minimal amount of blood is required for PCR assays. Samples are obtained mainly from the brachial and jugular vein after restraining the animal chemically, or from conscious individuals by severe handling methods and clamping. Herein, we present a minimally invasive technique that has proven effective for extracting small quantities of blood, suitable for genetic analyses. Furthermore, the samples obtained yielded better DNA amplification than other cell sources, such as cloacal epithelium cells. After two years of use on wild tortoises, this technique has shown to be harmless. We suggest that sampling a small amount of blood could also be useful for other types of analyses, such as physiologic and medical monitoring.

  20. Central acetabular fracture with dislocation treated by minimally invasive plate osteosynthesis.

    Science.gov (United States)

    2015-06-01

    Central acetabular fractures with dislocation are usually the result of high-energy trauma, resulting in joint incongruity, and are frequently associated with other injuries. Open reduction and internal fixation has been the standard treatment for acetabular fractures, but it is associated with extensive surgical trauma, and complications such as haematoma formation, iatrogenic nerve injury, and heterotopic ossification. We present the case of a 63-year-old female who sustained a central acetabular fracture of the hip with dislocation as a result of an automobile collision. Closed reduction of the dislocation was performed, and the fracture was managed by minimally invasive plate osteosynthesis using a specially prepared plate. At 01 year postoperatively, radiographs showed the fracture to have been well-healed with good congruity of the joint. However, heterotopic ossification of the joint was noted. The technique allowed reduction of the fracture with minimal surgical trauma.

  1. [Minimally invasive surgery and the economics of it. Can minimally invasive surgery be cost efficient from a business point of view?].

    Science.gov (United States)

    Ritz, J P; Stufler, M; Buhr, H J

    2007-06-01

    Minimally invasive surgery (MIS) is now accepted as equally valid as the use of a standard access in some areas of surgery. It is not possible to decide whether this access is economically worthwhile and if so for whom without a full economic cost-benefit analysis, which must take account of the hospital's own characteristics in addition to the cost involved for surgery, staff, infrastructure and administration. In summary, the main economic advantage of MIS lies in the patient-related early postoperative results, while the main disadvantage is that the operative material costs are higher. At present, the payment made for each procedure performed under the DRG system includes 14-17% of the total cost for materials, regardless of the access route and of the technical sophistication of the operation. The actual material costs are greater by a factor of 2-50 for MIS than for a conventional procedure. The task of the hospital is thus to lower the costs for material and infrastructure; that of industry is to offer less expensive alternatives; and that of our politicians, to implement better remuneration of the material costs.

  2. Differentiating pre- and minimally invasive from invasive adenocarcinoma using CT-features in persistent pulmonary part-solid nodules in Caucasian patients

    Energy Technology Data Exchange (ETDEWEB)

    Cohen, Julien G., E-mail: JCohen@chu-grenoble.fr [Clinique Universitaire de Radiologie et Imagerie Médicale (CURIM), Université Joseph Fourier, Centre Hospitalier Universitaire de Grenoble, CS 10217, 38043 Grenoble Cedex 9 (France); Reymond, Emilie [Clinique Universitaire de Radiologie et Imagerie Médicale (CURIM), Université Joseph Fourier, Centre Hospitalier Universitaire de Grenoble, CS 10217, 38043 Grenoble Cedex 9 (France); Lederlin, Mathieu [Service de Radiologie, Université Segalen Bordeaux, Centre Hospitalier Universitaire de Bordeaux, 12 rue Dubernat, 33404 Bordeaux Cedex (France); Medici, Maud [Centre d’Investigation Clinique – Innovation Technologique (CIC-IT), Pavillon Taillefer, 38706 La Tronche Cedex (France); Lantuejoul, Sylvie [Departement d’Anatomie et Cytologie Pathologique (DACP), Université Joseph Fourier, Centre Hospitalier Universitaire de Grenoble, CS 10217, 38043 Grenoble Cedex 9 (France); Laurent, François [Service de Radiologie, Université Segalen Bordeaux, Centre Hospitalier Universitaire de Bordeaux, 12 rue Dubernat, 33404 Bordeaux Cedex (France); Arbib, François [Departement de Pneumologie, Université Joseph Fourier, Centre Hospitalier Universitaire de Grenoble, CS 10217, 38043 Grenoble Cedex 9 (France); Jankowski, Adrien [Clinique Universitaire de Radiologie et Imagerie Médicale (CURIM), Université Joseph Fourier, Centre Hospitalier Universitaire de Grenoble, CS 10217, 38043 Grenoble Cedex 9 (France); and others

    2015-04-15

    Highlights: •We analyzed CT-features of part-solid ground glass nodules in Caucasians. •These CT-features were compared to pathology on full resection specimen. •Several CT-features can help differentiating invasive adenocarcinoma. •A solid component larger than 5 mm had 100% sensitivity for invasive adenocarcinoma. -- Abstract: Objective: To retrospectively investigate the diagnostic value of pre-operative CT-features between pre/minimally invasive and invasive lesions in part-solid persistent pulmonary ground glass nodules in a Caucasian population. Materials and methods: Retrospective review of two pre-operative CTs for 31 nodules in 30 patients. There were 10 adenocarcinomas in situ, 1 minimally invasive adenocarcinoma, 20 invasive adenocarcinomas. We analyzed the correlation between histopathology and the following CT-features: maximal axial diameter, maximal orthogonal axial diameter, height, density, size of solid component, air bronchogram, pleural retraction, nodule mass, disappearance rate and their evolution during follow-up. Results: In univariate analysis, invasive adenocarcinomas had a higher maximal height, density, solid component size, mass, a lower disappearance rate and presented more often with pleural retraction (p < 0.05). After logistic regression performed with the uncorrelated parameters using a method of selection of variables, only the size of solid component remained significant, with 100% sensitivity for invasive adenocarcinoma when larger than 5 mm. Conclusion: Preoperative CT-features can help differentiating in situ and minimally invasive adenocarcinomas from invasive adenocarcinomas in Caucasian patients. A solid component larger than 5 mm in diameter had 100% sensitivity for the diagnosis of invasive adenocarcinoma.

  3. Minimally invasive lateral trans-psoas approach for tuberculosis of lumbar spine

    Directory of Open Access Journals (Sweden)

    Nitin Garg

    2014-01-01

    Full Text Available Anterior, posterolateral and posterior approaches are used for managing lumbar tuberculosis. Minimally invasive methods are being used increasingly for various disorders of the spine. This report presents the utility of lateral trans-psoas approach to the lumbar spine (LS using minimal access techniques, also known as direct lateral lumbar interbody fusion in 2 cases with tuberculosis of LS. Two patients with tuberculosis at L2-3 and L4-5 presented with back pain. Both had destruction and deformity of the vertebral body. The whole procedure comprising debridement and placement of iliac crest graft was performed using tubular retractors and was augmented by posterior fixation using percutaneous transpedicular screws. Both patients recovered well with no significant procedure related morbidity. Post-operative computed tomography scans showed appropriate position of the graft and instrumentation. At follow-up, both patients are ambulant with no progression of the deformity. Minimal access direct lateral transpsoas approach can be used for debridement and reconstruction of ventral column in tuberculous of Lumbar spine. This paper highlights the growing applications of minimal access surgery for spine.

  4. Minimalism

    CERN Document Server

    Obendorf, Hartmut

    2009-01-01

    The notion of Minimalism is proposed as a theoretical tool supporting a more differentiated understanding of reduction and thus forms a standpoint that allows definition of aspects of simplicity. This book traces the development of minimalism, defines the four types of minimalism in interaction design, and looks at how to apply it.

  5. A fiber optic approach for in vivo minimally invasive study of tissue optical properties

    Science.gov (United States)

    Ilev, Ilko K.; Waynant, Ronald W.; Byrnes, Kimberly R.; Anders, Juanita

    2004-06-01

    Based on a fiber-optic approach, we present a fundamental in vivo study of optical properties and light transmission characteristics of single and multiple tissue layers and blood in a Sprague Dawley rat model. In our experiments, we utilize either coherent laser sources with various energy and spectral characteristics or incoherent light sources in a broadband spectral range covering the visible and near-infrared (from 400 nm to 1200 nm). The measurement techniques are based on a simple minimally invasive fiber-optic light delivery system that provides an effective method for homogeneously and precisely controlling the light irradiation of the tissue medium as well as being a highly sensitive detector of the tissue's scattered light. The delivery-sensor probes are placed into different tissue layers (skin, sub-cutaneous connective and deep connective tissue, back muscle, bone and spinal cord) and blood, and broadband spectral transmission characteristics of these media are measured in vivo. The transmission spectra are analyzed in order to determine the specificity of interaction of different tissues with light. The main goal is to determine the most effective coherent or incoherent light sources and their optimal parameters that might be used for minimally invasive therapeutic and optical diagnostics techniques.

  6. An interventional multispectral photoacoustic imaging platform for the guidance of minimally invasive procedures

    Science.gov (United States)

    Xia, Wenfeng; Nikitichev, Daniil I.; Mari, Jean Martial; West, Simeon J.; Ourselin, Sebastien; Beard, Paul C.; Desjardins, Adrien E.

    2015-07-01

    Precise and efficient guidance of medical devices is of paramount importance for many minimally invasive procedures. These procedures include fetal interventions, tumor biopsies and treatments, central venous catheterisations and peripheral nerve blocks. Ultrasound imaging is commonly used for guidance, but it often provides insufficient contrast with which to identify soft tissue structures such as vessels, tumors, and nerves. In this study, a hybrid interventional imaging system that combines ultrasound imaging and multispectral photoacoustic imaging for guiding minimally invasive procedures was developed and characterized. The system provides both structural information from ultrasound imaging and molecular information from multispectral photoacoustic imaging. It uses a commercial linear-array ultrasound imaging probe as the ultrasound receiver, with a multimode optical fiber embedded in a needle to deliver pulsed excitation light to tissue. Co-registration of ultrasound and photoacoustic images is achieved with the use of the same ultrasound receiver for both modalities. Using tissue ex vivo, the system successfully discriminated deep-located fat tissue from the surrounding muscle tissue. The measured photoacoustic spectrum of the fat tissue had good agreement with the lipid spectrum in literature.

  7. An augmented reality platform for planning of minimally invasive cardiac surgeries

    Science.gov (United States)

    Chen, Elvis C. S.; Sarkar, Kripasindhu; Baxter, John S. H.; Moore, John; Wedlake, Chris; Peters, Terry M.

    2012-02-01

    One of the fundamental components in all Image Guided Surgery (IGS) applications is a method for presenting information to the surgeon in a simple, effective manner. This paper describes the first steps in our new Augmented Reality (AR) information delivery program. The system makes use of new "off the shelf" AR glasses that are both light-weight and unobtrusive, with adequate resolution for many IGS applications. Our first application is perioperative planning of minimally invasive robot-assisted cardiac surgery. In this procedure, a combination of tracking technologies and intraoperative ultrasound is used to map the migration of cardiac targets prior to selection of port locations for trocars that enter the chest. The AR glasses will then be used to present this heart migration data to the surgeon, overlaid onto the patients chest. The current paper describes the calibration process for the AR glasses, their integration into our IGS framework for minimally invasive robotic cardiac surgery, and preliminary validation of the system. Validation results indicate a mean 3D triangulation error of 2.9 +/- 3.3mm, 2D projection error of 2.1 +/- 2.1 pixels, and Normalized Stereo Calibration Error of 3.3.

  8. Effectiveness of treatment of transtrochanteric fractures with Dynamic Hip Screws using minimally invasive access☆

    Science.gov (United States)

    de Abreu, Eduardo Lima; Sena, Caroline Brum; Saldanha Rodrigues Filho, Sergio Antonio

    2016-01-01

    Objective To analyze the short-term results from treating unstable intertrochanteric fractures with Dynamic Hip Screws (DHS), using a minimally invasive route, focusing on the functional aspects and complication and mortality rates of the method. Methods This was a prospective longitudinal study on 140 patients who underwent fixation of transtrochanteric fractures with the DHS system with a lateral minimally invasive access in the hip, between January and December 2013. The patients were evaluated pre and postoperatively (after six months of follow-up) by means of the Parker and Palmer mobility score. Women comprised 65.7% of the sample, and 54.3% of the fractures were on the right side. The patients’ mean age was 80 years, ranging from 60 to 93 years. Results We observed an overall decrease in the mobility score and an increase in the degree of dependence over the short term. However, we encountered only two deaths in the study sample and there were no cases of infection or nonunion. Conclusion Despite the efficacy of the treatment with DHS, with high rates of fracture consolidation and a low mortality rate, we noted that the patients still showed significant functional limitation at the follow-up six months after the operation. PMID:27069880

  9. Minimally-invasive treatment of communicating hydrocephalus using a percutaneous lumboperitoneal shunt

    Institute of Scientific and Technical Information of China (English)

    Lu JIA; Guo-ping LI; Zhong-xin ZHAO; Chao YOU; Jia-gang LIU; Si-qing HUANG; Min HE; Pei-gang JI; Jie DUAN; Yi-jun ZENG

    2011-01-01

    Objective: To investigate the clinical value of a minimally-invasive treatment of communicating hydrocephalus using a percutaneous lumboperitoneal (LP) shunt. Method: The clinical and long-term follow-up data of 256 patients suffering from communicating hydrocephalus and undergoing percutaneous LP shunt during 1998 to 2008 were retrospectively analyzed. Results: After the follow-up, which lasted 6 months to 10 years, 219 cases of communicating hydrocephalus recovered well (ventricular size returned to normal and symptoms completely disappeared),25 cases were brought under control (ventricle size reduced by 50% and symptoms partially abated), and 12 cases showed no obvious changes. Fifteen obese subjects needed modifications of the shunt due to the obstruction of the abdominal end following wrapping, and one subject underwent extubation as the subject was unable to tolerate stimulation of the cauda equina. The effectiveness of shunting was 91.40% and the probability of shunt-tube obstruction, which occurs predominantly in the abdominal end, was only 5.85%, far lower than that of ventriculoperitoneal (VP)shunt. Three subjects had a history of infection following VP shunting. Conclusion: LP shunting is minimally invasive and effective in treating communicating hydrocephalus, with fewer complications.

  10. Minimally invasive selective osteotomy of the knee: A new surgical technique.

    Science.gov (United States)

    Leon, H O; Blanco, C E; Guthrie, T B

    2001-05-01

    We present a simple surgical technique created by the authors to address degenerative chondral lesions of the knee and its application in a limited prospective case series. The technique assumes the concept of beneficial epiphyseal changes caused by disruption of the subchondral bone in improving symptoms, as with drilling, microfracture, periarticular osteotomy, and other invasive procedures. Minimally invasive selective osteotomy (MISO) is an expansion of the arthroscopic treatment of the knee, specifically targeting symptomatic lesions with minimal additional trauma and cost, while avoiding disruption of the articular surface of the subchondral bone. The technique involves a mimimal access approach with selective saw cuts placed with a 1-cm oscillating blade parallel to the joint surface 1 to 1.5 cm deep to identified lesions. The technique does not address malalignment but can address lesions not addressed by classic osteotomies and, as such, may be combined with other corrective alignment procedures as necessary. We present the results of MISO of the knee in a case series of 62 outpatients carried out at the Orthopaedic Division of the Clinical and Surgical Hermanos Ameijeiras Hospital in Havana, Cuba. At 2-year follow-up, there was improvement of symptoms without significant complications.

  11. MANAGEMENT OF COMMINUTED FRACTURES OF LOWER EXTREMITY WITH MINIMALLY INVASIVE PLATE OSTEOSYNTHESIS

    Directory of Open Access Journals (Sweden)

    Kapil A

    2015-07-01

    Full Text Available Comminuted multi fragmentary periarticular fractures are always a challenge to manage even today. Results of conservative management and ORIF by traditional methods are associated with number of complications. This study evaluate the role of minimally invasive plate osteosynthesis in management of such fractures. Seventeen (17 multi fragmentary fractures of long bones of lower extremity (in 15 patients were treated in t he present prospective study using the technique of minimally invasive plate osteosynthesis (MIPO. There were 11 cases of supracondylar fracture femur, two intra articular, 3 cases of proximal tibial fractures, 2 cases of tibial shaft fractures and 1 cases of subtrochanteric fracture. Mean age of the patients was 45.6 years with 13 male and 2 female patients. Most fractures were caused by high velocity road traffic accidents. Average injury surgery interval was 8.64 days. Average operative time was 67.35 mi nutes. Average period of union was 19.17 weeks and average period for full weight bearing was 15 weeks. Average hospital stay was 18.41 days. All fractures went on to union. Incidence of complications was low. Range of motion at the proximal and distal joi nts was excellent. Overall 93.33% (16 of 17 cases had excellent to good results.

  12. Kinematic, workspace and singularity analysis of a new parallel robot used in minimally invasive surgery

    Science.gov (United States)

    Stoica, Alin; Pisla, Doina; Andras, Szilaghyi; Gherman, Bogdan; Gyurka, Bela-Zoltan; Plitea, Nicolae

    2013-03-01

    In the last ten years, due to development in robotic assisted surgery, the minimally invasive surgery has greatly changed. Until now, the vast majority of robots used in surgery, have serial structures. Due to the orientation parallel module, the structure is able to reduce the pressure exerted on the entrance point in the patient's abdominal wall. The parallel robot can also handle both a laparoscope as well an active instrument for different surgical procedures. The advantage of this parallel structure is that the geometric model has been obtained through an analytical approach. The kinematic modelling of a new parallel architecture, the inverse and direct geometric model and the inverse and direct kinematic models for velocities and accelerations are being determined. The paper will demonstrate that with this parallel structure, one can obtain the necessary workspace required for a minimally invasive operation. The robot workspace was generated using the inverse geometric model. An indepth study of different types of singularity is performed, allowing the development of safe control algorithms of the experimental model. Some kinematic simulation results and the experimental model of the robot are presented in the paper.

  13. Productivity benefits of minimally invasive surgery in patients with chronic sacroiliac joint dysfunction

    Directory of Open Access Journals (Sweden)

    Saavoss JD

    2016-04-01

    Full Text Available Josh D Saavoss,1 Lane Koenig,1 Daniel J Cher2 1KNG Health Consulting, LLC, Rockville, MD, 2SI-BONE, Inc., San Jose, CA, USA Introduction: Sacroiliac joint (SIJ dysfunction is associated with a marked decrease in quality of life. Increasing evidence supports minimally invasive SIJ fusion as a safe and effective procedure for the treatment of chronic SIJ dysfunction. The impact of SIJ fusion on worker productivity is not known. Methods: Regression modeling using data from the National Health Interview Survey was applied to determine the relationship between responses to selected interview questions related to function and economic outcomes. Regression coefficients were then applied to prospectively collected, individual patient data in a randomized trial of SIJ fusion (INSITE, NCT01681004 to estimate expected differences in economic outcomes across treatments. Results: Patients who receive SIJ fusion using iFuse Implant System® have an expected increase in the probability of working of 16% (95% confidence interval [CI] 11%–21% relative to nonsurgical patients. The expected change in earnings across groups was US $3,128 (not statistically significant. Combining the two metrics, the annual increase in worker productivity given surgical vs nonsurgical care was $6,924 (95% CI $1,890–$11,945. Conclusion: For employees with chronic, severe SIJ dysfunction, minimally invasive SIJ fusion may improve worker productivity compared to nonsurgical treatment. Keywords: sacroiliac joint fusion, low back pain, sacroiliac joint pain, clinical trial, health care costs, indirect costs

  14. A Minimally-invasive Blood-derived Biomarker of Oligodendrocyte Cell-loss in Multiple Sclerosis.

    Science.gov (United States)

    Olsen, John A; Kenna, Lauren A; Tipon, Regine C; Spelios, Michael G; Stecker, Mark M; Akirav, Eitan M

    2016-08-01

    Multiple sclerosis (MS) is a neurodegenerative disease of the central nervous system (CNS). Minimally invasive biomarkers of MS are required for disease diagnosis and treatment. Differentially methylated circulating-free DNA (cfDNA) is a useful biomarker for disease diagnosis and prognosis, and may offer to be a viable approach for understanding MS. Here, methylation-specific primers and quantitative real-time PCR were used to study methylation patterns of the myelin oligodendrocyte glycoprotein (MOG) gene, which is expressed primarily in myelin-producing oligodendrocytes (ODCs). MOG-DNA was demethylated in O4(+) ODCs in mice and in DNA from human oligodendrocyte precursor cells (OPCs) when compared with other cell types. In the cuprizone-fed mouse model of demyelination, ODC derived demethylated MOG cfDNA was increased in serum and was associated with tissue-wide demyelination, demonstrating the utility of demethylated MOG cfDNA as a biomarker of ODC death. Collected sera from patients with active (symptomatic) relapsing-remitting MS (RRMS) demonstrated a higher signature of demethylated MOG cfDNA when compared with patients with inactive disease and healthy controls. Taken together, these results offer a minimally invasive approach to measuring ODC death in the blood of MS patients that may be used to monitor disease progression.

  15. AxiaLIF system: minimally invasive device for presacral lumbar interbody spinal fusion

    Directory of Open Access Journals (Sweden)

    Rapp SM

    2011-08-01

    Full Text Available Steven M Rapp1, Larry E Miller2,3, Jon E Block31Michigan Spine Institute, Waterford, MI, USA; 2Miller Scientific Consulting Inc, Biltmore Lake, NC, USA; 3Jon E. Block, Ph.D., Inc., San Francisco, CA, USAAbstract: Lumbar fusion is commonly performed to alleviate chronic low back and leg pain secondary to disc degeneration, spondylolisthesis with or without concomitant lumbar spinal stenosis, or chronic lumbar instability. However, the risk of iatrogenic injury during traditional anterior, posterior, and transforaminal open fusion surgery is significant. The axial lumbar interbody fusion (AxiaLIF system is a minimally invasive fusion device that accesses the lumbar (L4–S1 intervertebral disc spaces via a reproducible presacral approach that avoids critical neurovascular and musculoligamentous structures. Since the AxiaLIF system received marketing clearance from the US Food and Drug Administration in 2004, clinical studies of this device have reported high fusion rates without implant subsidence, significant improvements in pain and function, and low complication rates. This paper describes the design and approach of this lumbar fusion system, details the indications for use, and summarizes the clinical experience with the AxiaLIF system to date.Keywords: AxiaLIF, fusion, lumbar, minimally invasive, presacral

  16. Results of kyphoplasty in the minimally invasive treatment of vertebral metastasis

    Directory of Open Access Journals (Sweden)

    Carlos Fernando Pereira da Silva Herrero

    2014-09-01

    Full Text Available OBJECTIVE: To evaluate the clinical and radiological outcome of minimally invasive surgical treatment of vertebral metastases using the technique of kyphoplasty. METHODS: This was a prospective observational study of patients with the diagnosis of spinal metastasis who underwent minimally invasive surgical treatment by filling the vertebral body with balloon kyphoplasty technique. Clinical evaluation included patient age at surgery, diagnosis of the tumor, biopsy results, data of the surgical procedure performed, visual pain scale (VAS and complications related to surgery. Radiological evaluation involved the study of radiographic procedures in the anteroposterior and lateral incidences, with the analysis of vertebral body kyphosis and the occurrence of extravasation of cement. RESULTS: 22 patients with spinal metastases who were treated by balloon kyphoplasty, 8 (36% males and 14 (64% females were studied. The average age was 56.05 years and the mean follow-up was 8.5 months. The mean preoperative VAS was 8.73, 1.73 in the initial postoperative period, and 1.92 in the late postoperative period. CONCLUSION: Kyphoplasty proved to be a safe and effective technique for symptomatic treatment of vertebral metastases.

  17. Modified minimally invasive two-incision total hip arthroplasty using large diameter femoral head

    Directory of Open Access Journals (Sweden)

    Kyung Soon Park

    2012-01-01

    Full Text Available Background: Minimally invasive (MI total hip arthroplasty (THA is an alternative to standard THA, but has created much controversy among orthopedic surgeons. The authors modified the original minimally invasive two-incision THA technique and used large-diameter (32 mm, 36 mm ceramic-on-ceramic articulation. Materials and Methods: One hundred and seventy patients that underwent unilateral MI two-incision THA were retrospectively reviewed, and surgical morbidity, functional recovery, radiological properties, and complications were assessed. Results: Mean Harris hip score (HHS improved from 41.8 to 96.1 at last followup, and mean Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC score from 66.2 to 26.9. The mean lateral opening angle of the acetabular component was 38.2° and the mean stem position was valgus 1.9°. There was an intraoperative femur fracture and one revision surgery due to stem subsidence. No patient had dislocation. Conclusions: Our data suggest that this modified technique combined with large ceramic femoral head is safe and reproducible in terms of achieving proper implant positioning and early functional recovery.

