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Sample records for effective minimally invasive

  1. Cost-effectiveness analysis in minimally invasive spine surgery.

    Science.gov (United States)

    Al-Khouja, Lutfi T; Baron, Eli M; Johnson, J Patrick; Kim, Terrence T; Drazin, Doniel

    2014-06-01

    Medical care has been evolving with the increased influence of a value-based health care system. As a result, more emphasis is being placed on ensuring cost-effectiveness and utility in the services provided to patients. This study looks at this development in respect to minimally invasive spine surgery (MISS) costs. A literature review using PubMed, the Cost-Effectiveness Analysis (CEA) Registry, and the National Health Service Economic Evaluation Database (NHS EED) was performed. Papers were included in the study if they reported costs associated with minimally invasive spine surgery (MISS). If there was no mention of cost, CEA, cost-utility analysis (CUA), quality-adjusted life year (QALY), quality, or outcomes mentioned, then the article was excluded. Fourteen studies reporting costs associated with MISS in 12,425 patients (3675 undergoing minimally invasive procedures and 8750 undergoing open procedures) were identified through PubMed, the CEA Registry, and NHS EED. The percent cost difference between minimally invasive and open approaches ranged from 2.54% to 33.68%-all indicating cost saving with a minimally invasive surgical approach. Average length of stay (LOS) for minimally invasive surgery ranged from 0.93 days to 5.1 days compared with 1.53 days to 12 days for an open approach. All studies reporting EBL reported lower volume loss in an MISS approach (range 10-392.5 ml) than in an open approach (range 55-535.5 ml). There are currently an insufficient number of studies published reporting the costs of MISS. Of the studies published, none have followed a standardized method of reporting and analyzing cost data. Preliminary findings analyzing the 14 studies showed both cost saving and better outcomes in MISS compared with an open approach. However, more Level I CEA/CUA studies including cost/QALY evaluations with specifics of the techniques utilized need to be reported in a standardized manner to make more accurate conclusions on the cost effectiveness of

  2. Cost-effectiveness of minimally invasive sacroiliac joint fusion.

    Science.gov (United States)

    Cher, Daniel J; Frasco, Melissa A; Arnold, Renée Jg; Polly, David W

    2016-01-01

    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. To determine the cost-effectiveness of minimally invasive SIJ fusion. 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. 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) dysfunction due to degenerative sacroiliitis or SIJ disruption.

  3. Cost-effectiveness of minimally invasive sacroiliac joint fusion

    Science.gov (United States)

    Cher, Daniel J; Frasco, Melissa A; Arnold, Renée JG; Polly, David W

    2016-01-01

    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, SIJ fusion is a cost-effective, and, in the long term, cost-saving strategy for the treatment of SIJ dysfunction due to degenerative sacroiliitis or SIJ disruption. PMID:26719717

  4. 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

  5. Minimally invasive orthognathic surgery.

    Science.gov (United States)

    Resnick, Cory M; Kaban, Leonard B; Troulis, Maria J

    2009-02-01

    Minimally invasive surgery is defined as the discipline in which operative procedures are performed in novel ways to diminish the sequelae of standard surgical dissections. The goals of minimally invasive surgery are to reduce tissue trauma and to minimize bleeding, edema, and injury, thereby improving the rate and quality of healing. In orthognathic surgery, there are two minimally invasive techniques that can be used separately or in combination: (1) endoscopic exposure and (2) distraction osteogenesis. This article describes the historical developments of the fields of orthognathic surgery and minimally invasive surgery, as well as the integration of the two disciplines. Indications, techniques, and the most current outcome data for specific minimally invasive orthognathic surgical procedures are presented.

  6. 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.

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

    Science.gov (United States)

    Ledonio, Charles Gt; Polly, David W; Swiontkowski, Marc F; Cummings, John T

    2014-01-01

    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. 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. 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 resulting in greater improvement. The open and MIS sacroiliac joint fusion techniques resulted in statistically and clinically significant improvement for patients with degenerative sacroiliitis refractory to nonoperative management. However, the number of patients

  8. Minimally invasive distal pancreatectomy

    NARCIS (Netherlands)

    Røsok, Bård I.; de Rooij, Thijs; van Hilst, Jony; Diener, Markus K.; Allen, Peter J.; Vollmer, Charles M.; Kooby, David A.; Shrikhande, Shailesh V.; Asbun, Horacio J.; Barkun, Jeffrey; Besselink, Marc G.; Boggi, Ugo; Conlon, Kevin; Han, Ho Seong; Hansen, Paul; Kendrick, Michael L.; Kooby, David; Montagnini, Andre L.; Palanivelu, Chinnasamy; Wakabayashi, Go; Zeh, Herbert J.

    2017-01-01

    The first International conference on Minimally Invasive Pancreas Resection was arranged in conjunction with the annual meeting of the International Hepato-Pancreato-Biliary Association (IHPBA), in Sao Paulo, Brazil on April 19th 2016. The presented evidence and outcomes resulting from the session

  9. 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

  10. Effectiveness and efficacy of minimally invasive lung volume reduction surgery for emphysema.

    Science.gov (United States)

    Pertl, Daniela; Eisenmann, Alexander; Holzer, Ulrike; Renner, Anna-Theresa; Valipour, A

    2014-01-01

    Lung emphysema is a chronic, progressive and irreversible destruction of the lung tissue. Besides non-medical therapies and the well established medical treatment there are surgical and minimally invasive methods for lung volume reduction (LVR) to treat severe emphysema. This report deals with the effectiveness and cost-effectiveness of minimally invasive methods compared to other treatments for LVR in patients with lung emphysema. Furthermore, legal and ethical aspects are discussed. No clear benefit of minimally invasive methods compared to surgical methods can be demonstrated based on the identified and included evidence. In order to assess the different methods for LVR regarding their relative effectiveness and safety in patients with lung emphysema direct comparative studies are necessary.

  11. Effectiveness and efficacy of minimally invasive lung volume reduction surgery for emphysema

    Directory of Open Access Journals (Sweden)

    Pertl, Daniela

    2014-10-01

    Full Text Available [english] Lung emphysema is a chronic, progressive and irreversible destruction of the lung tissue. Besides non-medical therapies and the well established medical treatment there are surgical and minimally invasive methods for lung volume reduction (LVR to treat severe emphysema. This report deals with the effectiveness and cost-effectiveness of minimally invasive methods compared to other treatments for LVR in patients with lung emphysema. Furthermore, legal and ethical aspects are discussed. No clear benefit of minimally invasive methods compared to surgical methods can be demonstrated based on the identified and included evidence. In order to assess the different methods for LVR regarding their relative effectiveness and safety in patients with lung emphysema direct comparative studies are necessary.

  12. [Minimally invasive approach for cervical spondylotic radiculopathy].

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    Ding, Liang; Sun, Taicun; Huang, Yonghui

    2010-01-01

    To summarize the recent minimally invasive approach for cervical spondylotic radiculopathy (CSR). The recent literature at home and abroad concerning minimally invasive approach for CSR was reviewed and summarized. There were two techniques of minimally invasive approach for CSR at present: percutaneous puncture techniques and endoscopic techniques. The degenerate intervertebral disc was resected or nucleolysis by percutaneous puncture technique if CSR was caused by mild or moderate intervertebral disc herniations. The cervical microendoscopic discectomy and foraminotomy was an effective minimally invasive approach which could provide a clear view. The endoscopy techniques were suitable to treat CSR caused by foraminal osteophytes, lateral disc herniations, local ligamentum flavum thickening and spondylotic foraminal stenosis. The minimally invasive procedure has the advantages of simple handling, minimally invasive and low incidence of complications. But the scope of indications is relatively narrow at present.

  13. The Effect of Microneedle Thickness on Pain During Minimally Invasive Facial Procedures: A Clinical Study.

    Science.gov (United States)

    Sezgin, Billur; Ozel, Bora; Bulam, Hakan; Guney, Kirdar; Tuncer, Serhan; Cenetoglu, Seyhan

    2014-07-01

    Minimally invasive procedures are becoming increasingly popular because they require minimal downtime and are effective for achieving a more youthful appearance. The choice of needle for minimally invasive procedures can be a major factor in the patient's comfort level, which in turn affects the physician's comfort level. In this comparative study, the authors assessed levels of pain and bruising after participants were injected with 30-gauge or 33-gauge (G) microneedles, which are commonly used for minimally invasive injection procedures. Twenty healthy volunteers were recruited for this prospective study. Eight injection points (4 on each side of the face) were determined for each patient. All participants received injections of saline with both microneedles in a randomized, blinded fashion. Levels of pain and bruising were assessed and analyzed for significance. The highest level of pain was in the malar region, and the lowest level was in the glabella. Although all pain scores were lower for the 33-G microneedle, the difference was significant only for the forehead. Because most minimally invasive procedures require multiple injections during the same sitting, the overall procedure was evaluated as well. Assessment of the multiple-injection process demonstrated a significant difference in pain level, favoring the 33-G needle. Although the difference in bruising was not statistically significant between the 2 needles, the degree of bruising was lower with the 33-G needle. For procedures that involve multiple injections to the face (such as mesotherapy and injection of botulinum toxin A), thinner needles result in less pain, making the overall experience more comfortable for the patient and the physician. 3. © 2014 The American Society for Aesthetic Plastic Surgery, Inc.

  14. 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.

  15. Radical perineal prostatectomy: cost efficient, outcome effective, minimally invasive prostate cancer management.

    Science.gov (United States)

    Harris, Michael J

    2003-09-01

    invasive nature of this procedure contribute to a short recovery and low overall cost of therapy. The anatomic radical perineal prostatectomy is a cost-efficient, outcome effective minimally invasive method of treating men with localized prostate cancer.

  16. Effects of realistic force feedback in a robotic assisted minimally invasive surgery system.

    Science.gov (United States)

    Moradi Dalvand, Mohsen; Shirinzadeh, Bijan; Nahavandi, Saeid; Smith, Julian

    2014-06-01

    Robotic assisted minimally invasive surgery systems not only have the advantages of traditional laparoscopic procedures but also restore the surgeon's hand-eye coordination and improve the surgeon's precision by filtering hand tremors. Unfortunately, these benefits have come at the expense of the surgeon's ability to feel. Several research efforts have already attempted to restore this feature and study the effects of force feedback in robotic systems. The proposed methods and studies have some shortcomings. The main focus of this research is to overcome some of these limitations and to study the effects of force feedback in palpation in a more realistic fashion. A parallel robot assisted minimally invasive surgery system (PRAMiSS) with force feedback capabilities was employed to study the effects of realistic force feedback in palpation of artificial tissue samples. PRAMiSS is capable of actually measuring the tip/tissue interaction forces directly from the surgery site. Four sets of experiments using only vision feedback, only force feedback, simultaneous force and vision feedback and direct manipulation were conducted to evaluate the role of sensory feedback from sideways tip/tissue interaction forces with a scale factor of 100% in characterising tissues of varying stiffness. Twenty human subjects were involved in the experiments for at least 1440 trials. Friedman and Wilcoxon signed-rank tests were employed to statistically analyse the experimental results. Providing realistic force feedback in robotic assisted surgery systems improves the quality of tissue characterization procedures. Force feedback capability also increases the certainty of characterizing soft tissues compared with direct palpation using the lateral sides of index fingers. The force feedback capability can improve the quality of palpation and characterization of soft tissues of varying stiffness by restoring sense of touch in robotic assisted minimally invasive surgery operations.

  17. 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.

  18. [Minimally invasive coronary artery surgery].

    Science.gov (United States)

    Zalaquett, R; Howard, M; Irarrázaval, M J; Morán, S; Maturana, G; Becker, P; Medel, J; Sacco, C; Lema, G; Canessa, R; Cruz, F

    1999-01-01

    There is a growing interest to perform a left internal mammary artery (LIMA) graft to the left anterior descending coronary artery (LAD) on a beating heart through a minimally invasive access to the chest cavity. To report the experience with minimally invasive coronary artery surgery. Analysis of 11 patients aged 48 to 79 years old with single vessel disease that, between 1996 and 1997, had a LIMA graft to the LAD performed through a minimally invasive left anterior mediastinotomy, without cardiopulmonary bypass. A 6 to 10 cm left parasternal incision was done. The LIMA to the LAD anastomosis was done after pharmacological heart rate and blood pressure control and a period of ischemic pre conditioning. Graft patency was confirmed intraoperatively by standard Doppler techniques. Patients were followed for a mean of 11.6 months (7-15 months). All patients were extubated in the operating room and transferred out of the intensive care unit on the next morning. Seven patients were discharged on the third postoperative day. Duplex scanning confirmed graft patency in all patients before discharge; in two patients, it was confirmed additionally by arteriography. There was no hospital mortality, no perioperative myocardial infarction and no bleeding problems. After follow up, ten patients were free of angina, in functional class I and pleased with the surgical and cosmetic results. One patient developed atypical angina on the seventh postoperative month and a selective arteriography confirmed stenosis of the anastomosis. A successful angioplasty of the original LAD lesion was carried out. A minimally invasive left anterior mediastinotomy is a good surgical access to perform a successful LIMA to LAD graft without cardiopulmonary bypass, allowing a shorter hospital stay and earlier postoperative recovery. However, a larger experience and a longer follow up is required to define its role in the treatment of coronary artery disease.

  19. Acquiring minimally invasive surgical skills

    OpenAIRE

    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. This thesis has led to an enlarged insight in the organization of surgical skills training during residency training of surgical medical specialists.

  20. 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…

  1. Minimal Invasive Urologic Surgery and Postoperative Ileus

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    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.

  2. Therapeutic effect of minimally invasive intracranial hematoma evacuation in the treatment of hypertensive cerebral hemorrhage and TCD evaluation

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    Zi-Hao Zhang

    2017-06-01

    Full Text Available Objective: To explore the therapeutic effect of minimally invasive intracranial hematoma evacuation in the treatment of hypertensive cerebral hemorrhage and the value of dynamic TCD monitoring in predicting the neurological function recovery. Methods: A total of 70 patients with hypertensive cerebral hemorrhage who were admitted in our hospital were included in the study and divided into the minimally invasive group and conservative group with 35 cases in each group according to different treatment protocols. The patients in the two groups were given drug conservative treatments. On this basis, the patients in the minimally invasive group were given urokinase in combined with minimally invasive hematoma puncture with YL-1 type needle. TCD was performed before treatment, 1 d, 5 d, 10 d, and 21 d after treatment. The hematoma and edema volume was calculated. NIHSS was used to evaluate the neurological function recovery. Results: Vs, Vd, and Vm after treatment in the minimally invasive group were significantly elevated, while PI was significantly reduced. Vs, Vd, and Vm after treatment in the conservative group were reduced first and elevated later, while PI was elevated first and reduced later, and reached the lowest/peak 10d after treatment. Vs, Vd, and Vm 5 d, 10 d, and 21 d after treatment in the minimally invasive group were significantly higher than those in the conservative group, while PI was significantly lower than that in the conservative group. The hematoma and edema volume after treatment in the two groups was significantly reduced. The hematoma and edema volume at each timing point was significantly lower than that in the conservative group. NIHSS score after treatment in the minimally invasive group was significantly reduced. NIHSS score in the conservative group was elevated first and reduced later, reached the peak 10d after treatment, and at each timing point was higher than that in the minimally invasive group. Conclusions: The

  3. Curative effect of minimally invasive puncture and drainage assisted with alteplase on treatment of acute intracerebral hemorrhage

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    Jun-Lin Hu

    2017-01-01

    >Conclusions: As for the effect on evacuation of hematoma and also the ameliorative effect on nerve injury, inflammatory reaction and oxidative stress response in treatment of acute intracerebral hemorrhage, minimally invasive puncture and drainage assisted with alteplase was superior to adjuvant therapy with urokinase.

  4. Effectiveness of Minimally Invasive Plate Osteosynthesis (MIPO on Comminuted Tibial or Femoral Fractures

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    Ali Andalib

    2017-09-01

    Full Text Available Background: Comminuted fractures happen frequently due to traumas. Fixation without opening the fracture site,known as minimally invasive plate osteosynthesis (MIPO, has recently become prevalent. This study has beendesigned to assess the outcomes of this treatment for tibial and femoral comminuted fractures.Methods: A total of 60 patients with comminuted femoral or tibial fractures were operated with MIPO method in thiscross-sectional study at Alzahra university hospital in 2015. Eleven patients were excluded due to lack of adequatefollow-ups. Patients’data including union time; infection in the fractured site; hip and knee range of motion; and anymalunion or deformities like limb length discrepancy were collected after the surgery in every session.Results: Among 32 femoral and 17 tibial fractures, union was completed in48 patients, while only one patient withfemoral fracture had nonunion. The mean union time was 18.57±2.42 weeks. Femur fractures healed faster than tibia(17.76±2.36 compared to 19±2.37 weeks, respectively, P=0.09. None of the patients suffered from infections or fistula.The range of motion in hip and knee remained intact in approximately all patients. Malunion happened in 3 patients; 100internal rotation in 1 patient; and 1cm limb shortening in 2 patients.Conclusion: According to the result of this study, MIPO is a simple and effective method of fixation with a high rateof union as well as minimal complications for comminuted fractures of long bones. Infection is rare, and malunion orany deformity is infrequent. MIPO appears to be a promising and safe treatment alternative for comminuted fractures.

  5. 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...... operations were completed as mini-sternotomies, 4 died later of noncardiac causes. The aortic cross-clamp and perfusion times were significantly different across all groups (P replacement...... 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...

  6. 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.

  7. Effect of minimally invasive surgery on related serum factors in patients with lumbar degenerative disease

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    Yi-Zhong Sun

    2016-11-01

    Full Text Available Objective: To explore the effect of minimally invasive surgery and transforaminal lumbar interbody fusion (TLIF on the related serum factors in patients with lumbar degenerative disease. Methods: A total of 100 patients with lumbar degenerative disease who were admitted in our hospital from May, 2014 to May, 2016 were included in the study and divided into the observation group and the control group according to different surgical methods. The patients in the observation group were given MIS-TLIF, while the patients in the control group were given the traditional TLIF. The peripheral venous blood before operation, 2 h, 4 h, 8 h and 24 h after operation in the two groups was collected, and centrifuged for the serum. ELISA was used to detect the serum IL-6 and IL-10 levels. The peripheral venous blood before operation, 1 h, 3 h, 5 h and 7 d after operation in the two groups was collected. DGKC velocity method was used to detect CK activity and fusion rate. The fusion grade was evaluated 6 months after operation according to Bridwell fusion grading standard. Results: The serum IL-6 and IL-10 levels 2 h, 4 h, 8 h and 24 h after operation in the two groups were significantly elevated when compared with before operation, and the serum IL-6 and IL-10 levels at each timing point after operation in the observation group were significantly lower than those in the control group. CK activity 1 d, 3 d, 5 d, and 7d after operation in the two groups was significantly elevated when compared with before operation, and CK activity at each timing point after operation in the observation group was significantly lower than that in the control group. Conclusions: MISTLIF has a small damage on the tissues, can effectively alleviate the inflammatory reaction, and preferably retain the stable structure of posterior column, whose advantage is significantly superior to that by the traditional TLIF.

  8. Evaluation of the Efficiency and Effectiveness of Three Minimally Invasive Methods of Caries Removal: An in vitro Study

    OpenAIRE

    Boob, Ankush Ramnarayan; Manjula, M; Reddy, E Rajendra; Srilaxmi, N; Rani, Tabitha

    2014-01-01

    ABSTRACT Background: Many chemomechanical caries removal (CMCR) agents have been introduced and marketed since 1970s, with each new one being better and effective than the previously introduced. Papacarie and Carisolv are new systems in the field of CMCR techniques. These are reportedly minimally invasive methods of removing carious dentin while preserving sound dentin. Aim: To compare the Efficiency (time taken for caries removal) and effectiveness (Knoop hardness number of the remaining den...

  9. 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.

  10. Evaluation of the Efficiency and Effectiveness of Three Minimally Invasive Methods of Caries Removal: An in vitro Study.

    Science.gov (United States)

    Boob, Ankush Ramnarayan; Manjula, M; Reddy, E Rajendra; Srilaxmi, N; Rani, Tabitha

    2014-01-01

    Many chemomechanical caries removal (CMCR) agents have been introduced and marketed since 1970s, with each new one being better and effective than the previously introduced. Papacarie and Carisolv are new systems in the field of CMCR techniques. These are reportedly minimally invasive methods of removing carious dentin while preserving sound dentin. To compare the Efficiency (time taken for caries removal) and effectiveness (Knoop hardness number of the remaining dentin) of caries removal by three minimally invasive methods, i.e. hand excavation and chemomechanical caries removal using Carisolv and Papacarie. Thirty recently extracted human permanent molars with occlusal carious lesions were divided randomly in three equal groups and bisected through the middle of the lesion mesiodistally and excavated by two methods on each tooth. Statistically significant difference was present among three methods with respect to time and knoop hardness values (KHN) of the remaining dentin. The Efficiency of Hand method is better compared to CMCR techniques and effectiveness of CMCR techniques is better than Hand method in terms of dentin preservation so the chances of maintaining vitality of the pulp will be enhanced. How to cite this article: Boob AR, Manjula M, Reddy ER, Srilaxmi N, Rani T. Evaluation of the Efficiency and Effectiveness of Three Minimally Invasive Methods of Caries Removal: An in vitro Study. Int J Clin Pediatr Dent 2014;7(1):11-18.

  11. Minimally invasive locked plating of distal tibia fractures is safe and effective.

    Science.gov (United States)

    Ronga, Mario; Longo, Umile Giuseppe; Maffulli, Nicola

    2010-04-01

    Distal tibial fractures are difficult to manage. Limited soft tissue and poor vascularity impose limitations for traditional plating techniques that require large exposures. The nature of the limitations for traditional plating techniques is intrinsic to the large exposure required to approach distal tibia, a bone characterized by limited soft tissue coverage and poor vascularity. The locking plate (LP) is a new device for treatment of fractures. We assessed the bone union rate, deformity, leg-length discrepancy, ankle range of motion, return to preinjury activities, infection, and complication rate in 21 selected patients who underwent minimally invasive osteosynthesis of closed distal tibia fractures with an LP. According to the AO classification, there were 12 Type A, 5 Type B, and 4 Type C fractures. The minimum followup was 2 years (average, 2.8 years; range, 2-4 years). Two patients were lost to followup. Union was achieved in all but one patient by the 24th postoperative week. Four patients had angular deformity less than 7 degrees . No patient had a leg-length discrepancy more than 1.1 cm. Five patients had ankle range of motion less than 20 degrees compared with the contralateral side. Sixteen patients had not returned to their preinjury sporting or leisure activities. Three patients developed a delayed infection. We judge the LP a reasonable device for treating distal tibia fractures. The level of physical activities appears permanently reduced in most patients. Level IV, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.

  12. Facet Effusion without Radiographic Instability Has No Effect on the Outcome of Minimally Invasive Decompression Surgery.

    Science.gov (United States)

    Tamai, Koji; Kato, Minori; Konishi, Sadahiko; Matsumura, Akira; Hayashi, Kazunori; Nakamura, Hiroaki

    2017-02-01

    Retrospective cohort study. Lumbar segmental instability is a key factor determining whether decompression alone or decompression and fusion surgery is required to treat lumbar spinal stenosis (LSS). Some recent reports have suggested that facet joint effusion is correlated with spinal segmental instability. The aim of this study is to report the effect of facet effusion without radiographic segmental instability on the outcome of less-invasive decompression surgery for LSS. Seventy-nine patients with LSS (32 women, mean age: 69.1 ± 9.1 years) who had no segmental instability on dynamic radiographs before undergoing L4-L5 microsurgical decompression and who were followed for at least 2 years postoperatively were analyzed. They were divided into three groups on the basis of the existence and size of L4-L5 facet effusion using preoperative magnetic resonance imaging: grade 0 had no effusion ( n  = 31), grade 1 had measurable effusion ( n  = 35), and grade 2 had large effusion ( n  = 13). Japanese Orthopedics Association (JOA) score, visual analog scale (VAS), and the Short-Form (SF)-36 scores were recorded preoperatively and 12 and 24 months postoperatively. JOA score; VAS of low back pain, leg pain, and numbness; and SF-36 (physical component summary and mental component summary) scores did not differ significantly between the three groups in every terms ( p  = 0.921, 0.996, 0.950, 0.693, 0.374, 0.304, and 0.624, respectively, at final follow-up). In the absence of radiographic instability, facet joint effusion has no effect on the outcome of less-invasive decompression surgery.

  13. Providing intraosseous anesthesia with minimal invasion.

    Science.gov (United States)

    Giffin, K M

    1994-08-01

    A new variation of intraosseous anesthesia--crestal anesthesia--that is rapid, site-specific and minimally invasive is presented. The technique uses alveolar crest nutrient canals for anesthetic delivery without penetrating either bone or periodontal ligament.

  14. Minimally invasive versus open sacroiliac joint fusion: are they similarly safe and effective?

    Science.gov (United States)

    Ledonio, Charles G T; Polly, David W; Swiontkowski, Marc F

    2014-06-01

    The sacroiliac joint has been implicated as a source of chronic low back pain in 15% to 30% of patients. When nonsurgical approaches fail, sacroiliac joint fusion may be recommended. Advances in intraoperative image guidance have assisted minimally invasive surgical (MIS) techniques using ingrowth-coated fusion rods; however, how these techniques perform relative to open anterior fusion of the sacroiliac joint using plates and screws is not known. We compared estimated blood loss (EBL), surgical time, length of hospital stay (LOS), and Oswestry Disability Index (ODI) between patients undergoing MIS and open sacroiliac joint fusion. We retrospectively studied 63 patients (open: 36; MIS: 27) who underwent sacroiliac joint fusion with minimum 1-year followup at our institution from 2006 to 2011. Of those, 10 in the open group had incomplete records. All patients had sacroiliac joint dysfunction confirmed by image-guided intraarticular anesthetic sacroiliac joint injection and had failed nonoperative treatment. Patients were matched via propensity score, adjusting for age, sex, BMI, history of spine fusion, and preoperative ODI scores, leaving 22 in each group. Nine patients were not matched. We reviewed patient medical records to obtain EBL, length of surgery, LOS, and pre- and postoperative ODI scores. Mean followup was 13 months (range, 11-33 months) in the open group and 15 months (range, 12-26 months) in the MIS group. Patients in the open group had a higher mean EBL (681 mL versus 41 mL, p sacroiliac fusion group. With the numbers available, ODI scores were similar between groups, though the study size was relatively small and it is possible that the study was underpowered on this end point. Because the implants used for these procedures make assessment of fusion challenging with available imaging techniques, we do not know how many patients' sacroiliac joints successfully fused, so longer followup and critical evaluation of outcomes scores over time are called

  15. The Role of Minimally Invasive Vertebral Body Stent on Reduction of the Deflation Effect After Kyphoplasty: A Biomechanical Study.

    Science.gov (United States)

    Wang, Dalin; Zheng, Shengnai; Liu, An; Xu, Jie; Du, Xiaotao; Wang, Yijin; Wang, Liming

    2018-03-15

    Biomechanical investigation using cadaver spines. The aim of the present study was to assess the magnitude of the deflation effect after balloon kyphoplasty (BKP) or use of minimally invasive vertebral body stent (MIVBS) in in vitro biomechanical condition. BKP is a well-established minimally invasive treatment option for osteoporotic vertebral compression fractures. However, this technique can lead to a secondary height loss-known as the "deflation effect"-causing intrasegmental kyphosis and an overall alignment failure. The study was conducted on 24 human cadaveric vertebral bodies (T12-L5). After creating a compression fracture model, the fractured vertebral bodies were reduced by BKP (n = 12) or by MIVBS (n = 12) and then augmented with polymethyl methacrylate bone cement. Each step of the procedure was performed under fluoroscopic guidance and the results were analyzed quantitatively. Finally, the strength and stiffness of augmented vertebral bodies were measured by biomechanical tests. Complete initial reduction of the fractured vertebral body height was achieved by both systems. Secondary loss of reduction after balloon deflation was significantly greater in the BKP group (2.36 ± 0.63 mm vs. 0.34 ± 0.43 mm in the MIVBS group; P deflation effect after BKP can be significantly decreased with the use of the MIVBS technique. N/A.

  16. Minimally invasive thyroidectomy (MIT): indications and results.

    Science.gov (United States)

    Docimo, Giovanni; Salvatore Tolone, Salvatore; Gili, Simona; d'Alessandro, A; Casalino, G; Brusciano, L; Ruggiero, Roberto; Docimo, Ludovico

    2013-01-01

    To establish if the indication for different approaches for thyroidectomy and the incision length provided by means of pre-operative assessment of gland volume and size of nodules resulted in safe and effective outcomes and in any notable aesthetic or quality-of-life impact on patients. Ninehundred eightytwo consecutive patients, undergoing total thyroidectomy, were enrolled. The thyroid volume and maximal nodule diameter were measured by means of ultrasounds. Based on ultrasounds findings, patients were divided into three groups: minimally invasive video assisted thyroidectomy (MIVAT), minimally invasive thyroidectomy (MIT) and conventional thyroidectomy (CT) groups. The data concerning the following parameters were collected: operative time, postoperative complications, postoperative pain and cosmetic results. The MIVAT group included 179 patients, MIT group included 592 patients and CT group included 211 patients. Incidence of complications did not differ significantly in each group. In MIVAT and MIT group, the perception of postoperative pain was less intense than CT group. The patients in the MIVAT (7±1.5) and MIT (8±2) groups were more satisfied with the cosmetic results than those in CT group (5±1.3) (p= MIT is a technique totally reproducible, and easily convertible to perform surgical procedures in respect of the patient, without additional complications, increased costs, and with better aesthetic results.

  17. MINIMAL INVASIVE PLATE OSTEOSYNTHESIS- AN EFFECTIVE TREATMENT METHOD FOR DISTAL TIBIA INTRAARTICULAR (PILON FRACTURES- AN 18 MONTHS FOLLOW UP

    Directory of Open Access Journals (Sweden)

    Saket Jati

    2016-12-01

    Full Text Available BACKGROUND Tibial pilon fracture though requires operative treatment is difficult to manage. Conventional osteosynthesis is not suitable, because distal tibia is subcutaneous bone with poor vascularity. Closed reduction and Minimally Invasive Plate Osteosynthesis (MIPO for distal tibia has emerged as an alternative treatment option because it respects fracture biology and haematoma and also provides biomechanically stable construct. The aim of the study is to evaluate the results of minimally invasive plate osteosynthesis using locking plates in treating tibial pilon fractures in terms of fracture union, restoration of ankle function and complications. MATERIALS AND METHODS 30 patients with closed tibial pilon fractures (Ruedi and Allgower type I (14, type II (13, type III (3 treated with MIPO with Locking Compression Plates (LCP were prospectively followed for average duration of 18 months. RESULTS Average duration of injury-hospital and injury-surgery interval was as 12.05 hrs. and 3.50 days, respectively. All fractures got united with an average duration of 20.8 weeks (range 14-28 weeks. Olerud and Molander score was used for evaluation at 3 months, 6 months and 18 months. One patient had union with valgus angulation of 15 degrees, but no nonunion was found. CONCLUSION The present study shows that MIPO with LCP is an effective treatment method in terms of union time and complications rate for tibial pilon fracture promoting early union and early weight bearing.

  18. Minimally invasive hysterectomy in Coatis ( Nasua nasua

    Directory of Open Access Journals (Sweden)

    Bruno W. Minto

    Full Text Available ABSTRACT: Some wildlife species, such as coatis, have a high degree of adaptability to adverse conditions, such as fragmented urban forests, increasingly common on the world stage. The increase in the number of these mesopredators causes drastic changes in the communities of smaller predators, interferes with reproductive success of trees, as well as becoming a form of exchange between domestic and wild areas, favoring the transmission of zoonosis and increasing the occurrence of attacks to animals or people. This report describes the use of minimally invasive hysterectomy in two individuals of the species Nasua nasua, which can be accomplished through the use of hook technique, commonly used to castrate dogs and cats. The small incision and healing speed of incised tissues are fundamental in wild life management since the postoperative care is limited by the behavior of these animals. This technique proved to be effective and can greatly reduce the morbidity of this procedure in coatis.

  19. Minimally Invasive Surgery in Thymic Malignances

    Directory of Open Access Journals (Sweden)

    Wentao FANG

    2018-04-01

    Full Text Available Surgery is the most important therapy for thymic malignances. The last decade has seen increasing adoption of minimally invasive surgery (MIS for thymectomy. MIS for early stage thymoma patients has been shown to yield similar oncological results while being helpful in minimize surgical trauma, improving postoperative recovery, and reduce incisional pain. Meanwhile, With the advance in surgical techniques, the patients with locally advanced thymic tumors, preoperative induction therapies or recurrent diseases, may also benefit from MIS in selected cases.

  20. Benefit from the minimally invasive sinus technique.

    Science.gov (United States)

    Salama, N; Oakley, R J; Skilbeck, C J; Choudhury, N; Jacob, A

    2009-02-01

    Sinus drainage is impeded by the transition spaces that the anterior paranasal sinuses drain into, not the ostia themselves. Addressing the transition spaces and leaving the ostia intact, using the minimally invasive sinus technique, should reverse chronic rhinosinusitis. To assess patient benefit following use of the minimally invasive sinus technique for chronic rhinosinusitis. One hundred and forty-three consecutive patients underwent the minimally invasive sinus technique for chronic rhinosinusitis. Symptoms (i.e. blocked nose, poor sense of smell, rhinorrhoea, post-nasal drip, facial pain and sneezing) were recorded using a visual analogue scale, pre-operatively and at six and 12 weeks post-operatively. Patients were also surveyed using the Glasgow benefit inventory, one and three years post-operatively. We found a significant reduction in all nasal symptom scores at six and 12 weeks post-operatively, and increased total quality of life scores at one and three years post-operatively (25.2 and 14.8, respectively). The patient benefits of treatment with the minimally invasive sinus technique compare with the published patient benefits for functional endoscopic sinus surgery.

  1. Systems for tracking minimally invasive surgical instruments

    NARCIS (Netherlands)

    Chmarra, M. K.; Grimbergen, C. A.; Dankelman, J.

    2007-01-01

    Minimally invasive surgery (e.g. laparoscopy) requires special surgical skills, which should be objectively assessed. Several studies have shown that motion analysis is a valuable assessment tool of basic surgical skills in laparoscopy. However, to use motion analysis as the assessment tool, it is

  2. New trends in minimally invasive urological surgery

    Directory of Open Access Journals (Sweden)

    Prabhakar Rajan

    2009-10-01

    Full Text Available Purpose: The perceived benefits of minimally-invasive surgery include less postoperative pain, shorter hospitalization, reduced morbidity and better cosmesis while maintaining diagnostic accuracy and therapeutic outcome. We review the new trends in minimally-invasive urological surgery. Materials and method: We reviewed the English language literature using the National Library of Medicine database to identify the latest technological advances in minimally-invasive surgery with particular reference to urology. Results: Amongst other advances, studies incorporating needlescopic surgery, laparoendoscopic single-site surgery , magnetic anchoring and guidance systems, natural orifice transluminal endoscopic surgery and flexible robots were considered of interest. The results from initial animal and human studies are also outlined. Conclusion: Minimally-invasive surgery continues to evolve to meet the demands of the operators and patients. Many novel technologies are still in the testing phase, whilst others have entered clinical practice. Further evaluation is required to confirm the safety and efficacy of these techniques and validate the published reports.

  3. Minimally invasive treatments of uterine fibroids

    NARCIS (Netherlands)

    Voogt, M.J.

    2012-01-01

    This thesis assesses clinical results and technical developments of two minimally invasive treatments for symptomatic uterine fibroids: uterine artery embolization (UAE) and magnetic resonance-guided high intensity focused ultrasound (MR-HIFU). Part I: Uterine artery embolization The results of a

  4. Effect of minimally invasive intracranial hematoma drainage on inflammatory factors, serum ferritin and serum P substance in patients with hypertensive cerebral hemorrhage

    Directory of Open Access Journals (Sweden)

    Sheng-De Nong

    2017-01-01

    Full Text Available Objective: To study the effect of minimally invasive intracranial hematoma drainage on inflammatory factors, serum ferritin and serum P substance in patients with hypertensive cerebral hemorrhage. Methods: 92 cases of hypertensive cerebral hemorrhage patients in our hospital were selected and randomly divided into 2 groups: minimally invasive group (51 cases and routine group (41 cases. Minimally invasive intracranial hematoma drainage was performed on the minimally invasive group. Bone flap decompression or small bone window craniotomy were used in the routine group. Tumor necrosis factor α (TNF-α, interleukin-6 (IL-6, high sensitive C reactive protein (hs-CRP and serum protein (SF, serum substance P (SP in the 2 groups were detected before treatment and 2 weeks after treatment. Results: The comparison of TNF-α, IL-6, hs-CRP, SP, and SF in the two groups before treatment was not statistically significant (P>0.05. TNF-α, IL-6, hs-CRP and SF in both groups after treatment significantly decreased, compared with that before treatment (P<0.01, P<0.05. TNF-α, IL-6, and SF in minimally invasive group decreased more significantly than that in routine group (P<0.01; The comparison of SP in the two groups after treatment significantly increased compared with that before treatment (P<0.01, P<0.05. SP in minimally invasive group increased more significantly than that in routine group (P<0.05. Conclusions: Compared with bone flap decompression or small bone window craniotomy, minimally invasive intracranial hematoma drainage can inhibit inflammatory reaction, reduce the degree of nerve damage and alleviate clinical symptoms more effectively

  5. Comparative Effects of Snoring Sound between Two Minimally Invasive Surgeries in the Treatment of Snoring: A Randomized Controlled Trial

    Science.gov (United States)

    Lee, Li-Ang; Yu, Jen-Fang; Lo, Yu-Lun; Chen, Ning-Hung; Fang, Tuan-Jen; Huang, Chung-Guei; Cheng, Wen-Nuan; Li, Hsueh-Yu

    2014-01-01

    Background Minimally invasive surgeries of the soft palate have emerged as a less-invasive treatment for habitual snoring. To date, there is only limited information available comparing the effects of snoring sound between different minimally invasive surgeries in the treatment of habitual snoring. Objective To compare the efficacy of palatal implant and radiofrequency surgery, in the reduction of snoring through subjective evaluation of snoring and objective snoring sound analysis. Patients and Method Thirty patients with habitual snoring due to palatal obstruction (apnea-hypopnea index ≤15, body max index ≤30) were prospectively enrolled and randomized to undergo a single session of palatal implant or temperature-controlled radiofrequency surgery of the soft palate under local anesthesia. Snoring was primarily evaluated by the patient with a 10 cm visual analogue scale (VAS) at baseline and at a 3-month follow-up visit and the change in VAS was the primary outcome. Moreover, life qualities, measured by snore outcomes survey, and full-night snoring sounds, analyzed by a sound analytic program (Snore Map), were also investigated at the same time. Results Twenty-eight patients completed the study; 14 received palatal implant surgery and 14 underwent radiofrequency surgery. The VAS and snore outcomes survey scores were significantly improved in both groups. However, the good response (postoperative VAS ≤3 or postoperative VAS ≤5 plus snore outcomes survey score ≥60) rate of the palatal implant group was significantly higher than that of the radiofrequency group (79% vs. 29%, P = 0.021). The maximal loudness of low-frequency (40–300 Hz) snores was reduced significantly in the palatal implant group. In addition, the snoring index was significantly reduced in the radiofrequency group. Conclusions Both palatal implants and a single-stage radiofrequency surgery improve subjective snoring outcomes, but palatal implants have a greater effect on most measures

  6. Minimally invasive approach of panfacial fractures

    Directory of Open Access Journals (Sweden)

    Yudi Wijaya

    2017-08-01

    Full Text Available Background. Panfacial fractures involves fractures of several bones of face. They are associated with malocclusion, dish face deformity, enopthalmos, diplopia, cerebrospinal fluid leak and soft tissue injuries. Purpose. The purpose of this paper is to present a case of minimizing surgical wound and morbidity. Case. A 40 year old female presented with severe maxillofacial injuries caused by motor vehicle collisions about 5 days prior to admission. The assessment of the patient is mild head injury, panfacial fractures, lacerated wound at face,  rupture of globe of occular sinistra. An open reduction and internal fixation  (ORIF and enucleation of globe occular sinistra was performed.  Intraoral vestibular incision is made in the upper and lower vestibular region. Mucoperiosteal flap elevation of vestibular will exposure of the anterior maxilla and mandibular fractures. Intermaksilary fixation within 3 week and restore aesthetic with prosthesis fitting eyeball and denture. Discusion. The goal of  treatment of  panfacial fracture is to restore both the functions and pre-injury 3-dimensional facial contours. To achieve this goal two common  sequences of management of Panfacial fractures are proposed, “Bottom up and inside out” or “Top down and outside in”. Other sequences exist but there are variations of these two major approaches. Conclusion. A minimally invasive approach to  the fracture site is an alternative method  to manage panfacial fracture with a simple, effective and lower complication rate.

  7. Mechatronic Feasibility of Minimally Invasive, Atraumatic Cochleostomy

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    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.

  8. Procedures minimally invasive image-guided

    International Nuclear Information System (INIS)

    Mora Guevara, Alejandro

    2011-01-01

    A literature review focused on minimally invasive procedures, has been performed at the Department of Radiology at the Hospital Calderon Guardia. A multidisciplinary team has been raised for decision making. The materials, possible complications and the available imaging technique such as ultrasound, computed tomography, magnetic resonance imaging, have been determined according to the procedure to be performed. The revision has supported medical interventions didactically enjoying the best materials, resources and conditions for a successful implementation of procedures and results [es

  9. Minimally invasive aesthetic procedures in young adults

    OpenAIRE

    Wollina, Uwe; Goldman, Alberto

    2011-01-01

    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 asy...

  10. Minimally invasive surgery for esophageal achalasia

    OpenAIRE

    Bonavina, Luigi

    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 evide...

  11. The Effect of the Retroperitoneal Transpsoas Minimally Invasive Lateral Interbody Fusion on Segmental and Regional Lumbar Lordosis

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    Tien V. Le

    2012-01-01

    Full Text Available Background. The minimally invasive lateral interbody fusion (MIS LIF in the lumbar spine can correct coronal Cobb angles, but the effect on sagittal plane correction is unclear. Methods. A retrospective review of thirty-five patients with lumbar degenerative disease who underwent MIS LIF without supplemental posterior instrumentation was undertaken to study the radiographic effect on the restoration of segmental and regional lumbar lordosis using the Cobb angles on pre- and postoperative radiographs. Mean disc height changes were also measured. Results. The mean follow-up period was 13.3 months. Fifty total levels were fused with a mean of 1.42 levels fused per patient. Mean segmental Cobb angle increased from 11.10° to 13.61° (<0.001 or 22.6%. L2-3 had the greatest proportional increase in segmental lordosis. Mean regional Cobb angle increased from 52.47° to 53.45° (=0.392. Mean disc height increased from 6.50 mm to 10.04 mm (<0.001 or 54.5%. Conclusions. The MIS LIF improves segmental lordosis and disc height in the lumbar spine but not regional lumbar lordosis. Anterior longitudinal ligament sectioning and/or the addition of a more lordotic implant may be necessary in cases where significant increases in regional lumbar lordosis are desired.

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

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    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.

  13. Thymoma and minimally invasive surgical treatment

    International Nuclear Information System (INIS)

    Krajc, T.; Spalek, P.; Lucenic, M.; Benej, R.; Harustiak, S.

    2011-01-01

    The authors review the current thymoma classification schemes, diagnosis and surgical treatment options. Many minimally invasive techniques do not provide sufficient extensiveness when compared to complete sternotomy. The Zieliński technique combines transcervical, subxiphoidal and bilateral thoracoscopic approach in a hybrid procedure (MMIT, maximal minimally invasive thymectomy) based on double sternal traction, and allows for removal of the thymus gland, the thymoma and all the relevant mediastinal adipose tissue, thus adhering to principles of oncological radicality. Of the 28 patients undergoing MMIT there were 7 with myasthenia associated thymoma (MGAT) and 5 with a thymoma and no myasthenia, tumors staged Masaoka I-II. Apart from one temporary recurrent nerve palsy there were no postoperative complications. The largest thymoma measured 70 x 65 x 55 mm. Adjuvant radiotherapy was applied in 5 patients. Ectopic thymic tissue was identified in 100 % of patients with thymoma and no myasthenia and in 42.9 % of MGAT patients. Until now there were no recurrences, however, the follow-up median is very short, the longest follow-up period being 30 months. MMIT is a safe technique suitable also for Masaoka I-II thymoma patients and for some specific cases with Masaoka III stage (lung parenchyma invasion). The authors approach all the anterior mediastinal tumors with no mediastinal lymphadenopathy and no myasthenia as a potential thymoma and always attempt the MMIT procedure starting as VATS procedure on the side of tumor. (author)

  14. Creation of a novel simulator for minimally invasive neurosurgery: fusion of 3D printing and special effects.

    Science.gov (United States)

    Weinstock, Peter; Rehder, Roberta; Prabhu, Sanjay P; Forbes, Peter W; Roussin, Christopher J; Cohen, Alan R

    2017-07-01

    OBJECTIVE Recent advances in optics and miniaturization have enabled the development of a growing number of minimally invasive procedures, yet innovative training methods for the use of these techniques remain lacking. Conventional teaching models, including cadavers and physical trainers as well as virtual reality platforms, are often expensive and ineffective. Newly developed 3D printing technologies can recreate patient-specific anatomy, but the stiffness of the materials limits fidelity to real-life surgical situations. Hollywood special effects techniques can create ultrarealistic features, including lifelike tactile properties, to enhance accuracy and effectiveness of the surgical models. The authors created a highly realistic model of a pediatric patient with hydrocephalus via a unique combination of 3D printing and special effects techniques and validated the use of this model in training neurosurgery fellows and residents to perform endoscopic third ventriculostomy (ETV), an effective minimally invasive method increasingly used in treating hydrocephalus. METHODS A full-scale reproduction of the head of a 14-year-old adolescent patient with hydrocephalus, including external physical details and internal neuroanatomy, was developed via a unique collaboration of neurosurgeons, simulation engineers, and a group of special effects experts. The model contains "plug-and-play" replaceable components for repetitive practice. The appearance of the training model (face validity) and the reproducibility of the ETV training procedure (content validity) were assessed by neurosurgery fellows and residents of different experience levels based on a 14-item Likert-like questionnaire. The usefulness of the training model for evaluating the performance of the trainees at different levels of experience (construct validity) was measured by blinded observers using the Objective Structured Assessment of Technical Skills (OSATS) scale for the performance of ETV. RESULTS A

  15. Effectiveness of sonography assisted minimal invasive plate osteosynthesis (MIPO) compare with fluoroscope assisted in femoral shaft fracture: A cadaveric study.

    Science.gov (United States)

    Saengsin, Jirawat; Vaseenon, Tanawat; Pattamapaspong, Nuttaya; Kritsaneephaiboon, Apipop

    2017-08-01

    A minimal invasive plate osteosynthesis (MIPO) has an advantage of biological soft tissue preservation that consists of preserving bony blood supply, fracture hematoma and less soft tissue damage which leads to decreasing of infection rate and rapid bone healing. However, the radiation exposure is still a disadvantage of this technique. A sonography that provides dynamic real time imaging may be used as an alternative technique for assisting MIPO. The aim of this study was to compare the effectiveness of MIPO in femoral shaft fracture between the sonography assisted and the fluoroscopy assisted. Twenty-eight cadaveric limbs were subjected to create femoral shaft fracture. Then, sonography assisted reduction with temporary external fixation and MIPO were performed. Images of the sonography and the fluoroscopy were recorded including before reduction, after reduction and after MIPO in order to identify fracture displacements in anteroposterior and mediolateral directions. Moreover, the anterior and posterior distances from edge of the bone to the plate were measured to confirm plate position. The effectiveness of this technique was defined as the proper plate position and acceptable alignment after fixation. All distances from the sonography and the fluoroscopy were also analyzed and compared using Pearson correlation and Bland-Altman method to assess the agreements between two tests. All of the subjects were met the criteria for acceptable alignment. We found only three femoral shaft fracture (11%) operated with MIPO by sonography assisted that showed slipped plate off femoral bones. According to Pearson correlation, there were good to excellent agreements in term of measuring fracture displacement before (Pearson Correlation >0.7) and after reduction (Pearson Correlation >0.7) between these two tests. There was moderate agreement regarding to evaluation of plate position (Pearson Correlation 03.-0.7). When we compared two methods of measurement using Bland

  16. Minimally invasive repair of pectus excavatum deformity.

    Science.gov (United States)

    Krasopoulos, George; Goldstraw, Peter

    2011-02-01

    This review is trying to address the effectiveness and sustainability of results following minimally invasive repair of pectus excavatum (MIRPE). The aim is to present these results for the benefit of clinicians and the patients. Literature search has revealed 179 hits, which were independently assessed and led to 80 publications being formally reviewed. Studies reporting results from less than 10 patients were excluded. Thirty-five studies were found to be reporting results from patients' and/or surgeons' perspective and they were included in this review. Data from the United Kingdom registry for MIRPE were also included. Results from over 2997 patients (age: reported an 'unsatisfactory end result.' However, these percentages are not necessarily referring to the same patients and an unsatisfactory result does not seem to affect the positive effect on self-esteem. The reported changes in social life, lung capacity, cardiovascular capacity, exercise capacity and general health are based on weak data and significant improvements, if any, are probably seen in a limited number of patients. The metallic bars were removed after 1.5-4.5 years and there is an overall 0-4.5% reported recurrence post-bar removal. In conclusion, MIRPE may improve cosmesis and self-esteem of patients with pectus excavatum deformity. Direct or indirect improvement in other physiological parameters may also help the 'well-being' of these patients and their social integration. There is a clear need for standardisation in the way results are reported in the literature and a socioeconomic analysis with regard to gains, benefits and costs related to MIRPE. Copyright © 2010 European Association for Cardio-Thoracic Surgery. Published by Elsevier B.V. All rights reserved.

  17. Minimally invasive surgery for esophageal achalasia.

    Science.gov (United States)

    Chen, Huan-Wen; Du, Ming

    2016-07-01

    Esophageal achalasia is due to the esophagus of neuromuscular dysfunction caused by esophageal functional disease. Its main feature is the lack of esophageal peristalsis, the lower esophageal sphincter pressure and to reduce the swallow's relaxation response. Lower esophageal muscular dissection is one of the main ways to treat esophageal achalasia. At present, the period of muscular layer under the thoracoscope esophagus dissection is one of the treatment of esophageal achalasia. Combined with our experience in minimally invasive esophageal surgery, to improved incision and operation procedure, and adopts the model of the complete period of muscular layer under the thoracoscope esophagus dissection in the treatment of esophageal achalasia.

  18. Minimally invasive splenectomy: an update and review

    Science.gov (United States)

    Gamme, Gary; Birch, Daniel W.; Karmali, Shahzeer

    2013-01-01

    Laparoscopic splenectomy (LS) has become an established standard of care in the management of surgical diseases of the spleen. The present article is an update and review of current procedures and controversies regarding minimally invasive splenectomy. We review the indications and contraindications for LS as well as preoperative considerations. An individual assessment of the procedures and outcomes of multiport laparoscopic splenectomy, hand-assisted laparoscopic splenectomy, robotic splenectomy, natural orifice transluminal endoscopic splenectomy and single-port splenectomy is included. Furthermore, this review examines postoperative considerations after LS, including the postoperative course of uncomplicated patients, postoperative portal vein thrombosis, infections and malignancy. PMID:23883500

  19. Minimally Invasive Spine Surgery in Small Animals.

    Science.gov (United States)

    Hettlich, Bianca F

    2018-01-01

    Minimally invasive spine surgery (MISS) seems to have many benefits for human patients and is currently used for various minor and major spine procedures. For MISS, a change in access strategy to the target location is necessary and it requires intraoperative imaging, special instrumentation, and magnification. Few veterinary studies have evaluated MISS for canine patients for spinal decompression procedures. This article discusses the general requirements for MISS and how these can be applied to veterinary spinal surgery. The current veterinary MISS literature is reviewed and suggestions are made on how to apply MISS to different spinal locations. Copyright © 2017 Elsevier Inc. All rights reserved.

  20. Smartphone-assisted minimally invasive neurosurgery.

    Science.gov (United States)

    Mandel, Mauricio; Petito, Carlo Emanuel; Tutihashi, Rafael; Paiva, Wellingson; Abramovicz Mandel, Suzana; Gomes Pinto, Fernando Campos; Ferreira de Andrade, Almir; Teixeira, Manoel Jacobsen; Figueiredo, Eberval Gadelha

    2018-03-13

    OBJECTIVE Advances in video and fiber optics since the 1990s have led to the development of several commercially available high-definition neuroendoscopes. This technological improvement, however, has been surpassed by the smartphone revolution. With the increasing integration of smartphone technology into medical care, the introduction of these high-quality computerized communication devices with built-in digital cameras offers new possibilities in neuroendoscopy. The aim of this study was to investigate the usefulness of smartphone-endoscope integration in performing different types of minimally invasive neurosurgery. METHODS The authors present a new surgical tool that integrates a smartphone with an endoscope by use of a specially designed adapter, thus eliminating the need for the video system customarily used for endoscopy. The authors used this novel combined system to perform minimally invasive surgery on patients with various neuropathological disorders, including cavernomas, cerebral aneurysms, hydrocephalus, subdural hematomas, contusional hematomas, and spontaneous intracerebral hematomas. RESULTS The new endoscopic system featuring smartphone-endoscope integration was used by the authors in the minimally invasive surgical treatment of 42 patients. All procedures were successfully performed, and no complications related to the use of the new method were observed. The quality of the images obtained with the smartphone was high enough to provide adequate information to the neurosurgeons, as smartphone cameras can record images in high definition or 4K resolution. Moreover, because the smartphone screen moves along with the endoscope, surgical mobility was enhanced with the use of this method, facilitating more intuitive use. In fact, this increased mobility was identified as the greatest benefit of the use of the smartphone-endoscope system compared with the use of the neuroendoscope with the standard video set. CONCLUSIONS Minimally invasive approaches

  1. Minimally invasive brow suspension for facial paralysis.

    Science.gov (United States)

    Costantino, Peter D; Hiltzik, David H; Moche, Jason; Preminger, Aviva

    2003-01-01

    To report a new technique for unilateral brow suspension for facial paralysis that is minimally invasive, limits supraciliary scar formation, does not require specialized endoscopic equipment or expertise, and has proved to be equal to direct brow suspension in durability and symmetry. Retrospective survey of a case series of 23 patients between January 1997 and December 2000. Metropolitan tertiary care center. Patients with head and neck tumors and brow ptosis caused by facial nerve paralysis. The results of the procedure were determined using the following 3-tier rating system: outstanding (excellent elevation and symmetry); acceptable (good elevation and fair symmetry); and unacceptable (loss of elevation). The results were considered outstanding in 12 patients, acceptable in 9 patients, and unacceptable in only 1 patient. One patient developed a hematoma, and 1 patient required a secondary adjustment. The technique has proved to be superior to standard brow suspension procedures with regard to scar formation and equal with respect to facial symmetry and suspension. These results have caused us to abandon direct brow suspension and to use this minimally invasive method in all cases of brow ptosis due to facial paralysis.

  2. [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.

  3. Modifying gummy smile: a minimally invasive approach.

    Science.gov (United States)

    Abdullah, Walid Ahmed; Khalil, Hesham S; Alhindi, Maryam M; Marzook, Hamdy

    2014-11-01

    Excessive gingival display is a problem that can be managed by variety of procedures. These procedures include non-surgical and surgical methods. The underlying cause of gummy smile can affect the type of procedure to be selected. Most patients prefer minimally invasive procedures with outstanding results. The authors describe a minimally invasive lip repositioning technique for management of gummy smile. Twelve patients (10 females, 2 males) with gingival display of 4 mm or more were operated under local anesthesia using a modified lip repositioning technique. Patients were followed up for 1, 3, 6 and 12 months and gingival display was measured at each follow up visit. The gingival mucosa was dissected and levator labii superioris and depressor septi muscles were freed and repositioned in a lower position. The levator labii superioris muscles were pulled in a lower position using circumdental sutures for 10 days. Both surgeon's and patient's satisfaction of surgical outcome was recorded at each follow-up visit. At early stage of follow-up the main complaints of patients were the feeling of tension in the upper lip and circum oral area, mild pain which was managed with analgesics. One month postoperatively, the gingival display in all patients was recorded to be between 2 and 4 mm with a mean of (2.6 mm). Patient satisfaction records after 1 month showed that 10 patients were satisfied with the results. Three months postoperatively, the gingival display in all patients was recorded and found to be between 2 and 5 mm with a mean of 3 mm. Patient satisfaction records showed that 8 patients were satisfied with the results as they gave scores between. Surgeon's satisfaction at three months follow up showed that the surgeons were satisfied in 8 patients. The same results were found in the 6 and 12 months follow-up periods without any changes. Complete relapse was recorded only in one case at the third postoperative month. This study showed that the proposed lip

  4. Use of minimal invasive extracorporeal circulation in cardiac surgery: principles, definitions and potential benefits. A position paper from the Minimal invasive Extra-Corporeal Technologies international Society (MiECTiS)

    NARCIS (Netherlands)

    Anastasiadis, Kyriakos; Murkin, John; Antonitsis, Polychronis; Bauer, Adrian; Ranucci, Marco; Gygax, Erich; Schaarschmidt, Jan; Fromes, Yves; Philipp, Alois; Eberle, Balthasar; Punjabi, Prakash; Argiriadou, Helena; Kadner, Alexander; Jenni, Hansjoerg; Albrecht, Guenter; van Boven, Wim; Liebold, Andreas; de Somer, Fillip; Hausmann, Harald; Deliopoulos, Apostolos; El-Essawi, Aschraf; Mazzei, Valerio; Biancari, Fausto; Fernandez, Adam; Weerwind, Patrick; Puehler, Thomas; Serrick, Cyril; Waanders, Frans; Gunaydin, Serdar; Ohri, Sunil; Gummert, Jan; Angelini, Gianni; Falk, Volkmar; Carrel, Thierry

    2016-01-01

    Minimal invasive extracorporeal circulation (MiECC) systems have initiated important efforts within science and technology to further improve the biocompatibility of cardiopulmonary bypass components to minimize the adverse effects and improve end-organ protection. The Minimal invasive

  5. 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.

