Sample records for invasive surgery underestimated

  1. Zinc deficiency: a frequent and underestimated complication after bariatric surgery. (United States)

    Sallé, Agnès; Demarsy, Delphine; Poirier, Anne Lise; Lelièvre, Bénédicte; Topart, Philippe; Guilloteau, Gérard; Bécouarn, Guillaume; Rohmer, Vincent


    Although zinc deficiency is common after bariatric surgery, its incidence is underestimated. The objective was to monitor zinc and nutritional status before and 6, 12 and 24 months (M6, M12 and M24) after gastric bypass (Roux-en-Y gastric bypass), sleeve gastrectomy and biliopancreatic diversion with duodenal switch (DS) in patients receiving systematised nutritional care. Data for 324 morbidly obese patients (mean body mass index 46.2 ± 7.3 kg/m(2)) were reviewed retrospectively. The follow-up period was 6 months for 272 patients, 12 months for 175, and 24 months for 70. Anthropometric, dietary and serum albumin, prealbumin, zinc, iron and transferrin saturation measures were determined at each timepoint. Nine percent of patients had zinc deficiency pre-operatively. Zinc deficiency was present in 42.5% of the population at M12 and then remained stable. Zinc deficiency was significantly more frequent after DS, with a prevalence of 91.7% at M12. Between M0 and M6, variation in plasma prealbumin, surgery type and zinc supplementation explained 27.2% of the variance in plasma zinc concentration. Surgery type explained 22.1% of this variance between M0 and M24. Mean supplemental zinc intake was low (22 mg/day). The percentage of patients taking zinc supplementation at M6, M12 and M24 was 8.9%, 20.6% and 29%, respectively. Reduced protein intake, impaired zinc absorption and worsening compensatory mechanisms contribute to zinc deficiency. The mechanisms involved differ according to the type of surgery and time since surgery. Zinc supplementation is necessary early after bariatric surgery, but this requirement is often underestimated or is inadequate.

  2. Minimally Invasive Abdominal Surgery


    Richardson, William S.; Carter, Kristine M.; Fuhrman, George M.; Bolton, John S.; Bowen, John C.


    In the last decade, laparoscopy has been the most innovative surgical movement in general surgery. Minimally invasive surgery performed through a few small incisions, laparoscopy is the standard of care for the treatment of gallbladder disease and the gold standard for the treatment of reflux disease. The indications for a laparoscopic approach to abdominal disease continue to increase, and many diseases may be treated with laparoscopic techniques. At Ochsner, laparoscopic techniques have dem...

  3. Surgeons underestimate their influence on medical students entering surgery.

    NARCIS (Netherlands)

    Quillin 3rd, R.C.; Pritts, T.A.; Davis, B.R.; Hanseman, D.; Collins, J.M.; Athota, K.P.; Edwards, M.J.R.; Tevar, A.D.


    BACKGROUND: Positive surgical role models influence medical students to pursue a career in surgery. However, the perception by role models of their own effectiveness has yet to be examined. In this study, we evaluated the influence of surgical role models on medical student career choice, and how

  4. Robotic assisted minimally invasive surgery

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    Palep Jaydeep


    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.

  5. Aortic valve surgery - minimally invasive (United States)

    ... valve surgery. Techniques include min-thoracotomy, min-sternotomy, robot-assisted surgery, and percutaneous surgery. To perform the ... M. is also a founding member of Hi-Ethics and subscribes to the principles of the Health ...

  6. Surgeons often underestimate the amount of blood loss in replacement surgeries

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    Ram Ganesan Ganesan


    Full Text Available 【Abstract】Objective:To assess the accuracy of the clinically estimated blood loss (EBL when compared with the actual blood loss (ABL in replacement surgeries. Methods: This prospective study was done in Sri Ramachandra Medical Centre from April 2011 to April 2013. Altogether 140 patients undergoing total hip replacement or total knee replacement were included with the inclusion criteria being patients with haemoglobin higher than 100 g/ml and coagulation profile within normal limits. Exclusion criteria were intake of antiplatelet drug or anti-coagulant, bleeding disorders, thrombotic episode, and haematological disorders. There were 65 men and 75 women. In this study, the consultants were free to use any clinical method to estimate the blood loss, including counting the blood-soaked mops and gauze pieces (estimating the volume of blood carried in all the mops and gauzes, measuring blood lost to suction bottles and blood in and around the operative field. The ABL was calculated based on a modification of the Gross’s formula using haematocrit values. Results: In 42 of the 140 cases, the EBL exceeded the ABL. These cases had a negative difference in blood loss (or DIFF-BL<0 and were included in the overestimation group, which accounted for 30% of the study population. Of the remaining 98 cases (70%, the ABL exceeded the EBL. Therefore they were put into the underestimation group who had a positive difference in blood loss (DIFF-BL>0. We found that when the average blood loss was small, the accuracy of estimation was high. But when the average blood loss exceeded 500 ml, the accuracy rate decreased significantly. This suggested that clinical estimation is inaccurate with the increase of blood loss. Conclusion:This study has shown that using clinical estimation alone to guide blood transfusion is inadequate. In this study, 70% of patients had their blood loss underestimated, proving that surgeons often underestimate blood loss in replacement

  7. Development and evaluation of a prediction model for underestimated invasive breast cancer in women with ductal carcinoma in situ at stereotactic large core needle biopsy.

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    Suzanne C E Diepstraten

    Full Text Available BACKGROUND: We aimed to develop a multivariable model for prediction of underestimated invasiveness in women with ductal carcinoma in situ at stereotactic large core needle biopsy, that can be used to select patients for sentinel node biopsy at primary surgery. METHODS: From the literature, we selected potential preoperative predictors of underestimated invasive breast cancer. Data of patients with nonpalpable breast lesions who were diagnosed with ductal carcinoma in situ at stereotactic large core needle biopsy, drawn from the prospective COBRA (Core Biopsy after RAdiological localization and COBRA2000 cohort studies, were used to fit the multivariable model and assess its overall performance, discrimination, and calibration. RESULTS: 348 women with large core needle biopsy-proven ductal carcinoma in situ were available for analysis. In 100 (28.7% patients invasive carcinoma was found at subsequent surgery. Nine predictors were included in the model. In the multivariable analysis, the predictors with the strongest association were lesion size (OR 1.12 per cm, 95% CI 0.98-1.28, number of cores retrieved at biopsy (OR per core 0.87, 95% CI 0.75-1.01, presence of lobular cancerization (OR 5.29, 95% CI 1.25-26.77, and microinvasion (OR 3.75, 95% CI 1.42-9.87. The overall performance of the multivariable model was poor with an explained variation of 9% (Nagelkerke's R(2, mediocre discrimination with area under the receiver operating characteristic curve of 0.66 (95% confidence interval 0.58-0.73, and fairly good calibration. CONCLUSION: The evaluation of our multivariable prediction model in a large, clinically representative study population proves that routine clinical and pathological variables are not suitable to select patients with large core needle biopsy-proven ductal carcinoma in situ for sentinel node biopsy during primary surgery.

  8. "Open" minimally invasive surgery in pediatric urology. (United States)

    Hidalgo-Tamola, Josephine; Shnorhavorian, Margarett; Koyle, Martin A


    Minimally invasive surgery (MIS) offers alternative operative approaches to standard open surgical techniques. However, MIS has been defined primarily as substituting laparoendoscopic alternatives for the traditional open surgical approach. The concept of MIS methodology may also be applied to open surgery in an effort to decrease incision size, potentially reduce morbidity and enhance convalescence, without compromising 'gold standard' outcomes. Pediatric urological applications of open MIS include pediatric renal surgery, ureteral reimplantation, ureteral surgery, inguinal-scrotal and genital surgery. A thorough review of the pediatric urology literature was performed and studies were identified describing open MIS, including outcomes and complications.

  9. [Minimally invasive operations in vascular surgery]. (United States)

    Stádler, Petr; Sedivý, Petr; Dvorácek, Libor; Slais, Marek; Vitásek, Petr; El Samman, Khaled; Matous, Pavel


    Minimally invasive surgery provides an attractive alternative compared with conventional surgical approaches and is popular with patients, particularly because of its favourable cosmetic results. Vascular surgery has taken its inspiration from general surgery and, over the past few years, has also been reducing the invasiveness of its operating methods. In addition to traditional laparoscopic techniques, we most frequently encounter the endovascular treatment of aneurysms of the thoracic and abdominal aorta and, most recently, robot-assisted surgery in the area of the abdominal aorta and pelvic arteries. Minimally invasive surgical interventions also have other advantages, including less operative trauma, a reduction in post-operative pain, shorter periods spent in the intensive care unit and overall hospitalization times, an earlier return to normal life and, finally, a reduction in total treatment costs.

  10. Minimally invasive surgery for Achilles tendon pathologies

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    Nicola Maffulli


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

  11. Minimally Invasive Surgery in Thymic Malignances

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    Wentao FANG


    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.

  12. Mitral valve surgery - minimally invasive (United States)

    ... for when you get home from the hospital. Shower and wash your hair the day before surgery. You may need to wash your body below your neck with a special soap. Scrub your chest 2 or 3 times with this soap. You also may be asked ...

  13. Minimal Invasive Urologic Surgery and Postoperative Ileus

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    Fouad Aoun


    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.

  14. Minimally invasive surgery of the knee. (United States)

    Schindler, Oliver S


    Minimally invasive knee replacement surgery has been developed in an attempt to lessen the impact of operations on the patient's quality of life, in the same way as arthroscopy, the forefather of minimally invasive surgery (MIS), revolutionised cartilage and ligament surgery three decades earlier. The technique is based on minimising soft tissue and muscle trauma, skin incision length, and capsular disruption while trying to maintain the ultimate goal of a well-aligned, well-fixed knee replacement. Short-term advantages including accelerated recovery and reduction in blood loss have been demonstrated, but it remains to be investigated whether MIS is able to provide sustainable benefits and long-term outcome equivalent to conventional surgery. Successful application of MIS techniques have been confirmed in conjunction with unicompartmental knee arthroplasty (UKR) implantation, while its use with total knee arthroplasty remains experimental. Critics have expressed concern that reduced visibility may compromise implant positioning and leg alignment which could have a negative effect on prosthetic long-term survival. MIS clearly represents a unique and more technically demanding procedure, but the learning curve may perhaps overshadow the benefits. Computer navigation may help to avoid such problems but so far scientific evidence regarding definitive outcomes is lacking, and some of the MIS techniques are still in the early phases of development.

  15. Minimally invasive surgery for stomach cancer. (United States)

    Nunobe, Souya; Kumagai, Koshi; Ida, Satoshi; Ohashi, Manabu; Hiki, Naoki


    Laparoscopic surgery for gastric cancer has become extremely widespread in recent years especially in Asian countries due to its low invasiveness. As to evidence of indication for laparoscopic surgery for gastric cancer, laparoscopic surgery for gastric cancer often appears to be indicated for early gastric cancer at many institutions, while evidence was considered to be insufficient to recommend laparoscopic surgery for gastric cancer at Stage II and above. There are also problems with indications for cases other than tumour factors. No meta-analyses and prospective studies have been reported, but outcomes of laparoscopic surgery for gastric cancer in gastric cancer patients with co-morbid and/or existing diseases have been reported in retrospective studies. Indications in the elderly appear to be favourable in terms of post-operative ambulation considering factors such as the degree of dissection in accordance with the status of the patient. Meta-analyses, randomized controlled trials and several retrospective studies have compared the short-term usefulness of laparoscopic surgery for gastric cancer with that of conventional gastrectomy. The superiority of laparoscopic surgery for gastric cancer has been reported in terms of the reduced amount of bleeding, a reduction in the administration frequency and period of analgesic doses, a reduction in the duration of fever, early recovery of intestinal movement and early return to oral intake. A small-scale randomized controlled trial and several retrospective studies have demonstrated no significant differences in survival rate, recurrence rate and type of recurrence between laparoscopic surgery for gastric cancer and conventional gastrectomy. The results of the aforementioned trials in early gastric cancer in Japan and Korea for which enrolment is complete remain to be published. © The Author 2016. Published by Oxford University Press. All rights reserved. For Permissions, please email:

  16. The evolution of minimally invasive bariatric surgery. (United States)

    Batchelder, Andrew J; Williams, Robert; Sutton, Christopher; Khanna, Achal


    Obesity is a pandemic associated with significant morbidity and mortality. This historical article charts the progress of successful strategies that have been used to tackle weight loss from dietary modifications to the development of surgical interventions that have subsequently evolved. It also provides a précis of the reported outcome data following minimally invasive bariatric procedures. A literature review was performed. All articles relevant to the progression of bariatric surgery and minimally invasive surgery were assessed, as were those articles that described the ultimate evolution, combination, and establishment of the two techniques. This article charts the progression of early weight loss strategies, from early dietary modifications and pharmacologic interventions to initial techniques in small bowel bypass procedures, banding techniques, and sleeve gastrectomies. It also describes the simultaneous developments of endoscopic interventions and laparoscopic procedures. A range of procedures are described, which differ in their success in terms of loss of excess weight and in their complication rates. Weight loss is greatest for biliopancreatic diversion followed by gastric bypass and sleeve gastrectomy and least for adjustable gastric banding. Bariatric surgery is an evolving field, which will continue to expand given current epidemiologic trends. Developments in instrumentation and surgical techniques, including single access and natural orifice approaches, may offer further benefit in terms of patient acceptability. Copyright © 2013 Elsevier Inc. All rights reserved.

  17. A multidisciplinary evidence-based guideline for minimally invasive surgery.


    la Chapelle, Claire F.; Bemelman, Willem A.; Rademaker, Bart M. P.; van Barneveld, Teus A.; Jansen, Frank Willem


    The Dutch Society for Endoscopic Surgery together with the Dutch Society of Obstetrics and Gynecology initiated a multidisciplinary working group to develop a guideline on minimally invasive surgery to formulate multidisciplinary agreements for minimally invasive surgery aiming towards better patient care and safety. The guideline development group consisted of general surgeons, gynecologists, an anesthesiologist, and urologist authorized by their scientific professional association. Two advi...

  18. Surgeons' musculoskeletal pain in minimally invasive surgery

    DEFF Research Database (Denmark)

    Dalager, Tina; Søgaard, Karen; Bech, 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......Background: A large proportion of surgeons performing minimally invasive surgery (MIS) experience musculoskeletal pain in the upper body possibly due to awkward and long-term static positions. This can be detrimental for workability and health. The objective of the present review is to sum up...

  19. Venous thromboembolic events in minimally invasive gynecologic surgery (United States)

    Ramirez, Pedro T.; Nick, Alpa M.; Frumovitz, Michael; Schmeler, Kathleen M.


    The rate of venous thromboembolic events (VTE) including deep venous thrombosis (DVT) and pulmonary embolism (PE) among women undergoing gynecologic surgery is high, particularly for women with a gynecologic malignancy. Current guidelines recommend VTE thrombopropylaxis in the immediate postoperative period for patients undergoing open surgery. However, the VTE prophylaxis recommendations for women undergoing minimally invasive gynecologic surgery are not as well established. The risk of VTE in patients undergoing minimally invasive surgery appears to be low based on retrospective analyses. To date, there are no established guidelines that specifically provide a standard of care for patients undergoing minimally invasive gynecologic surgery for benign or malignant disease. PMID:23850360

  20. Minimally invasive cardiac surgery and transesophageal echocardiography

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    Ajay Kumar Jha


    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.

  1. Minimally invasive cardiac surgery and transesophageal echocardiography. (United States)

    Jha, Ajay Kumar; Malik, Vishwas; Hote, Milind


    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.

  2. Minimally Invasive Surgery for Complicated Diverticulitis. (United States)

    Mahmoud, Najjia N; Riddle, Elijah W


    Recent guidelines recommend an individualized approach to recurrent uncomplicated diverticulitis, reflecting research showing that non-operative treatment is safe. Thus, the majority of operations for diverticulitis in the future may be for complicated indications. A laparoscopic approach may be used for both acute and chronic complicated diverticulitis in appropriate patients, as described in the American and European guidelines. However, a safe approach to minimally invasive surgery requires recognition when conditions deteriorate or are not suited to laparoscopy as well as knowledge of a variety of technical maneuvers that elucidate difficult anatomy and facilitate resection. Primary anastomosis with or without diversion can be performed safely, and ileostomy reversal is significantly less morbid than Hartmann's (colostomy) reversal. Success in laparoscopy can be achieved with the use of adjunct techniques and technologies, including ureteral stents, hand ports, and hybrid approaches. When completed successfully, a laparoscopic approach has been shown to confer decreased ileus, length of stay, post-operative pain, surgical site infection, and ventral hernia compared to an open approach.

  3. The Technological Development of Minimally Invasive Spine Surgery (United States)

    Snyder, Laura A.; O'Toole, John; Eichholz, Kurt M.; Perez-Cruet, Mick J.; Fessler, Richard


    Minimally invasive spine surgery has its roots in the mid-twentieth century with a few surgeons and a few techniques, but it has now developed into a large field of progressive spinal surgery. A wide range of techniques are now called “minimally invasive,” and case reports are submitted constantly with new “minimally invasive” approaches to spinal pathology. As minimally invasive spine surgery has become more mainstream over the past ten years, in this paper we discuss its history and development. PMID:24967347

  4. Manual Control for Medical Instruments in Minimally Invasive Surgery

    NARCIS (Netherlands)

    Fan, C.


    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

  5. Early outcome of minimally invasive mitral valve surgery

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    Shawky Fareed


    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.

  6. Heart bypass surgery - minimally invasive - discharge (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 ...

  7. The Development of Augmented Reality to Enhance Minimally Invasive Surgery. (United States)

    Dodd, Keith; Brooks, Nathaniel P


    Minimally invasive surgery (MIS) reduces unnecessary tissue damage to the patient but obscures the natural surgical interface that is provided by open surgical procedures. Multiple feedback mechanisms, mainly visual and tactile, are greatly reduced in MIS. Microscopes, endoscopes, and image-guided navigation traditionally provide enough visual information for successful minimally invasive procedures, although the limited feedback makes these procedures more difficult to learn. Research has been performed to develop alternative solutions that regain additional feedback. Augmented reality (AR), a more recent guidance innovation that overlays digital visual data physically, has begun to be implemented in various applications to improve the safety and efficacy of minimally invasive procedures. This review focuses on the recent implementation of augmented display and direct visual overlay and discusses how these innovations address common feedback concerns associated with minimally invasive surgeries.

  8. Minimal invasive gastric surgery: A systematic review

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    Kirti Bushan


    Full Text Available Background: As an alternate to open surgery, laparoscopic gastrectomy (LG is currently being performed in many centers, and has gained a wide clinical acceptance. The aim of this review article is to compare oncologic adequacy and safety of LG with open surgery for gastric adenocarcinomas with respect to lymphadenectomy, short-term outcomes (postoperative morbidity and mortality and long-term outcome (5 years overall survival and disease-free survival. Materials and Methods: PubMed was searched using query “LG” for literature published in English from January 2000 to April 2014. A total of 875 entries were retrieved. These articles were screened and 59 manuscripts ultimately formed the basis of current review. Results: There is high-quality evidence to support short-term efficacy, safety and feasibility of LG for gastric adenocarcinomas, although accounts on long-term survivals are still infrequent.

  9. Risk factors in patient safety : Minimally invasive surgery versus conventional surgery

    NARCIS (Netherlands)

    Rodrigues, S.P.; Wever, A.M.; Denkelman, J.; Jansen, F.W.


    Background This study aimed to identify the frequency of events in the different patient safety risk domains during minimally invasive surgery (MIS) and conventional surgery (CS). Methods A convenience sample of gynecologic MIS and CS was observed. Events were observed and categorized into one of

  10. Cost Differences Between Open and Minimally Invasive Surgery. (United States)

    Fitch, Kathryn; Engel, Tyler; Bochner, Andrew


    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.

  11. Epilepsy surgery in children and non-invasive evaluation

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    Hashizume, Kiyotaka; Sawamura, Atsushi; Yoshida, Katsunari; Tsuda, Hiroshige; Tanaka, Tatsuya [Asahikawa Medical Coll., Hokkaido (Japan); Tanaka, Shigeya


    The technique of EEG recording using subdural and depth electrodes has became established, and such invasive EEG is available for epilepsy surgery. However, a non-invasive procedure is required for evaluation of surgical indication for epilepsy patients, particular for children. We analyzed the relationship between the results of presurgical evaluation and seizure outcome, and investigated the role of invasive EEG in epilepsy surgery for children. Over the past decade, 22 children under 16 years of age have been admitted to our hospital for evaluation of surgical indication. High-resolution MR imaging, MR spectroscopy, video-EEG monitoring, and ictal and interictal SPECT were used for presurgical evaluation. Organic lesions were found on MR images from 19 patients. Invasive EEG was recorded in only one patient with occipital epilepsy, who had no lesion. Surgical indication was determined in 17 children, and 6 temporal lobe and 11 extratemporal lobe resections were performed under intraoperative electrocorticogram monitoring. The surgical outcome was excellent in 14 patients who had Engel's class I or II. Surgical complications occurred in two children who had visual field defects. The results showed that a good surgical outcome could be obtained using an intraoperative electrocorticogram, without presurgical invasive EEG, for localization-related epilepsy in children. The role of invasive EEG should be reevaluated in such children. (author)

  12. Prevailing Trends in Haptic Feedback Simulation for Minimally Invasive Surgery. (United States)

    Pinzon, David; Byrns, Simon; Zheng, Bin


    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.