  18. Minimally Invasive Subcortical Parafascicular Transsulcal Access for Clot Evacuation (Mi SPACE for Intracerebral Hemorrhage

    Directory of Open Access Journals (Sweden)

    Benjamin Ritsma

    2014-01-01

    Full Text Available Background. Spontaneous intracerebral hemorrhage (ICH is common and causes significant mortality and morbidity. To date, optimal medical and surgical intervention remains uncertain. A lack of definitive benefit for operative management may be attributable to adverse surgical effect, collateral tissue injury. This is particularly relevant for ICH in dominant, eloquent cortex. Minimally invasive surgery (MIS offers the potential advantage of reduced collateral damage. MIS utilizing a parafascicular approach has demonstrated such benefit for intracranial tumor resection. Methods. We present a case of dominant hemisphere spontaneous ICH evacuated via the minimally invasive subcortical parafascicular transsulcal access clot evacuation (Mi SPACE model. We use this report to introduce Mi SPACE and to examine the application of this novel MIS paradigm. Case Presentation. The featured patient presented with a left temporal ICH and severe global aphasia. The hematoma was evacuated via the Mi SPACE approach. Postoperative reassessments showed significant improvement. At two months, bedside language testing was normal. MRI tractography confirmed limited collateral injury. Conclusions. This case illustrates successful application of the Mi SPACE model to ICH in dominant, eloquent cortex and subcortical regions. MRI tractography illustrates collateral tissue preservation. Safety and feasibility studies are required to further assess this promising new therapeutic paradigm.

  19. EXPERIENCE OF MINIMALLY INVASIVE TREATMENT IN 520 PATIENTS WITH INTRACRANIAL ANEURYSMS

    Institute of Scientific and Technical Information of China (English)

    丁育基; 李慎茂; 段安安; 于小千; 华杨; 柳江; 王建生; 曹家康; 赵瑞林; 徐庚; 谷春; 王仲朴

    2002-01-01

    Objective.To summarize the experience of minimally invasive treatment in 520 patients with intracranial aneurysms on a retrospective study.Methods.The measures used in the treatment of 520 patients were reviewed in terms of timing of surgery,induced hypotensive anesthesia,brain protection combined with temporal occlusion of the feeding artery,external drainage of CSF,dynamic monitoring of intracranial pressure,blood flow velocity,serum osmolality and CT scanning,anti vasospasm therapy as well as selected interventional endovascular embolization of aneurysms.Results.Of the 520 patients,485 were treated with either direct clipping or endovascular embolization and 35 patients were treated non surgically.In 449 patients undergoing direct clipping and 36 undergoing endovascular embolization,intraoperative rupture of aneurysm occurred in 27 (6.0%) and 0%,respectively.Death occurred in 13 (2.6%),hemiplegia in 8 (1.6%),and vegetative state in 2 (0.4%).The operative mortality of direct clipping was 3.8% in 210 patients before 1990 and 1.8% in 275 patients after 1990 (36 patients undergoing endovascular embolization,the operative mortality was 0%).Conclusion.The outcome of patients with intracranial aneurysms can be markedly improved and the operative mortality can be lowered by minimally invasive treatment.

  20. A Novel Technique for Transvaginal Retrieval of Enlarged Pelvic Viscera during Minimally Invasive Surgery

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    Allison Wyman

    2012-01-01

    Full Text Available Introduction. With the widespread adoption of laparoscopic and robotic surgery, more and more women are undergoing minimally invasive surgery for complex gynecological procedures. The rate-limiting step is often the delivery of an intact uterus or an unruptured adnexal mass. To avoid conversion to a minilaparotomy for specimen retrieval, we describe a novel technique using an Anchor Tissue Retrieval System bag in conjunction with a pneumo-occluder to easily retrieve large specimens through a colpotomy incision. Surgical Technique. After completion of the robotic-assisted hysterectomy, the uterus, fallopian tubes, and ovaries were too large to be retrieved intact despite multiple attempts of delivery through the colpotomy incision. Prior to resorting to a minilaparotomy or morcellation of the specimen, a 15 mm anchor retrieval bag with a pneumo-occluder was placed through the vagina and the intact specimen was easily placed inside the bag under direct visualization and removed through the colpotomy incision intact. Conclusion. We routinely utilize this technique to retrieve hysterectomy specimens that are not readily delivered through the colpotomy incision and find this technique to be safe, highly efficient, and cost effective when there is a need to remove large intact specimens during minimally invasive surgery.

  1. Anorectal function and outcomes after transanal minimally invasive surgery for rectal tumors

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    Feza Y Karakayali

    2015-01-01

    Full Text Available Background: Transanal endoscopic microsurgery is a minimally invasive technique that allows full-thickness resection and suture closure of the defect for large rectal adenomas, selected low-risk rectal cancers, or small cancers in patients who have a high risk for major surgery. Our aim, in the given prospective study was to report our initial clinical experience with TAMIS, and to evaluate its effects on postoperative anorectal functions. Materials and Methods: In 10 patients treated with TAMIS for benign and malignant rectal tumors, preoperative and postoperative anorectal function was evaluated with anorectal manometry and Cleveland Clinic Incontinence Score. Results: The mean distance of the tumors from the anal verge was 5.6 cm, and mean tumor diameter was 2.6 cm. All resection margins were tumor free. There was no difference in preoperative and 3-week postoperative anorectalmanometry findings; only mean minimum rectal sensory volume was lower at 3 weeks after surgery. The Cleveland Clinic Incontinence Score was normal in all patients except one which resolved by 6 weeks after surgery.The mean postoperative follow-up was 28 weeks without any recurrences. Conclusion: Transanal minimally invasive surgery is a safe and effective procedure for treatment of rectal tumors and can be performed without impairing anorectal functions.

  2. Hydrogel-forming microneedle arrays: Potential for use in minimally-invasive lithium monitoring.

    Science.gov (United States)

    Eltayib, Eyman; Brady, Aaron J; Caffarel-Salvador, Ester; Gonzalez-Vazquez, Patricia; Zaid Alkilani, Ahlam; McCarthy, Helen O; McElnay, James C; Donnelly, Ryan F

    2016-05-01

    We describe, for the first time, hydrogel-forming microneedle (s) (MN) arrays for minimally-invasive extraction and quantification of lithium in vitro and in vivo. MN arrays, prepared from aqueous blends of hydrolysed poly(methyl-vinylether-co-maleic anhydride) and crosslinked by poly(ethyleneglycol), imbibed interstitial fluid (ISF) upon skin insertion. Such MN were always removed intact. In vitro, mean detected lithium concentrations showed no significant difference following 30min MN application to excised neonatal porcine skin for lithium citrate concentrations of 0.9 and 2mmol/l. However, after 1h application, the mean lithium concentrations extracted were significantly different, being appropriately concentration-dependent. In vivo, rats were orally dosed with lithium citrate equivalent to 15mg/kg and 30mg/kg lithium carbonate, respectively. MN arrays were applied 1h after dosing and removed 1h later. The two groups, having received different doses, showed no significant difference between lithium concentrations in serum or MN. However, the higher dosed rats demonstrated a lithium concentration extracted from MN arrays equivalent to a mean increase of 22.5% compared to rats which received the lower dose. Hydrogel-forming MN clearly have potential as a minimally-invasive tool for lithium monitoring in outpatient settings. We will now focus on correlation between serum and MN lithium concentrations.

  3. Minimally invasive devices for treating lower urinary tract symptoms in benign prostate hyperplasia: technology update

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    Aoun F

    2015-08-01

    Full Text Available Fouad Aoun1, Quentin Marcelis,1,2 Thierry Roumeguère,2 1Department of Urology, Jules Bordet Institute, 2Department of Urology, Erasme Hospital, University Clinics of Brussels, Université Libre de Bruxelles, Brussels, Belgium Abstract: Benign prostatic hyperplasia (BPH represents a spectrum of related lower urinary tract symptoms (LUTS. The cost of currently recommended medications and the discontinuation rate due to side effects are significant drawbacks limiting their long-term use in clinical practice. Interventional procedures, considered as the definitive treatment for BPH, carry a significant risk of treatment-related complications in frail patients. These issues have contributed to the emergence of new approaches as alternative options to standard therapies. This paper reviews the recent literature regarding the experimental treatments under investigation and presents the currently available experimental devices and techniques used under local anesthesia for the treatment of LUTS/BPH in the vast majority of cases. Devices for delivery of thermal treatment (microwaves, radiofrequency, high-intensity focused ultrasound, and the Rezum system, mechanical devices (prostatic stent and urethral lift, fractionation of prostatic tissue (histotripsy and aquablation, prostate artery embolization, and intraprostatic drugs are discussed. Evidence for the safety, tolerability, and efficacy of these “minimally invasive procedures” is analyzed. Keywords: lower urinary tract symptoms (LUTS, benign prostatic hyperplasia (BPH, minimally invasive therapies, new approaches, experimental therapy

  4. Triangular Titanium Implants for Minimally Invasive Sacroiliac Joint Fusion: A Prospective Study.

    Science.gov (United States)

    Duhon, Bradley S; Cher, Daniel J; Wine, Kathryn D; Kovalsky, Don A; Lockstadt, Harry

    2016-05-01

    Study Design Prospective multicenter single-arm interventional clinical trial. Objective To determine the degree of improvement in sacroiliac (SI) joint pain, disability related to SI joint pain, and quality of life in patients with SI joint dysfunction who undergo minimally invasive SI joint fusion using triangular-shaped titanium implants. Methods Subjects (n = 172) underwent minimally invasive SI joint fusion between August 2012 and January 2014 and completed structured assessments preoperatively and at 1, 3, 6, and 12 months postoperatively, including a 100-mm SI joint and back pain visual analog scale (VAS), Oswestry Disability Index (ODI), Short Form-36 (SF-36), and EuroQOL-5D. Patient satisfaction with surgery was assessed at 6 and 12 months. Results Mean SI joint pain improved from 79.8 at baseline to 30.0 and 30.4 at 6 and 12 months, respectively (mean improvements of 49.9 and 49.1 points, p joint fusion resulted in improvement of pain, disability, and quality of life in patients with SI joint dysfunction due to degenerative sacroiliitis and SI joint disruption.

  5. Role of early minimal-invasive spine fixation in acute thoracic and lumbar spine trauma

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    Schmidt Oliver

    2007-01-01

    Full Text Available Polytraumatized patients following a severe trauma suffer from substantial disturbances of the immune system. Secondary organ dysfunction syndromes due to early hyperinflammation and late immunparalysis contribute to adverse outcome. Consequently the principle of damage control surgery / orthopedics developed in the last two decades to limit secondary iatrogenic insult in these patients. New percutaneous internal fixators provide implants for a damage control approach of spinal trauma in polytraumatized patients. The goal of this study is to evaluate the feasibility of minimal-invasive instrumentation in the setting of minor and major trauma and to discuss the potential benefits and drawbacks of this procedure. Materials and Methods: The present study is a prospective analysis of 76 consecutive patients (mean age 53.3 years with thoracolumbar spine fractures following major or minor trauma from August 2003 to January 2007 who were subjected to minimal-invasive dorsal instrumentation using CD Horizon ® Sextant TM Rod Insertion System and Longitude TM Rod Insertion System (Medtronic ® Sofamor Danek. Perioperative and postoperative outcome measures including e.g. local and systemic complications were assessed and discussed. Results: Forty-nine patients (64.5% suffered from minor trauma (Injury Severity Score < 16. Polytraumatized patients (n=27; 35.5% had associated chest (n=20 and traumatic brain injuries (n=22. For mono- and bisegmental dorsal instrumentation the Sextant TM was used in 60 patients, whereas in 16 longer ranging instrumentations the (prototype Longitude TM system was implanted. Operation time was substantially lower than in conventional approach at minimum 22.5 min for Sextant and 36.2 min for Longitude TM , respectively. Geriatric patients with high perioperative risk according to ASA classification benefited from the less invasive approach and lack of approach-related complications including no substantial blood loss

  6. Minimal invasive long PHILOS®-plate osteosynthesis in metadiaphyseal fractures of the proximal humerus.

    Science.gov (United States)

    Rancan, Mario; Dietrich, Michael; Lamdark, Tenzin; Can, Uenal; Platz, Andreas

    2010-12-01

    Minimal invasive plate osteosynthesis (MIPO) not only meets the criteria of a "biological" osteosynthesis by minimising invasivity as well as iatrogenic soft tissue damage, but can also provide adequate stability for fracture healing and early functional aftertreatment. Up to date, only few publications report on MIPO of humeral shaft fractures mainly using the anterolateral deltopectoral approach for proximal plate insertion. Objective of the present study was to assess the feasibility and clinical outcome of MIPO for metadiaphyseal fractures of the proximal humerus through a lateral approach using angular stable long PHILOS(®)-plates. We retrospectively evaluated 29 patients (mean age 77 years, range 48-95 years) with displaced metadiaphyseal fractures of the proximal humerus treated with MIPO technique. For the first time, an angular stable long PHILOS(®)-plate through a lateral deltoid-split approach proximally and a brachialis/brachioradialis intermuscular approach with exposure of the radial nerve distally, were used. There were no infections and no iatrogenic injuries to the axillary and radial nerve. One patient showed subacromial impingement and one patient had to be reoperated for redislocation of the distal fragment with screw breakage, which was most likely due to incorrect screw placement. This patient was successfully operated using the same method and implant. Besides one patient who refused further follow-up, 28 patients could be followed up to a mean of 8 months (range 3-12 months) each with an entirely healed fracture. Furthermore, patient's quality of life was documented using the SF-36 questionnaire. Comparison with published United States normative data showed no significant deficits in the physical as well as in the mental domains 8 months after MIPO. Minimal invasive long PHILOS(®)-plate osteosynthesis using a combined lateral deltoid-split and brachialis/brachioradialis intermuscular approach proved to be a safe procedure for the

  7. Minimally Invasive Cochlear Implantation Assisted by Bi-planar Device: An Exploratory Feasibility Study in vitro

    Science.gov (United States)

    Ke, Jia; Zhang, Shao-Xing; Hu, Lei; Li, Chang-Sheng; Zhu, Yun-Feng; Sun, Shi-Long; Wang, Li-Feng; Ma, Fu-Rong

    2016-01-01

    Background: A single drilled tunnel from the lateral mastoid cortex to the cochlea via the facial recess is essential for minimally invasive cochlear implant surgery. This study aimed to explore the safety profile of this kind of new image-guided and bi-planar device-assisted surgery procedure in vitro. Methods: Image-guided minimally invasive cochlear implantations were performed on eight cadaveric temporal bone specimens. The main procedures were: (1) temporal bone specimens were prepared for surgery and fiducial markers were registered. (2) computed tomography (CT) scans were performed for future reference. (3) CT scan images were processed and drill path was planned to minimize cochlear damage. (4) bi-planar device-assisted drilling was performed on the specimens using the registration. (5) surgical safety was evaluated by calculating the deviation between the drill and the planned paths, and by measuring the closest distance between the drilled path and critical anatomic structures. Results: Eight cases were operated successfully to the basal turn of the cochlear with intact facial nerves (FNs). The deviations from target points and entrance points were 0.86 mm (0.68–1.00 mm) and 0.44 mm (0.30–0.96 mm), respectively. The angular error between the planned and the drilled trajectory was 1.74° (1.26–2.41°). The mean distance from the edge of the drilled path to the FN and to the external canal was 0.60 mm (0.35–0.83 mm) and 1.60 mm (1.30–2.05 mm), respectively. In five specimens, the chorda tympani nerves were well preserved. In all cases, no injury happened to auditory ossicles. Conclusions: This exploratory study demonstrated the safety of the newly developed image-guided minimally invasive cochlear implantation assisted by the bi-planar device and established the operational procedures. Further, more in vitro experiments are needed to improve the system operation and its safety. PMID:27748341

  8. Minimally Invasive Cochlear Implantation Assisted by Bi-planar Device: An Exploratory Feasibility Study in vitro

    Institute of Scientific and Technical Information of China (English)

    Jia Ke; Shao-Xing Zhang; Lei Hu; Chang-Sheng Li; Yun-Feng Zhu; Shi-Long Sun; Li-Feng Wang

    2016-01-01

    Background:A single drilled tunnel from the lateral mastoid cortex to the cochlea via the facial recess is essential for minimally invasive cochlear implant surgery.This study aimed to explore the safety profile of this kind of new image-guided and bi-planar device-assisted surgery procedure in vitro.Methods:Image-guided minimally invasive cochlear implantations were performed on eight cadaveric temporal bone specimens.The main procedures were:(1) temporal bone specimens were prepared for surgery and fiducial markers were registered.(2) computed tomography (CT) scans were performed for future reference.(3) CT scan images were processed and drill path was planned to minimize cochlear damage.(4) bi-planar device-assisted drilling was performed on the specimens using the registration.(5) surgical safety was evaluated by calculating the deviation between the drill and the planned paths,and by measuring the closest distance between the drilled path and critical anatomic structures.Results:Eight cases were operated successfully to the basal turn of the cochlear with intact facial nerves (FNs).The deviations from target points and entrance points were 0.86 mm (0.68-1.00 mm) and 0.44 mm (0.30-0.96 mm),respectively.The angular error between the planned and the drilled trajectory was 1.74° (1.26-2.41°).The mean distance from the edge of the drilled path to the FN and to the external canal was 0.60 mm (0.35-0.83 mm) and 1.60 mm (1.30-2.05 mm),respectively.In five specimens,the chorda tympani nerves were well preserved.In all cases,no injury happened to auditory ossicles.Conclusions:This exploratory study demonstrated the safety of the newly developed image-guided minimally invasive cochlear implantation assisted by the bi-planar device and established the operational procedures.Further,more in vitro experiments are needed to improve the system operation and its safety.

  9. Comparative study on early period of recovery between minimally invasive surgery total knee arthroplasty and minimally invasive surgery-quadriceps sparing total knee arthroplasty in Chinese patients

    Institute of Scientific and Technical Information of China (English)

    YU Jia-kuo; YU Chang-long; AO Ying-fang; GONG Xi; WANG Yong-jian; WANG Shu; XING Xie; CHEN Lian-xu; JU Xiao-dong

    2008-01-01

    Background Different kinds of minimally invasive surgery (MIS) procedures have now been used in total knee arthroplasty (TKA). Compared with traditional TKA procedure with a long skin incision, clinical studies showed MIS procedures had some advantages. Quadriceps sparing (QS) procedures are the most minimally invasive MIS procedure until now. This study was aimed to find the insertion types for Chinese patients' vastus medialis and if the QS procedure had some advantages in patients' early recovery.Methods Between February 2006 and May 2007, 120 consecutive patients underwent unilateral primary TKA under general anesthesia, among whom 14 patients were lost to follow-up, the remaining 106 cases were enrolled in this study. Among the 106 cases there were 85 right knees, 21 left knees (15 men and 91 women, with a mean age of 65.1±7.4 years); osteoarthritis in 97 patients (91.5%) and rheumatoid arthritis in 9 patients (8.5%). MIS TKA was performed in 49 cases (MIS TKA group), while MIS-QS TKA in 57 cases (MIS-QS TKA group). During the operation, the type Ⅰ, Ⅱ and Ⅲ insertions of the vastus medialis for all patients were recorded. Each knee was rated post-operatively according to the Hospital of Special Surgery (HSS) scoring system. Clinical follow-up was undertaken at 1 week, 2, 6, 12 and 24 weeks. Operating time and complications were recorded.Results There was no statistically significant difference between the two groups for gender distribution, age, left or right knee incidence, pre-operative diagnosis, incidence of varus or valgus deformity. Of the 106 cases there was 1 (0.9%) case with a type Ⅰ insertion of the vastus medialis, 4 (3.8%) cases with type Ⅱ insertions, 101 (95.3%) cases with type Ⅲ insertions. The HSS scoring was significantly different between the MIS-QS TKA group and MIS TKA group within the first two weeks post operation. From 2 weeks later to 24 weeks, no significant difference was found. The average operating time was (53.3±12

  10. Minimally Invasive Spine Metastatic Tumor Resection and Stabilization: New Technology Yield Improved Outcome.

    Science.gov (United States)

    Harel, Ran; Doron, Omer; Knoller, Nachshon

    2015-01-01

    Spinal metastases compressing the spinal cord are a medical emergency and should be operated on if possible; however, patients' medical condition is often poor and surgical complications are common. Minimizing surgical extant, operative time, and blood loss can potentially reduce postoperative complications. This is a retrospective study describing the patients operated on in our department utilizing a minimally invasive surgery (MIS) approach to decompress and instrument the spine from November 2013 to November 2014. Five patients were operated on for thoracic or lumbar metastases. In all cases a unilateral decompression with expandable tubular retractor was followed by instrumentation of one level above and below the index level and additional screw at the index level contralateral to the decompression side. Cannulated fenestrated screws were used (Longitude FNS) and cement was injected to increase pullout resistance. Mean operative time was 134 minutes and estimated blood loss was minimal in all cases. Improvement was noticeable in neurological status, function, and pain scores. No complications were observed. Technological improvements in spinal instruments facilitate shorter and safer surgeries in oncologic patient population and thus reduce the complication rate. These technologies improve patients' quality of life and enable the treatment of patients with comorbidities.

  11. Minimally Invasive Spine Metastatic Tumor Resection and Stabilization: New Technology Yield Improved Outcome

    Directory of Open Access Journals (Sweden)

    Ran Harel

    2015-01-01

    Full Text Available Spinal metastases compressing the spinal cord are a medical emergency and should be operated on if possible; however, patients’ medical condition is often poor and surgical complications are common. Minimizing surgical extant, operative time, and blood loss can potentially reduce postoperative complications. This is a retrospective study describing the patients operated on in our department utilizing a minimally invasive surgery (MIS approach to decompress and instrument the spine from November 2013 to November 2014. Five patients were operated on for thoracic or lumbar metastases. In all cases a unilateral decompression with expandable tubular retractor was followed by instrumentation of one level above and below the index level and additional screw at the index level contralateral to the decompression side. Cannulated fenestrated screws were used (Longitude FNS and cement was injected to increase pullout resistance. Mean operative time was 134 minutes and estimated blood loss was minimal in all cases. Improvement was noticeable in neurological status, function, and pain scores. No complications were observed. Technological improvements in spinal instruments facilitate shorter and safer surgeries in oncologic patient population and thus reduce the complication rate. These technologies improve patients’ quality of life and enable the treatment of patients with comorbidities.

  12. ”No-preparation” and Minimally Invasive Veneers in Clinical Practice: Part 1

    Directory of Open Access Journals (Sweden)

    Beata Smielak

    2015-03-01

    Full Text Available Objectives: “No preparation” veneers and veneers requiring minimal preparation of dental enamel are steadily increasing in popularity among today’s dental practitioners but they are suitable for selected individual cases. Overview: The present study discusses the indications for, and limitations to, the use of ultra-thin veneers, their drawbacks and advantages. It also describes the veneer placement procedure, taking into account the issues of proper diagnostics and treatment planning. Clinical significance: “No preparation” veneers and veneers requiring minimal preparation should always be recommended whenever the clinical and laboratory conditions allow it. Their greatest advantage lies in the fact that they save healthy dental tissue and thus offer an excellent alternative to traditional veneers and crowns. On the other hand, “no-preparation” and minimally invasive veneers that are poorly designed and fabricated, heavy or chunky in appearance, and overcontoured can negatively influence the shape of a patient’s teeth and lead to periodontal problems.