  6. Systems for tracking minimally invasive surgical instruments.

    Science.gov (United States)

    Chmarra, M K; Grimbergen, C A; Dankelman, J

    2007-01-01

    Minimally invasive surgery (e.g. laparoscopy) requires special surgical skills, which should be objectively assessed. Several studies have shown that motion analysis is a valuable assessment tool of basic surgical skills in laparoscopy. However, to use motion analysis as the assessment tool, it is necessary to track and record the motions of laparoscopic instruments. This article describes the state of the art in research on tracking systems for laparoscopy. It gives an overview on existing systems, on how these systems work, their advantages, and their shortcomings. Although various approaches have been used, none of the tracking systems to date comes out as clearly superior. A great number of systems can be used in training environment only, most systems do not allow the use of real laparoscopic instruments, and only a small number of systems provide force feedback.

  7. 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 

  8. Danish surgeons' views on minimally invasive surgery

    DEFF Research Database (Denmark)

    Edwards, Hellen; Jørgensen, Lars Nannestad

    2014-01-01

    BACKGROUND AND AIM: Advancements in minimally invasive surgery have led to increases in popularity of single-incision laparoscopic surgery (SILS) and natural orifice translumenal surgery (NOTES(®); American Society for Gastrointestinal Endoscopy [Oak Brook, IL] and Society of American...... Gastrointestinal and Endoscopic Surgeons [Los Angeles, CA]) due to their postulated benefits of better cosmesis, less pain, and quicker recovery. This questionnaire-based study investigated Danish surgeons' attitudes toward these new procedures. SUBJECTS AND METHODS: A 26-item questionnaire was developed...... and distributed electronically via e-mail to a total of 1253 members of The Danish Society of Surgeons and The Danish Society of Young Surgeons. RESULTS: In total, 352 (approximately 30%) surgeons completed the questionnaire, 54.4% were over 50 years of age, and 76.6% were men. When choosing surgery, the most...

  9. Injectable biomaterials for minimally invasive orthopedic treatments.

    Science.gov (United States)

    Jayabalan, M; Shalumon, K T; Mitha, M K

    2009-06-01

    Biodegradable and injectable hydroxy terminated-poly propylene fumarate (HT-PPF) bone cement was developed. The injectable formulation consisting HT-PPF and comonomer, n-vinyl pyrrolidone, calcium phosphate filler, free radical catalyst, accelerator and radiopaque agent sets rapidly to hard mass with low exothermic temperature. The candidate bone cement attains mechanical strength more than the required compressive strength of 5 MPa and compressive modulus 50 MPa. The candidate bone cement resin elicits cell adhesion and cytoplasmic spreading of osteoblast cells. The cured bone cement does not induce intracutaneous irritation and skin sensitization. The candidate bone cement is tissue compatible without eliciting any adverse tissue reactions. The candidate bone cement is osteoconductive and inductive and allow osteointegration and bone remodeling. HT-PPF bone cement is candidate bone cement for minimally invasive radiological procedures for the treatment of bone diseases and spinal compression fractures.

  10. Effect of minimally invasive evacuation of hematoma combined with Xingnaojing therapy on neurological function injury and cytokine level in patients with hypertensive cerebral hemorrhagen

    OpenAIRE

    Yong-Feng Li; Wei Li

    2017-01-01

    Objective: To study the effect of minimally invasive evacuation of hematoma combined with Xingnaojing therapy on neurological function damage and cytokine level in patients with hypertensive cerebral hemorrhage. Methods: A total of 80 patients with hypertensive cerebral hemorrhage treated in our hospital between June 2010 and September 2015 were selected as the research subjects, the treatment methods and test results were reviewed, and then they were divided into the control g...

  11. Minimally Invasive Surgical Treatment of Esophageal Achalasia

    Science.gov (United States)

    Mercantini, Paolo; Amodio, Pietro M.; Stipa, Francesco; Corigliano, Nicola; Ziparo, Vincenzo

    2003-01-01

    Background and Objectives: A minimally invasive approach is considered the treatment of choice for esophageal achalasia. We report the evolution of our experience from thoracoscopic Heller myotomy (THM) to laparoscopic Heller myotomy (LHM). Our objective is to define the efficacy and safety of these 2 approaches. Methods: Between March 1993 and December 2001, 36 patients underwent minimally invasive surgery for achalasia. Sixteen patients underwent THM without an antireflux procedure, and 20 patients underwent LHM with partial anterior fundoplication (n=13) or closure of the angle of His (n=7). Results: Mean operative time and mean hospital stay were significantly shorter for LHM compared with that of THM (148.3±38.7 vs 222±46.1 min, respectively; P=0.0001) and (2.06±0.65 days vs 5.06±0.85 days, respectively; P=0.0001). Six of 16 patients (37.5%) in the THM group experienced persistent or recurrent dysphagia compared with 1 of 20 patients (5%) in the LHM group (P=0.01). Heartburn developed in 5 patients (31.2%) after THM and in 1 patient (5%) after LHM (P=0.06). Regurgitation developed in 4 patients (25%) after THM and in 2 patients (10%) after LHM (P=0.2). Lower esophageal sphincter (LES) basal pressure decreased significantly from 30.1±5.07 to 15.3±2.1 after THM and from 31.8±6.2 to 10.4±1.7 after LHM (P=0.0001). Mean esophageal diameter was significantly reduced after LHM compared with that after THM (from 53.9±5.9 mm to 27.2±3.3 mm vs 50.8±7.6 mm to 37.2±6.9 mm respectively; P=0.0001). Conclusion: In our experience, LHM is associated with better short-term results and is superior to THM in relieving dysphagia. LHM with partial anterior fundoplication should be considered the treatment of choice for achalasia. PMID:14558709

  12. Minimally Invasive Surgery (MIS) Approaches to Thoracolumbar Trauma.

    Science.gov (United States)

    Kaye, Ian David; Passias, Peter

    2018-03-01

    Minimally invasive surgical (MIS) techniques offer promising improvements in the management of thoracolumbar trauma. Recent advances in MIS techniques and instrumentation for degenerative conditions have heralded a growing interest in employing these techniques for thoracolumbar trauma. Specifically, surgeons have applied these techniques to help manage flexion- and extension-distraction injuries, neurologically intact burst fractures, and cases of damage control. Minimally invasive surgical techniques offer a means to decrease blood loss, shorten operative time, reduce infection risk, and shorten hospital stays. Herein, we review thoracolumbar minimally invasive surgery with an emphasis on thoracolumbar trauma classification, minimally invasive spinal stabilization, surgical indications, patient outcomes, technical considerations, and potential complications.

  13. Skill qualifications in pediatric minimally invasive surgery.

    Science.gov (United States)

    Iwanaka, Tadashi; Morikawa, Yasuhide; Yamataka, Atsuyuki; Nio, Masaki; Segawa, Osamu; Kawashima, Hiroshi; Sato, Masahito; Terakura, Hirotsugu; Take, Hiroshi; Hirose, Ryuichiro; Yagi, Makoto

    2011-07-01

    In 2006, The Japanese Society of Pediatric Endoscopic Surgeons devised a plan to develop a pediatric endoscopic surgical skill qualification (ESSQ) system. This system is controlled by The Japan Society for Endoscopic Surgery. The standard requirement for skills qualification is the ability of each applicant to complete common types of laparoscopic surgery. The main goal of the system is to decrease complications of laparoscopic surgery by evaluating the surgical skills of each applicant and subsequently certify surgeons with adequate skills to perform laparoscopic operations safely. A committee of pediatric ESSQ created a checklist to assess the applicant's laparoscopic surgical skills. Skills are assessed in a double-blinded fashion by evaluating an unedited video recording of a fundoplication for pediatric gastroesophageal reflux disease. The initial pediatric ESSQ system was started in 2008. In 2008 and 2009, respectively, 9 out of 17 (53%) and 6 out of 12 (50%) applicants were certified as expert pediatric laparoscopic surgeons. Our ultimate goal is to provide safe and appropriate pediatric minimally invasive procedures and to avoid severe complications. To prove the predictive validity of this system, a survey of the outcomes of operations performed by certified pediatric surgeons is required.

  14. 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.

  15. 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.

  16. Minimally Invasive Management of Ectopic Pancreas.

    Science.gov (United States)

    Vitiello, Gerardo A; Cavnar, Michael J; Hajdu, Cristina; Khaykis, Inessa; Newman, Elliot; Melis, Marcovalerio; Pachter, H Leon; Cohen, Steven M

    2017-03-01

    The management of ectopic pancreas is not well defined. This study aims to determine the prevalence of symptomatic ectopic pancreas and identify those who may benefit from treatment, with a particular focus on robotically assisted surgical management. Our institutional pathology database was queried to identify a cohort of ectopic pancreas specimens. Additional clinical data regarding clinical symptomatology, diagnostic studies, and treatment were obtained through chart review. Nineteen cases of ectopic pancreas were found incidentally during surgery for another condition or found incidentally in a pathologic specimen (65.5%). Eleven patients (37.9%) reported prior symptoms, notably abdominal pain and/or gastrointestinal bleeding. The most common locations for ectopic pancreas were the duodenum and small bowel (31% and 27.6%, respectively). Three out of 29 cases (10.3%) had no symptoms, but had evidence of preneoplastic changes on pathology, while one harbored pancreatic cancer. Over the years, treatment of ectopic pancreas has shifted from open to laparoscopic and more recently to robotic surgery. Our experience is in line with existing evidence supporting surgical treatment of symptomatic or complicated ectopic pancreas. In the current era, minimally invasive and robotic surgery can be used safely and successfully for treatment of ectopic pancreas.

  17. 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...

  18. Interoperative efficiency in minimally invasive surgery suites.

    Science.gov (United States)

    van Det, M J; Meijerink, W J H J; Hoff, C; Pierie, J P E N

    2009-10-01

    Performing minimally invasive surgery (MIS) in a conventional operating room (OR) requires additional specialized equipment otherwise stored outside the OR. Before the procedure, the OR team must collect, prepare, and connect the equipment, then take it away afterward. These extra tasks pose a thread to OR efficiency and may lengthen turnover times. The dedicated MIS suite has permanently installed laparoscopic equipment that is operational on demand. This study presents two experiments that quantify the superior efficiency of the MIS suite in the interoperative period. Preoperative setup and postoperative breakdown times in the conventional OR and the MIS suite in an experimental setting and in daily practice were analyzed. In the experimental setting, randomly chosen OR teams simulated the setup and breakdown for a standard laparoscopic cholecystectomy (LC) and a complex laparoscopic sigmoid resection (LS). In the clinical setting, the interoperative period for 66 LCs randomly assigned to the conventional OR or the MIS suite were analyzed. In the experimental setting, the setup and breakdown times were significantly shorter in the MIS suite. The difference between the two types of OR increased for the complex procedure: 2:41 min for the LC (p < 0.001) and 10:47 min for the LS (p < 0.001). In the clinical setting, the setup and breakdown times as a whole were not reduced in the MIS suite. Laparoscopic setup and breakdown times were significantly shorter in the MIS suite (mean difference, 5:39 min; p < 0.001). Efficiency during the interoperative period is significantly improved in the MIS suite. The OR nurses' tasks are relieved, which may reduce mental and physical workload and improve job satisfaction and patient safety. Due to simultaneous tasks of other disciplines, an overall turnover time reduction could not be achieved.

  19. 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.

  20. 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. © The Author(s) 2016.

  1. 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 ...

  2. Minimally invasive surgical treatment of malignant pleural effusions.

    Science.gov (United States)

    Ciuche, Adrian; Nistor, Claudiu; Pantile, Daniel; Prof Horvat, Teodor

    2011-10-01

    Usually the pleural cavity contains a small amount of liquid (approximately 10 ml). Pleural effusions appear when the liquid production rate overpasses the absorption rate with a greater amount of liquid inside the pleural cavity. Between January 1998 to December 2008 we conducted a study in order to establish the adequate surgical treatment for MPEs. Effective control of a recurrent malignant pleural effusion can greatly improve the quality of life of the cancer patient. The present review collects and examines the clinical results of minimally invasive techniques designed to treat this problem. Patients with MPEs were studied according to several criteria. In our study we observed the superiority of intraoperative talc poudrage, probably due to a more uniform distribution of talc particles over the pleural surface. Minimal pleurotomy with thoracic drainage and instillation of a talc suspension is also a safe and effective technique and should be employed when there are contraindications for the thoracoscopic minimally invasive procedure. On the basis of comparisons involving effectiveness, morbidity, and convenience, we recommend the thoracoscopic insufflations of talc as a fine powder with pleural drainage as the procedure of choice.

  3. 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.)

  4. Effects of "minimally invasive curricular surgery" - a pilot intervention study to improve the quality of bedside teaching in medical education.

    Science.gov (United States)

    Raupach, Tobias; Anders, Sven; Pukrop, Tobias; Hasenfuss, Gerd; Harendza, Sigrid

    2009-09-01

    Bedside teaching is an important element of undergraduate medical education. However, the impact of curricular course structure on student outcome needs to be determined. This study assessed changes in fourth-year medical students' evaluations of clinical teaching sessions before and after the introduction of a new course format. The curricular structure of bedside teaching sessions in cardiology was modified without changing the amount of teaching time. Clinical teachers were instructed about the new teaching format and learning objectives. The new format implemented for adult but not paediatric cardiology sessions was piloted with 143 students in winter 2007/08. By computing effect sizes, evaluation results were compared to data obtained from 185 students before the intervention. Significant rating increases were observed for adult cardiology teaching sessions (Cohen's d = 0.66) but not paediatric cardiology sessions (d = 0.22). In addition to improving the structure and organization of the course, the intervention significantly impacted on students' perceptions of their learning outcome regarding practical skills (d = 0.69). Minimal curricular changes combined with basic faculty development measures significantly increase students' perception of learning outcome. Curricular structure needs to be considered when planning bedside teaching sessions in medical undergraduate training.

  5. Minimally Invasive Approach to Eliminate Pyogenic Granuloma: A Case Report

    Directory of Open Access Journals (Sweden)

    B. Chandrashekar

    2012-01-01

    Full Text Available Pyogenic granuloma is one of the inflammatory hyperplasia seen in the oral cavity. The term is a misnomer because it is not related to infection and arises in response to various stimuli such as low-grade local irritation, traumatic injury, or hormonal factors. It is most commonly seen in females in their second decade of life due to vascular effects of hormones. Although excisional surgery is the treatment of choice for it, this paper presents the safest and most minimally invasive procedure for the regression of pyogenic granuloma.

  6. Minimally Invasive Treatment of Male Lower Urinary Tract Symptoms

    NARCIS (Netherlands)

    de La Rosette, Jean J. M. C. H.; Gravas, Stavros; Fitzpatrick, John M.

    2008-01-01

    During the past decade, increasing numbers of minimally invasive treatments for managing male lower urinary tract symptoms caused by urinary tract obstruction have been positioned. On one hand, transurethral needle ablation and transurethral microwave thermotherapy bridge the gap between medical

  7. A videoscope for use in minimally invasive periodontal surgery.

    Science.gov (United States)

    Harrel, Stephen K; Wilson, Thomas G; Rivera-Hidalgo, Francisco

    2013-09-01

    Minimally invasive periodontal procedures have been reported to produce excellent clinical results. Visualization during minimally invasive procedures has traditionally been obtained by the use of surgical telescopes, surgical microscopes, glass fibre endoscopes or a combination of these devices. All of these methods for visualization are less than fully satisfactory due to problems with access, magnification and blurred imaging. A videoscope for use with minimally invasive periodontal procedures has been developed to overcome some of the difficulties that exist with current visualization approaches. This videoscope incorporates a gas shielding technology that eliminates the problems of fogging and fouling of the optics of the videoscope that has previously prevented the successful application of endoscopic visualization to periodontal surgery. In addition, as part of the gas shielding technology the videoscope also includes a moveable retractor specifically adapted for minimally invasive surgery. The clinical use of the videoscope during minimally invasive periodontal surgery is demonstrated and discussed. The videoscope with gas shielding alleviates many of the difficulties associated with visualization during minimally invasive periodontal surgery. © 2013 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

  8. Effects of minimal exposures to atmospheric pressure plasma on the activity of Salmonella Typhimurium: Deactivation of bacterial motility and suppression of host-cell invasion.

    Science.gov (United States)

    Park, Jin-Sung; Kim, Kijung; Han, Je-Hyun; Gweon, Bomi; Ko, Ung Hyun; Yoo, Suk Jae; Choe, Wonho; Shin, Jennifer H

    2016-09-01

    Atmospheric pressure plasma (APP) has been shown effective in sterilization by reducing the number of viable microbes during surface cleaning, food processing, or human tissue treatment. For safe conduct, the majority of previous research focused on complete abolition of microbes, which may require severe treatments. Our aim is to investigate the minimal treatment conditions necessary for effective inactivation of bacteria in such a manner that the APP treated bacteria would not be able to harm the host cells. For this, we ought to identify the objective criteria to make the bacteria dysfunctional. We choose the motile properties and the host-cell invasion capability as two measures to quantify the pathogenic state of bacteria. In this paper, we investigated how the APP treatment in a minimal dosage affects the activity of Salmonella Typhimurium. At 100 W and 15 kHz for 20 s, the APP treatment effectively suppressed active "run and tumble" type motility and induced formation of abnormally long structures. With 20 s exposure, the bacterial cells failed to cause pyroptosis in the host cells with >90% survival after 12 h of co-incubation. Our results suggest novel measures to evaluate the functional pathogenic state for identifying safe APP treatment conditions. Copyright © 2016 Elsevier Inc. All rights reserved.

  9. Radio frequency energy for non-invasive and minimally invasive skin tightening.

    Science.gov (United States)

    Mulholland, R Stephen

    2011-07-01

    This article reviews the non-invasive and minimally invasive options for skin tightening, focusing on peer-reviewed articles and presentations and those technologies with the most proven or promising RF non-excisional skin-tightening results for excisional surgeons. RF has been the mainstay of non-invasive skin tightening and has emerged as the "cutting edge" technology in the minimally invasive skin-tightening field. Because these RF skin-tightening technologies are capital equipment purchases with a significant cost associated, this article also discusses some business issues and models that have proven to work in the plastic surgeon's office for non-invasive and minimally invasive skin-tightening technologies. Copyright © 2011 Elsevier Inc. All rights reserved.

  10. Minimally invasive spine surgery: Hurdles to be crossed

    Directory of Open Access Journals (Sweden)

    Mahesh Bijjawara

    2014-01-01

    Full Text Available MISS as a concept is noble and all surgeons need to address and minimize the surgical morbidity for better results. However, we need to be cautions and not fall prey into accepting that minimally invasive spine surgery can be done only when certain metal access systems are used. Minimally invasive spine surgery (MISS has come a long way since the description of endoscopic discectomy in 1997 and minimally invasive TLIF (mTLIF in 2003. Today there is credible evidence (though not level-I that MISS has comparable results to open spine surgery with the advantage of early postoperative recovery and decreased blood loss and infection rates. However, apart from decreasing the muscle trauma and decreasing the muscle dissection during multilevel open spinal instrumentation, there has been little contribution to address the other morbidity parameters like operative time , blood loss , access to decompression and atraumatic neural tissue handling with the existing MISS technologies. Since all these parameters contribute to a greater degree than posterior muscle trauma for the overall surgical morbidity, we as surgeons need to introspect before we accept the concept of minimally invasive spine surgery being reduced to surgeries performed with a few tubular retractors. A spine surgeon needs to constantly improve his skills and techniques so that he can minimize blood loss, minimize traumatic neural tissue handling and minimizing operative time without compromising on the surgical goals. These measures actually contribute far more, to decrease the morbidity than approach related muscle damage alone. Minimally invasine spine surgery , though has come a long way, needs to provide technical solutions to minimize all the morbidity parameters involved in spine surgery, before it can replace most of the open spine surgeries, as in the case of laparoscopic surgery or arthroscopic surgery.

  11. 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.

  12. Minimally invasive surgery for esophageal motility disorders.

    Science.gov (United States)

    Balaji, Nagammapudur S; Peters, Jeffrey H

    2002-08-01

    Laparoscopic Heller myotomy has emerged as an excellent primary treatment for patients with dysphagia secondary to achalasia. A laparoscopic rather than thoracoscopic approach has stood the test of time. An antireflux procedure combined with the myotomy is crucial to the maintenance of the antireflux barrier. Thoracoscopic long myotomy offers effective relief for spastic disorders of the esophagus. Endoscopic stapled diverticulotomy is a safe and effective procedure for Zenker's diverticulum and has potential advantages over the open approach.

  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. Treatment of cervical agenesis with minimally invasive therapy: Case report

    Directory of Open Access Journals (Sweden)

    Azami Denas Azinar

    2017-11-01

    Full Text Available Cervical agenesis is very rare congenital disorder case with cervical not formed. Because of cervical clogged so that menstruation can not be drained. We Report the case of a19 years old women still single with endometrioma, hematometra, cervical agenesis and perform surgery combination laparoscopy and transvaginally with laparoscopic cystectomy, neocervix, and use catheter no 24f in the new cervix. And now she can currently be normal menstruation. Minimally invasive theraphy of congenital anomalies case is recommended to save reproductive function. Keywords: Cervical agenesis, minimal invasive theraphy

  15. 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.

  16. [Strategy for minimally invasive cochlear implantation and residual hearing preservation].

    Science.gov (United States)

    Huang, Y Y; Chen, J Y; Shen, M; Yang, J

    2018-01-07

    In the past few decades, considerable development was achieved in the cochlear implantation following the emergence of innovative electrode array and advances in minimally invasive surgery. Minimally invasive technique led to a better preservation of residual low-frequency hearing. The loss of residual hearing was caused by complicated factors. According to previous studies, a slower and stable speed of electrode insertion and the use of perioperative steroids were demonstrated to have a positive impact on hearing preservation. The selection of electrode array or its insertion approaches didn't show any distinctive benefits in hearing preservation.

  17. Minimally invasive approaches for gastric cancer-Korean experience.

    Science.gov (United States)

    Yang, Han-Kwang; Suh, Yun-Suhk; Lee, Hyuk-Joon

    2013-03-01

    Laparoscopic surgery in Korea increased rapidly because of the early detection of gastric cancer by the development of diagnostic tools and nationwide screening. The Korean Laparoscopic Gastrointestinal Surgery Study Group (KLASS group) played a leading role in various projects related with minimally invasive surgery. The justification of minimally invasive procedures including robotic surgery, sentinel-node biopsy, or single-port surgery/Natural Orifice Transluminal Endoscopic Surgery (NOTES) must be predetermined by the clinical trial before a wide application, and the medical industry as well as surgeons should have great responsibility. Copyright © 2012 Wiley Periodicals, Inc.

  18. Cost Effectiveness of Screening Patients With Gastroesophageal Reflux Disease for Barrett's Esophagus With a Minimally Invasive Cell Sampling Device

    OpenAIRE

    Heberle, Curtis; Omidvari, A.-H. (Amir-Houshang); Ali, Ayman; Kroep, Sonja; Kong, Chung Yin; Inadomi, John; Rubenstein, J.; Tramontano, Angela C.; Dowling, E.C. (Emily C.); Hazelton, William; Luebeck, E. Georg; Lansdorp-Vogelaar, Iris; Hur, Chin

    2017-01-01

    textabstractBackground & Aims It is important to identify patients with Barrett's esophagus (BE), the precursor to esophageal adenocarcinoma (EAC). Patients with BE usually are identified by endoscopy, which is expensive. The Cytosponge, which collects tissue from the esophagus noninvasively, could be a cost-effective tool for screening individuals with gastroesophageal reflux disease (GERD) who are at increased risk for BE. We developed a model to analyze the cost effectiveness of using the ...

  19. Minimally invasive surgery when treating endometriosis has a positive effect on health and on quality of work life of affected women.

    Science.gov (United States)

    Wullschleger, M F; Imboden, S; Wanner, J; Mueller, M D

    2015-03-01

    What is the effect of the minimally invasive surgical treatment of endometriosis on health and on quality of work life (e.g. working performance) of affected women? Absence from work, performance loss and the general negative impact of endometriosis on the job are reduced significantly by the laparoscopic surgery. The benefits of surgery overall and of the laparoscopic method in particular for treating endometriosis have been described before. However, previous studies focus on medical benchmarks without including the patient's perspective in a quantitative manner. A retrospective questionnaire-based survey covering 211 women with endometriosis and a history of specific laparoscopic surgery in a Swiss university hospital, tertiary care center. Data were returned anonymously and were collected from the beginning of 2012 until March 2013. Women diagnosed with endometriosis and with at least one specific laparoscopic surgery in the past were enrolled in the study. The study investigated the effect of the minimally invasive surgery on health and on quality of work life of affected women. Questions used were obtained from the World Endometriosis Research Foundation (WERF) Global Study on Women's Health (GSWH) instrument. The questionnaire was shortened and adapted for the purpose of the present study. Of the 587 women invited to participate in the study, 232 (232/587 = 40%) returned the questionnaires. Twenty-one questionnaires were excluded due to incomplete data and 211 sets (211/587 = 36%) were included in the study. Our data show that 62% (n = 130) of the study population declared endometriosis as influencing the job during the period prior to surgery, compared with 28% after surgery (P work due to endometriosis was reduced from 2.0 (4.9) to 0.5 (1.4) hours per week (P working performance after the surgery averaged out at 5.7% (12.6%) compared with 17.5% (30.5%) before this treatment (P performed. A bias due to selection, information and negativity effects within a

  20. Urolift - minimally invasive surgical BPH management.

    Science.gov (United States)

    Pushkaran, Anish; Stainer, Victoria; Muir, Gordon; Shergill, Iqbal S

    2017-03-01

    An ideal treatment option for symptomatic Benign Prostatic Hyperplasia (BPH) should relieve lower urinary tract symptoms (LUTS) and restore Quality of Life (QoL). Currently available medical therapies and surgical options for symptomatic BPH have side effects that adversely affects quality of life. Prostatic urethral lift (PUL) is a novel endourology procedure that promises to relieve LUTS without the aforementioned side effects. Areas covered: We diligently reviewed all the published literature on PUL, till July 2016 using standard search criteria. Expert commentary: There is good quality evidence to establish the efficiency of PUL in treating symptomatic BPH without adversely affecting the QoL. Based on the current literature, PUL can be considered as an option for those symptomatic BPH patients with small or medium size prostates (< 80 ml) without median lobe enlargement, who failed on medical therapy or are intolerant to it and wish to preserve their sexual function.

  1. 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...... complex equipment than open procedures, likely requiring a different set of NTS for each kind of team. The aims of this study were to identify the MIS teams' key NTS and investigate the effect of training and assessment of NTS on MIS teams. METHODS: The databases of PubMed, Cochrane Library, Embase, Psyc...... 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...

  2. A 3-DOF haptic master device for minimally invasive surgery

    Science.gov (United States)

    Nguyen, Phuong-Bac; Oh, Jong-Seok; Choi, Seung-Bok

    2012-04-01

    This paper introduces a novel 3-DOF haptic master device for minimally invasive surgery featuring magneto-rheological (MR) fluid. It consists of three rotational motions. These motions are constituted by two bi-directional MR (BMR) plus one conventional MR brakes. The BMR brake used in the system possesses a salient advantage that its range of braking torque varies from negative to positive values. Therefore, the device is expected to be able sense in a wide environment from very soft tissues to bones. In this paper, overall of the design of the device is presented from idea, modeling, optimal design, manufacturing to control of the device. Moreover, experimental investigation is undertaken to validate the effectiveness of the device.

  3. [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.

  4. Limitations and ceiling effects with circumferential minimally invasive correction techniques for adult scoliosis: analysis of radiological outcomes over a 7-year experience.

    Science.gov (United States)

    Anand, Neel; Baron, Eli M; Khandehroo, Babak

    2014-05-01

    Minimally invasive correction of adult scoliosis is a surgical method increasing in popularity. Limited data exist, however, as to how effective these methodologies are in achieving coronal plane and sagittal plane correction in addition to improving spinopelvic parameters. This study serves to quantify how much correction is possible with present circumferential minimally invasive surgical (cMIS) methods. Ninety patients were selected from a database of 187 patients who underwent cMIS scoliosis correction. All patients had a Cobb angle greater than 15°, 3 or more levels fused, and availability of preoperative and postoperative 36-inch standing radiographs. The mean duration of follow-up was 37 months. Preoperative and postoperative Cobb angle, sagittal vertical axis (SVA), coronal balance, lumbar lordosis (LL), and pelvic incidence (PI) were measured. Scatter plots were performed comparing the pre- and postoperative radiological parameters to calculate ceiling effects for SVA correction, Cobb angle correction, and PI-LL mismatch correction. The mean preoperative SVA value was 60 mm (range 11.5-151 mm); the mean postoperative value was 31 mm (range 0-84 mm). The maximum SVA correction achieved with cMIS techniques in any of the cases was 89 mm. In terms of coronal Cobb angle, a mean correction of 61% was noted, with a mean preoperative value of 35.8° (range 15°-74.7°) and a mean postoperative value of 13.9° (range 0°-32.5°). A ceiling effect for Cobb angle correction was noted at 42°. The ability to correct the PI-LL mismatch to 10° was limited to cases in which the preoperative PI-LL mismatch was 38° or less. Circumferential MIS techniques as currently used for the treatment of adult scoliosis have limitations in terms of their ability to achieve SVA correction and lumbar lordosis. When the preoperative SVA is greater than 100 mm and a substantial amount of lumbar lordosis is needed, as determined by spinopelvic parameter calculations, surgeons should

  5. Cost Effectiveness of Screening Patients With Gastroesophageal Reflux Disease for Barrett's Esophagus With a Minimally Invasive Cell Sampling Device.

    Science.gov (United States)

    Heberle, Curtis R; Omidvari, Amir-Houshang; Ali, Ayman; Kroep, Sonja; Kong, Chung Yin; Inadomi, John M; Rubenstein, Joel H; Tramontano, Angela C; Dowling, Emily C; Hazelton, William D; Luebeck, E Georg; Lansdorp-Vogelaar, Iris; Hur, Chin

    2017-09-01

    It is important to identify patients with Barrett's esophagus (BE), the precursor to esophageal adenocarcinoma (EAC). Patients with BE usually are identified by endoscopy, which is expensive. The Cytosponge, which collects tissue from the esophagus noninvasively, could be a cost-effective tool for screening individuals with gastroesophageal reflux disease (GERD) who are at increased risk for BE. We developed a model to analyze the cost effectiveness of using the Cytosponge in first-line screening of patients with GERD for BE with endoscopic confirmation, compared with endoscopy screening only. We incorporated data from a large clinical trial of Cytosponge performance into 2 validated microsimulation models of EAC progression (the esophageal adenocarcinoma model from Massachusetts General Hospital and the microsimulation screening analysis model from Erasmus University Medical Center). The models were calibrated for US Surveillance, Epidemiology and End Results data on EAC incidence and mortality. In each model, we simulated the effect of a 1-time screen for BE in male patients with GERD, 60 years of age, using endoscopy alone or Cytosponge collection of tissue, and analysis for the level of trefoil factor 3 with endoscopic confirmation of positive results. For each strategy we recorded the number of cases of EAC that developed, the number of EAC cases detected with screening by Cytosponge only or by subsequent targeted surveillance, and the number of endoscopies needed. In addition, we recorded the cumulative costs (including indirect costs) incurred and quality-adjusted years of life lived within each strategy, discounted at a rate of 3% per year, and computed incremental cost-effectiveness ratios (ICERs) among the 3 strategies. According to the models, screening patients with GERD by Cytosponge with follow-up confirmation of positive results by endoscopy would reduce the cost of screening by 27% to 29% compared with screening by endoscopy, but led to 1.8 to 5

  6. Surgeons' musculoskeletal pain in minimally invasive surgery

    DEFF Research Database (Denmark)

    Dalager, Tina; Søgaard, Karen; Bech (Katrine Tholstrup Pedersen), Katrine Tholstrup

    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...... put the patients at a higher risk of complications, and on the longer term there is an increasing risk for the surgeon to develop chronic musculoskeletal pain that will disable him/her to perform his/her job. Therefore, surgeons’ musculoskeletal health is of vital importance and must be considered...... alongside patient safety. The present literature study supports the need for a randomized controlled trial evaluating the effect of an individually designed training program for surgeons performing MIS....

  7. Predicting blood transfusion in patients undergoing minimally invasive oesophagectomy.

    Science.gov (United States)

    Schneider, Crispin; Boddy, Alex P; Fukuta, Junaid; Groom, William D; Streets, Christopher G

    2014-12-01

    To evaluate predictors of allogenic blood transfusion requirements in patients undergoing minimal invasive oesophagectomy at a tertiary high volume centre for oesophago-gastric surgery. Retrospective analysis of all patients undergoing minimal access oesophagectomy in our department between January 2010 and December 2011. Patients were divided into two groups depending on whether they required a blood transfusion at any time during their index admission. Factors that have been shown to influence perioperative blood transfusion requirements in major surgery were included in the analysis. Binary logistic regression analysis was performed to determine the impact of patient and perioperative characteristics on transfusion requirements during the index admission. A total of 80 patients underwent minimal access oesophagectomy, of which 61 patients had a laparoscopic assisted oesophagectomy and 19 patients had a minimal invasive oesophagectomy. Perioperative blood transfusion was required in 28 patients at any time during hospital admission. On binary logistic regression analysis, a lower preoperative haemoglobin concentration (p blood transfusion requirements. It has been reported that requirement for blood transfusion can affect long-term outcomes in oesophageal cancer resection. Two factors which could be addressed preoperatively; haemoglobin concentration and type of oesophageal resection, may be valuable in predicting blood transfusions in patients undergoing minimally invasive oesophagectomy. Our analysis revealed that preoperative haemoglobin concentration, occurrence of significant complications and type of minimal access oesophagectomy predicted blood transfusion requirements in the patient population examined. Copyright © 2014 Surgical Associates Ltd. Published by Elsevier Ltd. All rights reserved.

  8. Minimally invasive management of hepatic cysts: indications and complications.

    Science.gov (United States)

    Vardakostas, D; Damaskos, C; Garmpis, N; Antoniou, E A; Kontzoglou, K; Kouraklis, G; Dimitroulis, D

    2018-03-01

    Liver cysts are divided into congenital and acquired. Congenital cystic lesions include polycystic liver disease, simple cysts, duct related and ciliated hepatic foregut cysts. Acquired cystic lesions are divided into infectious and non-infectious. The infectious cysts are the hydatid cyst, the amoebic abscess, and the pyogenic abscess, whereas the non-infectious cysts are neoplastic cysts and false cysts. While modern medicine provides a lot of minimally invasive therapeutic modalities, there has emerged a pressing need for understanding the various types of liver cysts, the possible minimal therapeutic options along with their indications and complications. We aim is to clarify the role of minimally invasive techniques in the management of hepatic cysts. A literature review was performed using the MEDLINE database. The search terms were: liver cyst, minimally invasive, laparoscopic, percutaneous, drainage and fenestration. We reviewed 82 English language publications articles, published until October 2017. Minimally invasive management of liver LC is an emerging field including many therapeutic modalities ranging from the percutaneous aspiration of pyogenic abscesses to laparoscopic hepatectomy for hepatic cystadenomas. The most used techniques are percutaneous drainage, laparoscopic fenestration, and laparoscopic hepatectomy. The application of the various minimally invasive approaches, as well as their indication and complications, depend on the type of the cystic lesion, its size and its position in the liver. Percutaneous drainage is mostly used in simple cysts, hydatid cysts, pyogenic abscesses and bilomas. Laparoscopic fenestration is mostly used in simple cysts and polycystic liver disease. Finally, laparoscopic hepatectomy is mostly used in polycystic liver disease, hydatid cysts, and cystadenomas.

  9. A new minimally invasive mesotherapy technique for facial rejuvenation.

    Science.gov (United States)

    Savoia, Antonella; Landi, Simone; Baldi, Alfonso

    2013-06-01

    This study describes a pivotal clinical trial of a new minimally invasive mesotherapy technique for facial rejuvenation. The authors utilized two formulations: formulation A with hyaluronic acid, vitamins, amino acids, minerals, coenzymes, and antioxidant substances; formulation B with hyaluronic acid and idebenone. Fifty participants were enrolled in the study and divided in two groups. Group 1 (50-65 years) treated with formulation A. Group 2 (35-50 years) treated with formulation B. The groups underwent four sessions of mesotherapy involving multiple injections. Treatment was conducted at 15 day intervals. All participants had pre- and posttreatment photographs. Punch biopsies were taken from randomly selected participants, baseline and after 6 weeks, and stained for interleukin (IL)-6, IL-1β, matrix metalloproteinase (MMP)-1, and collagen 1. Clinical evaluation was based on the Global Aesthetic Scale (GAIS) and on the Wrinkle Severity Rating Scale (WSRS). The results produced were statistically analyzed and resulted in a significant and long-lasting effect on facial rejuvenation. Evaluation of photographs at 0, 1, and 2 months revealed significant clinical improvement: brightness, texture, and firmness of the skin. The analysis of the GAIS and WSRS scores in the two groups demonstrated statistically significant results after 2 months. The biopsies taken from randomly selected participants at baseline and after 3 months showed a decrease in IL-1β, IL-6, and MMP1, and an increase in collagen 1. The new minimally invasive mesotherapy technique described can improve the clinical appearance of the skin in different age groups.

  10. Rapid, minimally invasive adult voluntary male circumcision: A ...

    African Journals Online (AJOL)

    To compare conventional open surgical circumcision with suturing to a minimally invasive technique using a single-use-only disposable instrument (Unicirc) plus tissue adhesive. This technique completes the circumcision at the time of surgery, and requires no further visits for device removal. We hypothesised that the new ...

  11. ISASS Policy 2016 Update – Minimally Invasive Sacroiliac Joint Fusion

    Science.gov (United States)

    Lorio, Morgan P.

    2016-01-01

    Rationale The index 2014 ISASS Policy Statement - Minimally Invasive Sacroiliac Joint Fusion was generated out of necessity to provide an ICD9-based background and emphasize tools to ensure correct diagnosis. A timely ICD10-based 2016 Update provides a granular threshold selection with improved level of evidence and a more robust, relevant database. PMID:27652197

  12. Factors Influencing the Adoption of Minimally Invasive Surgery ...

    African Journals Online (AJOL)

    Background: Cost is a major concern for delivery of minimally invasive surgical technologies due to the nature of resources required. It is unclear whether factors extrinsic to technology availability impact on this uptake. Objectives: To establish the influence of institutional, patient and surgeon-related factors in the adoption of ...

  13. Minimally invasive non-surgical lung volume reduction

    International Nuclear Information System (INIS)

    Shen Liming; Zhou Dayong; Shen Junkang

    2006-01-01

    Minimally invasive treatment with lung volume reduction is the promising future for severe pulmonary emphysema patients. With emerging and improving of new techniques and instruments, it would become an important choice for managing severe emphysema. A comprehensive review is here documented through the correlative techniques, instruments, new achievements and latest research work. (authors)

  14. Exciting times: Towards a totally minimally invasive paediatric urology service

    OpenAIRE

    Lazarus, John

    2011-01-01

    Following on from the first paediatric laparoscopic nephrectomy in 1992, the growth of minimally invasive ablative and reconstructive procedures in paediatric urology has been dramatic. This article reviews the literature related to laparoscopic dismembered pyeloplasty, optimising posterior urethral valve ablation and intravesical laparoscopic ureteric reimplantation.

  15. Minimally invasive diagnostics and immunotherapy of lung cancer

    NARCIS (Netherlands)

    Talebian-Yazdi, M.

    2017-01-01

    This thesis deals with aspects of diagnostics and immunotherapy of lung cancer. The first aim of this thesis is to investigate how the implementation of minimally invasive endoscopic ultrasound techniques (EUS and EBUS) in the staging algorithm of NSCLC can be optimized. The second aim of this

  16. 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

  17. Haptic feedback designs in teleoperation systems for minimal invasive surgery

    NARCIS (Netherlands)

    Font, I.; Weiland, S.; Franken, M.; Steinbuch, M.; Rovers, A.F.

    2004-01-01

    One of the major shortcomings of state-of-the-art robotic systems for minimal invasive surgery is the lack of haptic feedback for the surgeon. In order to provide haptic information, sensors and actuators have to be added to the master and slave device. A control system should process the data and

  18. Minimally Invasive Technique for PMMA Augmentation of Fenestrated Screws

    Directory of Open Access Journals (Sweden)

    Jan-Helge Klingler

    2015-01-01

    Full Text Available Purpose. To describe the minimally invasive technique for cement augmentation of cannulated and fenestrated screws using an injection cannula as well as to report its safety and efficacy. Methods. A total of 157 cannulated and fenestrated pedicle screws had been cement-augmented during minimally invasive posterior screw-rod spondylodesis in 35 patients from January to December 2012. Retrospective evaluation of cement extravasation and screw loosening was carried out in postoperative plain radiographs and thin-sliced triplanar computed tomography scans. Results. Twenty-seven, largely prevertebral cement extravasations were detected in 157 screws (17.2%. None of the cement extravasations was causing a clinical sequela like a new neurological deficit. One screw loosening was noted (0.6% after a mean follow-up of 12.8 months. We observed no cementation-associated complication like pulmonary embolism or hemodynamic insufficiency. Conclusions. The presented minimally invasive cement augmentation technique using an injection cannula facilitates convenient and safe cement delivery through polyaxial cannulated and fenestrated screws during minimally invasive screw-rod spondylodesis. Nevertheless, the optimal injection technique and design of fenestrated screws have yet to be identified. This trial is registered with German Clinical Trials DRKS00006726.

  19. 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. Copyright © 2014 Elsevier Inc. All rights reserved.

  20. Short-term and long-term effects of a minimally invasive transilial vertebral blocking procedure on the lumbosacral morphometry in dogs measured by computed tomography.

    Science.gov (United States)

    Müller, Friedrich; Schenk, Henning C; Forterre, Franck

    2017-04-01

    To determine the effects of a minimally invasive transilial vertebral (MTV) blocking procedure on the computed tomographic (CT) appearance of the lumbosacral (L7/S1) junction of dogs with degenerative lumbosacral stenosis (DLSS). Prospective study. 59 client-owned dogs with DLSS. Lumbosacral CT images were acquired with hyperextended pelvic limbs before and after MTV in all dogs. Clinical follow-up was obtained after 1 year, including a neurologic status classified in 4 grades, and if possible, CT. Morphometric measurements (Mean ± SEM) including foraminal area, endplate distance at L7/S1 and LS angle were obtained on sets of reformatted parasagittal and sagittal CT images. The mean foraminal area (ForL) increased from 32.5 ± 1.7 mm 2 to 59.7 ± 1.9 mm 2 on the left and from 31.1 ± 1.4 mm 2 to 59.1 ± 2.0 mm 2 on the right (ForR) side after MTV. The mean endplate distance (EDmd) between L7/S1 increased from 3.7 ± 0.1 mm to 6.0 ± 0.1 mm, and mean lumbosacral angle (LSa) from 148.0 ± 1.1° to 170.0 ± 1.1° after MTV. CT measurements were available 1 year postoperatively in 12 cases: ForL: 41.2 ± 3.1 mm 2 ; ForR: 37.9 ± 3.1 mm 2 ; EDmd: 4.3 ± 0.4 mm, and LSa 157.6 ± 2.1° (values are mean and standard error of mean =  SEM). All 39 dogs with long-term follow-up improved by at least 1 neurologic grade, 9/39 improving by 3 grades, 15/39 by 2 grades, and 15/39 by 1 grade. MTV results in clinical improvement and morphometric enlargement of the foraminal area in dogs with variable degrees of foraminal stenosis. MTV may be a valuable minimally invasive option for treatment of dogs with DLSS. © 2017 The American College of Veterinary Surgeons.

  1. Minimally invasive transcanal myringotomy for pediatric early stage congenital cholesteatoma.

    Science.gov (United States)

    Jang, Chul Ho; Jung, Eun Kyung; Sung, Chung Man; Kim, Seung Beom; Kim, Young Yoon; Seong, Jong Yuap; Kang, Sung Hoon; Cho, Yong Beom

    2016-11-01

    Recently, minimally invasive transcanal myringotomy (MITM), which is a useful surgical technique for early stage congenital cholesteatoma (CC) in children, was introduced. The purpose of this study is to evaluate the short-term surgical results of MITM in pediatric early stage CC. We retrospectively reviewed the charts of 24 patients who underwent MITM between January 2013 and October 2015. The patients' ages ranged from 1 to 16 years (mean, 2.6 years). There were 17 male and 7 female patients. The right side (n = 13) was affected twice as often as the left side (n = 11). The most common site was the anterosuperior quadrant (15 cases). The diameter of the CC on axial computed tomography images ranged from 2.8 to 5.7 mm (mean, 3.9 mm). CCs were graded according to Potsic's system: 18 cases were classified as stage I, 3 case as stage II, and 3 cases as stage III. AllCCs except 1 were closed type. In21 patients, the tympanic membrane closed naturally without recurrence. Three patients showed small persistent dry perforation. Natural closure occurred in these patients, who were treated with paper patches. MITM is a simple, effective technique for removing an early stage CC from the middle ear, and it can minimize operative time, length of hospitalization, and postoperative morbidity. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

  2. Minimally invasive radical pancreatectomy for left-sided pancreatic cancer: Current status and future perspectives

    Science.gov (United States)

    Kang, Chang Moo; Lee, Sung Hwan; Lee, Woo Jung

    2014-01-01

    Minimally invasive distal pancreatectomy with splenectomy has been regarded as a safe and effective treatment for benign and borderline malignant pancreatic lesions. However, its application for left-sided pancreatic cancer is still being debated. The clinical evidence for radical antegrade modular pancreatosplenectomy (RAMPS)-based minimally invasive approaches for left-sided pancreatic cancer was reviewed. Potential indications and surgical concepts for minimally invasive RAMPS were suggested. Despite the limited clinical evidence for minimally invasive distal pancreatectomy in left-sided pancreatic cancer, the currently available clinical evidence supports the use of laparoscopic distal pancreatectomy under oncologic principles in well-selected left sided pancreatic cancers. A pancreas-confined tumor with an intact fascia layer between the pancreas and left adrenal gland/kidney positioned more than 1 or 2 cm away from the celiac axis is thought to constitute a good condition for the use of margin-negative minimally invasive RAMPS. The use of minimally invasive (laparoscopic or robotic) anterior RAMPS is feasible and safe for margin-negative resection in well-selected left-sided pancreatic cancer. The oncologic feasibility of the procedure remains to be determined; however, the currently available interim results indicate that even oncologic outcomes will not be inferior to those of open radical distal pancreatosplenectomy. PMID:24605031

  3. Minimally invasive surgical treatment of Bertolotti's Syndrome: case report.

    Science.gov (United States)

    Ugokwe, Kene T; Chen, Tsu-Lee; Klineberg, Eric; Steinmetz, Michael P

    2008-05-01

    This article aims to provide more insight into the presentation, diagnosis, and treatment of Bertolotti's syndrome, which is a rare spinal disorder that is very difficult to recognize and diagnose correctly. The syndrome was first described by Bertolotti in 1917 and affects approximately 4 to 8% of the population. It is characterized by an enlarged transverse process at the most caudal lumbar vertebra with a pseudoarticulation of the transverse process and the sacral ala. It tends to present with low back pain and may be confused with facet and sacroiliac joint disease. In this case report, we describe a 40-year-old man who presented with low back pain and was eventually diagnosed with Bertolotti's syndrome. The correct diagnosis was made based on imaging studies which included computed tomographic scans, plain x-rays, and magnetic resonance imaging scans. The patient experienced temporary relief when the abnormal pseudoarticulation was injected with a cocktail consisting of lidocaine and steroids. In order to minimize the trauma associated with surgical treatment, a minimally invasive approach was chosen to resect the anomalous transverse process with the accompanying pseudoarticulation. The patient did well postoperatively and had 97% resolution of his pain at 6 months after surgery. As with conventional surgical approaches, a complete knowledge of anatomy is required for minimally invasive spine surgery. This case is an example of the expanding utility of minimally invasive approaches in treating spinal disorders.

  4. Minimally Invasive Follicular Thyroid Carcinoma in Pediatric Age

    International Nuclear Information System (INIS)

    Romero, Alfredo; Diaz, Julio; Messa Oscar; Chinchilla, Sandra; Gomez, Constanza; Restrepo, Ligia

    2009-01-01

    Thyroid carcinomas are rare during childhood and adolescence. They have increased recently probably due to a higher frequency radiation over the head, neck and mediastinum. The papillary carcinoma is the most common and true follicular carcinoma is far less common. Follicular thyroid carcinoma is associated with endemic goiter, genetic disorders, and increased TSH levels. Its morphological characteristics are peculiar and have been recently redefined, thus helping the diagnosis. A minimally invasive follicular thyroid carcinoma in 13 years old girl is described, presenting a hypocaptant thyroid nodule in the left lobe lower pole. The fine needle aspiration biopsy revealed a follicular cell lesion suspicious of malignancy. Thyroid lobectomy was performed reporting minimally invasive follicular carcinoma.

  5. Repair of traumatic tricuspid insufficiency via minimally invasive port access.

    Science.gov (United States)

    Kasahara, Hirofumi; Kudo, Mikihiko; Kawajiri, Hiroyuki; Yozu, Ryohei

    2010-04-01

    We report on a successful tricuspid valve plasty using port-access minimally invasive cardiac surgery (MICS) for severe traumatic tricuspid insufficiency caused by blunt chest trauma suffered 15 years previously. A combination repair procedure, consisting of cleft closures, plication of the anteroseptal commissure, and ring annuloplasty, was necessary to achieve valve competence and proved possible via port access without difficulty. Port-access MICS is an alternative approach for tricuspid valve surgery.

  6. Minimally invasive surgical approach to treat posterior urethral diverticulum

    Directory of Open Access Journals (Sweden)

    Ossamah Alsowayan

    2015-01-01

    Full Text Available Urethral diverticulum is a localized saccular or fusiform out-pouching of the urethra. It may occur at any point along the urethra in both male and females. Male urethral diverticulum is rare, and could be either congenital or acquired, anterior or posterior. The mainstay treatment of posterior urethral diverticulum (PUD is the open surgical approach. Here we discuss our minimally invasive surgical approach (MIS in managing posterior urethral diverticulum.

  7. Continuous minimally-invasive alcohol monitoring using microneedle sensor arrays

    OpenAIRE

    Mohan, AMV; Windmiller, JR; Mishra, RK; Wang, J

    2017-01-01

    The present work describes an attractive skin-worn microneedle sensing device for the minimally invasive electrochemical monitoring of subcutaneous alcohol. The device consists of an assembly of pyramidal microneedle structures integrated with Pt and Ag wires, each with a microcavity opening. The microneedle aperture was modified by electropolymerizing o-phenylene diamine onto the Pt wire microtransducer, followed by the immobilization of alcohol oxidase (AOx) in an intermediate chitosan laye...

  8. The effect of zero-ischaemia laparoscopic minimally invasive partial nephrectomy using the modified sequential preplaced suture renorrhaphy technique on long-term renal functions.

    Science.gov (United States)

    Sönmez, Mehmet Giray; Kara, Cengiz

    2017-09-01

    Laparoscopic minimally invasive partial nephrectomy (MIPN) is the preferred technique in renal surgery, especially T1 phase kidney tumours, and it is recommended for the protection of renal functions in methods that do not involve ischaemia. To evaluate long-term renal functions of zero-ischaemia laparoscopic MIPN patients who underwent a modified sequential preplaced suture renorrhaphy technique. In a total of 17 renal units in 16 patients with kidney tumours that were determined incidentally and did not cause any complaints, the masses were extracted via laparoscopic partial nephrectomy (LPN) using the modified sequential preplaced suture renorrhaphy technique. Creatinine and estimated glomerular filtration rate (eGFR) values of the patients were measured preoperatively and on the first day and after 12 months postoperatively, and the results were compared. The differences between the pre- and postoperative values were statistically significant (p = 0.033, p = 0.045), but the changes in postoperative creatinine and eGFR values were clinically insignificant. While the differences between preoperative and first-day postoperative creatinine and eGFR values were found to be statistically significant (p = 0.039, p = 0.042, respectively), a statistically significant difference was not detected between preoperative and 12-month postoperative creatinine and eGFR values (p = 0.09, p = 0.065, respectively). The global percentage of functional recovery was measured as 92.5% on the first day and 95.9% at the 12 th month. The modified sequential preplaced suture renorrhaphy technique is an effective, reliable method for avoiding complications and preserving renal functions and nephrons in appropriate patients.

  9. Effect of intercostal nerve block combined with general anesthesia on the stress response in patients undergoing minimally invasive mitral valve surgery.

    Science.gov (United States)

    Zhan, Yanping; Chen, Guo; Huang, Jian; Hou, Benchao; Liu, Weicheng; Chen, Shibiao

    2017-10-01

    The aim of the present study was to investigate the effect of intercostal nerve block combined with general anesthesia on the stress response and postoperative recovery in patients undergoing minimally invasive mitral valve surgery (MIMVS). A total of 30 patients scheduled for MIMVS were randomly divided into two groups (n=15 each): Group A, which received intercostal nerve block combined with general anesthesia and group B, which received general anesthesia alone. Intercostal nerve block in group A was performed with 0.5% ropivacaine from T3 to T7 prior to anesthesia induction. In each group, general anesthesia was induced using midazolam, sufentanil, propofol and vecuronium. Central venous blood samples were collected to determine the concentrations of cortisol, glucose, interleukin-6 (IL-6) and tumor necrosis factor-α (TNF-α) at the following time points: During central venous catheterization (T 1 ), 5 min prior to cardiopulmonary bypass (T 2 ), perioperative (T 3 ) and 24 h following surgery (T 4 ). Clinical data, including parameters of opioid (sufentanil) consumption, time of mechanical ventilation, duration of intensive care unit (ICU) stay, visual analog scale scores and any complications arising from intercostal nerve block, were recorded. Levels of cortisol, glucose, IL-6 and TNF-α in group A were significantly lower than those in group B at T 2 (all Pblock combined with general anesthesia may inhibit the stress response to MIMVS. Additionally, intercostal nerve block combined with general anesthesia may significantly reduce sufentanil consumption (Pblock combined with general anesthesia conforms to the concept of rapid rehabilitation surgery and may be suitable for clinical practice.

  10. TELMA: Technology-enhanced learning environment for minimally invasive surgery.

    Science.gov (United States)

    Sánchez-González, Patricia; Burgos, Daniel; Oropesa, Ignacio; Romero, Vicente; Albacete, Antonio; Sánchez-Peralta, Luisa F; Noguera, José F; Sánchez-Margallo, Francisco M; Gómez, Enrique J

    2013-06-01

    Cognitive skills training for minimally invasive surgery has traditionally relied upon diverse tools, such as seminars or lectures. Web technologies for e-learning have been adopted to provide ubiquitous training and serve as structured repositories for the vast amount of laparoscopic video sources available. However, these technologies fail to offer such features as formative and summative evaluation, guided learning, or collaborative interaction between users. The "TELMA" environment is presented as a new technology-enhanced learning platform that increases the user's experience using a four-pillared architecture: (1) an authoring tool for the creation of didactic contents; (2) a learning content and knowledge management system that incorporates a modular and scalable system to capture, catalogue, search, and retrieve multimedia content; (3) an evaluation module that provides learning feedback to users; and (4) a professional network for collaborative learning between users. Face validation of the environment and the authoring tool are presented. Face validation of TELMA reveals the positive perception of surgeons regarding the implementation of TELMA and their willingness to use it as a cognitive skills training tool. Preliminary validation data also reflect the importance of providing an easy-to-use, functional authoring tool to create didactic content. The TELMA environment is currently installed and used at the Jesús Usón Minimally Invasive Surgery Centre and several other Spanish hospitals. Face validation results ascertain the acceptance and usefulness of this new minimally invasive surgery training environment. Copyright © 2013 Elsevier Inc. All rights reserved.