  13. The estimation of the thyroid volume before surgery--an important prerequisite for minimally invasive thyroidectomy. (United States)

    Ruggieri, M; Fumarola, A; Straniero, A; Maiuolo, A; Coletta, I; Veltri, A; Di Fiore, A; Trimboli, P; Gargiulo, P; Genderini, M; D'Armiento, M


    Actually, thyroid volume >25 ml, obtained by preoperative ultrasound evaluation, is a very important exclusion criteria for minimally invasive thyroidectomy. So far, among different imaging techniques, two-dimensional ultrasonography has become the more accepted method for the assessment of thyroid volume (US-TV). The aims of this study were: (1) to estimate the preoperative thyroid volume in patients undergoing minimally invasive total thyroidectomy using a mathematical formula and (2) to verify its validity by comparing it with the postsurgical TV (PS-TV). In 53 patients who underwent minimally invasive total thyroidectomy (from January 2003 to December 2007), US-TV, obtained by ellipsoid volume formula, was compared to PS-TV determined by the Archimedes' principle. A mathematical formula able to predict the TV from the US-TV was applied in 34 cases in the last 2 years. Mean US-TV (14.4 +/- 5.9 ml) was significantly lower than mean PS-TV (21.7 +/- 10.3 ml). This underestimation was related to gland multinodularity and/or nodular involvement of the isthmus. A mathematical formula to reduce US-TV underestimation and predict the real TV was developed using a linear model. Mean predicted TV (16.8 +/- 3.7 ml) perfectly matched mean PS-TV, underestimating PS-TV in 19% of cases. We verified the accuracy of this mathematical model in patients' eligibility for minimally invasive total thyroidectomy, and we demonstrated that a predicted TV <25 ml was confirmed post-surgery in 94% of cases. We demonstrated that using a linear model, it is possible to predict from US the PS-TV with high accuracy. In fact, the mean predicted TV perfectly matched the mean PS-TV in all cases. In particular, the percentage of cases in which the predicted TV perfectly matched the PS-TV increases from 23%, estimated by US, to 43%. Moreover, the percentage of TV underestimation was reduced from 77% to 19%, as well as the range of the disagreement from up to 200% to 80%. This study shows that two

  14. Danish surgeons' views on minimally invasive surgery

    DEFF Research Database (Denmark)

    Edwards, Hellen; Jørgensen, Lars Nannestad


    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...... important factors taken into consideration were the risk of complication and short convalescence, whereas the least important factors were cosmesis and option of local anaesthesia. If the surgeons themselves were to undergo cholecystectomy, 35.5% would choose SILS, and 14.5% would choose NOTES provided...... become standard techniques for cholecystectomy within 6 years. CONCLUSIONS: The importance of risk of complications has not surprisingly a high priority among surgeons in this questionnaire. Why this is has to be investigated further before implementing SILS and NOTES as standard of care....

  15. The Top 50 Articles on Minimally Invasive Spine Surgery. (United States)

    Virk, Sohrab S; Yu, Elizabeth


    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.

  16. Laparoscopic and mini-invasive surgery. (United States)

    Pugliese, Raffaele; Maggioni, Dario; Costanzi, Andrea; Ferrari, Giovanni; Gualtierotti, Monica


    JGCA Gastric Cancer Treatment Guidelines (2004) include Laparoscopic Assisted Distal Gastrectomy (LADG) within the chapter of modified surgery. A metanalysis published in 2010 shows that LADG is significantly superior to Open Distal Gastrectomy (ODG) if comparing short term outcomes. Oncologic results prove to be comparable to ODG by one RCT and 2 retrospective studies. Little evidence is available on Laparoscopic Total Gastrectomy and concerns are raised about long-term oncologic outcomes. Laparoscopic Subtotal Gastrectomy is carried out with 4 to 5 ports in the periumbilical region (Hasson trocar for laparoscope) and upper quadrants. After exploration of the abdominal cavity surgical steps include coloepiploic detachment, omentectomy, dissection of the gastrocolic ligament, division of the left gastroepiploic vessels, division of right gastroepiploic vessels, division of pyloric vessels. The duodenum is transected with a linear stapler. Incision of the lesser omentum and dissection of the hepatoduodenal ligament allows completion of D2 lymphadenectomy. The 4/5ths of the stomach are transected starting from the greater curve at the junction of left and right gastroepiploic arcades by linear stapler. Roux-en-Y loop reconstruction is performed through a stapled side-to-side gastro-jejunal anastomosis and a side-to-side jejuno-jejunal anastomosis. Reconstruction after Laparoscopic Total Gastrectomy is performed preferably by a side-to-side esophago-jejunal anastomosis according to Orringer. A robotic assisted approach adds precision on lymphadenectomy and reconstructive techniques.

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

    Directory of Open Access Journals (Sweden)

    Fader Amanda


    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.

  18. Minimally invasive heart valve surgery: how and why in 2012. (United States)

    Suri, Rakesh M; Thalji, Nassir M


    Cardiac surgical procedures via traditional sternotomy are safe and effective operations performed by cardiothoracic surgeons worldwide. However, postoperative limitations in upper extremity activity during bone healing are seen as undesirable by some. Percutaneous catheter-based attempts to emulate the outcomes of traditional cardiac surgical procedures have largely fallen short of established standards of efficacy and durability. The field of minimally invasive heart valve surgery thus developed out of a need to offer smaller, better-tolerated incisions to patients while maintaining high-quality clinical outcomes. These operations are safe and effective when performed by proficient surgical teams, allowing patients to resume normal activities more rapidly. We explore current evidence supporting the practice of minimally invasive heart valve surgery in 2012 and analyze the clinical impact of these nascent surgical platforms.

  19. 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.


    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

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


    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.

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

    Directory of Open Access Journals (Sweden)

    Donald A. Ross


    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.

  2. The production of audiovisual teaching tools in minimally invasive surgery. (United States)

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


    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.

  3. [Minimally Invasive Surgery in Pediatric Oncology. Tertiary center experience]. (United States)

    Gómez-Chacón Villalba, J; Rodríguez Caraballo, L; Marco Macián, A; Segarra Llido, V; Vila Carbó, J J


    To describe our experience using Minimally Invasive Surgery (MIS) techniques in tertiary center with specific oncological pediatric surgery unit. Retrospective review of patients undergoing MIS techniques in pediatric oncology surgery unit between January 2011 and December 2014. MIS procedures were considered made by both techniques such as laparoscopy and thoracoscopy with both diagnostic and therapeutic intent. 4 procedures were diagnostic and the rest were therapeutic: During the study, 56 procedures were performed by MIS. By type of technique, 13 were thoracoscopic (7 metastasectomies, 6 thoracic masses) and 43 laparoscopic (3 hepatic masses, 3 pancreatic masses 7 abdominal masses, 2 ovarian masses, 2 typhlitis 1 splenic mass and 25 oophorectomy for ovarian cryopreservation). In 5 cases (2 thoracic masses 1 pancreatic mass abdominal masses) conversion to open surgery to complete the procedure (2 for caution in the absence of vascular control bleeding 1 and 2 for lack of space) was necessary. In all cases safety principles of oncological surgery were respected. Providing an adecuate selection of patiens, MIS techniques are safe, reproducible and fulfill the objectives of quality of cancer surgery.

  4. The Role of Minimally Invasive Techniques in Scoliosis Correction Surgery

    Directory of Open Access Journals (Sweden)

    Michael B. Cloney


    Full Text Available Objective. Recently, minimally invasive surgery (MIS has been included among the treatment modalities for scoliosis. However, literature comparing MIS to open surgery for scoliosis correction is limited. The objective of this study was to compare outcomes for scoliosis correction patients undergoing MIS versus open approach. Methods. We retrospectively collected data on demographics, procedure characteristics, and outcomes for 207 consecutive scoliosis correction surgeries at our institution between 2009 and 2015. Results. MIS patients had lower number of levels fused (p<0.0001, shorter surgeries (p=0.0023, and shorter overall lengths of stay (p<0.0001, were less likely to be admitted to the ICU (p<0.0001, and had shorter ICU stays (p=0.0015. On multivariable regression, number of levels fused predicted selection for MIS procedure (p=0.004, and multiple other variables showed trends toward significance. Age predicted ICU admission and VTE. BMI predicted any VTE, and DVT specifically. Comorbid disease burden predicted readmission, need for transfusion, and ICU admission. Number of levels fused predicted prolonged surgery, need for transfusion, and ICU admission. Conclusions. Patients undergoing MIS correction had shorter surgeries, shorter lengths of stay, and shorter and fewer ICU stays, but there was a significant selection effect. Accounting for other variables, MIS did not independently predict any of the outcomes.

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

    Directory of Open Access Journals (Sweden)

    Chia-Jen Wu


    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.

  6. Past, Present, and Future of Minimally Invasive Abdominal Surgery. (United States)

    Antoniou, Stavros A; Antoniou, George A; Antoniou, Athanasios I; Granderath, Frank-Alexander


    Laparoscopic surgery has generated a revolution in operative medicine during the past few decades. Although strongly criticized during its early years, minimization of surgical trauma and the benefits of minimization to the patient have been brought to our attention through the efforts and vision of a few pioneers in the recent history of medicine. The German gynecologist Kurt Semm (1927-2003) transformed the use of laparoscopy for diagnostic purposes into a modern therapeutic surgical concept, having performed the first laparoscopic appendectomy, inspiring Erich Mühe and many other surgeons around the world to perform a wide spectrum of procedures by minimally invasive means. Laparoscopic cholecystectomy soon became the gold standard, and various laparoscopic procedures are now preferred over open approaches, in the light of emerging evidence that demonstrates less operative stress, reduced pain, and shorter convalescence. Natural orifice transluminal endoscopic surgery (NOTES) and single-incision laparoscopic surgery (SILS) may be considered further steps toward minimization of surgical trauma, although these methods have not yet been standardized. Laparoscopic surgery with the use of a robotic platform constitutes a promising field of investigation. New technologies are to be considered under the prism of the history of surgery; they seem to be a step toward further minimization of surgical trauma, but not definite therapeutic modalities. Patient safety and medical ethics must be the cornerstone of future investigation and implementation of new techniques.

  7. Vacuum grasping as a manipulation technique for minimally invasive surgery (United States)

    Goossens, R. H. M.; van Eijk, D. J.; de Hingh, I. H. J. T.; Jakimowicz, J. J.


    Background Laparoscopic surgery requires specially designed instruments. Bowel tissue damage is considered one of the most serious forms of lesion, specifically perforation of the bowel. Methods An experimental setting was used to manipulate healthy pig bowel tissue via two vacuum instruments. During the experiments, two simple manipulations were performed for both prototypes by two experienced surgeons. Each manipulation was repeated 20 times for each prototype at a vacuum level of 60 kPa and 20 times for each prototype at a vacuum level of 20 kPa. All the manipulations were macroscopically assessed by two experienced surgeons in terms of damage to the bowel. Results In 160 observations, 63 ecchymoses were observed. All 63 ecchymoses were classified as not relevant and negligible. No serosa or seromuscular damages and no perforations were observed. Conclusion Vacuum instruments such as the tested prototypes have the potential to be used as grasper instruments in minimally invasive surgery. PMID:20195640

  8. A multidisciplinary evidence-based guideline for minimally invasive surgery.: Part 1: entry techniques and the pneumoperitoneum

    NARCIS (Netherlands)

    la Chapelle, Claire F.; Bemelman, Willem A.; Rademaker, Bart M. P.; van Barneveld, Teus A.; Jansen, Frank Willem


    The Dutch Society for Endoscopic Surgery together with the Dutch Society of Obstetrics and Gynecology initiated a multidisciplinary working group to develop a guideline on minimally invasive surgery to formulate multidisciplinary agreements for minimally invasive surgery aiming towards better

  9. Controlled invasive mechanical ventilation strategies in obese patients undergoing surgery. (United States)

    Maia, Lígia de Albuquerque; Silva, Pedro Leme; Pelosi, Paolo; Rocco, Patricia Rieken Macedo


    The obesity prevalence is increasing in surgical population. As the number of obese surgical patients increases, so does the demand for mechanical ventilation. Nevertheless, ventilatory strategies in this population are challenging, since obesity results in pathophysiological changes in respiratory function. Areas covered: We reviewed the impact of obesity on respiratory system and the effects of controlled invasive mechanical ventilation strategies in obese patients undergoing surgery. To date, there is no consensus regarding the optimal invasive mechanical ventilation strategy for obese surgical patients, and no evidence that possible intraoperative beneficial effects on oxygenation and mechanics translate into better postoperative pulmonary function or improved outcomes. Expert commentary: Before determining the ideal intraoperative ventilation strategy, it is important to analyze the pathophysiology and comorbidities of each obese patient. Protective ventilation with low tidal volume, driving pressure, energy, and mechanical power should be employed during surgery; however, further studies are required to clarify the most effective ventilation strategies, such as the optimal positive end-expiratory pressure and whether recruitment maneuvers minimize lung injury. In this context, an ongoing trial of intraoperative ventilation in obese patients (PROBESE) should help determine the mechanical ventilation strategy that best improves clinical outcome in patients with body mass index≥35kg/m 2 .

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

    Directory of Open Access Journals (Sweden)

    Tanito M


    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

  11. [Minimally invasive surgery for Chance fractures: Three case studies]. (United States)

    Blondel, B; Fuentes, S; Rambolarimanana, T; Metellus, P; Dufour, H


    Chance fractures are quite rare injuries that require surgical treatment in cases of spinal instability. Development of percutaneous and minimally invasive procedures can alter the management of such lesions, resulting in fewer related soft tissue lesions and morbidities. We present our experience with three patients who underwent percutaneous posterior osteosynthesis associated with a minimally invasive anterior graft for discal lesion. The first two cases presented fracture through the disc and osteosynthesis was done on a single mobile level. In the third case with a bony Chance fracture, we performed a short-segment fixation one level above and below the fractured vertebra. In all three cases, operative blood loss was minimal and clinical outcomes were favorable, with tolerable postoperative pain. Fusion and consolidation were visible for all the patients without loss of correction or implant failure. Percutaneous osteosynthesis and minimally invasive surgery can be an advantageous alternative for the management of Chance fractures. They allow early mobilization of the patient with less soft tissue trauma and morbidities associated with open procedures. Copyright 2009 Elsevier Masson SAS. All rights reserved.

  12. Invasive hemodynamic monitoring in the postoperative period of cardiac surgery

    Directory of Open Access Journals (Sweden)

    Desanka Dragosavac


    Full Text Available OBJETIVE: To assess the hemodynamic profile of cardiac surgery patients with circulatory instability in the early postoperative period (POP. METHODS: Over a two-year period, 306 patients underwent cardiac surgery. Thirty had hemodynamic instability in the early POP and were monitored with the Swan-Ganz catheter. The following parameters were evaluated: cardiac index (CI, systemic and pulmonary vascular resistance, pulmonary shunt, central venous pressure (CVP, pulmonary capillary wedge pressure (PCWP, oxygen delivery and consumption, use of vasoactive drugs and of circulatory support. RESULTS: Twenty patients had low cardiac index (CI, and 10 had normal or high CI. Systemic vascular resistance was decreased in 11 patients. There was no correlation between oxygen delivery (DO2 and consumption (VO2, p=0.42, and no correlation between CVP and PCWP, p=0.065. Pulmonary vascular resistance was decreased in 15 patients and the pulmonary shunt was increased in 19. Two patients with CI < 2L/min/m² received circulatory support. CONCLUSION: Patients in the POP of cardiac surgery frequently have a mixed shock due to the systemic inflammatory response syndrome (SIRS. Therefore, invasive hemodynamic monitoring is useful in handling blood volume, choice of vasoactive drugs, and indication for circulatory support.

  13. Percutaneous Iliac Screws for Minimally Invasive Spinal Deformity Surgery

    Directory of Open Access Journals (Sweden)

    Michael Y. Wang


    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.

  14. Minimally invasive glaucoma surgery as primary stand-alone surgery for glaucoma. (United States)

    Kerr, Nathan M; Wang, Jing; Barton, Keith


    Recently, many new devices and procedures have been developed to lower intraocular pressure in a less invasive and purportedly safer manner than traditional glaucoma surgery. These new devices might encourage an earlier transition to surgery and reduce the long-term commitment to topical glaucoma medications with their associated compliance and intolerance issues. Although often seen as an adjunct to cataract surgery, a growing body of evidence suggests that primary minimally invasive glaucoma surgery may be a viable initial treatment option. New studies have shown that primary ab interno trabeculectomy (Trabectome, NeoMedix Inc., Tustin, CA, USA), trabecular micro-bypass stent insertion (iStent and iStent Inject, Glaukos Corporation, Laguna Hills, CA, USA), canalicular scaffolding (Hydrus, Invantis Inc., Irvine CA, USA), the ab interno gel Implant (XEN, Allergan, Dublin, Ireland) or supraciliary stenting (CyPass Micro-Stent, Alcon, Fort Worth, TX, USA) may lower the lowering intraocular pressure and/or topical medication burden in phakic or pseudophakic patients with glaucoma. This effect seems to last at least 12 months but reliable cost-effectiveness and quality of life indicators have not yet been established by investigator-initiated randomized trials of sufficient size and duration. © 2016 Royal Australian and New Zealand College of Ophthalmologists.

  15. A 3-DOF haptic master device for minimally invasive surgery (United States)

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


    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.

  16. [Advantages and disadvantages of minimally invasive surgery in colorectal cancer surgery]. (United States)

    Zheng, Minhua; Ma, Junjun


    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

  17. Minimally Invasive Spine Surgery: Analyzing Internet-based Education Material. (United States)

    Bryant, Jessica; Mohan, Rohith; Koottappillil, Brian; Wong, Kevin; Yi, Paul H


    This is a cross-sectional study. The purpose of this study is to evaluate the content of information available on the Internet regarding minimally invasive spine surgery (MISS). Patients look to the Internet for quick and accessible information on orthopedic procedures to help guide their personal decision making process regarding the care they receive. However, the quality of internet-based orthopedic education material varies significantly with respect to accuracy and readability. The top 50 results were generated from each of 3 search engines (Google, Yahoo!, and Bing) using the search term "minimally invasive spine surgery." Results were categorized by authorship type and evaluated for their description of key factors such as procedural benefits, risks, and techniques. Comparisons between search engines and between authorship types were done using the Freeman-Halton extension for the Fisher exact test. The content of websites certified by Health on the Net Foundation (HONcode) was compared with those not HONcode certified. Of the 150 websites and videos, only 26% were authored by a hospital or university, whereas 50% were by a private physician or clinic. Most resources presented some benefits of MISS (84%, 126/150), but only 17% presented risks of the procedure (26/150). Almost half of all resources described the technique of MISS, but only 27% had thorough descriptions that included visual representations while 26% failed to describe the procedure. Only 12 results were HONcode certified, and 10 (83%) of these were authored by a medical industry company. Internet-based resources on MISS provide inconsistent content and tend to emphasize benefits of MISS over risks.

  18. 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)


    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

  19. On the Kinematics of Robotic-assisted Minimally Invasive Surgery

    Directory of Open Access Journals (Sweden)

    Pål Johan From


    Full Text Available Minimally invasive surgery is characterized by the insertion of the surgical instruments into the human body through small insertion points called trocars, as opposed to open surgery which requires substantial cutting of skin and tissue to give the surgeon direct access to the operating area. To avoid damage to the skin and tissue, zero lateral velocity at the insertion point is crucial. Entering the human body through trocars in this way thus adds constraints to the robot kinematics and the end-effector velocities cannot be found from the joint velocities using the simple relation given by the standard Jacobian matrix. We therefore derive a new Jacobian matrix which gives the relation between the joint variables and the end-effector velocities and at the same time guarantees that the velocity constraints at the insertion point are always satisfied. We denote this new Jacobian the Remote Center of Motion Jacobian Matrix (RCM Jacobian. The main contribution of this paper is that we address the problem at a kinematic level and that we through the RCM Jacobian can guarantee that the insertion point constraints are satisfied which again allows for the controller to be implemented in the end-effector workspace. By eliminating the kinematic constraints from the control loop we can derive the control law in the end-effector space and we are therefore able to apply Cartesian control schemes such as compliant or hybrid control.

  20. Minimally invasive surgery in the treatment of esophageal cancer

    International Nuclear Information System (INIS)

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


    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)

  1. Effects of Camera Arrangement on Perceptual-Motor Performance in Minimally Invasive Surgery (United States)

    Delucia, Patricia R.; Griswold, John A.


    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…

  2. [Reflection on the Biological Significance of Minimally Invasive Surgery for Lung Cancer]. (United States)

    Luo, Qingquan; Huang, Jia


    Minimal invasive surgery with short operation time and enhanced recovery after surgery can truly achieve biological minimal invasiveness. The minimal invasive lung cancer surgery includes several kinds, such as uni-portal video-assisted thoracoscopic surgery (VATS) and multi-portal VATS. Robotic-assisted thoracic surgery (RATS) can be categorized into multi-portal VATS. As a frontier technology of minimal invasive surgical technique, surgical robotic system has been broadly applied in many areas. The average RATS operation time is (91.51±30.80) min among our team, which is much shorter than reported uni-portal VATS operation time. For now, RATS has some drawbacks and is lacking of national practice guidelines, which, we believe, will be solved by technology development and large-scale randomized controlled trials. 