  13. Minimally Invasive Direct Lateral Interbody Fusion (MIS-DLIF): Proof of Concept and Perioperative Results

    Science.gov (United States)

    Abbasi, Hamid

    2017-01-01

    Background Minimally invasive direct lateral interbody fusion (MIS-DLIF) is a novel approach for fusions of the lumbar spine. In this proof of concept study, we describe the surgical technique and report our experience and the perioperative outcomes of the first nine patients who underwent this procedure. Study design/setting In this study we establish the safety and efficacy of this approach. MIS-DLIF was performed on 15 spinal levels in nine patients who failed to respond to conservative therapy for the treatment of a re-herniated disk, spondylolisthesis, or other severe disk disease of the lumbar spine. We recorded surgery time, blood loss, fluoroscopy time, patient-reported pain, and complications. Methods Throughout the MIS-DLIF procedure, the surgeon is aided by biplanar fluoroscopic imaging to place an interbody graft or cage into the disc space through the interpleural space. A discectomy is performed in the same minimally invasive fashion. The procedure is usually completed with posterior pedicle screw fixation. Results MIS-DLIF took 44/85 minutes, on average, for 1/2 levels, with 54/112 ml of blood loss, and 0.3/1.7 days of hospital stay. Four of nine patients did not require overnight hospitalization and were discharged two to four hours after surgery. We did not encounter any clinically significant complications. At more than ninety days post surgery, the patients reported a statistically significant reduction of 4.5 points on a 10-point sliding pain scale. Conclusions MIS-DLIF with pedicle screw fixation is a safe and clinically effective procedure for fusions of the lumbar spine. The procedure overcomes many of the limitations of the current minimally invasive approaches to the lumbar spine and is technically straightforward. MIS-DLIF has the potential to improve patient outcomes and reduce costs relative to the current standard of care and therefore warrants further investigation. We are currently expanding this study to a larger cohort and

  14. Minimally invasive removal of lumbar intradural extramedullary lesions using the interlaminar approach.

    Science.gov (United States)

    Zhu, Yong-Jian; Ying, Guang-Yu; Chen, Ai-Qin; Wang, Lin-Lin; Yu, Dan-Feng; Zhu, Liang-Liang; Ren, Yu-Cheng; Wang, Chen; Wu, Peng-Cheng; Yao, Ying; Shen, Fang; Zhang, Jian-Min

    2015-08-01

    OBJECT Posterior midline laminectomy or hemilaminectomy has been successfully applied as the standard microsurgical technique for the treatment of spinal intradural pathologies. However, the associated risks of postoperative spinal instability increase the need for subsequent fusion surgery to prevent potential long-term spinal deformity. Continuous efforts have been made to minimize injuries to the surrounding tissue resulting from surgical manipulations. The authors report here their experiences with a novel minimally invasive surgical approach, namely the interlaminar approach, for the treatment of lumbar intraspinal tumors. METHODS A retrospective review was conducted of patients at the Second Affiliated Hospital of Zhejiang University School of Medicine who underwent minimally invasive resection of lumbar intradural-extramedullary tumors. By using an operative microscope, in addition to an endoscope when necessary, the authors were able to treat all patients with a unilateral, paramedian, bone-sparing interlaminar technique. Data including preoperative neurological status, tumor location, size, pathological diagnosis, extension of resections, intraoperative blood loss, length of hospital stay, and clinical outcomes were obtained through clinical and radiological examinations. RESULTS Eighteen patients diagnosed with lumbar intradural-extramedullary tumors were treated from October 2013 to March 2015 by this interlaminar technique. A microscope was used in 15 cases, and the remaining 3 cases were treated using a microscope as well as an endoscope. There were 14 schwannomas, 2 ependymomas, 1 epidermoid cyst, and 1 enterogenous cyst. Postoperative radiological follow-up revealed complete removal of all the lesions and no signs of bone defects in the lamina. At clinical follow-up, 14 of the 18 patients had less pain, and patients' motor/sensory functions improved or remained normal in all cases except 1. CONClUSIONS When meeting certain selection criteria

  15. Minimally Invasive Posterior Stabilization Improved Ambulation and Pain Scores in Patients with Plasmacytomas and/or Metastases of the Spine

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    Joseph H. Schwab

    2011-01-01

    Full Text Available Background. The incidence of spine metastasis is expected to increase as the population ages, and so is the number of palliative spinal procedures. Minimally invasive procedures are attractive options in that they offer the theoretical advantage of less morbidity. Purpose. The purpose of our study was to evaluate whether minimally invasive posterior spinal instrumentation provided significant pain relief and improved function. Study Design. We compared pre- and postoperative pain scores as well as ambulatory status in a population of patients suffering from oncologic conditions in the spine. Patient Sample. A consecutive series of patients with spine tumors treated minimally invasively with stabilization were reviewed. Outcome Measures. Visual analog pain scale as well as pre- and postoperative ambulatory status were used as outcome measures. Methods. Twenty-four patients who underwent minimally invasive posterior spinal instrumentation for metastasis were retrospectively reviewed. Results. Seven (29% patients were unable to ambulate secondary to pain and instability prior to surgery. All patients were ambulating within 2 to 3 days after having surgery (=0.01. The mean visual analog scale value for the preoperative patients was 2.8, and the mean postoperative value was 1.0 (=0.001. Conclusion. Minimally invasive posterior spinal instrumentation significantly improved pain and ambulatory status in this series.

  16. Semiautomatic Cochleostomy Target and Insertion Trajectory Planning for Minimally Invasive Cochlear Implantation

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    Wilhelm Wimmer

    2014-01-01

    Full Text Available A major component of minimally invasive cochlear implantation is atraumatic scala tympani (ST placement of the electrode array. This work reports on a semiautomatic planning paradigm that uses anatomical landmarks and cochlear surface models for cochleostomy target and insertion trajectory computation. The method was validated in a human whole head cadaver model (n=10 ears. Cochleostomy targets were generated from an automated script and used for consecutive planning of a direct cochlear access (DCA drill trajectory from the mastoid surface to the inner ear. An image-guided robotic system was used to perform both, DCA and cochleostomy drilling. Nine of 10 implanted specimens showed complete ST placement. One case of scala vestibuli insertion occurred due to a registration/drilling error of 0.79 mm. The presented approach indicates that a safe cochleostomy target and insertion trajectory can be planned using conventional clinical imaging modalities, which lack sufficient resolution to identify the basilar membrane.

  17. Go-Smart: Web-based Computational Modeling of Minimally Invasive Cancer Treatments

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    Weir, Phil; Ellerweg, Roland; Alhonnoro, Tuomas; Pollari, Mika; Voglreiter, Philip; Mariappan, Panchatcharam; Flanagan, Ronan; Park, Chang Sub; Payne, Stephen; Staerk, Elmar; Voigt, Peter; Moche, Michael; Kolesnik, Marina

    2015-01-01

    The web-based Go-Smart environment is a scalable system that allows the prediction of minimally invasive cancer treatment. Interventional radiologists create a patient-specific 3D model by semi-automatic segmentation and registration of pre-interventional CT (Computed Tomography) and/or MRI (Magnetic Resonance Imaging) images in a 2D/3D browser environment. This model is used to compare patient-specific treatment plans and device performance via built-in simulation tools. Go-Smart includes evaluation techniques for comparing simulated treatment with real ablation lesions segmented from follow-up scans. The framework is highly extensible, allowing manufacturers and researchers to incorporate new ablation devices, mathematical models and physical parameters.

  18. Penile prosthesis implant for erectile dysfunction: A new minimally invasive infrapubic surgical technique

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    Gabriele Antonini

    2016-01-01

    Full Text Available Erectile dysfunction, the most common male sexual disorder after premature ejaculation, with its important impact on man and partner’s sexuality and quality of life is a persistent inability to obtain and maintain an erection sufficient to permit satisfactory sexual performance. Non-surgical treatments with controversial results are usually applyed before surgical treatment that has reached high levels of satisfaction. We describe a new surgical technique to implant three-pieces penile prosthesis in patients suffering from erectile dysfunction (ED not responding to conventional medical therapy or reporting side effects with such a therapy. Implantation of an inflatable prosthesis, for treatment of ED, is a safe and efficacious approach with high satisfaction reported by patients and partners. Surgical technique should be minimally invasive and latest technology equipment should be implanted in order to decrease common complications and to obtain a better aesthetic result.

  19. High definition in minimally invasive surgery: a review of methods for recording, editing, and distributing video.

    Science.gov (United States)

    Kelly, Christopher R; Hogle, Nancy J; Landman, Jaime; Fowler, Dennis L

    2008-09-01

    The use of high-definition cameras and monitors during minimally invasive procedures can provide the surgeon and operating team with more than twice the resolution of standard definition systems. Although this dramatic improvement in visualization offers numerous advantages, the adoption of high definition cameras in the operating room can be challenging because new recording equipment must be purchased, and several new technologies are required to edit and distribute video. The purpose of this review article is to provide an overview of the popular methods for recording, editing, and distributing high-definition video. This article discusses the essential technical concepts of high-definition video, reviews the different kinds of equipment and methods most often used for recording, and describes several options for video distribution.

  20. Post-traumatic Vertebral Compression Fracture Treated with Minimally Invasive Biologic Vertebral Augmentation for Reconstruction.

    Science.gov (United States)

    Chiu, John C; Maziad, Ali M

    2011-12-01

    In the United States, there is a high incidence of motor vehicle and sports injuries among the active population causing symptomatic post-traumatic vertebral compression fracture. At our institution, 28 cases of painful post-traumatic vertebral compression fractures (PPT-VCFs) were successfully treated with percutaneous vertebral augmentation (VA) for stabilization and reconstruction with intravertebral polyethylene mesh sac (OptiMesh®, Spineology, Inc., Stillwater, MN) and biological morcelized bone graft. The surgical approach provides an efficacious and controlled minimally invasive delivery mechanism to stabilize and reconstruct VCFs, as well as avoiding serious complications from Polymethylmethacrylate (PMMA) of vertebroplasty and kyphoplasty. The construct for biological bone graft/vertebral augmentation is osteoconductive and osteoinductive, and is used to create biologic vertebral stabilization and reconstruction. The adjacent vertebra integrity is protected by the construct with similar elasticity and physical characteristics of the biologic morcelized bone, more matched to that of adjacent bone than PMMA. The surgical techniques are described herein.

  1. Early Clinical and Radiographic Results of Minimally Invasive Anterior Approach Hip Arthroplasty

    Directory of Open Access Journals (Sweden)

    Tamara Alexandrov

    2014-01-01

    consecutive patients with 43 total hip arthroplasties performed through an anterior muscle sparing minimally invasive approach. We found the early complication rates and radiographic outcomes comparable to those reported from arthroplasties performed via traditional approaches. Complications included dislocation (2%, femur fracture (2%, greater trochanteric fracture (12%, postoperative periprosthetic intertrochanteric fracture (2%, femoral nerve palsy (5%, hematoma (2%, and postoperative iliopsoas avulsion (2%. Radiographic analysis revealed average cup anteversion of 19.6°±6.6, average cup abduction angle of 48.4°±7, stem varus of 0.9°±2, and a mean leg length discrepancy of 0.7 mm. The anterior approach to the hip is an attractive alternative to the more traditional approaches. Acceptable component placement with comparable complication rates is possible using a muscle sparing technique which may lead to faster overall recovery.

  2. Minimally Invasive Plate Osteosynthesis with Conventional Compression Plate for Diaphyseal Tibia Fracture

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    IM Anuar-Ramdhan

    2014-11-01

    Full Text Available The diaphyseal tibia fracture is best treated with intramedullary nail but in some cases where the nail is not applicable, plate fixation will be the next option of fixation. The extensile anterior approach is normally used for conventional compression plate fixation in tibia shaft fractures. The extensive surgical dissection may devitalizes the bony fragments and interfere with the fracture union as well as soft tissue healing. Minimally Invasive Plate Osteosynthesis (MIPO provides good preservation of blood supply and fracture hematoma at the fracture site thus promotes biological bone healing. The use of indirect reduction techniques and small skin incisions to introduce the plate is technically demanding and requires fluoroscopy exposures throughout the surgery, being some of its drawbacks. We recommend MIPO for conventional compression plate fixation in tibial shaft fractures in view of the reduced surgical trauma to the surrounding soft tissue and good functional outcome.

  3. Minimally invasive direct coronary artery bypass plus coronary stent for acute coronary syndrome: a case report

    Institute of Scientific and Technical Information of China (English)

    Caiyi Lu; Gang Wang; Qi Zhou; Jinwen Tian; Lei Gao; Shenhua Zhou; Jinyue Zhai; Rui Chen; Zhongren Zhao; Cangqing Gao; Shiwen Wang; Yuxiao Zhang; Ming Yang; Qiao Xue; Cangsong Xiao; Wei Gao; Yang Wu

    2008-01-01

    A 69-year old female patient was admitted because of 3 days of worsened chest pain.Coronary angiography showed60% stenosis of distal left main stem,chronic total occlusion of left anterior descending (LAD),70% stenosis at the ostium of a smallleft circumflex,70-90%stenosis at the paroxysmal and middle part of a dominant fight coronary artery (RCA),and a normal left internalmammary artery (LIMA) with normal origination and orientation.Percutaneous intervention was attempted but failed on the occludedlesion of LAD.The patient received minimally invasive direct coronary artery bypass (MIDCAB) with left LIMA isolation by Davincirobot.Eleven days later,the RCA lesion was treated by Sirolimus Rapamicin eluting stents implantation percutaneously.Then thepatient was discharged uneventfully after 3 days hospitalization.Our experience suggests that two stop shops of hybrid technique befeasible and safe in the treatment of elderly patient with multiple coronary diseases.

  4. Minimally invasive procedures for the management of vertebral bone pain due to cancer

    DEFF Research Database (Denmark)

    Mercadante, Sebastiano; Klepstad, Pål; Kurita, Geana Paula

    2016-01-01

    BACKGROUND: Image-guided percutaneous ablation methods have proved effective for treatment of benign bone tumors and for palliation of metastases involving the bone. However, the role of these techniques is controversial and has to be better defined in the setting of palliative care. METHODS......: A systematic review of the existing data regarding minimally invasive techniques for the pain management of vertebral bone metastases was performed by experts of the European Palliative Care Research Network. RESULTS: Only five papers were taken into consideration after performing rigorous screening according...... to inclusion and exclusion criteria (low number of patients, retrospective series, proceedings). DISCUSSION: According to the present data a recommendation should be made to perform kiphoplasty in patients with vertebral tumors or metastases. However, the strength of this recommendation was based on one...

  5. Minimally Invasive Calcaneal Displacement Osteotomy Site Using a Reference Kirschner Wire: A Technique Tip.

    Science.gov (United States)

    Lee, Moses; Guyton, Gregory P; Zahoor, Talal; Schon, Lew C

    2016-01-01

    As a standard open approach, the lateral oblique incision has been widely used for calcaneal displacement osteotomy. However, just as with other orthopedic procedures that use an open approach, complications, including wound healing problems and neurovascular injury in the heel, have been reported. To help avoid these limitations, a percutaneous technique using a Shannon burr for calcaneal displacement osteotomy was introduced. However, relying on a free-hand technique without direct visualization at the osteotomy site has been a major obstacle for this technique. To address this problem, we developed a technical tip using a reference Kirschner wire. A reference Kirschner wire technique provides a reliable and accurate guide for minimally invasive calcaneal displacement osteotomy. Also, the technique should be easy to learn for surgeons new to the procedure.

  6. Distraction correction for flexion contractures of the fingers: A minimally invasive technique

    Directory of Open Access Journals (Sweden)

    Ravishanker R

    2003-01-01

    Full Text Available Burns injuries account for over 2 million cases in our country. With over 75% of the patients sustaining injuries to the hands, post burn contractures of the finger are a very common condition presenting for treatment. Similarly trauma to the upper limbs, accounting for about a third of all injuries to the body also result in flexion deformities of the fingers. Standard treatment for these deformities is by way of surgical release of the contractures, skin cover with split skin grafting or full thickness grafts followed by prolonged immobilization and splintage. The relatively minimally invasive technique of distraction has been used in this small but representative series to correct flexion deformities caused by burns and other injuries. Results have been very gratifying.

  7. The Role of Minimally Invasive Enucleation in the Treatment of Pancreatic Tumors

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    Lea Matsuoka

    2016-02-01

    Full Text Available Pancreatic enucleation has been performed for small, benign or premalignant lesions of the pancreas. The goal of this parenchymapreserving strategy is to reduce the risk of exocrine and endocrine insufficiency and potentially the risks associated with pancreatic and biliary anastomoses. Studies have shown open pancreatic enucleation to be a viable option for patients, with a debatable increased risk of pancreatic fistula. With the advent of minimally invasive techniques and increasing experience, centers have started to perform laparoscopic pancreatic enucleation. Small studies have been performed demonstrating the safety and feasibility of laparoscopic pancreatic enucleation, with patient positioning and port placement dependent upon the location of the lesion. Laparoscopic intraoperative ultrasound plays an important role in the localization of these tumors and their proximity to the pancreatic duct and vascular structures, which helps to determine appropriateness for enucleation.

  8. A minimally invasive "overwrapping" technique for repairing neglected ruptures of the Achilles tendon.

    Science.gov (United States)

    Lui, Tun Hing

    2014-01-01

    About 10% to 25% of acute ruptures of the Achilles tendon go undiagnosed for some time beyond what would be optimal for repair and a return to optimal function. Managing these chronic or neglected ruptures is a surgical challenge, because the tendon ends retract and atrophy and could develop a short, fibrous distal stump. In the present report, a patient with a ruptured right Achilles tendon, neglected for approximately 10 years, is described. The chronically injured tendon was successfully treated by overwrapping the interposed scar at the rupture site. This minimally invasive technique restored tension to the tendon, a prerequisite for which was the presence of functional triceps surae, confirmed by identification of gross contraction of the muscle during tiptoeing. The procedure is contraindicated when the scar tissue is not intact and does not have sufficient laxity to allow adequate dorsiflexion of the ankle after overwrapping the tendon or when the triceps surae are nonfunctional.

  9. Minimally invasive post-mortem CT-angiography in a case involving a gunshot wound.

    Science.gov (United States)

    Ruder, Thomas D; Ross, Steffen; Preiss, Ulrich; Thali, Michael J

    2010-05-01

    Non-contrast post-mortem computed tomography (pm-CT) is useful in the evaluation of bony pathologies, whereas minimally invasive pm-CT-angiography allows for the detection of subtle vascular lesions. We present a case of an accidentally self-inflicted fatal bullet wound to the chest where pm-CT-angiography revealed a small laceration of the anterior interventricular branch of the left coronary artery and a tiny disruption of the right ventricle with pericardial and pleural effusion. Subsequent autopsy confirmed our radiological findings. Post-mortem CT-angiography has a great potential for the detection of vascular lesions and can be considered equivalent to autopsy for selected cases in forensic medicine.

  10. Minimally invasive intracellular delivery based on electrokinetic forces combined with vibration-assisted cell membrane perforation

    Science.gov (United States)

    Shibata, Takayuki; Ozawa, Tatsuya; Ito, Yasuharu; Yamamoto, Keita; Nagai, Moeto

    2017-01-01

    To provide an effective platform for the fundamental analysis of cellular mechanisms and the regulation of cellular functions, we developed a unique method of minimally invasive intracellular delivery. Using this method, we successfully demonstrated the delivery of DNA molecules into living HeLa cells via a glass micropipette based on DC-biased AC-driven electrokinetic forces with much better controllability than that of the pressure-driven flow method. We also proposed a vibration-assisted insertion method for penetrating the cell membrane to reduce cell damage. Preliminary insertion tests revealed that application of mechanical oscillation can reduce the deformation of cells due to increases in their viscous resistance, resulting in a high probability of cell membrane perforation and cell viability. Moreover, to overcome the intrinsic low throughput of intracellular delivery with a single glass micropipette, we developed a fabrication process involving an array of stepped hollow silicon dioxide (SiO2) nanoneedles with well-defined tips.

  11. Video-atlas on minimally invasive mitral valve surgery-The David Adams technique.

    Science.gov (United States)

    Castillo, Javier G; Milla, Federico; Anyanwu, Anelechi C; Adams, David H

    2013-11-01

    Median sternotomy has unquestionably evolved over recent decades. Modern sternotomy involves a 7-8 cm lower midline skin incision, tunneling of the subcutaneous tissues with subsequent creation of myocutaneous flaps, full sternotomy, and standard cardiopulmonary bypass techniques with central cannulation. In experienced centers, modern sternotomy may achieve all the goals of minimally invasive surgery, including excellent cosmesis, excellent postoperative pain control, low rates of bleeding and transfusion (our re-exploration rate for bleeding is <1%), and the ability to perform any reconstructive technique that would be used in a standard sternotomy, with very high repair rates (our most recent series documented a repair rate exceeding 99% in an all-comers population of degenerative disease regardless of complexity).

  12. Insights into a microwave susceptible agent for minimally invasive microwave tumor thermal therapy.

    Science.gov (United States)

    Shi, Haitang; Liu, Tianlong; Fu, Changhui; Li, Linlin; Tan, Longfei; Wang, Jingzhuo; Ren, Xiangling; Ren, Jun; Wang, Jianxin; Meng, Xianwei

    2015-03-01

    This work develops a kind of sodium alginate (SA) microcapsules as microwave susceptible agents for in vivo tumor microwave thermal therapy for the first time. Due to the excellent microwave susceptible properties and low bio-toxicity, excellent therapy efficiency can be achieved with the tumor inhibiting ratio of 97.85% after one-time microwave thermal therapy with ultralow power (1.8 W, 450 MHz). Meanwhile, the mechanism of high microwave heating efficiency was confirmed via computer-simulated model in theory, demonstrating that the spatial confinement efficiency of microcapsule walls endows the inside ions with high microwave susceptible properties. This strategy offers tremendous potential applications in clinical tumor treatment with the benefits of safety, reliability, effectiveness and minimally invasiveness.

  13. Gaze-contingent soft tissue deformation tracking for minimally invasive robotic surgery.

    Science.gov (United States)

    Mylonas, George P; Stoyanov, Danail; Deligianni, Fani; Darzi, Ara; Yang, Guang-Zhong

    2005-01-01

    The introduction of surgical robots in Minimally Invasive Surgery (MIS) has allowed enhanced manual dexterity through the use of microprocessor controlled mechanical wrists. Although fully autonomous robots are attractive, both ethical and legal barriers can prohibit their practical use in surgery. The purpose of this paper is to demonstrate that it is possible to use real-time binocular eye tracking for empowering robots with human vision by using knowledge acquired in situ. By utilizing the close relationship between the horizontal disparity and the depth perception varying with the viewing distance, it is possible to use ocular vergence for recovering 3D motion and deformation of the soft tissue during MIS procedures. Both phantom and in vivo experiments were carried out to assess the potential frequency limit of the system and its intrinsic depth recovery accuracy. The potential applications of the technique include motion stabilization and intra-operative planning in the presence of large tissue deformation.

  14. Lupus mastitis in systemic lupus erythematosus: a rare condition requiring a minimally invasive diagnostic approach.

    Science.gov (United States)

    Lucivero, G; Romano, C; Ferraraccio, F; Sellitto, A; De Fanis, U; Giunta, R; Guarino, A; Auriemma, P P; Benincasa, M; Iovino, F

    2011-01-01

    Breast involvement is a rare event in SLE patients. The most frequent presentation is lupus panniculitis with skin erythema, tenderness, and parenchymal nodules. However, when breast masses are detected in SLE patients without significant superficial inflammation, it is mandatory to rule out breast carcinoma. Here, we report the case of a 47-year-old woman with an 18-year-long history of SLE, who presented with a suspicious breast mass. Since surgical trauma has been reported to be able to exacerbate breast inflammation in lupus mastitis, an ultrasound-guided minimally invasive Mammotome biopsy was performed to obtain tissue samples for histological and immunohistochemical examinations. Histology was consistent with lupus mastitis. The patient was already on mycophenolate mofetil and hydroxychloroquine. At the latest follow-up visit 6 years later, no progression of the breast lesion was observed.

  15. Safety and 6-month effectiveness of minimally invasive sacroiliac joint fusion: a prospective study

    Directory of Open Access Journals (Sweden)

    Duhon BS

    2013-12-01

    Full Text Available Bradley S Duhon,1 Daniel J Cher,2 Kathryn D Wine,2 Harry Lockstadt,3 Don Kovalsky,4 Cheng-Lun Soo5On behalf of the SIFI Study Group1Neurosurgical and Spine Specialists, Parker, CO, 2SI-BONE, Inc, San Jose, CA, 3Bluegrass Orthopaedics and Hand Care, Lexington, KY, 4Orthopaedic Center of Southern Illinois, Mount Vernon, IL, 5Health Research Institute, Oklahoma City, OK, USABackground: Sacroiliac (SI joint pain is an often overlooked cause of low back pain. SI joint arthrodesis has been reported to relieve pain and improve quality of life in patients suffering from degeneration or disruption of the SI joint who have failed non-surgical care. We report herein early results of a multicenter prospective single-arm cohort of patients with SI joint degeneration or disruption who underwent minimally invasive fusion using the iFuse Implant System®.Methods: The safety cohort includes 94 subjects at 23 sites with chronic SI joint pain who met study eligibility criteria and underwent minimally invasive SI joint fusion with the iFuse Implant System® between August 2012 and September 2013. Subjects underwent structured assessments preoperatively, immediately postoperatively, and at 1, 3, and 6 months postoperatively, including SI joint and back pain visual analog scale (VAS, Oswestry Disability Index (ODI, Short Form-36 (SF-36, and EuroQoL-5D (EQ-5D. Patient satisfaction with surgery was assessed at 6 months. The effectiveness cohort includes the 32 subjects who have had 6-month follow-up to date.Results: Mean subject age was 51 years (n=94, safety cohort and 66% of patients were women. Subjects were highly debilitated at baseline (mean VAS pain score 78, mean ODI score 54. Three implants were used in 80% of patients; two patients underwent staged bilateral implants. Twenty-three adverse events occurred within 1 month of surgery and 29 additional events occurred between 30 days and latest follow-up. Six adverse events were severe but none were device

  16. Minimally invasive cardiac surgery in the adult: surgical instruments, equipment, and techniques.

    Science.gov (United States)

    Kitamura, M; Uwabe, K; Hirota, J; Kawai, A; Endo, M; Koyanagi, H

    1998-09-01

    To clarify the special instruments and equipment used for minimally invasive cardiac surgery (MICS), we examined the initial experiences with MICS operations with ministernotomy or minithoracotomy at our institution. Fifty adult patients with congenital, valvular, and/or ischemic heart diseases underwent MICS operations, and all surgical procedures were completed without conversion to full sternotomy. The length of the skin incision was about 10 cm or less in all patients. Postoperative recovery was favorable, and the majority of the patients were discharged from the hospital around the end of the second postoperative week. In this series of patients, an oscillating bone saw, lifting type retractor, 2 blade spreader, cannula with a balloon, and right-angled aortic clamp among other items, were very useful for successfully performing various operations with MICS approaches and techniques. The associated results suggest that MICS with ministernotomy or minithoracotomy was feasible using special instruments and equipment and could be encouraged for adult patients with various cardiovascular diseases.