  11. Multiple biopsy probe sampling enabled minimally invasive electrical impedance tomography

    International Nuclear Information System (INIS)

    Shini, Mohanad; Rubinsky, Boris

    2008-01-01

    Biopsies are a reliable method for examining tissues and organs inside the body, in particular for detection of tumors. However, a single biopsy produces only limited information on the site from which it is taken. Therefore, tumor detection now employs multiple biopsy samplings to examine larger volumes of tissue. Nevertheless, even with multiple biopsies, the information remains discrete, while the costs of biopsy increase. Here we propose and evaluate the feasibility of using minimally invasive medical imaging as a means to overcome the limitations of discrete biopsy sampling. The minimally invasive medical imaging technique employs the biopsy probe as electrodes for measurements of electrical impedance tomography relevant data during each biopsy sampling. The data from multiple samplings are combined and used to produce an EIT image of the tissue. Two- and three-dimensional mathematical simulations confirm that the minimally invasive medical imaging technique can produce electrical impedance tomography images of the tissues between the biopsy probe insertion sites. We show that these images can detect tumors that would be missed with multiple biopsy samplings only, and that the technique may facilitate the detection of tumors with fewer biopsies, thereby reducing the cost of cancer detection

  12. Laparoscopic subtotal hysterectomy in the era of minimally invasive surgery

    Directory of Open Access Journals (Sweden)

    Chia-Jen Wu

    2015-02-01

    Full Text Available According to a nation-wide population-based study in Taiwan, along with the expanding concepts and surgical techniques of minimally invasive surgery, laparoscopic supracervical/subtotal hysterectomy (LSH has been blooming. Despite this, the role of LSH in the era of minimally invasive surgery remains uncertain. In this review, we tried to evaluate the perioperative and postoperative outcomes of LSH compared to other types of hysterectomy, including total abdominal hysterectomy (TAH, vaginal hysterectomy, laparoscopic-assisted vaginal hysterectomy, and total laparoscopic hysterectomy (TLH. From the literature, LSH has a better perioperative outcome than TAH, and comparable perioperative complications compared with laparoscopic-assisted vaginal hysterectomy. LSH had less bladder injury, vaginal cuff bleeding, hematoma, infection, and dehiscence requiring re-operation compared with TLH. Despite this, LSH has more postoperative cyclic menstrual bleeding and re-operations with extirpations of the cervical stump. LSH does, however, have a shorter recovery time than TAH due to the minimally invasive approach; and there is quicker resumption of coitus than TLH, due to cervical preservation and the avoidance of vaginal cuff dehiscence. LSH is therefore an alternative option when the removal of the cervix is not strictly necessary or desired. Nevertheless, the risk of further cervical malignancy, postoperative cyclic menstrual bleeding, and re-operations with extirpations of the cervical stump is a concern when discussing the advantages and disadvantages of LSH with patients.

  13. 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.

  14. 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.

  15. An optimized hollow microneedle for minimally invasive blood extraction.

    Science.gov (United States)

    Li, Cheng Guo; Lee, Chang Yeol; Lee, Kwang; Jung, Hyungil

    2013-02-01

    The healthcare system relies widely on biochemical information obtained from blood sample extracted via hypodermic needles, despite the invasiveness and pain associated with this procedure. Therefore, an alternative micro-scale needle for minimally invasive blood sampling is highly desirable. Traditional fabrication techniques to create microneedles do not generate needles with the combined features of a sharp tip, long length, and hollow structure concurrently. Here, we report the fabrication of a microneedle long enough to reach blood vessels and sharp enough to minimize nerve contact for minimally invasive blood extraction. The microneedle structure was precisely controlled using a drawing lithography technique, and a sharp tip angle was introduced using a laser-cutting system. We investigated the characteristics of a microneedle with a length of 1,800 μm length, an inner diameter of 60 μm, a tip diameter of 120 μm, and a 15° bevel angle through in-vitro liquid extraction and mechanical strength analysis. We demonstrated that the proposed structure results in blood extraction at a reasonable rate, and that a microneedle with this geometry can reliably penetrate skin without breaking. We integrated this microneedle into a blood extraction device to extract a 20 μl volume of mouse blood in-vivo. Our optimized, hollow microneedle can potentially be incorporated with other cutting-edge technologies such as microactuators, biosensors, and microfluidic chips to create blood analysis systems for point-of-care diagnostics.

  16. Cost-effectiveness of minimally invasive versus open transforaminal lumbar interbody fusion for degenerative spondylolisthesis associated low-back and leg pain over two years.

    Science.gov (United States)

    Parker, Scott L; Adogwa, Owoicho; Bydon, Ali; Cheng, Joseph; McGirt, Matthew J

    2012-07-01

    Minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF) for lumbar spondylolisthesis allows for surgical treatment of back and leg pain while theoretically minimizing tissue injury and accelerating overall recovery. Although the authors of previous studies have demonstrated shorter length of hospital stay and reduced blood loss with MIS versus open-TLIF, short- and long-term outcomes have been similar. No studies to date have evaluated the comprehensive health care costs associated with TLIF procedures or assessed the cost-utility of MIS- versus open-TLIF. As such, we set out to assess previously unstudied end points of health care cost and cost-utility associated with MIS- versus open-TLIF. Thirty patients undergoing MIS-TLIF (n=15) or open-TLIF (n=15) for grade I degenerative spondylolisthesis associated back and leg pain were prospectively studied. Total back-related medical resource use, missed work, and health-state values (quality-adjusted life years [QALYs], calculated from EQ-5D with U.S. valuation) were assessed after two-year follow-up. Two-year resource use was multiplied by unit costs on the basis of Medicare national allowable payment amounts (direct cost) and work-day losses were multiplied by the self-reported gross-of-tax wage rate (indirect cost). Difference in mean total cost per QALY gained for MIS- versus open-TLIF was assessed as incremental cost-effectiveness ratio (ICER: COSTmis-COSTopen/QALYmis-QALYopen). MIS versus open-TLIF cohorts were similar at baseline. By two years postoperatively, patients undergoing MIS- versus open-TLIF reported similar mean QALYs gained (0.50 vs. 0.41, P=0.17). Mean total two-year cost of MIS- and open-TLIF was $35,996 and $44,727, respectively. The $8,731 two-year cost savings of MIS- versus open-TLIF did not reach statistical significance (P=0.18) for this sample size. Although our limited sample size prevented statistical significance, MIS- versus open-TLIF was associated with reduced costs over

  17. Minimally invasive surgical approaches for temporal lobe epilepsy

    Science.gov (United States)

    Chang, Edward F.; Englot, Dario J.; Vadera, Sumeet

    2016-01-01

    Surgery can be a highly effective treatment for medically refractory temporal lobe epilepsy (TLE). The emergence of minimally invasive resective and nonresective treatment options has led to interest in epilepsy surgery among patients and providers. Nevertheless, not all procedures are appropriate for all patients, and it is critical to consider seizure outcomes with each of these approaches, as seizure freedom is the greatest predictor of patient quality of life. Standard anterior temporal lobectomy (ATL) remains the gold standard in the treatment of TLE, with seizure freedom resulting in 60–80% of patients. It is currently the only resective epilepsy surgery supported by randomized controlled trials and offers the best protection against lateral temporal seizure onset. Selective amygdalohippocampectomy techniques preserve the lateral cortex and temporal stem to varying degrees and can result in favorable rates of seizure freedom but the risk of recurrent seizures appears slightly greater than with ATL, and it is not clear whether neuropsychological outcomes are improved with selective approaches. Stereotactic radiosurgery presents an opportunity to avoid surgery altogether, with seizure outcomes now under investigation. Stereotactic laser thermo-ablation allows destruction of the mesial temporal structures with low complication rates and minimal recovery time, and outcomes are also under study. Finally, while neuromodulatory devices such as responsive neurostimulation, vagus nerve stimulation, and deep brain stimulation have a role in the treatment of certain patients, these remain palliative procedures for those who are not candidates for resection or ablation, as complete seizure freedom rates are low. Further development and investigation of both established and novel strategies for the surgical treatment of TLE will be critical moving forward, given the significant burden of this disease. PMID:26017774

  18. Minimizing the Pacman effect

    International Nuclear Information System (INIS)

    Ritson, D.; Chou, W.

    1997-10-01

    The Pacman bunches will experience two deleterious effects: tune shift and orbit displacement. It is known that the tune shift can be compensated by arranging crossing planes 900 relative to each other at successive interaction points (lPs). This paper gives an analytical estimate of the Pacman orbit displacement for a single as well as for two crossings. For the latter, it can be minimized by using equal phase advances from one IP to another. In the LHC, this displacement is in any event small and can be neglected

  19. [The minimally invasive Chevron and Akin osteotomy (MICA)].

    Science.gov (United States)

    Altenberger, Sebastian; Kriegelstein, Stefanie; Gottschalk, Oliver; Dreyer, Florian; Mehlhorn, Alexander; Röser, Anke; Walther, Markus

    2018-04-18

    Percutaneous correction of a hallux valgus deformity with or without transfer metatarsalgia. Hallux valgus deformity up to 20° intermetatarsal angle, without instability of the first tarsometatarsal joint. Symptomatic arthritis of the first metatarsophalangeal joint, as well as instability of the first tarsometatarsal joint. Percutaneous performed osteotomy of the distal metatarsal 1 in combination with a medial closing wedge osteotomy of the proximal phalanx of the first toe. The use of a postoperative shoe with a rigid sole allows adapted weight bearing in the first 6 weeks. Active and passive mobilization can start immediately after surgery. The method is very effective to treat even severe deformities with or without metatarsalgia. The amount of correction is similar to open procedures. We recommend cadaver training to become familiar with this technique. Thus, complications such as nerve, vessel or tendon injuries can be avoided. The intraoperative radiation exposure remains significantly elevated even for experienced surgeons. In addition to the aesthetic benefits, there is less soft tissue traumatization compared to conventional open procedures. There is no need of bloodlessness. The minimally invasive Chevron and Akin osteotomy is a safe and powerful technique for the treatment of hallux valgus deformity.

  20. Navicular stress fractures treated with minimally invasive fixation

    Directory of Open Access Journals (Sweden)

    Korula Mani Jacob

    2013-01-01

    Early intervention with minimally invasive surgery has significantly less morbidity and a reliable early return to active sports and is therefore the best option in high-performance athletes. Materials and Methods: Nine athletes with ten stress fractures of the navicular treated at our institution between April 1991 and October 2000. The mean age of the patients was 22.8 years (range 18-50 years. All patients were treated by minimally invasive screw fixation and early weight bearing mobilization without a cast. The average followup was 7 years (range 2-11 years. Results: Seven of the nine patients returned to their pre-fracture level of sporting activity at an average of 5 months (range 3-9 months. One patient returned to full sporting activity following a delay of 2 years due to an associated tibial stress fracture and one patient had an unsatisfactory result. Long term review at an average of 7 years showed that six of these eight patients who returned to sports remained symptom free with two patients experiencing minimal intermittent discomfort after prolonged activity. Conclusions: We recommend percutaneous screw fixation as a reliable, low morbidity procedure allowing early return to full sporting activity without long term complications or recurrences.

  1. The production of audiovisual teaching tools in minimally invasive surgery.

    Science.gov (United States)

    Tolerton, Sarah K; Hugh, Thomas J; Cosman, Peter H

    2012-01-01

    Audiovisual learning resources have become valuable adjuncts to formal teaching in surgical training. This report discusses the process and challenges of preparing an audiovisual teaching tool for laparoscopic cholecystectomy. The relative value in surgical education and training, for both the creator and viewer are addressed. This audiovisual teaching resource was prepared as part of the Master of Surgery program at the University of Sydney, Australia. The different methods of video production used to create operative teaching tools are discussed. Collating and editing material for an audiovisual teaching resource can be a time-consuming and technically challenging process. However, quality learning resources can now be produced even with limited prior video editing experience. With minimal cost and suitable guidance to ensure clinically relevant content, most surgeons should be able to produce short, high-quality education videos of both open and minimally invasive surgery. Despite the challenges faced during production of audiovisual teaching tools, these resources are now relatively easy to produce using readily available software. These resources are particularly attractive to surgical trainees when real time operative footage is used. They serve as valuable adjuncts to formal teaching, particularly in the setting of minimally invasive surgery. Copyright © 2012 Association of Program Directors in Surgery. Published by Elsevier Inc. All rights reserved.

  2. Continuous minimally-invasive alcohol monitoring using microneedle sensor arrays.

    Science.gov (United States)

    Mohan, A M Vinu; Windmiller, Joshua Ray; Mishra, Rupesh K; Wang, Joseph

    2017-05-15

    The present work describes an attractive skin-worn microneedle sensing device for the minimally invasive electrochemical monitoring of subcutaneous alcohol. The device consists of an assembly of pyramidal microneedle structures integrated with Pt and Ag wires, each with a microcavity opening. The microneedle aperture was modified by electropolymerizing o-phenylene diamine onto the Pt wire microtransducer, followed by the immobilization of alcohol oxidase (AOx) in an intermediate chitosan layer, along with an outer Nafion layer. The resulting microneedle-based enzyme electrode displays an interference-free ethanol detection in artificial interstitial fluid without compromising its sensitivity, stability and response time. The skin penetration ability and the efficaciousness of the biosensor performance towards subcutaneous alcohol monitoring was substantiated by the ex vivo mice skin model analysis. Our results reveal that the new microneedle sensor holds considerable promise for continuous non-invasive alcohol monitoring in real-life situations. Copyright © 2017 Elsevier B.V. All rights reserved.

  3. Ergonomics of disposable handles for minimally invasive surgery.

    Science.gov (United States)

    Büchel, D; Mårvik, R; Hallabrin, B; Matern, U

    2010-05-01

    The ergonomic deficiencies of currently available minimally invasive surgery (MIS) instrument handles have been addressed in many studies. In this study, a new ergonomic pistol handle concept, realized as a prototype, and two disposable ring handles were investigated according to ergonomic properties set by new European standards. In this study, 25 volunteers performed four practical tasks to evaluate the ergonomics of the handles used in standard operating procedures (e.g., measuring a suture and cutting to length, precise maneuvering and targeting, and dissection of a gallbladder). Moreover, 20 participants underwent electromyography (EMG) tests to measure the muscle strain they experienced while carrying out the basic functions (grasp, rotate, and maneuver) in the x, y, and z axes. The data measured included the number of errors, the time required for task completion, perception of pressure areas, and EMG data. The values for usability in the test were effectiveness, efficiency, and user satisfaction. Surveys relating to the subjective rating were completed after each task for each of the three handles tested. Each handle except the new prototype caused pressure areas and pain. Extreme differences in muscle strain could not be observed for any of the three handles. Experienced surgeons worked more quickly with the prototype when measuring and cutting a suture (approximately 20%) and during precise maneuvering and targeting (approximately 20%). On the other hand, they completed the dissection task faster with the handle manufactured by Ethicon. Fewer errors were made with the prototype in dissection of the gallbladder. In contrast to the handles available on the market, the prototype was always rated as positive by the volunteers in the subjective surveys. None of the handles could fulfil all of the requirements with top scores. Each handle had its advantages and disadvantages. In contrast to the ring handles, the volunteers could fulfil most of the tasks more

  4. Surgical outcomes of early congenital cholesteatoma: minimally invasive transcanal approach.

    Science.gov (United States)

    Lee, Sang H; Jang, Jeong H; Lee, Dongjun; Lee, Hye-Ryung; Lee, Kyu-Yup

    2014-03-01

    To introduce a simple and alternative surgical technique, minimally invasive transcanal myringotomy (MITM), for early stage congenital cholesteatoma in children and to evaluate the feasibility and results of MITM for management of early stage congenital cholesteatoma with respect to its effectiveness and safety. Retrospective review. Between August 2008 and September 2012, a total of 36 patients with congenital cholesteatoma met the inclusion criteria and were analyzed. Patient medical records, including demographic characteristics, intraoperative findings, and follow-up records, were reviewed. Subjects consisted of 23 males (64%) and 13 females (36%), and the age at operation ranged from 12 months to 6 years (mean age = 3 years and 6 months). The number of congenital cholesteatoma was as follows: 26 patients at stage I and 10 patients at stage II. The follow-up duration was between 12 and 56 months, with an average of 30 months. There were no postoperative complications such as tympanic membrane perforation, dizziness, or secondary middle ear infection. Among 36 patients who had undergone the MITM approach for the treatment of congenital cholesteatoma, five (13.8%) showed recurrence and underwent a second-look operation. On the basis of our data, the MITM approach is a useful surgical technique for early stage congenital cholesteatoma in children. It has many advantages, in that there is no external wound and it is a simple surgical technique that involves easy postoperative care, a short operation time and hospitalization period, avoidance of serious complications, and easy repeatability for recurrence. © 2013 The American Laryngological, Rhinological and Otological Society, Inc.

  5. Minimally invasive distal pancreatectomy for PNETs: laparoscopic or robotic approach?

    Science.gov (United States)

    Zhang, Jiaqiang; Jin, Jiabin; Chen, Shi; Gu, Jiangning; Zhu, Yi; Qin, Kai; Zhan, Qian; Cheng, Dongfeng; Chen, Hao; Deng, Xiaxing; Shen, Baiyong; Peng, Chenghong

    2017-05-16

    The most effective and radical treatment for pancreatic neuroendocrine tumors (PNETs) is surgical resection. Minimally invasive surgery has been increasingly used in pancreatectomy. Initial results in robotic distal pancreatectomy (RDP) have been encouraging. Nonetheless, data comparing outcomes of RDP with those of laparoscopic distal pancreatectomy (LDP) in treating PNETs are rare. The aim of this study was to compare the safety and efficacy of RDP and LDP for PNETs. From September 2010 to January 2017, operative parameters and perioperative outcomes in an initial experience with 43 consecutive patients undergoing RDP were collected and compared with those in 31 patients undergoing LDP. Patients undergoing RDP and LDP demonstrated equivalent age, sex, ASA score, tumor location and tumor size. Operating time, length of resected pancreas, postoperative length of hospital stay and rates of conversion to open, pancreatic fistula, transfusion and reoperation were not statistically different. Patients in the RDP group were associated with significantly higher overall (79.1 vs. 48.4 %, P = 0.006) and Kimura spleen preservation rates (72.1 vs. 16.1%, P < 0.001) and had reduced risk of excessive blood loss (50 vs. 200mL, P < 0.001). Oncological outcomes in this series were superior for the RDP group with more lymph node harvest for G2 and G3 PNETs (3.5 vs. 2, P = 0.034). Both RDP and LDP are efficacious and safe methods in treating PNETs located in the body or tail of pancreas. Robotic approach offers advantages with less intraoperative blood loss, higher spleen preservation rate and more lymph node harvest. It may be sensible to choose RDP for patients who fit indications for scheduled spleen preservation.

  6. [Minimally invasive surgical therapy of gynecomastia: liposuction and exeresis technique].

    Science.gov (United States)

    Voigt, M; Walgenbach, K J; Andree, C; Bannasch, H; Looden, Z; Stark, G B

    2001-10-01

    A number of techniques are available for the correction of gynecomastia. Nonscarring sparing methods are preferred, and the minimally invasive technique is to use liposuction for the gland and the fatty tissue exclusively. In this retrospective study we present our experience with a combination of liposuction and subsequent resection of the remaining gland. Sixty-two patients (112 breasts) were surgically treated for gynecomastia from January 1996 and September 2000. From 1996 to 1997 all patients suffering from gynecomastia grade Simon I-II were treated by the method described by Rosenberg and Stark, which is exclusively suction of the fatty and glandular tissue. In a retrospective chart study a high recurrence rate was found in these patients. Subsequently we changed our technique to liposuction of the fatty tissue followed by sharp excision of the glandular tissue through the incision made for the liposuction cannula in the submammary fold. Suction alone was not sufficient to remove the glandular tissue; the rate of recurrence after suction was 35%. When sharp resection of the glandular tissue was carried out after the liposuction the recurrence rate dropped to under 10%. In total our complication rate was 50% including minor sequelae. The most frequent complication was unacceptable scarring of the nipple-areola complex. Hypesthesia of the nipple-areola occurred in 13.4% of the patients. The combination of liposuction and resection of the glandular tissue is a minimally invasive correction that can be used in all cases of gynecomastia grade Simon I-II.

  7. Coordinated Multiple Cadaver Use for Minimally Invasive Surgical Training

    Science.gov (United States)

    Blaschko, Sarah D.; Brooks, H. Mark; Dhuy, S. Michael; Charest-Shell, Cynthia; Clayman, Ralph V.

    2007-01-01

    Background: The human cadaver remains the gold standard for anatomic training and is highly useful when incorporated into minimally invasive surgical training programs. However, this valuable resource is often not used to its full potential due to a lack of multidisciplinary cooperation. Herein, we propose the coordinated multiple use of individual cadavers to better utilize anatomical resources and potentiate the availability of cadaver training. Methods: Twenty-two postgraduate surgeons participated in a robot-assisted surgical training course that utilized shared cadavers. All participants completed a Likert 4-scale satisfaction questionnaire after their training session. Cadaveric tissue quality and the quality of the training session related to this material were assessed. Results: Nine participants rated the quality of the cadaveric tissue as excellent, 7 as good, 5 as unsatisfactory, and 1 as poor. Overall, 72% of participants who operated on a previously used cadaver were satisfied with their training experience and did not perceive the previous use deleterious to their training. Conclusion: The coordinated use of cadavers, which allows for multiple cadaver use for different teaching sessions, is an excellent training method that increases availability of human anatomical material for minimally invasive surgical training. PMID:18237501

  8. Application of minimally invasive pancreatic surgery: an Italian survey.

    Science.gov (United States)

    Capretti, Giovanni; Boggi, Ugo; Salvia, Roberto; Belli, Giulio; Coppola, Roberto; Falconi, Massimo; Valeri, Andrea; Zerbi, Alessandro

    2018-05-16

    The value of minimally invasive pancreatic surgery (MIPS) is still debated. To assess the diffusion of MIPS in Italy and identify the barriers preventing wider implementation, a questionnaire was developed under the auspices of three Scientific Societies (AISP, It-IHPBA, SICE) and was sent to the largest possible number of Italian surgeons also using the mailing list of the two main Italian Surgical Societies (SIC and ACOI). The questionnaire consisted of 25 questions assessing: centre characteristics, facilities and technologies, type of MIPS performed, surgical techniques employed and opinions on the present and future value of MIPS. Only one reply per unit was considered. Fifty-five units answered the questionnaire. While 54 units (98.2%) declared to perform MIPS, the majority of responders were not dedicated to pancreatic surgery. Twenty-five units (45.5%) performed MIPS per year. Forty-nine units (89.1%) performed at least one minimally invasive (MI) distal pancreatectomy (DP), and 10 (18.2%) at least one MI pancreatoduodenectomy (PD). Robotic assistance was used in 18 units (31.7%) (14 DP, 7 PD). The major constraints limiting the diffusion of MIPS were the intrinsic difficulty of the technique and the lack of specific training. The overall value of MIPS was highly rated. Our survey illustrates the current diffusion of MIPS in Italy and underlines the great interest for this approach. Further diffusion of MIPS requires the implementation of standardized protocols of training. Creation of a prospective National Registry should also be considered.

  9. 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.

  10. [TECHNIQUES IN MITRAL VALVE REPAIR VIA A MINIMALLY INVASIVE APPROACH].

    Science.gov (United States)

    Ito, Toshiaki

    2016-03-01

    In mitral valve repair via a minimally invasive approach, resection of the leaflet is technically demanding compared with that in the standard approach. For resection and suture repair of the posterior leaflet, premarking of incision lines is recommended for precise resection. As an alternative to resection and suture, the leaflet-folding technique is also recommended. For correction of prolapse of the anterior leaflet, neochordae placement with the loop technique is easy to perform. Premeasurement with transesophageal echocardiography or intraoperative measurement using a replica of artificial chordae is useful to determine the appropriate length of the loops. Fine-tuning of the length of neochordae is possible by adding a secondary fixation point on the leaflet if the loop is too long. If the loop is too short, a CV5 Gore-Tex suture can be passed through the loop and loosely tied several times to stack the knots, with subsequent fixation to the edge of the leaflet. Finally, skill in the mitral valve replacement technique is necessary as a back-up for surgeons who perform minimally invasive mitral valve repair.

  11. A novel minimal invasive mouse model of extracorporeal circulation.

    Science.gov (United States)

    Luo, Shuhua; Tang, Menglin; Du, Lei; Gong, Lina; Xu, Jin; Chen, Youwen; Wang, Yabo; Lin, Ke; An, Qi

    2015-01-01

    Extracorporeal circulation (ECC) is necessary for conventional cardiac surgery and life support, but it often triggers systemic inflammation that can significantly damage tissue. Studies of ECC have been limited to large animals because of the complexity of the surgical procedures involved, which has hampered detailed understanding of ECC-induced injury. Here we describe a minimally invasive mouse model of ECC that may allow more extensive mechanistic studies. The right carotid artery and external jugular vein of anesthetized adult male C57BL/6 mice were cannulated to allow blood flow through a 1/32-inch external tube. All animals (n = 20) survived 30 min ECC and subsequent 60 min observation. Blood analysis after ECC showed significant increases in levels of tumor necrosis factor α, interleukin-6, and neutrophil elastase in plasma, lung, and renal tissues, as well as increases in plasma creatinine and cystatin C and decreases in the oxygenation index. Histopathology showed that ECC induced the expected lung inflammation, which included alveolar congestion, hemorrhage, neutrophil infiltration, and alveolar wall thickening; in renal tissue, ECC induced intracytoplasmic vacuolization, acute tubular necrosis, and epithelial swelling. Our results suggest that this novel, minimally invasive mouse model can recapitulate many of the clinical features of ECC-induced systemic inflammatory response and organ injury.

  12. A Novel Minimal Invasive Mouse Model of Extracorporeal Circulation

    Directory of Open Access Journals (Sweden)

    Shuhua Luo

    2015-01-01

    Full Text Available Extracorporeal circulation (ECC is necessary for conventional cardiac surgery and life support, but it often triggers systemic inflammation that can significantly damage tissue. Studies of ECC have been limited to large animals because of the complexity of the surgical procedures involved, which has hampered detailed understanding of ECC-induced injury. Here we describe a minimally invasive mouse model of ECC that may allow more extensive mechanistic studies. The right carotid artery and external jugular vein of anesthetized adult male C57BL/6 mice were cannulated to allow blood flow through a 1/32-inch external tube. All animals (n=20 survived 30 min ECC and subsequent 60 min observation. Blood analysis after ECC showed significant increases in levels of tumor necrosis factor α, interleukin-6, and neutrophil elastase in plasma, lung, and renal tissues, as well as increases in plasma creatinine and cystatin C and decreases in the oxygenation index. Histopathology showed that ECC induced the expected lung inflammation, which included alveolar congestion, hemorrhage, neutrophil infiltration, and alveolar wall thickening; in renal tissue, ECC induced intracytoplasmic vacuolization, acute tubular necrosis, and epithelial swelling. Our results suggest that this novel, minimally invasive mouse model can recapitulate many of the clinical features of ECC-induced systemic inflammatory response and organ injury.

  13. Minimally invasive tension band wiring technique for olecranon fractures.

    Science.gov (United States)

    Takada, Naoya; Kato, Kenji; Fukuta, Makoto; Wada, Ikuo; Otsuka, Takanobu

    2013-12-01

    Some types of implants, such as plates, screws, wires, and nails, have been used for open reduction and internal fixation of olecranon fractures. A ≥ 10 cm longitudinal incision is used for open reduction and internal fixation of olecranon fractures. According to previous studies, tension band wiring is a popular method that gives good results. However, back out of the wires after the surgery is one of the main postoperative complications. Moreover, if the Kirschner wires are inserted through the anterior ulnar cortex, they may impinge on the radial neck, supinator muscle, or biceps tendon. Herein, we describe the minimally invasive tension band wiring technique using Ring-Pin. This technique can be performed through a 2 cm incision. Small skin incisions are advantageous from an esthetic viewpoint. Ring-Pin was fixed by using a dedicated cable wire that does not back out unless the cable wire breaks or slips out of the dedicated metallic clamp. As the pins are placed in intramedullary canal, this technique does not lead to postoperative complications that may occur after transcortical fixation by conventional tension band wiring. Minimally invasive tension band wiring is one of the useful options for the treatment of olecranon fractures with some advantages.

  14. Confocal fluorescence microscopy for minimal-invasive tumor diagnosis

    International Nuclear Information System (INIS)

    Zenzinger, M.; Bille, J.

    2000-01-01

    The goal of the project ''stereotactic laser-neurosurgery'' is the development of a system for careful and minimal-invasive resection of brain tumors with ultrashort laser pulses through a thin probe. A confocal laser-scanning-microscope is integrated in the probe. In this paper, the simulation of its optical properties by a laboratory setup and the expansion by the ability for fluorescence microscopy are reported. For a valuation of the imaging properties, the point-spread-function in three dimensions and the axial depth-transfer-function were measured and thus, among other things, the resolving power and the capacity for depth discrimination were analysed. The microscope will enable intra-operative detection of tumor cells by the method of immunofluorescence. As a first model of the application in the brain, cell cultures, that fluorescein-labelled antibodies were bound to specifically, were used in this work. Due to the fluorescence signal, it was possible to detect and identify clearly the areas that had been marked in this manner, proving the suitability of the setup for minimal-invasive tumor diagnosis. (orig.)

  15. Minimally invasive redo mitral valve surgery without aortic crossclamp.

    Science.gov (United States)

    Milani, Rodrigo; Brofman, Paulo Roberto Slud; Oliveira, Sergio; Patrial Neto, Luiz; Rosa, Matheus; Lima, Victor Hugo; Binder, Luis Fernando; Sanches, Aline

    2013-01-01

    Reoperations of the mitral valve have a higher rate of complications when compared with the first surgery. With the field of video-assisted techniques for the first surgery of mitral valve became routine, reoperation cases began to arouse interest for this less invasive procedures. To assess the results and the technical difficulties in 10 patients undergoing minimally invasive redo mitral valve surgery. Cardiopulmonary bypass was installed through a cannula placed in the femoral vessels and right internal jugular vein, conducted in 28 degrees of temperature in ventricular fibrillation. A right lateral thoracotomy with 5 to 6 cm in the third or fourth intercostal space was done, pericardium was displaced only at the point of atriotomy. The aorta was not clamped. Ten patients with mean age of 56.9 ± 10.5 years, four were in atrial fibrilation rhythm and six in sinusal. Average time between first operation and reoperations was 11 ± 3.43 years. The mean EuroSCORE group was 8.3 ± 1.82. The mean ventricular fibrillation and cardiopulmonary bypass was respectively 70.9 ± 17.66 min and 109.4 ± 25.37 min. The average length of stay was 7.6 ± 1.5 days. There were no deaths in this series. Mitral valve reoperation can be performed through less invasive techniques with good immediate results, low morbidity and mortality. However, this type of surgery requires a longer duration of cardiopulmonary bypass, especially in cases where the patient already has prosthesis. The presence of a minimal aortic insufficiency also makes this procedure technically more challenging.

  16. Management of mediastinal parathyroid adenoma via minimally invasive thoracoscopic surgery: Case report

    Directory of Open Access Journals (Sweden)

    Saulat Hasnain Fatimi

    2017-01-01

    Conclusion: Symptomatic hypercalcemia and high level of PTH without local PA should alert physicians to search for ectopic locations through imaging. VATS is a safe and effective minimally invasive procedure for the resection of ectopic mediastinal PA and it should be considered as the first line approach for resection of these ectopic tumors.

  17. Impact of minimally invasive surgery on medical spending and employee absenteeism.

    Science.gov (United States)

    Epstein, Andrew J; Groeneveld, Peter W; Harhay, Michael O; Yang, Feifei; Polsky, Daniel

    2013-07-01

    As many surgical procedures have undergone a transition from a standard, open surgical approach to a minimally invasive one in the past 2 decades, the diffusion of minimally invasive surgery may have had sizeable but overlooked effects on medical expenditures and worker productivity. To examine the impact of standard vs minimally invasive surgery on health plan spending and workplace absenteeism for 6 types of surgery. Cross-sectional regression analysis. National health insurance claims data and matched workplace absenteeism data from January 1, 2000, to December 31, 2009. A convenience sample of adults with employer-sponsored health insurance who underwent either standard or minimally invasive surgery for coronary revascularization, uterine fibroid resection, prostatectomy, peripheral revascularization, carotid revascularization, or aortic aneurysm repair. Health plan spending and workplace absenteeism from 14 days before through 352 days after the index surgery. There were 321,956 patients who underwent surgery; 23,814 were employees with workplace absenteeism data. After multivariable adjustment, mean health plan spending was lower for minimally invasive surgery for coronary revascularization (-$30,850; 95% CI, -$31,629 to -$30,091), uterine fibroid resection (-$1509; 95% CI, -$1754 to -$1280), and peripheral revascularization (-$12,031; 95% CI, -$15,552 to -$8717) and higher for prostatectomy ($1350; 95% CI, $611 to $2212) and carotid revascularization ($4900; 95% CI, $1772 to $8370). Undergoing minimally invasive surgery was associated with missing significantly fewer days of work for coronary revascularization (mean difference, -37.7 days; 95% CI, -41.1 to -34.3), uterine fibroid resection (mean difference, -11.7 days; 95% CI, -14.0 to -9.4), prostatectomy (mean difference, -9.0 days; 95% CI, -14.2 to -3.7), and peripheral revascularization (mean difference, -16.6 days; 95% CI, -28.0 to -5.2). For 3 of 6 types of surgery studied, minimally invasive

  18. 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.

  19. First Robotic SPECT for Minimally Invasive Sentinel Lymph Node Mapping.

    Science.gov (United States)

    Fuerst, Bernhard; Sprung, Julian; Pinto, Francisco; Frisch, Benjamin; Wendler, Thomas; Simon, Hervé; Mengus, Laurent; van den Berg, Nynke S; van der Poel, Henk G; van Leeuwen, Fijs W B; Navab, Nassir

    2016-03-01

    In this paper we present the usage of a drop-in gamma probe for intra-operative Single-Photon Emission Computed Tomography (SPECT) imaging in the scope of minimally invasive robot-assisted interventions. The probe is designed to be inserted and reside inside the abdominal cavity during the intervention. It is grasped during the procedure using a robotic laparoscopic gripper enabling full six degrees of freedom handling by the surgeon. We demonstrate the first deployment of the tracked probe for intra-operative in-patient robotic SPECT enabling augmented-reality image guidance. The hybrid mechanical- and image-based in-patient probe tracking is shown to have an accuracy of 0.2 mm. The overall system performance is evaluated and tested with a phantom for gynecological sentinel lymph node interventions and compared to ground-truth data yielding a mean reconstruction accuracy of 0.67 mm.

  20. 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.)

  1. Interventional MRI of the breast: minimally invasive therapy

    International Nuclear Information System (INIS)

    Hall-Craggs, M.A.

    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.)

  2. The Top 50 Articles on Minimally Invasive Spine Surgery.

    Science.gov (United States)

    Virk, Sohrab S; Yu, Elizabeth

    2017-04-01

    Bibliometric study of current literature. To catalog the most important minimally invasive spine (MIS) surgery articles using the amount of citations as a marker of relevance. MIS surgery is a relatively new tool used by spinal surgeons. There is a dynamic and evolving field of research related to MIS techniques, clinical outcomes, and basic science research. To date, there is no comprehensive review of the most cited articles related to MIS surgery. A systematic search was performed over three widely used literature databases: Web of Science, Scopus, and Google Scholar. There were four searches performed using the terms "minimally invasive spine surgery," "endoscopic spine surgery," "percutaneous spinal surgery," and "lateral interbody surgery." The amount of citations included was averaged amongst the three databases to rank each article. The query of the three databases was performed in November 2015. Fifty articles were selected based upon the amount of citations each averaged amongst the three databases. The most cited article was titled "Extreme Lateral Interbody Fusion (XLIF): a novel surgical technique for anterior lumbar interbody fusion" by Ozgur et al and was credited with 447, 239, and 279 citations in Google Scholar, Web of Science, and Scopus, respectively. Citations ranged from 27 to 239 for Web of Science, 60 to 279 for Scopus, and 104 to 462 for Google Scholar. There was a large variety of articles written spanning over 14 different topics with the majority dealing with clinical outcomes related to MIS surgery. The majority of the most cited articles were level III and level IV studies. This is likely due to the relatively recent nature of technological advances in the field. Furthermore level I and level II studies are required in MIS surgery in the years ahead. 5.

  3. Minimally Invasive Distal Pancreatectomy: Review of the English Literature.

    Science.gov (United States)

    Wang, Kai; Fan, Ying

    2017-02-01

    Recently, the superiority of the minimally invasive approach, which results in a better cosmetic result, faster recovery, and shorter length of hospital stay, is a technique that has been progressively recognized as it has developed. And the minimally invasive approach has been applied to distal pancreatectomy (DP), which is a standard method for the treatment of benign, borderline, and part of malignant lesions of the pancreatic body and tail. This article aims to analyze the types, postoperative recovery, and outcomes of laparoscopic distal pancreatectomy (LDP). A systematic search of the scientific literature was performed using PubMed, EMBASE, online journals, and the Internet for all publications on LDP. Articles were selected if the abstract contained patients who underwent LDP for pancreatic diseases. All selected articles were reviewed and analyzed. If there were no contraindications for LDP, this operation is suitable for benign, borderline, or malignant tumors of the pancreatic body and tail, which should try to be performed with preservation of the spleen. LDP is safe and feasible under some conditions to experienced surgeon. Single-incision laparoscopic distal pancreatectomy (S-LDP) and robotic laparoscopic distal pancreatectomy (R-LDP) perioperative outcomes are similar with conventional multi-incision laparoscopic distal pancreatectomy (C-LDP). And the advantages of S-LDP and R-LDP require further exploration. With the application of enhanced recovery program (ERP), length of hospital stay and costs are reduced. LDP is safe and feasible under some conditions. Compared with open distal pancreatectomy, LDP has a lot of advantages; a trend was observed for LDP to replace traditional open surgery. LDP combined with ERP is expected to become standard in the treatment of pancreatic body and tail lesions.

  4. Minimally invasive surgery in the treatment of esophageal cancer

    International Nuclear Information System (INIS)

    Janik, M.; Lucenic, M.; Juhos, P.; Harustiak, S.

    2016-01-01

    Esophageal cancer represents the sixth most common cause of the death caused by malignant diseases. The incidence is 11.5/100 000 in men population and 4.7/100 000 in women. It is the eighth most common malignancy. The incidence grows up, it doubled in Slovakia in last period and 5-year survival is only 18 %. Esophagectomy is a huge burden for organism. Mortality varies from 8.1 % to 23 % in low-volume departments in comparison with high-volume centres, where it is lower then 5 %. Complications range after operations is 30 – 80 %. Minimally invasive approach leads to the reduction of mortality and morbidity according to lot of studies. We performed 121 esophagectomies in cancer in period 2010 – 2015 and in 2015 it was 32 operations. We performed 29 totally minimally invasive esophagectomies, 16 hybrid MIE and 66 open esophagectomies. The chylothorax occurs twice, we managed it by surgery. The anastomotic dehiscence represents 9.09 %. Cardiovascular system complications occur in 43 %, need for vasopressors caused by hypotensia was in 44 %. It concluded from that we started with restrictive management of patients during the operation and need for vasopressors last only for two days after the operation and did not cause renal failure or any other complications.30 days mortality was related to MODS evolved by sepsis caused by pneumonia, most common in cirrhotic patients in very poor condition. Tracheoneoesophageal fistula occur in three patients, they all underwent operation, one of them died because of severe pneumonia. We recorded grow number of patient in our institution, which is probably related to better cooperation with gastroenterologists all over Slovakia. (author)

  5. 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.

  6. Minimally invasive treatment of hepatic adenoma in special cases

    International Nuclear Information System (INIS)

    Nasser, Felipe; Affonso, Breno Boueri; Galastri, Francisco Leonardo; Odisio, Bruno Calazans; Garcia, Rodrigo Gobbo

    2013-01-01

    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

  7. Microhook ab interno trabeculotomy, a novel minimally invasive glaucoma surgery

    Directory of Open Access Journals (Sweden)

    Tanito M

    2017-12-01

    Full Text Available Masaki Tanito Division of Ophthalmology, Matsue Red Cross Hospital, Matsue, Japan Abstract: Trabeculotomy (LOT is performed to reduce the intraocular pressure in patients with glaucoma, both in children and adults. It relieves the resistance to aqueous flow by cleaving the trabecular meshwork and the inner walls of Schlemm’s canal. Microhook ab interno LOT (µLOT, a novel minimally invasive glaucoma surgery, incises trabecular meshwork using small hooks that are inserted through corneal side ports. An initial case series reported that both µLOT alone and combination of µLOT and cataract surgery normalize the intraocular pressure during the early postoperative period in Japanese patients with glaucoma. Microhook can incise the inner wall of Schlemm’s canal without damaging its outer wall easier than the regular straight knife that is used during goniotomy. Advantages of µLOT include: a wider extent of LOT (two-thirds of the circumference, a simpler surgical technique, being less invasiveness to the ocular surface, a shorter surgical time than traditional ab externo LOT, and no requirement for expensive devices. In this paper, the surgical technique of µLOT and tips of the technique are introduced. Keywords: trabecular meshwork, Schlemm’s canal, intraocular pressure, surgical procedure, glaucoma

  8. Theory of invasion extinction dynamics in minimal food webs

    Science.gov (United States)

    Haerter, Jan O.; Mitarai, Namiko; Sneppen, Kim

    2018-02-01

    When food webs are exposed to species invasion, secondary extinction cascades may be set off. Although much work has gone into characterizing the structure of food webs, systematic predictions on their evolutionary dynamics are still scarce. Here we present a theoretical framework that predicts extinctions in terms of an alternating sequence of two basic processes: resource depletion by or competitive exclusion between consumers. We first propose a conceptual invasion extinction model (IEM) involving random fitness coefficients. We bolster this IEM by an analytical, recursive procedure for calculating idealized extinction cascades after any species addition and simulate the long-time evolution. Our procedure describes minimal food webs where each species interacts with only a single resource through the generalized Lotka-Volterra equations. For such food webs ex- tinction cascades are determined uniquely and the system always relaxes to a stable steady state. The dynamics and scale invariant species life time resemble the behavior of the IEM, and correctly predict an upper limit for trophic levels as observed in the field.

  9. Minimally invasive trans-portal resection of deep intracranial lesions.

    Science.gov (United States)

    Raza, S M; Recinos, P F; Avendano, J; Adams, H; Jallo, G I; Quinones-Hinojosa, A

    2011-02-01

    The surgical management of deep intra-axial lesions still requires microsurgical approaches that utilize retraction of deep white matter to obtain adequate visualization. We report our experience with a new tubular retractor system, designed specifically for intracranial applications, linked with frameless neuronavigation for a cohort of intraventricular and deep intra-axial tumors. The ViewSite Brain Access System (Vycor, Inc) was used in a series of 9 adult and pediatric patients with a variety of pathologies. Histological diagnoses either resected or biopsied with the system included: colloid cyst, DNET, papillary pineal tumor, anaplastic astrocytoma, toxoplasmosis and lymphoma. The locations of the lesions approached include: lateral ventricle, basal ganglia, pulvinar/posterior thalamus and insular cortex. Post-operative imaging was assessed to determine extent of resection and extent of white matter damage along the surgical trajectory (based on T (2)/FLAIR and diffusion restriction/ADC signal). Satisfactory resection or biopsy was obtained in all patients. Radiographic analysis demonstrated evidence of white matter damage along the surgical trajectory in one patient. None of the patients experienced neurological deficits as a result of white matter retraction/manipulation. Based on a retrospective review of our experience, we feel that this access system, when used in conjunction with frameless neuronavigational systems, provides adequate visualization for tumor resection while permitting the use of standard microsurgical techniques through minimally invasive craniotomies. Our initial data indicate that this system may minimize white matter injury, but further studies are necessary. © Georg Thieme Verlag KG Stuttgart · New York.

  10. A comparative analysis of minimally invasive and open spine surgery patient education resources.

    Science.gov (United States)

    Agarwal, Nitin; Feghhi, Daniel P; Gupta, Raghav; Hansberry, David R; Quinn, John C; Heary, Robert F; Goldstein, Ira M

    2014-09-01

    The Internet has become a widespread source for disseminating health information to large numbers of people. Such is the case for spine surgery as well. Given the complexity of spinal surgeries, an important point to consider is whether these resources are easily read and understood by most Americans. The average national reading grade level has been estimated to be at about the 7th grade. In the present study the authors strove to assess the readability of open spine surgery resources and minimally invasive spine surgery resources to offer suggestions to help improve the readability of patient resources. Online patient education resources were downloaded in 2013 from 50 resources representing either traditional open back surgery or minimally invasive spine surgery. Each resource was assessed using 10 scales from Readability Studio Professional Edition version 2012.1. Patient education resources representing traditional open back surgery or minimally invasive spine surgery were all found to be written at a level well above the recommended 6th grade level. In general, minimally invasive spine surgery materials were written at a higher grade level. The readability of patient education resources from spine surgery websites exceeds the average reading ability of an American adult. Revisions may be warranted to increase quality and patient comprehension of these resources to effectively reach a greater patient population.

  11. 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. Copyright 2013, SLACK Incorporated.

  12. Minimally Invasive Distal Metatarsal Osteotomy for Mild-to-Moderate Hallux Valgus Deformity

    Directory of Open Access Journals (Sweden)

    Yu-Chuan Lin

    2009-08-01

    Full Text Available Minimally invasive surgery has recently been introduced for foot and ankle surgery, and hallux valgus surgery is no exception. The purpose of our study was to analyze the early results and to present our experience of minimally invasive distal metatarsal osteotomy in correcting mild-to-moderate hallux valgus deformities. Between September 2005 and December 2006, 31 consecutive patients (47 feet with mild-to-moderate hallux valgus deformities underwent minimally invasive distal metatarsal osteotomies. The clinical and radiographic outcomes were assessed. The satisfaction rate was 90.32%. The mean total American Orthopedic Foot and Ankle Society halluxmetatarsophalangeal-interphalangeal scale was 92.7 points. Complications included two (4.26% episodes of stiffness, six (12.77% episodes of pin tract infection, and one (2.13% deep infection. There were no cases with nonunion, malunion, overcorrection, transfer metatarsalgia or osteonecrosis. On weight-bearing anteroposterior foot radiographs, the mean hallux valgus angle and first intermetatarsal angle corrections were 11.8° and 6.3°, respectively, which is a statistically significant difference (p < 0.001 between the preoperative and postoperative status. Here, minimally invasive distal metatarsal osteotomy was associated with good satisfaction, functional improvement and low complication rates. This technique offers an effective, safe and simple way to treat hallux valgus with a first intermetatarsal angle less than 15°.

  13. 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.

  14. Myocardial Protection and Financial Considerations of Custodiol Cardioplegia in Minimally Invasive and Open Valve Surgery.

    Science.gov (United States)

    Hummel, Brian W; Buss, Randall W; DiGiorgi, Paul L; Laviano, Brittany N; Yaeger, Nalani A; Lucas, M Lee; Comas, George M

    Single-dose antegrade crystalloid cardioplegia with Custodiol-HTK (histidine-tryptophan-ketoglutarate) has been used for many years. Its safety and efficacy were established in experimental and clinical studies. It is beneficial in complex valve surgery because it provides a long period of myocardial protection with a single dose. Thus, valve procedures (minimally invasive or open) can be performed with limited interruption. The aim of this study is to compare the use of Custodiol-HTK cardioplegia with traditional blood cardioplegia in patients undergoing minimally invasive and open valve surgery. A single-institution, retrospective case-control review was performed on patients who underwent valve surgery in Lee Memorial Health System at either HealthPark Medical Center or Gulf Coast Medical Center from July 1, 2011, through March 7, 2015. A total of 181 valve cases (aortic or mitral) performed using Custodiol-HTK cardioplegia were compared with 181 cases performed with traditional blood cardioplegia. Each group had an equal distribution of minimally invasive and open valve cases. Right chest thoracotomy or partial sternotomy was performed on minimally invasive valve cases. Demographics, perioperative data, clinical outcomes, and financial data were collected and analyzed. Patient outcomes were superior in the Custodiol-HTK cardioplegia group for blood transfusion, stroke, and hospital readmission within 30 days (P < 0.05). No statistical differences were observed in the other outcomes categories. Hospital charges were reduced on average by $3013 per patient when using Custodiol-HTK cardioplegia. Use of Custodiol-HTK cardioplegia is safe and cost-effective when compared with traditional repetitive blood cardioplegia in patients undergoing minimally invasive and open valve surgery.

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

    Directory of Open Access Journals (Sweden)

    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.

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

    Directory of Open Access Journals (Sweden)

    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

  17. Minimally invasive facial rejuvenation endolaser mid-face lift.

    Science.gov (United States)

    Badin, A Z; Casagrande, C; Roberts, T; Saltz, R; Moraes, L M; Santiago, M; Chiaratti, M G

    2001-01-01

    Endolaser mid-face lift was performed on patients in a multi-center study over a 36-month period (Feb. 1998 to Feb. 2001). It permits significant facial rejuvenation through small incisions. This technique achieves aesthetic results and wider rejuvenation while being less traumatic and creating minimal morbidity. Combined with other procedures, it rejuvenates the face by three strategic methods: soft tissue suspension, reversal of photo aging, and correction of the depletion of volume. To achieve this triple result, the mid-face lift is performed by endoscopic approach, and in every case is combined with the endoscopic lift of the frontal area. Laser resurfacing was used to reverse skin photo damage. The Ultrapulse CO2 laser and/or the Ultrafine Erbium YAG(Coherent, Inc, Palo Alto, CA) were used. The third combined procedure was the introduction of fat graft to compensate the atrophy/ptosis of fat and the depletion of bone mass (other filling materials besides fat may be used, depending on the preference of the surgeon). Our method of fixation using the Casagrande Needle (an evolution of Reverdin Needle) makes the mechanical purchase on the tissues to be suspended much easier, permitting the intra-oral and/or infra-orbital incisions to be eliminated. The present study of the technical evolution of the endolaser mid-face lift method allows us to conclude that a very satisfactory outcome has been reached, offering patients a minimally invasive procedure, which can be performed under local anesthesia, with low morbidity, imperceptible incisions, and an excellent long-term result.

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

    Directory of Open Access Journals (Sweden)

    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.

  19. Application of Minimally Invasive Treatment of Locking Compression Plate in Schatzker Ⅰ-Ⅲ Tibial Plateau Fracture

    OpenAIRE

    Guohui Zhao

    2014-01-01

    Objective: To investigate the clinical effect of minimally invasive treatment of locking compression plate (LCP) in Schatzker Ⅰ-Ⅲ tibial plateau fracture. Methods: Thirty-eight patients with Schatzker Ⅰ-Ⅲ tibial 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 efficacy were observed. Results: All patients were followed-up for 14- 20 months, and the...

  20. 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.

  1. Development of a medical robot system for minimally invasive surgery.

    Science.gov (United States)

    Feng, Mei; Fu, Yili; Pan, Bo; Liu, Chang

    2012-03-01

    Robot-assisted systems have been widely used in minimally invasive surgery (MIS) practice, and with them the precision and accuracy of surgical procedures can be significantly improved. Promoting the development of robot technology in MIS will improve robot performance and help in tackling problems from complex surgical procedures. A medical robot system with a new mechanism for MIS was proposed to achieve a two-dimensional (2D) remote centre of motion (RCM). An improved surgical instrument was designed to enhance manipulability and eliminate the coupling motion between the wrist and the grippers. The control subsystem adopted a master-slave control mode, upon which a new method with error compensation of repetitive feedback can be based for the inverse kinematics solution. A unique solution with less computation and higher satisfactory accuracy was also obtained. Tremor filtration and trajectory planning were also addressed with regard to the smoothness of the surgical instrument movement. The robot system was tested on pigs weighing 30-45 kg. The experimental results show that the robot can successfully complete a cholecystectomy and meet the demands of MIS. The results of the animal experiments were excellent, indicating a promising clinical application of the robot with high manipulability. Copyright © 2011 John Wiley & Sons, Ltd.

  2. Augmented reality-assisted bypass surgery: embracing minimal invasiveness.

    Science.gov (United States)

    Cabrilo, Ivan; Schaller, Karl; Bijlenga, Philippe

    2015-04-01

    The overlay of virtual images on the surgical field, defined as augmented reality, has been used for image guidance during various neurosurgical procedures. Although this technology could conceivably address certain inherent problems of extracranial-to-intracranial bypass procedures, this potential has not been explored to date. We evaluate the usefulness of an augmented reality-based setup, which could help in harvesting donor vessels through their precise localization in real-time, in performing tailored craniotomies, and in identifying preoperatively selected recipient vessels for the purpose of anastomosis. Our method was applied to 3 patients with Moya-Moya disease who underwent superficial temporal artery-to-middle cerebral artery anastomoses and 1 patient who underwent an occipital artery-to-posteroinferior cerebellar artery bypass because of a dissecting aneurysm of the vertebral artery. Patients' heads, skulls, and extracranial and intracranial vessels were segmented preoperatively from 3-dimensional image data sets (3-dimensional digital subtraction angiography, angio-magnetic resonance imaging, angio-computed tomography), and injected intraoperatively into the operating microscope's eyepiece for image guidance. In each case, the described setup helped in precisely localizing donor and recipient vessels and in tailoring craniotomies to the injected images. The presented system based on augmented reality can optimize the workflow of extracranial-to-intracranial bypass procedures by providing essential anatomical information, entirely integrated to the surgical field, and help to perform minimally invasive procedures. Copyright © 2015 Elsevier Inc. All rights reserved.

  3. Miniature fibre optic probe for minimally invasive photoacoustic sensing

    Science.gov (United States)

    Mathews, Sunish J.; Zhang, Edward Z.; Desjardins, Adrien E.; Beard, Paul C.

    2016-03-01

    A miniature (175 μm) all-optical photoacoustic probe has been developed for minimally invasive sensing and imaging applications. The probe comprises a single optical fibre which delivers the excitation light and a broadband 50 MHz Fabry-Pérot (F-P) ultrasound sensor at the distal end for detecting the photoacoustic waves. A graded index lens proximal to the F-P sensor is used to reduce beam walk-off and thus increase sensitivity as well as confine the excitation beam in order to increase lateral spatial resolution. The probe was evaluated in non-scattering media and found to provide lateral and axial resolutions of < 100 μm and < 150 μm respectively for distances up to 1 cm from the tip of the probe. The ability of the probe to detect a blood vessel mimicking phantom at distances up to 7 mm from the tip was demonstrated in order to illustrate its potential suitability for needle guidance applications.

  4. Comparison of 3 Minimally Invasive Methods for Distal Tibia Fractures.

    Science.gov (United States)

    Fang, Jun-Hao; Wu, Yao-Sen; Guo, Xiao-Shan; Sun, Liao-Jun

    2016-07-01

    This study compared the results of external fixation combined with limited open reduction and internal fixation (EF + LORIF), minimally invasive percutaneous plate osteosynthesis (MIPPO), and intramedullary nailing (IMN) for distal tibia fractures. A total of 84 patients with distal tibia shaft fractures were randomized to operative stabilization using EF + LORIF (28 cases), MIPPO (28 cases), or IMN (28 cases). The 3 groups were comparable with respect to patient demographics. Data were collected on operative time and radiation time, union time, complications, time of recovery to work, secondary operations, and measured joint function using the American Orthopaedic Foot and Ankle Society (AOFAS) score. There was no significant difference in time to union, incidence of union status, time of recovery to work, and AOFAS scores among the 3 groups (P>.05). Mean operative time and radiation time in the MIPPO group were longer than those in the IMN or EF + LORIF groups (Pknee pain occurred frequently after IMN (32.1%), and irritation symptoms were encountered more frequently after MIPPO (46.4%). Although EF + LORIF was associated with fewer secondary procedures vs MIPPO or IMN, it was related with more pin-tract infections (14.3%). Findings indicated that EF + LORIF, MIPPO, and IMN all achieved similar good functional results. However, EF + LORIF had some advantages over MIPPO and IMN in reducing operative and radiation times, postoperative complications, and reoperation rate. [Orthopedics. 2016; 39(4):e627-e633.]. Copyright 2016, SLACK Incorporated.

  5. Update on Minimally Invasive Glaucoma Surgery (MIGS and New Implants

    Directory of Open Access Journals (Sweden)

    Lívia M. Brandão

    2013-01-01

    Full Text Available Traditional glaucoma surgery has been challenged by the advent of innovative techniques and new implants in the past few years. There is an increasing demand for safer glaucoma surgery offering patients a timely surgical solution in reducing intraocular pressure (IOP and improving their quality of life. The new procedures and devices aim to lower IOP with a higher safety profile than fistulating surgery (trabeculectomy/drainage tubes and are collectively termed “minimally invasive glaucoma surgery (MIGS.” The main advantage of MIGS is that they are nonpenetrating and/or bleb-independent procedures, thus avoiding the major complications of fistulating surgery related to blebs and hypotony. In this review, the clinical results of the latest techniques and devices are presented by their approach, ab interno (trabeculotomy, excimer laser trabeculotomy, trabecular microbypass, suprachoroidal shunt, and intracanalicular scaffold and ab externo (canaloplasty, Stegmann Canal Expander, suprachoroidal Gold microshunt. The drawback of MIGS is that some of these procedures produce a limited IOP reduction compared to trabeculectomy. Currently, MIGS is performed in glaucoma patients with early to moderate disease and preferably in combination with cataract surgery.