  3. Teach and Playback Training Device for Minimally Invasive Surgery

    Directory of Open Access Journals (Sweden)

    Sriram Garudeswaran


    Full Text Available Recent technological progress offers the opportunity to significantly transform conventional open surgical procedures in ways that allow minimally invasive surgery (MIS to be accomplished by specific operative instruments’ entry into the body through key-sized holes rather than large incisions. Although MIS offers an opportunity for less trauma and quicker recovery, thereby reducing length of hospital stay and attendant costs, the complex nature of this procedure makes it difficult to master, not least because of the limited work area and constricted degree of freedom. Accordingly, this research seeks to design a Teach and Playback device that can aid surgical training by key-framing and then reproducing surgical motions. The result is an inexpensive and portable Teach and Playback laparoscopic training device that can record a trainer’s surgical motions and then play them back for trainees. Indeed, such a device could provide a training platform for surgical residents generally and would also be susceptible of many other applications for other robot-assisted tasks that might require complex motion training and control.

  4. Soft Robotic Manipulator for Improving Dexterity in Minimally Invasive Surgery. (United States)

    Diodato, Alessandro; Brancadoro, Margherita; De Rossi, Giacomo; Abidi, Haider; Dall'Alba, Diego; Muradore, Riccardo; Ciuti, Gastone; Fiorini, Paolo; Menciassi, Arianna; Cianchetti, Matteo


    Combining the strengths of surgical robotics and minimally invasive surgery (MIS) holds the potential to revolutionize surgical interventions. The MIS advantages for the patients are obvious, but the use of instrumentation suitable for MIS often translates in limiting the surgeon capabilities (eg, reduction of dexterity and maneuverability and demanding navigation around organs). To overcome these shortcomings, the application of soft robotics technologies and approaches can be beneficial. The use of devices based on soft materials is already demonstrating several advantages in all the exploitation areas where dexterity and safe interaction are needed. In this article, the authors demonstrate that soft robotics can be synergistically used with traditional rigid tools to improve the robotic system capabilities and without affecting the usability of the robotic platform. A bioinspired soft manipulator equipped with a miniaturized camera has been integrated with the Endoscopic Camera Manipulator arm of the da Vinci Research Kit both from hardware and software viewpoints. Usability of the integrated system has been evaluated with nonexpert users through a standard protocol to highlight difficulties in controlling the soft manipulator. This is the first time that an endoscopic tool based on soft materials has been integrated into a surgical robot. The soft endoscopic camera can be easily operated through the da Vinci Research Kit master console, thus increasing the workspace and the dexterity, and without limiting intuitive and friendly use.

  5. Design of Micro Robot for Minimally Invasive Surgery

    Directory of Open Access Journals (Sweden)

    Deiva Ganesh A


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

  6. A comparative analysis of minimally invasive and open spine surgery patient education resources. (United States)

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


    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.

  7. Two Invasive Thymomas Incidentally Found during Coronary Artery Bypass Graft Surgery

    Directory of Open Access Journals (Sweden)

    Navid Omidifar


    Full Text Available Thymoma, the most common neoplasm of the anterior mediastinum, is a rare tumor of thymic epithelium that can be locally invasive. We reported 2 cases of invasive thymoma incidentally found during routine coronary artery bypass graft (CABG surgery at Faghihee Hospital of Shiraz University of Medical Sciences of Iran in a period of about 6 months. The 2 patients were male and above 60 years old. They had no clinical symptoms and radiological evidence of mediastinal mass before detection of the tumor during operation. For both patients mass was completely excised and sent to the laboratory. The ultimate pathological diagnosis of both masses was invasive thymoma (stage 2. There are few reports in which thymomas were found incidentally during cardiac surgery. In spite of rare coincidence, due to being asymptomatic and possibly invasive, special attention to thymus gland during cardiac surgery or other mediastinal surgery and preoperative imaging studies seem to be reasonable approach.

  8. Electromyographic monitoring and its anatomical implications in minimally invasive spine surgery. (United States)

    Uribe, Juan S; Vale, Fernando L; Dakwar, Elias


    Literature review. The objective of this article is to examine current intraoperative electromyography (EMG) neurophysiologic monitoring methods and their application in minimally invasive techniques. We will also discuss the recent application of EMG and its anatomic implications to the minimally invasive lateral transpsoas approach to the spine. Minimally invasive techniques require that the same goals of surgery be achieved, with the hope of decreased morbidity to the patient. Unlike standard open procedures, direct visualization of the anatomy is decreased. To increase the safety of minimally invasive spine surgery, neurophysiological monitoring techniques have been developed. Review of the literature was performed using the National Center for Biotechnology Information databases using PUBMED/MEDLINE. All articles in the English language discussing the use of intraoperative EMG monitoring and minimally invasive spine surgery were reviewed. The role of EMG monitoring in special reference to the minimally invasive lateral transpsoas approach is also described. In total, 76 articles were identified that discussed the role of neuromonitoring in spine surgery. The majority of articles on EMG and spine surgery discuss the use of intraoperative neurophysiological monitoring (IOM) for safe and accurate pedicle screw placement. In general, there is a paucity of literature that pertains to intraoperative EMG neuromonitoring and minimally invasive spine surgery. Recently, EMG has been used during minimally invasive lateral transpsoas approach to the lumbar spine for interbody fusion. The addition of EMG to the lateral approach has contributed to decrease the complication rate from 30% to less than 1%. In minimally invasive approaches to the spine, the use of EMG IOM might provide additional safety, such as percutaneous pedicle screw placement, where visualization is limited compared with conventional open procedures. In addition to knowledge of the anatomy and image

  9. Factors Influencing the Adoption of Minimally Invasive Surgery

    African Journals Online (AJOL)

    mean score, 2.61). The ... Absence of enabling functional equipment or device at the time of surgery is the most significant institutional ..... Wound Healing After Hip Replacement Surgery: Effects on Duration of Hospitalization,” Anesth. Analg. 2005 ...

  10. Preoperative and postoperative anesthetic and analgesic techniques for minimally invasive surgery of the spine. (United States)

    Buvanendran, Asokumar; Thillainathan, Vijay


    A review of methods to optimize anesthesia and analgesia for minimally invasive spine procedures. To provide information to surgeons and anesthesiologists of methods to provide optimal anesthesia and pain control for minimally invasive spine surgery with an emphasis on preoperative planning. Postoperative pain management in patients undergoing minimally invasive spine surgery is a challenge for the perioperative anesthesiologist. In addition to the incisional pain, trauma to deeper tissues, such as ligaments, muscles, intervertebral discs, and periosteum are reasons for significant pain. The increasing number of minimally invasive surgeries and the need for improved and rapid return of the patient of functionality have brought the perioperative anesthesiologist and the surgeon closer. We undertook a review of the literature currently available on anesthesia and analgesia for minimally invasive spine surgery with an emphasis on preoperative planning. A large number of reports of randomized controlled clinical trials with respect to perioperative anesthetic and postoperative pain management for minimally invasive spine surgery are reviewed and the applicability of some of the principles and protocols used for other types of minimally invasive surgical procedures are placed in the context of spine surgery. It is important to understand and implement a multimodal analgesic therapy during a patient's preoperative visits. Perioperative multimodal analgesia with a fast-track anesthetic protocol is also important and provided in the manuscript. This protocol poses a challenge to the anesthesiologist with respect to neurophysiologic monitoring, which requires further study. The postoperative analgesic management should be a continuance of the multimodal analgesia provided before surgery. Some drugs are not appropriate for patients undergoing fusion surgery because of their effect on bone healing. An optimal preoperative, perioperative, and postoperative anesthesia and

  11. 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.


    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

  12. 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.


    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

  13. The feasibility of vacuum technique in minimal invasive surgery : Improving the patient safety through instrument design

    NARCIS (Netherlands)

    Vonck, D.


    Grasping in minimal invasive surgery (MIS) is conducted with so called laparoscopic graspers. These graspers are generally derivatives of instruments used in open surgery. The performance of these graspers depends on the technical and medical functionality, the skills and experience of the user, the

  14. Child pectus excavatum: correction by minimally invasive surgery. (United States)

    Felts, E; Jouve, J-L; Blondel, B; Launay, F; Lacroix, F; Bollini, G


    Pectus excavatum (PE) is a congenital deformity essentially responsible for an unattractive aspect, much more rarely for compression problems. The classical treatments consist either in filling the excavation or in open thoracic reconstruction (the Ravitch technique). Alternatively, the treatment described by Nuss raises the sternum with a retrosternal metallic bar placed under thoracoscopic guidance. We present the preliminary results of a series of 25 children operated on using this technique. The minimally invasive procedure described by Nuss is a valid surgical strategy to treat PE. Twenty-five patients were operated on between February 2004 and April 2007 by the same surgeon. Nineteen of these patients presented a purely cosmetic indication. The six other patients were considered to have a more severe form of PE, with cardiorespiratory repercussions. In this group, there were two cases of Marfan syndrome and two patients presenting a history of previous cardiothoracic surgery. The technique has always consisted in placing a retrosternal bar through two lateral incisions. The surgery was always performed with right lung exclusion and was guided by thoracoscopy in 21 cases. In four particularly severe cases, a subxiphoid approach was required, making endoscopic guidance unnecessary. The severity of the lesion was evaluated by the Haller Index. All the patients had regular clinical follow-up (at three weeks, three months, and then every six months); assessment of pain, satisfaction with the cosmetic results, and perceived improvement in respiratory function were the criteria used for this follow-up. The cosmetic result was judged to be positive by 24 patients. One patient was dissatisfied (because of the asymmetrical shape resulting from the use of a single implant). Five patients presented minor complications with no repercussions on the cosmetic or functional result. One case of secondary bar displacement required revision on day 15. Following this revision

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

    Directory of Open Access Journals (Sweden)

    Abbi Hamed


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

  16. Minimally Invasive Surgery for Early-Stage Lung Cancer: From Innovation to Standard of Care. (United States)

    White, Abby; Swanson, Scott J


    The era of minimally invasive surgery for lung cancer follows decades of research; the collection and interpretation of countless qualitative and quantitative data points; and tireless efforts by a few pioneering thoracic surgeons who believed they could deliver a safe and oncologically sound operation with less tissue trauma, an improved physiologic profile, and fewer complications than traditional open surgery. This review highlights those efforts and the role of minimally invasive surgery for early-stage lung cancer in light of evolving technology, the emerging understanding of the biology of early-stage lung cancer, and lung cancer screening.

  17. Minimally invasive hallux valgus surgery: a critical review of the evidence. (United States)

    Trnka, Hans-Joerg; Krenn, Sabine; Schuh, Reinhard


    This systematic review aims to illustrate the published results of "minimally invasive" procedures for correction of hallux valgus. Based on former systematic reviews on that topic, the literature search was organised by two independent investigators. MEDLINE was systematically searched for available studies. The keywords used were "hallux valgus", "bunion", "percutaneous surgery", "minimally invasive surgery", "arthroscopy", "Bosch" and "SERI". Studies were assessed using the level of evidence rating. A total of 21 papers were included in this review. These studies described a total of 1,750 patients with 2,195 instances of percutaneous, minimally invasive or arthroscopic hallux valgus surgery. Clinical reports of results after minimally invasive hallux valgus surgery at meetings are common. Published results in peer-reviewed journals are less common and the majority of papers are level IV studies according to the level of evidence ratings. We found one level II and three level III studies. Reported complications seem to be less than one may see in one's own clinical practice. This possible bias may be related to the fact that most studies are published by centres performing primarily minimally invasive hallux valgus surgery.

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


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


    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. PATIENT...

  19. Non-invasive vascular imaging in perforator flap surgery

    International Nuclear Information System (INIS)

    Saba, Luca; Piga, Mario; Atzeni, Matteo; Ribuffo, Diego; Rozen, Warren Matthew; Alonso-Burgos, Alberto; Bura, Raffaella


    Preoperative imaging using a range of imaging modalities has become increasingly popular for preoperative planning in plastic surgery, in particular in perforator flap surgery. Modalities in this role include ultrasound (US), magnetic resonance angiography (MRA), and computed tomographic angiography (CTA). The evidence for the use of these techniques has been reported in only a handful of studies. In this paper we conducted a non-systematic review of the literature to establish the role for each of these modalities. The role of state-of-the-art vascular imaging as an application in perforator flap surgery is thus offered

  20. Non-invasive vascular imaging in perforator flap surgery

    Energy Technology Data Exchange (ETDEWEB)

    Saba, Luca; Piga, Mario [Dept. of Radiology, Azienda Ospedaliero Univ. (AOU), di Cagliari-Polo di Monserrato, Cagliari (Italy)], e-mail:; Atzeni, Matteo; Ribuffo, Diego [Dept. of Surgery, Section of Plastic Surgery, Azienda Ospedaliero Univ. (AOU), di Cagliari-Polo di Monserrato, Cagliari (Italy); Rozen, Warren Matthew [Jack Brockhov Reconstructive Plastic Surgery Research Unit, Dept. of Anatomy and Cell Biology, The Univ. of Melbourne, Parkville, Victoria (Australia); Alonso-Burgos, Alberto [Dept. of Radiology, Clinica Univ., Univ. de Navarra, Pamplona (Spain); Bura, Raffaella [Dept. of Surgery, Section of Vascular Surgery, Azienda Ospedaliero Univ. (AOU), di Cagliari-Polo di Monserrato, Cagliari (Italy)


    Preoperative imaging using a range of imaging modalities has become increasingly popular for preoperative planning in plastic surgery, in particular in perforator flap surgery. Modalities in this role include ultrasound (US), magnetic resonance angiography (MRA), and computed tomographic angiography (CTA). The evidence for the use of these techniques has been reported in only a handful of studies. In this paper we conducted a non-systematic review of the literature to establish the role for each of these modalities. The role of state-of-the-art vascular imaging as an application in perforator flap surgery is thus offered.



    I. L. Chernikovskiy; V. M. Gelfond; A. S. Zagryadskikh; S. A. Savchuk


    Introduction. The patient’s age is one of the major risk factors of death from colorectal cancer. The role of laparo- scopic radical surgeries in the treatment of colorectal cancer in elderly patients is being studied. The purpose of the study was to evaluate the experience of surgical treatment for elderly patients with colorectal cancer. material and methods. The treatment outcomes of 106 colorectal cancer patients aged 75 years or over, who underwent surgery between 2013 and 2015 were pres...

  2. Incidence of cerebrovascular accidents in patients undergoing minimally invasive valve surgery. (United States)

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


    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.

  3. Twenty years of minimally invasive surgery in the Czech Republic

    Directory of Open Access Journals (Sweden)

    Miloslav Duda


    Full Text Available Aim: To outline the history and evaluate the development and current situation of miniinvasive surgery in the Czech Republic (CR.Material and methods: The authors discuss their experience with the introduction of miniinvasive surgery in CR. Questionnaires used repeatedly in surgical departments in CR provide the data for the evaluation of the development and current status of endoscopic surgery.Results: In the Czech Republic laparoscopic surgery was first performed in 1991, and by 1997 laparoscopic interventions were performed at all surgical departments. The proportion of the laparoscopic approach within overall abdominal surgery increased between 1997 and 2002 from 22% to 37%. The most frequent laparoscopic (L treatment applied today is cholecystectomy (CH, which is a method used at all departments. Nowadays, the proportion of LCH within all cholecystectomies performed is between 71% and 76%. CH is followed by appendectomy (A, which is carried out in 94-97% of surgical departments; the proportion of LA is between 38% and 41%. Laparoscopic herniotomy (H is performed at 85-87% of surgical departments, and its proportion within all herniotomies reached 19%. In 1997-1999 resection of the colon was performed at 9% of surgical departments, in 2004 at 26%, and in 2006 at as many as 58% of surgical departments. Between 2004 and 2006 the proportion of laparoscopic management of resection of colorectal carcinoma increased from 7% to 15%. A smaller number of departments perform highly specialized endoscopic surgery. In 2006 we recorded 365 gastric bandings for the treatment of obesity, 90 resections of the stomach, 139 resections of the liver, 60 splenectomies, and 70 adrenalectomies. Video-assisted thoracoscopic interventions also became routine: in 2006 we recorded 953, in 2007 there were 1214 this procedures performed, and in 2008 the number increased to 1163.Conclusions: The proportion of endoscopic surgery within all forms of surgical management has

  4. 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 ...

  5. Minimally invasive surgery for ovarian cysts in children ...

    African Journals Online (AJOL)

    Background/purposeA transumbilical approach was recently reported for management of several surgical procedures in children. The aim of this study was to evaluate the feasibility and safety of a minimally invasive transumbilical approach against the laparoscopic approach in the management of ovarian cysts in children.

  6. Minimally Invasive Multiport Surgery of the Lateral Skull Base

    Directory of Open Access Journals (Sweden)

    Igor Stenin


    Full Text Available Objective. Minimally invasive procedures minimize iatrogenic tissue damage and lead to a lower complication rate and high patient satisfaction. To date only experimental minimally invasive single-port approaches to the lateral skull base have been attempted. The aim of this study was to verify the feasibility of a minimally invasive multiport approach for advanced manipulation capability and visual control and develop a software tool for preoperative planning. Methods. Anatomical 3D models were extracted from twenty regular temporal bone CT scans. Collision-free trajectories, targeting the internal auditory canal, round window, and petrous apex, were simulated with a specially designed planning software tool. A set of three collision-free trajectories was selected by skull base surgeons concerning the maximization of the distance to critical structures and the angles between the trajectories. Results. A set of three collision-free trajectories could be successfully simulated to the three targets in each temporal bone model without violating critical anatomical structures. Conclusion. A minimally invasive multiport approach to the lateral skull base is feasible. The developed software is the first step for preoperative planning. Further studies will focus on cadaveric and clinical translation.

  7. Cement retrieval in minimally invasive knee surgery: the 90 degrees ball probe. (United States)

    Keene, Gregory C R; Jeer, Parminder J S


    Minimally invasive knee surgery has many potential advantages as well as disadvantages. One such disadvantage in both unicompartmental and total knee arthroplasty is the inability to visualize or retrieve extruded cement. We describe the use of a new instrument, a 90 degrees ball probe, which we have used in more than 300 minimally invasive unicompartmental knee arthroplasty cases. It provides a simple, consistent, and safe method of cement retrieval.

  8. Advances in minimally invasive surgery in pediatric patients. (United States)

    Jackson, Hope T; Kane, Timothy D


    Surgery has changed dramatically over the last several decades. The emergence of MIS has allowed pediatric surgeons to manage critically ill neonates, children, and adolescents with improved outcomes in pain, postoperative course, cosmesis, and return to normal activity. Procedures that were once thought to be too difficult to attempt or even contraindicated in pediatric patients in many instances are now the standard of care. New and emerging techniques, such as single-incision laparoscopy, endoscopy-assisted surgery, robotic surgery, and techniques yet to be developed, all hold and reveal the potential for even further advancement in the management of these patients. The future of MIS in pediatrics is exciting; as long as our primary focus remains centered on developing techniques that limit morbidity and maximize positive outcomes for young patients and their families, the possibilities are both promising and infinite.

  9. Non-technical skills in minimally invasive surgery teams

    DEFF Research Database (Denmark)

    Gjeraa, Kirsten; Spanager, Lene; Konge, Lars


    in MIS compared to open surgery, mainly due to equipment- and patient-related challenges. Fixed teams improved teamwork and safety levels, while deficient planning and poor teamwork were found to obstruct workflow and increase errors. Training NTS mitigates these issues and improves staff attitudes...... towards NTS. CONCLUSIONS: MIS teams' NTS are important for workflow and prevention of errors and can be enhanced by working in fixed teams. In the technological complex sphere of MIS, communication revolves around equipment- and patient-related topics, much more so than in open surgery. In all, only a few...

  10. Mini-invasive surgery of infratemporal fossa schwannomas. (United States)

    Haidar, H; Deveze, A; Lavieille, J P


    Infratemporal fossa schwannomas are benign, encapsulated tumours of the trigeminal nerve limited to the infratemporal fossa. Because of the complications and significant morbidity associated with traditional surgical approaches to the infratemporal fossa, which include facial nerve dysfunction, hearing loss, dental malocclusion and cosmetic problems, less invasive alternatives have been sought. This paper reports two cases of infratemporal fossa schwannomas treated in 2012 using mini-invasive approaches. The literature regarding different infratemporal fossa approaches was reviewed. The first schwannoma was 30 mm in size and was removed completely by a preauricular subtemporal approach. The second one was 25 mm in size and was removed completely using a purely transnasal endoscopic approach. In both cases, there were no intra-operative or post-operative complications. These two approaches allow non-invasive and wide exposure of the infratemporal fossa as compared to classical approaches. Surgical approach should be selected according to the tumour's anatomical location with respect to the maxillary sinus posterior wall. The preauricular subtemporal approach is recommended for tumours localised posterolaterally with respect to the maxillary sinus posterior wall. Medial and anterior tumours near the maxillary sinus posterior wall can be best removed using a transnasal endoscopic approach.