  17. Integration of force reflection with tactile sensing for minimally invasive robotics-assisted tumor localization.

    Science.gov (United States)

    Talasaz, A; Patel, R V

    2013-01-01

    Tactile sensing and force reflection have been the subject of considerable research for tumor localization in soft-tissue palpation. The work presented in this paper investigates the relevance of force feedback (presented visually as well as directly) during tactile sensing (presented visually only) for tumor localization using an experimental setup close to one that could be applied for real robotics-assisted minimally invasive surgery. The setup is a teleoperated (master-slave) system facilitated with a state-of-the-art minimally invasive probe with a rigidly mounted tactile sensor at the tip and an externally mounted force sensor at the base of the probe. The objective is to capture the tactile information and measure the interaction forces between the probe and tissue during palpation and to explore how they can be integrated to improve the performance of tumor localization. To quantitatively explore the effect of force feedback on tactile sensing tumor localization, several experiments were conducted by human subjects to locate artificial tumors embedded in the ex vivo bovine livers. The results show that using tactile sensing in a force-controlled environment can realize, on average, 57 percent decrease in the maximum force and 55 percent decrease in the average force applied to tissue while increasing the tumor detection accuracy by up to 50 percent compared to the case of using tactile feedback alone. The results also show that while visual presentation of force feedback gives straightforward quantitative measures, improved performance of tactile sensing tumor localization is achieved at the expense of longer times for the user. Also, the quickness and intuitive data mapping of direct force feedback makes it more appealing to experienced users.

  18. Intrathecal morphine is superior to intravenous PCA in patients undergoing minimally invasive cardiac surgery.

    Science.gov (United States)

    Mukherjee, Chirojit; Koch, Eva; Banusch, Joergen; Scholz, Markus; Kaisers, Udo X; Ender, Joerg

    2012-01-01

    Aim of our study was to evaluate the beneficial effect of low dose intrathecal morphine on postoperative analgesia, over the use of intravenous patient controlled anesthesia (PCA), in patients undergoing fast track anesthesia during minimally invasive cardiac surgical procedures. A randomized controlled trial was undertaken after approval from local ethical committee. Written informed consent was obtained from 61 patients receiving mitral or tricuspid or both surgical valve repair in minimal invasive technique. Patients were assigned randomly to 2 groups. Group 1 received general anesthesia and intravenous patient controlled analgesia (PCA) pump with Piritramide (GA group). Group 2 received a single shot of intrathecal morphine (1.5 μg/kg body weight) prior to the administration of general anesthesia (ITM group). Site of puncture was confined to lumbar (L1-2 or L2-3) intrathecal space. The amount of intravenous piritramide used in post anesthesia care unit (PACU) and the first postoperative day was defined as primary end point. Secondary end points included: time for tracheal extubation, pain and sedation scores in PACU upto third postoperative day. For statistical analysis Mann-Whitney-U Test and Fishers exact test (SPSS) were used. We found that the demand for intravenous opioids in PACU was significantly reduced in ITM group (P <0.001). Pain scores were significantly decreased in ITM group until second postoperative day (P <0.01). There was no time delay for tracheal extubation in ITM group, and sedation scores did not differ in either group. We conclude that low dose single shot intrathecal morphine provides adequate postoperative analgesia, reduces the intravenous opioid consumption during the early postoperative period and does not defer early extubation.

  19. Intrathecal morphine is superior to intravenous PCA in patients undergoing minimally invasive cardiac surgery

    Directory of Open Access Journals (Sweden)

    Chirojit Mukherjee

    2012-01-01

    Full Text Available Aim of our study was to evaluate the beneficial effect of low dose intrathecal morphine on postoperative analgesia, over the use of intravenous patient controlled anesthesia (PCA, in patients undergoing fast track anesthesia during minimally invasive cardiac surgical procedures. A randomized controlled trial was undertaken after approval from local ethical committee. Written informed consent was obtained from 61 patients receiving mitral or tricuspid or both surgical valve repair in minimal invasive technique. Patients were assigned randomly to 2 groups. Group 1 received general anesthesia and intravenous patient controlled analgesia (PCA pump with Piritramide (GA group. Group 2 received a single shot of intrathecal morphine (1.5 μg/kg body weight prior to the administration of general anesthesia (ITM group. Site of puncture was confined to lumbar (L1-2 or L2-3 intrathecal space. The amount of intravenous piritramide used in post anesthesia care unit (PACU and the first postoperative day was defined as primary end point. Secondary end points included: time for tracheal extubation, pain and sedation scores in PACU upto third postoperative day. For statistical analysis Mann-Whitney-U Test and Fishers exact test (SPSS were used. We found that the demand for intravenous opioids in PACU was significantly reduced in ITM group (P <0.001. Pain scores were significantly decreased in ITM group until second postoperative day (P <0.01. There was no time delay for tracheal extubation in ITM group, and sedation scores did not differ in either group. We conclude that low dose single shot intrathecal morphine provides adequate postoperative analgesia, reduces the intravenous opioid consumption during the early postoperative period and does not defer early extubation.

  20. MINIMALLY INVASIVE SPINE SURGERY IN THE NUEVO HOSPITAL CIVIL DE GUADALAJARA "DR. JUAN I. MENCHACA"

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    MIGUEL ÁNGEL ANDRADE-RAMOS

    Full Text Available ABSTRACT Objective: To describe our experience on a case series treated with minimal invasive techniques in spine surgery, with short-term follow-up and identify complications. Methods: A prospective analysis was performed on 116 patients operated on by the same team from September 2015 to June 2016. Evaluating the short-term follow-up we registered the surgical time, bleeding, complications, hospital stay, pre- and postoperatively neurological status, as well as scales of disability and quality of life. Demographic and surgical procedure data were analyzed with SPSS version 20 program. Results: A total of 116 patients with a mean age of 49.7 + 15.7 (21-85 years underwent surgery being 76 (65% with lumbar conditions and 37 (32% with cervical conditions. The most common procedures were tubular discectomies (31, tubular bilateral decompression (17, lumbar MI-TLIFs (7, and anterior cervical discectomy and fusion (35. The mean blood loss was 50.6 cc, the hospital stay was 1.7 day, pre- and postoperative pain VAS were 7.4 % and 2.3%, respectively, pre- and postoperative Oswestry (ODI were 64.6% and 13.1%, respectively, pre- and postoperative SF-36 of 37.8% and 90.3%. There were no major complications, except for a surgical wound infection in diabetic patient and three incidental durotomies, one of these being a contained fistula, treated conservatively. Conclusions: The current tendency towards minimally invasive surgery has been justified on multiple studies in neoplastic and degenerative diseases, with the preservation of the structures that support the spine biomechanics. The benefits should not replace the primary objectives of surgery and its usefulness depends on the skills of the surgeon, pathology and the adequate selection of the techniques. We found that the tubular access allows developing techniques such as discectomy, corpectomy and fusion without limiting exposure, avoiding manipulation of adjacent structures, reducing complications and

  1. Effect of steerable cage placement during minimally invasive transforaminal lumbar interbody fusion on lumbar lordosis.

    Science.gov (United States)

    Lindley, Timothy E; Viljoen, Stephanus V; Dahdaleh, Nader S

    2014-03-01

    Minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF) is commonly used for the treatment of a variety of degenerative spine disorders. Recently, steerable interbody cages have been developed which potentially allow for greater restoration of lumbar lordosis. Here we describe a technique and radiographic results following minimally invasive placement of steerable cages through a bilateral approach. A retrospective review was conducted of the charts and radiographs of 15 consecutive patients who underwent 19 levels of bilateral MIS-TLIF with the placement of steerable cages. These were compared to 10 patients who underwent 16 levels of unilateral MIS-TLIF with the placement of bullet cages. The average age, body mass index, distribution of the levels operated and follow-up were similar in both groups. The average height of the steerable cage placed was 10.9 mm compared to 8.5mm for bullet cages. The preoperative focal Cobb's angle per level was similar between both groups with a mean of -5.3 degrees for the steerable cage group and -4.8 degrees for the bullet cage group. There was a significant improvement in postoperative Cobb's angle after placement of a steerable cage with a mean of -13.7 (p<0.01) and this persisted at the last follow-up with -13 degrees (p<0.01). There was no significant change in Cobb's angle after bullet cage placement with -5.7 degrees postoperatively and a return to the baseline preoperative Cobb's angle of -4.8 at the last follow-up. Steerable cage placement for MIS-TLIF improves focal lordosis compared to bullet cage placement.

  2. The strength and function of hip abductors following anterolateral minimally invasive total hip arthroplasty

    Directory of Open Access Journals (Sweden)

    Tan Jixiang

    2014-04-01

    Full Text Available Objective: To analyze the extent of postoperative hip abductor insufficiency in primary total hip arthroplasty (THA patients undergoing anterolateral minimally invasive (ALMI approach, and to investigate whether the clinical outcomes are more favorable in femoral neck fracture (FNF patients than in non-femoral neck fracture (nFNF patients. Methods:A total of 48 patients were enrolled in this study. Each patient underwent a clinical examination preoperatively and 6, 12, 24 and 48 weeks postoperatively. The abductor torque, Trendelenburg's sign, gait velocity, Harris hip score, Oxford hip score, Westren Ontario and McMaster Universities (WOMAC score and visual analog scale pain score were recorded. Statistical evaluation was performed with SPSS software version 18.0. The significance level was set at P<0.05. Results:The abductor torque of the operated hip and the recovery ratio showed a gradual improving tendency from 6 weeks postoperatively until the last follow-up. Gait velocity, Harris hip score, Oxford hip score and WOMAC score improved significantly after the operation until 24 weeks postoperatively. In the FNF group, the abductor torque of the operated side and the recovery ratio were significantly higher than in nFNF group at 6 weeks postoperatively, however, as time passed, this trend tended to disappear. Conclusion:This study demonstrates that patients can obtain good abductor strength and function in the early postoperative period and the hip abductor function of patients who suffer from hip osteoarthritis, rheumatoid arthritis, avascular necrosis of the femoral head could be significantly improved following ALMI THA. Key words: Arthroplasty, replacement, hip; Surgical procedures, minimally invasive; Recovery of function

  3. Minimally Invasive Treatment of Pelvic Fractures%骨盆骨折的微创治疗

    Institute of Scientific and Technical Information of China (English)

    闫双根

    2013-01-01

    不稳定性骨盆骨折多因巨大暴力直接作用于骨盆所致,常合并有休克、腹盆腔脏器及泌尿生殖道损伤.采取非手术疗法治疗的并发症较多,而开放内固定手术又存在创伤大、出血多、风险高等缺点.随着影像学设备的发展和骨科手术技术的不断改进,采用微创技术治疗骨盆骨折已逐渐应用于临床,如经皮采用外固定支架、骶髂螺钉或钢板等微创内固定方法治疗不同类型骨盆骨折的临床疗效已渐显优势.%Unstable pelvic fractures are mostly caused by the enormous violence which act directly on the pelvis,often associated with shock,abdominal and pelvic organs,and genitourinary tract injury. Non-surgical treatment will cause more complications, while open internal fixation has the demerits of maximal trauma, much bleeding and high-risk. With continuous improvement of imaging and orthopedic operation technology, minimally invasive surgery has been gradually applied to treat pelvic fracture. To different types of pelvic fracture , the advantages in clinical efficacy of the corresponding minimally invasive fixations have been gradually shown,such as percutaneous frame of external fixation,sacroiliac screw or steel plate etc..

  4. Laparoscopic endoscopic cooperative surgery as a minimally invasive treatment for gastric submucosal tumor

    Institute of Scientific and Technical Information of China (English)

    Tsutomu; Namikawa; Kazuhiro; Hanazaki

    2015-01-01

    Laparoscopic wedge resection is a useful procedure fortreating patients with submucosal tumor(SMT) including gastrointestinal stromal tumor(GIST) of the stomach. However, resection of intragastric-type SMTs can be problematic due to the difficulty in accurately judging the location of endoluminal tumor growth, and often excessive amounts of healthy mucosa are removed; thus, full-thickness local excision using laparoscopic and endoscopic cooperative surgery(LECS) is a promising procedure for these cases. Our experience with LECS has confirmed this procedure to be a safe, feasible, and minimally invasive treatment method for gastric GISTs less than 5 cm in diameter, with outcomes similar to conventional laparoscopic wedge resection. The important advantage of LECS is the reduction in the resected area of the gastric wall compared to that in conventional laparoscopic wedge resection using a linear stapler. Early gastric cancer fits the criteria for endoscopic resection; however, if performing endoscopic submucosal dissection is difficult, the LECS procedure might be a good alternative. In the future, LECS is also likely to be indicated for duodenal tumors, as well as gastric tumors. Furthermore, developments in endoscopic and laparoscopic technology have generated various modified LECS techniques, leading to even less invasive surgery.

  5. Locking internal fixator with minimally invasive plate osteosynthesis for the proximal and distal tibial fractures

    Institute of Scientific and Technical Information of China (English)

    TONG Da-ke; JI Fang; CAI Xiao-bing

    2011-01-01

    Objective: To investigate the efficacy of the locking internal fixator (LIF), which includes the locking compression plate (LCP) and the less invasive stable system (LISS), in the proximal and distal tibial fractures. Methods: We did a retrospective study on a total of 98 patients with either proximal or distal tibial fractures from January 2003 to January 2007, who had received the operation with LIF by the minimally invasive plate osteosynthesis (MIPO) technique. The data consisted of 43 proximal tibial fractures (type AO41C3) and 55 distal tibial fractures (type AO43C3). Results: No complications were observed in all patients after operation. The mean healing time was 8.4 months (range 5-14 months). Only two cases of delayed union occurred at postoperative 10 months. No infections were reported after the definitive surgery even in the cases of open fractures. All patients reached a full range of motion at postoperative 6 to 9 months and regained the normal functions of knee and ankle joints. Conclusion: Using LIF in MIPO technique is a reliable approach towards the proximal and distal tibial fractures that are not suitable for intramedullary nailing.

  6. Multidetector CT of Locally Invasive Advanced Gastric Cancer: Value of Oblique Coronal Reconstructed Images for the Assessment of Local Invasion

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    Jung, Jin Hee; Kim, Ah Yong; Kim, Hye Jin; Yook, Jeong Hwan; Yu, Eun Sil; Jang, Yoon Jin; Park, Seong Ho; Shin, Yong Moon; Ha, Hyun Kwon [Asan Medical Center, Seoul (Korea, Republic of)

    2010-01-15

    To evaluate the diagnostic value of oblique coronal reconstructed CT images to determine the local invasion of advanced gastric cancer (AGC). Thirty-four consecutive patients, who were suspected to have locally invasive advanced gastric cancer (more than T3 stage) on a preoperative MDCT scan and underwent a diagnostic or curative laparotomy, were enrolled in this study. Two reviewers performed an independent blind review of three series of MDCT images in random order; axial (AXI), conventional coronal (CCI), and oblique coronal (OCI) (parallel to long axis of gastric body and pancreas) images. In assessing the local invasion, the reader's confidence for the local invasion of AGC was graded using a five point scale (1 = definitely negative, 5 = definitely positive: T4). With surgical findings and histopathological proofs as reference standards, the diagnostic performance of the three different plans of CT images was employed for the verification of local invasion of AGC on a preoperative CT scan using the receiver operating characteristic (ROC) method. Agreements between the two reviewers were analyzed using weighted kappa statistics. Results: In 19 out of 34 patients, local invasion was confirmed surgically or histopathologically (13 pancreas invasion, 6 liver invasion, 4 major vascular invasion, 3 colon and mesocolon invasion, and 2 spleen invasion). The diagnostic performance of OCI was superior to AXI or CCI in the local invasion of AGC. The differences in the area under the curve of AXI (0.770 {+-} 0.087, 0.700 {+-} 0.094), CCI (0.884 {+-} 0.058, 0.958 {+-} 0.038), and OCI (0.954 {+-} 0.050, 0.956 {+-} 0.049), were statistically significant for both reviewers. Inter-observer agreement was excellent for OCI ({kappa}= .973), which was greater than CCI (({kappa}= .839), and AXI (({kappa}= .763). On a CT scan, OCI might be a useful imaging technique in evaluating locally invasive advanced gastric cancer.

  7. Minimally invasive Approach to Restore with Porcelain Laminate Veneer on Maxillary Lateral Incisors

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    Luiz Guilherme Freitas de Paula

    2014-01-01

    Full Text Available The enhancement of indirect restorations along the advancement of adhesive systems made possible the preservation of tooth structure through the completion of minimal wear. The laminates ceramics veneers type "contact lens" are presented as a great option when compared to other restorations and excellent results can be noted in a conservative approach. The indication and proper planning are critical to the success of treatment. The present case aims to show the restoration of height and shape of lateral incisors combining the wishes of the patient to the possibilities that dentistry has to offer.

  8. Minimally invasive proximal interphalangeal joint arthrodesis using a locking compression plate and tissue engineering in horses: a pilot study.

    Science.gov (United States)

    Seo, Jong-pil; Yamaga, Takashi; Tsuzuki, Nao; Yamada, Kazutaka; Haneda, Shingo; Furuoka, Hidefumi; Tabata, Yasuhiko; Sasaki, Naoki

    2014-11-01

    This pilot study assessed the efficacy of 2 minimally invasive techniques for proximal interphalangeal (PIP) joint arthrodesis in horses. The PIP joints of both forelimbs (n = 6) were stabilized with locking compression plates (LCP) using a minimally invasive technique (LCP technique). Subsequently, for 1 randomly selected PIP joint of each horse, surgical drilling (SurD) was performed and tissue engineering (TE) was applied (LCP/SurD/TE technique). Minimally invasive PIP joint arthrodesis with LCP demonstrated low postoperative infection rates. Gross and histological evaluations revealed considerable destruction of the articular cartilage in the LCP/SurD/TE-treated joints. In contrast, almost no destruction of the cartilage was observed in the LCP-treated joints. Our results suggest that the LCP technique alone is not sufficient for PIP joint arthrodesis and that the LCP/SurD/TE technique may be useful for PIP joint arthrodesis in horses.

  9. Management of pilonidal sinus by Kshar Sutra, a minimally invasive treatment.

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    Dwivedi, Amar P

    2010-04-01

    A Pilonidal sinus (PNS) occurs in the cleavage between the buttocks (natal cleft) and can cause discomfort, embarrassment and absence from work. It is more common in men (as they have more hair) than in women. The most commonly used surgical techniques for this disorder include excision and primary closure and excision with reconstructive flap. However, the risk of recurrence or of developing an infection of the wound after the operation is high. Also, the patient requires longer hospitalization, and the procedure is expensive. There is a similarity between Shalyaj Nadi Vran described in Sushruta Samhita and Pilonidal sinus. Sushruta has advocated a minimally invasive para-surgical treatment, viz., Kshar Sutra procedure, for nadi vran. Hence this therapy was tried in Pilonidal sinus, and is described in this case report. Kshar Sutra treatment not only minimizes complications and recurrence but also enables the patient to resume work quicker and with less discomfort, impact upon body image and self-esteem as well as reduced cost.

  10. Neurological complications using a novel retractor system for direct lateral minimally invasive lumbar interbody fusion.

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    Sedra, Fady; Lee, Robert; Dominguez, Ignacio; Wilson, Lester

    2016-09-01

    We describe our experience using the RAVINE retractor (K2M, Leesburg, VA, USA) to gain access to the lateral aspect of the lumbar spine through a retroperitoneal approach. Postoperative neurological adverse events, utilising the mentioned retractor system, were recorded and analysed. We included 140 patients who underwent minimally invasive lateral lumbar interbody fusion (MI-LLIF) for degenerative spinal conditions between 2011 and 2015 at two major spinal centres. A total of 228 levels were treated, 35% one level, 40% two level, 20% three level and 5% 4 level surgeries. The L4/5 level was instrumented in 28% of cases. 12/140 patients had postoperative neurological complications. Immediately after surgery, 5% of patients (7/140) had transient symptoms in the thigh ranging from sensory loss, pain and paraesthesia, all of which recovered within 12weeks following surgery. There were five cases of femoral nerve palsy (3.6% - two ipsilateral and three contralateral), all of which recovered completely with no residual sensory or motor deficit within 6months. MI-LLIF done with help of the described retractor system has proved a safe and efficient way to achieve interbody fusion with minimal complications, mainly nerve related, that recovered quickly. Judicious use of the technique to access the L4/5 level is advised.

  11. Automatic prebent customized prosthesis for pectus excavatum minimally invasive surgery correction.

    Science.gov (United States)

    Vilaça, João L; Rodrigues, Pedro L; Soares, Tony R; Fonseca, Jaime C; Pinho, António C M; Henriques-Coelho, Tiago; Correia-Pinto, Jorge

    2014-06-01

    Pectus excavatum is the most common deformity of the thorax. A minimally invasive surgical correction is commonly carried out to remodel the anterior chest wall by using an intrathoracic convex prosthesis in the substernal position. The process of prosthesis modeling and bending still remains an area of improvement. The authors developed a new system, i3DExcavatum, which can automatically model and bend the bar preoperatively based on a thoracic CT scan. This article presents a comparison between automatic and manual bending. The i3DExcavatum was used to personalize prostheses for 41 patients who underwent pectus excavatum surgical correction between 2007 and 2012. Regarding the anatomical variations, the soft-tissue thicknesses external to the ribs show that both symmetric and asymmetric patients always have asymmetric variations, by comparing the patients' sides. It highlighted that the prosthesis bar should be modeled according to each patient's rib positions and dimensions. The average differences between the skin and costal line curvature lengths were 84 ± 4 mm and 96 ± 11 mm, for male and female patients, respectively. On the other hand, the i3DExcavatum ensured a smooth curvature of the surgical prosthesis and was capable of predicting and simulating a virtual shape and size of the bar for asymmetric and symmetric patients. In conclusion, the i3DExcavatum allows preoperative personalization according to the thoracic morphology of each patient. It reduces surgery time and minimizes the margin error introduced by the manually bent bar, which only uses a template that copies the chest wall curvature.

  12. Minimally Invasive Anal Fistula Treatment (MAFT)-An Appraisal of Early Results in 416 Patients.

    Science.gov (United States)

    Chowbey, P K; Khullar, R; Sharma, A; Soni, V; Najma, K; Baijal, M

    2015-12-01

    Minimally invasive anal fistula treatment (MAFT) was introduced to minimize early postoperative morbidity, preserve sphincter continence, and reduce recurrence. We report our early experience with MAFT in 416 patients. Preoperative MRI was performed in 150 patients initially and subsequently thereafter. The technique involves fistuloscope-aided localization of internal fistula opening, examination and fulguration of all fistula tracks, and secure stapled closure of internal fistula opening within anal canal/rectum. MAFT was performed as day-care procedure in 391 patients (93.9 %). During surgery, internal fistula opening could not be located in 100 patients (24 %). Seven patients required readmission to hospital. Mean visual analog scale scores for pain on discharge and at 1 week were 3.1 (1-6) and 1.6 (0-3), respectively. Mean duration for return to normal activity was 3.2 days (2-11 days). Fistula recurrence was observed in 35/134 patients (26.1 %) at 1 year follow-up. MAFT may be performed as day-care procedure with benefits of less pain, absence of perianal wounds, faster recovery, and preservation of sphincter continence. However, long-term results from more centers are needed especially for recurrence.