  6. 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

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

    Science.gov (United States)

    Vigneswaran, Yalini; Ujiki, Michael B

    2015-01-01

    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. PMID:26468336

  8. A highly articulated robotic surgical system for minimally invasive surgery.

    Science.gov (United States)

    Ota, Takeyoshi; Degani, Amir; Schwartzman, David; Zubiate, Brett; McGarvey, Jeremy; Choset, Howie; Zenati, Marco A

    2009-04-01

    We developed a novel, highly articulated robotic surgical system (CardioARM) to enable minimally invasive intrapericardial therapeutic delivery through a subxiphoid approach. We performed preliminary proof of concept studies in a porcine preparation by performing epicardial ablation. CardioARM is a robotic surgical system having an articulated design to provide unlimited but controllable flexibility. The CardioARM consists of serially connected, rigid cyclindrical links housing flexible working ports through which catheter-based tools for therapy and imaging can be advanced. The CardioARM is controlled by a computer-driven, user interface, which is operated outside the operative field. In six experimental subjects, the CardioARM was introduced percutaneously through a subxiphoid access. A commercial 5-French radiofrequency ablation catheter was introduced through the working port, which was then used to guide deployment. In all subjects, regional ("linear") left atrial ablation was successfully achieved without complications. Based on these preliminary studies, we believe that the CardioARM promises to enable deployment of a number of epicardium-based therapies. Improvements in imaging techniques will likely facilitate increasingly complex procedures.

  9. Minimally invasive breast surgery: vacuum-assisted core biopsy

    Directory of Open Access Journals (Sweden)

    A. V. Goncharov

    2017-01-01

    Full Text Available Fibrocystic breast disease is diagnosed in 20 % of women. Morphological verification of breast lumps is an important part of monitoring of these patients.Study objective. To study the role of vacuum-assisted core biopsy (VAB in differential diagnosis of fibrocystic breast disease.Materials and methods. In 2014 in Innomed plus clinic the VAB method for tumor diagnostics was introduced for the first time in the PrimorskyRegion. We studied application of VAB in 22 patients with a diagnosis of nonpalpable breast lesion.Results. Relapse rate for VAB is 4.5 %, complication rate in the form of postoperative hematomas is 22.7 %, but these complications do not increase duration of rehabilitation and are not clinically relevant.Conclusion. VAB is a minimally invasive surgical approach which allows to collect the same volume of tumor tissue as sectoral resection. The benefits of the method are better cosmetic results and shorter rehabilitation period with comparable complication rate. This allows to use VAB not only for diagnostic purposes but as a treatment for benign breast tumors.

  10. Kinematic design considerations for minimally invasive surgical robots: an overview.

    Science.gov (United States)

    Kuo, Chin-Hsing; Dai, Jian S; Dasgupta, Prokar

    2012-06-01

    Kinematic design is a predominant phase in the design of robotic manipulators for minimally invasive surgery (MIS). However, an extensive overview of the kinematic design issues for MIS robots is not yet available to both mechanisms and robotics communities. Hundreds of archival reports and articles on robotic systems for MIS are reviewed and studied. In particular, the kinematic design considerations and mechanism development described in the literature for existing robots are focused on. The general kinematic design goals, design requirements, and design preferences for MIS robots are defined. An MIS-specialized mechanism, namely the remote center-of-motion (RCM) mechanism, is revisited and studied. Accordingly, based on the RCM mechanism types, a classification for MIS robots is provided. A comparison between eight different RCM types is given. Finally, several open challenges for the kinematic design of MIS robotic manipulators are discussed. This work provides a detailed survey of the kinematic design of MIS robots, addresses the research opportunity in MIS robots for kinematicians, and clarifies the kinematic point of view to MIS robots as a reference for the medical community. Copyright © 2012 John Wiley & Sons, Ltd.

  11. Recurrent and acquired tracheoesophageal fistulae (TEF)-Minimally invasive management.

    Science.gov (United States)

    Nazir, Zafar; Khan, Muhammad Arif Mateen; Qamar, Javaria

    2017-10-01

    Recurrent and acquired fistulae are a serious complication of congenital esophageal atresia and tracheoesophageal fistula (TEF) repair and foreign body ingestion (FBI) (e.g., button battery). We report our experience with a minimally invasive approach to recurrent and acquired TEF. Medical records of patients referred for management of recurrent and acquired TEF between 2003 and 2015 were reviewed retrospectively. Patients underwent endoscopic procedures (de-epithelization of fistulous tract and fibrin tissue adhesive-Tisseel R ) under general anesthesia. Nine children (7 male, 2 female) with age range 3months to 3years (mean 1.5year) were managed. TEF closed spontaneously in four patients, whereas in 5 patients the TEF closed after combined endoscopic procedure. Three patients required repeat endoscopic procedures. Follow-up ranged between 7months to 10years (mean 4.2years). Active observation and repeat combined endoscopic procedures are safe alternatives to open surgical repair of acquired and recurrent TEF. Level IV study. Copyright © 2017 Elsevier Inc. All rights reserved.

  12. Percutaneous Iliac Screws for Minimally Invasive Spinal Deformity Surgery

    Directory of Open Access Journals (Sweden)

    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.

  13. Cost Differences Between Open and Minimally Invasive Surgery.

    Science.gov (United States)

    Fitch, Kathryn; Engel, Tyler; Bochner, Andrew

    2015-09-01

    To analyze the cost difference between minimally invasive surgery (MIS) and open surgery from a commercial payer perspective for colectomy, ventral hernia repair, thoracic resection (resection of the lung), and hysterectomy. A retrospective claims data analysis was conducted using the 2011 and 2012 Truven Health Analytics MarketScan Commercial Claims and Encounter Database. Study eligibility criteria included age 18-64 years, pharmacy coverage, ≥ 1 month of eligibility in 2012, and a claim coded with 1 of the 4 surgical procedures of interest; the index year was 2012. Average allowed facility and professional costs were calculated during inpatient stay (or day of surgery for outpatient hysterectomy) and the 30 days after discharge for MIS vs open surgery. Cost difference was compared after adjusting for presence of cancer, geographic region, and risk profile (age, gender, and comorbidities). In total, 46,386 cases in the 2012 MarketScan database represented one of the surgeries of interest. The difference in average allowed surgical procedure cost (facility and professional) between open surgery vs adjusted MIS was $10,204 for colectomy; $3,721, ventral hernia repair; $12,989, thoracic resection; and $1,174, noncancer hysterectomy (P average allowed cost in the 30 days after surgery between open surgery vs adjusted MIS was $1,494 for colectomy, $1,320 for ventral hernia repair, negative $711 for thoracic resection, and negative $425 for noncancer hysterectomy (P costs than open surgery for all 4 analyzed surgeries.

  14. Comparing open and minimally invasive surgical procedures for oesophagectomy in the treatment of cancer: the ROMIO (Randomised Oesophagectomy: Minimally Invasive or Open) feasibility study and pilot trial.

    Science.gov (United States)

    Metcalfe, Chris; Avery, Kerry; Berrisford, Richard; Barham, Paul; Noble, Sian M; Fernandez, Aida Moure; Hanna, George; Goldin, Robert; Elliott, Jackie; Wheatley, Timothy; Sanders, Grant; Hollowood, Andrew; Falk, Stephen; Titcomb, Dan; Streets, Christopher; Donovan, Jenny L; Blazeby, Jane M

    2016-06-01

    Localised oesophageal cancer can be curatively treated with surgery (oesophagectomy) but the procedure is complex with a risk of complications, negative effects on quality of life and a recovery period of 6-9 months. Minimal-access surgery may accelerate recovery. The ROMIO (Randomised Oesophagectomy: Minimally Invasive or Open) study aimed to establish the feasibility of, and methodology for, a definitive trial comparing minimally invasive and open surgery for oesophagectomy. Objectives were to quantify the number of eligible patients in a pilot trial; develop surgical manuals as the basis for quality assurance; standardise pathological processing; establish a method to blind patients to their allocation in the first week post surgery; identify measures of postsurgical outcome of importance to patients and clinicians; and establish the main cost differences between the surgical approaches. Pilot parallel three-arm randomised controlled trial nested within feasibility work. Two UK NHS departments of upper gastrointestinal surgery. Patients aged ≥ 18 years with histopathological evidence of oesophageal or oesophagogastric junctional adenocarcinoma, squamous cell cancer or high-grade dysplasia, referred for oesophagectomy or oesophagectomy following neoadjuvant chemo(radio)therapy. Oesophagectomy, with patients randomised to open surgery, a hybrid open chest and minimally invasive abdomen or totally minimally invasive access. The primary outcome measure for the pilot trial was the number of patients recruited per month, with the main trial considered feasible if at least 2.5 patients per month were recruited. During 21 months of recruitment, 263 patients were assessed for eligibility; of these, 135 (51%) were found to be eligible and 104 (77%) agreed to participate, an average of five patients per month. In total, 41 patients were allocated to open surgery, 43 to the hybrid procedure and 20 to totally minimally invasive surgery. Recruitment is continuing

  15. 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.

  16. The minimally invasive spinal deformity surgery algorithm: a reproducible rational framework for decision making in minimally invasive spinal deformity surgery.

    Science.gov (United States)

    Mummaneni, Praveen V; Shaffrey, Christopher I; Lenke, Lawrence G; Park, Paul; Wang, Michael Y; La Marca, Frank; Smith, Justin S; Mundis, Gregory M; Okonkwo, David O; Moal, Bertrand; Fessler, Richard G; Anand, Neel; Uribe, Juan S; Kanter, Adam S; Akbarnia, Behrooz; Fu, Kai-Ming G

    2014-05-01

    Minimally invasive surgery (MIS) is an alternative to open deformity surgery for the treatment of patients with adult spinal deformity. However, at this time MIS techniques are not as versatile as open deformity techniques, and MIS techniques have been reported to result in suboptimal sagittal plane correction or pseudarthrosis when used for severe deformities. The minimally invasive spinal deformity surgery (MISDEF) algorithm was created to provide a framework for rational decision making for surgeons who are considering MIS versus open spine surgery. A team of experienced spinal deformity surgeons developed the MISDEF algorithm that incorporates a patient's preoperative radiographic parameters and leads to one of 3 general plans ranging from MIS direct or indirect decompression to open deformity surgery with osteotomies. The authors surveyed fellowship-trained spine surgeons experienced with spinal deformity surgery to validate the algorithm using a set of 20 cases to establish interobserver reliability. They then resurveyed the same surgeons 2 months later with the same cases presented in a different sequence to establish intraobserver reliability. Responses were collected and tabulated. Fleiss' analysis was performed using MATLAB software. Over a 3-month period, 11 surgeons completed the surveys. Responses for MISDEF algorithm case review demonstrated an interobserver kappa of 0.58 for the first round of surveys and an interobserver kappa of 0.69 for the second round of surveys, consistent with substantial agreement. In at least 10 cases there was perfect agreement between the reviewing surgeons. The mean intraobserver kappa for the 2 surveys was 0.86 ± 0.15 (± SD) and ranged from 0.62 to 1. The use of the MISDEF algorithm provides consistent and straightforward guidance for surgeons who are considering either an MIS or an open approach for the treatment of patients with adult spinal deformity. The MISDEF algorithm was found to have substantial inter- and

  17. From the ground up: building a minimally invasive aortic valve surgery program

    OpenAIRE

    Nguyen, Tom C.; Lamelas, Joseph

    2015-01-01

    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 nurs...

  18. Sacroiliac Joint Fusion: One Year Clinical and Radiographic Results Following Minimally Invasive Sacroiliac Joint Fusion Surgery.

    Science.gov (United States)

    Kube, Richard A; Muir, Jeffrey M

    2016-01-01

    Recalcitrant sacroiliac joint pain responds well to minimally-invasive surgical (MIS) techniques, although long-term radiographic and fusion data are limited. To evaluate the one-year clinical results from a cohort of patients with chronic sacroiliac (SI) joint pain unresponsive to conservative therapies who have undergone minimally invasive SI joint fusion. SI joint fusion was performed between May 2011 and January 2014. Outcomes included radiographic assessment of fusion status, leg and back pain severity via visual analog scale (VAS), disability via Oswestry Disability Index (ODI) and complication rate. Outcomes were measured at baseline and at follow-up appointments 6 months and 12 months post-procedure. Twenty minimally invasive SI joint fusion procedures were performed on 18 patients (mean age: 47.2 (14.2), mean BMI: 29.4 (5.3), 56% female). At 12 months, the overall fusion rate was 88%. Back and leg pain improved from 81.7 to 44.1 points (p<0.001) and from 63.6 to 27.7 points (p=0.001), respectively. Disability scores improved from 61.0 to 40.5 (p=0.009). Despite a cohort containing patients with multiple comorbidities and work-related injuries, eight patients (50%) achieved the minimal clinically important difference (MCID) in back pain at 12 months, with 9 (69%) patients realizing this improvement in leg pain and 8 (57%) realizing the MCID in ODI scores at 12 months. No major complications were reported. Minimally invasive SI joint surgery is a safe and effective procedure, with a high fusion rate, a satisfactory safety profile and significant improvements in pain severity and disability reported through 12 months post-procedure.

  19. Transabdominal midline reconstruction by minimally invasive surgery: technique and results.

    Science.gov (United States)

    Costa, T N; Abdalla, R Z; Santo, M A; Tavares, R R F M; Abdalla, B M Z; Cecconello, I

    2016-04-01

    The introduction of the minimally invasive approach changed the way abdominal surgery was carried out. Open suture and mesh reinforcement in ventral hernia repair used to be the surgeon's choice of procedure. Although the laparoscopic approach, with defect bridging and mesh fixation, has been described since 1993, the procedure remains largely unchanged. Evidence shows that defect closure and retro-muscular mesh positioning have the best outcomes and are the best surgical practice. We therefore aimed to develop and demonstrate a procedure which combined the good results of open surgery using the Rives-Stoppa principles, particularly in terms of recurrence, with all the benefits of minimally invasive surgery. Between October 2012 and February 2014, 15 post-bariatric surgery patients underwent laparoscopic midline incisional hernia repair. The peritoneal cavity was accessed through a 5-mm optical view cannula at the superior left quadrant. A suprapubic and two right and left lower quadrant cannulas were inserted for inferior access and dissection. The defect adhesions were released. The whole midline was closed with an endoscopic linear stapler, including the defect, from the lower abdomen, 4 cm below the umbilicus, until the epigastric region, including posterior sheath mechanical suturing and cutting in the same movement. A retrorectus space was created in which a retro-muscular mesh was deployed. Fixation was done using a hernia stapler against the posterior sheath from the peritoneal cavity to the abdominal wall muscles. Selection was based on xifo-umbilical incisional midline hernias post open bariatric surgery. Pregnant women, cancer patients, or patients with clinical contraindications were excluded. The patients mean age was 51.2 years (range 39-67). Four patients were men and eleven women. Two had well-compensated fibromyalgia, four had diabetes, and five had hypertension. The mean BMI was 29.5 kg/m2 (range 23-31.6). Surgery was performed successfully in all

  20. 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.

  1. Outcomes of minimally invasive strabismus surgery for horizontal deviation.

    Science.gov (United States)

    Merino, P; Blanco Domínguez, I; Gómez de Liaño, P

    2016-02-01

    To study the outcomes of minimally invasive strabismus surgery (MISS) for treating horizontal deviation Case Series of the first 26 consecutive patients operated on using the MISS technique in our hospital from February 2010 to March 2014. A total of 40 eyes were included: 26 patients (mean age: 7.7 years old ± 4.9); 34.61%: male. A total of 43 muscles were operated on: 20 medial, and 23 lateral recti; 28 recessions (range: 3-7.5mm), 6 resections (6-7 mm), and 9 plications (6.5-7.5 mm) were performed. No significant difference was found (P>0.05) for visual acuity at postoperative day 1, and 6 months after surgery. A mild hyperaemia was observed in 29.27%, moderate in 48.78%, and severe in 21.95% at postoperative day 1 and in 63.41%, 31.70% and 4.87%, respectively, at 4 days after surgery. The complications observed were 4 intraoperative conjunctival haemorrhages, 1 scleral perforation, and 2 Tenon's prolapses. A conversion from MISS to a fornix approach was necessary in 1 patient because of bad visualization. The operating time range decreased from 30 to 15 minutes. The MISS technique has obtained good results in horizontal strabismus surgery. The conjunctival inflammation was mild in most of the cases at postoperative day 4. The visual acuity was stable during follow-up, and operating time decreased after a 4-year learning curve. Copyright © 2015 Sociedad Española de Oftalmología. Published by Elsevier España, S.L.U. All rights reserved.

  2. Quantification of Operational Learning in Minimal Invasive Extracorporeal Circulation.

    Science.gov (United States)

    Anastasiadis, Kyriakos; Antonitsis, Polychronis; Asteriou, Christos; Argiriadou, Helena; Deliopoulos, Apostolos; Konstantinou, Dimitrios; Grosomanidis, Vassilios; Tossios, Paschalis

    2017-07-01

    Minimal invasive extracorporeal circulation (MiECC) has initiated important new efforts within science and technology towards a more physiologic perfusion. In this study, we aim to investigate the learning curve of our center regarding MiECC. We studied a series of 150 consecutive patients who underwent elective coronary artery bypass grafting by the same surgical team during the initial phase of MiECC application. Patients were randomly assigned into two groups. Group A (n = 75) included patients operated on MiECC, while group B (n = 75) included patients operated with conventional cardiopulmonary bypass (cCPB). The primary end-point of the study was to identify whether there is a learning curve when operating on MiECC. The following parameters were unrelated with increasing experience, even though the results favored MiECC use: reduced CPB duration (102.9 ± 25 vs. 122.2 ± 33 min, P learning applied to postoperative hematocrit and hemoglobin levels (R 2  = 0.098, P = 0.006). We identified that advantages of MiECC technology in terms of reduced hemodilution and improved end-organ protection and clinical outcome are evident from the first patient. Optimal results are obtained with 50 cases; this refers mainly to significant reduction in the need for intraoperative blood transfusion. Teamwork from surgeons, anesthesiologists, and perfusionists is of paramount importance in order to maximize the clinical benefits from this technology. © 2016 International Center for Artificial Organs and Transplantation and Wiley Periodicals, Inc.

  3. 100 consecutive minimally invasive Heller myotomies: lessons learned.

    Science.gov (United States)

    Sharp, Kenneth W; Khaitan, Leena; Scholz, Stefan; Holzman, Michael D; Richards, William O

    2002-05-01

    To evaluate the authors' first 100 patients treated for achalasia by a minimally invasive approach. Between November 1992 and February 2001, the authors performed 95 laparoscopic and 5 thoracoscopic Heller myotomies in 100 patients (age 49.5 +/- 1.5 years) with manometrically confirmed achalasia. Before presentation, 51 patients had previous dilation, 23 had been treated with botulinum toxin (Botox), and 4 had undergone prior myotomy. Laparoscopic myotomy was performed by incising the distal 4 to 6 cm of esophageal musculature and extended 1 to 2 cm onto the cardia under endoscopic guidance. Fifteen patients underwent antireflux procedures. There were eight intraoperative perforations and only four conversions to open surgery. Follow-up is 10.8 +/- 1 months; 75% of the patients have been followed up for at least 14 months. Outcomes assessed by patient questionnaires revealed satisfactory relief of dysphagia in 93 patients and "poor" relief in 7 patients. Postoperative heartburn symptoms were reported as "moderate to severe" in 14 patients and "none or mild" in 86 patients. Fourteen patients required postoperative procedures for continued symptoms of dysphagia after myotomy. Esophageal manometry studies revealed a decrease in lower esophageal sphincter pressure (LESP) from 37 +/- 1 mm Hg to 14 +/- 1 mm Hg. Patients with a decrease in LESP of more than 18 mm Hg and whose absolute postoperative LESP was 18 or less were more likely to have relief of dysphagia after surgery. Thirty-one patients who underwent Heller alone were studied with a 24-hour esophageal pH probe and had a median Johnson-DeMeester score of 10 (normal open techniques. Satisfactory outcomes occurred in 93% of patients. Patients whose postoperative LESP was less than 18 mm Hg reported the fewest symptoms. After myotomy, patients rarely have abnormal esophageal acid exposure, and the addition of an antireflux procedure is not required.

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

    Energy Technology Data Exchange (ETDEWEB)

    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.

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

    International Nuclear Information System (INIS)

    Masala, Salvatore; Tarantino, Umberto; Nano, Giovanni; Iundusi, Riccardo; Fiori, Roberto; Da Ros, Valerio; Simonetti, Giovanni

    2013-01-01

    Purpose. The purpose of this study was to evaluate the effectiveness of a new pedicle screw-based posterior dynamic stabilization device PDS Percudyn System™ 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™ has effectively improved the clinical setting of 83 % of highly selected patients treated, delaying the need for traditional surgical therapy.

  6. Minimally invasive surgical treatment for temporomandibular joint in patients with various rheumatic diseases

    Directory of Open Access Journals (Sweden)

    A. Yu. Drobyshev

    2017-01-01

    Full Text Available Temporomandibular joint (TMJ involvement occurs in patients with different rheumatic diseases (RDs. Pain, limitation of mouth opening can lead to significant problems in both oral hygiene and when eating. Conservative treatments for TMJ lesions are not always effective. Objective: to evaluate the efficiency of minimally invasive surgical interventions (TMJ arthrocentesis and arthroscopy in patients with RDs. Patients and methods. The investigation enrolled 64 patients with different RDs (43 with rheumatoid arthritis, 11 with psoriatic arthritis, 8 with systemic lupus erythematosus, and 2 with ankylosing spondylitis who were divided into three groups in relation to the severity of TMJ involvement in accordance with the Wilkes classification. All the patients underwent TMJ magnetic resonance imaging at baseline and 6 months after treatment. Also at baseline, 14 days, and 1, 6, and 12 months after surgery, the investigators assessed TMJ pain intensity by visual analogue scale and the parameters of mandibular movements. Patients with Wilkes stages IV and V TMJ involvement underwent arthroscopic intervention into the TMJ and those with III stage received TMJ arthrocentesis with arthrolavage. Results and discussion. After surgical treatment, all the groups were noted to have a significant decrease in TMJ pain intensity compared with the baseline level; moreover, the severity of TMJ pain most significantly decreased on day 7 after surgery. Later on, positive changes remained within subsequent follow-up months. There were data similar in the higher degree of mouth opening. The results of surgical treatment in patients with Wilkes stage V TMJ involvement were worse than in those with stages III and IV. Conclusion. Minimally invasive TMJ surgery in patients with RDs is effective and associated with the low frequency of postoperative complications and exacerbations of RDs. The efficiency of minimally invasive TMJ surgery is higher in patients with the

  7. Minimally invasive pediatric surgery: Increasing implementation in daily practice and resident's training

    NARCIS (Netherlands)

    E.A.T. Velde (Te); N.M.A. Bax (Klaas); S.H.A.J. Tytgat; J.R. de Jong (Justin); D.V. Travassos (Vieira); W.L.M. Kramer; D.C. van der Zee (David)

    2008-01-01

    textabstractBackground: In 1998, the one-year experience in minimally invasive abdominal surgery in children at a pediatric training center was assessed. Seven years later, we determined the current status of pediatric minimally invasive surgery in daily practice and surgical training. Methods: A

  8. 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....

  9. The prospect of minimally invasive therapy for oncology in 21st century

    International Nuclear Information System (INIS)

    Wu Peihong

    2005-01-01

    Minimally invasive therapy and biotherapy are two tendencies in medicine of the 21st century. It is minimally invasive with exact fixing and therapy, few pains and fast recovery. By the host self defecnce mechanism and biologicals, confinement of tumor and decreasing recurrence will give improvement to the patient's quality of life. The followings are the megatrends of minimally invasive therapy in the 21st century: 1. Follow closely with new technology; 2. Exact fixing and therapy; 3. Mode of sequencely combination; 4. Combined with immunotherapy; 5. Radical cure of minimally invasive therapy on oncology. New mode of minimally invasive therapy combined with biotherapy is expected as an important ingredient for oncotherapy in the 21 century. (authors)

  10. Results of completion arteriography after minimally invasive off-pump coronary artery bypass.

    Science.gov (United States)

    Hoff, Steven J; Ball, Stephen K; Leacche, Marzia; Solenkova, Natalia; Umakanthan, Ramanan; Petracek, Michael R; Ahmad, Rashid; Greelish, James P; Walker, Kristie; Byrne, John G

    2011-01-01

    The benefits of a minimally invasive approach to off-pump coronary artery bypass remain controversial. The value of completion arteriography in validating this technique has not been investigated. From April 2007 to October 2009, fifty-six patients underwent isolated minimally invasive coronary artery bypass grafting through a left thoracotomy without cardiopulmonary bypass. Forty-three of these patients underwent completion arteriography. Sixty-five grafts were performed in these 56 patients, (average, 1.2 grafts per patient; range, 1 to 3). Forty-eight grafts were studied in the 43 patients undergoing completion arteriography. There were 4 findings on arteriogram leading to further immediate intervention (8.3%). These included 3 grafts with anastomotic stenoses or spasm requiring stent placement, and 1 patient who had limited dissection in the left internal mammary artery graft and underwent placement of an additional vein graft. These findings were independent of electrocardiographic changes or hemodynamic instability. The remainder of the studies showed no significant abnormalities. There were no deaths. One patient who did not have a completion arteriogram suffered a postoperative myocardial infarction requiring stent placement for anastomotic stenosis. Patients were discharged home an average of 6.8 days postoperatively. There were no instances of renal dysfunction postoperatively attributable to catheterization. Minimally invasive coronary artery bypass is safe and effective. Findings of completion arteriography occasionally reveal previously under-recognized findings that, if corrected in a timely fashion, could potentially impact graft patency and clinical outcomes. Our experience validates this minimally invasive technique. Copyright © 2011 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.

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

    Directory of Open Access Journals (Sweden)

    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.

  12. Image-guided therapy and minimally invasive surgery in children: a merging future

    International Nuclear Information System (INIS)

    Shlomovitz, Eran; Amaral, Joao G.; Chait, Peter G.

    2006-01-01

    Minimally invasive image-guided therapy for children, also known as pediatric interventional radiology (PIR), is a new and exciting field of medicine. Two key elements that helped the rapid evolution and dissemination of this specialty were the creation of devices appropriate for the pediatric population and the development of more cost-effective and minimally invasive techniques. Despite its clear advantages to children, many questions are raised regarding who should be performing these procedures. Unfortunately, this is a gray zone with no clear answer. Surgeons fear that interventional radiologists will take over additional aspects of the surgical/procedural spectrum. Interventional radiologists, on the other hand, struggle to avoid becoming highly specialized technicians rather than physicians who are responsible for complete care of their patients. In this article, we briefly discuss some of the current aspects of minimally invasive image-guided therapy in children and innovations that are expected to be incorporated into clinical practice in the near future. Then, we approach the current interspecialty battles over the control of this field and suggest some solutions to these issues. Finally, we propose the development of a generation of physicians with both surgical and imaging skills. (orig.)

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

    International Nuclear Information System (INIS)

    Castro, Josué Viana Neto; Melo, Emanuel Carvalho; Silva, Juliana Fernandes; Rebouças, Leonardo Lemos; Corrêa, Larissa Chagas; Germano, Amanda de Queiroz; Machado, João José Aquino

    2014-01-01

    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

  14. 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

  15. Minimally invasive unicompartmental knee replacement: Midterm clinical outcome.

    Science.gov (United States)

    Tian, Shaoqi; Liu, Jiangjun; Yuan, Wanqing; Wang, Yuanhe; Ha, Chengzhi; Liu, Lun; Li, Qicai; Yang, Xu; Sun, Kang

    2017-01-01

    The purpose of this study was to explore the midterm clinical outcomes of unicompartmental knee replacement (UKR) for medial knee arthropathy through a minimally invasive approach (MIA). From January 2006 to June 2010, 442 consecutive patients (485 knees) were included in the study. All patients underwent MIA-UKR with the mobile bearing Oxford phrase III prosthesis. The incision was made starting 1 cm medial to the medial pole of the patella and extending distally to the tibial tubercle. Radiographic evaluations include femorotibial angle (FTA) from coronal x-rays and rectified varus deformity angle, while clinical evaluations included Knee Society Score (KSS, clinical score and function score), the Western Ontario and McMaster Universities Arthritis Index (WOMAC) osteoarthritis index and visual analog scale (VAS) for pain. Patients followed-up at 1, 3, 6, 12 months after surgery and each year thereafter. Four hundreds and two patients completed the entire follow-up, 40 patients (45 knees) were lost to follow-up. The average follow-up time was 73.0 ± 1.9 months. The mean length of the incisions was 5.0 ± 0.2 cm. The average FTA decreased from 183.6° ± 5.1° preoperatively to 174.3° ± 4.2° postoperatively, and the mean rectified varus deformity angle was 9.3° ± 1.2°. The KSS clinical score improved from 42.4 ± 2.9 to 92.9 ± 3.8, and the function score improved from 53.5 ± 3.8 to 93.5 ± 4.0. The WOMAC score improved from 47.5 ± 3.1 preoperatively to 12.3 ± 1.5 at the last evaluation. The VAS dropped from 7.8 ± 1.9 preoperatively to 1.6 ± 0.2 postoperatively. All clinical evaluations (KSS, WOMAC, VAS) were significantly different (p clinical outcomes of MIA-UKR are satisfactory in a Chinese patient population, which is a good surgical option for patients with medial arthropathy of the knee. However, longer-term follow-up studies should be performed in these patients.

  16. Minimally invasive unicompartmental knee replacement: Midterm clinical outcome.

    Directory of Open Access Journals (Sweden)

    Shaoqi Tian

    Full Text Available The purpose of this study was to explore the midterm clinical outcomes of unicompartmental knee replacement (UKR for medial knee arthropathy through a minimally invasive approach (MIA.From January 2006 to June 2010, 442 consecutive patients (485 knees were included in the study. All patients underwent MIA-UKR with the mobile bearing Oxford phrase III prosthesis. The incision was made starting 1 cm medial to the medial pole of the patella and extending distally to the tibial tubercle. Radiographic evaluations include femorotibial angle (FTA from coronal x-rays and rectified varus deformity angle, while clinical evaluations included Knee Society Score (KSS, clinical score and function score, the Western Ontario and McMaster Universities Arthritis Index (WOMAC osteoarthritis index and visual analog scale (VAS for pain. Patients followed-up at 1, 3, 6, 12 months after surgery and each year thereafter.Four hundreds and two patients completed the entire follow-up, 40 patients (45 knees were lost to follow-up. The average follow-up time was 73.0 ± 1.9 months. The mean length of the incisions was 5.0 ± 0.2 cm. The average FTA decreased from 183.6° ± 5.1° preoperatively to 174.3° ± 4.2° postoperatively, and the mean rectified varus deformity angle was 9.3° ± 1.2°. The KSS clinical score improved from 42.4 ± 2.9 to 92.9 ± 3.8, and the function score improved from 53.5 ± 3.8 to 93.5 ± 4.0. The WOMAC score improved from 47.5 ± 3.1 preoperatively to 12.3 ± 1.5 at the last evaluation. The VAS dropped from 7.8 ± 1.9 preoperatively to 1.6 ± 0.2 postoperatively. All clinical evaluations (KSS, WOMAC, VAS were significantly different (p < 0.05 from pre and post-operative evaluations. The survival rate was 99.1% at 73 months, and the revision rate was 0.9%.The midterm clinical outcomes of MIA-UKR are satisfactory in a Chinese patient population, which is a good surgical option for patients with medial arthropathy of the knee. However, longer

  17. Decontamination of minimally invasive surgical endoscopes and accessories.

    Science.gov (United States)

    Ayliffe, G

    2000-08-01

    lung function testing by spirometry. (7) Possible alternative disinfectants to glutaraldehyde include peracetic acid (0.2-0.35%), chlorine dioxide (700-1100 ppm) and superoxidized water. These are very effective, killing vegetative bacteria, including mycobacteria, and viruses in 5 min and bacterial spores in 10 min. An endorsement of compatibility with endoscopes, accessories and processing equipment is required from both the solution/device manufacturer and the endoscope manufacturer. Other important considerations are stability, cost and safety from the user and environmental standpoints. (8) Cleaning and disinfection or sterilization should be undertaken by trained staff in a dedicated area, e.g., SSD or TSSU. A suitable training programme is described. (9) If endoscopes are processed by immersion in disinfectants, harmful residues must be removed by thorough rinsing. Sterile or bacteria free water is essential for rinsing all invasive endoscopes and accessories to prevent recontamination. (10) If an automated washer disinfector is used it must be effective, non-damaging, reliable, easy to use and its performance regularly monitored. (11) If used, washer disinfectors and other processing equipment should be disinfected on a regular basis, i.e., between patients or at the start of each session. This will prevent biofilm formation and recontamination of instruments during rinsing. Disinfection should include the water treatment system, if present. (12) To comply with the Medical Devices Directive, manufacturers are obliged to provide full details on how to decontaminate the reusable devices they supply. This should include details of compatibility with heat, pressure, moisture, processing chemicals and ultrasonics. (13) The Infection Control Team should always be involved in the formulation and implementation of decontamination policies. Wherever possible, the national good practice guidelines produced by the Medical Devices Agency and/or professional societies shoul

  18. Management of hyperfunctioning single thyroid nodules in the era of minimally invasive thyroid surgery.

    Science.gov (United States)

    Tan, Charles; Sidhu, Stan; Sywak, Mark; Delbridge, Leigh

    2009-05-01

    Both surgical excision and radioiodine ablation are effective modalities in the management of hyperfunctioning thyroid nodules. Minimally invasive thyroid surgery (MITS) using the lateral mini-incision approach has previously been demonstrated to be a safe and effective technique for thyroid lobectomy. As such MITS may offer advantages as a surgical approach to hyperfunctioning thyroid nodules without the need for a long cervical incision or extensive dissection associated with formal open hemithyroidectomy. The aim of the present study was to assess the safety and efficacy of MITS for the treatment of hyperfunctioning thyroid nodules. This is a retrospective case study. Data were obtained from the University of Sydney Endocrine Surgical Unit Database from 2002 to 2007. There were 86 cases of hyperfunctioning thyroid nodules surgically removed during the study period, of which 10 (12%) were managed using the MITS approach. The ipsilateral recurrent laryngeal nerve was identified and preserved in all cases with no incidence of temporary or permanent nerve palsy. The external branch of the superior laryngeal nerve was visualized and preserved in eight cases (80%). There were no cases of postoperative bleeding. There was one clinically significant follicular thyroid carcinoma in the series (10%). In nine of 10 cases (90%) normalization of thyroid function followed surgery. MITS is a safe and effective procedure, achieving the benefits of a minimally invasive procedure with minimal morbidity. As such it now presents an attractive alternative to radioiodine ablation for the management of small hyperfunctioning thyroid nodules.

  19. Clinical study of treatment of cerebral hemorrhage: remove the intracranial hematoma with a minimal invasive procedure

    International Nuclear Information System (INIS)

    Ke Dongfeng; He Yunguang; Hu Wen; Lin Yang; Yang Danyang; Chen Shaokai; Ma Shaobing

    2004-01-01

    Objective: To study the feasibility and factors of minimal invasive intracranial hematoma removing procedure as a treatment of cerebral hemorrhage. Methods: From May, 2000 to September, 2003, 33 patients with intracerebral hemorrhage underwent minimal invasive intracranial hematoma removing procedure and from May, 1997 to September, 2000, 27 patients with cerebral hemorrhage received conservative treatments. Two groups were compared and analyzed. The quantity of hemorrhage and the indication of procedure were also studied. Results: State of an illness has no significant difference between the two groups (P<0.05). The rate of recovery were higher in the group undergoing the procedure (57.6%) than in the control group (14.8%) (P<0.05). The rate of handicap were lower in the procedure group (24.0%) than in the control group (60.0%) (P<0.05). The mortality were also lower in the procedure group (24.2%) than in the control group (63.0%) (P<0.01). In the control group no patient with a hematoma larger than 70 ml survived. In the procedure group patients with hematoma larger than 70 ml had less chance of survival than the other patients (P<0.01). The mortality rate were respectively 50%, 5.6%, 33.3% when the procedure was done in super early, early, delayed stage. The mortality rate was higher in the super early stage than in early stage (P<0.05). Conclusion: The minimal invasive intracranial hematoma removing procedure has a better clinical outcome than the conservative treatment. The procedure reduces obviously mortality rate and increase the quality of survival. Multiple puncturing and draining or craniotomy are recommended to remove huge hematoma. The earlier treatment brings better clinical effects. This technique is simple, less invasive and provides good clinical outcome, which is worth recommendation

  20. Differentiation of widely invasive and minimally invasive follicular thyroid carcinoma with sonography

    International Nuclear Information System (INIS)

    Shin, Jung Hee; Han, Boo-Kyung; Ko, Eun Young; Oh, Young Lyun; Kim, Jung Han

    2010-01-01

    Purpose: We evaluated the sonographic findings that can help differentiate widely invasive follicular thyroid carcinomas (WIFTC) from minimally invasive follicular thyroid carcinomas (MIFTC). Methods: We retrospectively compared the sonographic and clinical findings of 24 patients (M:F = 5:19) with 24 MIFTCs and 12 patients (M:F = 1:11) with 13 WIFTCs that were confirmed pathologically and available in sonography at our institution between 1995 and 2007. Results: WIFTC was more common in elderly patients than MIFTC (p < 0.0001). WIFTC was seen with a larger size than MIFTC (p = 0.0092). The best cut-off values for age and size were 49 years and 5.6 cm, respectively. On sonography, all tumors were seen as a well-defined oval or round mass. Heterogeneous mulberry-like echotexture was more common for WIFTC than for MIFTC (77% vs. 25%) (p = 0.0046). The presence of calcifications was more frequent in WIFTC than in MIFTC (54% vs. 8%) (p = 0.0041). Ring calcifications (86%) were the most common type for WIFTC. WIFTC was commonly hypoechoic (70%) and rarely cystic change (8%), but without statistical differences. When WIFTCs represented tumors with two or more findings with a statistical difference, the specificity was 96%. Conclusion: WIFTC is distinguishable from MIFTC by sonography for patients with an age ≥49 years, a tumor ≥5.6 cm, a heterogeneous mulberry-like echotexure, or the presence of calcifications. The sonographic impression of a WIFTC can support a preoperative or intraoperative diagnosis of a difficult case as determined by FNA or with a frozen section.

  1. Minimally invasive three-dimensional site characterization system

    International Nuclear Information System (INIS)

    Steedman, D.; Seusy, F.E.; Gibbons, J.; Bratton, J.L.

    1993-09-01

    This paper presents an improved for hazardous site characterization. The major components of the systems are: (1) an enhanced cone penetrometer test, (2) surface geophysical surveys and (3) a field database and visualization code. The objective of the effort was to develop a method of combining geophysical data with cone penetrometer data in the field to produce a synergistic effect. Various aspects of the method were tested at three sites. The results from each site are discussed and the data compared. This method allows the data to be interpreted more fully with greater certainty, is faster, cheaper and leads to a more accurate site characterization. Utilizing the cone penetrometer test rather than the standard drilling, sampling and laboratory testing reduces the workers exposure to hazardous materials and minimizes the hazardous material disposal problems. The technologies employed in this effort are, for the most part, state-of-the-art procedures. The approach of using data from various measurement systems to develop a synergistic effect was a unique contribution to environmental site characterization. The use of the cone penetrometer for providing ''ground truth'' data and as a platform for subsurface sensors in environmental site characterization represents a significant advancement in environmental site characterization

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

    Directory of Open Access Journals (Sweden)

    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.

  3. 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.

  4. GPU-based RFA simulation for minimally invasive cancer treatment of liver tumours

    NARCIS (Netherlands)

    Mariappan, P.; Weir, P.; Flanagan, R.; Voglreiter, P.; Alhonnoro, T.; Pollari, M.; Moche, M.; Busse, H.; Futterer, J.J.; Portugaller, H.R.; Sequeiros, R.B.; Kolesnik, M.

    2017-01-01

    PURPOSE: Radiofrequency ablation (RFA) is one of the most popular and well-standardized minimally invasive cancer treatments (MICT) for liver tumours, employed where surgical resection has been contraindicated. Less-experienced interventional radiologists (IRs) require an appropriate planning tool

  5. Prevalence of Musculoskeletal Disorders Among Surgeons Performing Minimally Invasive Surgery: A Systematic Review

    NARCIS (Netherlands)

    Alleblas, C.C.J.; Man, A.M. de; Haak, L. van den; Vierhout, M.E.; Jansen, F.W.; Nieboer, T.E.

    2017-01-01

    OBJECTIVE: The aim of this study was to review musculoskeletal disorder (MSD) prevalence among surgeons performing minimally invasive surgery. BACKGROUND: Advancements in laparoscopic surgery have primarily focused on enhancing patient benefits. However, compared with open surgery, laparoscopic

  6. Minimally invasive versus open distal pancreatectomy (LEOPARD) : Study protocol for a randomized controlled trial

    NARCIS (Netherlands)

    de Rooij, Thijs; van Hilst, Jony; Vogel, Jantien A.; van Santvoort, Hjalmar C.; de Boer, Marieke T.; Boerma, Djamila; van den Boezem, Peter B.; Bonsing, Bert A.; Bosscha, Koop; Coene, Peter-Paul; Daams, Freek; van Dam, Ronald M.; Dijkgraaf, Marcel G.; van Eijck, Casper H.; Festen, Sebastiaan; Gerhards, Michael F.; Koerkamp, Bas Groot; Hagendoorn, Jeroen; van der Harst, Erwin; de Hingh, Ignace H.; Dejong, Cees H.; Kazemier, Geert; Klaase, Joost; de Kleine, Ruben H.; van Laarhoven, Cornelis J.; Lips, Daan J.; Luyer, Misha D.; Molenaar, I. Quintus; Nieuwenhuijs, Vincent B.; Patijn, Gijs A.; Roos, Daphne; Scheepers, Joris J.; van der Schelling, George P.; Steenvoorde, Pascal; Swijnenburg, Rutger-Jan; Wijsman, Jan H.; Abu Hilal, Moh'd; Busch, Olivier R.; Besselink, Marc G.

    2017-01-01

    Background: Observational cohort studies have suggested that minimally invasive distal pancreatectomy (MIDP) is associated with better short-term outcomes compared with open distal pancreatectomy (ODP), such as less intraoperative blood loss, lower morbidity, shorter length of hospital stay, and

  7. Use of Minimally Invasive Distal Metatarsal Osteotomy for Correction of Hallux Valgus

    Directory of Open Access Journals (Sweden)

    Chun-Kit Tong

    2012-06-01

    Conclusion: Good clinical and radiographic results have been achieved with minimally invasive techniques for treatment of hallux valgus. This is an acceptable alternative operation for mild-to-moderate hallux valgus.

  8. 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.

  9. Time Management in the Operating Room: An Analysis of the Dedicated Minimally Invasive Surgery Suite

    Science.gov (United States)

    Hsiao, Kenneth C.; Machaidze, Zurab

    2004-01-01

    Background: Dedicated minimally invasive surgery suites are available that contain specialized equipment to facilitate endoscopic surgery. Laparoscopy performed in a general operating room is hampered by the multitude of additional equipment that must be transported into the room. The objective of this study was to compare the preparation times between procedures performed in traditional operating rooms versus dedicated minimally invasive surgery suites to see whether operating room efficiency is improved in the specialized room. Methods: The records of 50 patients who underwent laparoscopic procedures between September 2000 and April 2002 were retrospectively reviewed. Twenty-three patients underwent surgery in a general operating room and 18 patients in an minimally invasive surgery suite. Nine patients were excluded because of cystoscopic procedures undergone prior to laparoscopy. Various time points were recorded from which various time intervals were derived, such as preanesthesia time, anesthesia induction time, and total preparation time. A 2-tailed, unpaired Student t test was used for statistical analysis. Results: The mean preanesthesia time was significantly faster in the minimally invasive surgery suite (12.2 minutes) compared with that in the traditional operating room (17.8 minutes) (P=0.013). Mean anesthesia induction time in the minimally invasive surgery suite (47.5 minutes) was similar to time in the traditional operating room (45.7 minutes) (P=0.734). The average total preparation time for the minimally invasive surgery suite (59.6 minutes) was not significantly faster than that in the general operating room (63.5 minutes) (P=0.481). Conclusion: The amount of time that elapses between the patient entering the room and anesthesia induction is statically shorter in a dedicated minimally invasive surgery suite. Laparoscopic surgery is performed more efficiently in a dedicated minimally invasive surgery suite versus a traditional operating room. PMID

  10. Minimally Invasive Surgical Approach to Distal Fibula Fractures: A Technique Tip

    Directory of Open Access Journals (Sweden)

    Tyler A. Gonzalez

    2017-01-01

    Full Text Available Wound complications following ankle fracture surgery are a major concern. Through the use of minimally invasive surgical techniques some of these complications can be mitigated. Recent investigations have reported on percutaneous fixation of distal fibula fractures demonstrating similar radiographic and functional outcomes to traditional open approaches. The purpose of this manuscript is to describe in detail the minimally invasive surgical approach for distal fibula fractures.

  11. Treatment of Pseudoarthrosis After Minimally Invasive Hallux Valgus ...

    African Journals Online (AJOL)

    access techniques enable correction of 80-90% of hallux valgus deformities solely via hallux manipulation without removal of the eminence or open lateral release yielding more than 90% excellent and good results.[2,4,5] Nonunion is rarely reported. We describe our operative technique for nonunion following minimally ...

  12. Use of an Automated Suture Fastening Device in Minimally Invasive Aortic Valve Replacement.

    Science.gov (United States)

    Beute, Tyler J; Orem, Matthew D; Schiller, Timothy M; Goehler, Matthew; Parker, Jessica; Willekes, Charles L; Timek, Tomasz

    2018-03-01

    Minimally invasive aortic valve replacement (mAVR) is gaining clinical acceptance, however, it is associated with increased operative times due to limited surgical field and access. The Cor-Knot is an automated fastening device designed to facilitate suture fastening, but clinical data in mAVR are lacking. From May 2014 to February 2017, 92 patients underwent mAVR at our center with 39 valves secured with manually-tied (MT) sutures and 53 valves entirely secured with the Cor-Knot (CK). Pre-operative characteristics and 30-day outcomes data were extracted from our local Society of Thoracic Surgeons database and the electronic medical record. Survival data were obtained from the Michigan State Social Security Death Index. No significant difference in pre-operative characteristics were noted between the two groups. Aortic cross-clamp time (72±12 min vs 82±15 min, p=0.001) was significantly shorter with CK. There was no difference in post-operative mortality (0% vs 0%), stroke (0% vs 1.9%), atrial fibrillation (28% vs 33%), renal failure (0% vs 3.8%), or pacemaker implantation (5.1% vs 5.7%) between MT and CK. Valve function on post-operative echocardiography and 1-year patient survival were similar. In minimally invasive aortic valve replacement, the Cor-Knot device was associated with reduced aortic cross-clamp time while providing equivalent clinical outcomes. Larger studies are needed to confirm efficacy, safety, and cost-effectiveness of the Cor-Knot device in minimally invasive aortic valve surgery. Copyright © 2018 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.

  13. Management of Peritonitis After Minimally Invasive Colorectal Surgery: Can We Stick to Laparoscopy?

    Science.gov (United States)

    Marano, Alessandra; Giuffrida, Maria Carmela; Giraudo, Giorgio; Pellegrino, Luca; Borghi, Felice

    2017-04-01

    Although laparoscopy is becoming the standard of care for the treatment of colorectal disease, its application in case of postoperative peritonitis is still not widespread. The objective of this article is to evaluate the role of laparoscopy in the management of postoperative peritonitis after elective minimally invasive colorectal resection for malignant and benign diseases. Between April 2010 and May 2016, 536 patients received primary minimally invasive colorectal surgery at our Department. Among this series, we carried out a retrospective study of those patients who, having developed signs of peritonitis, were treated with a laparoscopic reintervention. Patient demographics, type of complication and of the main relaparoscopic treatment, and main outcomes of reoperation were recorded. A total of 20 patients (3.7%) underwent relaparoscopy for the management of postoperative peritonitis, of which exact causes were detected by laparoscopy in 75% as follows: anastomotic leakage (n = 8, 40%), colonic ischemia (n = 2, 10%), iatrogenic bowel tear (n = 4, 20%), and other (n = 1, 5%). The median time between operations was 3.5 days (range, 2-8). The laparoscopic reintervention was tailored case by case and ranged from lavage and drainage to redo anastomosis with ostomy fashioning. Conversion rate was 10% and overall morbidity was 50%. No cases required additional surgery and 30-day mortality was nil. Three patients (15%) were admitted to intensive care unit for 24-hour surveillance. Our experience suggests that in experienced hands and in hemodynamically stable patients, a prompt laparoscopic reoperation appears as an accurate diagnostic tool and an effective and safe option for the treatment of postoperative peritonitis after primary colorectal minimally invasive surgery.

  14. Impact insertion of transfer-molded microneedle for localized and minimally invasive ocular drug delivery.

    Science.gov (United States)

    Song, Hyun Beom; Lee, Kang Ju; Seo, Il Ho; Lee, Ji Yong; Lee, Sang-Mok; Kim, Jin Hyoung; Kim, Jeong Hun; Ryu, WonHyoung

    2015-07-10

    It has been challenging for microneedles to deliver drugs effectively to thin tissues with little background support such as the cornea. Herein, we designed a microneedle pen system, a single microneedle with a spring-loaded microneedle applicator to provide impact insertion. To firmly attach solid microneedles with 140 μm in height at the end of macro-scale applicators, a transfer molding process was employed. The fabricated microneedle pens were then applied to mouse corneas. The microneedle pens successfully delivered rhodamine dye deep enough to reach the stromal layer of the cornea with small entry only about 1000 μm(2). When compared with syringes or 30 G needle tips, microneedle pens could achieve more localized and minimally invasive delivery without any chances of perforation. To investigate the efficacy of microneedle pens as a way of drug delivery, sunitinib malate proven to inhibit in vitro angiogenesis, was delivered to suture-induced angiogenesis model. When compared with delivery by a 30 G needle tip dipped with sunitinib malate, only delivery by microneedle pens could effectively inhibit corneal neovascularization in vivo. Microneedle pens could effectively deliver drugs to thin tissues without impairing merits of using microneedles: localized and minimally invasive delivery. Copyright © 2015 Elsevier B.V. All rights reserved.

  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. Non-invasive or minimally invasive autopsy compared to conventional autopsy of suspected natural deaths in adults: a systematic review.

    Science.gov (United States)

    Blokker, Britt M; Wagensveld, Ivo M; Weustink, Annick C; Oosterhuis, J Wolter; Hunink, M G Myriam

    2016-04-01

    Autopsies are used for healthcare quality control and improving medical knowledge. Because autopsy rates are declining worldwide, various non-invasive or minimally invasive autopsy methods are now being developed. To investigate whether these might replace the invasive autopsies conventionally performed in naturally deceased adults, we systematically reviewed original prospective validation studies. We searched six databases. Two reviewers independently selected articles and extracted data. Methods and patient groups were too heterogeneous for meaningful meta-analysis of outcomes. Sixteen of 1538 articles met our inclusion criteria. Eight studies used a blinded comparison; ten included less than 30 appropriate cases. Thirteen studies used radiological imaging (seven dealt solely with non-invasive procedures), two thoracoscopy and laparoscopy, and one sampling without imaging. Combining CT and MR was the best non-invasive method (agreement for cause of death: 70 %, 95%CI: 62.6; 76.4), but minimally invasive methods surpassed non-invasive methods. The highest sensitivity for cause of death (90.9 %, 95%CI: 74.5; 97.6, suspected duplicates excluded) was achieved in recent studies combining CT, CT-angiography and biopsies. Minimally invasive autopsies including biopsies performed best. To establish a feasible alternative to conventional autopsy and to increase consent to post-mortem investigations, further research in larger study groups is needed. • Health care quality control benefits from clinical feedback provided by (alternative) autopsies. • So far, sixteen studies investigated alternative autopsy methods for naturally deceased adults. • Thirteen studies used radiological imaging modalities, eight tissue biopsies, and three CT-angiography. • Combined CT, CT-angiography and biopsies were most sensitive diagnosing cause of death.

  17. Anorectal function and outcomes after transanal minimally invasive surgery for rectal tumors

    Directory of Open Access Journals (Sweden)

    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.

  18. Minimally invasive treatment of peristomal metastases from gastric cancer at an ileostomy site by electrochemotherapy

    International Nuclear Information System (INIS)

    Campana, Luca G.; Scarpa, Marco; Sommariva, Antonio; Bonandini, Elena; Valpione, Sara; Sartore, Leonardo; Rossi, Carlo R.

    2013-01-01

    Peristomal metastases are rare, but potentially associated with relevant morbidity. Surgical resection, followed by stoma relocation, represent the gold standard in most patients. We describe electrochemotherapy (ECT), a minimally invasive method for locally-enhancing drug delivery by means of electric pulses, as an alternative approach. A 49-year-old man with advanced gastric cancer developed skin metastases around an ileostomy site. The ulcerated and oozing tumor growth impaired patient’s quality of life due to continuous trouble in fitting the ostomy appliance, its poor adherence and consequent stools spillage. ECT consisted of a 20-minute course under mild general sedation. A bleomycin bolus of 15 000 IU/m 2 was followed by the percutaneous application of multiple, 1.5 ms -long electric pulses by means of a needle electrode. Post ECT course was uneventful and the patient was discharged on the same day. After one week, tumor nodules were flattened and partial tumor regression was appreciable at one-month follow-up. More importantly, peristomal skin conditions significantly improved, thus allowing for an effective application of the ostomy appliance during the following moths, until patient’s death. This report suggests the feasibility of ECT as a minimally invasive approach for peristomal tumors. In selected cases, ECT, by achieving a rapid tumor control, may ensure effective ostomy management and preserve patients’ quality of life

  19. Minimally invasive treatment of peristomal metastases from gastric cancer at an ileostomy site by electrochemotherapy

    Energy Technology Data Exchange (ETDEWEB)

    Campana, Luca G., E-mail: maximizing@hotmail.com [Sarcoma and Melanoma Unit, Veneto Institute of Oncology (IOV-IRCCS), Padova (Italy); Scarpa, Marco [Surgical Oncology Unit, Veneto Institute of Oncology (IOV-IRCCS), Padova (Italy); Sommariva, Antonio [Sarcoma and Melanoma Unit, Veneto Institute of Oncology (IOV-IRCCS), Padova (Italy); Bonandini, Elena [Department of Pathology, University of Padova, Padova (Italy); Valpione, Sara [Melanoma Cancer Unit, Veneto Institute of Oncology (IOV-IRCCS), Padova (Italy); Sartore, Leonardo [Plastic Surgery Unit, University of Padova, Padova (Italy); Rossi, Carlo R. [Sarcoma and Melanoma Unit, Veneto Institute of Oncology (IOV-IRCCS), Padova (Italy)

    2013-01-01

    Peristomal metastases are rare, but potentially associated with relevant morbidity. Surgical resection, followed by stoma relocation, represent the gold standard in most patients. We describe electrochemotherapy (ECT), a minimally invasive method for locally-enhancing drug delivery by means of electric pulses, as an alternative approach. A 49-year-old man with advanced gastric cancer developed skin metastases around an ileostomy site. The ulcerated and oozing tumor growth impaired patient’s quality of life due to continuous trouble in fitting the ostomy appliance, its poor adherence and consequent stools spillage. ECT consisted of a 20-minute course under mild general sedation. A bleomycin bolus of 15 000 IU/m{sup 2} was followed by the percutaneous application of multiple, 1.5 ms -long electric pulses by means of a needle electrode. Post ECT course was uneventful and the patient was discharged on the same day. After one week, tumor nodules were flattened and partial tumor regression was appreciable at one-month follow-up. More importantly, peristomal skin conditions significantly improved, thus allowing for an effective application of the ostomy appliance during the following moths, until patient’s death. This report suggests the feasibility of ECT as a minimally invasive approach for peristomal tumors. In selected cases, ECT, by achieving a rapid tumor control, may ensure effective ostomy management and preserve patients’ quality of life.

  20. Re: Fibrin Glue Injections: A Minimally Invasive and Cost-Effective Treatment for Post-Renal Transplant Lymphoceles and Lymph Fistulas

    Directory of Open Access Journals (Sweden)

    Presser N

    2016-03-01

    Full Text Available In this retrospective study, 46 (2.7% patients out of 1662 kidney transplant recipients had developed symptomatic lymphocele/lymph fistula requiring intervention over an 11-year period. Open surgical drainage (22, laparoscopic surgical drainage (11 and percutaneous fibrin glue injections into the drained lymphocele cavity (13 were used to treat this complication. Besides being effective both on the early and late developed lymphoceles, significantly lower recurrence rates by fibrin glue injections and lower median treatment costs were observed when compared with the other two surgical modalities. It has also the advantage of an outpatient procedure that can be performed using fluoroscopic guidance, under local anesthesia. However, due to era effect, most of the open and laparoscopic surgical recipients were treated with sirolimus, a well-known antiproliferative immunosuppressive agent, which can promote development of lymphoceles and surgical failure. However, the majority of fibrin glue-treated cases were with tacrolimus-based regimens, but this study, in its nature, is far from giving the answer for decreased number of recurrences with fibrin glue

  1. Application of minimally invasive technique in surgical treatment of pancreatic diseases

    Directory of Open Access Journals (Sweden)

    ZHANG Yixi

    2015-05-01

    Full Text Available In recent years, with the rapid development of minimally invasive concept, from laparoscopic operation to three-dimension laparoscopic technique and to robotic surgical system, treatment modalities have changed a lot. Pancreatic diseases, including multiple lesions, have different prognoses. An appropriate surgical procedure should be selected while ensuring the radical treatment of disease, so as to minimize the injury to patients and the impairment of organ function. Minimally invasive technique is of great significance in the surgical treatment of pancreatic diseases.