    Directory of Open Access Journals (Sweden)

    I. L. Chernikovskiy


    Full Text Available Introduction. The patient’s age is one of the major risk factors of death from colorectal cancer. The role of laparo- scopic radical surgeries in the treatment of colorectal cancer in elderly patients is being studied. The purpose of the study was to evaluate the experience of surgical treatment for elderly patients with colorectal cancer. material and methods. The treatment outcomes of 106 colorectal cancer patients aged 75 years or over, who underwent surgery between 2013 and 2015 were presented. Out of them, 66 patients underwent laparatomy and 40 patients underwent laparoscopy. Patients were matched for ASA and CR-PОSSUM scales, age-and body mass index, dis- ease stage and type of surgery. Results. The mean duration of surgery was significantly less for laparoscopy than for laparotomy (127 min versus 146 min. Intraoperative blood loss was higher in patients treated by laparotomy than by laparoscopy (167 ml versus 109 ml, but the differences were insignificant (р=0.36. No differences in lymphodissection quality and adequate resection volume between the groups were found. The average hospital stay was not significantly shorter in the laparoscopic group (р=0.43. Complications occurred with equal frequency in both groups (13.6 % compared to 15.0 %. The median follow-up time was 16 months (range, 6-30 months. The number of patients died during a long-term follow-up was 2 times higher after laparotomic surgery than after laparoscopic surgery, however, the difference was not statistically significant. Conclusion. Postoperative compli- cations in elderly patients with colorectal cancer did not exceed the average rates and did not depend on the age. Both groups were matched for the intraoperative bleeding volume and quality of lymphodenectomy. Significantly shorter duration of laparoscopic surgery was explained by the faster surgical access however, it showed no benefit in reducing the average length of hospital stay and decreasing the number of

  12. The past, present and future of minimally invasive spine surgery: a review and speculative outlook. (United States)

    Spetzger, Uwe; Von Schilling, Andrej; Winkler, Gerd; Wahrburg, Jürgen; König, Alexander


    In the last 25 years of spinal surgery, tremendous improvements have been made. The development of smart technologies with the overall aim of reducing surgical trauma has resulted in the concept of minimally invasive surgical techniques. Enhancements in microsurgery, endoscopy and various percutaneous techniques, as well as improvement of implant materials, have proven to be milestones. The advancement of training of spine surgeons and the integration of image guidance with precise intraoperative imaging, computer- and robot-assisted treatment modalities constitute the era of reducing treatment morbidity in spinal surgery. This progress has led to the present era of preserving spinal function. The promise of the continuing evolution of spinal surgery, the era of restoring spinal function, already appears on the horizon. The current state of minimally invasive spine surgery is the result of a long-lasting and consecutive development of smart technologies, along with stringent surgical training practices and the improvement of instruments and techniques. However, much effort in research and development is still mandatory to establish, maintain and evolve minimally invasive spine surgery. The education and training of the next generation of highly specialized spine surgeons is another key point. This paper will give an overview of surgical techniques and methods of the past 25 years, examine what is in place today, and suggest a projection for spine surgery in the coming 25 years by drawing a connection from the past to the future.

  13. Using VR technology for training in minimally invasive vascular surgery (United States)

    Cai, Yiyu; Chui, Cheekong K.; Ye, Xiuzi; Anderson, James H.; Wang, Yaoping


    This paper describes a computerized simulation system for minimally invasive vascular interventions using Virtual-Reality (VR) based technology. A virtual human patient is constructed using the Visible Human Data (VHD). A knowledge-based human vascular network is developed to describe human vascular anatomy with diseased lesions for different interventional applications. A potential field method is applied to model the interaction between the blood vessels and vascular catheterization devices. A haptic interface is integrated with the computer simulation system to provide tactile sensations to the user during the simulated catheterization procedures. The system can be used for physician training and for pre-treatment planning of interventional vascular procedures.

  14. A thematic analysis of experiences of varicose veins and minimally invasive surgery under local anaesthesia. (United States)

    Hudson, Briony F; Ogden, Jane; Whiteley, Mark S


    To gain insight into the experience of living with varicose veins and undergoing minimally invasive surgery under local anaesthesia in a private clinic. Minimally invasive surgery under local anaesthesia is replacing traditional surgical stripping for the treatment for varicose veins. Conscious surgery has previously been associated with elevated levels of anxiety and some associated pain. There is limited research exploring the experiences of patients undergoing varicose vein surgery under local anaesthesia. Qualitative semi-structured interviews with 20 patients who took part in a mixed methods study exploring the effects of distraction on intra-operative pain and anxiety. Participants were interviewed eight weeks post surgery about their experiences before, during and after surgery. Interviews were analysed using thematic analysis. Four themes were captured (1) negative emotions associated with symptoms, (2) unpreparedness for the surgical process, (3) feeling cared for and (4) improvements in well-being. An overarching theme of relationships was identified. Overall, varicose veins had a detrimental impact on quality of life prior to surgery. Patients felt unprepared for their procedure and experienced the operation as anxiety provoking and uncomfortable. This was much helped by the support of nursing staff in the theatre. Post surgery, patients' quality of life was reported as improved. More emphasis needs to be placed on preparing patients for surgery under local anaesthesia. The role of the nurse is central to creating a caring, relaxed environment which could improve patient experience. Patients' experiences of varicose veins and their treatment both influence, and are influenced by relationships with others at all stages of the management process. Nurses play an important role in improving patient experience during surgery and care needs to be taken to ensure that patients understand and accept the processes of surgery and recovery. © 2015 John Wiley

  15. Identification of risk factors in minimally invasive surgery : a prospective multicenter study

    NARCIS (Netherlands)

    Driessen, Sara R C; Sandberg, Evelien M.; Rodrigues, Sharon P.; Van Zwet, Erik W.; Jansen, F.W.


    Background: Since the introduction of minimally invasive surgery (MIS), concerns for patient safety are more often brought to the attention. Knowledge about and awareness of patient safety risk factors are crucial in order to improve and enhance the surgical team, the environment, and finally

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

    NARCIS (Netherlands)

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


    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

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

    DEFF Research Database (Denmark)

    Kibsgaard, Martin; Kraus, Martin


    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, an...

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

    Directory of Open Access Journals (Sweden)

    Tamer El Banna


    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.

  19. Trends in the use of minimally invasive surgery in children. (United States)

    Tovaranonte, Preechapon Pleay; Beasley, Spencer W; Maoate, Kiki; Blakelock, Russell; Skinner, Adrian


    To determine trends in the scope of use of minimally invasive surgical (MIS) techniques in children as a predictor of future operative workload and operating theatre requirements. A retrospective review was conducted of all paediatric patients less than 16 years of age who underwent minimally invasive surgical procedures at Christchurch Hospital, New Zealand between 1996 and 2007. There were 1693 children who received 1826 MIS procedures during a period in which 11,893 operative procedures were performed. MI case-weights, an indirect measure of the financial burden and technical difficulty of the procedures, represented 29% of the workload of the unit overall. There was a rapid rise of the number of MIS procedures from 1996 to 2000, but since then the scope and volume has changed little. Use of MIS in children increased rapidly until 2000 since which time it has remained relatively constant. Recent additional applications have involved a small number of rare low-volume and more complex procedures. These observations may assist in the planning of theatre allocation requirements for MIS in children.

  20. Evolving minimally invasive spine surgery: a surgeon's perspective on technological convergence and digital or control system. (United States)

    Chiu, John C; Maziad, Ali M; Rappard, George; Thacker, James T; Liu, Brent; Documet, Jorge


    Degenerated spinal disc and spinal stenosis are common problems requiring decompressive spinal surgery. Traditional open spinal discectomy is associated with significant tissue trauma, greater morbidity/complications, scarring, often longer term of convalescence, and even destabilization of the spine. Therefore, the pursuit of less traumatic minimally invasive spine surgery (MISS) began. The trend of spinal surgery is rapidly moving toward MISS. MISS is a technologically dependent surgery, and requires increased utilization of advanced endoscopic surgical instruments, imaging-video technology, and tissue modulation technology for performing spinal surgery in a digital operating room (DOR). It requires seamless connectivity and control to perform the surgical procedures in a precise and orchestrated manner. A new integrated DOR, the technological convergence and control system SurgMatix(R), was created in response to the need and to facilitate MISS with "organized control instead of organized chaos" in the endoscopic OR suite. It facilitates the performance, training, and further development of MISS.

  1. Treatment of malignant glaucoma with minimal invasive vitrectomy surgery

    Directory of Open Access Journals (Sweden)

    Li Meng


    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.

  2. Current standards and recent progress in minimally invasive Phlebo surgery

    Directory of Open Access Journals (Sweden)

    Oliver Göckeritz


    Full Text Available Venous disorders are among the most frequent disease patterns in the Western world. Still at the turn to the 21st century there was no alternative available to the surgical treatment of varicosis. Meanwhile the endoluminal treatment methods have established and have demonstrated their efficiency while having lower side effects in comparison to the traditional treatment, even though conservatively oriented surgeons are still skeptically eyeing these methods. In the US, according to the latest MRG report of 2011, about 95% of all venous surgeries are already done endoluminally. This paper offers an overview of prevailing treatment standards of the most important endoluminal therapy techniques and shows current trends.

  3. Two year outcomes of minimally invasive hallux valgus surgery. (United States)

    Chan, Chloe Xiaoyun; Gan, Jonathan Zhi-Wei; Chong, Hwei Chi; Rikhraj Singh, Inderjeet; Ng, Sean Yung Chuan; Koo, Kevin


    We report our experience with the Minimally Invasive Chevron Akin (MICA) technique for correcting hallux valgus, and evaluate its effectiveness and associated complications. Case series of 13 feet with mild to moderate symptomatic hallux valgus treated surgically from July 2013 to December 2014, with at least 48-months follow-up. Patients were assessed pre-operatively and post-operatively with radiographical measurements (Hallux Valgus Angle (HVA) and Intermetatarsal Angle (IMA)) and clinical scores (American Orthopaedic Foot and Ankle Society (AOFAS), 36-Item Short Form Health Survery (SF-36), Visual Analog Scale (VAS)). Mean HVA and IMA decreased from 30.4° and 13.9°-10.9° and 10.2° respectively (phallux valgus deformity, and continued use is justified. Copyright © 2017 European Foot and Ankle Society. Published by Elsevier Ltd. All rights reserved.

  4. A Computational Investigation Of Minimal Invasive Spine Surgery

    DEFF Research Database (Denmark)

    Rasmussen, Sten; Rasmussen, John

    invasive insertion systems are designed to minimize the approach-related morbidity of traditional lumbar pedicle fixation. A major part of reducing morbidity might be the preservation of the tendon attachment of the muscle. Objectives: The aim of the study was to investigate the implication of preserving...... tendon attachment using MISS compared to TOSS. Methods: The computational investigation is based on the AnyBody Modeling System version 5.2 (AnyBody Technology, Aalborg, Denmark) and its associated model library, the AnyScript Managed Model Repository, version 1.5. The library allows for composition...... of ad-hoc models by combination of individual body parts but the present investigation used the entire body comprising a spinal part, upper extremities and lower extremities, totaling more than 1000 independently activated muscle-tendon units. The stiffness of the joints can consequently be controlled...

  5. Augmented reality-assisted bypass surgery: embracing minimal invasiveness. (United States)

    Cabrilo, Ivan; Schaller, Karl; Bijlenga, Philippe


    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.

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

    Directory of Open Access Journals (Sweden)

    A. V. Goncharov


    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.

  7. Risks and benefits of invasive epilepsy surgery workup with implanted subdural and depth electrodes. (United States)

    Wellmer, Jörg; von der Groeben, Ferdinand; Klarmann, Ute; Weber, Christian; Elger, Christian E; Urbach, Horst; Clusmann, Hans; von Lehe, Marec


    In patients with pharmacoresistant focal-onset seizures, invasive presurgical workup can identify epilepsy surgery options when noninvasive workup has failed. Yet, the potential benefit must be balanced with procedure-related risks. This study examines risks associated with the implantation of subdural strip and grid, and intracerebral depth electrodes. Benefit of invasive monitoring is measured by seizure outcomes. Diagnostic procedures made possible by electrode implantation are described. Retrospective evaluation of invasive workups in 242 epilepsy surgery candidates and additional 18 patients with primary brain tumors implanted for mapping only. Complications are scaled in five grades of severity. A regression analysis identifies risk factors for complications. Outcome is classified according to Engel's classification. Complications of any type were documented in 23% of patients, and complications requiring surgical revision in 9%. We did not find permanent morbidity or mortality. Major risk factor for complications was the implantation of grids and the implantation of electrode assemblies comprising strip and grid electrodes. Depth electrodes were significantly correlated with a lower risk. Tumors were not correlated with higher complication rates. Chronic invasive monitoring of 3-40 days allowed seizure detection in 99.2% of patients with epilepsy and additional extensive mapping procedures. Patients with epilepsy with follow-up >24 months (n = 165) had an Engel class 1a outcome in 49.7% if epilepsy surgery was performed, but only 6.3% when surgery was rejected. The benefit of chronic invasive workup outweighs its risks, but complexity of implantations should be kept to a minimum. Wiley Periodicals, Inc. © 2012 International League Against Epilepsy.

  8. Quality assurance of multiport image-guided minimally invasive surgery at the lateral skull base. (United States)

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


    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.

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

    Directory of Open Access Journals (Sweden)

    Maria Nau-Hermes


    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.

  10. Role of minimally invasive surgery in the treatment of diverticular disease: an evidence-based analysis. (United States)

    Bissolati, Massimiliano; Orsenigo, Elena; Staudacher, Carlo


    The clinical spectrum of diverticular disease varies from asymptomatic diverticulosis to symptomatic disease with potentially fatal complications, such as perforation or bleeding. While the presence of diverticula is common, symptomatic diverticulitis is relatively uncommon, occurring in an estimated 10-30 % of patients. There is continued debate as to whether patients should undergo elective resection for diverticular disease and regarding the role of minimally invasive surgery. Since the first publication on laparoscopic colorectal procedures, the interest in minimally invasive surgery has kept growing. Laparoscopic sigmoid resection with restoration of continuity is currently the prevailing modality for treating acute and recurrent sigmoid diverticulitis. However, it still remains unclear whether laparoscopy should be recommended also for complicated sigmoid diverticulitis. The potential benefits of reduced pain and analgesic requirements, smaller scars, and shorter hospital stay but longer operative times are appealing to both patients and surgeons. Nevertheless, there many concerns regarding the time and the type of surgery. Although the role of minimally invasive surgery in the treatment of colonic diseases is progressively increased, current randomized controlled trials should demonstrate whether laparoscopic lavage, Hartmann's procedure or resection and anastomosis achieve the best results for patients. This review aimed to analyze the results of laparoscopic colonic resection for patients with uncomplicated and complicated forms of sigmoid diverticular disease and to determine what stages profit from a laparoscopic procedure and whether the approach can be performed with a low complication rate even for patients with complicated forms of the disease.

  11. Mammotome HH biopsy - the future of minimal invasive breast surgery?

    International Nuclear Information System (INIS)

    Pietrzyk, G.; Nowicki, J.; Bojarski, B.; Kedzierski, B.; Wysocki, A.; Prudlak, E.


    Vacuum-assisted breast biopsy / Mammotome HH '' R '' Breast Biopsy System/ is the milestone in the diagnosis of breast lesions. This system has proven to be as diagnostically reliable as open surgery, but without scarring, deformations and hospitalizations associated with an open procedure. The aim of our study was to assess the role and possibilities of using this biopsy in treatment of benign breast lesions like fibroadenoma. From 2001 to 2004, about 1118 Mammotome biopsies were performed in our Department. Among 445 Mammotome biopsies performed under US control there were 211 cases of fibroadenomas. Follow-up was performed in 156 patients with this result at 6 and 12 months after biopsy. In our study we took into considerations the size, localizations as well as performers. In 2002 there were 70.8% patients with total lesion excision, 16.7% with residual lesion and 12.5% women with hematomas or scars. In 2003-2004 there were more women with total lesion excision (84.3%), fewer residual tumors and other lesions. In future, Mammotome breast biopsy can replace scalpel, and will become an alternative method to open surgical excision of fibroadenomas. It is important especially in the cases of young women to prevent cosmetic deformations and scars. (author)

  12. Laparoscopic vs. open approach for colorectal cancer: evolution over time of minimal invasive surgery. (United States)

    Biondi, Antonio; Grosso, Giuseppe; Mistretta, Antonio; Marventano, Stefano; Toscano, Chiara; Drago, Filippo; Gangi, Santi; Basile, Francesco


    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.

  13. Effect of minimally invasive surgery on stress reaction and fallopian tube patency in patients with salpingocyesis

    Directory of Open Access Journals (Sweden)

    Yu-Ping Li


    Full Text Available Objective: To observe the effect of minimally invasive surgery on the stress reaction and fallopian tube patency in patients with ectopic pregnancy (EP. Methods: A total of 90 patients with EP who were admitted in our hospital from May, 2013 to May, 2015 and had reproduction requirements were included in the study and randomized into the laparoscope group and the open group. The patients in the open group were given routine open conservative surgery, while the patients in the laparoscope group were given laparoscopic conservative surgery. Ang-Ⅱ, ALD, VEGF, Cor, ALT, and AST levels before operation, 1 and 3d after operation in the two groups were compared. Salpingography was performed 3 months after operation to compare the patency of affected fallopian tube after operation. Results: The differenceof serum Ang-Ⅱ, Cor, ALD, and VEGF levels before operation between the two groups was not statistically significant (P>0.05. The serum Ang-Ⅱ, Cor, ALD, and VEGF levels 1 and 3 d after operation in the laparoscope group were significantly lower than those in the open group (P0.05. The patency rate of affected fallopian tube in the laparoscope group (84.44% was significantly higher than that in the open group (46.67% (P<0.05. Conclusions: The laparoscopic minimally invasive surgery has less stress reaction in patients with salpingocyesis when compared with the traditional open surgery, with good patency of affected fallopian tube; therefore, it should be preferred in the clinic.

  14. Enhanced Recovery Pathways for Improving Outcomes After Minimally Invasive Gynecologic Oncology Surgery. (United States)

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


    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.

  15. Radical trachelectomy in early-stage cervical cancer: A comparison of laparotomy and minimally invasive surgery. (United States)

    Vieira, Marcelo A; Rendón, Gabriel J; Munsell, Mark; Echeverri, Lina; Frumovitz, Michael; Schmeler, Kathleen M; Pareja, Rene; Escobar, Pedro F; Reis, Ricardo Dos; Ramirez, Pedro T


    Radical trachelectomy is considered standard of care in patients with early-stage cervical cancer interested in future fertility. The goal of this study was to compare operative, oncologic, and fertility outcomes in patients with early-stage cervical cancer undergoing open vs. minimally invasive radical trachelectomy. A retrospective review was performed of patients from four institutions who underwent radical trachelectomy for early-stage cervical cancer from June 2002 to July 2013. Perioperative, oncologic, and fertility outcomes were compared between patients undergoing open vs. minimally invasive surgery. A total of 100 patients were included in the analysis. Fifty-eight patients underwent open radical trachelectomy and 42 patients underwent minimally invasive surgery (MIS=laparoscopic or robotic). There were no differences in patient age, body mass index, race, histology, lymph vascular space invasion, or stage between the two groups. The median surgical time for MIS was 272min [range, 130-441min] compared with 270min [range, 150-373min] for open surgery (p=0.78). Blood loss was significantly lower for MIS vs. laparotomy (50mL [range, 10-225mL] vs. 300mL [50-1100mL]) (psurgery group (p=0.010). Length of hospitalization was shorter for MIS than for laparotomy (1day [1-3 days] vs. 4days [1-9 days]) (psurgery group. The median lymph node count was 17 (range, 5-47) for MIS vs. 22 (range, 7-48) for open surgery (p=0.03). There were no differences in the rate of postoperative complications (30% MIS vs. 31% open surgery). Among 83 patients who preserved their fertility (33 MIS vs. 50 open surgery), 34 (41%) patients attempted to get pregnant. Sixteen (47%) patients were able to do so (MIS: 2 vs. laparotomy: 14, p=0.01). The pregnancy rate was higher in the open surgery group when compared to the MIS group (51% vs. 28%, p=0.018). However, median follow-up was shorter is the MIS group compared with the open surgery group (25months [range, 10-69] vs. 66months [range, 11

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

    Directory of Open Access Journals (Sweden)

    Aaron Raney


    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

  17. Limited access atrial septal defect closure and the evolution of minimally invasive surgery. (United States)

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


    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. A magnetic force sensor on a catheter tip for minimally invasive surgery. (United States)

    Chatzipirpiridis, G; Erne, P; Ergeneman, O; Pane, S; Nelson, B J


    This paper presents a magnetically guided catheter for minimally invasive surgery (MIS) with a magnetic force sensing tip. The force sensing element utilizes a magnetic Hall sensor and a miniature permanent magnet mounted on a flexible encapsulation acting as the sensing membrane. It is capable of high sensitivity and robust force measurements suitable for in-vivo applications. A second larger magnet placed on the catheter allows the catheter to be guided by applying magnetic fields. Precise orientation control can be achieved with an external magnetic manipulation system. The proposed device can be used in many applications of minimally invasive surgery (MIS) to detect forces applied on tissue during procedures or to characterize different types of tissue for diagnosis.

  19. 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.


    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.

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

    Directory of Open Access Journals (Sweden)

    Pankaj Kandwal


    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

  1. Lessons from aviation - the role of checklists in minimally invasive cardiac surgery. (United States)

    Hussain, S; Adams, C; Cleland, A; Jones, P M; Walsh, G; Kiaii, B


    We describe an adverse event during minimally invasive cardiac surgery that resulted in a multi-disciplinary review of intra-operative errors and the creation of a procedural checklist. This checklist aims to prevent errors of omission and communication failures that result in increased morbidity and mortality. We discuss the application of the aviation - led "threats and errors model" to medical practice and the role of checklists and other strategies aimed at reducing medical errors. © The Author(s) 2015.