  13. Modern possibilities of minimally invasive methods of diagnosis and treatment in China

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    Kuo Chen

    2016-01-01

    Full Text Available Breast cancer is now the most common cancer that threatens the health of women in China. The annual number of new cases of breast cancer and the number of deaths in China is 12.2 and 9.6 % respectively of the total amount in the world. Following the scientific and technological progress in the development direction of surgery for breast cancer has been the development in the field of endoscopic surgery, this treatment method with little section provides a good therapeutic result. Along with the aesthetic appearance of cure is achieved at the site of surgery and minimizing the trauma. In China use system “Mammotome” and dustoscopic for preoperative biopsy; and through mastoscopic do breast-conserving surgery, operations mastectomy in breast cancer and reconstruction, sentinel lymph node biopsy, and axillary lymph node dissection; ablation. In China now fully implemented the treatment of breast cancer minimally invasive techniques which is the general trend of the development of surgery in the country.

  14. Ultrafast mid-IR laser scalpel: protein signals of the fundamental limits to minimally invasive surgery.

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    Saeid Amini-Nik

    Full Text Available Lasers have in principle the capability to cut at the level of a single cell, the fundamental limit to minimally invasive procedures and restructuring biological tissues. To date, this limit has not been achieved due to collateral damage on the macroscale that arises from thermal and shock wave induced collateral damage of surrounding tissue. Here, we report on a novel concept using a specifically designed Picosecond IR Laser (PIRL that selectively energizes water molecules in the tissue to drive ablation or cutting process faster than thermal exchange of energy and shock wave propagation, without plasma formation or ionizing radiation effects. The targeted laser process imparts the least amount of energy in the remaining tissue without any of the deleterious photochemical or photothermal effects that accompanies other laser wavelengths and pulse parameters. Full thickness incisional and excisional wounds were generated in CD1 mice using the Picosecond IR Laser, a conventional surgical laser (DELight Er:YAG or mechanical surgical tools. Transmission and scanning electron microscopy showed that the PIRL laser produced minimal tissue ablation with less damage of surrounding tissues than wounds formed using the other modalities. The width of scars formed by wounds made by the PIRL laser were half that of the scars produced using either a conventional surgical laser or a scalpel. Aniline blue staining showed higher levels of collagen in the early stage of the wounds produced using the PIRL laser, suggesting that these wounds mature faster. There were more viable cells extracted from skin using the PIRL laser, suggesting less cellular damage. β-catenin and TGF-β signalling, which are activated during the proliferative phase of wound healing, and whose level of activation correlates with the size of wounds was lower in wounds generated by the PIRL system. Wounds created with the PIRL systsem also showed a lower rate of cell proliferation. Direct

  15. Ultrafast mid-IR laser scalpel: protein signals of the fundamental limits to minimally invasive surgery.

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    Amini-Nik, Saeid; Kraemer, Darren; Cowan, Michael L; Gunaratne, Keith; Nadesan, Puviindran; Alman, Benjamin A; Miller, R J Dwayne

    2010-09-28

    Lasers have in principle the capability to cut at the level of a single cell, the fundamental limit to minimally invasive procedures and restructuring biological tissues. To date, this limit has not been achieved due to collateral damage on the macroscale that arises from thermal and shock wave induced collateral damage of surrounding tissue. Here, we report on a novel concept using a specifically designed Picosecond IR Laser (PIRL) that selectively energizes water molecules in the tissue to drive ablation or cutting process faster than thermal exchange of energy and shock wave propagation, without plasma formation or ionizing radiation effects. The targeted laser process imparts the least amount of energy in the remaining tissue without any of the deleterious photochemical or photothermal effects that accompanies other laser wavelengths and pulse parameters. Full thickness incisional and excisional wounds were generated in CD1 mice using the Picosecond IR Laser, a conventional surgical laser (DELight Er:YAG) or mechanical surgical tools. Transmission and scanning electron microscopy showed that the PIRL laser produced minimal tissue ablation with less damage of surrounding tissues than wounds formed using the other modalities. The width of scars formed by wounds made by the PIRL laser were half that of the scars produced using either a conventional surgical laser or a scalpel. Aniline blue staining showed higher levels of collagen in the early stage of the wounds produced using the PIRL laser, suggesting that these wounds mature faster. There were more viable cells extracted from skin using the PIRL laser, suggesting less cellular damage. β-catenin and TGF-β signalling, which are activated during the proliferative phase of wound healing, and whose level of activation correlates with the size of wounds was lower in wounds generated by the PIRL system. Wounds created with the PIRL systsem also showed a lower rate of cell proliferation. Direct comparison of wound

  16. Evaluation of a novel tool for bone graft delivery in minimally invasive transforaminal lumbar interbody fusion

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    Kleiner JB

    2016-05-01

    Full Text Available Jeffrey B Kleiner, Hannah M Kleiner, E John Grimberg Jr, Stefanie J Throlson The Spine Center of Innovation, The Medical Center of Aurora, Aurora, CO, USA Study design: Disk material removed (DMR during L4-5 and L5-S1 transforaminal lumbar interbody fusion (T-LIF surgery was compared to the corresponding bone graft (BG volumes inserted at the time of fusion. A novel BG delivery tool (BGDT was used to apply the BG. In order to establish the percentage of DMR during T-LIF, it was compared to DMR during anterior diskectomy (AD. This study was performed prospectively. Summary of background data: Minimal information is available as to the volume of DMR during a T-LIF procedure, and the relationship between DMR and BG delivered is unknown. BG insertion has been empiric and technically challenging. Since the volume of BG applied to the prepared disk space likely impacts the probability of arthrodesis, an investigation is justified. Methods: A total of 65 patients with pathology at L4-5 and/or L5-S1 necessitating fusion were treated with a minimally invasive T-LIF procedure. DMR was volumetrically measured during disk space preparation. BG material consisting of local autograft, BG extender, and bone marrow aspirate were mixed to form a slurry. BG slurry was injected into the disk space using a novel BGDT and measured volumetrically. An additional 29 patients who were treated with L5-S1 AD were compared to L5-S1 T-LIF DMR to determine the percent of T-LIF DMR relative to AD. Results: DMR volumes averaged 3.6±2.2 mL. This represented 34% of the disk space relative to AD. The amount of BG delivered to the disk spaces was 9.3±3.2 mL, which is 2.6±2.2 times the amount of DMR. The BGDT allowed uncomplicated filling of the disk space in <1 minute. Conclusion: The volume of DMR during T-LIF allows for a predictable volume of BG delivery. The BGDT allowed complete filling of the entire prepared disk space. The T-LIF diskectomy debrides 34% of the disk

  17. Quantitative body fluid proteomics in medicine - A focus on minimal invasiveness.

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    Csősz, Éva; Kalló, Gergő; Márkus, Bernadett; Deák, Eszter; Csutak, Adrienne; Tőzsér, József

    2017-02-05

    Identification of new biomarkers specific for various pathological conditions is an important field in medical sciences. Body fluids have emerging potential in biomarker studies especially those which are continuously available and can be collected by non-invasive means. Changes in the protein composition of body fluids such as tears, saliva, sweat, etc. may provide information on both local and systemic conditions of medical relevance. In this review, our aim is to discuss the quantitative proteomics techniques used in biomarker studies, and to present advances in quantitative body fluid proteomics of non-invasively collectable body fluids with relevance to biomarker identification. The advantages and limitations of the widely used quantitative proteomics techniques are also presented. Based on the reviewed literature, we suggest an ideal pipeline for body fluid analyses aiming at biomarkers discoveries: starting from identification of biomarker candidates by shotgun quantitative proteomics or protein arrays, through verification of potential biomarkers by targeted mass spectrometry, to the antibody-based validation of biomarkers. The importance of body fluids as a rich source of biomarkers is discussed.

  18. SECOND AND THIRD DEGREE HAEMORRHOIDS: MANAGEMENT WITH MINIMALLY INVASIVE PROCEDURE FOR HAEMORRHOID (MIPH AND OUTCOME

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    Rajesh Kumar

    2014-12-01

    Full Text Available The present study was carried out to study the management of second and third degree haemorrhoids with Minimally Invasive Procedure for Haemorrhoid (MIPH and its outcome. Twenty five cases were included in the study. The major aims of the study were to evaluate the merits and demerits of Minimal Invasive Procedure for management of second and third degree haemorrhoids by using haemorrhoidal set and to study the efficacy of MIPH ( S tapled haemorrho idopexy in terms of duration of surgery , early complications , time of ambulation , mean hospital stay , time of rejoin to work and late complications. The study was carried out in MB Government Hospital associated with R.N.T. Medical C ollege , Udaipur. Patients admitted in different s urgical wards were taken for study. Material and method used in this study include various laboratory investigations including CBC , BT , CT , Blood Sugar , S - urea , S - creatinine , HIV , HBsAg , Urine complete , X - Ray Chest and ECG. Special Investigation including Per rectal examination for anal sphincter tone , pain , any rectal growth , prolapse , bleeding , discharge and Proctoscopy to evaluate positions and grades of piles. Statistical analysis of various data done and maximum incidence thirty six percent of second and third degree haemorrhiods was found in 31 - 40 year age group. Males were predominantly affected as compared to females. Patients with second and third degree of haemorrhoids mostly visited hospital for bleeding pe r rectum and prolapse . Other symptoms about which patient were concerned were pain , itching and discharge and about half of the patients had associated history of constipation. Most of patients seek surgeons attention after a period of about one month. Twe nty percent patients had positive family history of haemorrhoid. Eighty eight percent patients had taken some treatment in the form of laxative and ointment. Eight percent patients had undergone sclerotherapy and twelve percent

  19. The Role of Minimally Invasive Plate Osteosynthesis in Rib Fixation: A Review.

    Science.gov (United States)

    Bemelman, Michael; van Baal, Mark; Yuan, Jian Zhang; Leenen, Luke

    2016-02-01

    More than a century ago, the first scientific report was published about fracture fixation with plates. During the 1950's, open reduction and plate fixation for fractures were standardized by the founders of Arbeitsgemeinschaft für osteosynthesefragen/Association for the Study of Internal Fixation. Since the introduction of plate fixation for fractures, several plates and screws have been developed, all with their own characteristics. To accomplice more fracture stability, it was thought the bigger the plate, the better. The counter side was a compromised blood supply of the bone, often resulting in bone necrosis and ultimately delayed or non-union. With the search and development of new materials and techniques for fracture fixation, less invasive procedures have become increasingly popular. This resulted in the minimally invasive plate osteosynthesis (MIPO) technique for fracture fixation. With the MIPO technique, procedures could be performed with smaller incisions and thus with less soft tissue damage and a better preserved blood supply. The last 5 years rib fixation has become increasingly popular, rising evidence has become available suggesting that surgical rib fixation improves outcome of patients with a flail chest or isolated rib fractures. Many surgical approaches for rib fixation have been described in the old literature, however, most of these techniques are obscure nowadays. Currently mostly large incisions with considerable surgical insult are used to stabilize rib fractures. We think that MIPO deserves a place in the surgical treatment of rib fractures. We present the aspects of diagnosis, preoperative planning and operative techniques in regard to MIPO rib fixation.

  20. 3. Early outcomes of minimally invasive versus conventional mitral valve surgery in mitral valve diseases. A single institutional experience

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    E. Nourelden

    2016-07-01

    Full Text Available Minimally invasive techniques in cardiac surgery gained popularity due to many advantages like less postoperative pain, minimal blood loss, less hospital stay, less cost. Minimally invasive mitral valve surgery through right anterolateral mini thoracotomy became safe technique. In our study we compared mini-MV surgery with conventional technique regarding cross clamp time, bypass time, total blood loss, reopening for bleeding, and hospital and ICU length of stay. In our institution between 2010 and 2015, 147patients underwent minimally invasive mitral surgery through right lateral minithoracotomy 8 cm incision and 118 patient underwent conventional mitral valve surgery through median sternotomy in minimally invasive technique: mean age was 38 ± 20 vs 59 ± 21, 70.7% were female (n = 104 vs 39.8% (n = 47, 23.8% were associated with tricuspid valve regurgitation (n = 33 vs 55% in conventional technique (n = 65, 0.08% were able to use endovascular clamp (n = 12, mean Euroscore predected risk of mortality 14.7 ± 13.6% vs 8.7 ± 10.9%. Minimally invasive mitral valve repair surgery was accomplished in 77.5% (n = 114 vs 46.15% (n = 55 and replacement of mitral valve in 22.4% (n = 30 vs 53.8% (n = 64 , concomitant procedures consists of tricuspid valve surgery in 23.8% (n = 35 vs 55% (n = 65, primary mitral valve repair included implantation of rigid annuloplasty ring in 79.6% vs 38.9% (n = 46, duration of cardiopulmonary bypass in minimally invasive surgery was 123 ± 64 min vs 116 ± 62 min, cross clamp time was 64 ± 27 min vs 59 ± 23 min, postoperative mechanical ventilation time 4 ± 1.5 h vs 6.5 ± 2 h, ICU lenght of stay (LOS was 48 ± 12 h vs 3 ± 1 days. Minimally invasive mitral surgery can be performed very safely with excellent early results. mini-MV surgery can be performed with a reasonable operative time, good perioperative course with decrease in postoperative ICU and hospital

  1. Computed Tomography Guided Hook-wire Precise Localization and Minimally Invasive Resection of Pulmonary Nodules

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    Tong WANG

    2015-11-01

    Full Text Available Background and objective Localization of pulmonary ground glass nodule is the technical difficulty of minimally invasive operation resection. The aim of this study is to evaluate the value of computed tomography (CT-guided Hook-wire precise localization in resection of pulmonary nodules by video-assisted thoracoscopic surgery (VATS as well as to discuss the necessity and feasibility of surgical resection of GGOs through a minimally invasive approach. Methods CT-guided Hook-wire precise localization and wedge resection was done on 25 cases with 26 pulmonary nodules by VATS from May 2013 to June 2015. The efficacy of localization was evaluated in terms of procedure time, VATS success rate, and associated complications of localization. Results All the 26 pulmonary nodules (6 solid nodules and 20 GGOs of 25 patients (10 males and 15 females were preoperatively detected and localized with Hook-wire under CT guidance. Nodule diameters ranged from 5 mm-20 mm (mean: 8 mm. The distance of lung lesions from the nearest pleural surfaces ranged within 5 mm-30 mm (mean: 14 mm. All resections of lesions guided by the Hook-wire were successfully performed by VATS (success rate: 100%. The mean procedure time for the CT-guided Hook-wire localization was 10 min (range: 5 min-10 min. The mean procedure time for VATS wedge resection was 20 min (range: 15 min-40 min. The mean hospital time was 4 d (range: 3 d-6 d. The major complication of CT-guided Hook-wire localization was mild pneumothorax in 4 patients, but no one needed chest tube drainage. Wedge resection was performed successfully in all cases. The dislocation of Hook-wire was found in only one patient during the operation, but the lesion was still successfully resected under VATS. Results of pathological examination of 16 mGGOs revealed 8 primary lung cancers and 8 nonspecific chronic inflammations. Results of pathological examination of 4 pGGOs revealed 1 primary lung cancers, 1 atypical adenomatous

  2. Minimal invasive transforaminal lumbar interbody fusion versus open transforaminal lumbar interbody fusion

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    Kulkarni, Arvind G; Bohra, Hussain; Dhruv, Abhilash; Sarraf, Abhishek; Bassi, Anupreet; Patil, Vishwanath M

    2016-01-01

    Background: The aim of the present prospective study is to evaluate whether the touted advantages of minimal invasive-transforaminal lumbar interbody fusion (MI-TLIF) translate into superior, equal, or inferior outcomes as compared to open-transforaminal lumbar interbody fusion (O-TLIF). This is the first study from the Indian subcontinent prospectively comparing the outcomes of MI-TLIF and O-TLIF. Materials and Methods: All consecutive cases of open and MI-TLIF were prospectively followed up. Single-level TLIF procedures for spondylolytic and degenerative conditions (degenerative spondylolisthesis, central disc herniations) operated between January 2011 and January 2013 were included. The pre and postoperative Oswestry Disability Index (ODI) and visual analog scale (VAS) for back pain and leg pain, length of hospital stay, operative time, radiation exposure, quantitative C-reactive protein (QCRP), and blood loss were compared between the two groups. The parameters were statistically analyzed (using IBM® SPSS® Statistics version 17). Results: 129 patients underwent TLIF procedure during the study period of which, 71 patients (46 MI-TLIF and 25 O-TLIF) fulfilled the inclusion criteria. Of these, a further 10 patients were excluded on account of insufficient data and/or no followup. The mean followup was 36.5 months (range 18-54 months). The duration of hospital stay (O-TLIF 5.84 days + 2.249, MI-TLIF 4.11 days + 1.8, P blood loss (open 358.8 ml, MI 111.81 ml, P group. On an average, 57.77 fluoroscopic exposures were required in MI-TLIF which was significantly higher than in O-TLIF (8.2). There was no statistically significant difference in the improvement in ODI and VAS scores in MI-TLIF and O-TLIF groups. The change in QCRP values preoperative and postoperative was significantly lower (P group than in O-TLIF group, indicating lesser tissue trauma. Conclusion: The results in MI TLIF are comparable with O-TLIF in terms of outcomes. The advantages of MI-TLIF are

  3. Minimally invasive treatment of lumbar spinal stenosis with a novel interspinous spacer

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    Shabat S

    2011-09-01

    Full Text Available Shay Shabat1, Larry E Miller2,3, Jon E Block3, Reuven Gepstein11Spinal Care Unit, Sapir Medical Center, Kfar Saba, Israel; 2Miller Scientific Consulting, Inc, Biltmore Lake, NC, USA; 3Jon E Block, PhD, Inc, San Francisco, CA, USAPurpose: To assess the safety and effectiveness of a novel, minimally invasive interspinous spacer in patients with moderate lumbar spinal stenosis (LSS.Methods: A total of 53 patients (mean age, 70 ± 11 years; 45% female with intermittent neurogenic claudication secondary to moderate LSS, confirmed on imaging studies, were treated with the Superion® Interspinous Spacer (VertiFlex, Inc, San Clemente, CA and returned for follow-up visits at 6 weeks, 1 year, and 2 years. Study endpoints included axial and extremity pain severity with an 11-point numeric scale, Zurich Claudication Questionnaire (ZCQ, back function with the Oswestry Disability Index (ODI, health-related quality of life with the Physical Component Summary (PCS and Mental Component Summary (MCS scores from the SF-12, and adverse events.Results: Axial and extremity pain each decreased 54% (both P < 0.001 over the 2-year follow-up period. ZCQ symptom severity scores improved 43% (P < 0.001 and ZCQ physical function improved 44% (P < 0.001 from pre-treatment to 2 years post-treatment. A statistically significant 50% improvement (P < 0.001 also was noted in back function. PCS and MCS each improved 40% (both P < 0.001 from pre-treatment to 2 years. Clinical success rates at 2 years were 83%–89% for ZCQ subscores, 75% for ODI, 78% for PCS, and 80% for MCS. No device infection, implant breakage, migration, or pull-out was observed, although two (3.8% patients underwent explant with subsequent laminectomy.Conclusion: Moderate LSS can be effectively treated with a minimally invasive interspinous spacer. This device is appropriate for select patients who have failed nonoperative treatment measures for LSS and meet strict anatomical criteria.Keywords: Superion, axial

  4. A novel, minimally invasive rat model of normothermic cardiopulmonary bypass model without blood priming

    Institute of Scientific and Technical Information of China (English)

    Zhu Yaobin; Liu Donghai; Li Xiaofeng; Liu Aijun; Wang Qiang; Qiao Chenhui; Zhang Jing

    2014-01-01

    Background Cardiopulmonary bypass (CPB) has been shown to be associated with systemic inflammatory response leading to postoperative organ dysfunction.Elucidating the underlying mechanisms and developing protective strategies for the pathophysiological consequences of CPB have been hampered due to the absence of a satisfactory recovery animal model.The purpose of this study was to establish a novel,minimally invasive rat model of normothermic CPB model without blood priming.Methods Twenty adult male Sprague-Dawley rats weighing 450-560 g were randomly divided into CPB group (n=10) and control group (n=10).All rats were anaesthetized and mechanically ventilated.The carotid artery and jugular vein were cannulated.The blood was drained from the right atrium via the right jugular and further transferred by a miniaturized roller pump to a hollow fiber oxygenator and back to the rat via the left carotid artery.The volume of the priming solution,composed of 6% HES130/0.4 and 125 IU heparin,was less than 12 ml.The surface of the hollow fiber oxygenator was 0.075 m2.CPB was conducted for 60 minutes at a flow rat of 100-120 ml· kg-1· min-1 in CPB group.Oxygen flow/perfusion flow was 0.8 to 1.0,and the mean arterial pressure remained 60-80 mmHg.Results All CPB processes were successfully achieved.Blood gas analysis and hemodynamic parameters of each time point were in accordance with normal ranges.The vital signs of all rats were stable.Conclusions The establishment of CPB without blood priming in rats can be achieved successfully.The nontransthoracic model should facilitate the investigation of pathophysiological processes concerning CPB-related multiple organ dysfunction and possible protective interventions.This novel,recovery,and reproducible minimally invasive CPB model may open the field for various studies on the pathophysiological process of CPB and systemic ischemia-reperfusion injury in vivo.

  5. [New minimally invasive approach for palmar plating in distal radius fractures].

    Science.gov (United States)

    Chmielnicki, M; Prokop, A

    2015-02-01

    Distal radius fractures are among the most common fractures. Types A3 and C2 make up almost half of these. Volar fixed-angle plate fixation is the gold standard of treatment today. We wanted to minimise the approach to the distal radius through a transverse 2-3 cm incision in the wrist flexor fold, tunnelling beneath the pronator muscle. The operative technique is demonstrated here. 11 patients, averaging 70 years of age, underwent surgery for 7 A3 and 4 C2 type fractures. Average operating time was 50 minutes. Length of admission averaged 2.9 days. Using a visual analogue scale, pain decreased from 6/10 preoperatively to 3/10 on post-op day one and 2/10 on post-op day three. After 6 weeks, flexion and extension averaged 45-0-45°, and radial and ulnar deviation 20-0-20°. Pronation and supination averaged 85-0-85°. Grip strength with manometer averaged 90 % compared to the contralateral side at 6 weeks and 96 % at 3 months. As comparison, from 1 January 2008 until 31 May 2013, we treated 908 patients with distal radius fractures with volar fixed-angle plates through a conventional longitudinal incision of 5-8 cm. The average skin to skin time was 46 minutes, with an average length of admission of 5.6 days. A minimally invasive approach to treat distal radius fractures with volar plate fixation and sparing of the pronator muscle is possible. The initial patients treated with this approach experienced minimal post-operative pain, shorter hospital admissions, and rapid grip strength recovery with almost undisturbed rotational motion.

  6. A fluoroscopy-based planning and guidance software tool for minimally invasive hip refixation by cement injection

    NARCIS (Netherlands)

    Malan, D.F.; Van der Walt, S.J.; Raidou, R.G.; Van den Berg, B.; Stoel, B.C.; Botha, C.P.; Nelissen, R.G.H.H.; Valstar, E.R.

    2015-01-01

    Purpose In orthopaedics, minimally invasive injection of bone cement is an established technique. We present HipRFX, a software tool for planning and guiding a cement injection procedure for stabilizing a loosening hip prosthesis. HipRFX works by analysing a pre-operative CT and intraoperative C-arm

  7. Simple Tools for Surgeons: Design and Evaluation of mechanical alternatives for robotic instruments for Minimally Invasive Surgery

    NARCIS (Netherlands)

    Jaspers, J.E.N.

    2006-01-01

    Performing complex tasks in Minimally Invasive Surgery (MIS) is demanding due to a disturbed hand-eye co-ordination, the application of non-ergonomic instruments with limited number of degrees of freedom (DOFs) and the two-dimensional (2D) view controlled by the surgical assistance. Robotic camera h

  8. Correlative analysis of MRI-evident abductor hip muscle degeneration and power after minimally invasive versus conventional unilateral cementless THA.