  2. Risk of incisional hernia after minimally invasive and open radical prostatectomy.

    Science.gov (United States)

    Carlsson, Sigrid V; Ehdaie, Behfar; Atoria, Coral L; Elkin, Elena B; Eastham, James A

    2013-11-01

    The number of radical prostatectomies has increased. Many urologists have shifted from the open surgical approach to minimally invasive techniques. It is not clear whether the risk of post-prostatectomy incisional hernia varies by surgical approach. In the linked Surveillance, Epidemiology and End Results (SEER)-Medicare data set we identified men 66 years old or older who were treated with minimally invasive or open radical prostatectomy for prostate cancer diagnosed from 2003 to 2007. The main study outcome was incisional hernia repair, as identified in Medicare claims after prostatectomy. We also examined the frequency of umbilical, inguinal and other hernia repairs. We identified 3,199 and 6,795 patients who underwent minimally invasive and open radical prostatectomy, respectively. The frequency of incisional hernia repair was 5.3% at a median 3.1-year followup in the minimally invasive group and 1.9% at a 4.4-year median followup in the open group, corresponding to an incidence rate of 16.1 and 4.5/1,000 person-years, respectively. Compared to the open technique, the minimally invasive procedure was associated with more than a threefold increased risk of incisional hernia repair when controlling for patient and disease characteristics (adjusted HR 3.39, 95% CI 2.63-4.38, p<0.0001). Minimally invasive radical prostatectomy was associated with an attenuated but increased risk of any hernia repair compared with open radical prostatectomy (adjusted HR 1.48, 95% CI 1.29-1.70, p<0.0001). Minimally invasive radical prostatectomy was associated with a significantly increased risk of incisional hernia compared with open radical prostatectomy. This is a potentially remediable complication of prostate cancer surgery that warrants increased vigilance with respect to surgical technique. Copyright © 2013 American Urological Association Education and Research, Inc. Published by Elsevier Inc. All rights reserved.

  3. Accuracy of linear drilling in temporal bone using drill press system for minimally invasive cochlear implantation.

    Science.gov (United States)

    Dillon, Neal P; Balachandran, Ramya; Labadie, Robert F

    2016-03-01

    A minimally invasive approach for cochlear implantation involves drilling a narrow linear path through the temporal bone from the skull surface directly to the cochlea for insertion of the electrode array without the need for an invasive mastoidectomy. Potential drill positioning errors must be accounted for to predict the effectiveness and safety of the procedure. The drilling accuracy of a system used for this procedure was evaluated in bone surrogate material under a range of clinically relevant parameters. Additional experiments were performed to isolate the error at various points along the path to better understand why deflections occur. An experimental setup to precisely position the drill press over a target was used. Custom bone surrogate test blocks were manufactured to resemble the mastoid region of the temporal bone. The drilling error was measured by creating divots in plastic sheets before and after drilling and using a microscope to localize the divots. The drilling error was within the tolerance needed to avoid vital structures and ensure accurate placement of the electrode; however, some parameter sets yielded errors that may impact the effectiveness of the procedure when combined with other error sources. The error increases when the lateral stage of the path terminates in an air cell and when the guide bushings are positioned further from the skull surface. At contact points due to air cells along the trajectory, higher errors were found for impact angles of [Formula: see text] and higher as well as longer cantilevered drill lengths. The results of these experiments can be used to define more accurate and safe drill trajectories for this minimally invasive surgical procedure.

  4. Minimal invasive puncture and drainage versus endoscopic surgery for spontaneous intracerebral hemorrhage in basal ganglia

    Directory of Open Access Journals (Sweden)

    Li Z

    2017-01-01

    Full Text Available Zhihong Li,1,* Yuqian Li,1,* Feifei Xu,2,* Xi Zhang,3 Qiang Tian,4 Lihong Li1 1Department of Neurosurgery, Tangdu Hospital, 2Department of Foreign Languages, 3Department of Biomedical Engineering, 4Department of Radiology, Tangdu Hospital, The Fourth Military Medical University, Xi’an, Shaanxi Province, People’s Republic of China *These authors contributed equally to this work Abstract: Two prevalent therapies for the treatment of spontaneous intracerebral hemorrhage (ICH in basal ganglia are, minimally invasive puncture and drainage (MIPD, and endoscopic surgery (ES. Because both surgical techniques are of a minimally invasive nature, they have attracted greater attention in recent years. However, evidence comparing the curative effect of MIPD and ES has been uncertain. The indication for MIPD or ES has been uncertain till now. In the present study, 112 patients with spontaneous ICH in basal ganglia who received MIPD or ES were reviewed retrospectively. Baseline parameters prior to the operation, evacuation rate (ER, perihematoma edema, postoperative complications, and rebleeding incidences were collected. Moreover, 1-year postictus, the long-term functional outcomes of patients with regard to hematoma volume (HV or Glasgow Coma Scale (GCS score were judged, respectively, by the case fatality, Glasgow Outcome Scale (GOS, Barthel Index (BI, and modified Rankin Scale (mRS. The ES group had a higher ER than the MIPD group on postoperative day 1. The MIPD group had fewer adverse outcomes, which included less perihematoma edema, anesthetic time, and blood loss, than the ES group. The functional outcomes represented by GOS, BI, and mRS were better in the MIPD group than in the ES group for patients with HV 30–60 mL or GCS score 9–14. These results indicate that ES is more effective in evacuating hematoma in basal ganglia, while MIPD is less invasive than ES. Patients with HV 30–60 mL or GCS score 9–14 may benefit more from the MIPD

  5. 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.

  6. Impact of continuous training through distributed practice for acquisition of minimally invasive surgical skills.

    Science.gov (United States)

    Nakata, Bruce Negrello; Cavalini, Worens; Bonin, Eduardo A; Salvalaggio, Paolo R; Loureiro, Marcelo P

    2017-10-01

    Minimally invasive surgery (MIS) requires the mastery of manual skills and a specific training is required. Apart from residencies and fellowships in MIS, other learning opportunities utilize massive training, mainly with use of simulators in short courses. A long-term postgraduate course represents an opportunity to learn through training using distributed practice. The objective of this study is to assess the use of distributed practice for acquisition of basic minimally invasive skills in surgeons who participated in a long-term MIS postgraduate course. A prospective, longitudinal and quantitative study was conducted among surgeons who attended a 1-year postgraduate course of MIS in Brazil, from 2012 to 2014. They were tested through five different exercises in box trainers (peg-transfer, passing, cutting, intracorporeal knot, and suture) in the first (t0), fourth (t1) and last, eighth, (t2) meetings of this course. The time and penalties of each exercise were collected for each participant. Participant skills were assessed based on time and accuracy on a previously tested score. Fifty-seven surgeons (participants) from three consecutive groups participated in this study. There was a significant improvement in scores in all exercises. The average increase in scores between t0 and t2 was 88% for peg-transfer, 174% for passing, 149% for cutting, 130% for intracorporeal knot, and 120% for suture (p < 0.001 for all exercises). Learning through distributed practice is effective and should be integrated into a MIS postgraduate course curriculum for acquisition of core skills.

  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. Minimally invasive devices for treating lower urinary tract symptoms in benign prostate hyperplasia: technology update

    Directory of Open Access Journals (Sweden)

    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

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

    Science.gov (United States)

    Saavoss, Josh D; Koenig, Lane; Cher, Daniel J

    2016-01-01

    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. 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. 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). For employees with chronic, severe SIJ dysfunction, minimally invasive SIJ fusion may improve worker productivity compared to nonsurgical treatment.

  10. 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

  11. A microneedle biosensor for minimally-invasive transdermal detection of nerve agents.

    Science.gov (United States)

    Mishra, Rupesh K; Vinu Mohan, A M; Soto, Fernando; Chrostowski, Robert; Wang, Joseph

    2017-03-13

    A microneedle electrochemical biosensor for the minimally invasive detection of organophosphate (OP) chemical agents is described. The new sensor relies on the coupling of the effective biocatalytic action of organophosphorus hydrolase (OPH) with a hollow-microneedle modified carbon-paste array electrode transducer, and involves rapid square-wave voltammetric (SWV) measurements of the p-nitrophenol product of the OPH enzymatic reaction in the presence of the OP substrate. The scanning-potential SWV transduction mode offers an additional dimension of selectivity compared to common fixed-potential OPH-amperometric biosensors. The microneedle device offers a highly linear response for methyl paraoxon (MPOx) over the range of 20-180 μM, high selectivity in the presence of excess co-existing ascorbic acid and uric acid and a high stability sensor upon exposure to the interstitial fluid (ISF). The OPH microneedle sensor was successfully tested ex vivo using mice skin samples exposed to MPOx, demonstrating its promise for minimally-invasive monitoring of OP agents and pesticides and as a wearable sensor for detecting toxic compounds, in general.

  12. Does robotics improve minimally invasive rectal surgery? Functional and oncological implications.

    Science.gov (United States)

    Guerra, Francesco; Pesi, Benedetta; Amore Bonapasta, Stefano; Perna, Federico; Di Marino, Michele; Annecchiarico, Mario; Coratti, Andrea

    2016-02-01

    Robot-assisted surgery has been reported to be a safe and effective alternative to conventional laparoscopy for the treatment of rectal cancer in a minimally invasive manner. Nevertheless, substantial data concerning functional outcomes and long-term oncological adequacy is still lacking. We aimed to assess the current role of robotics in rectal surgery focusing on patients' functional and oncological outcomes. A comprehensive review was conducted to search articles published in English up to 11 September 2015 concerning functional and/or oncological outcomes of patients who received robot-assisted rectal surgery. All relevant papers were evaluated on functional implications such as postoperative sexual and urinary dysfunction and oncological outcomes. Robotics showed a general trend towards lower rates of sexual and urinary postoperative dysfunction and earlier recovery compared with laparoscopy. The rates of 3-year local recurrence, disease-free survival and overall survival of robotic-assisted rectal surgery compared favourably with those of laparoscopy. This study fails to provide solid evidence to draw definitive conclusions on whether robotic systems could be useful in ameliorating the outcomes of minimally invasive surgery for rectal cancer. However, the available data suggest potential advantages over conventional laparoscopy with reference to functional outcomes. © 2016 Chinese Medical Association Shanghai Branch, Chinese Society of Gastroenterology, Renji Hospital Affiliated to Shanghai Jiaotong University School of Medicine and John Wiley & Sons Australia, Ltd.

  13. Safety and effectiveness of minimally invasive sacroiliac joint fusion in women with persistent post-partum posterior pelvic girdle pain: 12-month outcomes from a prospective, multi-center trial.

    Science.gov (United States)

    Capobianco, Robyn; Cher, Daniel

    2015-01-01

    Postpartum posterior pelvic girdle pain (PPGP) affects nearly 20 % of women who experience back pain in the peripartum period. The sacroiliac joint is a source of this pain in 75 % of women with persistent PPGP. A subset of women will fail to obtain acceptable pain relief from the current array of non-surgical treatment options. The purpose of this study is to assess the safety and effectiveness of minimally invasive sacroiliac (SI) joint fusion in women with chronic SI joint dysfunction whose pain began in the peri-partum period whose symptoms were recalcitrant to non-surgical management. A sub-group analysis of subjects with sacroiliac joint disruption and/or degenerative sacroiliitis enrolled in a prospective, multi-center trial of SI joint fusion was performed. Subjects with PPGP were identified and compared with women without PPGP and with men. Of 172 enrolled subjects, 52 were male, 100 were females without PPGP and 20 females had PPGP. PPGP subjects were significantly younger (43.3 years, vs. 52.8 for females without PPGP and 50.5 for men, p = 0.002). There were no differences in any other demographic or baseline clinical measure. Women with PPGP experienced a significant improvement in pain (-51 mm on VAS), function (-20.6 pts on ODI) and quality of life (SF-36 PCS +10.4, MCS +7.2, EQ-5D +0.31) at 12 months after surgery. These improvements were characteristic of the overall study results; no difference was detected between sub-groups. The sacroiliac joint can be a source of pain in women with persistent PPGP and should be investigated as a pain generator. In this study, women with carefully diagnosed chronic SI joint pain from PPGP recalcitrant to conservative therapies experienced clinically beneficially improvements in pain, disability and quality of life after minimally invasive SI joint fusion using a series of triangular porous plasma spray coated implants.

  14. 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. © 2015 International Society for Diseases of the Esophagus.

  15. 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.

  16. 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.

  17. Limited access atrial septal defect closure and the evolution of minimally invasive surgery.

    Science.gov (United States)

    Izzat, M B; Yim, A P; El-Zufari, M H

    1998-04-01

    While minimizing the "invasiveness" in general surgery has been equated with minimizing "access", what constitutes minimally invasive intra-cardiac surgery remains controversial. Many surgeons doubt the benefits of minimizing access when the need for cardiopulmonary bypass cannot be waived. Recognizing that median sternotomy itself does entail significant morbidity, we investigated the value of alternative approaches to median sternotomy using atrial septal defect closure as our investigative model. We believe that some, but not all minimal access approaches are associated with reduced postoperative morbidity and enhanced recovery. Our current strategy is to use a mini-sternotomy approach in adult patients, whereas conventional median sternotomy remains our standard approach in the pediatric population. Considerable clinical experiences coupled with documented clinical benefits are fundamental before a certain approach is adopted in routine practice.

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

    Energy Technology Data Exchange (ETDEWEB)

    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

  19. 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. Copyright © 2015 International Association of Oral and Maxillofacial Surgeons. Published by Elsevier Ltd. All rights reserved.

  20. Minimally invasive neuronavigator-guided microsurgery and photodynamic therapy for gliomas.

    Science.gov (United States)

    Wang, Yezhong; Lei, Ting; Wang, Zhi

    2009-06-01

    In order to evaluate the effectiveness of neuronavigator-guided microsurgery and keyhole technique for the resection of gliomas, a total of 60 patients with gliomas were exactly located by using neuronavigator during microsurgery. Forty deep-seated gliomas were resected through a keyhole operative approach. Thirty out of the 60 cases were subjected to photodynamic therapy (PDT) after tumor resection. The therapeutic effectiveness of all the cases was recorded and analyzed. The results showed that glioma was totally resected in 52 cases (86.7%), subtotally in 5 (8.3%), and most partially in 3 (5%). Neurological deficits occurred postoperatively in 4 cases. One patient died of multiple system organ failure 4 days after operation. It was concluded that the application of minimally invasive technique could dramatically decrease surgical complications following resection of glioma, and its combination with PDT could obviously improve the quality of life of patients and prolong the survival time.

  1. 3D printing-based minimally invasive cannulated screw treatment of unstable pelvic fracture.

    Science.gov (United States)

    Cai, Leyi; Zhang, Yingying; Chen, Chunhui; Lou, Yiting; Guo, Xiaoshan; Wang, Jianshun

    2018-04-04

    Open reduction and internal fixation of pelvic fractures could restore the stability of the pelvic ring, but there were several problems. Minimally invasive closed reduction cannulated screw treatment of pelvic fractures has lots advantages. However, how to insert the cannulated screw safely and effectively to achieve a reliable fixation were still hard for orthopedist. Our aim was to explore the significance of 3D printing technology as a new method for minimally invasive cannulated screw treatment of unstable pelvic fracture. One hundred thirty-seven patients with unstable pelvic fractures from 2014 to 2016 were retrospectively analyzed. Based on the usage of 3D printing technology for preoperative simulation surgery, they were assigned to 3D printing group (n = 65) and control group (n = 72), respectively. These two groups were assessed in terms of operative time, intraoperative fluoroscopy, postoperative reduction effect, fracture healing time, and follow-up function. The effect of 3D printing technology was evaluated through minimally invasive cannulated screw treatment. There was no significant difference in these two groups with respect to general conditions, such as age, gender, fracture type, time from injury to operation, injury cause, and combined injury. Length of surgery and average number of fluoroscopies were statistically different for 3D printing group and the control group (p 3D printing group, versus 22/72 cases (30.6%) scored as excellent and 36/72 cases (50%) as good for the control group. On the other hand, using the Majeed functional scoring criteria, there were 27/65 (41.5%) excellent and 26/65 (40%) good cases for the 3D printing group in comparison to 30/72 (41.7%) and 28/72 (38.9%) cases for the control group, respectively. This suggests no significant difference between these two groups about the function outcomes. Full reduction and proper fixation of the pelvic ring and reconstruction of anatomical morphology are of great

  2. Fixing a fractured arthrodesed hip with rapid prototype templating and minimal invasive plate osteosynthesis

    Directory of Open Access Journals (Sweden)

    Christian Fang

    2015-12-01

    Full Text Available CASE:: We present an elderly lady with an intertrochanteric fracture of a previously fused hip. A 3D printed model of her pelvis and femur was used for implant templating before surgery. Minimal invasive fixation was performed with a spanning reversed distal femur locking plate without the need for removal of the previous implant. Multiple long locking screws were placed in the supra-acetabular region. The patient had union in 4 months, return to function and no complication. Conclusion:: The technique allowed us to optimize implant selection and insert screws safely at difficult trajectories using minimal invasive surgery. Keywords: Hip fusion, Fracture, Plating, Minimal invasive, 3D printing

  3. Unicameral bone cyst of the calcaneus - minimally invasive endoscopic surgical treatment. Case report.

    Science.gov (United States)

    Stoica, Ioan Cristian; Pop, Doina Mihaela; Grosu, Florin

    2017-01-01

    The role of arthroscopic surgery for the treatment of various orthopedic pathologies has greatly improved during the last years. Recent publications showed that benign bone lesion may benefit from this minimally invasive surgical method, in order to minimize the invasiveness and the period of immobilization and to increase visualization. Unicameral bone cysts may be adequately treated by minimally invasive endoscopic surgery. The purpose of the current paper is to present the case report of a patient with a unicameral bone cyst of the calcaneus that underwent endoscopically assisted treatment with curettage and bone grafting with allograft from a bone bank, with emphasis on the surgical technique. Unicameral bone cyst is a benign bone lesion, which can be adequately treated by endoscopic curettage and percutaneous injection of morselized bone allograft in symptomatic patients.

  4. [Robotic-assisted minimally invasive abdominothoracal oesophageal resection with intrathoracic anastomosis].

    Science.gov (United States)

    Egberts, J-H; Aselmann, H; Schafmayer, C; Jünemann, K-P; Becker, T

    2014-02-01

    Ivor Lewis oesophagectomy is one of the approaches used worldwide for treating oesophageal cancer. The adoption of minimally invasive oesophagectomy has increased worldwide since its first description more than 15 years ago. However, minimally invasive oesophagectomy with a chest anastomosis has advantages. By using a four-arm robotic platform, not only the preparation of the gastric tube and mobilisation of the oesophagus but also the intrathoracic anastomosis of the oesophagogastrostomy can be performed in a comfortable and safe way. The indication for oesophageal resection is oesophageal cancer. The operative procedure comprises robotic-assisted abdominothoracal oesophageal resection with reconstruction by a gastric tube and intrathoracic anastomosis (Ivor Lewis procedure). Robotic abdominal and thoracic minimally invasive esophagectomy is feasible, and safe with a complete lymph node dissection. Especially the intrathoracic anastomosis of the oesophagogastrostomy can be performed in a comfortable and safe way. Georg Thieme Verlag KG Stuttgart · New York.

  5. 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.

  6. The past, present and future of minimally invasive therapy in urology: a review and speculative outlook.

    Science.gov (United States)

    Rassweiler, Jens; Rassweiler, Marie-Claire; Kenngott, Hannes; Frede, Thomas; Michel, Maurice-Stephan; Alken, Peter; Clayman, Ralph

    2013-08-01

    to determine the pathohistological pattern of the tumour to decide whether the patient requires removal, ablation or active surveillance. Management of localized prostate cancer underwent significant changes as well. 25 years ago open retropubic nerve-sparing radical prostatectomy was introduced as the optimal option for effective treatment of the cancer providing minimal side-effects. Basically, the same operation is performed today, but with robot-assisted laparoscopic techniques providing 7-DOF instruments, 3D-vision and tenfold magnification and enabling the surgeon to work in a sitting position at the console. In 25 years, prostate cancer may be managed in most cases by focal therapy and/or genetically targeting therapy. Only a few patients may still require robot-assisted removal of the entire gland. There has been a dramatic change in the management of the most frequent urologic diseases almost completely replacing open surgery by minimally invasive techniques. This was promoted by technical realisation of physical principles (shock waves, optical resolution, master-slave system) used outside of medicine. The future of medicine may lie in translational approaches individualizing the management based on genetic information and focalizing the treatment by further improvement of imaging technology.

  7. A minimally invasive option for the treatment of persistent ...

    African Journals Online (AJOL)

    . Hospital, King Saud ... We present two patients with persistent esophageal leak after compli- .... easy, and quite effective in the management of persistent ... 6 Rakocz M, Mazar A, Varon D, Spierer S, Blinder D, Martinowitz U. Dental extractions ...

  8. [Advantages and disadvantages of minimally invasive surgery in colorectal cancer surgery].

    Science.gov (United States)

    Zheng, Minhua; Ma, Junjun

    2017-06-25

    Since the emergence of minimally invasive technology twenty years ago, as a surgical concept and surgical technique for colorectal cancer surgery, its obvious advantages have been recognized. Laparoscopic technology, as one of the most important technology platform, has got a lot of evidence-based support for the oncological safety and effectiveness in colorectal cancer surgery Laparoscopic technique has advantages in terms of identification of anatomic plane and autonomic nerve, protection of pelvic structure, and fine dissection of vessels. But because of the limitation of laparoscopic technology there are still some deficiencies and shortcomings, including lack of touch and lack of stereo vision problems, in addition to the low rectal cancer, especially male, obese, narrow pelvis, larger tumors, it is difficult to get better view and manipulating triangle in laparoscopy. However, the emergence of a series of new minimally invasive technology platform is to make up for the defects and deficiencies. The robotic surgical system possesses advantages, such as stereo vision, higher magnification, manipulator wrist with high freedom degree, filtering of tremor and higher stability, but still has disadvantages, such as lack of haptic feedback, longer operation time, high operation cost and expensive price. 3D system of laparoscopic surgery has similar visual experience and feelings as robotic surgery in the 3D view, the same operating skills as 2D laparoscopy and a short learning curve. The price of 3D laparoscopy is also moderate, which makes the 3D laparoscopy more popular in China. Transanal total mesorectal excision (taTME) by changing the traditional laparoscopic pelvic surgery approach, may have certain advantages for male cases with narrow pelvic and patients with large tumor, and it is in accordance with the technical concept of natural orifice, with less minimally invasive and better cosmetics, which can be regarded as a supplemental technique of the

  9. Hyperparathyroidism in octogenarians: A plea for ambulatory minimally invasive surgery under local anesthesia.

    Science.gov (United States)

    Fui, Stéphanie Li Sun; Bonnichon, Philippe; Bonni, Nicolas; Delbot, Thierry; André, Jean Pascal; Pion-Graff, Joëlle; Berrod, Jean-Louis; Fontaine, Marine; Brunaud, Catherine; Cocagne, Nicolas

    2016-10-01

    With the current aging of the world's population, diagnosis of primary hyperparathyroidism is being reported in increasingly older patients, with the associated functional symptomatology exacerbating the vicissitudes of age. This retrospective study was designed to establish functional improvements in older patients following parathyroid adenomectomy under local anesthesia as outpatient surgery. Data were collected from 53 patients aged 80 years or older who underwent a minimally invasive parathyroid adenomectomy. All patients underwent a preoperative ultrasound, scintigraphy, and were monitored for the effectiveness of the procedure according to intra- and postdosage of parathyroid hormone (PTH) at 5min, 2h and 4h. Mean preoperative serum calcium level was 2.8mmol/L (112mg/L) and mean PTH was 180pg/ml. Thirty-eight patients were operated under local anesthesia using minimally invasive surgery and 18 patients were operated under general anesthesia. In 26 cases, the procedure was planned on an outpatient basis but could only be carried out in 21 patients. Fifty-one patients had normal serum calcium and PTH levels during the immediate postoperative period. Two patients were reoperated under general anesthesia, since immediate postoperative PTH did not return to normal. Four patients died due to reasons unrelated to hyperparathyroidism. Five patients were lost to follow-up six months to two years postsurgery. Of the 44 patients (83%) with long-term monitoring for PTH, none had recurrence of biological hyperparathyroidism. Excluding the three asymptomatic patients, 38 of the 41 symptomatic patients (93%) with long-term follow-up were considering themselves as "improved" or "strongly improved" after the intervention, notably with respect to fatigue, muscle and bone pain. Two patients (4.9%) reported no difference and one patient (2.4%) said her condition had worsened and regretted having undergone surgery. In patients 80 years or older, minimally invasive surgery as an

  10. The minimally invasive endoscopic management of septated chronic subdural hematomas: surgical technique.

    Science.gov (United States)

    Berhouma, M; Jacquesson, T; Jouanneau, E

    2014-12-01

    Fibrin membranes and compartmentalization within the subdural space are a frequent cause of failure in the treatment of chronic subdural hematomas (CSH). This specific subtype of CSH classically requires craniotomy, which carries significant morbidity and mortality rates, particularly in elderly patients. In this work, we describe a minimally invasive endoscopic alternative. Under local scalp anesthesia, a rigid endoscope is inserted through a parietal burr hole in the subdural space to collapse fibrin septa and cut the internal membrane. It also allows cauterization of active bleedings and the placement of a drain under direct visualization. The endoscopic treatment of septated CSH represents a minimally invasive alternative to craniotomy especially for the internal membranectomy.

  11. Outcome of a graduated minimally invasive facial reanimation in patients with facial paralysis.

    Science.gov (United States)

    Holtmann, Laura C; Eckstein, Anja; Stähr, Kerstin; Xing, Minzhi; Lang, Stephan; Mattheis, Stefan

    2017-08-01

    Peripheral paralysis of the facial nerve is the most frequent of all cranial nerve disorders. Despite advances in facial surgery, the functional and aesthetic reconstruction of a paralyzed face remains a challenge. Graduated minimally invasive facial reanimation is based on a modular principle. According to the patients' needs, precondition, and expectations, the following modules can be performed: temporalis muscle transposition and facelift, nasal valve suspension, endoscopic brow lift, and eyelid reconstruction. Applying a concept of a graduated minimally invasive facial reanimation may help minimize surgical trauma and reduce morbidity. Twenty patients underwent a graduated minimally invasive facial reanimation. A retrospective chart review was performed with a follow-up examination between 1 and 8 months after surgery. The FACEgram software was used to calculate pre- and postoperative eyelid closure, the level of brows, nasal, and philtral symmetry as well as oral commissure position at rest and oral commissure excursion with smile. As a patient-oriented outcome parameter, the Glasgow Benefit Inventory questionnaire was applied. There was a statistically significant improvement in the postoperative score of eyelid closure, brow asymmetry, nasal asymmetry, philtral asymmetry as well as oral commissure symmetry at rest (p facial nerve repair or microneurovascular tissue transfer cannot be applied, graduated minimally invasive facial reanimation is a promising option to restore facial function and symmetry at rest.

  12. Minimal invasive stabilization of osteoporotic vertebral compression fractures. Methods and preinterventional diagnostics

    International Nuclear Information System (INIS)

    Grohs, J.G.; Krepler, P.

    2004-01-01

    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.) [de

  13. Atrioesophageal Fistula after Minimally Invasive Video-Assisted Epicardial Ablation for Lone Atrial Fibrillation.

    Science.gov (United States)

    Kik, Charles; van Valen, Richard; Mokhles, Mostafa M; Bekkers, Jos A; Bogers, Ad J J C

    2017-09-01

    Minimally invasive video-assisted epicardial beating heart ablation for lone atrial fibrillation claims to be safe and effective. We, however, report on three patients with an atrioesophageal fistula after this procedure. The exact pathogenesis of this complication is unknown. All patients presented around 6 weeks after surgery with either fever or neurological deficits. Diagnosis can be made by computed tomography scan. We advocate an aggressive surgical approach with closure of the atrial defect on cardiopulmonary bypass and closure and reinforcement of the esophagus with an intercostal muscle flap in a single-stage surgery. Some caution as to the low-risk character of this procedure seems to be realistic. Georg Thieme Verlag KG Stuttgart · New York.

  14. Towards Clinically Optimized MRI-guided Surgical Manipulator for Minimally Invasive Prostate Percutaneous Interventions: Constructive Design*

    Science.gov (United States)

    Eslami, Sohrab; Fischer, Gregory S.; Song, Sang-Eun; Tokuda, Junichi; Hata, Nobuhiko; Tempany, Clare M.; Iordachita, Iulian

    2013-01-01

    This paper undertakes the modular design and development of a minimally invasive surgical manipulator for MRI-guided transperineal prostate interventions. Severe constraints for the MRI-compatibility to hold the minimum artifact on the image quality and dimensions restraint of the bore scanner shadow the design procedure. Regarding the constructive design, the manipulator kinematics has been optimized and the effective analytical needle workspace is developed and followed by proposing the workflow for the manual needle insertion. A study of the finite element analysis is established and utilized to improve the mechanism weaknesses under some inevitable external forces to ensure the minimum structure deformation. The procedure for attaching a sterile plastic drape on the robot manipulator is discussed. The introduced robotic manipulator herein is aimed for the clinically prostate biopsy and brachytherapy applications. PMID:24683502

  15. A minimally invasive surgical approach for large cyst-like periapical lesions: a case series.

    Science.gov (United States)

    Shah, Naseem; Logani, Ajay; Kumar, Vijay

    2014-01-01

    Various conservative approaches have been utilized to manage large periapical lesions. This article presents a relatively new, very conservative technique known as surgical fenestration which is both diagnostic and curative. The technique involves partially excising the cystic lining, gently curetting the cystic cavity, performing copious irrigation, and closing the surgical site. This technique allows for decompression and allows the clinician the freedom to take a biopsy of the lesion, as well as perform other procedures such as root resection and retrograde sealing, if required. As the procedure does not perform a complete excision of the cystic lining, it is both minimally invasive and cost-effective. The technique and the concepts involved are reviewed in 4 cases treated with this novel surgical approach.

  16. Update on Pharmaceutical and Minimally Invasive Management Strategies for Chronic Obstructive Pulmonary Disease

    Directory of Open Access Journals (Sweden)

    Rokhsara Rafii

    2011-01-01

    Full Text Available Chronic obstructive pulmonary disease (COPD is a debilitating pulmonary disorder with systemic effects, and it is the fourth leading cause of death in the United States. COPD patients not only develop respiratory limitations, but can also demonstrate systemic wasting, features of depression, and can succumb to social isolation. Smoking cessation is crucial, and pharmacotherapy with bronchodilators is helpful in symptom management. Inhaled corticosteroids may be beneficial in some patients. In addition, pulmonary rehabilitation and palliative care are important components under the right clinical circumstance. This review highlights current guidelines and management strategies for COPD and emphasizes novel pharmacotherapy and minimally invasive (nonsurgical lung-volume reduction interventions that may prove to be of significant benefit in the future.

  17. Spontaneous and traumatic hepatic rupture: imaging findings and minimally invasive treatment

    International Nuclear Information System (INIS)

    Palacio, Glaucia Andrade e Silva; D'Ippolito, Giuseppe

    2003-01-01

    Spontaneous hepatic bleeding is a rare condition. Our aim was to describe the imaging findings and minimally invasive treatment using transcatheter arterial embolization in patients with spontaneous and traumatic hepatic rupture. Three patients presented acute hemoperitoneum dur to hepatic rupture caused by spontaneous rupture of hepatocellular carcinoma, HELLP syndrome and a blunt hepatic trauma. The patients were submitted to ultrasound and computed tomography of the abdomen and subsequently treated by transcatheter arterial embolization. All patients underwent helical computed tomography before and after treatments. Computed tomography played an important role in the evaluation and follow-up in the therapeutic intervention. Different types of liver injuries were identified. Transcatheter arterial embolization blocked arterial hemorrhage in the patients who were hemodynamically unstable. The conclusion was: transcatheter arterial embolization is an effective and well-tolerated treatment method for the management of hepatic rupture and computed tomography is an excellent method for the diagnosis and follow-up of these patients. (author)

  18. Impact of novel techniques on minimally invasive adrenal surgery: trends and outcomes from a contemporary international large series in urology.

    Science.gov (United States)

    Pavan, Nicola; Autorino, Riccardo; Lee, Hak; Porpiglia, Francesco; Sun, Yinghao; Greco, Francesco; Jeff Chueh, S; Han, Deok Hyun; Cindolo, Luca; Ferro, Matteo; Chen, Xiang; Branco, Anibal; Fornara, Paolo; Liao, Chun-Hou; Miyajima, Akira; Kyriazis, Iason; Puglisi, Marco; Fiori, Cristian; Yang, Bo; Fei, Guo; Altieri, Vincenzo; Jeong, Byong Chang; Berardinelli, Francesco; Schips, Luigi; De Cobelli, Ottavio; Chen, Zhi; Haber, Georges-Pascal; He, Yao; Oya, Mototsugu; Liatsikos, Evangelos; Brandao, Luis; Challacombe, Benjamin; Kaouk, Jihad; Darweesh, Ithaar

    2016-10-01

    To evaluate contemporary international trends in the implementation of minimally invasive adrenalectomy and to assess contemporary outcomes of different minimally invasive techniques performed at urologic centers worldwide. A retrospective multinational multicenter study of patients who underwent minimally invasive adrenalectomy from 2008 to 2013 at 14 urology institutions worldwide was included in the analysis. Cases were categorized based on the minimally invasive adrenalectomy technique: conventional laparoscopy (CL), robot-assisted laparoscopy (RAL), laparoendoscopic single-site surgery (LESS), and mini-laparoscopy (ML). The rates of the four treatment modalities were determined according to the year of surgery, and a regression analysis was performed for trends in all surgical modalities. Overall, a total of 737 adrenalectomies were performed across participating institutions and included in this analysis: 337 CL (46 % of cases), 57 ML (8 %), 263 LESS (36 %), and 80 RA (11 %). Overall, 204 (28 %) operations were performed with a retroperitoneal approach. The overall number of adrenalectomies increased from 2008 to 2013 (p = 0.05). A transperitoneal approach was preferred in all but the ML group (p Asia and South America reported the highest rate in LESS procedures, and RAL was adopted to larger extent in the USA. LESS had the fastest increase in utilization at 6 %/year. The rate of RAL procedures increased at slower rates (2.2 %/year), similar to ML (1.7 %/year). Limitations of this study are the retrospective design and the lack of a cost analysis. Several minimally invasive surgical techniques for the management of adrenal masses are successfully implemented in urology institutions worldwide. CL and LESS seem to represent the most commonly adopted techniques, whereas ML and RAL are growing at a slower rate. All the MIS techniques can be safely and effectively performed for a variety of adrenal disease.

  19. Total abdominal hysterectomy versus minimal-invasive hysterectomy: a systemic review and meta-analysis

    International Nuclear Information System (INIS)

    Aragon Palmero, Felipe Jorge; Exposito Exposito, Moises

    2011-01-01

    INTRODUCTION. At the present time three types of hysterectomies are used: the vaginal hysterectomy and the minimal-invasive hysterectomy (MIH). The objective of present research was to compare the MIH and the total abdominal hysterectomy (TAH) in women presenting with benign uterine diseases. METHODS. A systemic review was made and a meta-analysis from the following databases: MEDLINE, EBSCO HOST AND The Cochrane Central Register of Controlled Trials. Only the controlled and randomized studies were selected. The data of all studies were combined and also the relative risk (RR) with a 95% CI was used with the Mantel-Haenszel method as an effect measure for dichotomy variables. For the analysis of continuing variables the mean difference was used. In all the comparisons performed the results were obtained with the fix effect and randomized forms. RESULTS. A total of 53 transoperative complications were registered in the MIH hysterectomy versus 17 in the TAH group (RR: 1,78; 95% CI: 1,04-3.05). Postoperative complications evolved in a similar way in both groups without significant differences from the statistical point of view. The blood losses, the hospital stay and the patient's reincorporation to usual and work activities were lesser in the laparoscopy group; however, the operative time is higher when it is compared with TAH (mean difference: 37,36; 95% CI: 34,36-39,93). CONCLUSIONS. Both techniques have advantages and disadvantages. The indication of MIH must to be individualized according to the clinical situation of each patient and these not to be performed in those centers without a properly trained surgical staff and with experience in advanced minimal invasive surgery. (author)

  20. MAGNAMOSIS IV: magnetic compression anastomosis for minimally invasive colorectal surgery.

    Science.gov (United States)

    Wall, J; Diana, M; Leroy, J; Deruijter, V; Gonzales, K D; Lindner, V; Harrison, M; Marescaux, J

    2013-08-01

    MAGNAMOSIS forms a compression anastomosis using self-assembling magnetic rings that can be delivered via flexible endoscopy. The system has proven to be effective in full-thickness porcine small-bowel anastomoses. The aim of this study was to show the feasibility of the MAGNAMOSIS system in hybrid endoscopic colorectal surgery and to compare magnetic and conventional stapled anastomoses. A total of 16 swine weighing 35 - 50 kg were used following animal ethical committee approval. The first animal was an acute model to establish the feasibility of the procedure. The subsequent 15 animals were survival models, 10 of which underwent side-to-side anastomoses (SSA) and 5 of which underwent end-to-side (ESA) procedures. Time to patency, surveillance endoscopy, burst pressure, compression force, and histology were assessed. Histology was compared with conventional stapled anastomoses. Magnetic compression forces were measured in various anastomosis configurations. Colorectal anastomoses were performed in all cases using a hybrid NOTES technique. The mean operating time was 71 minutes. Mean time to completion of the anastomosis was similar between the SSA and ESA groups. Burst pressure at 10 days was greater than 95 mmHg in both groups. One complication occurred in the ESA group. Compression force among various configurations of the magnetic rings was significantly different (P < 0.05). Inflammation and fibrosis were similar between magnetic SSA and conventional stapled anastomoses. MAGNAMOSIS was feasible in performing a hybrid NOTES colorectal anastomosis. It has the advantage over circular staplers of precise endoscopic delivery throughout the entire colon. SSA was reliable and effective. A minimum initial compression force of 4 N appears to be required for reliable magnetic anastomoses. © Georg Thieme Verlag KG Stuttgart · New York.

  1. Procedural virtual reality simulation in minimally invasive surgery.

    Science.gov (United States)

    Våpenstad, Cecilie; Buzink, Sonja N

    2013-02-01

    Simulation of procedural tasks has the potential to bridge the gap between basic skills training outside the operating room (OR) and performance of complex surgical tasks in the OR. This paper provides an overview of procedural virtual reality (VR) simulation currently available on the market and presented in scientific literature for laparoscopy (LS), flexible gastrointestinal endoscopy (FGE), and endovascular surgery (EVS). An online survey was sent to companies and research groups selling or developing procedural VR simulators, and a systematic search was done for scientific publications presenting or applying VR simulators to train or assess procedural skills in the PUBMED and SCOPUS databases. The results of five simulator companies were included in the survey. In the literature review, 116 articles were analyzed (45 on LS, 43 on FGE, 28 on EVS), presenting a total of 23 simulator systems. The companies stated to altogether offer 78 procedural tasks (33 for LS, 12 for FGE, 33 for EVS), of which 17 also were found in the literature review. Although study type and used outcomes vary between the three different fields, approximately 90 % of the studies presented in the retrieved publications for LS found convincing evidence to confirm the validity or added value of procedural VR simulation. This was the case in approximately 75 % for FGE and EVS. Procedural training using VR simulators has been found to improve clinical performance. There is nevertheless a large amount of simulated procedural tasks that have not been validated. Future research should focus on the optimal use of procedural simulators in the most effective training setups and further investigate the benefits of procedural VR simulation to improve clinical outcome.

  2. Treatment of malignant glaucoma with minimal invasive vitrectomy surgery

    Directory of Open Access Journals (Sweden)

    Li Meng

    2015-09-01

    Full Text Available AIM:To evaluate the efficacy of 25G vitrectomy surgery for malignant glaucoma. METHODS: Thirteen eyes of 11 patients with malignant glaucoma who had a history of primary angle-closure glaucoma were analyzed retrospectively from September 2012 to October 2013 in our hospital. All patients had undergone a prior surgery of trebeculectomy combined with iridectomy. The pre-operative mean best corrected visual acuity(BCVAin LogMAR was 0.70±0.13 and the mean intraocular pressure(IOPwas 41.3±12.7mmHg. Corneal edema, ciliary body edema and very shallow anterior chamber with a mean value of 0.69±0.17mm were showed by ultrasound biomicroscopy(UBM. Anterior vitrectomy and posterior capsulotomy were performed with 25G vitrectomy system in all eyes. Seven phakic eyes underwent phacoimulsification combined IOL implantation surgery during vitrectomy.RESULTS: The patients were followed up for 6~18mo with an average of 11.7±5.4mo. BCVA at the last follow-up improved to 0.29±0.08 and the mean IOP was 18.6±3.9mmHg. UBM results showed that ciliary body edema was eliminated, the iris was flattened and the anterior chamber was deepened with a mean depth of 2.48±0.31mm at 1mo after surgery. Postoperative complications included corneal edma, Descemet membrane folds, anterior chamber inflammation, fibrotic exudation, local iris posterior synechia and hypotony(IOP≤5mmHg. One eye had high IOP of 26.4mmHg and required long-term topical antiglaucoma medication to control the IOP≤21mmHg. No complications such as corneal endothelium decompensation, IOL capture, intraocular hemorrhage, infection and uncontrolled IOP were observed. CONCLUSION: 25G vitrectomy is safe and effective for treating malignant glaucoma, controls IOP and reduces complications associated with traditional vitrectomy. Combined vitrectomy with phacoemulsification may improve the success rate and visual function.

  3. Manual of extravascular minimally invasive interventional procedures of the liver and biliary tract

    International Nuclear Information System (INIS)

    Miranda Mena, Shirley

    2011-01-01

    The use of interventional radiology and image-guided surgery has increased. Interventional radiologists are involved in patient treatment, well as in the diagnosis of the disease carrying his knowledge to the tumor treatment and procedures more invasive. Large amount of didactic material there are available, but the country lacks a manual to standardize interventional radiological techniques carried out. Also, those that could be instituted and adapted effectively in the management of hepatobiliary pathology of the Sistema de Salud Publica in Costa Rica, that covers the main procedures and adopt guidelines in a standardized way. A manual of procedures minimally invasive radiologic extravascular of the liver and biliary tract, is presented with broad bibliographic support that directs, standardizes and is adaptable to the needs and own resources of Costa Rica. Interventional radiology has been a non surgical alternative of a low index of complications, useful for the management of some health problems, avoids surgery and certainly lower costs. An alternative to surgical treatment of many conditions is offered, thereby reducing complications (morbidity) and can eliminate the need for hospitalization, in some cases. The development of new materials has allowed the most common working tools of the medical field are improved and become increasingly more efficient in the diagnosis and treatment of diseases, improving the training of radiologists in the interventional field. (author) [es

  4. 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.

  5. 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.

  6. Minimally invasive repair of Morgagni hernia – A multicenter case series

    Directory of Open Access Journals (Sweden)

    R. Lamas-Pinheiro

    2016-09-01

    Full Text Available 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 ± 23 min. 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 24 h. 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. Keywords: Laparoscopy, Minimally invasive surgery, Percutaneous, Morgagni hernia, Diaphragmatic hernia

  7. Minimizing opportunity costs to aquatic connectivity restoration while controlling an invasive species.

    Science.gov (United States)

    Milt, Austin W; Diebel, Matthew W; Doran, Patrick J; Ferris, Michael C; Herbert, Matthew; Khoury, Mary L; Moody, Allison T; Neeson, Thomas M; Ross, Jared; Treska, Ted; O'Hanley, Jesse R; Walter, Lisa; Wangen, Steven R; Yacobson, Eugene; McIntyre, Peter B

    2018-03-08

    Controlling invasive species is critical for conservation but can have unintended consequences for native species and divert resources away from other efforts. This dilemma occurs on a grand scale in the North American Great Lakes, where dams and culverts block tributary access to habitat of desirable fish species and are a lynchpin of long-standing efforts to limit ecological damage inflicted by the invasive, parasitic sea lamprey (Petromyzon marinus). Habitat restoration and sea-lamprey control create conflicting goals for managing aging infrastructure. We used optimization to minimize opportunity costs of habitat gains for 37 desirable migratory fishes that arose from restricting sea lamprey access (0-25% increase) when selecting barriers for removal under a limited budget (US$1-105 million). Imposing limits on sea lamprey habitat reduced gains in tributary access for desirable species by 15-50% relative to an unconstrained scenario. Additional investment to offset the effect of limiting sea-lamprey access resulted in high opportunity costs for 30 of 37 species (e.g., an additional US$20-80 million for lake sturgeon [Acipenser fulvescens]) and often required ≥5% increase in sea-lamprey access to identify barrier-removal solutions adhering to the budget and limiting access. Narrowly distributed species exhibited the highest opportunity costs but benefited more at less cost when small increases in sea-lamprey access were allowed. Our results illustrate the value of optimization in limiting opportunity costs when balancing invasion control against restoration benefits for diverse desirable species. Such trade-off analyses are essential to the restoration of connectivity within fragmented rivers without unleashing invaders. © 2018 Society for Conservation Biology.

  8. Continuous spinal anaesthesia with minimally invasive haemodynamic monitoring for surgical hip repair in two patients with severe aortic stenosis

    Directory of Open Access Journals (Sweden)

    María Mercedes López

    2016-02-01

    Full Text Available BACKGROUND AND OBJECTIVES: Aortic stenosis increases perioperative morbidity and mortality, perioperative invasive monitoring is advised for patients with an aortic valve area 30 mm Hg and it is important to avoid hypotension and arrhythmias. We report the anaesthetic management with continuous spinal anaesthesia and minimally invasive haemodynamic monitoring of two patients with severe aortic stenosis undergoing surgical hip repair. CASE REPORT: Two women with severe aortic stenosis were scheduled for hip fracture repair. Continuous spinal anaesthesia with minimally invasive haemodynamic monitoring was used for anaesthetic management of both. Surgery was performed successfully after two consecutive doses of 2 mg of isobaric bupivacaine 0.5% in one of them and four consecutive doses in the other. Haemodynamic conditions remained stable throughout the intervention. Vital signs and haemodynamic parameters remained stable throughout the two interventions. CONCLUSION: Our report illustrates the use of continuous spinal anaesthesia with minimally invasive haemodynamic monitoring as a valid alternative to general or epidural anaesthesia in two patients with severe aortic stenosis who are undergoing lower limb surgery. However, controlled clinical trials would be required to establish that this technique is safe and effective in these type or patients.

  9. 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.

  10. The stability of the femoral component of a minimal invasive total hip replacement system.

    NARCIS (Netherlands)

    Willems, M.M.M.; Kooloos, J.G.M.; Gibbons, P.; Minderhoud, N.; Weernink, T.; Verdonschot, N.J.J.

    2006-01-01

    In this study, the initial stability of the femoral component of a minimal invasive total hip replacement was biomechanically evaluated during simulated normal walking and chair rising. A 20 mm diameter canal was created in the femoral necks of five fresh frozen human cadaver bones and the femoral

  11. Patient Preferences for Minimally Invasive and Open Locoregional Treatment for Early-Stage Breast Cancer

    NARCIS (Netherlands)

    Knuttel, Floor; van den Bosch, Maurice A A J; Young-Afat, Danny A.; Emaus, Marleen J.; van den Bongard, Desirée H J G; Witkamp, Arjen J.; Verkooijen, Helena M.

    Background: Noninvasive or minimally invasive treatments are being developed as alternatives to surgery for patients with early-stage breast cancer. Patients' preferences with regard to these new treatments have not been investigated. Objectives: To assess preferences of patients with breast cancer

  12. Patient safety risk factors in minimally invasive surgery : A validation study

    NARCIS (Netherlands)

    Rodrigues, S.P.; Ter Kuile, M.; Dankelman, J.; Jansen, F.W.

    2012-01-01

    This study was conducted to adapt and validate a patient safety (PS) framework for minimally invasive surgery (MIS) as a first step in understanding the clinical relevance of various PS risk factors in MIS. Eight patient safety risk factor domains were identified using frameworks from a systems

  13. Pan-European survey on the implementation of minimally invasive pancreatic surgery with emphasis on cancer

    NARCIS (Netherlands)

    de Rooij, Thijs; Besselink, Marc G.; Shamali, Awad; Butturini, Giovanni; Busch, Olivier R.; Edwin, Bjørn; Troisi, Roberto; Fernández-Cruz, Laureano; Dagher, Ibrahim; Bassi, Claudio; Abu Hilal, Mohammad

    2016-01-01

    Minimally invasive (MI) pancreatic surgery appears to be gaining popularity, but its implementation throughout Europe and the opinions regarding its use in pancreatic cancer patients are unknown. A 30-question survey was sent between June and December 2014 to pancreatic surgeons of the European

  14. Stabilization of Flail Chest and Fractured Sternum by Minimally Invasive Repair of Pectus Excavatum

    OpenAIRE

    Akku?, Murat; Utkusava?, Ayfer; Han?z?, Murat; Kaya, Mehmet; Bakir, Ihsan

    2015-01-01

    We report a 55-year-old male patient with a massive flail chest that required chest stabilization by minimally invasive repair of pectus excavatum (MIRPE) employing a Nuss bar. Surgical stabilization of severe flail chest and fractured sternum with Nuss bar by MIRPE is a safe and useful treatment modality in properly selected patients.

  15. Perioperative outcomes of minimally invasive versus open radical cystectomy: A single-center experience

    Directory of Open Access Journals (Sweden)

    Pankaj Panwar

    2018-01-01

    Conclusions: MIS is associated with significantly longer operative time than open RC. Robotic RC has significantly higher lymph node yield than open or laparoscopic RC. Minimally invasive RC is equivalent to open surgery in terms of perioperative morbidity, mortality, and blood loss.

  16. Influence of Minimally Invasive Total Hip Replacement on Hip Reaction Forces and Their Orientations

    NARCIS (Netherlands)

    Weber, Tim; Al-Munajjed, Amir A.; Verkerke, Gijsbertus Jacob; Dendorfer, Sebastian; Renkawitz, Tobias

    2014-01-01

    Minimally invasive surgery (MIS) is becoming increasingly popular. Supporters claim that the main advantages of MIS total hip replacement (THR) are less pain and a faster rehabilitation and recovery. Critics claim that safety and efficacy of MIS are yet to be determined. We focused on a

  17. Minimally Invasive Cochlear Implantation Assisted by Bi-planar Device: An Exploratory Feasibility Study in vitro

    Directory of Open Access Journals (Sweden)

    Jia Ke

    2016-01-01

    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.

  18. Local immobilization of the left anterior descending artery for minimally invasive coronary bypass grafting

    NARCIS (Netherlands)

    Boonstra, PW; Grandjean, JG; Mariani, MA

    We describe a device for coronary artery stabilization during minimally invasive coronary artery bypass grafting performed without cardiopulmonary bypass via a small (8 to 10 cm) left anterolateral thoracotomy. This device facilitates the anastomosis of the left internal mammary artery to the left

  19. Transurethral microwave thermotherapy: The gold standard for minimally invasive therapies for patients with benign prostatic hyperplasia?

    NARCIS (Netherlands)

    de La Rosette, Jean J. M. C. H.; Laguna, M. Pilar; Gravas, Stavros; de Wildt, Michel J. A. M.

    2003-01-01

    From all available minimally invasive methods for the treatment of symptomatic benign prostatic hyperplasia (BPH), transurethral microwave thermotherapy (TUMT) has gained a firm position as the most attractive option. Recent research has produced innovations in high-energy TUMT, including new

  20. Impact of a Nationwide Training Program in Minimally Invasive Distal Pancreatectomy (LAELAPS)

    NARCIS (Netherlands)

    de Rooij, Thijs; van Hilst, Jony; Boerma, Djamila; Bonsing, Bert A.; Daams, Freek; van Dam, Ronald M.; Dijkgraaf, Marcel G.; van Eijck, Casper H.; Festen, Sebastiaan; Gerhards, Michael F.; Koerkamp, Bas Groot; van der Harst, Erwin; de Hingh, Ignace H.; Kazemier, Geert; Klaase, Joost; de Kleine, Ruben H.; van Laarhoven, Cornelis J.; Lips, Daan J.; Luyer, Misha D.; Molenaar, I. Quintus; Patijn, Gijs A.; Roos, Daphne; Scheepers, Joris J.; van der Schelling, George P.; Steenvoorde, Pascal; Vriens, Menno R.; Wijsman, Jan H.; Gouma, Dirk J.; Busch, Olivier R.; Hilal, Mohammed Abu; Besselink, Marc G.; de Boer, Marieke T.

    2016-01-01

    Objective:To study the feasibility and impact of a nationwide training program in minimally invasive distal pancreatectomy (MIDP).Summary of Background Data:Superior outcomes of MIDP compared with open distal pancreatectomy have been reported. In the Netherlands (2005 to 2013) only 10% of distal

  1. 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...

  2. Minimally invasive treatment of pilon fractures with a low profile plate: preliminary results in 17 cases

    NARCIS (Netherlands)

    Borens, Olivier; Kloen, Peter; Richmond, Jeffrey; Roederer, Goetz; Levine, David S.; Helfet, David L.

    2009-01-01

    To determine the results of "biologic fixation" with a minimally invasive plating technique using a newly designed low profile "Scallop" plate in the treatment of pilon fractures. Retrospective case series. A tertiary referral center. Seventeen patients were treated between 1999 and 2001 for a

  3. Training potential in minimally invasive surgery in a tertiary care, paediatric urology centre

    NARCIS (Netherlands)

    Schroeder, R. P. J.; Chrzan, R. J.; Klijn, A. J.; Kuijper, C. F.; Dik, P.; de Jong, T. P. V. M.

    2015-01-01

    Background Minimally invasive surgery (MIS) is being utilized more frequently as a surgical technique in general surgery and in paediatric urology. It is associated with a steep learning curve. Currently, the centre does not offer a MIS training programme. It is hypothesized that the number of MIS

  4. Training potential in minimally invasive surgery in a tertiary care, paediatric urology centre

    NARCIS (Netherlands)

    Schroeder, R. P. J.; Chrzan, R. J.; Klijn, A. J.; Kuijper, C. F.; Dik, P.; de Jong, T. P. V. M.

    2015-01-01

    Minimally invasive surgery (MIS) is being utilized more frequently as a surgical technique in general surgery and in paediatric urology. It is associated with a steep learning curve. Currently, the centre does not offer a MIS training programme. It is hypothesized that the number of MIS procedures

  5. 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

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

    OpenAIRE

    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...

  7. 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

  8. 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

  9. 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.

  10. 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.

  11. Minimally invasive oesophagectomy more expensive than open despite shorter length of stay.

    Science.gov (United States)

    Dhamija, Anish; Dhamija, Ankit; Hancock, Jacquelyn; McCloskey, Barbara; Kim, Anthony W; Detterbeck, Frank C; Boffa, Daniel J

    2014-05-01

    The minimally invasive oesophagectomy (MIO) approach offers a number of advantages over open approaches including reduced discomfort, shorter length of stay and a faster recovery to baseline status. On the other hand, minimally invasive procedures typically are longer and consume greater disposable instrumentation, potentially resulting in a greater overall cost. The objective of this study was to compare costs associated with various oesophagectomy approaches for oesophageal cancer. An institutional Resource Information Management System (RIMS) was queried for cost data relating to hospital expenditures (as opposed to billings or collections). The RIMS was searched for patients undergoing oesophagectomy for oesophageal cancer between 2003 and 2012 via minimally invasive, open transthoracic (OTT) (including Ivor Lewis, modified McKeown or thoracoabdominal) or transhiatal approaches. Patients that were converted from minimally invasive to open, or involved hybrid procedures, were excluded. A total of 160 oesophagectomies were identified, including 61 minimally invasive, 35 open transthoracic and 64 transhiatal. Costs on the day of surgery averaged higher in the MIO group ($12 476 ± 2190) compared with the open groups, OTT ($8202 ± 2512, P < 0.0001) or OTH ($5809 ± 2575, P < 0.0001). The median costs associated with the entire hospitalization also appear to be higher in the MIO group ($25 935) compared with OTT ($24 440) and OTH ($15 248). The average length of stay was lowest in the MIO group (11 ± 9 days) compared with OTT (19 ± 18 days, P = 0.006) and OTH (18 ± 28 days P = 0.07). The operative mortality was similar in the three groups (MIO = 3%, OTT = 9% and OTH = 3%). The operating theatre costs associated with minimally invasive oesophagectomy are significantly higher than OTT or OTH approaches. Unfortunately, a shorter hospital stay after MIO does not consistently offset higher surgical expense, as total hospital costs trend higher in the MIO patients. In

  12. Heated CO(2) with or without humidification for minimally invasive abdominal surgery.

    Science.gov (United States)

    Birch, Daniel W; Manouchehri, Namdar; Shi, Xinzhe; Hadi, Ghassan; Karmali, Shahzeer

    2011-01-19

    Intraoperative hypothermia during both open and laparoscopic abdominal surgery may be associated with adverse events. For laparoscopic abdominal surgery, the use of heated insufflation systems for establishing pneumoperitoneum has been described to prevent hypothermia. Humidification of the insufflated gas is also possible. Past studies have shown inconclusive results with regards to maintenance of core temperature and reduction of postoperative pain and recovery times. To determine the effect of heated gas insufflation on patient outcomes following minimally invasive abdominal surgery. The Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library), MEDLINE (PubMed), EMBASE, International Pharmaceutical Abstracts (IPA), Web of Science, Scopus, www.clinicaltrials.gov and the National Research Register were searched (1956 to 14 June 2010). Grey literature and cross-references were also searched. Searches were limited to human studies without language restriction. All included studies were randomized trials comparing heated (with or without humidification) gas insufflation with cold gas insufflation in adult and pediatric populations undergoing minimally invasive abdominal procedures. Study quality was assessed in regards to relevance, design, sequence generation, allocation concealment, blinding, possibility of incomplete data and selective reporting. The selection of studies for the review was done independently by two authors, with any disagreement resolved in consensus with a third co-author. Screening of eligible studies, data extraction and methodological quality assessment of the trials were performed by the authors. Data from eligible studies were collected using data sheets. Results were presented using mean differences for continuous outcomes and relative risks with 95% confidence intervals for dichotomous outcomes. The estimated effects were calculated using the latest version of RevMan software. Publication bias was taken into

  13. A simultaneous minimally invasive approach to treat a patient with coronary artery disease and metastatic lung cancer.