  2. Underestimation of Project Costs (United States)

    Jones, Harry W.


    Large projects almost always exceed their budgets. Estimating cost is difficult and estimated costs are usually too low. Three different reasons are suggested: bad luck, overoptimism, and deliberate underestimation. Project management can usually point to project difficulty and complexity, technical uncertainty, stakeholder conflicts, scope changes, unforeseen events, and other not really unpredictable bad luck. Project planning is usually over-optimistic, so the likelihood and impact of bad luck is systematically underestimated. Project plans reflect optimism and hope for success in a supposedly unique new effort rather than rational expectations based on historical data. Past project problems are claimed to be irrelevant because "This time it's different." Some bad luck is inevitable and reasonable optimism is understandable, but deliberate deception must be condemned. In a competitive environment, project planners and advocates often deliberately underestimate costs to help gain project approval and funding. Project benefits, cost savings, and probability of success are exaggerated and key risks ignored. Project advocates have incentives to distort information and conceal difficulties from project approvers. One naively suggested cure is more openness, honesty, and group adherence to shared overall goals. A more realistic alternative is threatening overrun projects with cancellation. Neither approach seems to solve the problem. A better method to avoid the delusions of over-optimism and the deceptions of biased advocacy is to base the project cost estimate on the actual costs of a large group of similar projects. Over optimism and deception can continue beyond the planning phase and into project execution. Hard milestones based on verified tests and demonstrations can provide a reality check.

  3. Surgery in reverse : Minimally invasive with minimum visibility: a virtual training simulator for keyhole surgery

    NARCIS (Netherlands)

    Dankelman, J.; Stassen, H.; Van der Graaf, A.


    From the patients point of view, keyhole surgery is the perfect solution. Recovery from the operation is more rapid, and scarring is minimal. For the surgeon,however, it remains a new and inconvenient way of working, having to watch a video monitor instead of being able to see directly what is going

  4. National trends in minimally invasive and open operative experience of graduating general surgery residents: implications for surgical skills curricula development? (United States)

    Carson, Jeffrey S; Smith, Lynette; Are, Madhuri; Edney, James; Azarow, Kenneth; Mercer, David W; Thompson, Jon S; Are, Chandrakanth


    The aim of this study was to analyze national trends in minimally invasive and open cases of all graduating residents in general surgery. A retrospective analysis was performed on data obtained from Accreditation Council for Graduate Medical Education logs (1999-2008) of graduating residents from all US general surgery residency programs. Data were analyzed using Mantel-Haenszel χ(2) tests and the Bonferroni adjustment to detect trends in the number of minimally invasive and open cases. Minimally invasive procedures accounted for an increasing proportion of cases performed (3.7% to 11.1%, P surgery (P general surgery residents in the United States are performing a greater number of minimally invasive and fewer open procedures for common surgical conditions. Copyright © 2011 Elsevier Inc. All rights reserved.

  5. Minimal invasive single-site surgery in colorectal procedures: Current state of the art

    Directory of Open Access Journals (Sweden)

    Diana Michele


    Full Text Available Background: Minimally invasive single-site (MISS surgery has recently been applied to colorectal surgery. We aimed to assess the current state of the art and the adequacy of preliminary oncological results. Methods: We performed a systematic review of the literature using Pubmed, Medline, SCOPUS and Web of Science databases. Keywords used were "Single Port" or "Single-Incision" or "LaparoEndoscopic Single Site" or "SILS™" and "Colon" or "Colorectal" and "Surgery". Results: Twenty-nine articles on colorectal MISS surgery have been published from July 2008 to July 2010, presenting data on 149 patients. One study reported analgesic requirement. The final incision length ranged from 2.5 to 8 cm. Only two studies reported fascial incision length. There were two port site hernias in a series of 13 patients (15.38%. Two "fully laparoscopic" MISS procedures with preparation and achievement of the anastomosis completely intracorporeally are reported. Future site of ileostomy was used as the sole access for the procedures in three studies. Lymph node harvesting, resection margins and length of specimen were sufficient in oncological cases. Conclusions: MISS colorectal surgery is a challenging procedure that seems to be safe and feasible, but the existing clinical evidence is limited. In selected cases, and especially when an ileostomy is planned, colorectal surgery may be an ideal indication for MISS surgery leading to a no-scar surgery. Despite preliminary oncological results showing the feasibility of MISS surgery, we want to stress the need to standardize the technique and carefully evaluate its application in oncosurgery under ethical committee control.

  6. Patient body image, self-esteem, and cosmetic results of minimally invasive robotic cardiac surgery. (United States)

    İyigün, Taner; Kaya, Mehmet; Gülbeyaz, Sevil Özgül; Fıstıkçı, Nurhan; Uyanık, Gözde; Yılmaz, Bilge; Onan, Burak; Erkanlı, Korhan


    Patient-reported outcome measures reveal the quality of surgical care from the patient's perspective. We aimed to compare body image, self-esteem, hospital anxiety and depression, and cosmetic outcomes by using validated tools between patients undergoing robot-assisted surgery and those undergoing conventional open surgery. This single-center, multidisciplinary, randomized, prospective study of 62 patients who underwent cardiac surgery was conducted at Hospital from May 2013 to January 2015. The patients were divided into two groups: the robotic group (n = 33) and the open group (n = 29). The study employed five different tools to assess body image, self-esteem, and overall patient-rated scar satisfaction. There were statistically significant differences between the groups in terms of self-esteem scores (p = 0.038), body image scores (p = 0.026), overall Observer Scar Assessment Scale (p = 0.013), and overall Patient Scar Assessment Scale (p = 0.036) scores in favor of the robotic group during the postoperative period. Robot-assisted surgery protected the patient's body image and self-esteem, while conventional open surgery decreased these levels but without causing pathologies. Preoperative depression and anxiety level was reduced by both robot-assisted surgery and conventional open surgery. The groups did not significantly differ on Patient Satisfaction Scores and depression/anxiety scores. The results of this study clearly demonstrated that a minimally invasive approach using robotic-assisted surgery has advantages in terms of body image, self-esteem, and cosmetic outcomes over the conventional approach in patients undergoing cardiac surgery. Copyright © 2017 IJS Publishing Group Ltd. Published by Elsevier Ltd. All rights reserved.

  7. A New Era of Minimally Invasive Surgery: Progress and Development of Major Technical Innovations in General Surgery Over the Last Decade. (United States)

    Siddaiah-Subramanya, Manjunath; Tiang, Kor Woi; Nyandowe, Masimba


    Minimally invasive surgery (MIS) continues to play an important role in general surgery as an alternative to traditional open surgery as well as traditional laparoscopic techniques. Since the 1980s, technological advancement and innovation have seen surgical techniques in MIS rapidly grow as it is viewed as more desirable. MIS, which includes natural orifice transluminal endoscopic surgery (NOTES) and single-incision laparoscopic surgery (SILS), is less invasive and has better cosmetic results. The technological growth and adoption of NOTES and SILS by clinicians in the last decade has however not been uniform. We look at the differences in new developments and advancement in the different techniques in the last 10 years. We also aim to explain these differences as well as the implications in general surgery for the future.

  8. Benefits of non-invasive ventilation after extubation in the postoperative period of heart surgery. (United States)

    Lopes, Célia Regina; Brandão, Carlos Manuel de Almeida; Nozawa, Emília; Auler, José Otávio Costa


    to show the benefits of the use of non-invasive positive pressure ventilation (NPPV) in the process of weaning from mechanical ventilation in the immediate postoperative period of heart surgery. A prospective, randomized and controlled study was performed involving 100 consecutive patients submitted to coronary artery bypass grafting or valve surgery. The subjects were admitted into the Intensive Care Unit (ICU) under mechanical ventilation and randomized in a study group (n=50), which used NPPV with bilevel pressure for 30 minutes after extubation, and a control group (n=50) which only used a nasal O2 catheter. Anthropometric variables and the times of the intra-operative periods corresponding to anesthesia, surgery and cardiopulmonary bypass, as well as the time required for weaning from invasive mechanical ventilation were analysed. The arterial blood gases and hemodynamic variables were also assessed before and after extubation. The evolution was similar for the control and study groups without statistically significant differences of the variables analyzed except for the PaO2. On comparing the groups, the PaO2 improved significantly (p = 0.0009) with the use of NPPV for 30 minutes after extubation, but there was no statistically significant difference in the PaCO2 (p = 0.557). The use of NPPV for 30 minutes after extubation improved oxygenation in the immediate postoperative period of heart surgery.

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

    Directory of Open Access Journals (Sweden)

    Feza Y Karakayali


    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.

  10. An Update on Less Invasive and Endoscopic Techniques Mimicking the Effect of Bariatric Surgery

    Directory of Open Access Journals (Sweden)

    Froukje J. Verdam


    Full Text Available Obesity (BMI 30–35 kg/m2 and its associated disorders such as type 2 diabetes, nonalcoholic fatty liver disease, and cardiovascular disease have reached pandemic proportions worldwide. For the morbidly obese population (BMI 35–50 kg/m2, bariatric surgery has proven to be the most effective treatment to achieve significant and sustained weight loss, with concomitant positive effects on the metabolic syndrome. However, only a minor percentage of eligible candidates are treated by means of bariatric surgery. In addition, the expanding obesity epidemic consists mostly of relatively less obese patients who are not (yet eligible for bariatric surgery. Hence, less invasive techniques and devices are rapidly being developed. These novel entities mimic several aspects of bariatric surgery either by gastric restriction (gastric balloons, gastric plication, by influencing gastric function (gastric botulinum injections, gastric pacing, and vagal nerve stimulation, or by partial exclusion of the small intestine (duodenal-jejunal sleeve. In the last decade, several novel less invasive techniques have been introduced and some have been abandoned again. The aim of this paper is to discuss the safety, efficacy, complications, reversibility, and long-term results of these latest developments in the treatment of obesity.

  11. Anesthesia for minimally invasive chest wall reconstructive surgeries: Our experience and review of literature. (United States)

    Shah, Shagun Bhatia; Hariharan, Uma; Bhargava, Ajay Kumar; Darlong, Laleng M


    Minimal access procedures have revolutionized the field of surgery and opened newer challenges for the anesthesiologists. Pectus carinatum or pigeon chest is an uncommon chest wall deformity characterized by a protruding breast bone (sternum) and ribs caused by an overgrowth of the costal cartilages. It can cause a multitude of problems, including severe pain from an intercostal neuropathy, respiratory dysfunction, and psychologic issues from the cosmetic disfigurement. Pulmonary function indices, namely, forced expiratory volume over 1 s, forced vital capacity, vital capacity, and total lung capacity are markedly compromised in pectus excavatum. Earlier, open surgical correction in the form of the Ravitch procedure was followed. Currently, in the era of minimally invasive surgery, Nuss technique (pectus bar procedure) is a promising step in chest wall reconstructive surgery for pectus excavatum. Reverse Nuss is a corrective, minimally invasive surgery for pectus carinatum chest deformity. A tailor-made anesthetic technique for this new procedure has been described here based on the authors' personal experience and thorough review of literature based on Medline, Embase, and Scopus databases search.

  12. Anesthesia for minimally invasive chest wall reconstructive surgeries: Our experience and review of literature

    Directory of Open Access Journals (Sweden)

    Shagun Bhatia Shah


    Full Text Available Minimal access procedures have revolutionized the field of surgery and opened newer challenges for the anesthesiologists. Pectus carinatum or pigeon chest is an uncommon chest wall deformity characterized by a protruding breast bone (sternum and ribs caused by an overgrowth of the costal cartilages. It can cause a multitude of problems, including severe pain from an intercostal neuropathy, respiratory dysfunction, and psychologic issues from the cosmetic disfigurement. Pulmonary function indices, namely, forced expiratory volume over 1 s, forced vital capacity, vital capacity, and total lung capacity are markedly compromised in pectus excavatum. Earlier, open surgical correction in the form of the Ravitch procedure was followed. Currently, in the era of minimally invasive surgery, Nuss technique (pectus bar procedure is a promising step in chest wall reconstructive surgery for pectus excavatum. Reverse Nuss is a corrective, minimally invasive surgery for pectus carinatum chest deformity. A tailor-made anesthetic technique for this new procedure has been described here based on the authors' personal experience and thorough review of literature based on Medline, Embase, and Scopus databases search.

  13. Is circumferential minimally invasive surgery effective in the treatment of moderate adult idiopathic scoliosis? (United States)

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


    Outcomes for minimally invasive scoliosis correction surgery have been reported for mild adult scoliosis. Larger curves historically have been treated with open surgical procedures including facet resections or posterior column osteotomies, which have been associated with high-volume blood loss. Further, minimally invasive techniques have been largely reported in the setting of degenerative scoliosis. We describe the effects of circumferential minimally invasive surgery (cMIS) for moderate to severe scoliosis in terms of (1) operative time and blood loss, (2) overall health and disease-specific patient-reported outcomes, (3) deformity correction and fusion rate, and (4) frequency and types of complications. Between January 2007 and January 2012, we performed 50 cMIS adult idiopathic scoliosis corrections in patients with a Cobb angle of greater than 30° but less than 75° who did not have prior thoracolumbar fusion surgery; this series represented all patients we treated surgically during that time meeting those indications. Our general indications for this approach during that period were increasing back pain unresponsive to nonoperative therapy with cosmetic and radiographic worsening of curves. Surgical times and estimated blood loss were recorded. Functional clinical outcomes including VAS pain score, Oswestry Disability Index (ODI), and SF-36 were recorded preoperatively and postoperatively. Patients' deformity correction was assessed on pre- and postoperative 36-inch (91-cm) standing films and fusion was assessed on CT scan. Minimum followup was 24 months (mean, 48 months; range, 24-77 months). Mean blood loss was 613 mL for one-stage surgery and 763 mL for two-stage surgery. Mean operative time was 351 minutes for one-stage surgery and 482 minutes for two-stage surgery. At last followup, mean VAS and ODI scores decreased from 5.7 and 44 preoperatively to 2.9 and 22 (p surgery in 10 more patients at last followup. cMIS provides for good clinical and

  14. Pose optimization and port placement for robot-assisted minimally invasive surgery in cholecystectomy. (United States)

    Feng, Mei; Jin, Xingze; Tong, Weihua; Guo, Xiaoyu; Zhao, Ji; Fu, Yili


    Pose optimization and port placement are critical issues for preoperative preparation in robot-assisted minimally invasive surgery (RMIS), and affect the robot performance and surgery quality. This paper proposes a method for pose optimization and port placement for RMIS in cholecystectomy that considers both the robot and surgery requirements. The robot pose optimization was divided into optimization of the positioning joint configuration and optimization of the end effector configuration. To determine the optimal location for the trocar port placement, the operational workspace was defined as the evaluation index. The port area was divided into many sub-areas, and that with the maximum operational workspace was selected as the location for the port placement. Considering the left robotic arm as an example, the location for the port placement and joints angles for robotic arm configuration were discussed and simulated using the proposed method. This research can provide guidelines for surgeons in preoperative preparation. Copyright © 2017 John Wiley & Sons, Ltd.

  15. Multi-channel LED light source for fluorescent agent aided minimally invasive surgery. (United States)

    Ren, Jiacheng; Venugopalan, Janani; Xu, Jian; Kairdolf, Brad; Durfee, Robert; Wang, May D


    Cancer is one of the most common and deadly diseases around the world. Amongst all the different treatments of cancer such as surgery, chemotherapy and radiation therapy, surgical resection is the most effective. Successful surgeries greatly rely on the detection of the accurate tumor size and location, which can be enhanced by contrast agents. Commercial endoscope light sources, however, offer only white light illumination. In this paper, we present the development of a LED endoscope light source that provides 2 light channels plus white light to help surgeons to detect a clear tumor margin during minimally invasive surgeries. By exciting indocyanine green (ICG) and 5-Aminolaevulinic acid (ALA)-induced protoporphyrin IX (PPIX), the light source is intended to give the user a visible image of the tumor margin. This light source is also portable, easy to use and costs less than $300 to build.

  16. Endoscopic and minimally-invasive ear surgery: A path to better outcomes

    Directory of Open Access Journals (Sweden)

    Natasha Pollak


    Full Text Available The development of endoscopic ear surgery techniques promises to change the way we approach ear surgery. In this review paper, we explore the current evidence, seek to determine the advantages of endoscopic ear surgery, and see if these advantages are both measureable and meaningful. The wide field of view of the endoscope allows the surgeon to better visualize the various recesses of the middle ear cleft. Endoscopes make it possible to address the target pathology transcanal, while minimizing dissection or normal tissue done purely for exposure, leading to the evolution of minimally-invasive ear surgery and reducing morbidity. When used in chronic ear surgery, endoscopy appears to have the potential to significantly reduce cholesteatoma recidivism rates. Using endoscopes as an adjunct can increase the surgeon's confidence in total cholesteatoma removal. By doing so, endoscopes reduce the need to reopen the mastoid during second-look surgery, help preserve the canal wall, or even change post-cholesteatoma follow-up protocols by channeling more patients away from a planned second-look.

  17. Minimally invasive surgery: national trends in adoption and future directions for hospital strategy. (United States)

    Tsui, Charlotte; Klein, Rachel; Garabrant, Matthew


    Surgeons have rapidly adopted minimally invasive surgical (MIS) techniques for a wide range of applications since the first laparoscopic appendectomy was performed in 1983. At the helm of this MIS shift has been laparoscopy, with robotic surgery also gaining ground in a number of areas. Researchers estimated national volumes, growth forecasts, and MIS adoption rates for the following procedures: cholecystectomy, appendectomy, gastric bypass, ventral hernia repair, colectomy, prostatectomy, tubal ligation, hysterectomy, and myomectomy. MIS adoption rates are based on secondary research, interviews with clinicians and administrators involved in MIS, and a review of clinical literature, where available. Overall volume estimates and growth forecasts are sourced from The Advisory Board Company's national demand model which provides current and future utilization rate projections for inpatient and outpatient services. The model takes into account demographics (growth and aging of the population) as well as non demographic factors such as inpatient to outpatient shift, increase in disease prevalence, technological advancements, coverage expansion, and changing payment models. Surgeons perform cholecystectomy, a relatively simple procedure, laparoscopically in 96 % of the cases. Use of the robot as a tool in laparoscopy is gaining traction in general surgery and seeing particular growth within colorectal surgery. Surgeons use robotic surgery in 15 % of colectomy cases, far behind that of prostatectomy but similar to that of hysterectomy, which have robotic adoption rates of 90 and 20 %, respectively. Surgeons are using minimally invasive surgical techniques, primarily laparoscopy and robotic surgery, to perform procedures that were previously done as open surgery. As risk-based pressures mount, hospital executives will increasingly scrutinize the cost of new technology and the impact it has on patient outcomes. These changing market dynamics may thwart the expansion of new

  18. Global Health Estimate of Invasive Mycobacterium chimaera Infections Associated with Heater-Cooler Devices in Cardiac Surgery. (United States)

    Sommerstein, Rami; Hasse, Barbara; Marschall, Jonas; Sax, Hugo; Genoni, Michele; Schlegel, Matthias; Widmer, Andreas F


    Investigations of a worldwide epidemic of invasive Mycobacterium chimaera associated with heater-cooler devices in cardiac surgery have been hampered by low clinical awareness and challenging diagnoses. Using data from Switzerland, we estimated the burden of invasive M. chimaera to be 156-282 cases/year in 10 major cardiac valve replacement market countries.

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

    LENUS (Irish Health Repository)

    Kavanagh, Dara O


    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.

  20. The role of minimally invasive spine surgery in the management of pyogenic spinal discitis (United States)

    Turel, Mazda K; Kerolus, Mena; Deutsch, Harel


    Background: Diagnostic yields for spondylodiscitis from CT guided biopsy is low. In the recent years, minimally invasive surgery (MIS) has shown to have a low morbidity and faster recovery. For spinal infections, MIS surgery may offer an opportunity for early pain control while obtaining a higher diagnostic yield than CT-guided biopsies. The aim of this study was to review our patients who underwent MIS surgery for spinal infection and report outcomes. Methods: A retrospective review of seven patients who underwent MIS decompression and/or discectomy in the setting of discitis, osteomyelitis, spondylodiscitis, and/or an epidural abscess was identified. Patient data including symptoms, visual analog score (VAS), surgical approach, antibiotic regimen, and postoperative outcomes were obtained. Results: Of the 7 patients, 5 patients had lumbar infections and two had thoracic infections. All seven patients improved in VAS immediately after surgery and at discharge. The average VAS improved by 4.4 ± 1.9 points. An organism was obtained in 6 of the 7 (85%) patients by the operative cultures. All patients made an excellent clinical recovery without the need for further spine surgery. All patients who received postoperative imaging on follow-up showed complete resolution or dramatically improved magnetic resonance imaging changes. The follow-up ranged from 2 to 9 months. Conclusions: MIS surgery provides an opportunity for early pain relief in patients with discitis, osteomyelitis, spondylodiscitis, and/or epidural abscess by directly addressing the primary cause of pain. MIS surgery for discitis provides a higher diagnostic yield to direct antibiotic treatment. MIS surgery results in good long-term recovery. PMID:28250635

  1. A national review of the frequency of minimally invasive surgery among general surgery residents: assessment of ACGME case logs during 2 decades of general surgery resident training. (United States)

    Richards, Morgan K; McAteer, Jarod P; Drake, F Thurston; Goldin, Adam B; Khandelwal, Saurabh; Gow, Kenneth W


    Minimally invasive surgery (MIS) has created a shift in how many surgical diseases are treated. Examining the effect on resident operative experience provides valuable insight into trends that may be useful for restructuring the requirements of resident training. To evaluate changes in general surgery resident operative experience regarding MIS. Retrospective review of the frequency of MIS relative to open operations among general surgery residents using the Accreditation Council for Graduate Medical Education case logs for academic years 1993-1994 through 2011-2012. General surgery residency training among accredited programs in the United States. We analyzed the difference in the mean number of MIS techniques and corresponding open procedures across training periods using 2-tailed t tests with statistical significance set at P surgery has an increasingly prominent role in contemporary surgical therapy for many common diseases. The open approach, however, still predominates in all but 5 procedures. Residents today must become efficient at performing multiple techniques for a single procedure, which demands a broader skill set than in the past.