    Science.gov (United States)

    Vasilakis, Ioannis; Solomou, Ekaterini; Vitsas, Vasilis; Fennema, Peter; Korovessis, Panagiotis; Siamblis, Dimitrios K

    2012-12-01

    The 2 main null hypotheses of this study were: (1) the 4-year surgical trauma-related degeneration within the hip abductor muscles after a minimally invasive approach to total hip arthroplasty would be similar to that following a conventional approach; and (2) no differences in perioperative blood loss or postoperative hip pain would be observed between the minimally invasive and conventional approaches.In 40 consecutive randomly selected adult patients with unilateral primary hip osteoarthritis, a cementless Zweymüller-Plus THA (Smith & Nephew Orthopaedics, Baar, Switzerland) was implanted by a single surgeon in 1 institution during the same period. Twenty patients underwent a minimally invasive approach (group A), and 20 patients underwent a conventional anterolateral approach (group B). Four years postoperatively, the operated and contralateral nonoperated hips of 37 available patients from both groups were examined with magnetic resonance imaging to show any changes in the gluteus medius and tensor fascia latae. Simultaneously, hip abductor power was measured bilaterally in both groups. Anthropometric data, blood loss, Short Form 36 self-assessment questionnaire, visual analog pain score, and walking distance were also analyzed.The reliability of magnetic resonance imaging and hip abductor power measurements was high. No difference was found in hip abductor power on the operated side between the 2 groups, whereas hip abductor power on the nonoperated side was significantly higher in both groups. This study revealed no mechanical and functional benefits in favor of patients undergoing minimally invasive vs conventional total hip arthroplasty.

  9. Intraprostatic ozone therapy: A minimally invasive approach in benign prostatic hyperplasia

    Science.gov (United States)

    Hussain, Shabbir; Sharma, Deepti B.; Solanki, Fanindra S.; Pathak, Ajay; Sharma, Dhananjay

    2017-01-01

    Introduction: Transurethral resection of prostate (TURP) remains the golden standard therapy since decades. There are various minimally invasive therapies (MITs) for the treatment of benign prostatic hyperplasia (BPH). Still, there is a need for therapy with lesser side effects and better outcome. We had studied the effect of intraprostatic ozone injection (IPOI) as an MIT for patients with BPH who have failed trial without catheter (TWOC). Materials and Methods: Thirty elderly patients with BPH with a prostate size of 30 g or more were enrolled for the study. Forty milliliters of ozone at a concentration of 30 μg/dl was injected in prostate (20 ml in each lateral lobe) per rectally. Prostate volume (PV) by ultrasonography was assessed after catheter removal on the 7th day and after 1 month. Observations and Results: Totally thirty patients (mean age - 67.8 years) with mean prostatic volume (MPV) of 46.10cc received IPOI. MPV came as 44.96cc on the 7th day of postozone therapy (P = 0.008). Successful voiders showed a significant reduction in PV (mean = 13.12cc) as compared to unsuccessful voiders (mean = 2.61cc) after 1 month. Conclusion: Intraprostatic ozone injection helps to reduce the PV to some extent and can be helpful in patients who have failed TWOC even on alpha blockers and are unfit for TURP. Larger studies are required to assess the efficacy and long-term results of this technique. PMID:28216927

  10. Muscle damage during minimally invasive surgical total knee arthroplasty traditional versus optimized subvastus approach.

    Science.gov (United States)

    Rossi, Roberto; Maiello, Alessio; Bruzzone, Matteo; Bonasia, Davide Edoardo; Blonna, Davide; Castoldi, Filippo

    2011-08-01

    Decreased muscle damage is reported as an advantage of minimally invasive surgical (MIS) approaches in total knee arthroplasty (TKA). The purpose of this study was to evaluate the anatomy of vastus medialis obliquus (VMO) tendon at its patellar insertion as well as to determine the amount and location of muscle damage comparing traditional subvastus approach and optimized subvastus approach. TKAs were performed in ten human cadavers (20 knees). In each specimen, one knee underwent the traditional subvastus approach and the contralateral knee the optimized subvastus approach. The risk of tearing and damaging the VMO muscle during the traditional subvastus approach is significantly higher (70% of the cases) compared to the optimized technique (30%). The amount of damage to the VMO muscle using the traditional subvastus approach was: 80% of the muscle's width in two cases, 60% in three cases, and 30% in two. The damage created by the optimized subvastus approach occurred along the edge of the tendon and the first fibers of the VMO muscle close to the muscle-tendon junction (less than 20% of muscle's width). Clinical studies are needed to determine the functional implications of these findings.

  11. Ergonomic deficiencies in the operating room: examples from minimally invasive surgery.

    Science.gov (United States)

    Matern, Ulrich

    2009-01-01

    The importance of minimally invasive surgery (MIS) has constantly increased in the last 20 years. Laparoscopic removal of the gallbladder has become the gold standard with advantages for patients. However, in laparoscopy, the surgeon loses direct contact with the surgical site. Rather than seeing the entire surgical field including adjacent organs, the surgeon's vision is restricted by an optic and camera system. Pictures of the surgical site in the abdomen are presented on a monitor. Hand eye coordination is decreasing because the operating team is not able to position the monitor at an ergonomically preferable position given that operation tables, constructed for open surgery where surgeons use short instruments, are too high for laparoscopic procedures where surgeons use long-shafted instruments. Additionally the degrees of freedom for camera movements and the instruments are limited, tactile feedback given in open surgery is lost. The typical design of instrument handles leads to pressure areas and nerve lesions. All these aspects force the surgeon into unnatural and uncomfortable body postures that can affect the outcome of the operation. An ideal posture for laparoscopic surgeons is described and ergonomic requirements for an optimal height of operation tables, monitor positions and man-machine interfaces are discussed.

  12. Comparison of minimally invasive plate osteosynthesis and conventional plate osteosynthesis for humeral shaft fracture

    Science.gov (United States)

    Yu, Bin-feng; Liu, Liang-le; Yang, Guo-jing; Zhang, Lei; Lin, Xi-peng

    2016-01-01

    Abstract Background: The objective of this meta-analysis was to compare the efficacy and safety of minimally invasive plate osteosynthesis (MIPO) and conventional plate osteosynthesis (CPO) for humeral shaft fracture. Methods: Potential academic articles were identified from the Cochrane Library, Medline (1966–2016.3), PubMed (1966–2016.3), Embase (1980–2016.3), and ScienceDirect (1966–2016.3). Gray studies were identified from the references of the included literature. Randomized controlled trials (RCTs) and non-RCT involving MIPO and CPO for humeral shaft fracture were included. Two independent reviewers performed independent data abstraction. I2 statistic was used to assess heterogeneity. Fixed or random effects model was used for meta-analysis. Results: Two RCTs and 3 non-RCTs met the inclusion criteria. There was a lower incidence of iatrogenic radial nerve palsy in patients with MIPO (P = 0.006). There was no statistically significant difference in in the risk of developing nonunion, delay union, malformation, screw loosening, infection, operation time, UCLA, and MEPS function score between the 2 groups. Conclusion: MIPO decreased incidence of iatrogenic radial nerve palsy and is an efficacy and safety technique for humeral shaft fracture. Due to the limited quality and data of the evidence currently available, more high-quality RCTs are required. PMID:27684839

  13. Minimally invasive compared to conventional approach for coronary artery bypass grafting improves outcome

    Directory of Open Access Journals (Sweden)

    Jitumoni Baishya

    2017-01-01

    Full Text Available Introduction: Minimally invasive (MI cardiac surgery is a rapidly gaining popularity, globally as well as in India. We aimed to compare the outcome of MI to the conventional approach for coronary artery bypass graft (CABG surgery. Methods: This prospective, comparative study was conducted at a tertiary care cardiac surgical center. All patients who underwent CABG surgery via MI approach (MI group from July 2015 to December 2015 were enrolled and were compared against same number of EuroSCORE II matched patients undergoing CABG through conventional mid-sternotomy approach (CON group. Demographic, intra- and post-operative variables were collected. Results: In MI group, duration of the surgery was significantly longer (P = 0.029. Intraoperative blood loss lesser (P = 0.002, shorter duration of ventilation (P = 0.002, shorter Intensive Care Unit stay (P = 0.004, shorter hospital stay (P = 0.003, lesser postoperative analgesic requirements (P = 0.027, and lower visual analog scale scores on day of surgery (P = 0.032 and 1 st postoperative day (P = 0.025. No significant difference in postoperative blood loss, blood transfusion, or duration of inotrope requirement observed. There was no conversion to mid-sternotomy in any patients, 8% of patients had desaturation intraoperatively. There was no operative mortality. Conclusion: MI surgery is associated with lesser intraoperative blood loss, better analgesia, and faster recovery.

  14. Total 3D Airo® Navigation for Minimally Invasive Transforaminal Lumbar Interbody Fusion

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    Xiaofeng Lian

    2016-01-01

    Full Text Available Introduction. A new generation of iCT scanner, Airo®, has been introduced. The purpose of this study is to describe how Airo facilitates minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF. Method. We used the latest generation of portable iCT in all cases without the assistance of K-wires. We recorded the operation time, number of scans, and pedicle screw accuracy. Results. From January 2015 to December 2015, 33 consecutive patients consisting of 17 men and 16 women underwent single-level or two-level MIS-TLIF operations in our institution. The ages ranged from 23 years to 86 years (mean, 66.6 years. We treated all the cases in MIS fashion. In four cases, a tubular laminectomy at L1/2 was performed at the same time. The average operation time was 192.8 minutes and average time of placement per screw was 2.6 minutes. No additional fluoroscopy was used. Our screw accuracy rate was 98.6%. No complications were encountered. Conclusions. Airo iCT MIS-TLIF can be used for initial planning of the skin incision, precise screw, and cage placement, without the need for fluoroscopy. “Total navigation” (complete intraoperative 3D navigation without fluoroscopy can be achieved by combining Airo navigation with navigated guide tubes for screw placement.

  15. Minimally-Invasive Gene Transfection by Chemical and Physical Interaction of Atmospheric Pressure Plasma Flow

    Science.gov (United States)

    Kaneko, Toshiro

    2014-10-01

    Non-equilibrium atmospheric pressure plasma irradiated to the living-cell is investigated for medical applications such as gene transfection, which is expected to play an important role in molecular biology, gene therapy, and creation of induced pluripotent stem (iPS) cells. However, the conventional gene transfection using the plasma has some problems that the cell viability is low and the genes cannot be transferred into some specific lipid cells, which is attributed to the unknown mechanism of the gene transfection using the plasma. Therefore, the time-controlled atmospheric pressure plasma flow is generated and irradiated to the living-cell suspended solution for clarifying the transfection mechanism toward developing highly-efficient and minimally- invasive gene transfection system. In this experiment, fluorescent dye YOYO-1 is used as the simulated gene and LIVE/DEAD Stain is simultaneously used for cell viability assay. By the fluorescence image, the transfection efficiency is calculated as the ratio of the number of transferred and surviving cells to total cell count. It is clarified that the transfection efficiency is significantly increased by the short-time (cell viability (>90%). This result indicates that the physical effects such as the electric field caused by the charged particles arriving at the surface of the cell membrane, and chemical effects associated with plasma-activated products in solution act synergistically to enhance the cell-membrane transport with low-damage. This work was supported by JSPS KAKENHI Grant Number 24108004.

  16. Dionis: A Novel Remote-Center-of-Motion Parallel Manipulator for Minimally Invasive Surgery

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    R. Beira

    2011-01-01

    Full Text Available The large volume and reduced dexterity of current surgical robotic systems are factors that restrict their effective performance. To improve the usefulness of surgical robots in minimally invasive surgery (MIS, a compact and accurate positioning mechanism, named Dionis, is proposed in this paper. This spatial hybrid mechanism based on a novel parallel kinematics is able to provide three rotations and one translation for single port procedures. The corresponding axes intersect at a remote center of rotation (RCM that is the MIS entry port. Another important feature of the proposed positioning manipulator is that it can be placed below the operating table plane, allowing a quick and direct access to the patient, without removing the robotic system. This, besides saving precious space in the operating room, may improve safety over existing solutions. The conceptual design of Dionis is presented in this paper. Solutions for the inverse and direct kinematics are developed, as well as the analytical workspace and singularity analysis. Due to its unique design and kinematics, the proposed mechanism is highly compact, stiff and its dexterity fullfils the workspace specifications for MIS procedures.

  17. Stereotactic Laser Ablation for Medically Intractable Epilepsy: The Next Generation of Minimally Invasive Epilepsy Surgery

    Directory of Open Access Journals (Sweden)

    Michael Joseph LaRiviere

    2016-12-01

    Full Text Available Epilepsy is a common, disabling illness that is refractory to medical treatment in approximately one third of patients, particularly among those with mesial temporal lobe epilepsy. While standard open mesial temporal resection is effective, achieving seizure freedom in most patients, efforts to develop safer, minimally invasive techniques have been underway for over half a century. Stereotactic ablative techniques, in particular radiofrequency ablation, were first developed in the 1960s, with refinements in the 1990s with the advent of modern computed tomography and magnetic resonance-based imaging. In the past 5 years, the most recent techniques have used MRI-guided laser interstitial thermotherapy (LITT, whose development began in the 1980s, saw refinements in MRI thermal imaging through the 1990s, and was initially used primarily for the treatment of intracranial and extracranial tumors. The present review describes the original stereotactic ablation trials, followed by modern imaging-guided radiofrequency ablation series for mesial temporal lobe epilepsy. The development of LITT and MRI thermometry are then discussed. Finally, the two currently available MRI-guided laser interstitial thermotherapy systems are reviewed for their role in the treatment of mesial temporal lobe and other medically refractory epilepsies.

  18. Safyreä: a readjustable minimally invasive sling for female urinary stress incontinence

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    Palma Paulo C.R

    2003-01-01

    Full Text Available INTRODUCTION: SAFYREä is a readjustable and minimally invasive sling for the treatment of stress urinary incontinence (SUI. It is as a pubovaginal sling placed in the medial third of the urethra. The initial experience is described. MATERIALS AND METHODS: Forty-five patients (mean age = 59 years underwent a SAFYREä implant to treat SUI. Physical examination and urodynamic study were performed before surgery. All patients presented symptoms of SUI and 20% also reported mild urgency. Approximately 60% of this group had a previously failed anti-incontinence procedure. Urethral hypermobility was diagnosed in 40% of the patients and intrinsic sphincter deficiency (ISD in 60% of the cases. RESULTS: The average follow up period was 10 months. The mean operative time was 20 minutes. Dystopia repair was performed whenever necessary, during the same procedure. The average hospital stay was 24 hours. In 11% of the implants, bladder perforation occurred. During the postoperative period, 9 patients (20% developed transient urgency symptoms. During the initial follow up period, 90% were found to be continent, 3% reported an improvement and 7% were unchanged. CONCLUSION: SAFYREä is a safe and quick procedure that allows postoperative readjustment. This technique may be an attractive alternative in the management of SUI, should the good result obtained so far prove to be long lasting.

  19. Minimal Invasive Management of Small Renal Masses: State of Art and New Trends

    Directory of Open Access Journals (Sweden)

    Senol Tonyali

    2016-04-01

    Full Text Available With the widespread use of abdominal imaging modalities such as ultrasound (US, computerized tomography (CT and magnetic resonance imaging (MRI, there has been a pronounced increase in the incidence of renal tumors especially clinically localized, small < 2 cm ones. Moreover the final pathology of these lesions is benign up to 30%. The development of ablation techniques (radiofrequency ablation, cryoablation, high-intensity focused ultrasound and microwave ablation with continuous innovations such as refinement of probes and real-time imaging capabilities has pioneered the great interest in these techniques, especially for the treatment of T1 renal malignancies. RFA and CA have similar cancer specific survival, disease-free survival, recurrence free survival and overall survival rates compared to nephrectomy. MWA and HIFU remain still experimental due to low patient volume and insufficient clinical experience. Minimal invasive techniques can be a feasible treatment alternative for patients who have high surgical and anesthetic risk with multiple comorbidities, have multiple tumors due to a systemic disease like VHL or do not want to undergo extirpative surgery. Especially elderly patients can be good candidates for these procedures with their relatively short life expectance and impaired performance status.

  20. The Minimally Invasive Plate Osteosynthesis (MIPO Technique with a Locking Compression Plate for Femoral Lengthening

    Directory of Open Access Journals (Sweden)

    Tetsunaga,Tomonori

    2008-10-01

    Full Text Available A minimally invasive plate osteosynthesis technique using a locking compression plate (LCP has been used widely in trauma cases. Its advantages are that the MIPO technique does not interfere with the fracture site and thus provides improved biological healing, and that the LCP has excellent angular stability. Its use in bone lengthening, however, has not been established. In such cases, it is desirable to shorten the external skeletal fixation period as much as possible. Here, the MIPO technique using an LCP was applied to femoral distraction osteogenesis in an attempt to shorten the external skeletal fixation period. For femoral lengthening, the MIPO technique was performed in 2 stages. Orthofix external fixators (Orthofix, England were used to insert screws from the anterolateral side rather than from the lateral side of the femur for bone lengthening. When sufficient callus formation was detected postoperatively at the site of bone lengthening, and the absence of infection was ensured, limb draping was performed, including a whole external fixator, and then the MIPO technique was applied with an LCP. In 3 cases (5 limbs, the average duration of external skeletal fixation was 134days, the average external-fixation index was 24days/cm, and the average consolidation index was 22days/cm. The MIPO technique using an LCP made it possible to shorten the external skeletal fixation-wearing period in femoral lengthening.

  1. Minimally Invasive Drainage of a Post-Laminectomy Subfascial Seroma with Cervical Spinal Cord Compression.

    Science.gov (United States)

    Kitshoff, Adriaan Mynhardt; Van Goethem, Bart; Cornelis, Ine; Combes, Anais; Dvm, Ingeborgh Polis; Gielen, Ingrid; Vandekerckhove, Peter; de Rooster, Hilde

    2016-01-01

    A 14 mo old female neutered Doberman pinscher was evaluated for difficulty in rising, a wide based stance, pelvic limb gait abnormalities, and cervical pain of 2 mo duration. Neurologic examination revealed pelvic limb ataxia and cervical spinal hyperesthesia. Spinal reflexes and cranial nerve examination were normal. The pathology was localized to the C1-C5 or C6-T2 spinal cord segments. Computed tomography (CT) findings indicated bony proliferation of the caudal articular processes of C6 and the cranial articular processes of C7, resulting in bilateral dorsolateral spinal cord compression that was more pronounced on the left side. A limited dorsal laminectomy was performed at C6-C7. Due to progressive neurological deterioration, follow-up CT examination was performed 4 days postoperatively. At the level of the laminectomy defect, a subfacial seroma had developed, entering the spinal canal and causing significant spinal cord compression. Under ultrasonographic guidance a closed-suction wound catheter was placed. Drainage of the seroma successfully relieved its compressive effects on the spinal cord and the patient's neurological status improved. CT was a valuable tool in assessing spinal cord compression as a result of a postoperative subfascial seroma. Minimally invasive application of a wound catheter can be successfully used to manage this condition.

  2. A novel linear elastic actuator for minimally invasive surgery: development of a surgical gripper

    Science.gov (United States)

    Gerboni, G.; Brancadoro, M.; Tortora, G.; Diodato, A.; Cianchetti, M.; Menciassi, A.

    2016-10-01

    Minimally invasive surgery (MIS) applications require lightweight actuators that can generate a high force in a limited volume. Among pressure driven actuators, fluid elastic actuators demonstrate high potential for use in the medical field. They are characterized by nearly no friction and wear and they can be made of low-cost biocompatible elastomers. However, when compared to traditional piston-cylinder fluid actuators, fluid elastic actuators often result in smaller output forces as well as weaker return forces. This work is about the design of a linear elastic actuator (LEA) which is able to develop relevant pulling-pushing force in one direction. The LEA is composed of entirely disposable materials and it requires a simple manufacturing process. Thanks to its design, the LEA can be compared to traditional piston-cylinders actuators in terms of output forces (up to 7 N) with the advantage of using relative low working pressures (0, 2 MPa). The actuator has been used for the actuation of a gripper for MIS, as a case study. The whole range of gripping forces developed by the tool actated by the LEA has been evaluated, thus verifying that the gripping device, is able to meet the force requirements for accomplishing typical surgical tasks.

  3. Treatment feasibility study of osteoporosis using minimal invasive laser needle system

    Science.gov (United States)

    Kang, Dongyeon; Ko, Chang-Yong; Ryu, Yeon-Hang; Park, Sunwook; Kim, Han-Sung; Jung, Byungjo

    2010-02-01

    Although the mechanism of laser stimulation effect in bone has not completely understood, laser stimulation is recommended in the treatment of osteoporosis due to positive treatment efficacy. In this study, a minimal invasive laser needle system (MILNS) was developed using a fine hollow needle in order to stimulate directly bone site by guiding an optical fiber. In order to evaluate the MILNS as a treatment method, in-vivo animal experiment study was performed using osteopenic mice. Twelve virginal ICR mice were employed and divided two groups: SHAM-group and LASERgroup. SHARM-group was stimulated by only fine hollow needle and LASER-group by fine hollow needle combined with laser stimulation. All mice were served in-vivo micro-CT images before and after treatment. Three dimensional (3D) structural parameters and vBMD (volume bone mineral density, g/cm3) in the trabecular bone were measured. After 2 weeks of stimulation, the vBMD, BV/TV, Tb.Th and Tb.N in LASER-group were significantly higher than those in SHAM-group (pprevent the bone loss and maintains the bone mineral density of osteopenic mice.

  4. Cirugía mínimamente invasiva en craneoestenosis Minimal invasive surgery in craniostenosis

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    E. Ochoa Díaz López

    2006-09-01

    Full Text Available En el presente trabajo se describe la experiencia en craneoestenosis con cirugía mínimamente invasiva, evaluando el diseño y eficacia de un nuevo craneotomo en cadáveres así como su aplicación clínica en un caso de sinostósis sagital con instrumentación endoscópica. Este procedimiento es sin duda un gran recurso en el tratamiento de las craneoestenosis brindando los beneficios de la cirugía mínimamente invasiva, eliminando la necesidad de grandes incisiones, disminuyendo el sangrado quirúrgico, reduciendo estancia hospitalaria y disminuyendo la morbilidad operatoriaIn this paper, we describe the experience with the use of endoscopic craniofacial procedures, evaluating the design and the efficacy of a new craniotome in cadavers and his clinical application in a case of sagittal synostosis for an endoscopic assisted cranioplasty. This procedure is a great option in the treatment of craniosynostosis, giving the benefits of minimal invasive surgery and eliminating the needing of big incisions, long hospital stay and reducing the postoperative morbidity

  5. Subclinical Breast Cancer: Minimally Invasive Approaches. Our Experience with Percutaneous Radiofrequency Ablation vs. Cryotherapy

    Science.gov (United States)

    Manenti, Guglielmo; Scarano, Angela L.; Pistolese, Chiara A.; Perretta, Tommaso; Bonanno, Elena; Orlandi, Augusto; Simonetti, Giovanni

    2013-01-01

    Summary Background The aim of this study was to compare the efficacy of radiofrequency ablation vs. cryoablation in the treatment of early breast cancer. Patients and Methods 80 women (mean age 73 ± 5 years) with early breast cancer were retrospectively evaluated. 40 patients underwent cryoablation and 40 patients underwent radiofrequency ablation, both with sentinel lymph node excision. Tumor volume and histopatological data were compared by means of postprocedural 3.0-T magnetic resonance imaging (MRI). 30–45 days after the percutaneous ablation, all patients underwent surgical resection of the tumor. The mean follow-up was 18 months without any local recurrences. Results Both techniques allow good correlation with histopathological data. In 75 patients (93.8%) we observed complete necrosis; in 5 cases there was residual disease in the postprocedural MRI and postoperative histological examination. There was a good correlation between MRI volume and histologic samples. Cosmetic results were good in all patients but 2. Conclusion Both percutaneous radiofrequency ablation and cryotherapy are minimally invasive techniques with a good clinical and cosmetic outcome in selected cases. MRI examination is an ideal method to assess breast neoplasms in terms of quality and quantity as well as residual tumor extent after percutaneous ablation. Cryotherapy is the preferred method because of the analgesic effect of freezing with better patients compliance. PMID:24415989

  6. Shaeer’s Technique: A Minimally Invasive Procedure for Monsplasty and Revealing the Concealed Penis

    Science.gov (United States)

    2016-01-01

    Background: A concealed penis is a condition where part of the penis is invisible below the surface of the prepubic skin. Dermolipectomy can correct this condition, although it involves a long abdominal crease incision, or infrapubic incision around the base of the penis, and a possibility for genital lymphedema. This study describes Shaeer’s technique, a minimally invasive method for revealing the concealed penis. Methods: A 1- to 2-cm-long incision was cut over the anterior superior iliac spine (ASIS) on either side. A long curved blunt forceps was inserted from one incision, down to the base of the penis and then up to the contralateral ASIS. A 5-mm wide nonabsorbable tape was picked up by the forceps from 1 incision and pulled through to emerge from the other. Pulling on the tape cephalad pulled the mons pubis and revealed the penis. The tape was sutured to the periosteum overlying the ASIS on either side. Patients were followed up for 18 months for penile length, complications, and overall satisfaction. Results: Twenty patients were operated upon. Preoperatively, flaccid visible length was 3 ± 0.9 cm, and erect visible length was 8 ± 4.6 cm. Postoperatively, the flaccid visible length was 7.1 ± 2.1 cm, with a 57.9% improvement in length (P penis. PMID:27622092

  7. A 4-DOF haptic master using ER fluid for minimally invasive surgery system application

    Science.gov (United States)

    Oh, Jong-Seok; Han, Young-Min; Lee, Sang-Rock; Choi, Seung-Bok

    2013-04-01

    This paper presents a novel 4-degrees-of-freedom (4-DOF) haptic master using a electrorheological (ER) fluid which is applicable to minimally invasive surgery (MIS) systems. By adopting a controllable ER fluid, the master can easily generate 4-DOF repulsive forces with the advantages of a simple mechanism and continuous force control capability. The proposed master consists of two actuators: an ER spherical joint for 3-DOF rotational motion and an ER piston device for 1-DOF translational motion. The generated torque/force models are mathematically derived by analyzing the mechanism geometry and using the Bingham characteristics of an ER Fluid. The haptic master is optimally designed and manufactured based on the mathematical torque/force models. The repulsive torque/force responses are experimentally evaluated and expressed by the first-order and second-order dynamic equations for each motion. A sliding mode controller (SMC), which is known to be robust to uncertainties, is then designed and empirically implemented to achieve the desired torque/force trajectories. It is demonstrated by presenting torque/force tracking results of both rotational and translational motions that the proposed 4-DOF ER haptic master integrated with the SMC can provide an effective haptic control performance for MIS applications.