    Science.gov (United States)

    Fu, Yuanhao; Zhang, Lufeng; Ji, Ling; Xu, Chenyang

    2016-01-01

    Concurrent lung cancer and coronary artery disease requiring treatment with percutaneous coronary intervention or coronary artery bypass grafting is not rare. An individualized perioperative anticoagulation regimen and minimal surgical trauma will benefit the patient's postoperative recovery. We successfully treated a 68-year-old female patient with a lesion in the left anterior descending artery and metastatic right lung carcinoma by simultaneous minimally invasive direct coronary artery bypass grafting via a small left thoracotomy and thoracoscopic wedge resection of the lung lesion. She recovered and was discharged on the eighth postoperative day. The patient showed no symptoms of myocardial ischemia postoperatively. Computed tomography scan did not indicate metastatic lesion of lung carcinoma at 1-year follow-up. In conclusion, minimally invasive direct coronary artery bypass grafting combined with thoracoscopic wedge resection is an effective minimally invasive treatment for concurrent lung cancer and coronary artery disease. This technique eliminates the risk of perioperative bleeding and provides satisfactory mid-term follow-up results.

  14. Emergency treatment of splenic injury in a novel mobile minimally invasive interventional shelter following disaster: a feasibility study

    Science.gov (United States)

    2014-01-01

    Background There has been an increase in natural disasters in recent years, which leads to a great number of injuries and deaths. It still remains an unsolved problem to treat patients with vascular injury of solid organs effectively following natural disasters, but on-spot emergency interventional transcatheter arterial embolization (TAE) has been highly recommended to cure serious vascular injury of solid organs nowadays. Spleen is the most vulnerable abdominal organ, severe arterial hemorrhage of which can cause death if untreated timely. In this research, we aimed to study the possibility of performing emergency surgical intervention in mobile minimally invasive interventional shelter for splenic injury in the case of natural disasters. Methods First, the mobile minimally invasive interventional shelter was unfolded in the field, and then disinfection and preoperative preparation were performed immediately. Eight large animal models of splenic injury were created, and angiograms were performed using a digital subtraction angiography machine in the mobile minimally invasive interventional shelter, and then the hemostatic embolizations of injured splenic artery were performed following the established convention of rapid intervention therapy. The operating time was recorded, and the survival condition and postoperative complications were observed for two weeks. Results and discussion The average time of unfolding the shelter, and performing disinfection and preoperative preparation was 33 ± 7 min. The number of colonies in the sterilized shelter body was 86 ± 13 cfu/m3. The average TAE time was 31 ± 7 min. All the hemostatic embolizations of splenic injury were performed successfully in the mobile minimally invasive interventional shelter during the operation. A pseudoaneurysm was found in an animal model using angiography two weeks after the operation. The primary clinical success rate of embolization was 87.5%. The two-week survival rate in

  15. A systematic review of minimally invasive sacroiliac joint fusion utilizing a lateral transarticular technique.

    Science.gov (United States)

    Heiney, Jake; Capobianco, Robyn; Cher, Daniel

    2015-01-01

    A number of studies have been published regarding minimally invasive surgical (MIS) fusion of the sacroiliac (SI) joint using a lateral transarticular approach. Herein we report a systematic review and meta-analysis to summarize operative measures and clinical outcomes reported in published studies of MIS SI joint fusion. The systematic review was done according to PRISMA standards. PubMed and EMBASE were searched using the terms sacroiliac joint AND fusion. Original peer-reviewed articles in the English language that reported clinical outcomes on at least 5 cases of MIS SI joint fusion using a lateral transarticular approach were included. Random effects meta-analysis (RMA) was performed on selected variables using the DerSimonian and Laird method, including operative measures, VAS SI joint pain ratings (0-10 scale) and Oswestry Disability Index (ODI). Mean and 95% confidence intervals (CI) were calculated and heterogeneity was assessed. Other findings were summarized qualitatively. A total of 18 articles met the inclusion criteria. After accounting for overlapping cohorts, 12 unique cohorts from 4 countries were extracted for a total of 432 subjects. The RMA mean (range) was 59 minutes (27-78) for procedure time, 36.9cc (10-70) for estimated blood loss and 1.7 days (range 0-7) for length of stay (LOS). The RMA mean [95% CI] pain score dropped by 5.2 points at 6 months and 5.3 points at 12 months (baseline score of 8.1 [7.8-8.4], 12-month score of 2.7 [2.1-3.3]), and a 24-month score of 2.0(1.4-2.5). ODI decreased by 31 points at 12 months (baseline score of 56.2 [51.0-61.5], 6-month score of 30.7 [21.8-39.6], and 12-month score of 25.1 [12.3-37.9]). Some estimates showed significant variation across studies and between the types of implants used. Other reported outcomes were supportive of the positive effects of SI joint fusion. Published studies of MIS SI joint fusion using a lateral transarticular approach confirm its minimally invasive characteristics with

  16. Ultrafast mid-IR laser scalpel: protein signals of the fundamental limits to minimally invasive surgery.

    Science.gov (United States)

    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

  17. Ultrafast mid-IR laser scalpel: protein signals of the fundamental limits to minimally invasive surgery.

    Directory of Open Access Journals (Sweden)

    Saeid Amini-Nik

    2010-09-01

    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

  18. Pectoral Fascial (PECS) I and II Blocks as Rescue Analgesia in a Patient Undergoing Minimally Invasive Cardiac Surgery.

    Science.gov (United States)

    Yalamuri, Suraj; Klinger, Rebecca Y; Bullock, W Michael; Glower, Donald D; Bottiger, Brandi A; Gadsden, Jeffrey C

    Patients undergoing minimally invasive cardiac surgery have the potential for significant pain from the thoracotomy site. We report the successful use of pectoral nerve block types I and II (Pecs I and II) as rescue analgesia in a patient undergoing minimally invasive mitral valve repair. In this case, a 78-year-old man, with no history of chronic pain, underwent mitral valve repair via right anterior thoracotomy for severe mitral regurgitation. After extubation, he complained of 10/10 pain at the incision site that was minimally responsive to intravenous opioids. He required supplemental oxygen because of poor pulmonary mechanics, with shallow breathing and splinting due to pain, and subsequent intensive care unit readmission. Ultrasound-guided Pecs I and II blocks were performed on the right side with 30 mL of 0.2% ropivacaine with 1:400,000 epinephrine. The blocks resulted in near-complete chest wall analgesia and improved pulmonary mechanics for approximately 24 hours. After the single-injection blocks regressed, a second set of blocks was performed with 266 mg of liposomal bupivacaine mixed with bupivacaine. This second set of blocks provided extended analgesia for an additional 48 hours. The patient was weaned rapidly from supplemental oxygen after the blocks because of improved analgesia. Pectoral nerve blocks have been described in the setting of breast surgery to provide chest wall analgesia. We report the first successful use of Pecs blocks to provide effective chest wall analgesia for a patient undergoing minimally invasive cardiac surgery with thoracotomy. We believe that these blocks may provide an important nonopioid option for the management of pain during recovery from minimally invasive cardiac surgery.

  19. Development of a quantum dot mediated thermometry for minimally invasive thermal therapy

    Science.gov (United States)

    Hanson, Willard L.

    Thermally-related, minimally invasive therapies are designed to treat tumors while minimizing damage to the surrounding tissues. Adjacent tissues become susceptible to thermal injury to ensure the cancer is completely destroyed. Destroying tumor cells, while minimizing collateral damage to the surrounding tissue, requires the capacity to control and monitor tissue temperatures both spatially and temporally. Current devices measure the tumor's tissue temperature at a specific location leaving the majority unmonitored. A point-wise application can not substantiate complete tumor destruction. This type of surgery would be more effective if volumetric tissue temperature measurement were available. On this premise, the feasibility of a quantum dot (QD) assembly to measure the tissue temperature volumetrically was tested in the experiments described in this dissertation. QDs are fluorescence semiconductor nanoparticles having various superior optical properties. This new QD-mediated thermometry is capable of monitoring the thermal features of tissues non-invasively by measuring the aggregate fluorescence intensity of the QDs accumulated at the target tissues prior to and during the surgical procedure. Thus, such a modality would allow evaluation of tissue destruction by measuring the fluorescence intensity of the QD as a function of temperature. The present study also quantified the photoluminescence intensity and attenuation of the QD as a function of depth and wavelength using a tissue phantom. A prototype system was developed to measure the illumination through a tissue phantom as a proof of concept of the feasibility of a noninvasive thermal therapy. This prototype includes experimental hardware, software and working methods to perform image acquisition, and data reduction strategic to quantify the intensity and transport characteristics of the QD. The significance of this work is that real-time volumetric temperature information will prove a more robust tool for use

  20. 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.

  1. Accidental Durotomy in Minimally Invasive Transforaminal Lumbar Interbody Fusion: Frequency, Risk Factors, and Management

    Directory of Open Access Journals (Sweden)

    Jan-Helge Klingler

    2015-01-01

    Full Text Available Purpose. To assess the frequency, risk factors, and management of accidental durotomy in minimally invasive transforaminal lumbar interbody fusion (MIS TLIF. Methods. This single-center study retrospectively investigates 372 patients who underwent MIS TLIF and were mobilized within 24 hours after surgery. The frequency of accidental durotomies, intraoperative closure technique, body mass index, and history of previous surgery was recorded. Results. We identified 32 accidental durotomies in 514 MIS TLIF levels (6.2%. Analysis showed a statistically significant relation of accidental durotomies to overweight patients (body mass index ≥25 kg/m2; P=0.0493. Patient age older than 65 years tended to be a positive predictor for accidental durotomies (P=0.0657. Mobilizing patients on the first postoperative day, we observed no durotomy-associated complications. Conclusions. The frequency of accidental durotomies in MIS TLIF is low, with overweight being a risk factor for accidental durotomies. The minimally invasive approach seems to minimize durotomy-associated complications (CSF leakage, pseudomeningocele because of the limited dead space in the soft tissue. Patients with accidental durotomy can usually be mobilized within 24 hours after MIS TLIF without increased risk. The minimally invasive TLIF technique might thus be beneficial in the prevention of postoperative immobilization-associated complications such as venous thromboembolism. This trial is registered with DRKS00006135.

  2. 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.

  3. 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.

  4. [MINIMALLY INVASIVE SURGERY FOR DIRECT REPAIR OF LUMBAR SPONDYLOLYSIS BY UTILIZING INTRAOPERATIVE NAVIGATION AND MICROENDOSCOPIC TECHNIQUES].

    Science.gov (United States)

    Zhu, Xiaolong; Wang, Jian; Zhou, Yue; Zhang, Zhengfeng; Li, Changqing; Zheng, Wenjie

    2015-10-01

    To analyze the effectiveness of direct screw repair for lumbar spondylolysis by using intraoperative O-arm based navigation and microendoscopic techniques. Between February 2012 and May 2014, 11 consecutive patients with lumbar spondylolysis were treated with Buck's procedure by the aid of intraoperative O-arm based navigation and minimally invasive approach. The debridement and autograft of pars interarticularis defects was performed under microendoscopy. There were 7 males and 4 females, with an average age of 28.4 years (range, 19 - 47 years) and an average disease duration of 10.5 months (range, 8-23 months); no nerve symptoms or signs of lower limb was observed. The radiological examinations showed single level bilateral lumbar spondylolysis without obvious disc degeneration, lumbar instability, or spondylolisthesis. Isthmic injury located at L4 in 2 cases and at L5 in 9 cases. Of 11 patients, 7 were rated as grade 2 disc degeneration, and 4 as grade 3 disc degeneration according to the modified Pfirrmann classification system. The operation time, intraoperative blood loss, and complications were recorded. The fluoroscopic examinations were performed to assess defect repair and screw position. Visual analogue scale (VAS) score was used to evaluate the improvement of low back pain. The average operation time was 147.6 minutes (range, 126-183 minutes). The average blood loss was 54.9 mL (range, 40-85 mL). Primary healing of incision was obtained. There was no complication of nerve root injury, dural tear, or infection. Three patients had pain at donor site postoperatively, and pain disappeared within 3 weeks. The average follow-up duration was 15.7 months (range, 10-23 months). VAS score of low back pain was significantly decreased from preoperative 7.1 ± 2.3 to 1.8 ± 0.4 at last follow-up (t = 13.42, P = 0.01). Of 22 isthmic bone grafting, bilateral isthmic bony fusion was achieved in 7 patients and unilateral isthmic bony fusion in 3 patients at 6-10 months

  5. Secondhand Tobacco Smoke Exposure and Lung Adenocarcinoma In Situ/Minimally Invasive Adenocarcinoma (AIS/MIA).

    Science.gov (United States)

    Kim, Claire H; Lee, Yuan-Chin Amy; Hung, Rayjean J; Boffetta, Paolo; Xie, Dong; Wampfler, Jason A; Cote, Michele L; Chang, Shen-Chih; Ugolini, Donatella; Neri, Monica; Le Marchand, Loic; Schwartz, Ann G; Morgenstern, Hal; Christiani, David C; Yang, Ping; Zhang, Zuo-Feng

    2015-12-01

    The aim of this study was to estimate the effect of exposure to secondhand tobacco smoke on the incidence of lung adenocarcinoma in situ/minimally invasive adenocarcinoma (AIS/MIA). Data from seven case-control studies participating in the International Lung Cancer Consortium (ILCCO) were pooled, resulting in 625 cases of AIS/MIA and 7,403 controls, of whom 170 cases and 3,035 controls were never smokers. Unconditional logistic regression was used to estimate adjusted ORs (ORadj) and 95% confidence intervals (CI), controlling for age, sex, race, smoking status (ever/never), and pack-years of smoking. Study center was included in the models as a random-effects intercept term. Ever versus never exposure to secondhand tobacco smoke was positively associated with AIS/MIA incidence in all subjects (ORadj = 1.48; 95% CI, 1.14-1.93) and in never smokers (ORadj = 1.45; 95% CI, 1.00-2.12). There was, however, appreciable heterogeneity of ORadj across studies (P = 0.01), and the pooled estimates were largely influenced by one large study (40% of all cases and 30% of all controls). These findings provide weak evidence for an effect of secondhand tobacco smoke exposure on AIS/MIA incidence. Further studies are needed to assess the impact of secondhand tobacco smoke exposure using the newly recommended classification of subtypes of lung adenocarcinoma. ©2015 American Association for Cancer Research.

  6. The sticky business of adhesion prevention in minimally invasive gynecologic surgery.

    Science.gov (United States)

    Han, Esther S; Scheib, Stacey A; Patzkowsky, Kristin E; Simpson, Khara; Wang, Karen C

    2017-08-01

    The negative impact of postoperative adhesions has long been recognized, but available options for prevention remain limited. Minimally invasive surgery is associated with decreased adhesion formation due to meticulous dissection with gentile tissue handling, improved hemostasis, and limiting exposure to reactive foreign material; however, there is conflicting evidence on the clinical significance of adhesion-related disease when compared to open surgery. Laparoscopic surgery does not guarantee the prevention of adhesions because longer operative times and high insufflation pressure can promote adhesion formation. Adhesion barriers have been available since the 1980s, but uptake among surgeons remains low and there is no clear evidence that they reduce clinically significant outcomes such as chronic pain or infertility. In this article, we review the ongoing magnitude of adhesion-related complications in gynecologic surgery, currently available interventions and new research toward more effective adhesion prevention. Recent literature provides updated epidemiologic data and estimates of healthcare costs associated with adhesion-related complications. There have been important advances in our understanding of normal peritoneal healing and the pathophysiology of adhesions. Adhesion barriers continue to be tested for safety and effectiveness and new agents have shown promise in clinical studies. Finally, there are many experimental studies of new materials and pharmacologic and biologic prevention agents. There is great interest in new adhesion prevention technologies, but new agents are unlikely to be available for clinical use for many years. High-quality effectiveness and outcomes-related research is still needed.

  7. Improving Perioperative Outcomes Through Minimally Invasive and Non-invasive Hemodynamic Monitoring Techniques

    Directory of Open Access Journals (Sweden)

    Takashige Yamada

    2018-05-01

    Full Text Available An increasing number of patients require precise intraoperative hemodynamic monitoring due to aging and comorbidities. To prevent undesirable outcomes from intraoperative hypotension or hypoperfusion, appropriate threshold settings are required. These setting can vary widely from patient to patient. Goal-directed therapy techniques allow for flow monitoring as the standard for perioperative fluid management. Based on the concept of personalized medicine, individual assessment and treatment are more advantageous than conventional or uniform interventions. The recent development of minimally and noninvasive monitoring devices make it possible to apply detailed control, tracking, and observation of broad patient populations, all while reducing adverse complications. In this manuscript, we review the monitoring features of each device, together with possible advantages and disadvantages of their use in optimizing patient hemodynamic management.

  8. Application of Minimally Invasive Treatment of Locking Compression Plate in Schatzker Ⅰ-Ⅲ Tibial Plateau Fracture

    Directory of Open Access Journals (Sweden)

    Guohui Zhao

    2014-06-01

    Full Text Available Objective: To investigate the clinical effect of minimally invasive treatment of locking compression plate (LCP in Schatzker Ⅰ-Ⅲ tibial plateau fracture. Methods: Thirty-eight patients with Schatzker Ⅰ-Ⅲ tibial 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 efficacy 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 artificial 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 Schatzker Ⅰ - Ⅲ tibial plateau fracture can reduce the postoperative relocation loss, and has small trauma and stable fixation.

  9. Minimally invasive treatment of lumbar spinal stenosis with a novel interspinous spacer

    Directory of Open Access Journals (Sweden)

    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

  10. Minimally Invasive Transforaminal Lumbar Interbody Fusion and Unilateral Fixation for Degenerative Lumbar Disease.

    Science.gov (United States)

    Wang, Hui-Wang; Hu, Yong-Cheng; Wu, Zhan-Yong; Wu, Hua-Rong; Wu, Chun-Fu; Zhang, Lian-Suo; Xu, Wei-Kun; Fan, Hui-Long; Cai, Jin-Sheng; Ma, Jian-Qing

    2017-08-01

    To evaluate the clinical effect of the minimally invasive transforaminal lumbar interbody fusion combined with posterolateral fusion and unilateral fixation using a tubular retractor in the management of degenerative lumbar disease. A retrospective analysis was conducted to analyze the clinical outcome of 58 degenerative lumbar disease patients who were treated with minimally invasive transforaminal lumbar interbody fusion combined with posterolateral fusion and unilateral fixation during December 2012 to January 2015. The spine was unilaterally approached through a 3.0-cm skin incision centered on the disc space, located 2.5 cm lateral to the midline, and the multifidus muscles and longissimus dorsi were stripped off. After transforaminal lumbar interbody fusion and posterolateral fusion the unilateral pedicle screw fixation was performed. The visual analogue scale (VAS) for back and leg pain, the Oswestry disability index (ODI), and the MacNab score were applied to evaluate clinical effects. The operation time, peri-operative bleeding, postoperative time in bed, hospitalization costs, and the change in the intervertebral height were analyzed. Radiological fusion based on the Bridwell grading system was also assessed at the last follow-up. The quality of life of the patients before and after the operation was assessed using the short form-36 scale (SF-36). Fifty-eight operations were successfully performed, and no nerve root injury or dural tear occurred. The average operation time was 138 ± 33 min, intraoperative blood loss was 126 ± 50 mL, the duration from surgery to getting out of bed was 46 ± 8 h, and hospitalization cost was 1.6 ± 0.2 ten thousand yuan. All of the 58 patients were followed up for 7-31 months, with an average of 14.6 months. The postoperative VAS scores and ODI score were significantly improved compared with preoperative data (P degenerative lumbar disease, and the short-term clinical outcome is satisfactory

  11. 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.

  12. Virtual and augmented medical imaging environments: enabling technology for minimally invasive cardiac interventional guidance.

    Science.gov (United States)

    Linte, Cristian A; White, James; Eagleson, Roy; Guiraudon, Gérard M; Peters, Terry M

    2010-01-01

    Virtual and augmented reality environments have been adopted in medicine as a means to enhance the clinician's view of the anatomy and facilitate the performance of minimally invasive procedures. Their value is truly appreciated during interventions where the surgeon cannot directly visualize the targets to be treated, such as during cardiac procedures performed on the beating heart. These environments must accurately represent the real surgical field and require seamless integration of pre- and intra-operative imaging, surgical tracking, and visualization technology in a common framework centered around the patient. This review begins with an overview of minimally invasive cardiac interventions, describes the architecture of a typical surgical guidance platform including imaging, tracking, registration and visualization, highlights both clinical and engineering accuracy limitations in cardiac image guidance, and discusses the translation of the work from the laboratory into the operating room together with typically encountered challenges.

  13. 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.

  14. The trivector approach for minimally invasive total knee arthroplasty: a technical note.

    Science.gov (United States)

    Benazzo, Francesco; Rossi, Stefano Marco Paolo

    2012-09-01

    One of the main criticisms of minimally invasive approaches in total knee arthroplasty has been their poor adaptability in cases of major deformity or stiffness of the knee joint. When they are used in such cases, excessive soft-tissue tension is needed to provide appropriate joint exposure. Here, we describe the "mini trivector approach," which has become our standard approach for total knee replacement because it permits us to enlarge the indication for minimally or less invasive total knee replacement to many knees where quad sparing, a subvastus approach, or a mini quad or mini midvastus snip may not be sufficient to achieve correct exposure. It consists of a limited double snip of the VMO and the quadriceps tendon that reduces tension on the extensor mechanism and allows easier verticalization of the patella as well as good joint exposure.

  15. Time-to-administration in postoperative chemotherapy for colorectal cancer: does minimally-invasive surgery help?

    Science.gov (United States)

    Amore Bonapasta, Stefano; Checcacci, Paolo; Guerra, Francesco; Mirasolo, Vita M; Moraldi, Luca; Ferrara, Angelo; Annecchiarico, Mario; Coratti, Andrea

    2016-06-01

    The optimal delay in the start of chemotherapy following rectal cancer surgery has not yet been identified. However, postponed adjuvant therapy has been proven to be connected with a significant survival detriment. We aimed to investigate whether the time to initiation of adjuvant treatment can be influenced by the application of minimally invasive surgery rather than traditional open surgery. By comprehensively evaluating the available inherent literature, several factors appear to be associated with delayed postoperative chemotherapy. Some of them are strictly related to surgical short-term outcomes. Laparoscopy results in shortened length of hospital stay, reduced surgical morbidity and lower rate of wound infection compared to conventional surgery. Probably due to such advantages, the application of minimally-invasive surgery to treat rectal malignancies seems to impact favorably the possibility to start adjuvant chemotherapy within an adequate timeframe following surgical resection, with potential improvement in patient survival.

  16. 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.

  17. NEUROGATE: a new MR-compatible device for realizing minimally invasive treatment of intracerebral tumors.

    Science.gov (United States)

    Vitzthum, Hans Ekkehart; Winkler, Dirk; Strauss, Gero; Lindner, Dirk; Krupp, Wolfgang; Schneider, Jens Peter; Schober, Ralf; Meixensberger, Jürgen

    2004-01-01

    The authors report on the handling and the practicability of a newly developed MR-compatible device, the NEUROGATE (Daum GmbH, Germany), which allows precise planning, simulation and control of stereotactic biopsy in patients with suspect intracranial lesions, and which allows minimally invasive maneuvers to be performed in a comfortable way. Twenty-eight patients were examined stereotactically in the Signa SP interventional 0.5 Tesla MRI (General Electric Medical Systems, USA), including 15 patients with malignant intracerebral tumors and poor general medical conditions (8 gliomas, 7 metastases) who were treated by laser-induced interstitial thermotherapy (LITT) after definite intraoperative neuropathological diagnosis. As a special stereotactic holding device, the NEUROGATE was favored as a reliable tool for stereotaxy and minimally invasive procedures.

  18. Minimally invasive single-site surgery for the digestive system: A technological review

    Directory of Open Access Journals (Sweden)

    Dhumane Parag

    2011-01-01

    Full Text Available Minimally Invasive Single Site (MISS surgery is a better terminology to explain the novel concept of scarless surgery, which is increasingly making its way into clinical practice. But, there are some difficulties. We review the existing technologies for MISS surgery with regards to single-port devices, endoscope and camera, instruments, retractors and also the future perspectives for the evolution of MISS surgery. While we need to move ahead cautiously and wait for the development of appropriate technology, we believe that the "Ultimate form of Minimally Invasive Surgery" will be a hybrid form of MISS surgery and Natural Orifice Transluminal Endoscopic Surgery, complimented by technological innovations from the fields of robotics and computer-assisted surgery.

  19. Perioral rejuvenation: restoration of attractiveness in aging females by minimally invasive procedures

    Directory of Open Access Journals (Sweden)

    Wollina U

    2013-09-01

    Full Text Available Uwe Wollina Department of Dermatology and Allergology, Academic Teaching Hospital Dresden-Friedrichstadt, Dresden, Germany Abstract: Lips and the perioral area are of outstanding importance in youthful appearance, attractiveness, and beauty. In contrast to younger and middle aged females, there is only scant published data on minimally invasive procedures to restore and revitalize lips and perioral soft tissue in elderly females. In this review we report the signs of aging in this particular region and the underlying anatomy. We review studies on lip restoration in younger females and present our techniques for elderly women. With an individually tailored approach, elderly females benefit from minimally invasive techniques. Keywords: facial aging, perioral soft tissue, lips, dermal fillers, anatomy

  20. Nuclear Imaging and Minimally Invasive Surgery in the Management of Hyperparathyroidism*

    Science.gov (United States)

    Judson, Benjamin L.; Shaha, Ashok R.

    2013-01-01

    Primary hyperparathyroidism is the most common cause of hypercalcemia, and the treatment is primarily surgical. Because of biochemical screening, more patients now present with asymptomatic primary hyperparathyroidism, and consensus guidelines have been developed for the treatment of these patients. There is now considerable interest in minimally invasive approaches to the treatment of hyperparathyroidism. Sestamibi scanning as a localizing study, used in combination with anatomic imaging and intraoperative rapid parathyroid hormone assays, has enabled focused surgical approaches. Patients with localizing studies that indicate a single parathyroid adenoma are candidates for such approaches, including unilateral neck exploration, minimally invasive single-gland exploration, or endoscopic exploration instead of the traditional approach of bilateral neck exploration. Nuclear imaging is also critical to the successful management of patients with persistent or recurrent hyperparathyroidism. PMID:18927330

  1. TACE with Ar-He Cryosurgery Combined Minimal Invasive Technique for the Treatment of Primary NSCLC in 139 Cases

    Directory of Open Access Journals (Sweden)

    Yunzhi ZHOU

    2010-01-01

    Full Text Available Background and objective TACE, Ar-He target cryosurgery and radioactive seeds implantation are the mainly micro-invasive methods in the treatment of lung cancer. This article summarizes the survival quality after treatment, the clinical efficiency and survival period, and analyzes the advantages and shortcomings of each methods so as to evaluate the clinical effect of non-small cell lung cancer with multiple minimally invasive treatment. Methods All the 139 cases were nonsmall cell lung cancer patients confirmed by pathology and with follow up from July 2006 to July 2009 retrospectively, and all of them lost operative chance by comprehensive evaluation. Different combination of multiple minimally invasive treatments were selected according to the blood supply, size and location of the lesion. Among the 139 cases, 102 cases of primary and 37 cases of metastasis to mediastinum, lung and chest wall, 71 cases of abundant blood supply used the combination of superselective target artery chemotherapy, Ar-He target cryoablation and radiochemotherapy with seeds implantation; 48 cases of poor blood supply use single Ar-He target cryoablation; 20 cases of poor blood supply use the combination of Ar-He target cryoablation and radiochemotheraoy with seeds implantation. And then the pre- and post-treatment KPS score, imaging data and the result of follow up were analyzed. Results The KPS score increased 20.01 meanly after the treatment. Follow up 3 years, 44 cases of CR, 87 cases of PR, 3 cases of NC and 5 cases of PD, and the efficiency was 94.2%. Ninety-nine cases of 1 year survival (71.2%, 43 cases of 2 years survival (30.2%, 4 cases with over 3 years survival and the median survival was 19 months. Average survival was (16±1.5months. There was no severe complications, such as spinal cord injury, vessel and pericardial aspiration. Conclusion Minimally invasive technique is a highly successful, micro-invasive and effective method with mild complications

  2. 3T MR-guided minimally-invasive penile fracture repair

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    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.

  3. Optimal design of a novel remote center-of-motion mechanism for minimally invasive surgical robot

    Science.gov (United States)

    Sun, Jingyuan; Yan, Zhiyuan; Du, Zhijiang

    2017-06-01

    Surgical robot with a remote center-of-motion (RCM) plays an important role in minimally invasive surgery (MIS) field. To make the mechanism has high flexibility and meet the demand of movements during processing of operation, an optimized RCM mechanism is proposed in this paper. Then, the kinematic performance and workspace are analyzed. Finally, a new optimization objective function is built by using the condition number index and the workspace index.

  4. CT-based needle marking of superficial intracranial lesions for minimal invasive neurosurgery

    International Nuclear Information System (INIS)

    Marquardt, G.; Wolff, R.; Schick, U.; Lorenz, R.

    2000-01-01

    A CT-based method of marking superficial intracranial lesions with a needle is presented. This form of neuronavigation can be applied in every neurosurgical centre. Owing to its rapid application it is also suitable for cases of emergency. The neurosurgical approach can be centred precisely over this lesion providing for a minimally invasive operation. The method has proved its efficacy in numerous cases of haematomas and cystic lesions. (author)

  5. Incidence of cerebrovascular accidents in patients undergoing minimally invasive valve surgery.

    Science.gov (United States)

    LaPietra, Angelo; Santana, Orlando; Mihos, Christos G; DeBeer, Steven; Rosen, Gerald P; Lamas, Gervasio A; Lamelas, Joseph

    2014-07-01

    Minimally invasive valve surgery has been associated with increased cerebrovascular complications. Our objective was to evaluate the incidence of cerebrovascular accidents in patients undergoing minimally invasive valve surgery. We retrospectively reviewed all the minimally invasive valve surgery performed at our institution from January 2009 to June 2012. The operative times, lengths of stay, postoperative complications, and mortality were analyzed. A total of 1501 consecutive patients were identified. The mean age was 73 ± 13 years, and 808 patients (54%) were male. Of the 1501 patients, 206 (13.7%) had a history of a cerebrovascular accident, and 225 (15%) had undergone previous heart surgery. The procedures performed were 617 isolated aortic valve replacements (41.1%), 658 isolated mitral valve operations (43.8%), 6 tricuspid valve repairs (0.4%), 216 double valve surgery (14.4%), and 4 triple valve surgery (0.3%). Femoral cannulation was used in 1359 patients (90.5%) and central cannulation in 142 (9.5%). In 1392 patients (92.7%), the aorta was clamped, and in 109 (7.3%), the surgery was performed with the heart fibrillating. The median aortic crossclamp and cardiopulmonary bypass times were 86 minutes (interquartile range [IQR], 70-107) minutes and 116 minutes (IQR, 96-143), respectively. The median intensive care unit length of stay was 47 hours (IQR, 29-74), and the median postoperative hospital length of stay was 7 days (IQR, 5-10). A total of 23 cerebrovascular accidents (1.53%) and 38 deaths (2.53%) had occurred at 30 days postoperatively. Minimally invasive valve surgery was associated with an acceptable stroke rate, regardless of the cannulation technique. Copyright © 2014 The American Association for Thoracic Surgery. Published by Mosby, Inc. All rights reserved.

  6. Resuspension of mild to moderate jawline laxity using a minimally invasive technique.

    Science.gov (United States)

    Bisaccia, Emil; Khan, Azim J; Herron, Joel B; Scarborough, Dwight A

    2003-08-01

    A practical approach for superficial musculoapponeurotic system plication and neck lift is indicated for early aging changes of jawline. A single or series of small punches or single incisions at the earlobe and then minor undermining to lift the superficial musculoapponeurotic system followed by removal of skin laxity in neck and jowl result in a seamless scar via a simple V to Y closure. A minimally invasive procedure was performed easily under local anesthesia in an office/ambulatory surgery center setting.

  7. Minimally Invasive Management of Achalasia Cardia: Results From a Single Center Study

    OpenAIRE

    Palanivelu, C.; Maheshkumar, G. S.; Jani, Kalpesh; Parthasarthi, R.; Sendhilkumar, K.; Rangarajan, M.

    2007-01-01

    Background: Since the performance of the first laparoscopic cardiomyotomy for achalasia cardia in 1991, the popularity of the minimally invasive approach for this troublesome disease has been growing. We present our experience of 226 patients who underwent laparoscopic cardiomyotomy and discuss the relevant issues. Methods: A retrospective analysis was carried out of 226 patients who have undergone laparoscopic cardiomyotomy since 1993. The preoperative workup, surgical technique, and postope...

  8. Challenging posterior mediastinal mass resection via a minimally invasive approach with neurological monitoring.

    Science.gov (United States)

    Smail, Hassiba; Baste, Jean Marc; Melki, Jean; Peillon, Christophe

    2013-02-01

    We report a novel surgical strategy for the resection of a rare type of posterior mediastinal tumour in a young patient. A melanotic schwannoma arose from the left thoracic sympathetic chain, adjacent to the origin of the artery of Adamkiewicz. Successful excision of this tumour via a minimally invasive approach without arterial or spinal cord injury was possible with the aid of neurological monitoring using spinal-evoked potentials.

  9. Early benefits of minimally invasive transforaminal lumbar interbody fusion in comparison with the traditional open procedure

    Directory of Open Access Journals (Sweden)

    Gregor Rečnik

    2015-06-01

    Full Text Available AbstractBackgroundLumbar interbody fusion is a standard operative procedure in orthopedic spine surgery. Morphological and functional changes in the multifidus muscle after an open procedure have led to the development of a minimally invasive technique, after which no such muscle changes were observed. MethodsSixty-four patients, with clinical and radiological criteria for one-level transforaminal lumbar interbody fusion were enrolled in our prospective randomized study between December 2011 and March 2014. They were randomized into two groups: open approach (33 patients vs. minimally invasive approach (31 patients; one patient was excluded from each group due to postoperative complications. Independent samples T-test was used to compare average values of increase in creatin kinase (CK, which is an enzymatic marker of muscle injury, average surgical time, loss of blood during and after surgery, back pain according to the Visual Analogue Scale (VAS and day of discharge from the hospital. ResultsStatistically important (P< 0.001 lower blood loss (188 ml vs. 527 ml total, less CK increase (15 ukat/L vs. 29 ukat/L, lower VAS score after surgery (7.3 vs. 8.7 and earlier discharge from the hospital (3.5 days vs. 5.2 days were observed in the minimally invasive transforaminal lumbar interbody fusion group. No significant difference in average surgical time was recorded. Conclusions Our results suggest, that minimally invasive transforaminal lumbar interbody fusion causes is associated with less muscle damage, lower blood loss, less post surgical pain and faster early rehabilitation, which is in accordance with previous studies.

  10. 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

  11. 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.

  12. Cryoablation in fibro-adipose vascular anomaly (FAVA): a minimally invasive treatment option

    International Nuclear Information System (INIS)

    Shaikh, Raja; Alomari, Ahmad I.; Kerr, Cindy L.; Miller, Patricia; Spencer, Samantha A.

    2016-01-01

    Fibro-adipose vascular anomaly (FAVA) is a complex vascular malformation that typically presents with persistent pain, discomfort, contracture and other disabling symptoms. There are no minimally invasive treatment options to effectively control these symptoms. Image-guided percutaneous cryoablation, which has been used to control pain in people with cancer, could be used for similar indications in FAVA. To assess the role of image-guided percutaneous cryoablation for control of symptoms in FAVA lesions. We conducted a retrospective cohort study of 20 children and young adults with FAVA who underwent percutaneous cryoablation at 26 sites, from September 2013 to August 2015. The outcome was based on the brief pain inventory scoring (BPI), concurrent symptoms, clinical response and patient satisfaction. After cryoablation there was significant improvement in pain, which dropped by 3 points (pain now) to 3.7 points (pain in the last 24 h). Most patients indicated that pain interfered less in their everyday social life. Concurrent symptoms like swelling, physical limitations and skin hyperesthesia also improved. Clinical response was greatest at 2-5 months follow-up after cryoablation, with acceptable patient satisfaction thereafter. Technical response was 100%. There were no major complications. Image-guided percutaneous cryoablation is a safe and effective option for treatment of symptomatic FAVA lesions. (orig.)

  13. Minimally invasive treatment for pubic ramus fractures combined with a sacroiliac joint complex injury.

    Science.gov (United States)

    Yu, Xiaowei; Tang, Mingjie; Zhou, Zubin; Peng, Xiaochun; Wu, Tianyi; Sun, Yuqiang

    2013-08-01

    Fractures of the pubic rami due to low energy trauma are common in the elderly, with an incidence of 26 per 100,000 people per year in those aged more than 60 years. The purpose of this study was to evaluate the clinical application of this minimally invasive technique in patients with pubic ramus fractures combined with a sacroiliac joint complex injury, including its feasibility, merits, and limitations. Fifteen patients with pubic ramus fractures combined with sacroiliac joint injury were treated with the minimally invasive technique from June 2008 until April 2012. The quality of fracture reduction was evaluated according to the Matta standard. Fourteen cases were excellent (93.3 %), and one case was good (6.7 %). The fracture lines were healed 12 weeks after the surgery. The 15 patients had follow-up visits between four to 50 months (mean, 22.47 months). All patients returned to their pre-injury jobs and lifestyles. One patient suffered a deep vein thrombosis during the peri-operative period. A filter was placed in the patient before the surgery and was removed six weeks later. There was no thrombus found at the follow-up visits of this patient. The minimally invasive technique in patients with pubic ramus fractures combined with a sacroiliac joint complex injury provided satisfactory efficacy.

  14. Measurement of temperature induced in bone during drilling in minimally invasive foot surgery.

    Science.gov (United States)

    Omar, Noor Azzizah; McKinley, John C

    2018-02-19

    There has been growing interest in minimally invasive foot surgery due to the benefits it delivers in post-operative outcomes in comparison to conventional open methods of surgery. One of the major factors determining the protocol in minimally invasive surgery is to prevent iatrogenic thermal osteonecrosis. The aim of the study is to look at various drilling parameters in a minimally invasive surgery setting that would reduce the risk of iatrogenic thermal osteonecrosis. Sixteen fresh-frozen tarsal bones and two metatarsal bones were retrieved from three individuals and drilled using various settings. The parameters considered were drilling speed, drill diameter, and inter-individual cortical variability. Temperature measurements of heat generated at the drilling site were collected using two methods; thermocouple probe and infrared thermography. The data obtained were quantitatively analysed. There was a significant difference in the temperatures generated with different drilling speeds (pdrilled using different drill diameters. Thermocouple showed significantly more sensitive tool in measuring temperature compared to infrared thermography. Drilling at an optimal speed significantly reduced the risk of iatrogenic thermal osteonecrosis by maintaining temperature below the threshold level. Although different drilling diameters did not produce significant differences in temperature generation, there is a need for further study on the mechanical impact of using different drill diameters. Copyright © 2018 Elsevier Ltd. All rights reserved.

  15. Extending the use of the pacing pulmonary artery catheter for safe minimally invasive cardiac surgery.

    Science.gov (United States)

    Levin, Ricardo; Leacche, Marzia; Petracek, Michael R; Deegan, Robert J; Eagle, Susan S; Thompson, Annemarie; Pretorius, Mias; Solenkova, Nataliya V; Umakanthan, Ramanan; Brewer, Zachary E; Byrne, John G

    2010-08-01

    In this study, the therapeutic use of pacing pulmonary artery catheters in association with minimally invasive cardiac surgery was evaluated. A retrospective study. A single institutional university hospital. Two hundred twenty-four consecutive patients undergoing minimally invasive cardiac surgery through a small (5-cm) right anterolateral thoracotomy using fibrillatory arrest without aortic cross-clamping. Two hundred eighteen patients underwent mitral valve surgery (97%) alone or in combination with other procedures. Six patients underwent other cardiac operations. In all patients, the pacing pulmonary artery catheter was used intraoperatively to induce ventricular fibrillation during the cooling period, and in the postoperative period it also was used in 37 (17%) patients who needed to be paced, mainly for bradyarrhythmias (51%). There were no complications related to the insertion of the catheters. Six (3%) patients experienced a loss of pacing capture, and 2 (1%) experienced another complication requiring the surgical removal of the catheter. Seven (3%) patients needed postoperative implantation of a permanent pacemaker. In combination with minimally invasive cardiac surgery, pacing pulmonary artery catheters were therapeutically useful to induce ventricular fibrillatory arrest intraoperatively and for obtaining pacing capability in the postoperative period. Their use was associated with a low number of complications. Copyright 2010 Elsevier Inc. All rights reserved.

  16. Evaluation of Open and Minimally Invasive Adrenalectomy: A Systematic Review and Network Meta-analysis.

    Science.gov (United States)

    Heger, Patrick; Probst, Pascal; Hüttner, Felix J; Gooßen, Käthe; Proctor, Tanja; Müller-Stich, Beat P; Strobel, Oliver; Büchler, Markus W; Diener, Markus K

    2017-11-01

    Adrenalectomy can be performed via open and various minimally invasive approaches. The aim of this systematic review was to summarize the current evidence on surgical techniques of adrenalectomy. Systematic literature searches (MEDLINE, EMBASE, Web of Science, Cochrane Library) were conducted to identify randomized controlled trials (RCTs) and controlled clinical trials (CCTs) comparing at least two surgical procedures for adrenalectomy. Statistical analyses were performed, and meta-analyses were conducted. Furthermore, an indirect comparison of RCTs and a network meta-analysis of CCTs were carried out for each outcome. Twenty-six trials (1710 patients) were included. Postoperative complication rates did not show differences for open and minimally invasive techniques. Operation time was significantly shorter for open adrenalectomy than for the robotic approach (p meta-analysis showed open adrenalectomy to be the fastest technique. Blood loss was significantly reduced in the robotic arm compared with open and laparoscopic adrenalectomy (p = 0.01). Length of hospital stay (LOS) was significantly lower after conventional laparoscopy than open adrenalectomy in CCTs (p meta-analysis revealed the lowest LOS after retroperitoneoscopic adrenalectomy. Minimally invasive adrenalectomy is safe and should be preferred over open adrenalectomy due to shorter LOS, lower blood loss, and equivalent complication rates. The retroperitoneoscopic access features the shortest LOS and operating time. Further high-quality RCTs are warranted, especially to compare the posterior retroperitoneoscopic and the transperitoneal robotic approach.

  17. Preliminary Results and Learning Curve of the Minimally Invasive Chevron Akin Operation for Hallux Valgus.

    Science.gov (United States)

    Jowett, Charlie R J; Bedi, Harvinder S

    Minimally invasive surgery is increasing in popularity. It is relevant in hallux valgus surgery owing to the potential for reduced disruption of the soft tissues and improved wound healing. We present our results and assess the learning curve of the minimally invasive Chevron Akin operation for hallux valgus. A total of 120 consecutive feet underwent minimally invasive Chevron Akin for symptomatic hallux valgus, of which 14 were excluded. They were followed up for a mean of 25 (range 18 to 38) months. The patients were clinically assessed using the American Orthopaedic Foot and Ankle Society score. Complications and patient satisfaction were recorded. The radiographs were analyzed and measurements recorded for hallux valgus and intermetatarsal angle correction. The mean age of the patients undergoing surgery was 55 (range 25 to 81) years. Of the 78 patients, 76 (97.4%) were female and 2 (2.6%) were male; 28 (35.9%) cases were bilateral. The mean American Orthopaedic Foot and Ankle Society score improved from 56 (range 23 to 76) preoperatively to 87 (range 50 to 100) postoperatively (p technique. They display a steep associated learning curve. However, the results are promising, and the learning curve is comparable to that for open hallux valgus surgery. Copyright © 2017 American College of Foot and Ankle Surgeons. Published by Elsevier Inc. All rights reserved.

  18. Quality Assurance of Multiport Image-Guided Minimally Invasive Surgery at the Lateral Skull Base

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    Maria Nau-Hermes

    2014-01-01

    Full Text Available For multiport image-guided minimally invasive surgery at the lateral skull base a quality management is necessary to avoid the damage of closely spaced critical neurovascular structures. So far there is no standardized method applicable independently from the surgery. Therefore, we adapt a quality management method, the quality gates (QG, which is well established in, for example, the automotive industry and apply it to multiport image-guided minimally invasive surgery. QG divide a process into different sections. Passing between sections can only be achieved if previously defined requirements are fulfilled which secures the process chain. An interdisciplinary team of otosurgeons, computer scientists, and engineers has worked together to define the quality gates and the corresponding criteria that need to be fulfilled before passing each quality gate. In order to evaluate the defined QG and their criteria, the new surgery method was applied with a first prototype at a human skull cadaver model. We show that the QG method can ensure a safe multiport minimally invasive surgical process at the lateral skull base. Therewith, we present an approach towards the standardization of quality assurance of surgical processes.

  19. Minimally invasive treatment of trochanteric fractures with intramedullary nails. Technique and results.

    Science.gov (United States)

    Todor, Adrian; Pojar, Adina; Lucaciu, Dan

    2013-01-01

    The aim of the study was to evaluate the results of minimally invasive treatment of trochanteric fractures with the use of intramedullary nails. From September 2010 to September 2012 we treated 21 patients with pertrochanteric fractures by a minimally invasive technique using the Gamma 3 (Stryker, Howmedica) nail. There were 13 females and 8 men with a mean age of 74.1 years, ranging from 58 to 88 years. Fractures were classified as being stable (AO type 31-A1) in 5 cases and unstable (AO type 31-A2 and A3) in the rest of 16 cases. Patients were reviewed at 6 weeks and 3 months postoperatively. Mean surgery time was 46.8 minutes and mean hospital stay was 14.9 days. No patients required blood transfusions. During the hospital stay all the patients were mobilized with weight bearing as tolerated. All patients were available for review at 6 weeks, and 2 were lost to the 3 months follow up. 16 patients regained the previous level of activity. This minimally invasive technique using a gamma nail device for pertrochanteric fractures gives reliable good results with excellent preservation of hip function.

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

    Directory of Open Access Journals (Sweden)

    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

  1. 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.

  2. [Manufacture method and clinical application of minimally invasive dental implant guide template based on registration technology].

    Science.gov (United States)

    Lin, Zeming; He, Bingwei; Chen, Jiang; D u, Zhibin; Zheng, Jingyi; Li, Yanqin

    2012-08-01

    To guide doctors in precisely positioning surgical operation, a new production method of minimally invasive implant guide template was presented. The mandible of patient was scanned by CT scanner, and three-dimensional jaw bone model was constructed based on CT images data The professional dental implant software Simplant was used to simulate the plant based on the three-dimensional CT model to determine the location and depth of implants. In the same time, the dental plaster models were scanned by stereo vision system to build the oral mucosa model. Next, curvature registration technology was used to fuse the oral mucosa model and the CT model, then the designed position of implant in the oral mucosa could be determined. The minimally invasive implant guide template was designed in 3-Matic software according to the design position of implant and the oral mucosa model. Finally, the template was produced by rapid prototyping. The three-dimensional registration technology was useful to fuse the CT data and the dental plaster data, and the template was accurate that could provide the doctors a guidance in the actual planting without cut-off mucosa. The guide template which fabricated by comprehensive utilization of three-dimensional registration, Simplant simulation and rapid prototyping positioning are accurate and can achieve the minimally invasive and accuracy implant surgery, this technique is worthy of clinical use.

  3. [Management of spinal metastasis by minimal invasive surgery technique: Surgical principles, indications: A literature review].

    Science.gov (United States)

    Toquart, A; Graillon, T; Mansouri, N; Adetchessi, T; Blondel, B; Fuentes, S

    2016-06-01

    Spinal metastasis are getting more frequent. This raises the question of pain and neurological complications, which worsen the functional and survival prognosis of this oncological population patients. The surgical treatment must be the most complete as possible: to decompress and stabilize without delaying the management of the oncological disease. Minimal invasive surgery techniques are by definition, less harmful on musculocutaneous plan than opened ones, with a comparable efficiency demonstrated in degenerative and traumatic surgery. So they seem to be applicable and appropriate to this patient population. We detailed different minimal invasive techniques proposed in the management of spinal metastasis. For this, we used our experience developed in degenerative and traumatic pathologies, and we also referred to many authors, establishing a literature review thanks to Pubmed, Embase. Thirty eight articles were selected and allowed us to describe different techniques: percutaneous methods such as vertebro-/kyphoplasty and osteosynthesis, as well as mini-opened surgery, through a posterior or anterior way. We propose a surgical approach using these minimal invasive techniques, first according to the predominant symptom (pain or neurologic failure), then characteristics of the lesions (number, topography, type…) and the deformity degree. Whatever the technique, the main goal is to stabilize and decompress, in order to maintain a good quality of life for these fragile patients, without delaying the medical management of the oncological disease. Copyright © 2016 Elsevier Masson SAS. All rights reserved.

  4. Quality assurance of multiport image-guided minimally invasive surgery at the lateral skull base.

    Science.gov (United States)

    Nau-Hermes, Maria; Schmitt, Robert; Becker, Meike; El-Hakimi, Wissam; Hansen, Stefan; Klenzner, Thomas; Schipper, Jörg

    2014-01-01

    For multiport image-guided minimally invasive surgery at the lateral skull base a quality management is necessary to avoid the damage of closely spaced critical neurovascular structures. So far there is no standardized method applicable independently from the surgery. Therefore, we adapt a quality management method, the quality gates (QG), which is well established in, for example, the automotive industry and apply it to multiport image-guided minimally invasive surgery. QG divide a process into different sections. Passing between sections can only be achieved if previously defined requirements are fulfilled which secures the process chain. An interdisciplinary team of otosurgeons, computer scientists, and engineers has worked together to define the quality gates and the corresponding criteria that need to be fulfilled before passing each quality gate. In order to evaluate the defined QG and their criteria, the new surgery method was applied with a first prototype at a human skull cadaver model. We show that the QG method can ensure a safe multiport minimally invasive surgical process at the lateral skull base. Therewith, we present an approach towards the standardization of quality assurance of surgical processes.

  5. Minimally invasive (13)C-breath test to examine phenylalanine metabolism in children with phenylketonuria.

    Science.gov (United States)

    Turki, Abrar; Murthy, Gayathri; Ueda, Keiko; Cheng, Barbara; Giezen, Alette; Stockler-Ipsiroglu, Sylvia; Elango, Rajavel

    2015-01-01

    Phenylketonuria (PKU) is an autosomal recessive disorder caused by deficiency of hepatic phenylalanine hydroxylase (PAH) leading to increased levels of phenylalanine in the plasma. Phenylalanine levels and phenylalanine hydroxylase (PAH) activity monitoring are currently limited to conventional blood dot testing. 1-(13)C-phenylalanine, a stable isotope can be used to examine phenylalanine metabolism, as the conversion of phenylalanine to tyrosine occurs in vivo via PAH and subsequently releases the carboxyl labeled (13)C as (13)CO2 in breath. Our objective was to examine phenylalanine metabolism in children with PKU using a minimally-invasive 1-(13)C-phenylalanine breath test ((13)C-PBT). Nine children (7 M: 2 F, mean age 12.5 ± 2.87 y) with PKU participated in the study twice: once before and once after sapropterin supplementation. Children were provided 6 mg/kg oral dose of 1-(13)C-phenylalanine and breath samples were collected at 20 min intervals for a period of 2h. Rate of CO2 production was measured at 60 min post-oral dose using indirect calorimetry. The percentage of 1-(13)C-phenylalanine exhaled as (13)CO2 was measured over a 2h period. Prior to studying children with PKU, we tested the study protocol in healthy children (n = 6; 4M: 2F, mean age 10.2 ± 2.48 y) as proof of principle. Production of a peak enrichment (Cmax) of (13)CO2 (% of dose) in all healthy children occurred at 20 min ranging from 17-29% of dose, with a subsequent return to ~5% by the end of 2h. Production of (13)CO2 from 1-(13)C-phenylalanine in all children with PKU prior to sapropterin treatment remained low. Following sapropterin supplementation for a week, production of (13)CO2 significantly increased in five children with a subsequent decline in blood phenylalanine levels, suggesting improved PAH activity. Sapropterin treatment was not effective in three children whose (13)CO2 production remained unchanged, and did not show a reduction in blood phenylalanine levels and improvement

  6. Minimally invasive treatment of pilon fractures with a low profile plate: preliminary results in 17 cases.

    Science.gov (United States)

    Borens, Olivier; Kloen, Peter; Richmond, Jeffrey; Roederer, Goetz; Levine, David S; Helfet, David L

    2009-05-01

    To determine the results of "biologic fixation" with a minimally invasive plating technique using a newly designed low profile "Scallop" plate in the treatment of pilon fractures. Retrospective case series. A tertiary referral center. Seventeen patients were treated between 1999 and 2001 for a tibial plafond fracture at the Hospital for Special Surgery with a newly designed low-profile plate. Eleven of the fractures (65%) were high-energy injuries. Two fractures were open. Staged surgical treatment with open reduction and fixation of the fibular fracture and application of an external fixator was performed in 12 cases. As soon as the soft tissues and swelling allowed, i.e. skin wrinkling, the articular surface was reconstructed and simply reduced, if necessary through an small incision, and the articular block was fixed to the diaphysis using a medially placed, percutaneously introduced flat scallop plate. In the remaining five cases the operation was performed in one session. Time to healing and complications including delayed union, non-union, instrument failure, loss of fixation, infection, quality of reduction and number of reoperations were evaluated. Quality of results and outcome were graded using the ankle-hindfoot-scale and a modified rating system. All patients went on to bony union at an average time of 14 weeks. There were no plate failures or loss of fixation/reduction. Two superficial wound-healing problems resolved with local wound care. At an average follow up of 17 months (range 6-29 months) eight patients (47%) had an excellent result; seven (41%) had a fair result whereas two (12%) had a poor result. The average ankle-hindfoot-score was 86.1 (range 61-100). Four patients have had the hardware removed and one of them is awaiting an ankle arthrodesis. Based on these initial results, it appears that a minimally invasive surgical technique including new low profile plate can decrease soft tissue problems while leading to fracture healing and

  7. The variability of practice in minimally invasive thoracic surgery for pulmonary resections.

    Science.gov (United States)

    Rocco, Gaetano; Internullo, Eveline; Cassivi, Stephen D; Van Raemdonck, Dirk; Ferguson, Mark K

    2008-08-01

    Thoracic surgeons participating in this survey seemed to have clearly indicated their perception of VATS major lung resections, in particular VATS lobectomy. 1. The acronym VATS as a short form of "video-assisted thoracic surgery" was the preferred terminology. 2. According to the respondents, the need or use of rib spreading served as the defining characteristic of "open" thoracic surgery. 3. It was most commonly suggested that VATS lobectomy is performed by means of two or three port incisions with the addition of a minithoracotomy or access incision. 4. Rib spreading (shearing) was not deemed acceptable as part of a strictly defined VATS procedure. 5. Although there was no general consensus, respondents suggested that the preferred approach for visualization in a VATS procedure was only through the video monitor. 6. Although minimally invasive procedures for lung resection are still mainly being used for diagnostic and minor therapeutic purposes, young surgeons seemed to be more likely to recommend VATS lung surgery for major pulmonary resections than their more senior colleagues. 7. The survey confirmed that the use of the standard posterolateral thoracotomy is still widespread. Almost 40% of the surgeons claimed to use the standard posterolateral thoracotomy for more than 50% of their cases and less than 30% use it for less than 5% of cases. 8. The major reasons to perform VATS lobectomy were perceived to be reduced pain and decreased hospitalization. 9. Approximately 60% of the surgeons claimed to perform VATS lobectomy in less than 5% of their lobectomy cases. Younger consultants reported using VATS lobectomy in up to 50% of their lobectomy cases. There was the suggestion that lack of resources could justify the minor impact of VATS lobectomy in the thoracic surgical practice in middle- to low-income countries. 10. The currently available scientific evidence on safety and effectiveness, and technologic advancements were emphasized as the two factors having a

  8. 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

  9. Radiofrequency waves with filling and peeling substances: An innovative minimally invasive technique for facial rejuvenation.