  2. How to set-up a program of minimally-invasive surgery for congenital heart defects. (United States)

    Gil-Jaurena, Juan-Miguel; Pérez-Caballero, Ramón; Pita-Fernández, Ana; González-López, María-Teresa; Sánchez, Jairo; De Agustín, Juan-Carlos


    Mid-line sternotomy is the commonest incision for cardiac surgery. Alternative approaches are becoming fashionable in many centres, amidst some reluctance because of learning curves and overall complexity. Our recent experience in starting a new program on minimally invasive pediatric cardiac surgery is presented. The rationale for a stepwise onset and the short-medium term results for a three-year span are displayed. A three-step schedule is planned: First, an experienced surgeon (A) starts performing simple cases. Second, new surgeons (B, C, D, E) are introduced to the minimally invasive techniques according to their own proficiency and skills. Third, the new adopters are enhanced to suggest and develop further minimally invasive approaches. Two quality markers are defined: conversion rate and complications. In part one, surgeon A performs sub-mammary, axillary and lower mini-sternotomy approaches for simple cardiac defects. In part two, surgeons B, C, D and E are customly introduced to such incisions. In part three, new approaches such as upper mini-sternotomy, postero-lateral thoracotomy and video-assisted mini-thoracotomy are introduced after being suggested and developed by surgeons B, C and E, as well as an algorithm to match cardiac conditions and age/weight to a given alternative approach. The conversion rate is one out of 148 patients. Two major complications were recorded, none of them related to our alternative approach. Four minor complications linked to the new incision were registered. The minimally invasive to mid-line sternotomy ratio rose from 20% in the first year to 40% in the third year. Minimally invasive pediatric cardiac surgery is becoming a common procedure worldwide. Our schedule to set up a program proves beneficial. The three-step approach has been successful in our experience, allowing a tailored training for every new surgeon and enhancing the enthusiasm in developing further strategies on their own. Recording conversion-rates and

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

    Directory of Open Access Journals (Sweden)

    J. Bredow


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

  4. Comparing oncologic outcomes after minimally invasive and open surgery for pediatric neuroblastoma and Wilms tumor. (United States)

    Ezekian, Brian; Englum, Brian R; Gulack, Brian C; Rialon, Kristy L; Kim, Jina; Talbot, Lindsay J; Adibe, Obinna O; Routh, Jonathan C; Tracy, Elisabeth T; Rice, Henry E


    Minimally invasive surgery (MIS) has been widely adopted for common operations in pediatric surgery; however, its role in childhood tumors is limited by concerns about oncologic outcomes. We compared open and MIS approaches for pediatric neuroblastoma and Wilms tumor (WT) using a national database. The National Cancer Data Base from 2010 to 2012 was queried for cases of neuroblastoma and WT in children ≤21 years old. Children were classified as receiving open or MIS surgery for definitive resection, with clinical outcomes compared using a propensity matching methodology (two open:one MIS). For children with neuroblastoma, 17% (98 of 579) underwent MIS, while only 5% of children with WT (35 of 695) had an MIS approach for tumor resection. After propensity matching, there was no difference between open and MIS surgery for either tumor for 30-day mortality, readmissions, surgical margin status, and 1- and 3-year survival. However, in both tumors, open surgery more often evaluated lymph nodes and had larger lymph node harvest. Our retrospective review suggests that the use of MIS appears to be a safe method of oncologic resection for select children with neuroblastoma and WT. Further research should clarify which children are the optimal candidates for this approach. © 2017 Wiley Periodicals, Inc.

  5. Diode laser assisted minimal invasive sphenoidotomy for endoscopic transphenoidal pituitary surgery: our technique and results. (United States)

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


    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 < 0.0001). No infections, hemorrhages, or other complications occurred intra- or post-operatively. The 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.

  6. A Novel Technique for Transvaginal Retrieval of Enlarged Pelvic Viscera during Minimally Invasive Surgery

    Directory of Open Access Journals (Sweden)

    Allison Wyman


    Full Text Available Introduction. With the widespread adoption of laparoscopic and robotic surgery, more and more women are undergoing minimally invasive surgery for complex gynecological procedures. The rate-limiting step is often the delivery of an intact uterus or an unruptured adnexal mass. To avoid conversion to a minilaparotomy for specimen retrieval, we describe a novel technique using an Anchor Tissue Retrieval System bag in conjunction with a pneumo-occluder to easily retrieve large specimens through a colpotomy incision. Surgical Technique. After completion of the robotic-assisted hysterectomy, the uterus, fallopian tubes, and ovaries were too large to be retrieved intact despite multiple attempts of delivery through the colpotomy incision. Prior to resorting to a minilaparotomy or morcellation of the specimen, a 15 mm anchor retrieval bag with a pneumo-occluder was placed through the vagina and the intact specimen was easily placed inside the bag under direct visualization and removed through the colpotomy incision intact. Conclusion. We routinely utilize this technique to retrieve hysterectomy specimens that are not readily delivered through the colpotomy incision and find this technique to be safe, highly efficient, and cost effective when there is a need to remove large intact specimens during minimally invasive surgery.

  7. An augmented reality platform for planning of minimally invasive cardiac surgeries (United States)

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


    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. Kinematic, workspace and singularity analysis of a new parallel robot used in minimally invasive surgery (United States)

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


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

  9. Minimally invasive surgery for endometrial cancer: does operative start time impact surgical and oncologic outcomes? (United States)

    Slaughter, Katrina N; Frumovitz, Michael; Schmeler, Kathleen M; Nick, Alpa M; Fleming, Nicole D; dos Reis, Ricardo; Munsell, Mark F; Westin, Shannon N; Soliman, Pamela T; Ramirez, Pedro T


    Recent literature in ovarian cancer suggests differences in surgical outcomes depending on operative start time. We sought to examine the effects of operative start time on surgical outcomes for patients undergoing minimally invasive surgery for endometrial cancer. A retrospective review was conducted of patients undergoing minimally invasive surgery for endometrial cancer at a single institution between 2000 and 2011. Surgical and oncologic outcomes were compared between patients with an operative start time before noon and those with a surgical start time after noon. A total of 380 patients were included in the study (245 with start times before noon and 135 with start times after noon). There was no difference in age (p=0.57), number of prior surgeries (p=0.28), medical comorbidities (p=0.19), or surgical complexity of the case (p=0.43). Patients with surgery starting before noon had lower median BMI than those beginning after noon, 31.2 vs. 35.3 respectively (p=0.01). No significant differences were observed for intraoperative complications (4.4% of patients after noon vs. 3.7% of patients before noon, p=0.79), estimated blood loss (median 100 cc vs. 100 cc, p=0.75), blood transfusion rates (7.4% vs. 8.2%, p=0.85), and conversion to laparotomy (12.6% vs. 7.4%, p=0.10). There was no difference in operative times between the two groups (198 min vs. 216.5 min, p=0.10). There was no association between operative start time and postoperative non-infectious complications (11.9% vs. 11.0%, p=0.87), or postoperative infections (17.8% vs. 12.3%, p=0.78). Length of hospital stay was longer for surgeries starting after noon (median 2 days vs. 1 day, p=0.005). No differences were observed in rates of cancer recurrence (12.6% vs. 8.8%, p=0.39), recurrence-free survival (p=0.97), or overall survival (p=0.94). Our results indicate equivalent surgical outcomes and no increased risk of postoperative complications regardless of operative start time in minimally invasive

  10. Pancreas-related complications following gastrectomy: systematic review and meta-analysis of open versus minimally invasive surgery. (United States)

    Guerra, Francesco; Giuliani, Giuseppe; Iacobone, Martina; Bianchi, Paolo Pietro; Coratti, Andrea


    Postoperative pancreas-related complications are quite uncommon but potentially life-threatening occurrences that may occasionally complicate the postoperative course of gastrectomy. A number of reports have described such conditions after both standard open and minimally invasive surgery. Our study has the purpose to systematically determine the pooled incidence of pancreatic events following radical gastrectomy. We also aimed to elucidate whether any difference in incidence exists between patients operated via conventional open or minimally invasive surgery. PubMed, EMBASE, and the Cochrane Library were systematically searched for randomized or well-matched studies comparing conventional with minimally invasive oncological gastrectomy and reporting pancreas-related postoperative complications. We evaluated possible differences in outcomes between open and minimally invasive surgery. A meta-analysis of relevant comparisons was performed using RevMan 5.3. A total of 20 studies, whereby 6 randomized and 14 non-randomized comparative studies including a total of 7336 patients, were considered eligible for data extraction. Globally, more than 1% of patients experienced some pancreatic occurrences during the postoperative course. The use of minimally invasive surgery showed a trend toward increased overall pancreatic morbidity (OR 1.39), pancreatitis (OR 2.69), and pancreatic fistula (OR 1.13). Although minimally invasive radical gastrectomy is currently established as a valid alternative to open surgery for the treatment of gastric cancer, a higher risk of pancreas-related morbidity should be taken into account.

  11. Minimally Invasive, Single-Stage, Multilevel Surgery for Obstructive Sleep Apnea in Asian Patients. (United States)

    Lin, Hsin-Ching; Friedman, Michael; Chang, Hsueh-Wen; Bonzelaar, Lauren; Salapatas, Anna M; Lin, Meng-Chih; Huang, Kuo-Tung


    This study adds to the literature on the efficacy and low complication rates associated with minimally invasive, single-stage, multilevel surgery for Asian adults with obstructive sleep apnea (OSA) for whom conservative treatment had failed. Overall, our experience has produced results that make this procedure an option for select patients with snoring and OSA. To investigate the effectiveness and safety of anatomy-based, minimally invasive, single-stage, multilevel surgery in the treatment of OSA in an Asian population. This retrospective study enrolled 59 consecutive patients with OSA from a tertiary academic medical center who had multilevel obstruction and unsuccessful conservative therapy and then underwent minimally invasive, single-stage, multilevel surgery. The subjective symptoms and objective polysomnographic findings were collected preoperatively and at a minimum of 3 months postoperatively. The Global Patient Assessment questionnaire was used to assess patient satisfaction after minimally invasive, single-stage, multilevel surgery. Scores on the Epworth Sleepiness Scale and bed partner evaluation of patient's snoring on a visual analog scale (scale of 0-10, with 0 indicating no snoring and 10 indicating the bed partner to leave the room or sleep separately, as assessed by the bed partner). The primary outcomes are a 50% decrease in bed partner's snoring visual analog scale level postoperatively and an improvement of 50% or more in apnea-hypopnea index by an at least 3-month follow-up. Adverse events and patient-reported quality measures were also assessed. Forty-seven patients (36 men and 11 women; mean [SD], 47.3 [10.9] years) with a minimum 3-month follow-up and complete data were included in the analysis. None of the patients had serious perioperative or postoperative complications. Three months postoperatively, the mean (SD) scores on the Epworth Sleepiness Scale and bed partner evaluation of patient's snoring on the visual analog scale decreased

  12. Management of Peritonitis After Minimally Invasive Colorectal Surgery: Can We Stick to Laparoscopy? (United States)

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


    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.

  13. Underestimation of adolescent obesity. (United States)

    Buttenheim, Alison M; Goldman, Noreen; Pebley, Anne R


    Previous studies assessing the validity of adolescent self-reported height and weight for estimating obesity prevalence have not accounted for, potential bias due to nonresponse in self-reports. The aim of this study was to assess the implications of selective nonresponse in self-reports of height and weight for estimates of adolescent obesity. The authors analyzed 613 adolescents ages 12-17 years from the 2006-2008 Los Angeles Family and Neighborhood Survey, a longitudinal study of Los Angeles County households with an oversample of poor neighborhoods. Obesity prevalence estimates were compared based on (a) self-report, (b) measured height and weight for those who did report, and (c) measured height and weight for those who did report. Among younger teens, measured obesity prevalence was higher for those who did not report height and weight compared with those who did (40% vs. 30%). Consequently, obesity prevalence based on self-reported height and weight underestimated measured prevalence by 12 percentage points (when accounting for nonresponse) versus 9 percentage points (when nonresponse was not accounted for). Results were robust to the choice of difference child growth references. Adolescent obesity surveillance and prevention efforts must take into account selective nonresponse for self-reported height and weight, particularly for younger teens. Results should be replicated in a nationally representative sample.

  14. Underestimation of Adolescent Obesity (United States)

    Buttenheim, Alison M.; Gol, Noreen; Pebley, Anne R.


    Background Previous studies assessing the validity of adolescent self-reported height and weight for estimating obesity prevalence have not accounted for potential bias due to non-response in self-reports. Objectives The purpose of this study was to assess the implications of selective non-response in self-reports of height and weight for estimates of adolescent obesity. Methods The authors analyzed 613 adolescents ages 12-17 from the 2006-08 Los Angeles Family and Neighborhood Survey, a longitudinal study of Los Angeles County households with an oversample of poor neighborhoods. Obesity prevalence estimates based on (1) self-report, (2) measured height and weight for those who did report, and (3) measured height and weight for those who did not report were compared. Results Among younger teens, measured obesity prevalence was higher for those who did not report height and weight compared to those who did (40% vs. 30). Consequently, obesity prevalence based on self-reported height and weight underestimated measured prevalence by 12 percentage points (when accounting for non-response) vs. 9 percentage points (when non-response was not accounted for). Results were robust to the choice of difference child growth references (i.e,, CDC vs. International Obesity Task Force). Discussion Adolescent obesity surveillance and prevention efforts must take into account selective non-response for self-reported height and weight, particularly for younger teens. Results should be replicated in a nationally-representative sample. PMID:23636345

  15. Minimally invasive approach to thyroid gland surgery--indications, methods, first results. (United States)

    Dimov, R; Kanchev, R; Apostolov, I; Boev, B; Ivanov, T; Hinov, A; Doikov, I; Cheshmedzhiev, N; Mitev, K; Spasov, Y; Dimova, R


    After the introduction of minimally invasive operative techniques in the surgery of organs located in body cavities, extensive work has been done in the last five years with respect to their application in thyroid gland surgery as well. In 2011, 406 patients underwent thyroid surgery at the Department of Surgery, Kaspela General Hospital for Active Treatment EOOD - Plovdiv. The study involved 48 of these patients, chosen at random and divided into two groups (A-minimally invasive thyroidectomy (MIT) - 26 patients, and B - minimally invasive video-assisted thyroidectomy (MIVAT) - 22 patients). All patients included in the study were selected on the basis of presence of one or more indeterminate nodules (fine needle aspiration biopsy - FNAB) sized up to 3.5 cm, with normal size of the thyroid gland up to 20-25 cm2, detected by preoperative ultrasonography. The study excluded patients with recurrent goitre, malignant disease of the thyroid gland and evidence of preoperative radiation therapy in the area of the head, neck and/or upper mediastinum. The preoperative investigation included history, physical examination, blood indices, echography, gamma camera and FNAB. Sensation of pain was evaluated by the patients according to a visual analogue scale, where lack of pain was evaluated as 0, and the most severe pain was evaluated as 10. The average duration of the hospitalization of patients undergoing MIT was 16 +/- 3.14 hours, whereas the patients undergoing MIVAT had to stay at the hospital for 18 +/- 3.56 hours. No complications were registered regarding the recurrent laryngeal nerves (RLN), as well as the operative wound. It should be noted that in all patients the course of the respective RLN was identified during the operative intervention, visually in most cases, or by electrostimulation. Postoperative hypoparathyroidism, registered by measuring the level of serum calcium, was observed in one visual analogue scale, as well as in the administration of pain

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

    Directory of Open Access Journals (Sweden)

    Sebastian John Baxter


    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.

  17. Milestone assessment of minimally invasive surgery in Pediatric Urology fellowship programs. (United States)

    Smith, P H; Carpenter, M; Herbst, K W; Kim, C


    Minimally invasive surgery has become an important aspect of Pediatric Urology fellowship training. In 2014, the Accreditation Council for Graduate Medical Education published the Pediatric Urology Milestone Project as a metric of fellow proficiency in multiple facets of training, including laparoscopic/robotic procedures. The present study assessed trends in minimally invasive surgery training and utilization of the Milestones among recent Pediatric Urology fellows. Using an electronic survey instrument, Pediatric Urology fellowship program directors and fellows who completed their clinical year in 2015 were surveyed. Participants were queried regarding familiarity with the Milestone Project, utilization of the Milestones, robotic/laparoscopic case volume and training experience, and perceived competency with robotic/laparoscopic surgery at the start and end of the fellowship clinical year according to Milestone criteria. Responses were accepted between August and November 2015. Surveys were distributed via e-mail to 35 fellows and 30 program directors. Sixteen fellows (46%) and 14 (47%) program directors responded. All fellows reported some robotic experience prior to fellowship, and 69% performed >50 robotic/laparoscopic surgeries during residency. Fellow robotic/laparoscopic case volume varied: three had 1-10 cases (19%), four had 11-20 cases (25%), and nine had >20 cases (56%). Supplementary or robotic training modalities included simulation (9), animal models (6), surgical videos (7), and courses (2). Comparison of beginning and end of fellowship robotic/laparoscopic Milestone assessment (Summary Fig.) revealed scores of assessments and 10 (75%) of program director assessments. End of training Milestone scores >4 were seen in 12 (75%) of fellow self-assessment and eight (57%) of program director assessments. An improvement in robotic/laparoscopic Milestone scores by both fellow self-assessment and program director assessment was observed during the course of

  18. Minimally Invasive Surgery Versus Open Surgery Spinal Fusion for Spondylolisthesis: A Systematic Review and Meta-analysis. (United States)

    Lu, Victor M; Kerezoudis, Panagiotis; Gilder, Hannah E; McCutcheon, Brandon A; Phan, Kevin; Bydon, Mohamad


    Systematic review and meta-analysis. Compare minimally invasive surgery (MIS) and open surgery (OS) spinal fusion outcomes for the treatment of spondylolisthesis. OS spinal fusion is an interventional option for patients with spinal disease who have failed conservative therapy. During the past decade, MIS approaches have increasingly been used, with potential benefits of reduced surgical trauma, postoperative pain, and length of hospital stay. However, current literature consists of single-center, low-quality studies with no review of approaches specific to spondylolisthesis only. This first systematic review of the literature regarding MIS and OS spinal fusion for spondylolisthesis treatment was performed using the Preferred Reporting Items for Systematic reviews and Meta-Analyses guidelines for article identification, screening, eligibility, and inclusion. Electronic literature search of Medline/PubMed, Cochrane, EMBASE, and Scopus databases yielded 2489 articles. These articles were screened against established criteria for inclusion into this study. A total of five retrospective and five prospective articles with a total of 602 patients were found. Reported spondylolisthesis grades were I and II only. Overall, MIS was associated with less intraoperative blood loss (mean difference [MD], -331.04 mL; 95% confidence interval [CI], -490.48 to -171.59; P spondylolisthesis. Moreover, although prospective trials associate MIS with better functional outcomes, longer-term and randomized trials are warranted to validate any association found in this study. 2.

  19. Increasing the safety of minimally invasive hallux surgery-An anatomical study introducing the clock method. (United States)

    Malagelada, Francesc; Dalmau-Pastor, Miki; Fargues, Betlem; Manzanares-Céspedes, Maria Cristina; Peña, Fernando; Vega, Jordi


    The purpose of this study is to describe a simple and reproducible method to localize the neurological structures at risk and to describe a safe zone for hallux minimally invasive surgery (MIS) procedures. Ten fresh-frozen cadaveric feet were dissected to identify the dorsomedial digital nerve (DMDN) and the dorsolateral digital nerve (DLDN) of the first toe. Axial sections were performed at the sites of metatarsal osteotomies. We documented the position of the nerves with respect to the extensor hallucis longus (EHL) tendon using a clock method superimposed on the axial section RESULTS: The DMDN was found at an average of 26.2° medial to the medial border of the EHL tendon. (SD 11.26, range 14.5-45.5), whereas the average distance of the DLDN was 32.3° lateral to the medial border of the EHL tendon. (SD 6.29, range 13.5-40). Using the clock method the DMDN and DLDN were found consistently between 10 o'clock and 2 o'clock in either right and left feet. The clock method may facilitate avoiding the area where these nerves are located serving as a valuable tool in minimally invasive foot surgery. Copyright © 2016 European Foot and Ankle Society. Published by Elsevier Ltd. All rights reserved.