  8. Rivaling paradigms in psychiatric neurosurgery: adjustability versus quick fix versus minimal-invasiveness.

    Science.gov (United States)

    Müller, Sabine; Riedmüller, Rita; van Oosterhout, Ansel

    2015-01-01

    In the wake of deep brain stimulation (DBS) development, ablative neurosurgical procedures are seeing a comeback, although they had been discredited and nearly completely abandoned in the 1970s because of their unethical practice. Modern stereotactic ablative procedures as thermal or radiofrequency ablation, and particularly radiosurgery (e.g., Gamma Knife) are much safer than the historical procedures, so that a re-evaluation of this technique is required. The different approaches of modern psychiatric neurosurgery refer to different paradigms: microsurgical ablative procedures is based on the paradigm 'quick fix,' radiosurgery on the paradigm 'minimal-invasiveness,' and DBS on the paradigm 'adjustability.' From a mere medical perspective, none of the procedures is absolutely superior; rather, they have different profiles of advantages and disadvantages. Therefore, individual factors are crucial in decision-making, particularly the patients' social situation, individual preferences, and individual attitudes. The different approaches are not only rivals, but also enriching mutually. DBS is preferable for exploring new targets, which may become candidates for ablative microsurgery or radiosurgery.

  9. Visualizing transplanted muscle flaps using minimally invasive multi-electrode bioimpedance spectroscopy

    Science.gov (United States)

    Gordon, R.; Zorkova, V.; Min, M.; Rätsep, I.

    2010-04-01

    We describe here an imaging system that uses bioimpedance spectroscopy with multi-electrode array to indicate the state of muscle flap regions under the array. The system is able to differentiate between different health states in the tissue and give early information about the location and size of ischemic sub-regions. The array will be 4*8 electrodes with the spacing of 5mm between the electrodes (the number of electrodes and the spacing may vary). The electrodes are minimally invasive short stainless steel needles, that penetrate 0.3 mm into the tissue with the goal of achieving a wet electric contact. We combine 32 configurations of 4-electrode multi-frequency impedance measurements to derive a health-state map for the transplanted flap. The imaging method is tested on a model consisting of 2 tissues and FEM software (Finite Element Method -COMSOL Multiphysics based) is used to conduct the measurements virtually. Dedicated multichannel bioimpedance measurement equipment has already been developed and tested, that cover the frequency range from 100 Hz to 1 MHz.

  10. Rectification and Robust Matching Using Oriented Image Triplets for Minimally Invasive Surgery

    Science.gov (United States)

    Conen, N.; Jepping, C.; Luhmann, T.; Maas, H.-G.

    2016-06-01

    Stereo endoscopes for minimally invasive surgery have been available on the market for several years and are well established in some areas. In practice, they offer a stereoscopic view to the surgeon but are not yet intended for 3D measurements. However, using current knowledge about the camera system and the difficult conditions in object space, it is possible to reconstruct a highly accurate surface model of the current endoscopic view. In particular for medical interventions, a highly reliable point cloud and real-time computation are required. To obtain good reliability, a miniaturised trinocular camera system is introduced that reduces the amount of outliers. To reduce computation time, an approach for generation of rectified image triplets and their corresponding interior and exterior camera parameters has been developed. With these modified and parameterised images it is possible to directly process 3D measurements in object space. Accordingly, an efficient semi-global optimisation is implemented by the authors. In this paper the special camera system, the rectification approach and the applied methodology of matching in rectified image triplets are explained. Finally, first results are presented. In conclusion, the trinocular camera system provides more reliable point clouds than a binocular one, especially for areas with repetitive or poor texture. Currently, the benefit of the third camera is not as great as desired.

  11. Minimally invasive plate osteosynthesis for humeral shaft fractures: are results reproducible?

    Science.gov (United States)

    Concha, Juan M; Sandoval, Alejandro; Streubel, Philipp N

    2010-12-01

    Minimally invasive plate osteosynthesis (MIPO) has been advocated as a safe approach to humeral shaft fracture management. We evaluated the reproducibility of this technique in a regional hospital. Thirty-five patients underwent MIPO of humerus shaft fractures. Fifteen patients had an open fracture, six a preoperative radial nerve palsy, and nine a concomitant thoracic, musculoskeletal or vascular injury. At an average 12-month follow-up, 91% of fractures healed after a mean of 12 weeks (range, 8-16). Two infections occurred. Final alignment averaged 4° of varus (range, 5° of valgus to 20° of varus). Active elbow ROM averaged 114° (range, 60-135°) and was less than 100° in nine elbows. Five of six preoperative radial nerve injuries recovered spontaneously. Healing and infection rates in this study are consistent with those reported in the literature. Lower elbow ROM and higher fracture angulation at healing were nevertheless found. MIPO is technically demanding and requires adequate intraoperative imaging and surgical experience in order to obtain adequate fracture alignment. Brachialis muscle scarring and inadequate postoperative rehabilitation may be involved in limited elbow range of motion.

  12. Assessment parameters for a novel simulator in minimally invasive spine surgery.

    Science.gov (United States)

    Fuerst, David; Hollensteiner, Marianne; Schrempf, Andreas

    2015-01-01

    Surgical simulators provide a safe environment where novice surgeons can acquire their surgical skills. Although the number of patients with diseases of the musculoskeletal system is growing, the development of orthopedic simulators is still in it's infancy. The aim of this work was to identify simulation-based assessment parameters for a novel simulator in minimally invasive spine surgery. Apart from parameters targeting the duration and the surgeon's economy of motion during percutaneous bone access, parameters characterizing the movement smoothness were also examined with respect to their suitability. The results indicated, that the overall duration, the number of instrument movements, the number of velocity peaks and the Movement Arrest Period Ratio are the most promising predictors of expertise. Targeting performance improvement, the overall duration (p = 0.001), the number of instrument movements (p = 0.003) and the traveled instrument path length (p = 0.009) detected significant differences between subsequent trials. Using these parameters, a study can be designed targeting the validity and reliability of the simulation-based assessment.

  13. Precision instrument placement using a 4-DOF robot with integrated fiducials for minimally invasive interventions

    Science.gov (United States)

    Stenzel, Roland; Lin, Ralph; Cheng, Peng; Kronreif, Gernot; Kornfeld, Martin; Lindisch, David; Wood, Bradford J.; Viswanathan, Anand; Cleary, Kevin

    2007-03-01

    Minimally invasive procedures are increasingly attractive to patients and medical personnel because they can reduce operative trauma, recovery times, and overall costs. However, during these procedures, the physician has a very limited view of the interventional field and the exact position of surgical instruments. We present an image-guided platform for precision placement of surgical instruments based upon a small four degree-of-freedom robot (B-RobII; ARC Seibersdorf Research GmbH, Vienna, Austria). This platform includes a custom instrument guide with an integrated spiral fiducial pattern as the robot's end-effector, and it uses intra-operative computed tomography (CT) to register the robot to the patient directly before the intervention. The physician can then use a graphical user interface (GUI) to select a path for percutaneous access, and the robot will automatically align the instrument guide along this path. Potential anatomical targets include the liver, kidney, prostate, and spine. This paper describes the robotic platform, workflow, software, and algorithms used by the system. To demonstrate the algorithmic accuracy and suitability of the custom instrument guide, we also present results from experiments as well as estimates of the maximum error between target and instrument tip.

  14. The design of the robot assisted magnetic resonance imaging guidance for minimally invasive surgery system

    Institute of Scientific and Technical Information of China (English)

    Shao Bing; Sun Lining; Du Zhijiang; Fu Lixin

    2005-01-01

    Robot assisted Minimally Invasive Surgery (MIS) is one of the rapidestdeveloping directions in the current surgical realm. Magnetic Resonance Imaging(MRI) is an optimal imaging modality which was applied in MIS in recent years. By combination of precise positioning to the target by intra-operative MRI guided surgery and dexterous motion by the robot, safe and smooth operation is expected to be performed. An overview of the MRI-guided robotic system for MIS is offered. The design of the intra-operative MR scanner system is described. The MR-compatible robotic system is carefully designed for safety and sterilization issues. This system unifies image information from open MRI, an optical endoscope and conventional vital-sign detectors. It helps and guides the surgeon and other medical staffs so they can make the right decisions. The high-performance manipulator can mimic the movement of the urgeon's hand precisely. And the analysis for active and passive interventional surgical instrument tracking is provided.

  15. A Miniature Robot for Retraction Tasks under Vision Assistance in Minimally Invasive Surgery

    Directory of Open Access Journals (Sweden)

    Giuseppe Tortora

    2014-03-01

    Full Text Available Minimally Invasive Surgery (MIS is one of the main aims of modern medicine. It enables surgery to be performed with a lower number and severity of incisions. Medical robots have been developed worldwide to offer a robotic alternative to traditional medical procedures. New approaches aimed at a substantial decrease of visible scars have been explored, such as Natural Orifice Transluminal Endoscopic Surgery (NOTES. Simple surgical tasks such as the retraction of an organ can be a challenge when performed from narrow access ports. For this reason, there is a continuous need to develop new robotic tools for performing dedicated tasks. This article illustrates the design and testing of a new robotic tool for retraction tasks under vision assistance for NOTES. The retraction robots integrate brushless motors to enable additional degrees of freedom to that provided by magnetic anchoring, thus improving the dexterity of the overall platform. The retraction robot can be easily controlled to reach the target organ and apply a retraction force of up to 1.53 N. Additional degrees of freedom can be used for smooth manipulation and grasping of the organ.

  16. A new visual feedback-based magnetorheological haptic master for robot-assisted minimally invasive surgery

    Science.gov (United States)

    Choi, Seung-Hyun; Kim, Soomin; Kim, Pyunghwa; Park, Jinhyuk; Choi, Seung-Bok

    2015-06-01

    In this study, we developed a novel four-degrees-of-freedom haptic master using controllable magnetorheological (MR) fluid. We also integrated the haptic master with a vision device with image processing for robot-assisted minimally invasive surgery (RMIS). The proposed master can be used in RMIS as a haptic interface to provide the surgeon with a sense of touch by using both kinetic and kinesthetic information. The slave robot, which is manipulated with a proportional-integrative-derivative controller, uses a force sensor to obtain the desired forces from tissue contact, and these desired repulsive forces are then embodied through the MR haptic master. To verify the effectiveness of the haptic master, the desired force and actual force are compared in the time domain. In addition, a visual feedback system is implemented in the RMIS experiment to distinguish between the tumor and organ more clearly and provide better visibility to the operator. The hue-saturation-value color space is adopted for the image processing since it is often more intuitive than other color spaces. The image processing and haptic feedback are realized on surgery performance. In this work, tumor-cutting experiments are conducted under four different operating conditions: haptic feedback on, haptic feedback off, image processing on, and image processing off. The experimental realization shows that the performance index, which is a function of pixels, is different in the four operating conditions.

  17. Design and control of MR haptic master/slave robot system for minimally invasive surgery

    Science.gov (United States)

    Uhm, Chang-Ho; Nguyen, Phoung Bac; Choi, Seung-Bok

    2013-04-01

    In this work, magnetorheological (MR) haptic master and slave robot for minimally invasive surgery (MIS) have been designed and tested. The proposed haptic master consists of four actuators; three MR brakes featuring gimbal structure for 3-DOF rotation motion(X, Y and Z axes) and one MR linear actuator for 1-DOF translational motion. The proposed slave robot which is connected with the haptic master has vertically multi- joints, and it consists of four DC servomotors; three for positioning endoscope and one for spinning motion. We added a fixed bar with a ball joint on the base of the slave for the endoscope position at the patient's abdomen to maintain safety. A gimbal structure at the end of the slave robotic arm for the last joint rotates freely with respect to the pivot point of the fixed bar. This master-slave system runs as if a teleoperation system through TCP/IP connection, programmed by LabVIEW. In order to achieve the desired position trajectory, a proportional-integral-derivative (PID) controller is designed and implemented. It has been demonstrated that the effective tracking control performances for the desired motion are well achieved and presented in time domain. At last, an experiment in virtual environments is undertaken to investigate the effectiveness of the MR haptic master device for MIS system.

  18. A Parametric Study Delineating Irreversible Electroporation from Thermal Damage Based on a Minimally Invasive Intracranial Procedure

    Directory of Open Access Journals (Sweden)

    Ellis Thomas L

    2011-04-01

    Full Text Available Abstract Background Irreversible electroporation (IRE is a new minimally invasive technique to kill undesirable tissue in a non-thermal manner. In order to maximize the benefits from an IRE procedure, the pulse parameters and electrode configuration must be optimized to achieve complete coverage of the targeted tissue while preventing thermal damage due to excessive Joule heating. Methods We developed numerical simulations of typical protocols based on a previously published computed tomographic (CT guided in vivo procedure. These models were adapted to assess the effects of temperature, electroporation, pulse duration, and repetition rate on the volumes of tissue undergoing IRE alone or in superposition with thermal damage. Results Nine different combinations of voltage and pulse frequency were investigated, five of which resulted in IRE alone while four produced IRE in superposition with thermal damage. Conclusions The parametric study evaluated the influence of pulse frequency and applied voltage on treatment volumes, and refined a proposed method to delineate IRE from thermal damage. We confirm that determining an IRE treatment protocol requires incorporating all the physical effects of electroporation, and that these effects may have significant implications in treatment planning and outcome assessment. The goal of the manuscript is to provide the reader with the numerical methods to assess multiple-pulse electroporation treatment protocols in order to isolate IRE from thermal damage and capitalize on the benefits of a non-thermal mode of tissue ablation.

  19. Minimally invasive transabdominal collection of preimplantation embryos from the common marmoset monkey (Callithrix jacchus).

    Science.gov (United States)

    Hanazawa, K; Mueller, T; Becker, T; Heistermann, M; Behr, R; Sasaki, E

    2012-09-01

    A novel, minimally invasive, transabdominal embryo collection method (transabdominal method) was developed as an alternative to a standard abdominal incision for embryo collection in the common marmoset. The abdominal incision method was used for 304 flushes using 36 female animals, whereas the transabdominal method was used for 488 flushes using 48 females; successful embryo collection rates were 48.0% and 48.4% (P > 0.05), respectively. These techniques were successfully duplicated at another institute (German Primate Center, DPZ). At that institution, successful embryo collection rates were 88.9% and 77.8% for the abdominal incision and transabdominal methods, respectively (P > 0.05), whereas the average numbers of preimplantation embryos obtained per flush were (mean ± SD) 1.91 ± 0.35 and 1.71 ± 0.14 (P > 0.05). The transabdominal method reduced animal stress, did not require incisional wound healing, and enabled successive embryo recoveries to be done much sooner. More embryos in early developmental stages (zygotes/morulae) were recovered using the transabdominal method (76.1%) than the abdominal incision method (52.6%, P marmoset developmental biology and embryology.

  20. Minimally Invasive Scoliosis Surgery: A Novel Technique in Patients with Neuromuscular Scoliosis

    Directory of Open Access Journals (Sweden)

    Vishal Sarwahi

    2015-01-01

    Full Text Available Minimally invasive surgery (MIS has been described in the treatment of adolescent idiopathic scoliosis (AIS and adult scoliosis. The advantages of this approach include less blood loss, shorter hospital stay, earlier mobilization, less tissue disruption, and relatively less pain. However, despite these significant benefits, MIS approach has not been reported in neuromuscular scoliosis patients. This is possibly due to concerns with longer surgery time, which is further increased due to more levels fused and instrumented, challenges of pelvic fixation, size and number of incisions, and prolonged anesthesia. We modified the MIS approach utilized in our AIS patients to be implemented in our neuromuscular patients. Our technique allows easy passage of contoured rods, placement of pedicle screws without image guidance, partial/complete facet resection, and all standard reduction maneuvers. Operative time needed to complete this surgery is comparable to the standard procedure and the majority of our patients have been extubated at the end of procedure, spending 1 day in the PICU and 5-6 days in the hospital. We feel that MIS is not only a feasible but also a superior option in patients with neuromuscular scoliosis. Long-term results are unavailable; however, short-term results have shown multiple benefits of this approach and fewer limitations.

  1. Four-dimensional modeling of the heart for image guidance of minimally invasive cardiac surgeries

    Science.gov (United States)

    Wierzbicki, Marcin; Drangova, Maria; Guiraudon, Gerard; Peters, Terry

    2004-05-01

    Minimally invasive surgery of the beating heart can be associated with two major limitations: selecting port locations for optimal target coverage from x-rays and angiograms, and navigating instruments in a dynamic and confined 3D environment using only an endoscope. To supplement the current surgery planning and guidance strategies, we continue developing VCSP - a virtual reality, patient-specific, thoracic cavity model derived from 3D pre-procedural images. In this work, we apply elastic image registration to 4D cardiac images to model the dynamic heart. Our method is validated on two image modalities, and for different parts of the cardiac anatomy. In a helical CT dataset of an excised heart phantom, we found that the artificial motion of the epicardial surface can be extracted to within 0.93 +/- 0.33 mm. For an MR dataset of a human volunteer, the error for different heart structures such as the myocardium, right and left atria, right ventricle, aorta, vena cava, and pulmonary artery, ranged from 1.08 +/- 0.18 mm to 1.14 +/- 0.22 mm. These results indicate that our method of modeling the motion of the heart is not only easily adaptable but also sufficiently accurate to meet the requirements for reliable cardiac surgery training, planning, and guidance.

  2. Endoscopic anatomical nerve observation and minimally invasive management of cubital tunnel syndrome.

    Science.gov (United States)

    Yoshida, A; Okutsu, I; Hamanaka, I

    2009-02-01

    Experience with the use of the Universal Subcutaneous Endoscope (USE) system in surgical treatment of cubital tunnel syndrome in 35 patients is reported. Patients included in the study had pre- and postoperative clinical and electrophysiological data, and had undergone a minimum follow-up period of 13 months. Mean patient age was 59.5 years and the mean follow-up period was 25.9 months. The operation was performed under local anaesthesia without pneumatic tourniquet and on an out-patient basis. A 1.5 cm portal is made at the cubital tunnel and the USE system is inserted next to the ulnar nerve, first distally and then proximally. The nerve is endoscopically assessed and only the tissue that compresses the nerve is released, in keeping with the principles of minimally invasive treatment. Preoperative tingling sensations disappeared postoperatively in 63% of cases. Pain and sensory disturbance recovered to normal in 92% and 89% of cases, respectively. Abnormal motor nerve conduction velocities improved in 77%. Abductor digiti minimi weakness MMT 0, 1, 2 in 16 hands recovered to MMT 4 or 5 in eight. First-dorsal interosseous weakness in 18 hands recovered to MMT 4 or 5 in seven. There were no complications in this series. The endoscopic approach facilitates inspection of the ulnar nerve so that selective release of the tissue that compresses the nerve can readily be performed. The technique has proven effective in the treatment of cubital tunnel syndrome.

  3. Minimal-invasive posterior approach in the treatment of the posterior wall fractures of the acetabulum.

    Science.gov (United States)

    Spagnolo, Rosario; Bonalumi, Matteo; Pace, Fabrizio; Capitani, Dario

    2009-05-01

    We examined patients affected by a posterior wall fracture of the acetabulum treated with a minimally invasive posterior approach (from 12 to 18 cm). During 2004-2006 19 patients were treated by this approach. 4 patients had a combined surgery by the ileo-inguinal approach. Fracture fixation was performed using reconstruction plates and screws. All the patients were studied with typical X-rays projection for pelvis and iliac oblique view and obturator oblique view (Judet view) and CT scan with 3D reconstruction. After 3 months a CT scan was performed on about 30% of our patients, which demonstrated the perfect healing of the fractures. The most important advantages we observed using this approach were a lesser split of the gluteus maximus and no risk of damage for the superior gluteal nerve. In the early post-operative rehabilitation we examined the trophism of the gluteus maximus, which was found to be better than in patients treated with the typical Kocher-Langenbeck approach. The only absolute contraindication for this technique is in obese patients. The post-operative complications include one case of heterotypic ossification of the gluteus minimus and one case of peroneal-nerve palsy with the spontaneous and complete recovery within 6 months. According to our experience this kind of approach could be used for posterior wall fracture of the pelvis and it can be extended to transverse fractures. In the post-operative period the greatest advantage is the lesser muscle damage and therefore a most effective rehabilitation.

  4. From the ground up: building a minimally invasive aortic valve surgery program.

    Science.gov (United States)

    Nguyen, Tom C; Lamelas, Joseph

    2015-03-01

    Minimally invasive aortic valve replacement (MIAVR) is associated with numerous advantages including improved patient satisfaction, cosmesis, decreased transfusion requirements, and cost-effectiveness. Despite these advantages, little information exists on how to build a MIAVR program from the ground up. The steps to build a MIAVR program include compiling a multi-disciplinary team composed of surgeons, cardiologists, anesthesiologists, perfusionists, operating room (OR) technicians, and nurses. Once assembled, this team can then approach hospital administrators to present a cost-benefit analysis of MIAVR, emphasizing the importance of reduced resource utilization in the long-term to offset the initial financial investment that will be required. With hospital approval, training can commence to provide surgeons and other staff with the necessary knowledge and skills in MIAVR procedures and outcomes. Marketing and advertising of the program through the use of social media, educational conferences, grand rounds, and printed media will attract the initial patients. A dedicated website for the program can function as a "virtual lobby" for patients wanting to learn more. Initially, conservative selection criteria of cases that qualify for MIAVR will set the program up for success by avoiding complex co-morbidities and surgical techniques. During the learning curve phase of the program, patient safety should be a priority.

  5. Buschke-Löwenstein Tumour: Successful Treatment with Minimally Invasive Techniques

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    Estefânia Correia

    2015-01-01

    Full Text Available We report a case of an 80-year-old female who presented with a four-year history of a growing mass in the perianal area with pain and bleeding during defaecation. Clinical examination revealed a locally destructive, cauliflower-like, verrucous mass measuring 10 × 12 cm in diameter. Histologic findings revealed a moderate degree of dysplasia of the epithelium with koilocytosis atypia, acanthosis, and parakeratosis, features that are consistent with Buschke-Löwenstein tumour. Polymerase-chain-reaction assay for human papillomavirus (HPV showed an infection with HPV type 11. Full-thickness excision of involved skin was undertaken by cryotherapy and electrocautery over five months. The entire wound was left open to heal by secondary intention. After 3 years of follow-up, the patient has not experienced a recurrence, with excellent functional results, but the cosmetic results were satisfactory. These minimally invasive techniques can be safer and more cost-effective than surgery and the General Practitioner can play a key role in diagnosis.