    Science.gov (United States)

    Savoia, Antonella; Vannini, Fulvio; Baldi, Alfonso

    2011-09-01

    This study describes a pivotal clinical trial of a new minimally invasive cosmetic procedure for facial rejuvenation and for the treatment of scars and wrinkles. The procedure consisted of a combination of techniques such as fillers, biorevitalization, peeling, and intradermal radiofrequency, emitted from a new device denominated by Spherofill Medical Plus (SMP; Spherofill MD, PromoItalia Group S.p.A., Pozzuoli, Italy), for treating cutaneous regeneration, depressions, and striae. One hundred and twelve patients, divided into five groups, were treated. The results produced were statistically analyzed and resulted in significant and long-lasting effects for facial rejuvenation. Indeed, the analysis of the Global Aesthetic Improvement Scale (GAIS) scores in the five groups demonstrated statistically significant results between 3 and 9 months after the treatments. Evaluating the patients included in the study, it is possible to conclude that the treatment with SMP represents a safe and efficient solution for the treatment of wrinkles, acne lesions, striae, and of degenerated tissues caused by aging.

  10. Minimally invasive corticotomy in orthodontics using a three-dimensional printed CAD/CAM surgical guide.

    Science.gov (United States)

    Cassetta, M; Giansanti, M; Di Mambro, A; Calasso, S; Barbato, E

    2016-09-01

    The aim of this prospective study was to evaluate the effectiveness of an innovative, minimally invasive, flapless corticotomy procedure in orthodontics. The STROBE guidelines were followed. Ten patients with severe dental crowding and a class I molar relationship were selected to receive orthodontic treatment with clear aligners and corticotomy-facilitated orthodontics. The mean age of these patients was 21 years (range 17-28, standard deviation 6.08 years); the male to female ratio was 2:1. The main outcome was a reduction in the total treatment time to correct dental crowding. The secondary outcomes were periodontal index changes, the degree of root resorption, and patient perceptions of the method used, assessed using the short-form Oral Health Impact Profile (OHIP-14). The occurrence of early surgical complications or unexpected events was also recorded. All patients completed the treatment to correct dental crowding. The average treatment time was reduced by two-thirds. The procedure did not significantly modify the periodontal indices or oral health-related quality of life. No early surgical complications or unexpected events were observed. In short, the results indicate that this new procedure is safe and accelerates tooth movement without periodontal complications or discomfort. However, the efficacy of this procedure must be confirmed in controlled clinical trials. Copyright © 2016 International Association of Oral and Maxillofacial Surgeons. Published by Elsevier Ltd. All rights reserved.

  11. Diode laser assisted minimal invasive sphenoidotomy for endoscopic transphenoidal pituitary surgery: our technique and results.

    Science.gov (United States)

    Lee, Jih-Chin; Lai, Wen-Sen; Ju, Da-Tong; Chu, Yueng-Hsiang; Yang, Jinn-Moon

    2015-03-01

    During endoscopic sinus surgery (ESS), intra-operative bleeding can significantly compromise visualization of the surgical field. The diode laser that provides good hemostatic and vaporization effects and excellent photocoagulation has been successfully applied in endoscopic surgery with several advantages. The current retrospective study demonstrates the feasibility of diode laser-combined endoscopic sinus surgery on sphenoidotomy. The patients who went through endoscopic transphenoidal pituitary surgery were enrolled. During the operation, the quality of the surgical field was assessed and graded by the operating surgeon using the scale proposed by Boezaart. The mean operation time was 37.80 ± 10.90 minutes. The mean score on the quality of surgical field was 1.95. A positive correlation between the lower surgical field quality score and the shorter surgical time was found with statistical significance (P diode laser-assisted sphenoidotomy is a reliable and safe approach of pituitary gland surgery with minimal invasiveness. It is found that application of diode laser significantly improved quality of surgical field and shortened operation time. © 2015 Wiley Periodicals, Inc.

  12. Minimally invasive treatment of tibial pilon fractures through arthroscopy and external fixator-assisted reduction.

    Science.gov (United States)

    Luo, Huasong; Chen, Liaobin; Liu, Kebin; Peng, Songming; Zhang, Jien; Yi, Yang

    2016-01-01

    The aim of this study was to evaluate the clinical outcome of tibial pilon fractures treated with arthroscopy and assisted reduction with an external fixator. Thirteen patients with tibial pilon fractures underwent assisted reduction for limited lower internal fixation with an external fixator under arthroscopic guidance. The weight-bearing time was decided on the basis of repeat radiography of the tibia 3 months after surgery. Postoperative ankle function was evaluated according to the Mazur scoring system. Healing of fractures was achieved in all cases, with no complications such as severe infection, skin necrosis, or an exposed plate. There were 9 excellent, 2 good, and 2 poor outcomes, scored according to the Mazur system. The acceptance rate was 85%. Arthroscopy and external fixator-assisted reduction for the minimally invasive treatment of tibial pilon fractures not only produced less trauma but also protected the soft tissues and blood supply surrounding the fractures. External fixation could indirectly provide reduction and effective operative space for arthroscopic implantation, especially for AO type B fractures and partial AO type C1 fractures.

  13. 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.

  14. Minimally invasive management of achalasia cardia: results from a single center study.

    Science.gov (United States)

    Palanivelu, C; Maheshkumar, G S; Jani, Kalpesh; Parthasarthi, R; Sendhilkumar, K; Rangarajan, M

    2007-01-01

    Since the performance of the first laparoscopic cardiomyotomy for achalasia cardia in 1991, the popularity of the minimally invasive approach for this troublesome disease has been growing. We present our experience of 226 patients who underwent laparoscopic cardiomyotomy and discuss the relevant issues. A retrospective analysis was carried out of 226 patients who have undergone laparoscopic cardiomyotomy since 1993. The preoperative workup, surgical technique, and postoperative management are described. Patients included 146 males and 80 females; average age was 36.4 years (range, 6 to 85). Mean duration of symptoms was 1.4 years. Nearly half of the patients (112) had undergone prior pneumatic dilatation. In 20 patients, myotomy alone was done, 44 patients had a Dor's fundoplication, and 162 had Toupet's fundoplication. The average operating time was 96 minutes. Mean postoperative hospital stay was 2.2 days. Dysphagia was eliminated in 88.9% of the patients with an overall morbidity of 4.4% and nil mortality over a mean follow-up of 4.3 years. Laparoscopic cardiomyotomy with Toupet's fundoplication is a safe and effective treatment of achalasia cardia. Dor's fundoplication is done selectively, especially when suspicion is present of mucosal injury.

  15. Clinical outcomes of two minimally invasive transforaminal lumbar interbody fusion (TLIF) for lumbar degenerative diseases.

    Science.gov (United States)

    Tian, Yonghao; Liu, Xinyu

    2016-10-01

    There are two modified TLIF, including MIS-TLIF and TLIF through Wiltse approach (W-TLIF). Although both of the two minimally invasive surgical procedures can be effective in the treatment for lumbar degenerative diseases, no comparative analysis has been made so far regarding their clinical outcomes. To compare the clinical outcomes of MIS-TLIF and W-TLIF for the treatment for single-segment degenerative lumbar diseases. Ninety-seven patients with single-segment degenerative lumbar disorders were included in this study. Forty-seven underwent MIS-TLIF surgery (group A). For group B, fifty patients underwent W-TLIF. The Japanese Orthopedic Association (JOA) score, the visual analog scale (VAS) of low back pain (LBP) and leg pain, MRI score and atrophy rate of CSA, interbody fusion rate were assessed during the postoperative follow-up. Incision length, blood loss, operative time, CPK, and postoperative incision pain VAS were better in group A (P degenerative disease. MIS-TLIF has less blood loss, shorter surgical incision, and less lower postoperative back pain, while W-TLIF is less expensive for hospital stay with lower exposure to X-rays.

  16. 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.

  17. Role of Appositional Screw Fixation in Minimally Invasive Plate Osteosynthesis for Distal Tibial Fracture.

    Science.gov (United States)

    Yang, Kyu-Hyun; Won, Yougun; Kang, Dong-Hyun; Oh, Jin-Cheol; Kim, Sung-Jun

    2015-09-01

    To determine the effect of interfragmentary appositional (gap-closing) screw fixation in minimally invasive plate osteosynthesis (MIPO) for distal tibial fractures on the clinical and radiologic results. Prospective nonrandomized study. Level I trauma center. Sixty patients who were diagnosed as distal metadiaphyseal oblique or spiral tibial fracture without displaced articular fragment. Thirty patients (group A) of the 60 patients were treated with MIPO without appositional screw fixation, and the other 30 (group B) were treated with the screw. Radiologic union, clinical union, clinical functional score [American Orthopaedic Foot and Ankle Society (AOFAS) score], and complications. The time for initial callus formation and radiologic union was significantly longer in group A than those in group B (76.8 vs. 58.0 days, P = 0.044; 409 vs. 258.7 days, P = 0.002, respectively). The rate of clinical union during 1 year was significantly higher in group B than in group A (P = 0.0063). Four nonunion patients in group A achieved bone union after placement of an additional bone graft. None of the patients in group B diagnosed with delayed union or nonunion (P fracture promoted callus formation and union rate compared with MIPO without appositional screw fixation. Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.

  18. Dionis: A Novel Remote-Center-of-Motion Parallel Manipulator for Minimally Invasive Surgery

    Directory of Open Access Journals (Sweden)

    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.

  19. 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.

  20. A new visual feedback-based magnetorheological haptic master for robot-assisted minimally invasive surgery

    International Nuclear Information System (INIS)

    Choi, Seung-Hyun; Kim, Soomin; Kim, Pyunghwa; Park, Jinhyuk; Choi, Seung-Bok

    2015-01-01

    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. (paper)

  1. Endoscopically assisted tunnel approach for minimally invasive corticotomies: a preliminary report.

    Science.gov (United States)

    Hernández-Alfaro, Federico; Guijarro-Martínez, Raquel

    2012-05-01

    The dental community has expressed low acceptance of traditional corticotomy techniques for corticotomy-facilitated orthodontics. These procedures are time consuming, entail substantial postoperative morbidity and periodontal risks, and are often perceived as highly invasive. A total of 114 interdental sites were treated in nine consecutive patients. Under local anesthesia, a tunnel approach requiring one to three vertical incisions per arch (depending on the targeted teeth) was used. Piezosurgical corticotomies and elective bone augmentation procedures were performed under endoscopic assistance. Postoperative cone-beam computerized tomography evaluation was used to confirm adequate corticotomy depth. Procedures were completed in a mean time of 26 minutes. Follow-up evaluations revealed no loss of tooth vitality, no changes in periodontal probing depth, good preservation of the papillae, and no gingival recession. No evidence of crestal bone height reduction or apical root resorption was detected. The tunnel approach minimizes soft-tissue debridement and permits effective cortical cuts. The combination of piezosurgery technique with endoscopic assistance provides a quick, reliable means to design and perform these corticotomies while maximizing root integrity preservation. Moreover, the sites needing bone augmentation are selected under direct vision. Compared to traditional corticotomies, this procedure has manifest advantages in surgical time, technical complexity, patient morbidity, and periodontium preservation.

  2. Force sensing of multiple-DOF cable-driven instruments for minimally invasive robotic surgery.

    Science.gov (United States)

    He, Chao; Wang, Shuxin; Sang, Hongqiang; Li, Jinhua; Zhang, Linan

    2014-09-01

    Force sensing for robotic surgery is limited by the size of the instrument, friction and sterilization requirements. This paper presents a force-sensing instrument to avoid these restrictions. Operating forces were calculated according to cable tension. Mathematical models of the force-sensing system were established. A force-sensing instrument was designed and fabricated. A signal collection and processing system was constructed. The presented approach can avoid the constraints of space limits, sterilization requirements and friction introduced by the transmission parts behind the instrument wrist. Test results showed that the developed instrument has a 0.03 N signal noise, a 0.05 N drift, a 0.04 N resolution and a maximum error of 0.4 N. The validation experiment indicated that the operating and grasping forces can be effectively sensed. The developed force-sensing system can be used in minimally invasive robotic surgery to construct a force-feedback system. Copyright © 2013 John Wiley & Sons, Ltd.

  3. Minimally invasive mini open split-muscular percutaneous pedicle screw fixation of the thoracolumbar spine

    Directory of Open Access Journals (Sweden)

    Murat Ulutaş

    2015-03-01

    Full Text Available We prospectively assessed the feasibility and safety of a new percutaneous pedicle screw (PPS fixation technique for instrumentation of the thoracic and lumbar spine in this study. All patients were operated in the prone position under general anesthesia. A 6 to 8 cm midline skin incision was made and wide sub-cutaneous dissection was performed. The paravertebral muscles were first dissected subperiosteally into the midline incision of the fascia for lumbar microdiscectomy with transforaminal lumbar interbody fusion cage implantation. After the secondary paramedian incisions on the fascia, the PPSs were inserted via cleavage of the multifidus muscles directly into the pedicles under fluoroscopy visualization. A total of 35 patients underwent surgery with this new surgical technique. The control group for operative time, blood loss and analgesic usage consisted of 35 randomly selected cases from our department. The control group underwent surgery via conventional pedicle screw instrumentation with paramedian fusion. All patients in the minimal invasive surgery series were ambulatory with minimal pain on the first postoperative day. The operation time and blood loss and the postoperative analgesic consumption were significantly less with this new technique. In conclusion, the minimal invasive mini open split-muscular percutaneous pedicle screw fixation technique is safe and feasible. It can be performed via a short midline skin incision and can also be combined with interbody fusion, causing minimal pain without severe muscle damage.

  4. Minimally invasive esthetic ridge preservation with growth-factor enhanced bone matrix.

    Science.gov (United States)

    Nevins, Marc L; Said, Sherif

    2017-12-28

    Extraction socket preservation procedures are critical to successful esthetic implant therapy. Conventional surgical approaches are technique sensitive and often result in alteration of the soft tissue architecture, which then requires additional corrective surgical procedures. This case series report presents the ability of flapless surgical techniques combined with a growth factor-enhanced bone matrix to provide esthetic ridge preservation at the time of extraction for compromised sockets. When considering esthetic dental implant therapy, preservation, or further enhancement of the available tissue support at the time of tooth extraction may provide an improved esthetic outcome with reduced postoperative sequelae and decreased treatment duration. Advances in minimally invasive surgical techniques combined with recombinant growth factor technology offer an alternative for bone reconstruction while maintaining the gingival architecture for enhanced esthetic outcome. The combination of freeze-dried bone allograft (FDBA) and rhPDGF-BB (platelet-derived growth factor-BB) provides a growth-factor enhanced matrix to induce bone and soft tissue healing. The use of a growth-factor enhanced matrix is an option for minimally invasive ridge preservation procedures for sites with advanced bone loss. Further studies including randomized clinical trials are needed to better understand the extent and limits of these procedures. The use of minimally invasive techniques with growth factors for esthetic ridge preservation reduces patient morbidity associated with more invasive approaches and increases the predictability for enhanced patient outcomes. By reducing the need for autogenous bone grafts the use of this technology is favorable for patient acceptance and ease of treatment process for esthetic dental implant therapy. © 2017 Wiley Periodicals, Inc.

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

    International Nuclear Information System (INIS)

    Hashimoto, Takuo

    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 invasive

  6. 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

  7. Cost-utility analysis of minimally invasive versus open multilevel hemilaminectomy for lumbar stenosis.

    Science.gov (United States)

    Parker, Scott L; Adogwa, Owoicho; Davis, Brandon J; Fulchiero, Erin; Aaronson, Oran; Cheng, Joseph; Devin, Clinton J; McGirt, Matthew J

    2013-02-01

    Two-year cost-utility study comparing minimally invasive (MIS) versus open multilevel hemilaminectomy in patients with degenerative lumbar spinal stenosis. The objective of the study was to determine whether MIS versus open multilevel hemilaminectomy for degenerative lumbar spinal stenosis is a cost-effective advancement in lumbar decompression surgery. MIS-multilevel hemilaminectomy for degenerative lumbar spinal stenosis allows for effective treatment of back and leg pain while theoretically minimizing blood loss, tissue injury, and postoperative recovery. No studies have evaluated comprehensive healthcare costs associated with multilevel hemilaminectomy procedures, nor assessed cost-effectiveness of MIS versus open multilevel hemilaminectomy. Fifty-four consecutive patients with lumbar stenosis undergoing multilevel hemilaminectomy through an MIS paramedian tubular approach (n=27) versus midline open approach (n=27) were included. Total back-related medical resource utilization, missed work, and health state values [quality adjusted life years (QALYs), calculated from EuroQuol-5D with US valuation] were assessed after 2-year follow-up. Two-year resource use was multiplied by unit costs based on Medicare national allowable payment amounts (direct cost) and work-day losses were multiplied by the self-reported gross-of-tax wage rate (indirect cost). Difference in mean total cost per QALY gained for MIS versus open hemilaminectomy was assessed as incremental cost-effectiveness ratio (ICER: COST(MIS)-COST(OPEN)/QALY(MIS)-QALY(OPEN)). MIS versus open cohorts were similar at baseline. MIS and open hemilaminectomy were associated with an equivalent cumulative gain of 0.72 QALYs 2 years after surgery. Mean direct medical costs, indirect societal costs, and total 2-year cost ($23,109 vs. $25,420; P=0.21) were similar between MIS and open hemilaminectomy. MIS versus open approach was associated with similar total costs and utility, making it a cost equivalent technology

  8. Optimal ergonomics for laparoscopic surgery in minimally invasive surgery suites: a review and guidelines.

    Science.gov (United States)

    van Det, M J; Meijerink, W J H J; Hoff, C; Totté, E R; Pierie, J P E N

    2009-06-01

    With minimally invasive surgery (MIS), a man-machine environment was brought into the operating room, which created mental and physical challenges for the operating team. The science of ergonomics analyzes these challenges and formulates guidelines for creating a work environment that is safe and comfortable for its operators while effectiveness and efficiency of the process are maintained. This review aimed to formulate the ergonomic challenges related to monitor positioning in MIS. Background and guidelines are formulated for optimal ergonomic monitor positioning within the possibilities of the modern MIS suite, using multiple monitors suspended from the ceiling. All evidence-based experimental ergonomic studies conducted in the fields of laparoscopic surgery and applied ergonomics for other professions working with a display were identified by PubMed searches and selected for quality and applicability. Data from ergonomic studies were evaluated in terms of effectiveness and efficiency as well as comfort and safety aspects. Recommendations for individual monitor positioning are formulated to create a personal balance between these two ergonomic aspects. Misalignment in the eye-hand-target axis because of limited freedom in monitor positioning is recognized as an important ergonomic drawback during MIS. Realignment of the eye-hand-target axis improves personal values of comfort and safety as well as procedural values of effectiveness and efficiency. Monitor position is an important ergonomic factor during MIS. In the horizontal plain, the monitor should be straight in front of each person and aligned with the forearm-instrument motor axis to avoid axial rotation of the spine. In the sagittal plain, the monitor should be positioned lower than eye level to avoid neck extension.

  9. Minimally invasive surgical treatment of patients with bilateral pulmonary tuberculosis complicated with pleural empyema

    Directory of Open Access Journals (Sweden)

    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. Enhanced Recovery Pathways for Improving Outcomes After Minimally Invasive Gynecologic Oncology Surgery.

    Science.gov (United States)

    Chapman, Jocelyn S; Roddy, Erika; Ueda, Stefanie; Brooks, Rebecca; Chen, Lee-Lynn; Chen, Lee-May

    2016-07-01

    To estimate whether an enhanced recovery after surgery pathway facilitates early recovery and discharge in gynecologic oncology patients undergoing minimally invasive surgery. This was a retrospective case-control study. Consecutive gynecologic oncology patients undergoing laparoscopic or robotic surgery between July 1 and November 5, 2014, were treated on an enhanced recovery pathway. Enhanced recovery pathway components included patient education, multimodal analgesia, opioid minimization, nausea prophylaxis as well as early catheter removal, ambulation, and feeding. Cases were matched in a one-to-two ratio with historical control patients on the basis of surgery type and age. Primary endpoints were length of hospital stay, rates of discharge by noon, 30-day hospital readmission rates, and hospital costs. There were 165 patients included in the final cohort, 55 of whom were enhanced recovery pathway patients. Enhanced recovery patients were more likely to be discharged on postoperative day 1 compared with patients in the control group (91% compared with 60%, Pcontrol patients (P=.03). Postoperative pain scores decreased (2.6 compared with 3.12, P=.03) despite a 30% reduction in opioid use. Average total hospital costs were decreased by 12% in the enhanced recovery group ($13,771 compared with $15,649, P=.01). Readmission rates, mortality, and reoperation rates did not differ between the two groups. An enhanced recovery pathway in patients undergoing gynecologic oncology minimally invasive surgery is associated with significant improvements in recovery time, decreased pain despite reduced opioid use, and overall lower hospital costs.

  11. 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.

  12. Flexible shape-memory scaffold for minimally invasive delivery of functional tissues

    Science.gov (United States)

    Montgomery, Miles; Ahadian, Samad; Davenport Huyer, Locke; Lo Rito, Mauro; Civitarese, Robert A.; Vanderlaan, Rachel D.; Wu, Jun; Reis, Lewis A.; Momen, Abdul; Akbari, Saeed; Pahnke, Aric; Li, Ren-Ke; Caldarone, Christopher A.; Radisic, Milica

    2017-10-01

    Despite great progress in engineering functional tissues for organ repair, including the heart, an invasive surgical approach is still required for their implantation. Here, we designed an elastic and microfabricated scaffold using a biodegradable polymer (poly(octamethylene maleate (anhydride) citrate)) for functional tissue delivery via injection. The scaffold’s shape memory was due to the microfabricated lattice design. Scaffolds and cardiac patches (1 cm × 1 cm) were delivered through an orifice as small as 1 mm, recovering their initial shape following injection without affecting cardiomyocyte viability and function. In a subcutaneous syngeneic rat model, injection of cardiac patches was equivalent to open surgery when comparing vascularization, macrophage recruitment and cell survival. The patches significantly improved cardiac function following myocardial infarction in a rat, compared with the untreated controls. Successful minimally invasive delivery of human cell-derived patches to the epicardium, aorta and liver in a large-animal (porcine) model was achieved.

  13. Feasibility of chemohyperthermia with docetaxel-embedded magnetoliposomes as minimally invasive local treatment for cancer.

    Science.gov (United States)

    Yoshida, Motohira; Watanabe, Yuji; Sato, Mitsunori; Maehara, Tsunehiro; Aono, Hiromichi; Naohara, Takashi; Hirazawa, Hideyuki; Horiuchi, Atsushi; Yukumi, Shungo; Sato, Koichi; Nakagawa, Hiromichi; Yamamoto, Yuji; Sugishita, Hiroki; Kawachi, Kanji

    2010-04-15

    Hyperthermia is a minimally invasive approach to cancer treatment, but it is difficult to heat only the tumor without damaging surrounding tissue. To solve this problem, we studied the effectiveness of chemohyperthermia with docetaxel-embedded magnetoliposomes (DMLs) and an applied alternating current (AC) magnetic field. Human MKN45 gastric cancer cells were implanted in the hind limb of Balb-c/nu/nu mice. Various concentrations of docetaxel-embedded DMLs were injected into the tumors and exposed to an AC magnetic field (n = 6, each). For comparison with hyperthermia alone, magnetite-loaded liposome (ML)-injected tumors were exposed to an AC magnetic field. Furthermore, the results of DML without AC treatment and docetaxel diluted into PBS with AC treatment were also compared (n = 10, each). Tumor surface temperature was maintained between 42 and 43 degrees C. Tumor volume was reduced in the DML group with a docetaxel concentration > 56.8 microg/ml, while a docetaxel concentration > 568.5 microg/ml was required for tumor reduction without hyperthermia. Statistically significant differences in tumor volume and survival rate were observed between the DML group exposed to the magnetic field and the other groups. The tumor disappeared in 3 mice in the DML group exposed to the magnetic field; 2 mice survived over 6 months after treatment, whereas all mice of the other groups died by 15 weeks. Histologically, hyperthermia with DML damaged tumor cells and DML diffused homogeneously. To the best of our knowledge, this is the first report to show that hyperthermia using chemotherapeutic agent-embedded magnetoliposomes has an anticancer effect.

  14. Multiple minimally invasive Erbium:YAG laser mini-peels for skin rejuvenation: An objective assessment

    Science.gov (United States)

    El-Domyati, Moetaz; El-Ammawi, Tarek S.; Medhat, Walid; Moawad, Osama; Mahoney, Mỹ G.; Uitto, Jouni

    2012-01-01

    Summary Background As the demand for minimally invasive rejuvenation is increasing, micro-peel resurfacing using Erbium:Yttrium Aluminium Garnet (Er:YAG ) laser 2940 nm has been reported for the treatment of photoaged skin without ablation of the epidermis. However, little is known about the efficacy and underlying histologic changes associated with this type of treatment. Aims The purpose of this study is to evaluate the clinical effect and objectively quantify the histological changes in response to multiple sessions of Er:YAG laser 2940 nm mini-peels. Patients and methods Six female volunteers of Fitzpatrick skin type III-IV and Glogau’s class I-III wrinkles were subjected to six microresurfacing peels at 2-week intervals using Er:YAG 2940 nm laser at sub-ablative fluences of 2 - 3 J/cm2 to treat periorbital rhytides. Quantitative evaluation of collagen types I, III and VII, newly synthesized collagen, total elastin and tropoelastin was performed by histochemistry and immunohistochemistry coupled with computerized morphometric analysis at base line, end of treatment, and three months post treatment. Results Compared to the base line, evaluation of volunteers revealed obvious clinical improvement in response to Er:YAG mini-peels. Collagen types I, III, and VII, as well as newly synthesized collagen, together with tropoelastin showed a statistically significant increase in response to treatment, while the mean level of total elastin was significantly decreased in response to treatment. However, this was followed by regression of improvement at 3 months post treatment, but was still better than baseline. Conclusions The present study revealed that multiple Er:YAG mini-peels is a promising treatment option for photoaging as it reverses the signs of photoaged skin with little downtime and side effects. However, to maintain the short term improvement achieved after treatment, continued Er:YAG 2940 nm laser mini-peels is required. PMID:22672276

  15. Pediatric endocanalicular diode laser dacryocystorhinostomy: results of a minimally invasive surgical technique.

    Science.gov (United States)

    Uysal, Ismail Onder; Ozçimen, Muammer; Yener, Halil Ibrahim; Kal, Ali

    2011-09-01

    The purpose of this study was to evaluate the effectiveness of endocanalicular diode laser dacryocystorhinostomy (DCR), which is a minimally invasive surgical technique, in pediatric patients with congenital nasolacrimal duct obstruction (NLDO). A retrospective study was carried out on patients treated between October 2008 and August 2009 for nasolacrimal duct obstruction with an endocanalicular diode laser procedure. Patients diagnosed as having nasolacrimal duct obstruction were included in this study and an endocanalicular diode laser procedure was performed. The main outcome measures were patients' previous treatments, clinical presentation, operative and postoperative complications, postoperative follow-up and resolution of epiphora. Eighteen children (10 girls, 8 boys) with a mean age of 6.11 ± 2.08 years (range, 4-10) underwent 20 endocanalicular laser DCR operations for congenital NLDO. In all eyes (100%), there was a history of epiphora and chronic dacryocystitis; two (10%) presented with acute dacryocystitis. Previous procedures included probing and irrigation of all eyes (100%) and silicone tube intubation in nine eyes (45%). None of the patients underwent any previous DCR operations. During a mean postoperative follow-up period of 20.50 ± 3.24 months (range, 14-24 months), the anatomical success rate (patency of ostium on nasal endoscopy) was 100%, and the clinical success rate (resolution of epiphora) was 85%. Endocanalicular diode laser DCR is an effective treatment modality for pediatric patients with congenital NLDO that compares favorably with the reported success rates of external and endoscopic endonasal DCR. Moreover, it has an added advantage of shorter operative time, less morbidity and avoidance of overnight admission.

  16. Minimal invasive surgery for unicameral bone cyst using demineralized bone matrix: a case series

    Directory of Open Access Journals (Sweden)

    Cho Hwan

    2012-07-01

    Full Text Available Abstract Background Various treatments for unicameral bone cyst have been proposed. Recent concern focuses on the effectiveness of closed methods. This study evaluated the effectiveness of demineralized bone matrix as a graft material after intramedullary decompression for the treatment of unicameral bone cysts. Methods Between October 2008 and June 2010, twenty-five patients with a unicameral bone cyst were treated with intramedullary decompression followed by grafting of demineralized bone matrix. There were 21 males and 4 female patients with mean age of 11.1 years (range, 3–19 years. The proximal metaphysis of the humerus was affected in 12 patients, the proximal femur in five, the calcaneum in three, the distal femur in two, the tibia in two, and the radius in one. There were 17 active cysts and 8 latent cysts. Radiologic change was evaluated according to a modified Neer classification. Time to healing was defined as the period required achieving cortical thickening on the anteroposterior and lateral plain radiographs, as well as consolidation of the cyst. The patients were followed up for mean period of 23.9 months (range, 15–36 months. Results Nineteen of 25 cysts had completely consolidated after a single procedure. The mean time to healing was 6.6 months (range, 3–12 months. Four had incomplete healing radiographically but had no clinical symptom with enough cortical thickness to prevent fracture. None of these four cysts needed a second intervention until the last follow-up. Two of 25 patients required a second intervention because of cyst recurrence. All of the two had a radiographical healing of cyst after mean of 10 additional months of follow-up. Conclusions A minimal invasive technique including the injection of DBM could serve as an excellent treatment method for unicameral bone cysts.

  17. Minimal invasive surgery for unicameral bone cyst using demineralized bone matrix: a case series.

    Science.gov (United States)

    Cho, Hwan Seong; Seo, Sung Hwa; Park, So Hyun; Park, Jong Hoon; Shin, Duk Seop; Park, Il Hyung

    2012-07-29

    Various treatments for unicameral bone cyst have been proposed. Recent concern focuses on the effectiveness of closed methods. This study evaluated the effectiveness of demineralized bone matrix as a graft material after intramedullary decompression for the treatment of unicameral bone cysts. Between October 2008 and June 2010, twenty-five patients with a unicameral bone cyst were treated with intramedullary decompression followed by grafting of demineralized bone matrix. There were 21 males and 4 female patients with mean age of 11.1  years (range, 3-19 years). The proximal metaphysis of the humerus was affected in 12 patients, the proximal femur in five, the calcaneum in three, the distal femur in two, the tibia in two, and the radius in one. There were 17 active cysts and 8 latent cysts. Radiologic change was evaluated according to a modified Neer classification. Time to healing was defined as the period required achieving cortical thickening on the anteroposterior and lateral plain radiographs, as well as consolidation of the cyst. The patients were followed up for mean period of 23.9 months (range, 15-36 months). Nineteen of 25 cysts had completely consolidated after a single procedure. The mean time to healing was 6.6 months (range, 3-12 months). Four had incomplete healing radiographically but had no clinical symptom with enough cortical thickness to prevent fracture. None of these four cysts needed a second intervention until the last follow-up. Two of 25 patients required a second intervention because of cyst recurrence. All of the two had a radiographical healing of cyst after mean of 10 additional months of follow-up. A minimal invasive technique including the injection of DBM could serve as an excellent treatment method for unicameral bone cysts.

  18. Minimally Invasive Treatment of Giant Haemangiomas of the Liver: Embolisation With Bleomycin

    Energy Technology Data Exchange (ETDEWEB)

    Bozkaya, Halil, E-mail: halilbozkaya@yahoo.com; Cinar, Celal, E-mail: celalcinar@hotmail.com [Ege University, Division of Interventional Radiology, Department of Radiology, School of Medicine (Turkey); Besir, Fahri Halit, E-mail: drfhbesir@gmail.com [Duzce University, Department of Radiology, School of Medicine (Turkey); Parıldar, Mustafa, E-mail: mparildar@yahoo.com; Oran, Ismail, E-mail: ismailoran@gmail.com [Ege University, Division of Interventional Radiology, Department of Radiology, School of Medicine (Turkey)

    2013-04-12

    PurposeThe management of patients with giant haemangioma of the liver remains controversial. Although the usual treatment method for symptomatic giant haemangioma is surgery, the classical paradigm of operative resection remains. In this study, we evaluated the symptomatic improvement and size-reduction effect of embolisation with bleomycin mixed with lipiodol for the treatment of symptomatic giant hepatic haemangioma.MethodsThis study included 26 patients [21 female, five male; age 41–65 years (mean 49.83 ± 1.53)] with symptomatic giant haemangioma unfit for surgery and treated with selective embolisation by bleomycin mixed with lipiodol. The patients were followed-up (mean 7.4 ± 0.81 months) clinically and using imaging methods. Statistical analysis was performed using SPSS version 16.0, and p < 0.05 was considered to indicate statistical significance.ResultsEmbolisation of 32 lesions in 26 patients was performed. The mean volume of the haemangiomas was 446.28 ± 88 cm{sup 3} (range 3.39–1559 cm{sup 3}) before intervention and 244.43 ± 54.38 cm{sup 3} (range 94–967 cm{sup 3}) after intervention. No mortality or morbidity related to the treatment was identified. Symptomatic improvement was observed in all patients, and significant volume reduction was achieved (p = 0.001).ConclusionThe morbidity of surgical treatment in patients with giant liver hemangioma were similar to those obtained in patients followed-up without treatment. Therefore, follow-up without treatment is preferred in most patients. Thus, minimally invasive embolisation is an alternative and effective treatment for giant symptomatic haemangioma of the liver.

  19. 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.

  20. 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 < 0.0001 each). Mean ODI improved from 55.2 at baseline to 32.5 and 31.4 at 6 and 12 months (improvements of 22.7 and 23.9 points, p < 0.0001 each). SF-36 physical component summary improved from 31.7 at baseline to 40.2 and 40.3 at 6 and 12 months (p < 0.0001). At 6 and 12 months, 93 and 87% of subjects, respectively, were somewhat or very satisfied and 92 and 91%, respectively, would have the procedure again. Conclusions Minimally invasive SI 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.

  1. Minimally invasive resection of large dumbbell tumors of the lumbar spine: Advantages and pitfalls.

    Science.gov (United States)

    Zairi, Fahed; Troux, Camille; Sunna, Tarek; Karnoub, Mélodie-Anne; Boubez, Ghassan; Shedid, Daniel

    2018-05-01

    The surgical management of dumbbell tumors of the lumbar spine remains controversial, because of their large volume and complex location, involving both the spinal canal and the retro peritoneum. While sporadically reported, our study aims to confirm the value of minimally invasive posterior access for the complete resection of large lumbar dumbbell tumors. In this prospective study, we included all consecutive patients who underwent the resection of a voluminous dumbbell tumor at the lumbar spine through a minimally invasive approach, between March 2015 and August 2017. There were 4 men and 4 women, with a mean age at diagnosis of 40.6 years (range 29-58 years). The resection was performed through a trans muscular tubular retractor by the same surgical team. Operative parameters and initial postoperative course were systematically reported. Clinical and radiological monitoring was scheduled at 3 months, 1 year and 2 years. The mean operative time was 144 min (range 58-300 minutes) and the mean estimated blood loss was 250 ml (range 100-500 ml). Gross total resection was achieved in all patients. No major complication was reported. The mean length of hospital stay was 3.1 days (range 2 to 6 days). Histological analysis confirmed the diagnosis of grade 1 schwannoma in all patients. The mean follow up period was 14.9 months (range 6 to 26 months), and 5 patients completed at least 1-year follow-up. At 6 months the Macnab was excellent in 6 patients, good in one patient and fair in one patient because of residual neuropathic pain requiring the maintenance of a long-term treatment. No tumor recurrence was noted to date. Lumbar dumbbell tumors can be safely and completely resected using a single-stage minimally invasive procedure, in a trained team. Copyright © 2018 Elsevier B.V. All rights reserved.

  2. Minimally invasive medial maxillectomy and the position of nasolacrimal duct: the CT study.

    Science.gov (United States)

    Sieskiewicz, Andrzej; Buczko, Krzysztof; Janica, Jacek; Lukasiewicz, Adam; Lebkowska, Urszula; Piszczatowski, Bartosz; Olszewska, Ewa

    2017-03-01

    Several minimally invasive modifications of endoscopic medial maxillectomy have been proposed recently, with the least traumatic techniques utilizing the lacrimal recess as a route to enter the sinus. The aim of the study was to analyze the anatomy of medial maxillary wall in the region of nasolacrimal canal and, thus, to determine the capability of performing minimally invasive approach to the maxillary sinus leading through the lacrimal recess. The course of nasolacrimal canal and the distance between the anterior maxillary wall and the nasolacrimal canal (the width of lacrimal recess) were evaluated in 125 randomly selected computed tomography (CT) head examinations. The proportion of cases with unfavorable anatomical conditions (lacrimal recess too narrow to accept a 4 mm optic) to perform minimally invasive middle maxillectomy was assessed. The width of lacrimal recess, measured at the level of the inferior turbinate attachment, varied between 0 and 15.2 mm and was related to slanted course of nasolacrimal canal. The more perpendicular the axis of the canal to the nasal flor, the narrower the lacrimal recess. In about 16% of cases, lacrimal recess width was less than 4 mm and in 14.4% it was missing. The endoscopic approach to maxillary sinus leading through lacrimal recess is possible in about 70% of patients. In the remaining group of patients when the lacrimal recess is too narrow, this type of approach may be difficult to perform without damaging the piriform aperture rim or bony framework of nasolacrimal duct, or it may be impracticable when lacrimal recess is missing.

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

    International Nuclear Information System (INIS)

    Bonaldi, G.; Brembilla, C.; Cianfoni, A.

    2015-01-01

    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

  4. Perception versus reality: elucidating motivation and expectations of current fellowship council minimally invasive surgery fellows.

    Science.gov (United States)

    Watkins, Jeffrey R; Pryor, Aurora D; Truitt, Michael S; Jeyarajah, D Rohan

    2018-04-17

    The aim of our study is to determine minimally invasive trainee motivation and expectations for their respective fellowship. Minimally Invasive Surgery (MIS) is one of the largest non-ACGME post-residency training pathways though little is known concerning the process of residents choosing MIS as a fellowship focus. As general surgery evolves, it is important to understand resident motivation in order to better prepare them for a surgical career. A survey invitation was sent to current trainees in the Minimally Invasive and related pathways through the Fellowship Council. The participants were asked to complete a web-based questionnaire detailing demographics, experiences preparing for fellowship, motivation in choosing an MIS fellowship, and expectations for surgical practice after fellowship. Sixty-seven MIS trainees responded to the survey out of 151 invitations (44%). The Fellowship Council website, mentors, and other fellows were cited as the most helpful source of information when applying for fellowship. Trainees were active in surgical societies as residents, with 78% having membership in the ACS and 60% in SAGES. When deciding to pursue MIS as a fellowship, the desire to increase laparoscopic training was the most important factor. The least important reasons cited were lack of laparoendoscopic training in residency and desire to learn robotic surgery. The majority of trainees believed their laparoscopic skill set was above that of their residency cohort (81%). The most desired post-fellowship employment model is hospital employee (46%) followed by private practice (27%). Most fellows plan on marketing themselves as MIS surgeons (90%) or General Surgeons (78%) when in practice. Residents who choose MIS as a fellowship have a strong exposure to laparoscopy and want to become specialists in their field. Mentors and surgical societies including ACS and SAGES play a vital role in preparing residents for fellowship and practice.

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

    Directory of Open Access Journals (Sweden)

    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.

  6. MINIMALLY INVASIVE SINGLE FLAP APPROACH WITH CONNECTIVE TISSUE WALL FOR PERIODONTAL REGENERATION

    Directory of Open Access Journals (Sweden)

    Kamen Kotsilkov

    2017-09-01

    Full Text Available INTRODUCTION: The destructive periodontal diseases are among the most prevalent in the human population. In some cases, bony defects are formed during the disease progression, thus sustaining deep periodontal pockets. The reconstruction of these defects is usually done with the classical techniques of bone substitutes placement and guided tissue regeneration. The clinical and histological data from the recent years, however, demonstrate the relatively low regenerative potential of these techniques. The contemporary approaches for periodontal regeneration rely on minimally invasive surgical protocols, aimed at complete tissue preservation in order to achieve and maintain primary closure and at stimulating the natural regenerative potential of the periodontal tissues. AIM: This presentation demonstrates the application of a new, minimally invasive, single flap surgical technique for periodontal regeneration in a clinical case with periodontitis and a residual deep intrabony defect. MATERIALS AND METHODS: A 37 years old patient presented with chronic generalised periodontitis. The initial therapy led to good control of the periodontal infection with a single residual deep periodontal pocket medially at 11 due to a deep intrabony defect. A single flap approach with an enamel matrix derivate application and a connective tissue wall technique were performed. The proper primary closure was obtained. RESULT: One month after surgery an initial mineralisation process in the defect was detected. At the third month, a complete clinical healing was observed. The radiographic control showed finished bone mineralisation and periodontal space recreation. CONCLUSION: In the limitation of the presented case, the minimally invasive surgical approach led to complete clinical healing and new bone formation, which could be proof for periodontal regeneration.

  7. Update on laparoscopic, robotic, and minimally invasive vaginal surgery for pelvic floor repair.

    Science.gov (United States)

    Ross, J W; Preston, M R

    2009-06-01

    Advanced laparoscopic surgery marked the beginning of minimally invasive pelvic surgery. This technique lead to the development of laparoscopic hysterectomy, colposuspension, paravaginal repair, uterosacral suspension, and sacrocolpopexy without an abdominal incision. With laparoscopy there is a significant decrease in postoperative pain, shorter length of hospital stay, and a faster return to normal activities. These advantages made laparoscopy very appealing to patients. Advanced laparoscopy requires a special set of surgical skills and in the early phase of development training was not readily available. Advanced laparoscopy was developed by practicing physicians, instead of coming down through the more usual academic channels. The need for special training did hinder widespread acceptance. Nonetheless by physician to physician training and society training courses it has continued to grow and now has been incorporated in most medical school curriculums. In the last few years there has been new interest in laparoscopy because of the development of robotic assistance. The 3D vision and 720 degree articulating arms with robotics have made suture intensive procedures much easier. Laparosco-pic robotic-assisted sacrocolpopexy is in the reach of most surgeons. This field is so new that there is very little data to evaluate at this time. There are short comings with laparoscopy and even with robotic-assisted procedures it is not the cure all for pelvic floor surgery. Laparoscopic procedures are long and many patients requiring pelvic floor surgery have medical conditions preventing long anesthesia. Minimally invasive vaginal surgery has developed from the concept of tissue replacement by synthetic mesh. Initially sheets of synthetic mesh were tailored by physicians to repair the anterior and posterior vaginal compartment. The use of mesh by general surgeons for hernia repair has served as a model for urogynecology. There have been rapid improvements in biomaterials

  8. Minimally invasive (MIS) Tönnis osteotomy- A technical annotation and review of short term results.

    Science.gov (United States)

    Balakumar, Balasubramanian; Racy, Malek; Madan, Sanjeev

    2018-03-01

    We detail a modified single incision approach to perform the Tonnis triple pelvic osteotomy by a minimally invasive approach. 12 children underwent minimally invasive Tonnis Osteotomy. There were five boys and seven girls in this study group. Average age was 11 years (9-15 years) at the time of surgery. Mean follow-up was 20.5 months (13-39 months). The average preoperative Antero-Posterior (AP) Centre Edge (CE) angle was -8.8° (-38.6°-18°), the average post-operative AP CE angle was 29.7° (25.1°-43.7°). The average preoperative lateral CE angle was -4.7° (-16°-0°), the average postoperative Lateral CE angle was 28.5° (21.3°-37.4°). The Sharp's angle before and after surgery were 55.7° (51.3°-66°) and 32.4° (16.1°-40.1°) respectively. The mean Tönnis angle before and after the osteotomy were 28.86° (19.7°-43.4°) and 6.3° (0.5°-9.4°) respectively. There was one major complication with sciatic nerve palsy which is in the recovery phase on followup and six minor complications including two cases of transient lateral femoral cutaneous nerve injury, two cases of ischial non-union, over granulation of the wound in one case, and metalwork irritation in one case. We have described a minimally invasive Tonnis osteotomy as a viable option based on our results. This technique is recommended for those who are conversant with the traditional pelvicosteotomies.

  9. Surgical closure of persistent arterial duct with minimal invasive anterior thoracotomy: an alternative technique.

    Science.gov (United States)

    Fouilloux, Virginie; Gran, Célia; Kreitmann, Bernard

    2014-10-01

    Surgical approach for persistent ductus arteriosus ligation is typically a left lateral thoracotomy opening the pleural-space with left lung retraction. We describe an alternative approach, with a minimally invasive anterior parasternal incision. This is particularly adapted to preterm infants weighing less than 1.5 kg. This approach ensures a good exposure of vessels. We believe that it is safe, reliable and reproducible. The learning curve should not be an issue for surgeons used to manage low weight patients. Georg Thieme Verlag KG Stuttgart · New York.

  10. Neuropathic Minimally Invasive Surgeries (NEMESIS):: Percutaneous Diabetic Foot Surgery and Reconstruction.

    Science.gov (United States)

    Miller, Roslyn J

    2016-09-01

    Patients with peripheral neuropathy associated with ulceration are the nemesis of the orthopedic foot and ankle surgeon. Diabetic foot syndrome is the leading cause of peripheral neuropathy, and its prevalence continues to increase at an alarming rate. Poor wound healing, nonunion, infection, and risk of amputation contribute to the understandable caution toward this patient group. Significant metalwork is required to hold these technically challenging deformities. Neuropathic Minimally Invasive Surgeries is an addition to the toolbox of management of the diabetic foot. It may potentially reduce the risk associated with large wounds and bony correction in this patient group. Copyright © 2016 Elsevier Inc. All rights reserved.

  11. Minimally invasive transforaminal lumbar interbody fusion for spondylolisthesis and degenerative spondylosis: 5-year results.

    Science.gov (United States)

    Park, Yung; Ha, Joong Won; Lee, Yun Tae; Sung, Na Young

    2014-06-01

    Multiple studies have reported favorable short-term results after treatment of spondylolisthesis and other degenerative lumbar diseases with minimally invasive transforaminal lumbar interbody fusion. However, to our knowledge, results at a minimum of 5 years have not been reported. We determined (1) changes to the Oswestry Disability Index, (2) frequency of radiographic fusion, (3) complications and reoperations, and (4) the learning curve associated with minimally invasive transforaminal lumbar interbody fusion at minimum 5-year followup. We reviewed our first 124 patients who underwent minimally invasive transforaminal lumbar interbody fusion to treat low-grade spondylolisthesis and degenerative lumbar diseases and did not need a major deformity correction. This represented 63% (124 of 198) of the transforaminal lumbar interbody fusion procedures we performed for those indications during the study period (2003-2007). Eighty-three (67%) patients had complete 5-year followup. Plain radiographs and CT scans were evaluated by two reviewers. Trends of surgical time, blood loss, and hospital stay over time were examined by logarithmic curve fit-regression analysis to evaluate the learning curve. At 5 years, mean Oswestry Disability Index improved from 60 points preoperatively to 24 points and 79 of 83 patients (95%) had improvement of greater than 10 points. At 5 years, 67 of 83 (81%) achieved radiographic fusion, including 64 of 72 patients (89%) who had single-level surgery. Perioperative complications occurred in 11 of 124 patients (9%), and another surgical procedure was performed in eight of 124 patients (6.5%) involving the index level and seven of 124 patients (5.6%) at adjacent levels. There were slowly decreasing trends of surgical time and hospital stay only in single-level surgery and almost no change in intraoperative blood loss over time, suggesting a challenging learning curve. Oswestry Disability Index scores improved for patients with spondylolisthesis

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

    Directory of Open Access Journals (Sweden)

    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.

  13. Rhabdomyolysis and compartment syndrome in a bodybuilder undergoing minimally invasive cardiac surgery

    Directory of Open Access Journals (Sweden)

    Sebastian John Baxter

    2017-01-01

    Full Text Available Rhabdomyolysis is the result of skeletal muscle tissue injury and is characterized by elevated creatine kinase levels, muscle pain, and myoglobinuria. It is caused by crush injuries, hyperthermia, drugs, toxins, and abnormal metabolic states. This is often difficult to diagnose perioperatively and can result in renal failure and compartment syndrome if not promptly treated. We report a rare case of inadvertent rhabdomyolysis and compartment syndrome in a bodybuilder undergoing minimally invasive cardiac surgery. The presentation, differential diagnoses, and management are discussed. Hyperkalemia may be the first presenting sign. Early recognition and management are essential to prevent life-threatening complications.

  14. Incorporating Minimally Invasive Procedures into an Aesthetic Surgery Practice.

    Science.gov (United States)

    Matarasso, Alan; Nikfarjam, Jeremy; Abramowitz, Lauren

    2016-07-01

    Minimally invasive procedures in an aesthetic practice have grown over the past decade. Plastic surgery practices are embracing the incorporation of injectables and lasers as adjuncts to their surgical procedures. The use of botulinum toxin, hyaluronic acid fillers, and lasers has made a significant impact on the authors' practice. The authors describe the important considerations, consultation goals, and procedural steps with injectables and fillers. The novel use of deoxycholic acid injections is also described. The authors strongly think that as options continue to expand, plastic surgeons will benefit from taking an active role in adopting these new innovations. Copyright © 2016 Elsevier Inc. All rights reserved.

  15. Integrated semiconductor optical sensors for chronic, minimally-invasive imaging of brain function.

    Science.gov (United States)

    Lee, Thomas T; Levi, Ofer; Cang, Jianhua; Kaneko, Megumi; Stryker, Michael P; Smith, Stephen J; Shenoy, Krishna V; Harris, James S

    2006-01-01

    Intrinsic optical signal (IOS) imaging is a widely accepted technique for imaging brain activity. We propose an integrated device consisting of interleaved arrays of gallium arsenide (GaAs) based semiconductor light sources and detectors operating at telecommunications wavelengths in the near-infrared. Such a device will allow for long-term, minimally invasive monitoring of neural activity in freely behaving subjects, and will enable the use of structured illumination patterns to improve system performance. In this work we describe the proposed system and show that near-infrared IOS imaging at wavelengths compatible with semiconductor devices can produce physiologically significant images in mice, even through skull.

  16. The affordability of minimally invasive procedures in major lung resection: a prospective study.

    Science.gov (United States)

    Gondé, Henri; Laurent, Marc; Gillibert, André; Sarsam, Omar-Matthieu; Varin, Rémi; Grimandi, Gaël; Peillon, Christophe; Baste, Jean-Marc

    2017-09-01

    Minimally invasive procedures are used for the surgical treatment of lung cancer. Two techniques are proposed: video-assisted thoracic surgery or robotic-assisted thoracic surgery. Our goal was to study the economic impact of our long-standing program for minimally invasive procedures for major lung resection. We conducted a single-centre, 1-year prospective cost study. Patients who underwent lobectomy or segmentectomy were included. Patient characteristics and perioperative outcomes were collected. Medical supply expenses based on the microcosting method and capital depreciation were estimated. Total cost was evaluated using a national French database. One hundred twelve patients were included, 57 with and 55 without robotic assistance. More segmentectomies were performed with robotic assistance. The median length of stay was 5 days for robotic-assisted and 6 days for video-assisted procedures (P = 0.13). The duration of median chest drains (4 days, P = 0.36) and of operating room time (255 min, P = 0.55) was not significantly different between the groups. The overall conversion rate to thoracotomy was 9%, significantly higher in the video-assisted group than in the robotic group (16% vs 2%, P = 0.008). No difference was observed in postoperative complications. The cost of most robotic-assisted procedures ranged from €10 000 to €12 000 (median €10 972) and that of most video-assisted procedures ranged from €8 000 to €10 000 (median €9 637) (P = 0.007); median medical supply expenses were €3 236 and €2 818, respectively (P = 0.004). The overall mean cost of minimally invasive techniques (€11 759) was significantly lower than the mean French cost of lung resection surgical procedures (€13 424) (P = 0.001). The cost at our centre of performing minimally invasive surgical procedures appeared lower than the cost nationwide. Robotic-assisted thoracic surgery demonstrated acceptable additional costs

  17. [Thymomectomy by minimally invasive surgery. Comparative study videosurgery versus robot-assisted surgery].

    Science.gov (United States)

    Witte Pfister, A; Baste, J-M; Piton, N; Bubenheim, M; Melki, J; Wurtz, A; Peillon, C

    2017-05-01

    To report the results of minimally invasive surgery in patients with stage I or II thymoma in the Masaoka classification. The reference technique is partial or complete thymectomy by sternotonomy. A retrospective single-center study of a prospective database including all cases of thymoma operated from April 2009 to February 2015 by minimally invasive techniques: either videosurgery (VATS) or robot-assisted surgery (RATS). The surgical technique, type of resection, length of hospital stay, postoperative complications and recurrences were analysed. Our series consisted of 22 patients (15 women and 7 men). The average age was 53 years. Myasthenia gravis was present in 12 patients. Eight patients were operated on by VATS and 14 patiens by RATS. There were no conversions to sternotomy and no perioperative deaths. The mean operating time was 92min for VATS and 137min for RATS (P<0.001). The average hospital stay was 5 days. The mean weight of the specimen for the VATS group was 13.2 and 45.7mg for the RATS group. Twelve patients were classified Masaoka stage I and 10 were stage II. According to the WHO classification there were 7 patients type A, 5 type AB, 4 type B1, 4 type B2 4 and 2 type B3. As proposed by the Group ITMIG-IASLC in 2015 all patients corresponded to group I. The mean follow-up period was 36 months. We noted 3 major perioperative complications according to the Clavien-Dindo classification: one pneumonia, one phrenic nerve paralysis and one recurrent laryngeal nerve palsy. We observed one case of local recurrence at 22 months. Following surgery 4 patients were treated with radiotherapy and 2 patients with chemotherapy. The minimally invasive route is safe, relatively atraumatic and may be incorporated in the therapeutic arsenal for the treatment of Masaoka stage I and II thymoma as an alternative to conventional sternotomy. RATS and VATS are two minimally invasive techniques and the results in the short and medium term are

  18. Measuring the Latency of an Augmented Reality System for Robot-Assisted Minimally Invasive Surgery

    DEFF Research Database (Denmark)

    Jørgensen, Martin Kibsgaard; Kraus, Martin

    2017-01-01

    visual communication in training for robot-assisted minimally invasive surgery with da Vinci surgical systems. To make sure that our augmented reality system provides the best possible user experience, we investigated the video latency of the da Vinci surgical system and how the components of our system...... affect the overall latency. To measure the photon-to-photon latency, we used a microcontroller to determine the time between the activation of a lightemitting diode in front of the endoscopic camera and the corresponding increase in intensity of the surgeon's display as measured by a phototransistor...

  19. Comprehensive simulation-enhanced training curriculum for an advanced minimally invasive procedure: a randomized controlled trial.

    Science.gov (United States)

    Zevin, Boris; Dedy, Nicolas J; Bonrath, Esther M; Grantcharov, Teodor P

    2017-05-01

    There is no comprehensive simulation-enhanced training curriculum to address cognitive, psychomotor, and nontechnical skills for an advanced minimally invasive procedure. 1) To develop and provide evidence of validity for a comprehensive simulation-enhanced training (SET) curriculum for an advanced minimally invasive procedure; (2) to demonstrate transfer of acquired psychomotor skills from a simulation laboratory to live porcine model; and (3) to compare training outcomes of SET curriculum group and chief resident group. University. This prospective single-blinded, randomized, controlled trial allocated 20 intermediate-level surgery residents to receive either conventional training (control) or SET curriculum training (intervention). The SET curriculum consisted of cognitive, psychomotor, and nontechnical training modules. Psychomotor skills in a live anesthetized porcine model in the OR was the primary outcome. Knowledge of advanced minimally invasive and bariatric surgery and nontechnical skills in a simulated OR crisis scenario were the secondary outcomes. Residents in the SET curriculum group went on to perform a laparoscopic jejunojejunostomy in the OR. Cognitive, psychomotor, and nontechnical skills of SET curriculum group were also compared to a group of 12 chief surgery residents. SET curriculum group demonstrated superior psychomotor skills in a live porcine model (56 [47-62] versus 44 [38-53], Ppsychomotor skills in the live porcine model and in the OR in a human patient (56 [47-62] versus 63 [61-68]; P = .21). SET curriculum group demonstrated inferior knowledge (13 [11-15] versus 16 [14-16]; P<.05), equivalent psychomotor skill (63 [61-68] versus 68 [62-74]; P = .50), and superior nontechnical skills (41 [38-45] versus 34 [27-35], P<.01) compared with chief resident group. Completion of the SET curriculum resulted in superior training outcomes, compared with conventional surgery training. Implementation of the SET curriculum can standardize training

  20. Anesthetic management of minimally invasive intervention in children's oncohematology: preoperative patient management protocol

    Directory of Open Access Journals (Sweden)

    V. V. Shchukin

    2013-01-01

    Full Text Available Preoperative patient management protocol in the complex anesthetic support of minimally invasive interventions in pediatric oncology is described. Choice of general anesthesia method was determined by the specific clinical situation by analyzing all of the following factors: airway management, necessity and anticipated duration of unconsciousness, the need for analgesia, necessity and duration of immobilization, prevention of hypothermia, the presence and severity of disturbances in the hemostatic system, comfort for the child and his representatives (parents. Basic techniques of child preoperative examination, as well as the methodology for predicting the risk of perioperative adverse events are described.