  20. The Steinberg-Bernstein Centre for Minimally Invasive Surgery at McGill University. (United States)

    Fried, Gerald M


    Surgical skills and simulation centers have been developed in recent years to meet the educational needs of practicing surgeons, residents, and students. The rapid pace of innovation in surgical procedures and technology, as well as the overarching desire to enhance patient safety, have driven the development of simulation technology and new paradigms for surgical education. McGill University has implemented an innovative approach to surgical education in the field of minimally invasive surgery. The goal is to measure surgical performance in the operating room using practical, reliable, and valid metrics, which allow the educational needs of the learner to be established and enable feedback and performance to be tracked over time. The GOALS system and the MISTELS program have been developed to measure operative performance and minimally invasive surgical technical skills in the inanimate skills lab, respectively. The MISTELS laparoscopic simulation-training program has been incorporated as the manual skills education and evaluation component of the Fundamentals of Laparoscopic Surgery program distributed by the Society of American Gastrointestinal and Endoscopic Surgeons (SAGES) and the American College of Surgeons.

  1. Design of a piezoelectric inchworm actuator and compliant end effector for minimally invasive surgery (United States)

    Canfield, Shawn; Edinger, Ben; Frecker, Mary I.; Koopmann, Gary H.


    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.


    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


    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

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


    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

  4. Del Nido cardioplegia in the setting of minimally invasive aortic valve surgery. (United States)

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


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

  5. Development and testing of a compact endoscope manipulator for minimally invasive surgery. (United States)

    Berkelman, Peter; Cinquin, Philippe; Boidard, Eric; Troccaz, Jocelyne; Létoublon, Christian; Long, Jean-Alexandre


    This report describes the design, development, and testing of a novel compact surgical assistant robot to control the orientation and insertion depth of a laparoscopic endoscope during minimally invasive abdominal surgery. In contrast to typical endoscope manipulators, the described robot is particularly compact and lightweight, is simple to set up and use, occupies no floor or operating table space, and does not limit access to the patient in any way. The sterilizable endoscope manipulator is sufficiently small and lightweight at 625 g and 110 mm in diameter that it can be placed directly on the abdomen of the patient without interfering with other handheld instruments during minimally invasive surgery. It consists of an annular base, a clamp to hold an endoscope trocar, and two joints which enable azimuth rotation and inclination of the endoscope about a pivot point at the incision. The endoscope insertion depth is controlled by a cable winding acting against a compression spring on the endoscope shaft. Voice recognition and miniature keypad user command interfaces are provided, and the manipulator motors are backdriveable for manual repositioning. Endoscope camera trajectory-following accuracy and response-time results were measured using an optical localizer. Experimental results are given comparing the current prototype with the previous cable-driven prototype. The endoscope manipulator and its user interface were tested and evaluated by several surgeons during a series of minimally invasive surgical training procedures on cadavers and animals. The endoscope manipulator described has been shown to be a viable, practical device with performance and functionality equivalent to those of commercially available models, yet with greatly reduced size, weight, and cost.

  6. A Panoramic Wireless Endoscope System Design for the Application of Minimally Invasive Surgery

    Directory of Open Access Journals (Sweden)

    Chun-Hsiang Peng


    Full Text Available Minimally Invasive Surgery (MIS is the current trend in surgery. Compared to traditional surgery, MIS can substantially decrease recovery time and expenses needed by patients after surgeries, reduce pain during surgical procedures, and is highly regarded by physicians and patients. An endoscope is widely used in the diagnosis and treatments of various medical disciplines, such as hysteroscopy, laparoscopy, and colonoscopy, and have been adopted by many branches of medicine. However, the limited image field of MIS is often the most difficult obstacles faced by surgeons and medical students, especially to less experienced physicians and difficult surgical procedures; the limited field of view of endoscopic imaging does not provide a whole picture of the surgery area, making the procedures difficult and full of uncertainty. In light of this problem, we proposed a "Panoramic Wireless Endoscope System design", hoping to provide physicians with a wide field of view of the endoscopic image. We combine images captured from two parallel-mounted endoscope lenses into a single, wide-angle image, giving physicians a wider field of view and easier access to the surgical area. In addition, we developed a wireless transmission system so the image can be transmitted to various display platforms, eliminating the needs for excessive cabling on surgical tools and enable physicians to better operate on the patient. Finally, our system allows surgical assistants a better view of the operation process, and enables other physicians and nurses to remotely observe the process. Our experiment results have shown that we can increase the image to 152% of its original size. We used the PandaBoard ES platform with an ARM9 processor and 1G of onboard RAM, and continuously implementing animal trials to verify the reliability of our system.

  7. Prevalence of Musculoskeletal Disorders Among Surgeons Performing Minimally Invasive Surgery: A Systematic Review. (United States)

    Alleblas, Chantal C J; de Man, Anne Marie; van den Haak, Lukas; Vierhout, Mark E; Jansen, Frank Willem; Nieboer, Theodoor E


    The aim of this study was to review musculoskeletal disorder (MSD) prevalence among surgeons performing minimally invasive surgery. Advancements in laparoscopic surgery have primarily focused on enhancing patient benefits. However, compared with open surgery, laparoscopic surgery imposes greater ergonomic constraints on surgeons. Recent reports indicate a 73% to 88% prevalence of physical complaints among laparoscopic surgeons, which is greater than in the general working population, supporting the need to address the surgeons' physical health. To summarize the prevalence of MSDs among surgeons performing laparoscopic surgery, we performed a systematic review of studies addressing physical ergonomics as a determinant, and reporting MSD prevalence. On April 15 2016, we searched Pubmed, EMBASE, the Cochrane Library, Web of Science, CINAHL, and PsychINFO. Meta-analyses were performed using the Hartung-Knapp-Sidik-Jonkman method. We identified 35 articles, including 7112 respondents. The weighted average prevalence of complaints was 74% [95% confidence interval (95% CI) 65-83]. We found high inconsistency across study results (I = 98.3%) and the overall response rate was low. If all nonresponders were without complaints, the prevalence would be 22% (95% CI 16-30). From the available literature, we found a 74% prevalence of physical complaints among laparoscopic surgeons. However, the low response rates and the high inconsistency across studies leave some uncertainty, suggesting an actual prevalence of between 22% and 74%. Fatigue and MSDs impact psychomotor performance; therefore, these results warrant further investigation. Continuous changes are enacted to increase patient safety and surgical care quality, and should also include efforts to improve surgeons' well-being.

  8. Heated CO(2) with or without humidification for minimally invasive abdominal surgery. (United States)

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


    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, 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

  9. Four-dimensional modeling of the heart for image guidance of minimally invasive cardiac surgeries (United States)

    Wierzbicki, Marcin; Drangova, Maria; Guiraudon, Gerard; Peters, Terry


    Minimally invasive surgery of the beating heart can be associated with two major limitations: selecting port locations for optimal target coverage from x-rays and angiograms, and navigating instruments in a dynamic and confined 3D environment using only an endoscope. To supplement the current surgery planning and guidance strategies, we continue developing VCSP - a virtual reality, patient-specific, thoracic cavity model derived from 3D pre-procedural images. In this work, we apply elastic image registration to 4D cardiac images to model the dynamic heart. Our method is validated on two image modalities, and for different parts of the cardiac anatomy. In a helical CT dataset of an excised heart phantom, we found that the artificial motion of the epicardial surface can be extracted to within 0.93 +/- 0.33 mm. For an MR dataset of a human volunteer, the error for different heart structures such as the myocardium, right and left atria, right ventricle, aorta, vena cava, and pulmonary artery, ranged from 1.08 +/- 0.18 mm to 1.14 +/- 0.22 mm. These results indicate that our method of modeling the motion of the heart is not only easily adaptable but also sufficiently accurate to meet the requirements for reliable cardiac surgery training, planning, and guidance.

  10. A Miniature Robot for Retraction Tasks under Vision Assistance in Minimally Invasive Surgery

    Directory of Open Access Journals (Sweden)

    Giuseppe Tortora


    Full Text Available Minimally Invasive Surgery (MIS is one of the main aims of modern medicine. It enables surgery to be performed with a lower number and severity of incisions. Medical robots have been developed worldwide to offer a robotic alternative to traditional medical procedures. New approaches aimed at a substantial decrease of visible scars have been explored, such as Natural Orifice Transluminal Endoscopic Surgery (NOTES. Simple surgical tasks such as the retraction of an organ can be a challenge when performed from narrow access ports. For this reason, there is a continuous need to develop new robotic tools for performing dedicated tasks. This article illustrates the design and testing of a new robotic tool for retraction tasks under vision assistance for NOTES. The retraction robots integrate brushless motors to enable additional degrees of freedom to that provided by magnetic anchoring, thus improving the dexterity of the overall platform. The retraction robot can be easily controlled to reach the target organ and apply a retraction force of up to 1.53 N. Additional degrees of freedom can be used for smooth manipulation and grasping of the organ.

  11. Minimally invasive video-assisted thyroidectomy compared with conventional thyroidectomy in a general surgery department. (United States)

    Dobrinja, Chiara; Trevisan, Giuliano; Makovac, Petra; Liguori, Gennaro


    We retrospectively evaluated a series of patients who underwent minimally invasive video-assisted thyroidectomy (MIVAT) to define its advantages or disadvantages. Between May 2005 and March 2008, 68 patients underwent MIVAT. Sixty-nine patients who underwent conventional thyroidectomy (CT) during the period before the introduction of the MIVAT technique in our department-chosen with the same inclusion criteria used for MIVAT-served as matched controls. The eligibility criteria for both groups was thyroid nodules surgery. Forty-five MIVAT and 43 CT patients underwent hemithyroidectomy. Twenty-three MIVAT and 26 CT patients underwent total thyroidectomy. No differences were found in terms of complications, operative time, and radicality of the procedure. Patients who underwent MIVAT experienced significantly less pain, better cosmetic results, and shorter hospital stay than patients who underwent conventional surgery The MIVAT technique, in selected patients, seems to be a valid option for thyroidectomy and even preferable to conventional surgery because of its significant advantages, especially in terms of cosmetic results, postoperative pain, and postoperative recovery.

  12. Ergonomic deficiencies in the operating room: examples from minimally invasive surgery. (United States)

    Matern, Ulrich


    The importance of minimally invasive surgery (MIS) has constantly increased in the last 20 years. Laparoscopic removal of the gallbladder has become the gold standard with advantages for patients. However, in laparoscopy, the surgeon loses direct contact with the surgical site. Rather than seeing the entire surgical field including adjacent organs, the surgeon's vision is restricted by an optic and camera system. Pictures of the surgical site in the abdomen are presented on a monitor. Hand eye coordination is decreasing because the operating team is not able to position the monitor at an ergonomically preferable position given that operation tables, constructed for open surgery where surgeons use short instruments, are too high for laparoscopic procedures where surgeons use long-shafted instruments. Additionally the degrees of freedom for camera movements and the instruments are limited, tactile feedback given in open surgery is lost. The typical design of instrument handles leads to pressure areas and nerve lesions. All these aspects force the surgeon into unnatural and uncomfortable body postures that can affect the outcome of the operation. An ideal posture for laparoscopic surgeons is described and ergonomic requirements for an optimal height of operation tables, monitor positions and man-machine interfaces are discussed.

  13. Minimally Invasive Scoliosis Surgery: A Novel Technique in Patients with Neuromuscular Scoliosis

    Directory of Open Access Journals (Sweden)

    Vishal Sarwahi


    Full Text Available Minimally invasive surgery (MIS has been described in the treatment of adolescent idiopathic scoliosis (AIS and adult scoliosis. The advantages of this approach include less blood loss, shorter hospital stay, earlier mobilization, less tissue disruption, and relatively less pain. However, despite these significant benefits, MIS approach has not been reported in neuromuscular scoliosis patients. This is possibly due to concerns with longer surgery time, which is further increased due to more levels fused and instrumented, challenges of pelvic fixation, size and number of incisions, and prolonged anesthesia. We modified the MIS approach utilized in our AIS patients to be implemented in our neuromuscular patients. Our technique allows easy passage of contoured rods, placement of pedicle screws without image guidance, partial/complete facet resection, and all standard reduction maneuvers. Operative time needed to complete this surgery is comparable to the standard procedure and the majority of our patients have been extubated at the end of procedure, spending 1 day in the PICU and 5-6 days in the hospital. We feel that MIS is not only a feasible but also a superior option in patients with neuromuscular scoliosis. Long-term results are unavailable; however, short-term results have shown multiple benefits of this approach and fewer limitations.

  14. Minimally invasive mitral valve surgery is associated with equivalent cost and shorter hospital stay when compared with traditional sternotomy. (United States)

    Atluri, Pavan; Stetson, Robert L; Hung, George; Gaffey, Ann C; Szeto, Wilson Y; Acker, Michael A; Hargrove, W Clark


    Mitral valve surgery is increasingly performed through minimally invasive approaches. There are limited data regarding the cost of minimally invasive mitral valve surgery. Moreover, there are no data on the specific costs associated with mitral valve surgery. We undertook this study to compare the costs (total and subcomponent) of minimally invasive mitral valve surgery relative to traditional sternotomy. All isolated mitral valve repairs performed in our health system from March 2012 through September 2013 were analyzed. To ensure like sets of patients, only those patients who underwent isolated mitral valve repairs with preoperative Society of Thoracic Surgeons scores of less than 4 were included in this study. A total of 159 patients were identified (sternotomy, 68; mini, 91). Total incurred direct cost was obtained from hospital financial records. Analysis demonstrated no difference in total cost (operative and postoperative) of mitral valve repair between mini and sternotomy ($25,515 ± $7598 vs $26,049 ± $11,737; P = .74). Operative costs were higher for the mini cohort, whereas postoperative costs were significantly lower. Postoperative intensive care unit and total hospital stays were both significantly shorter for the mini cohort. There were no differences in postoperative complications or survival between groups. Minimally invasive mitral valve surgery can be performed with overall equivalent cost and shorter hospital stay relative to traditional sternotomy. There is greater operative cost associated with minimally invasive mitral valve surgery that is offset by shorter intensive care unit and hospital stays. Copyright © 2016 The American Association for Thoracic Surgery. Published by Elsevier Inc. All rights reserved.

  15. Development of a laparoscope with multi-resolution foveation capability for minimally invasive surgery (United States)

    Qin, Yi; Hua, Hong; Nguyen, Mike


    Laparoscope is the essential tool for minimally invasive surgery (MIS) within the abdominal cavity. However, the focal length of a conventional laparoscope is fixed. Therefore, it suffers from the tradeoff between field of view (FOV) and spatial resolution. In order to obtain large optical magnification to see more details, a conventional laparoscope is usually designed with a small working distance, typically less than 50mm. Such a small working distance limits the field of coverage, which causes the situational awareness challenge during the laparoscopic surgery. We developed a multi-resolution foveated laparoscope (MRFL) aiming to address this limitation. The MRFL was designed to support a large working distance range from 80mm to 180mm. It is able to simultaneously provide both wide-angle overview and high-resolution image of the surgical field in real time within a fully integrated system. The high-resolution imaging probe can automatically scan and engage to any subfield of the wide-angle view. During the surgery, MRFL does not need to move; therefore it can reduce the instruments conflicts. The FOV of the wide-angle imaging probe is 80° and that of the high-resolution imaging probe is 26.6°. The maximum resolution is about 45um in the object space at an 80mm working distance, which is about 5 times as good as a conventional laparoscope at a 50mm working distance. The prototype can realize an equivalent 10 million-pixel resolution by using only two HD cameras because of its foveation capability. It saves the bandwidth and improves the frame rate compared to the use of a super resolution camera. It has great potential to aid safety and accuracy of the laparoscopic surgery.

  16. Design of a three-segment continuum robot for minimally invasive surgery. (United States)

    Ouyang, Bo; Liu, Yunhui; Sun, Dong

    Continuum robot, as known as snake-like robot, usually does not include rigid links and has the ability to reach into a confined space by shaping itself into smooth curves. This paper presents the design of a three-segment continuum robot for minimally invasive surgery. The continuum robot employs a single super-elastic nitinol rod as the backbone and concentric disks assembled on the backbone for tendons attachment. Each segment is driven by four tendons and controlled by two linear actuators. The length of each segment is optimized based on the surgical workspace. A visual servo system is designed to assist the surgeon in operating the robot. Simulation experiment is conducted to demonstrate the proposed design.

  17. Lapabot: a compact telesurgical robot system for minimally invasive surgery: part I. System description. (United States)

    Choi, Jaesoon; Park, Jun Woo; Kim, Dong Jun; Shin, Jungwook; Park, Chan Young; Lee, Jung Chan; Jo, Yung Ho


    The applications of robotic minimally invasive surgery (MIS) have widened, providing new advantages such as augmented dexterity and telesurgery. However, current commercial robotic laparoscopic surgical systems still have aspects to be improved such as heavy and bulky systems not suitable for agile operations, large rotational radii of robot manipulator arms, limited remote control capacity, and absence of force feedback. We have developed a robotic laparoscopic surgical system that features compact slave manipulators. The system can simultaneously operate one laparoscope arm and up to four instrument arms. The slave robot is controlled remotely through an Ethernet network and is ready for telesurgery. The developed surgical robot has sufficient workspace to perform general MIS and has been shown to provide acceptable motion tracking control performance.

  18. Overview of Photogrammetric Measurement Techniques in Minimally Invasive Surgery Using Endoscopes (United States)

    Conen, N.; Luhmann, T.


    This contribution provides an overview of various photogrammetric measurement techniques in minimally invasive surgery and presents a self-developed prototypical trinocular endoscope for reliable surface measurements. Most of the presented techniques focus on applications regarding laparoscopy, which mean endoscopic operations in the abdominal or pelvic cavities. Since endoscopic operations are very demanding to the surgeon, various assistant systems have been developed. Imaging systems may use photogrammetric techniques in order to perform 3D measurements during operation. The intra-operatively acquired 3D data may be used for analysis, model registration, guidance or documentation. Passive and active techniques have been miniaturised, integrated into endoscopes and investigated by several research groups. The main advantages and disadvantages of several active and passive techniques adapted to laparoscopy are described in this contribution. Additionally, a self-developed trinocular endoscope is described and evaluated.

  19. Radiologic Outcomes According to Varus Deformity in Minimally Invasive Surgery Total Knee Arthroplasty. (United States)

    Yoo, Ju Hyung; Park, Sang Hoon; Han, Chang Dong; Oh, Hyun Cheol; Park, Jun Young; Choi, Seung Jin


    To identify the accuracy of postoperative implant alignment in minimally invasive surgery total knee arthroplasty (MIS-TKA), based on the degree of varus deformity. The research examined 627 cases of MIS-TKA from November 2005 to December 2007. The cases were categorized according to the preoperative degree of varus deformity in the knee joint in order to compare the postoperative alignment of the implant: less than 5° varus (Group 1, 351 cases), 5° to less than 10° varus (Group 2, 189 cases), 10° to less than 15° varus (Group 3, 59 cases), and 15° varus or more (Group 4, 28 cases). On average, the alignment of the tibial implant was 0.2±1.4°, 0.1±1.3°, 0.1±1.6°, and 0.3±1.7° varus, and the tibiofemoral alignment was 5.2±1.9degrees, 4.7±1.9°, 4.9±1.9°, and 5.1±2.0° valgus for Groups 1, 2, 3, and 4, respectively, in the preoperative stage, indicating no difference between the groups (p>0.05). With respect to the accuracy of the tibial implant alignment, 98.1%, 97.6%, 87.5%, and 86.7% of Groups 1, 2, 3, and 4, respectively, had 0±3° varus angulation, demonstrating a reduced level of accuracy in Groups 3 and 4 (p0.05). Satisfactory component alignment was achieved in minimally invasive surgery in total knee arthroplasty, regardless of the degree of varus deformity.

  20. Design and Fabrication of an Elastomeric Unit for Soft Modular Robots in Minimally Invasive Surgery. (United States)

    De Falco, Iris; Gerboni, Giada; Cianchetti, Matteo; Menciassi, Arianna


    In recent years, soft robotics technologies have aroused increasing interest in the medical field due to their intrinsically safe interaction in unstructured environments. At the same time, new procedures and techniques have been developed to reduce the invasiveness of surgical operations. Minimally Invasive Surgery (MIS) has been successfully employed for abdominal interventions, however standard MIS procedures are mainly based on rigid or semi-rigid tools that limit the dexterity of the clinician. This paper presents a soft and high dexterous manipulator for MIS. The manipulator was inspired by the biological capabilities of the octopus arm, and is designed with a modular approach. Each module presents the same functional characteristics, thus achieving high dexterity and versatility when more modules are integrated. The paper details the design, fabrication process and the materials necessary for the development of a single unit, which is fabricated by casting silicone inside specific molds. The result consists in an elastomeric cylinder including three flexible pneumatic actuators that enable elongation and omni-directional bending of the unit. An external braided sheath improves the motion of the module. In the center of each module a granular jamming-based mechanism varies the stiffness of the structure during the tasks. Tests demonstrate that the module is able to bend up to 120° and to elongate up to 66% of the initial length. The module generates a maximum force of 47 N, and its stiffness can increase up to 36%.