  6. A novel minimally invasive dual-modality fiber optic probe for prostate cancer detection

    Science.gov (United States)

    Sharma, Vikrant

    Prostate cancer is the most common form of cancer in males, and is the second leading cause of cancer related deaths in United States. In prostate cancer diagnostics and therapy, there is a critical need for a minimally invasive tool for in vivo evaluation of prostate tissue. Such a tool finds its niche in improving TRUS (trans-rectal ultrasound) guided biopsy procedure, surgical margin assessment during radical prostatectomy, and active surveillance of patients with a certain risk levels. This work is focused on development of a fiber-based dual-modality optical device (dMOD), to differentiate prostate cancer from benign tissue, in vivo. dMOD utilizes two independent optical techniques, LRS (light reflectance spectroscopy) and AFLS (auto-fluorescence lifetime spectroscopy). LRS quantifies scattering coefficient of the tissue, as well as concentrations of major tissue chromophores like hemoglobin derivatives, β-carotene and melanin. AFLS was designed to target lifetime signatures of multiple endogenous fluorophores like flavins, porphyrins and lipo-pigments. Each of these methods was independently developed, and the two modalities were integrated using a thin (1-mm outer diameter) fiber-optic probe. Resulting dMOD probe was implemented and evaluated on animal models of prostate cancer, as well as on human prostate tissue. Application of dMOD to human breast cancer (invasive ductal carcinoma) identification was also evaluated. The results obtained reveal that both LRS and AFLS are excellent techniques to discriminate prostate cancer tissue from surrounding benign tissue in animal models. Each technique independently is capable of providing near absolute (100%) accuracy for cancer detection, indicating that either of them could be used independently without the need of implementing them together. Also, in case of human breast cancer, LRS and AFLS provided comparable accuracies to dMOD, LRS accuracy (96%) being the highest for the studied population. However, the

  7. Minimally invasive repair of pectus excavatum in an adolescent with a history of a median sternotomy as an infant

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    Lauren Huckaby

    2014-10-01

    Full Text Available The report by Nuss et al., in 1998 of their 10-year experience with minimally invasive repair of pectus excavatum introduced the possibility of a less invasive approach for the correction of chest wall abnormalities. This procedure is now well-accepted around the world, although serious complications such as intraoperative cardiac perforation and postoperative bar displacement have been reported. The Nuss procedure has been performed concurrently with sternotomy for cardiac operations. However, there have been no reports of minimally invasive pectus excavatum correction in a child with a remote history of a median sternotomy. With IRB approval (Protocol #1308002283 we report the successful completion of a Nuss procedure in an adolescent with a history of a median sternotomy in infancy. During the procedure, thoracoscopy on the right side revealed significant adhesions of the lung and pericardium to the posterior sternum. Additional trocars were placed bilaterally to facilitate visualization and to allow for lysis of the adhesions with bipolar cautery. Passage of the bar was accomplished uneventfully and the patient has an excellent cosmetic outcome 28 months following the operation. We believe that a previous median sternotomy should not be viewed as a contraindication to the minimally invasive repair of pectus excavatum.

  8. Thoracic bone remodeling after minimally invasive repair for pectus excavatum in adults and its clinical efficacy

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    Ji-fu LIU

    2012-04-01

    Full Text Available Objective To study thoracic bone remodeling after minimally invasive corrective surgery for pectus excavatum (PE in adults and ascertain its clinical efficacy. Methods A total of 82 patients aged 18 to 57 (23.5±6.1 were enrolled in this study. There were 67 male patients and 15 female patients. The symmetric type (Ⅰ type composed of 37 cases, whereas the nonsymmetric type (Ⅱ type comprised 45 cases. Haller index (HI was 3.2 to 11.8. Under general anesthesia, incisions located on looth sides of the mid-axillary line were made in all patients. The prepared supporting bar was inserted behind the sternum by videoassisted thoracoscopic monitoring (one bar for 60 patients and two bars for 22 patients. All patients were checked by chest CT scan pre-operation and 1 week post-operation to create a three-dimensional reconstruction thoracic image. In the sagittal plane, the center line of the body of the thoracic vertebrae was regarded as the incision line. The distance was measured between the sternum and the frontal edge of the body of the thoracic vertebrae. The condition of the displacement of the heart was also observed. Results When one bar was used, the middle and the inferior extremity of the mid-sternum was moved forward for 8.69 and 15.69mm, respectively, after correction. There was significant difference compared with that of the pre-operation (P < 0.01. However, the upper extremity of the mid-sternum and upper and inferior extremities of the manubrium were moved forward to 2.39, -2.38, and 1.44mm, which did not exhibit obvious difference compared with the values taken before the operation. When two bars were used for the patients, the inferior extremity of the manubrium and each of upper, middle, and inferior extremities of the mid-sternum showed a forward displacement for 10.8, 12.45, 17.61, and 20.62mm, respectively. There was significant difference compared with the pre-operative values (P < 0.001. The upper extremity of the

  9. Minimally invasive surgical treatment of patients with bilateral pulmonary tuberculosis complicated with pleural empyema

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    Korpusenko I.V

    2015-03-01

    Full Text Available Objective of our study was to increase the effectiveness of surgical treatment of bilateral destructive pulmonary tuberculosis complicated by pleural empyema by using VTS-technologies. The study was done in Dnepropetrovsk regional clinical therapeutic and prophylactic association "Phthisiology" in the period from 2008 to 2013. A retrospective analysis of 43 cases of bilateral destructive pulmonary tuberculosis complicated by pleural empyema on one side and dissemination focus or limited destructive process on contralateral side has been performed. Selected cases were divided into 2 groups: main (eighteen cases where the following procedures were done: performed transsternal occlusion of the main bronchus, sanation of empyema cavity using videothoracosopy, in 30-45 days followed by pleuropneumectomy with usage of minithoracothomy and control (nineteen cases who had undergone drainage of the empyema cavity, sanation, in 45-60 days followed by pleuropmeumectomy with usage of anterolateral access. The distribution of main and control groups for analyzed parameters was representative. Sanation of pleural cavity with videothoracosopy usage compared with Bulau’s drainage provides better antibacterial effect, effective sanitation of the pleural cavity as evidenced by following changes: significant decrease in the number of microbial cells; normalization of total white blood cells count and rod-shaped granulocytes in the peripheral blood 10 days after treatment; normalization of leukocyte intoxication index. The use of minimally invasive surgical treatment allowed to reduce intraoperative complications by 2 times, amount of intraoperative blood loss and hemotrasfusions by 1.5 times, postoperative mortality by 2.5 times. Pleural cavity sanation with videothoracoscopy usage with following pneumoectomy leads to reduce in the incidence and severity of postoperative complications. The most promising is stage-by-stage surgical approach with consecutive use

  10. Developments for the minimally invasive treatment of tumours by targeted magnetic heating

    Science.gov (United States)

    Hilger, Ingrid; Dietmar, Elke; Linß, Werner; Streck, Sibylle; Kaiser, Werner A.

    2006-09-01

    Purpose. Among the different minimally invasive methods for the treatment of tumours under investigation, the accumulation of magnetic material at the target region and the exposure to an alternating magnetic field comprises a highly selective approach. In the present study, we assessed if magnetic heating of tumour cells in vitro is feasible after binding of high-affinity magnetic nanoparticles to the tumour specific protein Her-2/neu, which is known to be expressed in 30% of breast cancers. Material and methods. Antibodies against the Her-2/neu protein (high-affinity probe) or non-specific gamma immunoglobulins (non-affinity probe, control) were coupled to the dextran shell of magnetic nanoparticles (mean total particle diameter, 150 nm). After incubation of Her-2/neu overexpressing SK-BR-3 tumour cells with the high-affinity probe, non-affinity probe or buffer, cell labelling was verified by electron microscopy. The iron content in cells was determined by atomic absorption spectroscopy. Moreover, cells were exposed to an alternating magnetic field (amplitude, 11 kA m-1 frequency, 410 kHz) for 2.8 min. Temperatures were measured using thermocouples. Results. A distinct cell labelling was observed by electron microscopy after incubation of cells with the high-affinity probe as compared to controls. Magnetic nanoparticles were found to be localized at the cell surface as well as in granules inside the cytoplasm. The iron content of high-affinity labelled cells (e.g. 76 µg/5 × 107 cells) was distinctly higher than in control cells (e.g. up to 25 µg/5 × 107 cells). During magnetic heating, temperature increases of up to approximately 8 °C were observed in relation to high-affinity labelled cells as compared to 1-2 °C in controls. Conclusion. Our results show that targeted magnetic heating of tumour cells seems to be feasible. Further investigations should focus on the corresponding relationships in the in vivo situation.

  11. Two-Stage Indicators to Assess Learning Curves for Minimally Invasive Ivor Lewis Esophagectomy.

    Science.gov (United States)

    Wang, Qi; Wu, Zixiang; Chen, Gang; Zhang, Sai; Shen, Gang; Wu, Ming

    2016-10-05

    Background Minimally invasive esophagectomy (MIE) Ivor Lewis has been increasingly performed over the last two decades. To guide the implementation of this technically demanding procedure, a comprehensive assessment of MIE-Ivor Lewis learning curves should include both the general competence to accomplish the procedure and the ability to generate oncological benefits. These objectives are believed to be associated with different phases of the learning curve. Methods A retrospective review of the first 109 patients who underwent MIE-Ivor Lewis by a single qualified surgeon was conducted. Relevant variables were collected and assessed by regression analysis to identify suitable indicators for patient stratification and learning curve assessment. Thereafter, the differential analysis was performed among groups to validate the learning curve model. Results Two variables, intrathoracic gastroesophageal anastomosis time and bilateral recurrent laryngeal nerve (RLN) lymphadenectomy number, which plateaued, respectively, after the 26th and 88th cases, were selected as meaningful indicators to identify different competence levels. Therefore, 109 patients were chronologically subcategorized into three groups (the first 26 MIEs as the early group, the next 62 cases as the middle group, and 21 most recent cases as the late group). Perioperative data were compared between groups with positive results to indicate a three-phase model for a learning curve for MIE-Ivor Lewis. Conclusions An MIE-Ivor Lewis learning curve should include three discrete phases that indicate, successively, unskilled operation (general competence to accomplish, less proficiency), surgical proficiency, and oncological efficacy. Intrathoracic anastomosis time and bilateral RLN lymphadenectomy were identified as suitable indicators delineate the different stages of an MIE-Ivor Lewis learning curve.

  12. Patient-Specific Biomechanical Modeling for Guidance During Minimally-Invasive Hepatic Surgery.

    Science.gov (United States)

    Plantefève, Rosalie; Peterlik, Igor; Haouchine, Nazim; Cotin, Stéphane

    2016-01-01

    During the minimally-invasive liver surgery, only the partial surface view of the liver is usually provided to the surgeon via the laparoscopic camera. Therefore, it is necessary to estimate the actual position of the internal structures such as tumors and vessels from the pre-operative images. Nevertheless, such task can be highly challenging since during the intervention, the abdominal organs undergo important deformations due to the pneumoperitoneum, respiratory and cardiac motion and the interaction with the surgical tools. Therefore, a reliable automatic system for intra-operative guidance requires fast and reliable registration of the pre- and intra-operative data. In this paper we present a complete pipeline for the registration of pre-operative patient-specific image data to the sparse and incomplete intra-operative data. While the intra-operative data is represented by a point cloud extracted from the stereo-endoscopic images, the pre-operative data is used to reconstruct a biomechanical model which is necessary for accurate estimation of the position of the internal structures, considering the actual deformations. This model takes into account the patient-specific liver anatomy composed of parenchyma, vascularization and capsule, and is enriched with anatomical boundary conditions transferred from an atlas. The registration process employs the iterative closest point technique together with a penalty-based method. We perform a quantitative assessment based on the evaluation of the target registration error on synthetic data as well as a qualitative assessment on real patient data. We demonstrate that the proposed registration method provides good results in terms of both accuracy and robustness w.r.t. the quality of the intra-operative data.

  13. Minimally invasive percutaneous compression plating versus dynamic hip screw for intertrochanteric fractures: a randomized control trial

    Institute of Scientific and Technical Information of China (English)

    Cheng Qiang; Huang Wei; Gong Xuan; Wang Changdong; Liang Xi; Hu Ning

    2014-01-01

    Objective:Intertrochanteric femur fracture is a common injury in elderly patients.The dynamic hip screw (DHS) has served as the standard choice for fixation; however it has several drawbacks.Studies of the percutaneous compression plate (PCCP) are still inconclusive in regards to its efficacy and safety.By comparing the two methods,we assessed their clinical therapeutic outcome.Methods:Atotal of 121 elderly patients with intertrochanteric femur fractures (type AO/OTA 31.A 1-A2,Evans type 1) were divided randomly into two groups undergoing either a minimally invasive PCCP procedure or a conventional DHS fixation.Results:The mean operation duration was significantly shorter in the PCCP group (55.2 min versus 88.5 min,P<0.01).The blood loss was 156.5 ml±18.3 ml in the PCCP group and 513.2 ml±66.2 ml in the DHS group (P<0.01).Among the patients treated with PCCP,3.1% needed blood transfusions,compared with 44.6% of those that had DHS surgery (P<0.01).The PCCP group displayed less postoperative complications (P<0.05).The mean American Society of Anesthesiologists score and Harris hip score in the PCCP group were better than those in the DHS group.There were no significant differences in the mean hospital stay,mortality rates,or fracture healing.Conclusion:Due to several advantages,PCCP has the potential to become the ideal choice for treating intertrochanteric fractures (type AO/OTA 31.A1-A2,Evans type 1),particularly in the elderly.

  14. Remote Minimally Invasive Surgery – Haptic Feedback and Selective Automation in Medical Robotics

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    Christoph Staub

    2011-01-01

    Full Text Available The automation of recurrent tasks and force feedback are complex problems in medical robotics. We present a novel approach that extends human-machine skill-transfer by a scaffolding framework. It assumes a consolidated working environment for both, the trainee and the trainer. The trainer provides hints and cues in a basic structure which is already understood by the learner. In this work, the scaffolding is constituted by abstract patterns, which facilitate the structuring and segmentation of information during “Learning by Demonstration” (LbD. With this concept, the concrete example of knot-tying for suturing is exemplified and evaluated. During the evaluation, most problems and failures arose due to intrinsic system imprecisions of the medical robot system. These inaccuracies were then improved by the visual guidance of the surgical instruments. While the benefits of force feedback in telesurgery has already been demonstrated and measured forces are also used during task learning, the transmission of signals between the operator console and the robot system over long-distances or across-network remote connections is still a challenge due to time-delay. Especially during incision processes with a scalpel into tissue, a delayed force feedback yields to an unpredictable force perception at the operator-side and can harm the tissue which the robot is interacting with. We propose a XFEM-based incision force prediction algorithm that simulates the incision contact-forces in real-time and compensates the delayed force sensor readings. A realistic 4-arm system for minimally invasive robotic heart surgery is used as a platform for the research.

  15. Minimally Invasive Antral Membrane Balloon Elevation (MIAMBE: A 3 cases report

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    Roberto Arroyo

    2013-12-01

    Full Text Available ABSTRACT Long-standing partial edentulism in the posterior segment of an atrophic maxilla is a challenging treatment. Sinus elevation via Cadwell Luc has several anatomical restrictions, post-operative discomfort and the need of complex surgical techniques. The osteotome approach is a significantly safe and efficient tecnique, as a variation of this technique the "minimal invasive antral membrane balloon elevation" (MIAMBE has been developed, which use a hydraulic system. We present three cases in which the system was used MIAMBE for tooth replacement in the posterior. This procedure seems to be a relatively simple and safe solution for the insertion of endo-osseus implants in the posterior atrophic maxilla. RESUMEN El edentulismo parcial de larga data en el segmento posterior en un maxilar atrófico supone un reto terapéutico. La elevación de seno vía Cadwell Luc presenta restricciones anatómicas, incomodidades post-operatorias y la necesidad de técnicas quirúrgicas complejas. El enfoque con osteotomos tiene una eficacia y seguridad considerable, como una variación a esta se ha desarrollado la "elevación mínimamente invasiva mediante globo de la membrana antral" (MIAMBE, que utiliza un sistema hidráulico. Se presentan tres casos en los que se utilizó el sistema MIAMBE para el reemplazo de dientes en el sector posterior. Este procedimiento parece ser una solución relativamente sencilla y segura para inserción de implates endo-óseos en el caso de un maxilar atrófico posterior.

  16. Reorientating dental curricula to reflect a minimally invasive dentistry approach for patient-centred management.

    Science.gov (United States)

    Kaidonis, J A; Skinner, V J; Lekkas, D; Winning, T A; Townsend, G C

    2013-06-01

    Minimally invasive dentistry (MID), together with patient-centred care (PCC), can be considered central to patient management. These approaches have been incorporated in the structure of various dental curricula and indeed formally assessed. However, there is limited evidence that students have an integrated skill-set and are able to apply these skills when providing direct patient care within the clinical setting. Assessment of students' application of core clinical skills has identified numerous deficiencies that need to be addressed. The revised Bachelor of Dental Surgery curriculum at the School of Dentistry, The University of Adelaide, provides an example of how MID, underpinned by PCC, can be presented throughout a dental curriculum. Essentially, MID and PCC are not considered as separate subjects but as a patient management approach that is 'woven into the whole fabric' of the curriculum. The programme relies on the development of empathic communication skills that enable students to obtain key patient information, including their patients' values, beliefs, needs, preferences and expectations, thereby allowing management to be tailor-made. As a result, patients are empowered to be a part of the oral health care team. The Adelaide undergraduate dental curriculum consists of one clinical stream called Dental Science and Practice (DSP), that promotes the application of student knowledge, skills and behaviours in the clinical setting. Vertical and horizontal integration, aligned with an integrated approach to assessment, drives the learning throughout the programme. Clearly-defined outcomes are introduced by Integrated Learning Activities (ILAs) that provide a focus for associated learning activities (e.g. class meetings, tutorials, simulation laboratories, etc). The aim of this approach to learning and teaching is to ensure the required learning outcomes are achieved. It also requires coordinated teaching teams including trained external tutors who clearly

  17. Types of Renal Calculi and Management Regimen for Chinese Minimally Invasive Percutaneous Nephrolithotomy.

    Science.gov (United States)

    Gu, Si-Ping; Zeng, Guo-Hua; You, Zhi-Yuan; Lu, Yi-Jin; Huang, Yun-Teng; Wang, Qing-Mao; He, Zhao-Hui

    2015-12-01

    Strict selection of patients for minimally invasive percutaneous nephrolithotomy could effectively improve the success rate of surgery. This study aimed to understand the required skills and the efficacy of mini-PCNL in the treatment of five types of upper ureteral calculi. Data collected after X-ray analysis and B mode ultrasound from 633 patients with upper ureteral and renal pelvis calculi who underwent B ultrasound-guided lithotomy was reviewed, including the following: type I, upper ureteral or renal pelvis calculi with moderate hydronephrosis (154 cases); type II, upper ureteral or renal pelvis calculi with severe hydronephrosis (157 cases); type III, upper ureteral or renal pelvis calculi without hydronephrosis (61 cases); type IV, renal pelvis calculi, one or two renal calyx calculi (206 cases); and type V, renal staghorn calculi (55 cases). Operations on 611 cases were successful. The treatment method for five patients was converted to open surgery. Twelve cases were treated by indwelling double-J tube retro-catheterization and extracorporeal shock wave lithotripsy. Five patients gave up the treatment. The rate of calculus clearance was 82.3 %, and the rate of residual calculus was 17.6 %. Selective renal artery embolization was performed in nine cases. Hydropneumothorax occurred in nine cases. No intestinal fistula occurred, and no patient had to undergo nephrectomy. The difficulty and the curative effect of the operation were different because the types of calculi varied. Selection of the procedure based on the different types of calculi could effectively improve the success rate of the procedure, reduce complications, and shorten the learning curve.

  18. Preoperative localization and minimally invasive management of primary hyperparathyroidism concomitant with thyroid disease

    Institute of Scientific and Technical Information of China (English)

    2007-01-01

    The coexistence of thyroid diseases with primary hyperparathyroidism (PHPT) can present a challenge in the clinical diagnosis and management for these patients. This study aims to determine the frequency of coexisting thyroid gland lesions in a consecutive series patients with PHPT, and to analyze the clinical features, diagnosis and treatment of these patients. Twenty-two cases of a total of 52 PHPT patients who had synchronous thyroid and parathyroid pathology were surgically managed in this study.Thirteen patients had ipsilateral thyroid nodules, and 9 patients had thyroid nodules in contralateral or bilateral side. Seven patients underwent direct parathyroidectomy and hemithyroidectomy via a mini-incision (about 3 cm), while other 15 procedures were converted to Kocher incision. Seventeen nodular goiter (32.7%), 2 thyroiditis (3.8%), 2 thyroid adenoma (3.8%) and 1 thyroid carcinoma (1.9%) coexisting with parathyroid adenoma were pathologically diagnosed. The sensitivity of preoperative ultrasonography (US) and methoxy-isobutyl-isonitrile (MIBI) scintigraphy for parathyroid lesions was 63.6% and 85.7%; and the overall positive predictive values for MIBI and US were 100% and 95.5% respectively. A high incidence of thyroid diseases that coexisted with PHPT in literatures was briefly reviewed. Our study illustrated the need for clinical awareness of concomitant PHPT and thyroid disease. A combination of US, computed tomography (CT) and MIBI scintigraphy would be recommended for preoperative localization of enlarged parathyroid adenoma and for evaluation of thyroid lesions. Synchronous treatment of associated thyroid abnormalities is desirable, and open minimally invasive surgical approach with additional resection of isolated ipsilateral thyroid nodules is possible in some of these patients.

  19. A Panoramic Wireless Endoscope System Design for the Application of Minimally Invasive Surgery

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    Chun-Hsiang Peng

    2014-05-01

    Full Text Available Minimally Invasive Surgery (MIS is the current trend in surgery. Compared to traditional surgery, MIS can substantially decrease recovery time and expenses needed by patients after surgeries, reduce pain during surgical procedures, and is highly regarded by physicians and patients. An endoscope is widely used in the diagnosis and treatments of various medical disciplines, such as hysteroscopy, laparoscopy, and colonoscopy, and have been adopted by many branches of medicine. However, the limited image field of MIS is often the most difficult obstacles faced by surgeons and medical students, especially to less experienced physicians and difficult surgical procedures; the limited field of view of endoscopic imaging does not provide a whole picture of the surgery area, making the procedures difficult and full of uncertainty. In light of this problem, we proposed a "Panoramic Wireless Endoscope System design", hoping to provide physicians with a wide field of view of the endoscopic image. We combine images captured from two parallel-mounted endoscope lenses into a single, wide-angle image, giving physicians a wider field of view and easier access to the surgical area. In addition, we developed a wireless transmission system so the image can be transmitted to various display platforms, eliminating the needs for excessive cabling on surgical tools and enable physicians to better operate on the patient. Finally, our system allows surgical assistants a better view of the operation process, and enables other physicians and nurses to remotely observe the process. Our experiment results have shown that we can increase the image to 152% of its original size. We used the PandaBoard ES platform with an ARM9 processor and 1G of onboard RAM, and continuously implementing animal trials to verify the reliability of our system.

  20. Bilateral neurological deficits following unilateral minimally invasive TLIF: A review of four patients

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    Alexander T Nixon

    2014-01-01

    Full Text Available Background: Minimally invasive transforaminal lumbar interbody fusion (MI-TLIF is commonly used for the treatment of degenerative lumbar spinal disorders. The rate of postoperative neurological deficits is traditionally low. New neurological postoperative complications may be underreported. We report our infrequent rate of MI-TLIF procedures complicated by postoperative weakness. Methods: A database of 340 patients was evaluated, all of whom underwent MI-TLIF procedures performed between January 2002 and June 2012 by the senior author. We identified four cases (1.2% whose postoperative course was complicated with bilateral lower extremity weakness. We retrospectively reviewed their past medical history, operative time, estimated blood loss, length of hospital stay, changes in intraoperative neurophysiological monitoring, and pre- and postoperative neurological exams. Results: The average age of the four patients was 65.5 years(range: 62-75 years, average body mass index (BMI was 25.1 (range: 24.1-26.6, and there were three females and one male. All patients had preoperative degenerative spondylolisthesis (either grade I or grade II. All patients were placed on a Wilson frame during surgery and underwent unilateral left-sided MI-TLIF. Three out of the four patients had a past medical history significant for abdominal or pelvic surgery and one patient had factor V Leiden deficiency syndrome. Conclusions: The rate of new neurological deficits following an MI-TLIF procedure is low, as documented in this study where the rate was 1.2%. Nonetheless, acknowledgement and open discussion of this serious complication is important for surgeon education. Of interest, the specific etiology or pathophysiology behind these complications remains relatively unknown (e.g. direct neural injury, traction injury, hypoperfusion, positioning complication, and others despite there being some similarities between the patients and their perioperative courses.