  1. Anesthetic management of minimally invasive intervention in children's oncohematology: preoperative patient management protocol

    Directory of Open Access Journals (Sweden)

    V. V. Shchukin

    2014-07-01

    Full Text Available Preoperative patient management protocol in the complex anesthetic support of minimally invasive interventions in pediatric oncology is described. Choice of general anesthesia method was determined by the specific clinical situation by analyzing all of the following factors: airway management, necessity and anticipated duration of unconsciousness, the need for analgesia, necessity and duration of immobilization, prevention of hypothermia, the presence and severity of disturbances in the hemostatic system, comfort for the child and his representatives (parents. Basic techniques of child preoperative examination, as well as the methodology for predicting the risk of perioperative adverse events are described.

  2. 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.

  3. Retroperitoneal abscess after transanal minimally invasive surgery: case report and review of literature

    Directory of Open Access Journals (Sweden)

    Aaron Raney

    2017-10-01

    Full Text Available Abscesses are a rare complication of transanal minimally invasive surgery and transanal endoscopic micro surgery. Reported cases have been in the rectal and pre-sacral areas and have been managed with either antibiotics alone or in conjunction with laparotomy and diverting colostomy. We report a case of a large retroperitoneal abscess following a Transanal minimally invasive surgery full thickness rectal polyp excision. The patient was successfully managed conservatively with antibiotics and a percutaneous drain. Retroperitoneal infection should be included in a differential diagnosis following a Transanal minimally invasive surgery procedure as the presentation can be insidious and timely intervention is needed to prevent further morbidity. Resumo: Os abscessos são uma complicação rara da cirurgia de ressecção transanal minimamente invasiva (TAMIS e da micro cirurgia endoscópica transanal (TEMS. Os casos notificados foram nas áreas rectal e pré-sacral e foram administrados com antibióticos isoladamente ou em conjunto com laparotomia e desvio de colostomia. Relatamos um caso de grande abscesso retroperitoneal após uma excisão de pólipo retal de espessura total TAMIS. O paciente foi tratado com sucesso com a administração de antibióticos e drenagem percutânea. Para prevenir mais morbidade é necessária incluir a infecção retroperitoneal no diagnostico diferencial após um procedimento TAMIS onde a apresentação pode ser insidiosa e a intervenção atempada. Keywords: Colorectal surgery, Transanal minimally invasive surgery (TAMIS, Retroperitoneal abscess, Natural orifice transluminal endoscopic surgery (NOTES, Single-site laparoscopic surgery (SILS, Surgical oncology, Palavras-chave: Cirurgia colorretal, Cirurgia de ressecção transanal minimamente invasiva (TAMIS, Abscesso retroperitoneal, Cirurgia endoscópica transluminal de orifício natural (NOTES, Cirurgia laparoscópica de único local (SILS, Oncologia cirúrgica

  4. Postoperative Outcomes of Minimally Invasive Gastrectomy Versus Open Gastrectomy During the Early Introduction of Minimally Invasive Gastrectomy in the Netherlands: A Population-based Cohort Study.

    Science.gov (United States)

    Brenkman, Hylke J F; Gisbertz, Suzanne S; Slaman, Annelijn E; Goense, Lucas; Ruurda, Jelle P; van Berge Henegouwen, Mark I; van Hillegersberg, Richard

    2017-11-01

    To compare postoperative outcomes of minimally invasive gastrectomy (MIG) to open gastrectomy (OG) for cancer during the introduction of MIG in the Netherlands. Between 2011 and 2015, the use of MIG increased from 4% to 53% in the Netherlands. This population-based cohort study included all patients with curable gastric adenocarcinoma that underwent gastrectomy between 2011 and 2015, registered in the Dutch Upper GI Cancer Audit. Patients with missing preoperative data, and patients in whom no lymphadenectomy or reconstruction was performed were excluded. Propensity score matching was applied to create comparable groups between patients receiving MIG or OG, using year of surgery and other potential confounders. Morbidity, mortality, and hospital stay were evaluated. Of the 1697 eligible patients, 813 were discarded after propensity score matching; 442 and 442 patients who underwent MIG and OG, respectively, remained. Conversions occurred in 10% of the patients during MIG. Although the overall postoperative morbidity (37% vs 40%, P = 0.489) and mortality rates (6% vs 4%, P = 0.214) were comparable between the 2 groups, patients who underwent MIG experienced less wound complications (2% vs 5%, P = 0.006). Anastomotic leakage occurred in 8% of the patients after MIG, and in 7% after OG (P = 0.525). The median hospital stay declined over the years for both procedures (11 to 8 days, P Netherlands, with overall morbidity and mortality comparable with OG, less wound complications and shorter hospitalization.

  5. A prospective randomized peri- and post-operative comparison of the minimally invasive anterolateral approach versus the lateral approach

    OpenAIRE

    Stefan Landgraeber; Henning Quitmann; Sebastian Güth; Marcel Haversath; Wojciech Kowalczyk; Andrés Kecskeméthy; Hansjörg Heep; Marcus Jäger

    2013-01-01

    There is still controversy as to whether minimally invasive total hip arthroplasty enhances the postoperative outcome. The aim of this study was to compare the outcome of patients who underwent total hip replacement through an anterolateral minimally invasive (MIS) or a conventional lateral approach (CON). We performed a randomized, prospective study of 75 patients with primary hip arthritis, who underwent hip replacement through the MIS (n=36) or CON (n=39) approach. The Western Ontario and ...

  6. Measuring the Latency of an Augmented Reality System for Robot-Assisted Minimally Invasive Surgery

    DEFF Research Database (Denmark)

    Jørgensen, Martin Kibsgaard; Kraus, Martin

    2017-01-01

    Minimal latency is important for augmented reality systems and teleoperation interfaces as even small increases in latency can affect user performance. Previously, we have developed an augmented reality system that can overlay stereoscopic video streams with computer graphics in order to improve....... The latency of the da Vinci S surgical system was on average 62 ms. None of the components of our overlay system (separately or combined) significantly affected the latency. However, the latency of the assistant's monitor increased by 14 ms. Passing the video streams through CPU or GPU memory increased...... visual communication in training for robot-assisted minimally invasive surgery with da Vinci surgical systems. To make sure that our augmented reality system provides the best possible user experience, we investigated the video latency of the da Vinci surgical system and how the components of our system...

  7. Minimally Invasive Direct Repair of Bilateral Lumbar Spine Pars Defects in Athletes

    Directory of Open Access Journals (Sweden)

    Gabriel A. Widi

    2013-01-01

    Full Text Available Spondylolysis of the lumbar spine has traditionally been treated using a variety of techniques ranging from conservative care to fusion. Direct repair of the defect may be utilized in young adult patients without significant disc degeneration and lumbar instability. We used minimally invasive techniques to place pars interarticularis screws with the use of an intraoperative CT scanner in three young adults, including two athletes. This technique is a modification of the original procedure in 1970 by Buck, and it offers the advantage of minimal muscle dissection and optimal screw trajectory. There were no intra- or postoperative complications. The detailed operative procedure and the postoperative course along with a brief review of pars interarticularis defect treatment are discussed.

  8. Laparoscopic vs. open approach for colorectal cancer: evolution over time of minimal invasive surgery.

    Science.gov (United States)

    Biondi, Antonio; Grosso, Giuseppe; Mistretta, Antonio; Marventano, Stefano; Toscano, Chiara; Drago, Filippo; Gangi, Santi; Basile, Francesco

    2013-01-01

    In the late '80s the successes of the laparoscopic surgery for gallbladder disease laid the foundations on the modern use of this surgical technique in a variety of diseases. In the last 20 years, laparoscopic colorectal surgery had become a popular treatment option for colorectal cancer patients. Many studies emphasized on the benefits stating the significant advantages of the laparoscopic approach compared with the open surgery of reduced blood loss, early return of intestinal motility, lower overall morbidity, and shorter duration of hospital stay, leading to a general agreement on laparoscopic surgery as an alternative to conventional open surgery for colon cancer. The reduced hospital stay may also decrease the cost of the laparoscopic surgery for colorectal cancer, despite th higher operative spending compared with open surgery. The average reduction in total direct costs is difficult to define due to the increasing cost over time, making challenging the comparisons between studies conducted during a time range of more than 10 years. However, despite the theoretical advantages of laparoscopic surgery, it is still not considered the standard treatment for colorectal cancer patients due to technical limitations or the characteristics of the patients that may affect short and long term outcomes. The laparoscopic approach to colectomy is slowly gaining acceptance for the management of colorectal pathology. Laparoscopic surgery for colon cancer demonstrates better short-term outcome, oncologic safety, and equivalent long-term outcome of open surgery. For rectal cancer, laparoscopic technique can be more complex depending on the tumor location. The advantages of minimally invasive surgery may translate better care quality for oncological patients and lead to increased cost saving through the introduction of active enhanced recovery programs which are likely cost-effective from the perspective of the hospital health-care providers.

  9. Limited open reduction is better for simple- distal tibial shaft fractures than minimally invasive plate osteosynthesis.

    Science.gov (United States)

    Li, Q; Zeng, B F; Luo, C F; Song, S; Zhang, C Q; Kong, W Q

    2014-07-24

    The aim of this study was to compare the effects and indications of minimally invasive plate osteosynthesis (MIPO) and limited open reduction (LOR) for managing distal tibial shaft fractures. A total of 79 cases of distal tibial shaft fractures were treated surgically in our trauma center. The 79 fracture cases were classified into type A, B, and C (C1) according to the Arbeitsgemeinschaft für Osteosynthesefragen (AO) classification, with 28, 32, and 19 cases, respectively. Among the 79 fracture cases, 52 were closed fractures and 27 were open fractures (GUSTILO, I-II). After adequate preparation, 48 cases were treated with LOR and 31 cases were treated with MIPO. All cases were followed up for 12 to 18 months, with an average of 16.4 months. During the follow-up period, 76 fracture cases were healed in the first stage, whereas the 3 cases that developed non-union were treated by changing the fixation device and autografting. For types A, B, and some of C simple fractures (C1), LOR accelerated the fracture healing and lowered the non-union rate. One case suffered from regional soft tissue infection, which was controlled by wound dressing and intravenous antibiotics. Another case that developed local skin necrosis underwent local flap transplant. LOR promoted bone healing and lowered the non-union rate of several simple-distal tibial shaft fractures. Thereafter, the incidence of soft tissue complication was not significantly increased. However, for complex and comminuted fractures, MIPO was the preferred method for correcting bone alignment and protecting soft tissue, leading to functional recovery.

  10. Thromboprophylaxis after minimally invasive total knee arthroplasty: A comparison of rivaroxaban and enoxaparin

    Directory of Open Access Journals (Sweden)

    Shih-Hsiang Yen

    2014-08-01

    Full Text Available Background: Total knee arthroplasty (TKA carries a substantial rate of venous thromboembolism (VTE. The blood-saving of effect of tranexamic acid (TEA in TKA using enoxaparin for thromboprophylaxis has been well known. However, the routine use of chemoprophylaxis in TKA remains controversial because of postoperative bleeding complications. Therefore, the purpose of this study was to retrospectively compare the incidence of VTE, and postoperative blood loss and wound-related complications in minimally invasive (MIS-TKA patients who received rivaroxaban or enoxaparin prophylaxis. Methods: A total of 113 patients who underwent primary unilateral MIS-TKA between 2009 and 2012 were studied. Of these, 61 patients (study group received rivaroxaban prophylaxis between 2011 and 2012 and a control group of 52 patients received enoxaparin prophylaxis between 2009 and 2010. All patients received one intraoperative injection of TEA (10 mg/kg. We compared the changes in hemoglobin (Hb level, postoperative drainage amount, total blood loss, transfusion rate, and incidence of postoperative wound complications and VTE between the two groups. Results: No differences in postoperative Hb levels, blood drainage amount, total blood loss, and transfusion rate were observed between the two groups. No deep-vein thrombosis of the leg or pulmonary embolism was noted in both groups. There were no major wound complications including hematoma and infection requiring surgical intervention for open irrigation or debridement. Conclusions: Our retrospective study demonstrated a low rate of VTE in MIS-TKA patients who received rivaroxaban or enoxaparin when TEA was used for bleeding prophylaxis. No increased perioperative bleeding or postoperative wound-related complications were observed in the rivaroxaban group compared with the enoxaparin group

  11. Intermittent Intraoperative Neural Monitoring Technology in Minimally Invasive Video-Assisted Thyroidectomy: A Preliminary Study.

    Science.gov (United States)

    Hei, Hu; Zhai, Yifei; Qin, Jianwu; Song, Yongping

    2016-01-01

    Intraoperative neural monitoring (IONM) technology was applied in minimally invasive video-assisted thyroidectomy (MIVAT) to explore its safety and effectiveness. Data were collected retrospectively from October 2009 to August 2011. Inclusion criteria included the following: (1) benign thyroid nodule with maximum diameter less than 4.0 cm by preoperative ultrasound evaluation; (2) no previous thyroid surgeries; (3) no cervical radiation history; (4) normal function of recurrent laryngeal nerve (RLN) examined by preoperative laryngoscopy; (5) patients who did not accept to take a "wait and see" follow-up strategy. Enrolled patients were randomly allocated into NIM group and control group. 46 patients were enrolled in NIM group, and 51 patients were enrolled in control group. All surgeries in NIM group were performed successfully, and majority of tracheal intubations were placed with one attempt. 47 RLNs in NIM group and 60 RLNs in control group were exposed. The time of RLN locating was 6.06 ± 1.48 min in NIM group and 6.92 ± 1.34 min in control group (p = .02). The time of RLN tracing and exposing was 28.96 ± 4.75 min in NIM group and 32.17 ± 5.56 min in control group (p = .02). 1 case of temporary RLN paralysis was observed in both groups, and no permanent RLN paralysis was reported. The application of intermittent IONM in MIVAT is feasible. Intermittent IONM can help reduce the time of RLN locating and the time of RLN tracing and exposing.

  12. Validation of the three web quality dimensions of a minimally invasive surgery e-learning platform.

    Science.gov (United States)

    Ortega-Morán, Juan Francisco; Pagador, J Blas; Sánchez-Peralta, Luisa Fernanda; Sánchez-González, Patricia; Noguera, José; Burgos, Daniel; Gómez, Enrique J; Sánchez-Margallo, Francisco M

    2017-11-01

    E-learning web environments, including the new TELMA platform, are increasingly being used to provide cognitive training in minimally invasive surgery (MIS) to surgeons. A complete validation of this MIS e-learning platform has been performed to determine whether it complies with the three web quality dimensions: usability, content and functionality. 21 Surgeons participated in the validation trials. They performed a set of tasks in the TELMA platform, where an e-MIS validity approach was followed. Subjective (questionnaires and checklists) and objective (web analytics) metrics were analysed to achieve the complete validation of usability, content and functionality. The TELMA platform allowed access to didactic content with easy and intuitive navigation. Surgeons performed all tasks with a close-to-ideal number of clicks and amount of time. They considered the design of the website to be consistent (95.24%), organised (90.48%) and attractive (85.71%). Moreover, they gave the content a high score (4.06 out of 5) and considered it adequate for teaching purposes. The surgeons scored the professional language and content (4.35), logo (4.24) and recommendations (4.20) the highest. Regarding functionality, the TELMA platform received an acceptance of 95.24% for navigation and 90.48% for interactivity. According to the study, it seems that TELMA had an attractive design, innovative content and interactive navigation, which are three key features of an e-learning platform. TELMA successfully met the three criteria necessary for consideration as a website of quality by achieving more than 70% of agreements regarding all usability, content and functionality items validated; this constitutes a preliminary requirement for an effective e-learning platform. However, the content completeness, authoring tool and registration process required improvement. Finally, the e-MIS validity methodology used to measure the three dimensions of web quality in this work can be applied to other

  13. Early and late outcomes of 1000 minimally invasive aortic valve operations.

    Science.gov (United States)

    Tabata, Minoru; Umakanthan, Ramanan; Cohn, Lawrence H; Bolman, Ralph Morton; Shekar, Prem S; Chen, Frederick Y; Couper, Gregory S; Aranki, Sary F

    2008-04-01

    Minimal access cardiac valve surgery is increasingly utilized. We report our 11-year experience with minimally invasive aortic valve surgery. From 07/96 to 12/06, 1005 patients underwent minimally invasive aortic valve surgery. Early and late outcomes were analyzed. Median patient age was 68 years (range: 24-95), 179 patients (18%) were 80 years or older, 130 patients (13%) had reoperative aortic valve surgery, 86 (8.4%) had aortic root replacement, 62 (6.1%) had concomitant ascending aortic replacement, and 26 (2.6%) had percutaneous coronary intervention on the day of surgery (hybrid procedure). Operative mortality was 1.9% (19/1005). The incidences of deep sternal wound infection, pneumonia and reoperation for bleeding were 0.5% (5/1005), 1.3% (13/1005) and 2.4% (25/1005), respectively. Median length of stay was 6 days and 733 patients (72%) were discharged home. Actuarial survival was 91% at 5 years and 88% at 10 years. In the subgroup of the elderly (> or =80 years), operative mortality was 1.7% (3/179), median length of stay was 8 days and 66 patients (37%) were discharged home. Actuarial survival at 5 years was 84%. There was a significant decreasing trend in cardiopulmonary bypass time, the incidence of bleeding, and operative mortality over time. Minimal access approaches in aortic valve surgery are safe and feasible with excellent outcomes. Aortic root replacement, ascending aortic replacement, and reoperative surgery can be performed with these approaches. These procedures are particularly well-tolerated in the elderly.

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

    International Nuclear Information System (INIS)

    Cohen, Julien G.; Reymond, Emilie; Lederlin, Mathieu; Medici, Maud; Lantuejoul, Sylvie; Laurent, François; Arbib, François; Jankowski, Adrien

    2015-01-01

    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

  15. 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.

  16. 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.

  17. Minimally invasive plate osteosynthesis of humeral shaft fractures: a technique to aid fracture reduction and minimize complications.

    Science.gov (United States)

    Shin, Sang-Jin; Sohn, Hoon-Sang; Do, Nam-Hoon

    2012-10-01

    To introduce a modified operative technique for minimally invasive plate osteosynthesis (MIPO) for acute displaced humeral shaft fractures and to evaluate the clinical and radiological outcomes. : Prospective clinical series study. University hospital. Twenty-one patients with acute displaced humeral shaft fractures were treated by MIPO with a modified fracture reduction technique. A narrow 4.5/5.0-mm locking compression plate was applied to the anterior aspect of the humerus. Fracture reduction and manipulation were performed using a plate and drill bits. The operating time, time to union, humeral alignment, and functional outcome of the shoulder and elbow joints were evaluated using the University of California Los Angeles shoulder score and Mayo elbow performance score. No patient experienced a neurological complication. Bony union was obtained in 20/21 patients at a mean 17.5 weeks postoperatively. Eighteen patients had excellent and 3 patients had good results in the University of California Los Angeles score. The average Mayo elbow performance score was 97.5. Two patients were converted to an open reduction during operation due to a failure of MIPO. There was 1 nonunion and 1 malunion in this series. Although the MIPO technique for humeral shaft fractures is technically demanding, satisfactory clinical outcomes in terms of bony union and shoulder and elbow function can be obtained using the modified fracture reduction method. Potential postoperative complications, such as malreduction and nonunion, must be considered. Appropriate surgical indications, a thorough understanding of the neurovascular anatomy and skillful surgical technique, are needed to reduce potential complications.

  18. Ultrasonographic diagnosis and minimally invasive treatment of a patent urachus associated with a patent omphalomesenteric duct in a newborn

    Science.gov (United States)

    Bertozzi, Mirko; Recchia, Nicola; Di Cara, Giuseppe; Riccioni, Sara; Rinaldi, Victoria Elisa; Esposito, Susanna; Appignani, Antonino

    2017-01-01

    Abstract Rational: Patent urachus (PU) is due to an incomplete obliteration of the urachus, whereas patent omphalomesenteric duct (POMD) is due to an incomplete obliteration of the vitelline duct. These anomalies are very rarely associated with one another. We describe a case of a newborn with a PU associated with a POMD, who was diagnosed by an abdominal ultrasound (US) and laparoscopy, and managed with a minimally invasive excision. Patient concern: A 28-day-old male neonate was referred to our hospital to investigate a delay in umbilical healing, with blood-mucinous material spillage for 3 weeks prior to the referral. The baby had no symptoms and was in good general health. Diagnosis: After a thorough cleaning of the umbilical stump, a clear granuloma with a suspected fistula was evident under the seat of the ligature of the stump. An abdominal US examination revealed the formation of a full communication, starting below the umbilical stump and developing along the anterior abdominal wall that connected with the bladder dome. The US also revealed a tubular formation containing air, which was compatible with POMD, in the deepest portion of the same umbilical stump. Considering these findings, the rare diagnosis of a PU associated with a POMD duct was suspected. Interventions: The child was then hospitalized for an elective laparoscopy that confirmed the US picture, and a minimally invasive excision was performed. Outcome: The postoperative course was favorable and uneventful. Lessons: Our case underlines the importance of evaluating all persisting umbilical lesions without delay when conventional pharmacological therapies fail. Using a US as the first approach is valuable and should be supported by laparoscopy to confirm the diagnosis; a minimally invasive excision of the remnants appears to be an effective therapeutic approach. PMID:28746173

  19. Accelerating orthodontic tooth movement: A new, minimally-invasive corticotomy technique using a 3D-printed surgical template

    Science.gov (United States)

    Giansanti, Matteo

    2016-01-01

    Background A reduction in orthodontic treatment time can be attained using corticotomies. The aggressive nature of corticotomy due to the elevation of muco-periosteal flaps and to the duration of the surgery raised reluctance for its employ among patients and dental community. This study aims to provide detailed information on the design and manufacture of a 3D-printed CAD-CAM (computer-aided design and computer-aided manufacturing) surgical guide which can aid the clinician in achieving a minimally-invasive, flapless corticotomy. Material and Methods An impression of dental arches was created; the models were digitally-acquired using a 3D scanner and saved as STereoLithography ( STL ) files. The patient underwent cone beam computed tomography (CBCT): images of jaws and teeth were transformed into 3D models and saved as an STL file. An acrylic template with the design of a surgical guide was manufactured and scanned. The STLs of jaws, scanned casts, and acrylic templates were matched. 3D modeling software allowed the view of the 3D models from different perspectives and planes with perfect rendering. The 3D model of the acrylic template was transformed into a surgical guide with slots designed to guide, at first, a scalpel blade and then a piezoelectric cutting insert. The 3D STL model of the surgical guide was printed. Results This procedure allowed the manufacturing of a 3D-printed CAD/CAM surgical guide, which overcomes the disadvantages of the corticotomy, removing the need for flap elevation. No discomfort, early surgical complications or unexpected events were observed. Conclusions The effectiveness of this minimally-invasive surgical technique can offer the clinician a valid alternative to other methods currently in use. Key words:Corticotomy, orthodontics, CAD/CAM, minimally invasive, surgical template, 3D printer. PMID:27031067

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

    Science.gov (United States)

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

    2008-11-01

    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 posture in relation to monitor position in a dedicated minimally invasive surgery (MIS) suite and a conventional operating room. Assessment of the neck was conducted for 16 surgeons, assisting surgeons, and scrub nurses performing a laparoscopic cholecystectomy in both types of operating room. Flexion and rotation of the cervical spine were measured intraoperatively using a video analysis system. A two-question visual analog scale (VAS) questionnaire was used to evaluate posture in relation to the monitor position. Neck rotation was significantly reduced in the MIS suite for the surgeon (p = 0.018) and the assisting surgeon (p < 0.001). Neck flexion was significantly improved in the MIS suite for the surgeon (p < 0.001) and the scrub nurse (p = 0.018). On the questionnaire, the operating room team scored their posture significantly higher in the MIS suite and also indicated fewer musculoskeletal complaints. The ergonomic quality of the neck posture is significantly improved in the MIS suite for the entire operating room team.

  1. Automatic classification of minimally invasive instruments based on endoscopic image sequences

    Science.gov (United States)

    Speidel, Stefanie; Benzko, Julia; Krappe, Sebastian; Sudra, Gunther; Azad, Pedram; Müller-Stich, Beat Peter; Gutt, Carsten; Dillmann, Rüdiger

    2009-02-01

    Minimally invasive surgery is nowadays a frequently applied technique and can be regarded as a major breakthrough in surgery. The surgeon has to adopt special operation-techniques and deal with difficulties like the complex hand-eye coordination and restricted mobility. To alleviate these constraints we propose to enhance the surgeon's capabilities by providing a context-aware assistance using augmented reality techniques. To analyze the current situation for context-aware assistance, we need intraoperatively gained sensor data and a model of the intervention. A situation consists of information about the performed activity, the used instruments, the surgical objects, the anatomical structures and defines the state of an intervention for a given moment in time. The endoscopic images provide a rich source of information which can be used for an image-based analysis. Different visual cues are observed in order to perform an image-based analysis with the objective to gain as much information as possible about the current situation. An important visual cue is the automatic recognition of the instruments which appear in the scene. In this paper we present the classification of minimally invasive instruments using the endoscopic images. The instruments are not modified by markers. The system segments the instruments in the current image and recognizes the instrument type based on three-dimensional instrument models.

  2. Long-term professional performance of minimally invasive surgery post-graduates

    Directory of Open Access Journals (Sweden)

    Marcelo de Paula Loureiro

    Full Text Available OBJECTIVE: to evaluate the contribution of a post-graduation program in surgeons professional careers. METHODS: participants were asked to answer a questionnaire with questions related to possible changes in their professional performance after the end of the course. RESULTS: forty-three (76.7% of the 56 participants eligible for the study responded to the questionnaires. Most participants, 32 (74.4%, had previous contact with laparoscopic surgery; however, only 14 (32.5% reported the experience as primary surgeon. The expectations on the course were reached or exceeded for 36 (83.7% participants. Thirty-seven (86% incorporated minimally invasive procedures in their daily surgical practice, 37 (86% reported improvements in their income above 10% and 12% reported income increase of over 100%, directly related to their increase of laparoscopic activity. CONCLUSION: the program in minimally invasive surgery provides a high level of satisfaction to its participants, enables them to perform more complex technical procedures, such as sutures, and improves their professional economic performance.

  3. Minimally invasive therapy of upside-down stomach: A single-center experience

    Directory of Open Access Journals (Sweden)

    Radek Vrba

    2017-01-01

    Full Text Available Introduction: The aim of this study is to evaluate short-term and long-term outcomes of minimally invasive therapy in Type IV hiatal hernia (upside-down stomach. Patients and Methods: A retrospective study of 58 consecutively operated patients with Type IV hiatal hernia between 1998 and 2015 was conducted. Short-term outcome was evaluated using Clavien-Dindo classification and long-term outcomes using phone survey and subjective assessment of patients at least 1 year following surgery. Results: Laparoscopic hiatoplasty was performed in all patients, with gastropexy in 55.2%, fundoplication in 39.6%, and combination of fundoplication and gastropexy in 5.2%. Complications were observed in 6.9%. Two early reoperations (within 30 days due to acute reherniation were necessary. Adverse events occurred in seven cases – pleural opening and peroperative bleeding. Three patients were reoperated laparoscopically 2–17 months after the first surgery due to receiving partial stomach herniation. In 67.2% of patients, long-term subjective quality of life assessment was available. Eighty percent of them were completely satisfied, without recurrence of preoperative symptoms. Conclusion: Elective laparoscopic surgery of hiatal hernia Type IV is a safe procedure, which has all the benefits of minimally invasive therapy with favorable short- and long-term results.

  4. Aging well--the role of minimally invasive aesthetic dermatological procedures in women over 65.

    Science.gov (United States)

    Wollina, Uwe; Payne, Christopher Rowland

    2010-03-01

    The western world is getting older. Aging well has become the new target of preventative medicine. Aesthetic dermatology can contribute to this quest. Females over 65 represent an important and growing group of consumers of cosmetic procedures. In this group, there is a paucity of scientific evaluation of aesthetic procedures. To review the use of minimally invasive procedures for facial rejuvenation in women over 65. Drawing from both the literature and personal experience, the opportunities, modifications, and limitations of minimally invasive techniques for facial rejuvenation in older women are considered. In this older age group, dermal fillers, chemical and laser peels, and nonablative photorejuvenation remain useful and can each be used as stand-alone treatments. In this age group, botulinum toxin (BTX) injections are more often used in combination with other procedures. With respect to aesthetic procedures, women over 65 are different from younger women. More scientific investigation is necessary to better meet needs of this growing part of the population. Available data suggest that aesthetic dermatology can make a major contribution to the complex matter of aging well.

  5. Minimally invasive soft tissue release of foot and ankle contracture secondary to stroke.

    Science.gov (United States)

    Boffeli, Troy J; Collier, Rachel C

    2014-01-01

    Lower extremity contracture associated with stroke commonly results in a nonreducible, spastic equinovarus deformity of the foot and ankle. Rigid contracture deformity leads to gait instability, pain, bracing difficulties, and ulcerations. The classic surgical approach for stroke-related contracture of the foot and ankle has been combinations of tendon lengthening, tendon transfer, osteotomy, and joint fusion procedures. Recovery after traditional foot and ankle reconstructive surgery requires a period of non-weightbearing that is not typically practical for these patients. Little focus has been given in published studies on minimally invasive soft tissue release of contracture. We present the case of a 61-year-old female with an equinovarus foot contracture deformity secondary to stroke. The patient underwent Achilles tendon lengthening, posterior tibial tendon Z lengthening, and digital flexor tenotomy of each toe with immediate weightbearing in a walking boot, followed by transition to an ankle-foot orthosis. The surgical principles and technique tips are presented to demonstrate our minimally invasive approach to release of foot and ankle contracture secondary to stroke. The main goal of this approach is to improve foot and ankle alignment for ease of bracing, which, in turn, will improve gait, reduce the risk of falls, decrease pain, and avoid the development of pressure sores. Copyright © 2014 American College of Foot and Ankle Surgeons. Published by Elsevier Inc. All rights reserved.

  6. 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

  7. Lateral Interbody Fusion for Treatment of Discogenic Low Back Pain: Minimally Invasive Surgical Techniques

    Directory of Open Access Journals (Sweden)

    Luis Marchi

    2012-01-01

    Full Text Available Low back pain is one of the most common ailments in the general population, which tends to increase in severity along with aging. While few patients have severe enough symptoms or underlying pathology to warrant surgical intervention, in those select cases treatment choices remain controversial and reimbursement is a substancial barrier to surgery. The object of this study was to examine outcomes of discogenic back pain without radiculopathy following minimally-invasive lateral interbody fusion. Twenty-two patients were treated at either one or two levels (28 total between L2 and 5. Discectomy and interbody fusion were performed using a minimallyinvasive retroperitoneal lateral transpsoas approach. Clinical and radiographic parameters were analyzed at standard pre- and postoperative intervals up to 24 months. Mean surgical duration was 72.1 minutes. Three patients underwent supplemental percutaneous pedicle screw instrumentation. Four (14.3% stand-alone levels experienced cage subsidence. Pain (VAS and disability (ODI improved markedly postoperatively and were maintained through 24 months. Segmental lordosis increased significantly and fusion was achieved in 93% of levels. In this series, isolated axial low back pain arising from degenerative disc disease was treated with minimally-invasive lateral interbody fusion in significant radiographic and clinical improvements, which were maintained through 24 months.

  8. Design of a piezoelectric inchworm actuator and compliant end effector for minimally invasive surgery

    Science.gov (United States)

    Canfield, Shawn; Edinger, Ben; Frecker, Mary I.; Koopmann, Gary H.

    1999-06-01

    Recent advances in robotics, tele-robotics, smart material actuators, and mechatronics raise new possibilities for innovative developments in millimeter-scale robotics capable of manipulating objects only fractions of a millimeter in size. These advances can have a wide range of applications in the biomedical community. A potential application of this technology is in minimally invasive surgery (MIS). The focus of this paper is the development of a single degree of freedom prototype to demonstrate the viability of smart materials, force feedback and compliant mechanisms for minimally invasive surgery. The prototype is a compliant gripper that is 7-mm by 17-mm, made from a single piece of titanium that is designed to function as a needle driver for small scale suturing. A custom designed piezoelectric `inchworm' actuator drives the gripper. The integrated system is computer controlled providing a user interface device capable of force feedback. The design methodology described draws from recent advances in three emerging fields in engineering: design of innovative tools for MIS, design of compliant mechanisms, and design of smart materials and actuators. The focus of this paper is on the design of a millimeter-scale inchworm actuator for use with a compliant end effector in MIS.

  9. A 3D virtual reality simulator for training of minimally invasive surgery.

    Science.gov (United States)

    Mi, Shao-Hua; Hou, Zeng-Gunag; Yang, Fan; Xie, Xiao-Liang; Bian, Gui-Bin

    2014-01-01

    For the last decade, remarkable progress has been made in the field of cardiovascular disease treatment. However, these complex medical procedures require a combination of rich experience and technical skills. In this paper, a 3D virtual reality simulator for core skills training in minimally invasive surgery is presented. The system can generate realistic 3D vascular models segmented from patient datasets, including a beating heart, and provide a real-time computation of force and force feedback module for surgical simulation. Instruments, such as a catheter or guide wire, are represented by a multi-body mass-spring model. In addition, a realistic user interface with multiple windows and real-time 3D views are developed. Moreover, the simulator is also provided with a human-machine interaction module that gives doctors the sense of touch during the surgery training, enables them to control the motion of a virtual catheter/guide wire inside a complex vascular model. Experimental results show that the simulator is suitable for minimally invasive surgery training.

  10. 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. Copyright © 2016 The Authors. Published by Elsevier B.V. All rights reserved.

  11. Simulated lumbar minimally invasive surgery educational model with didactic and technical components.

    Science.gov (United States)

    Chitale, Rohan; Ghobrial, George M; Lobel, Darlene; Harrop, James

    2013-10-01

    The learning and development of technical skills are paramount for neurosurgical trainees. External influences and a need for maximizing efficiency and proficiency have encouraged advancements in simulator-based learning models. To confirm the importance of establishing an educational curriculum for teaching minimally invasive techniques of pedicle screw placement using a computer-enhanced physical model of percutaneous pedicle screw placement with simultaneous didactic and technical components. A 2-hour educational curriculum was created to educate neurosurgical residents on anatomy, pathophysiology, and technical aspects associated with image-guided pedicle screw placement. Predidactic and postdidactic practical and written scores were analyzed and compared. Scores were calculated for each participant on the basis of the optimal pedicle screw starting point and trajectory for both fluoroscopy and computed tomographic navigation. Eight trainees participated in this module. Average mean scores on the written didactic test improved from 78% to 100%. The technical component scores for fluoroscopic guidance improved from 58.8 to 52.9. Technical score for computed tomography-navigated guidance also improved from 28.3 to 26.6. Didactic and technical quantitative scores with a simulator-based educational curriculum improved objectively measured resident performance. A minimally invasive spine simulation model and curriculum may serve a valuable function in the education of neurosurgical residents and outcomes for patients.

  12. 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.)

  13. Minimally invasive and targeted therapeutic cell delivery to the skin using microneedle devices.

    Science.gov (United States)

    Gualeni, B; Coulman, S A; Shah, D; Eng, P F; Ashraf, H; Vescovo, P; Blayney, G J; Piveteau, L-D; Guy, O J; Birchall, J C

    2018-03-01

    Translation of cell therapies to the clinic is accompanied by numerous challenges, including controlled and targeted delivery of the cells to their site of action, without compromising cell viability and functionality. To explore the use of hollow microneedle devices (to date only used for the delivery of drugs and vaccines into the skin and for the extraction of biological fluids) to deliver cells into skin in a minimally invasive, user-friendly and targeted fashion. Melanocyte, keratinocyte and mixed epidermal cell suspensions were passed through various types of microneedles and subsequently delivered into the skin. Cell viability and functionality are maintained after injection through hollow microneedles with a bore size ≥ 75 μm. Healthy cells are delivered into the skin at clinically relevant depths. Hollow microneedles provide an innovative and minimally invasive method for delivering functional cells into the skin. Microneedle cell delivery represents a potential new treatment option for cell therapy approaches including skin repigmentation, wound repair, scar and burn remodelling, immune therapies and cancer vaccines. © 2017 British Association of Dermatologists.

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

    International Nuclear Information System (INIS)

    Hashizume, M.; Yasunaga, T.; Konishi, K.; Tanoue, K.; Ieiri, S.; Kishi, K.; Nakamoto, H.; Ikeda, D.; Sakuma, I.; Fujie, M.; Dohi, T.

    2008-01-01

    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.)

  15. Impact of neoadjuvant chemotherapy on complications of minimally invasive radical cystectomy.

    Science.gov (United States)

    Lizée, D; Salas, R S; Barret, E; Galiano, M; Di Trapani, E; Montorsi, F; Cathelineau, X

    2017-03-01

    Neoadjuvant chemotherapy (NC) before minimally invasive radical cystectomy (MIRC) is considered a standard of care in muscle-invasive bladder cancer or recurrent high-risk non-muscle-invasive bladder cancer. To evaluate the impact of NC on morbidity and mortality after MIRC. We prospectively evaluated 135 patients who underwent MIRC (laparoscopic: n=100; robotic: n=35) between 2007 and 2013 with ≥90 days of follow-up (median age: 66 year). Complications were analyzed and graded according to the Clavien Dindo classification system. Logistic regression models were used to evaluate the impact of NC on postoperative complications. Kaplan-Meier methods with the log-rank test were used for cancer-specific survival probabilities and differences between the 2groups (MIRC with and without NC). Sixty-two of 135 patients received NC. A total of 118 patients (87.4%) developed 179 complications, chiefly infectious (48.0%) or gastrointestinal (21.2%), ≤90 days after surgery; 3 patients died bladder cancer who had NC versus no NC. We did not find any significant differences in terms of early or late complications, length of stay, or reintervention. The oncologic outcomes regarding NC were encouraging. Copyright © 2016. Publicado por Elsevier España, S.L.U.

  16. MINIMALLY INVASIVE SURGERY FOR GASTRIC CANCER: TIME TO CHANGE THE PARADIGM.

    Science.gov (United States)

    Barchi, Leandro Cardoso; Jacob, Carlos Eduardos; Bresciani, Cláudio José Caldas; Yagi, Osmar Kenji; Mucerino, Donato Roberto; Lopasso, Fábio Pinatel; Mester, Marcelo; Ribeiro-Júnior, Ulysses; Dias, André Roncon; Ramos, Marcus Fernando Kodama Pertille; Cecconello, Ivan; Zilberstein, Bruno

    2016-01-01

    Minimally invasive surgery widely used to treat benign disorders of the digestive system, has become the focus of intense study in recent years in the field of surgical oncology. Since then, the experience with this kind of approach has grown, aiming to provide the same oncological outcomes and survival to conventional surgery. Regarding gastric cancer, surgery is still considered the only curative treatment, considering the extent of resection and lymphadenectomy performed. Conventional surgery remains the main modality performed worldwide. Notwithstanding, the role of the minimally invasive access is yet to be clarified. To evaluate and summarize the current status of minimally invasive resection of gastric cancer. A literature review was performed using Medline/PubMed, Cochrane Library and SciELO with the following headings: gastric cancer, minimally invasive surgery, robotic gastrectomy, laparoscopic gastrectomy, stomach cancer. The language used for the research was English. 28 articles were considered, including randomized controlled trials, meta-analyzes, prospective and retrospective cohort studies. Minimally invasive gastrectomy may be considered as a technical option in the treatment of early gastric cancer. As for advanced cancer, recent studies have demonstrated the safety and feasibility of the laparoscopic approach. Robotic gastrectomy will probably improve outcomes obtained with laparoscopy. However, high cost is still a barrier to its use on a large scale. A cirurgia minimamente invasiva amplamente usada para tratar doenças benignas do aparelho digestivo, tornou-se o foco de intenso estudo nos últimos anos no campo da oncologia cirúrgica. Desde então, a experiência com este tipo de abordagem tem crescido, com o objetivo de fornecer os mesmos resultados oncológicos e sobrevivência à cirurgia convencional. Em relação ao câncer gástrico, o tratamento cirúrgico ainda é considerado o único tratamento curativo, considerando a extensão da

  17. 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.

  18. Minimally invasive or interventional repair of atrial septal defects in children: experience in 171 cases and comparison with conventional strategies.

    Science.gov (United States)

    Formigari, R; Di Donato, R M; Mazzera, E; Carotti, A; Rinelli, G; Parisi, F; Pasquini, L; Ballerini, L

    2001-05-01

    The goal of this study was to evaluate percutaneous interventional and minimally invasive surgical closure of secundum atrial septal defect (ASD) in children. Concern has surrounded abandoning conventional midline sternotomy in favor of the less invasive approaches pursuing a better cosmetic result and a more rational resource utilization. A retrospective analysis was performed on the patients treated from June 1996 to December 1998. One hundred seventy-one children (median age 5.8 years, median weight 22.1 kg) underwent 52 device implants, 72 minimally invasive surgical operations and 50 conventional sternotomy operations. There were no deaths and no residual left to right shunt in any of the groups. The overall complication rate causing delayed discharge was 12.6% for minimally invasive surgery, 12.0% for midline sternotomy and 3.8% for transcatheter device closure (p appeal of the percutaneous and minimally invasive approaches must be weighed against their greater exposure to technical pitfalls. Adequate training is needed if a strategy of surgical or percutaneous minimally invasive closure of ASD in children is planned in place of conventional surgery.

  19. Unilateral Approach for Bilateral Decompression of Lumbar Spinal Stenosis: A Minimal Invasive Surgery

    International Nuclear Information System (INIS)

    Usman, M.; Ali, M.; Khanzada, K.; Haq, N.U.; Aman, R.; Ali, M.

    2013-01-01

    Objective: To assess the feasibility and efficacy of a novel, minimally invasive spinal surgery technique for the correction of lumbar spinal stenosis involving unilateral approach for bilateral decompression. Study Design: Cross-sectional observational study. Place and Duration of Study: Neurosurgery Department of PGMI, Lady Reading Hospital, Peshawar, from January to December 2010. Methodology: A total of 60 patients with lumbar stenosis were randomly assigned to undergo either a conventional laminectomy (30 patients, Group A), or a unilateral approach (30 patients, Group B). Clinical outcomes was measured using the scale of Finneson and Cooper. All the data was collected by using a proforma and different parameters were assessed for a minimum follow-up period of three months. Data was analyzed by descriptive statistics using SPSS software version 17. Results: Adequate decompression was achieved in all patients. Compared with patients in the conventional laminectomy group, patients who received the novel procedure (unilateral approach) had a reduced mean duration of hospital stay, a faster recovery rate and majority of the patients (88.33%) had an excellent to fair operative result according to the Finneson and Cooper scale. Five major complications occurred in all patient groups, 2 patients had unintended dural rent and 2 wound dehiscence each and fifth patient had worsening of symptoms. There was no mortality in the series. Conclusion: The ultimate goal of the unilateral approach to treat lumbar spinal stenosis is to achieve adequate decompression of the neural elements. An additional benefit of a minimally invasive approach is adequate preservation of vertebral stability, as it requires only minimal muscle trauma, preservation of supraspinous/intraspinous ligament complex and spinous process, therefore, allows early mobilization. This also shortens the hospital stay, reduces postoperative back pain, and leads to satisfactory outcome. (author)

  20. Transanal minimally-invasive surgery (TAMIS: Technique and results from an initial experience

    Directory of Open Access Journals (Sweden)

    Carlos Ramon Silveira Mendes

    2013-10-01

    Full Text Available Transanal endoscopic microsurgery is a minimally-invasive approach for rectal lesions. Superior exposure and access to the entire rectum result in lesser risk of compromised margins and lower recurrence rates, when compared to conventional transanal excision. The aim of this study was to describe a single institution's initial experience with transanal minimally invasive surgery (TAMIS. This was a prospective review of our database. Elev- en procedures from January 2012 to June 2013 were analyzed. Results: eleven operations were completed. Five men were evaluated. Mean age was 62.9 (40-86. Mean follow-up was 9.3 (2-17 months. Average tumor size was 3.8 (1.8-8 cm. Mean distance from anal verge was 6.3 (3-12 cm. Mean operating time was 53.73 (28-118 min. Postoperative complica- tion rate was 9.1%. There were no readmissions. Mortality was null. Operative pathology disclosed the presence of adenoma in four patients, invasive adenocarcinoma in two, neu- roendocrine carcinoma in three, and no residual lesion in one case. TAMIS is a minimally- invasive procedure with low postoperative morbidity at the initial experience. TAMIS is a curative procedure for benign lesions and for selected early cancers. It is useful after neoadjuvant therapy for strictly selected cancers, pending the results of multi-institutional trials. Resumo: Microcirurgia endoscópica transanal é uma abordagem minimamente invasiva para lesões retais. Apresenta menor risco de margem comprometida e menores taxas de recorrência em comparação com excisão transanal convencional. Objetivou-se descrever a experiência inicial, de uma única instituição, com cirurgia minimamente invasiva transanal (TAMIS. Avaliação prospectiva de nosso banco de dados. Onze procedimentos de janeiro de 2012 a junho de 2013, foram analisados. Resultados: onze operações foram concluídas. Havia cinco homens. A média de idade foi de 62,9 (40-86. O acompanhamento médio foi de ww9,3 (2-17 meses. O

  1. 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.

  2. 微创钻颅术联合尼莫地平治疗脑内血肿的疗效及对神经功能的影响的临床研究%Effect of Minimally Invasive Cranial Drill Surgery Combined with Nimodip-ine in the Treatment of Intracerebral Hematoma and Its Effect on Nerve Function

    Institute of Scientific and Technical Information of China (English)

    马宝林

    2015-01-01

    Objective To study the effect of minimally invasive cranial drill surgery combined with nimodipine in the treat-ment of intracerebral hematoma and its effect on nerve function. Methods 112 patients with intracerebral hematoma admit-ted to our hospital from January 2012 and December 2014 were randomly divided into two groups. 56 patients in the control group were treated with minimally invasive cranial drill surgery while the 56 in the experimental group were treated with minimally invasive cranial drill surgery combined with nimodipine. The clinical outcomes and nerve function of the patients were compared between the two groups. Results The clinical effective rate (87.5%vs 71.4%) was higher in the experimental group than in the control group, and the difference was statistically significant, P<0.05; after treatment, the nerve function impairment scores decreased significantly in the experimental group, which was significantly lower than that in the control group with statistical difference, P<0.05. Conclusion Minimally invasive cranial drill surgery combined with nimodipine in the treatment of intracerebral hematoma has remarkable effect and high clinical effective rate. It can significantly improve the removal of hematoma, their nerve function, and quality of life and mental health. Therefore it is worthy of clinical application.%目的:探讨微创钻颅术联合尼莫地平治疗脑血肿的疗效及对神经功能的影响。方法将整群选取的2012年1月-2014年12月该院收治的112例脑血肿患者随机分为两组。对照组56例给予微创钻颅术,而试验组56例给予微创钻颅术联合尼莫地平治疗。比较两组临床疗效及神经功能的差异。结果试验组临床有效率为87.5%显著高于对照组71.4%,比较有统计学差异(P<0.05);治疗后试验组神经功能缺损评分显著降低,同时也显著低于同期对照组,比较差异具有统计学意义( P<0.05)。结论微创钻颅术联合尼莫地平

  3. Minimally invasive myotomy for the treatment of esophageal achalasia: evolution of the surgical procedure and the therapeutic algorithm.

    Science.gov (United States)

    Bresadola, Vittorio; Feo, Carlo V

    2012-04-01

    Achalasia is a rare disease of the esophagus, characterized by the absence of peristalsis in the esophageal body and incomplete relaxation of the lower esophageal sphincter, which may be hypertensive. The cause of this disease is unknown; therefore, the aim of the therapy is to improve esophageal emptying by eliminating the outflow resistance caused by the lower esophageal sphincter. This goal can be accomplished either by pneumatic dilatation or surgical myotomy, which are the only long-term effective therapies for achalasia. Historically, pneumatic dilatation was preferred over surgical myotomy because of the morbidity associated with a thoracotomy or a laparotomy. However, with the development of minimally invasive techniques, the surgical approach has gained widespread acceptance among patients and gastroenterologists and, consequently, the role of surgery has changed. The aim of this study was to review the changes occurred in the surgical treatment of achalasia over the last 2 decades; specifically, the development of minimally invasive techniques with the evolution from a thoracoscopic approach without an antireflux procedure to a laparoscopic myotomy with a partial fundoplication, the changes in the length of the myotomy, and the modification of the therapeutic algorithm.

  4. A comparative study of intramedullary interlocking nailing and minimally invasive plate osteosynthesis in extra articular distal tibial fractures.

    Science.gov (United States)

    Daolagupu, Arup K; Mudgal, Ashwani; Agarwala, Vikash; Dutta, Kaushik K

    2017-01-01

    Extraarticular distal tibial fractures are among the most challenging fractures encountered by an orthopedician for treatment because of its subcutaneous location, poor blood supply and decreased muscular cover anteriorly, complications such as delayed union, nonunion, wound infection, and wound dehiscence are often seen as a great challenge to the surgeon. Minimally invasive plate osteosynthesis (MIPO) and intramedullary interlocking nail (IMLN) are two well-accepted and effective methods, but each has been historically related to complications. This study compares clinical and radiological outcome in extraarticular distal tibia fractures treated by intramedullary interlocking nail (IMLN) and minimally invasive plate osteosynthesis (MIPO). 42 patients included in this study, 21 underwent IMLN and 21 were treated with MIPO who met the inclusion criteria and operated between June 2014 and May 2015. Patients were followed up for clinical and radiological evaluation. In IMLN group, average union time was 18.26 weeks compared to 21.70 weeks in plating group which was significant ( P ankle stiffness, and infection, were seen in interlocking group as compared to plating group. Average functional outcome according to American Orthopedic Foot and Ankle Society score was measured which came out to be 96.67. IMLN group was associated with lesser duration of surgery, earlier weight bearing and union rate, lesser incidence of infection and implant irritation which makes it a preferable choice for fixation of extra-articular distal tibial fractures. However, larger randomized controlled trials are required for confirming the results.

  5. Minimal invasive surgery for patients with urolithiasis with early postoperative rehabilitation in Truskavets

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    I. Derkach

    2017-07-01

    Full Text Available Introduction. Undoubtedly, technological progress, the "conquest" of civilization leads to a deterioration of the environmental situation. It affects the human body, causing a violation of homeostasis, due to disorders in it. The purpose of the work. In view of the above, the task was to study the peculiarities of the process of the use of minimally invasive techniques in patients with urolithiasis treated in the period from 2012 to 2017 in the urological department of the Truskavets City Hospital and in the private office of lithotripsy Ya.V. Feciak in the complex with the use of medical water "Naftusya" during treatment and in the early postoperative period as a means of metaphysics of recurrent stone formation and quicker rehabilitation of patients. Materials and methods of research. The treatment of 1757 patients with urolithiasis in the urological department of Truskavets city hospital and the private office of lithotripsy Ya.V. Fetsiak for the period of 2012 - 2017. The study included 681 patients with kidney stones, 1045 patients - with ureteric stones and 31 patients with urinary bladder specimens. 357 contact nephrolithotripsy, 491 contact ureterolithotripsy (CULT, 27 contact cystolithotripsy and 2074 extracorporeal shock-wave lithotripsy (ESWL sessions were performed for these patients. Men were 946 (54%, women 811 (46%. The age of the patients ranged from 18 to 84 years. The size of the concretions localized in the ureter ranged from 0.6 cm to 3.4 cm and, as a rule, was 0.9-1.2 cm. The maximum size of the kidney stone was 9.5 cm, and the average size varied within 1 , 4-27cm. ESWL was performed on the Dornier Compact S machine. In the 882 patients, 2074 procedures were carried out for the ESWL, which was 2.35 procedures per patient. In the planned period, 71% of patients, 29% in urgent (at the height of the renal colic or within the next 30 hours were treated. Results In the contingent of patients treated with ESWL, medical water

  6. [MINIMALLY INVASIVE TREATMENT OF POSTERIOR CRUCIATE LIGAMENT AVULSION FRACTURE IN A FLOPPY LATERAL POSITION].

    Science.gov (United States)

    Zhao, Junchao; Wang, Hao

    2016-09-08

    advantages of minimal invasion and safe approach, short operative time, and early postoperative rehabilitation exercises, so it can provide satisfactory function recovery of the knee joint.

  7. A minimally invasive multiple marker approach allows highly efficient detection of meningioma tumors

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    Meese Eckart

    2006-12-01

    Full Text Available Abstract Background The development of effective frameworks that permit an accurate diagnosis of tumors, especially in their early stages, remains a grand challenge in the field of bioinformatics. Our approach uses statistical learning techniques applied to multiple antigen tumor antigen markers utilizing the immune system as a very sensitive marker of molecular pathological processes. For validation purposes we choose the intracranial meningioma tumors as model system since they occur very frequently, are mostly benign, and are genetically stable. Results A total of 183 blood samples from 93 meningioma patients (WHO stages I-III and 90 healthy controls were screened for seroreactivity with a set of 57 meningioma-associated antigens. We tested several established statistical learning methods on the resulting reactivity patterns using 10-fold cross validation. The best performance was achieved by Naïve Bayes Classifiers. With this classification method, our framework, called Minimally Invasive Multiple Marker (MIMM approach, yielded a specificity of 96.2%, a sensitivity of 84.5%, and an accuracy of 90.3%, the respective area under the ROC curve was 0.957. Detailed analysis revealed that prediction performs particularly well on low-grade (WHO I tumors, consistent with our goal of early stage tumor detection. For these tumors the best classification result with a specificity of 97.5%, a sensitivity of 91.3%, an accuracy of 95.6%, and an area under the ROC curve of 0.971 was achieved using a set of 12 antigen markers only. This antigen set was detected by a subset selection method based on Mutual Information. Remarkably, our study proves that the inclusion of non-specific antigens, detected not only in tumor but also in normal sera, increases the performance significantly, since non-specific antigens contribute additional diagnostic information. Conclusion Our approach offers the possibility to screen members of risk groups as a matter of routine

  8. Early Clinical and Radiographic Results of Minimally Invasive Anterior Approach Hip Arthroplasty

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    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.

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

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    Rapp, Steven M; Miller, Larry E; Block, Jon E

    2011-01-01

    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.

  10. Desmoplastic fibroma of the distal tibia: A case report of a minimally invasive histological diagnosis

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    Levrini, Gabriele; Pattacini, Pierpaolo

    2016-01-01

    Desmoplastic fibroma (DF) is a benign, rare fibroblastic intraosseous neoplasm histologically resembling a desmoid soft tissue tumor. Although classified as benign, DF frequently exhibits an aggressive behavior, has a moderate-to-high recurrence rate, and often causes pathological fractures and extensive bone destruction. This case report presents an incidentally detected DF of the tibia, which was diagnosed using a minimally invasive approach. A 36-year-old African female patient was referred to the Department of Diagnostic Imaging of Arcispedale Santa Maria Nuova-IRCCS (Reggio Emilia, Italy), to be examined by a computed tomography scan on an outpatient basis, after an x-ray examination of the tibia, which was performed after an injury to exclude the presence of a fracture, revealed a hyperlucency of unknown origin. The aim of this study was to discuss the clinical, histological, immunohistochemical and radiographic characteristics of this rare neoplasm, with a focus on image-guided bone biopsy. PMID:27882239

  11. Chronic Morel-Lavallée Lesion: A Novel Minimally Invasive Method of Treatment.

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    Mettu, Ramireddy; Surath, Harsha Vardhan; Chayam, Hanumantha Rao; Surath, Amaranth

    2016-11-01

    A Morel-Lavallée lesion is a closed internal degloving injury resulting from a shearing force applied to the skin. The etiology of this condition may be motor vehicle accidents, falls, contact sports (ie, football, wrestling),1 and iatrogenic after mammoplasty or abdominal liposuction.2 Common sites of the lesions include the pelvis and/or thigh.3 Isolated Morel-Lavallée lesions without underlying fracture are likely to be missed, which result in chronicity. Management of this condition often requires extensive surgical procedures such as debridement, sclerotherapy, serial percutaneous drainage, negative pressure wound therapy (NPWT), and skin grafting.4,5 The authors wish to highlight a minimally invasive technique for the treatment of chronic Morel-Lavallée lesions.

  12. Efficacy of the Stonehenge Technique for Minimally Invasive Aortic Valve Replacement via Right Infraaxillary Thoracotomy.