  1. Minimally invasive aortic valve surgery. A safe and useful technique beyond the cosmetic benefits. (United States)

    Paredes, Federico A; Cánovas, Sergio J; Gil, Oscar; García-Fuster, Rafael; Hornero, Fernando; Vázquez, Alejandro; Martín, Elio; Mena, Armando; Martínez-León, Juan


    The aim of this study was to compare the in-hospital clinical outcomes of minimally invasive, isolated aortic valve replacement vs median sternotomy. Between 2005 and 2012, 615 patients underwent aortic valve replacement at a single institution, 532 by a median sternotomy (E group) and 83 by a J-shaped ministernotomy (M group). No significant differences were found between the E and M groups in terms of age (69.27 [9.31] years vs 69.40 [10.24] years, respectively), logistic EuroSCORE (6.27 [2.91] vs 5.64 [2.17], respectively), size of implanted valve prosthesis (21.94 [2.04] mm vs 21.79 [2.01] mm, respectively), or the incidence of diabetes, hypercholesterolemia, high blood pressure, or chronic obstructive pulmonary disease. Mean cardiopulmonary bypass time was 102.90 (41.68) min for the E group vs 81.37 (25.41) min for the M group (Psurgery for aortic valve replacement are at least comparable to those achieved with median sternotomy. The length of the hospital stay was reduced by minimally invasive surgery in our single-institution experience. The retrospective nature of this study warrants further randomized prospective trials to validate our results. Copyright © 2013 Sociedad Española de Cardiología. Published by Elsevier Espana. All rights reserved.

  2. Minimally Invasive Surgery for Intracochlear Schwannoma Removal and Simultaneous Cochlear Implantation

    Directory of Open Access Journals (Sweden)

    Bento, Ricardo Ferreira


    Full Text Available Introduction Hearing preservation has not yet been reported in patients undergoing resection of intracochlear schwannomas. This study describes a minimally invasive procedure for intracochlear schwannoma resection with simultaneous cochlear implantation that resulted in good hearing. Objective This study aims to describe a minimally invasive procedure for intracochlear schwannoma resection with simultaneous cochlear implantation. Data Synthesis The technique described in this study was developed for a 55-year-old male with a 20-year history of bilateral progressive hearing loss and tinnitus that had a mass in the left apical turn of the cochlea measuring 0.3 cm. Surgery accessed the apical turn of the cochlea. We performed mastoidectomy and posterior tympanotomy and removed incus and tensor tympani muscle to expose the cochlear apex. The tumor was identified and completely resected. After the cochlea was anatomically preserved, it was implanted with a straight electrode via round window insertion. The histopathological examination confirmed intracochlear schwannoma. Speech perception test revealed 100% speech recognition with closed sentences and the average audiometric threshold (500 to 2000 Hz was 23 dB. Conclusion Our technique led to rehabilitation of the patient and improved hearing without damaging the intracochlear structure, making it possible to perform CI in the same procedure with good results.

  3. 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.


    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.)

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

    Li, Zhihong; Li, Yuqian; Xu, Feifei; Zhang, Xi; Tian, Qiang; Li, Lihong


    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 procedure than from ES.

  5. Minimally invasive surgery for lumbar synovial cysts with coexisting degenerative spondylolisthesis (United States)

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


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

  6. A multimedia electronic patient record (ePR) system for image-assisted minimally invasive spinal surgery. (United States)

    Documet, Jorge; Le, Anh; Liu, Brent; Chiu, John; Huang, H K


    This paper presents the concept of bridging the gap between diagnostic images and image-assisted surgical treatment through the development of a one-stop multimedia electronic patient record (ePR) system that manages and distributes the real-time multimodality imaging and informatics data that assists the surgeon during all clinical phases of the operation from planning Intra-Op to post-care follow-up. We present the concept of this multimedia ePR for surgery by first focusing on image-assisted minimally invasive spinal surgery as a clinical application. Three clinical phases of minimally invasive spinal surgery workflow in Pre-Op, Intra-Op, and Post-Op are discussed. The ePR architecture was developed based on the three-phased workflow, which includes the Pre-Op, Intra-Op, and Post-Op modules and four components comprising of the input integration unit, fault-tolerant gateway server, fault-tolerant ePR server, and the visualization and display. A prototype was built and deployed to a minimally invasive spinal surgery clinical site with user training and support for daily use. A step-by-step approach was introduced to develop a multimedia ePR system for imaging-assisted minimally invasive spinal surgery that includes images, clinical forms, waveforms, and textual data for planning the surgery, two real-time imaging techniques (digital fluoroscopic, DF) and endoscope video images (Endo), and more than half a dozen live vital signs of the patient during surgery. Clinical implementation experiences and challenges were also discussed.

  7. Simple Tools for Surgeons : Design and Evaluation of mechanical alternatives for robotic instruments for Minimally Invasive Surgery

    NARCIS (Netherlands)

    Jaspers, J.E.N.


    Performing complex tasks in Minimally Invasive Surgery (MIS) is demanding due to a disturbed hand-eye co-ordination, the application of non-ergonomic instruments with limited number of degrees of freedom (DOFs) and the two-dimensional (2D) view controlled by the surgical assistance. Robotic camera

  8. Force sensing of multiple-DOF cable-driven instruments for minimally invasive robotic surgery. (United States)

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


    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.

  9. Real-time geometry-aware augmented reality in minimally invasive surgery. (United States)

    Chen, Long; Tang, Wen; John, Nigel W


    The potential of augmented reality (AR) technology to assist minimally invasive surgery (MIS) lies in its computational performance and accuracy in dealing with challenging MIS scenes. Even with the latest hardware and software technologies, achieving both real-time and accurate augmented information overlay in MIS is still a formidable task. In this Letter, the authors present a novel real-time AR framework for MIS that achieves interactive geometric aware AR in endoscopic surgery with stereo views. The authors' framework tracks the movement of the endoscopic camera and simultaneously reconstructs a dense geometric mesh of the MIS scene. The movement of the camera is predicted by minimising the re-projection error to achieve a fast tracking performance, while the three-dimensional mesh is incrementally built by a dense zero mean normalised cross-correlation stereo-matching method to improve the accuracy of the surface reconstruction. The proposed system does not require any prior template or pre-operative scan and can infer the geometric information intra-operatively in real time. With the geometric information available, the proposed AR framework is able to interactively add annotations, localisation of tumours and vessels, and measurement labelling with greater precision and accuracy compared with the state-of-the-art approaches.

  10. Prediction of Muscle Fatigue during Minimally Invasive Surgery Using Recurrence Quantification Analysis

    Directory of Open Access Journals (Sweden)

    Ali Keshavarz Panahi


    Full Text Available Due to its inherent complexity such as limited work volume and degree of freedom, minimally invasive surgery (MIS is ergonomically challenging to surgeons compared to traditional open surgery. Specifically, MIS can expose performing surgeons to excessive ergonomic risks including muscle fatigue that may lead to critical errors in surgical procedures. Therefore, detecting the vulnerable muscles and time-to-fatigue during MIS is of great importance in order to prevent these errors. The main goal of this study is to propose and test a novel measure that can be efficiently used to detect muscle fatigue. In this study, surface electromyography was used to record muscle activations of five subjects while they performed fifteen various laparoscopic operations. The muscle activation data was then reconstructed using recurrence quantification analysis (RQA to detect possible signs of muscle fatigue on eight muscle groups (bicep, triceps, deltoid, and trapezius. The results showed that RQA detects the fatigue sign on bilateral trapezius at 47.5 minutes (average and bilateral deltoid at 57.5 minutes after the start of operations. No sign of fatigue was detected for bicep and triceps muscles of any subject. According to the results, the proposed novel measure can be efficiently used to detect muscle fatigue and eventually improve the quality of MIS procedures with reducing errors that may result from overlooked muscle fatigue.

  11. Respiratory System Function in Patients After Minimally Invasive Aortic Valve Replacement Surgery: A Case Control Study. (United States)

    Stoliński, Jarosław; Musiał, Robert; Plicner, Dariusz; Andres, Janusz

    The aim of the study was to comparatively analyze respiratory system function after minimally invasive, through right minithoracotomy aortic valve replacement (RT-AVR) to conventional AVR. Analysis of 201 patients scheduled for RT-AVR and 316 for AVR between January 2010 and November 2013. Complications of the respiratory system and pulmonary functional status are presented. Complications of the respiratory system occurred in 16.8% of AVR and 11.0% of RT-AVR patients (P = 0.067). The rate of pleural effusions, thoracenteses, pneumonias, or phrenic nerve dysfunctions was not significantly different between groups. Perioperative mortality was 1.9% in AVR and 1.0% in RT-AVR (P = 0.417). Mechanical ventilation time after surgery was 9.7 ± 5.9 hours for AVR and 7.2 ± 3.2 hours for RT-AVR patients (P respiratory system complications. Spirometry examinations revealed that pulmonary functional status was more impaired after AVR in comparison with RT-AVR surgery.

  12. Port insertion for minimally invasive surgery: a report of practices in the Irish Republic. (United States)

    Harrington, Cuan M; Kavanagh, Dara O; Tierney, Sean; Deane, Richard; Hehir, Dermot


    With rapidly evolving surgical technologies, minimally invasive surgery (MIS) has become the mainstay approach for many surgeons worldwide. As laparoscopic surgery was introduced in Ireland over two decades ago, we may be encountering a higher prevalence of related complications. This study aimed to gather data pertaining to risk factors for port-site herniation in MIS. A 14-point anonymous questionnaire was distributed electronically between January and May 2017 to consultant and trainee laparoscopists in the Republic of Ireland. This survey related to laparoscopic volume and surgical approaches to laparoscopic port-sites. There were 172 eligible responses nationally. Approaches to peritoneal access included Hasson, veress (blind puncture) and SILS were 66.3, 32.6 and 1.2%, respectively. Senior surgeons and specialists in Obstetrics and Gynaecology (OBGYN) reported significantly higher utilisations of closed peritoneal access (p ports using absorbable suture in 76.7%, non-absorbable suture in 14.5% and port closure devices in 8.7%. Perceptions of risk factors for PSH were not congruent with significant variations in responses between levels of expertise. This study demonstrates significant variations in laparoscopic port-site practices amongst surgeons nationally. The new era of practitioners may benefit from evidence-based technical workshops and guidelines to increase awareness and reduce potential complications.

  13. Design and fabrication of an IPMC-embedded tube for minimally invasive surgery applications (United States)

    Liu, Jiayu; Wang, Yanjie; Zhao, Dongxu; Zhang, Chi; Chen, Hualing; Li, Dichen


    Minimally Invasive Surgery (MIS) is receiving much attention for a number of reasons, including less trauma, faster recovery and enhanced precision. The traditional robotic actuators do not have the capabilities required to fulfill the demand for new applications in MIS. Ionic Polymer-Metal Composite (IPMC), one of the most promising smart materials, has extensive desirable characteristics such as low actuation voltage, large bending deformation and high functionality. Compared with traditional actuators, IPMCs can mimic biological muscle and are highly promising for actuation in robotic surgery. In this paper, a new approach which involves molding and integrating IPMC actuators into a soft silicone tube to create an active actuating tube capable of multi-degree-of-freedom motion is presented. First, according to the structure and performance requirements of the actuating tube, the biaxial bending IPMC actuators fabricated by using solution casting method have been implemented. The silicone was cured at a suitable temperature to form a flexible tube using molds fabricated by 3D Printing technology. Then an assembly based fabrication process was used to mold or integrate biaxial bending IPMC actuators into the soft silicone material to create an active control tube. The IPMC-embedded tube can generate multi-degree-of-freedom motions by controlling each IPMC actuator. Furthermore, the basic performance of the actuators was analyzed, including the displacement and the response speed. Experimental results indicate that IPMC-embedded tubes are promising for applications in MIS.

  14. "Minimally invasive video-assisted thyroidectomy. Initial experience in a general surgery department". (United States)

    Dobrinja, Chiara; Trevisan, Giuliano; Liguori, Gennaro


    The aim of this study is to analyze our preliminary results from minimally invasive video-assisted thyroidectomy (MIVAT) and demonstrate the feasibility of MIVAT also in non-referral centers. We report our initial experience based on a series of 47 patients selected for MIVAT at General Surgery Department of University of Trieste during a period from May 2005 to February 2007. The eligibility criteria were rigorously observed. Age, goiter volume, major diameter of the dominant nodule, operative times, pathologic findings, postoperative pain, length of hospital stay, cosmetic results, and complications were retrospectively analyzed. Thyroid lobectomy was successfully accomplished in 33 cases, total thyroidectomy in 14. Conversion to standard cervicotomy was required in three patients (6%). Mean operative time of lobectomy was 82.6 min and 118.7 for total thyroidectomy. Postoperative complications included 11 (23.4%) transient hypocalcemias, 2 (4.2%) hematomas, and 2 (4.2%) temporary laryngeal nerve palsies. None-recurrent nerve palsies was observed. The cosmetic result was excellent in most cases. Our experience demonstrates that MIVAT, after adequate training, is feasible and safe, with results comparable to conventional thyroidectomy, also in a General Surgery Department, from a dedicated team, with a sufficient and specific activity volume.

  15. A new visual feedback-based magnetorheological haptic master for robot-assisted minimally invasive surgery (United States)

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


    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.

  16. Psychological trauma of funnel chest in adolescents and the appropriate age for minimally invasive surgery repair. (United States)

    Zhao, Jing; Luo, Li; Xiao, Li-jun; Gu, Ling-yun; Sun, Tian-sheng


    Funnel chest has a negative effect on adolescents and it has a strong effect on adolescents' psychological and behavior. This study aimed to investigate the psychological characteristics and factors that affect adolescents with funnel chest and to evaluate the relationship between the patients' age and their physiological and psychological health. We aimed to establish an age model for maximum surgery benefits for funnel chest patients to provide an objective basis for choosing surgery. The study adopted a general evaluation approach to assess the risk and benefits of minimally invasive surgery for funnel chest. The funnel chest index, the Symptom Checklist-90, and the Eysenck Personality Questionnaire were used as assessment tools to observe physiological and psychological features in funnel chest patients. A sample of 234 adolescents with funnel chest was selected from a third-grade class-A hospital in Beijing. Age groups were adopted as an independent variable, and other factors in funnel chest patients were dependent variables. There was a significant difference in the relapse rate for funnel chest in the different age groups (χ(2) = 11.883, P = 0.008). There was a higher relapse rate in patients of ≤10 or ≥19 years old than in patients of 11-18 years old. There was a significant difference in the SCL-90 total score in the different age groups (F = 12.538, P = 0.0001), the patients older than 13 years had a higher score than those younger than 13 years in the SCL-90. There was a significant difference in the standard score of E (introversion/ extraversion) in the different age groups (F = 10.06, P = 0.0001). There was also a significance in the funnel chest index before surgery in the different psychological scales (P funnel chest index score associated with more obvious psychological trauma. Age and the number of variables, including the relapse rate, SCL-90 score, standard score of E, and standard score of N in the EPQ were significantly correlated

  17. Implementation of minimal invasive gynaecological surgery certification will challenge gynaecologists with new legal and ethical issues (United States)

    Tanos, V; Socolov, R; Demetriou, P; Kyprianou, M; Watrelot, A; Van Belle, Y; Campo, R


    Abstract The introduction of a certification / diploma program in Minimal Invasive Surgery (MIS) is expected to improve surgical performance, patient’s safety and outcome. The Gynaecological Endoscopic Surgical Education and Assessment programme (GESEA) and the ESHRE Certification for Reproductive Endoscopic Surgery (ECRES) provides a structured learning path, recognising different pillars of competence. In order to achieve a high level of competence a two steps validation is necessary: (a) the individual should be certified of having the appropriate theoretical knowledge and (b) the endoscopic psychomotor skills before entering in the diploma programme reflecting the surgical competence. The influence of such an educational and credentialing path could improve safety and offer financial benefits to the hospitals, physicians and healthcare authorities. Moreover the medicolegal consequences can be important when a significant amount of surgeons possess the different diplomas. As the programs are becoming universally accessible, recognised as the best scientific standard, included in the continuous medical education (CME) and continuous professional development (CPD), it is expected that a significant number of surgeons will soon accomplish the diploma path. The co-existence and practice of both non-certified and certified surgeons with different degrees of experience is unavoidable. However, it is expected that national health systems (NHS), hospitals and insurance companies will demand and hire doctors with high and specific proficiency to endoscopic surgery. When medico-legal cases are under investigation, the experts should be aware of the limitations that individual experience provides. The court first of all examines and then judges if there is negligence and decides accordingly. However, lack of certification may be considered as negligence by a surgeon operating a case that eventual faces litigation problems. Patients’ safety and objective preoperative

  18. Augmented reality haptic (ARH): an approach of electromagnetic tracking in minimally invasive surgery. (United States)

    Pagador, J B; Sánchez, L F; Sánchez, J A; Bustos, P; Moreno, J; Sánchez-Margallo, F M


    Minimally Invasive Surgery (MIS) is a widely used surgical technique that requires a long training process due to its difficulty and complexity. We developed an Augmented Reality Haptic (ARH) System based on electromagnetic tracking devices for use in creation training models (computer-enhanced trainers), in computer-assisted surgery or telemanipulation applications. The ARH system consists currently in a Linux driver and a calibration protocol to acquire the tooltip position of conventional laparoscopic tools in real time. A Polhemus Isotrack(®) II was used to track surgical endoscopic tooltip movements. The receiver was mounted on the tool handle in order to measure laparoscopic tools positions without complex modifications. Two validation tests were done to guarantee the proper functioning of the ARH system in a MIS environment. The first one checks the driver operation and the second measures the accuracy and reliability of the tooltip pose estimation process. Jitter and orientation errors for the first test were 2.00±0.10 and 2.00±0.09 mm, respectively. Relative position error of 0.25±0.06 cm for a distance of 5 cm was found. Jitter error for the second test was 127 ± 60, 117 ± 40 and 122 ± 39 mm in Z, Y and X rotations, respectively. Results obtained with the ARH system are sufficiently accurate for use in MIS training. A supplementary correction procedure would be necessary to use this ARH system in computer-assisted surgery or telemanipulation.

  19. Minimally invasive video-assisted parathyroidectomy. Initial experience in a General Surgery Department. (United States)

    Dobrinja, C; Trevisan, G; Liguori, G


    The aim of this study is to analyze our preliminary results from minimally invasive video-assisted parathyroidectomy (MIVAP) and demonstrate the feasibility of MIVAP also in non-referral centers. During a period from June 2005 to January 2008, in the General Surgery Department of University of Trieste, we operated on 39 patients with primary hyperparathyroidism (pHPT). MIVAP by an anterior approach was proposed for 23 (59%) patients with sporadic pHPT and one unequivocally enlarged parathyroid gland on pre-operative ultrasound and 99mTc-SestaMIBI scintigraphy without associated goiter and without previous neck surgery. Intra-operatively, a quick parathyroid assay was used during the last 11 surgical procedures. All patients underwent pre-operative and post-operative investigations of calcemia, phoshoremia and PTH levels and vocal cord function. Age, operative times, pathologic findings, post-operative pain, calcemia, length of hospital stay, cosmetic results, and complications were retrospectively analyzed. MIVAP was successfully accomplished in 22 cases. Conversion to standard cervicotomy was required in one patient (4.34%). Mean operative time was 67 min. Post-operative complications included 1 (4.34%) transient hypocalcemia. No laryngeal nerve palsies, no definitive hypocalcemias, no persistent pHPT and no recurrent pHPT were observed. The cosmetic result was excellent in all cases. Our preliminary results demonstrate that MIVAP for localized single-gland adenoma, after adequate training, seems to be feasible with significant advantages, especially in terms of cosmetic results, post-operative pain, and post-operative recovery even in a General Surgery Department, if performed by a dedicated team, with a sufficient and specific activity volume.

  20. Comparative effects of snoring sound between two minimally invasive surgeries in the treatment of snoring: a randomized controlled trial. (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


    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. 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. 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. 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. Both palatal implants and a single-stage radiofrequency surgery improve subjective snoring outcomes, but palatal implants have a greater effect on most measures of subjective and objective snoring. Multi

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

    Directory of Open Access Journals (Sweden)

    Li Z


    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

  2. Minimally invasive surgery in the era of step-up approach for treatment of severe acute pancreatitis. (United States)

    Morató, Olga; Poves, Ignasi; Ilzarbe, Lucas; Radosevic, Aleksandar; Vázquez-Sánchez, Antonia; Sánchez-Parrilla, Juan; Burdío, Fernando; Grande, Luís


    To assess the minimally invasive surgery into the step-up approach procedures as a standard treatment for severe acute pancreatitis and comparing its results with those obtained by classical management. Retrospective cohort study comparative with two groups treated over two consecutive, equal periods of time were defined: group A, classic management with open necrosectomy from January 2006 to June 2010; and group B, management with the step-up approach with minimally invasive surgery from July 2010 to December 2014. In group A, 83 patients with severe acute pancreatitis were treated, of whom 19 underwent at least one laparotomy, and in 5 any minimally invasive surgery. In group B, 81 patients were treated: minimally invasive surgery was necessary in 17 cases and laparotomy in 3. Among operated patients, the time from admission to first interventional procedures was significantly longer in group B (9 days vs. 18.5 days; p = 0.042). There were no significant differences in Intensive Care Unit stay or overall stay: 9.5 and 27 days (group A) vs. 8.5 and 21 days (group B). Mortality in operated patients and mortality overall were 50% and 18.1% in group A vs 0% and 6.2% in group B (p < 0.001 and p = 0.030). The combination of the step-up approach and minimally invasive surgery algorithm is feasible and could be considered as the standard of treatment for severe acute pancreatitis. The mortality rate deliberately descends when it is used. Copyright © 2018 IJS Publishing Group Ltd. Published by Elsevier Ltd. All rights reserved.

  3. 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.


    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)

  4. Significant reduction of fluoroscopy repetition with lumbar localization system in minimally invasive spine surgery (United States)

    Fan, Guoxin; Zhang, Hailong; Gu, Xin; Wang, Chuanfeng; Guan, Xiaofei; Fan, Yunshan; He, Shisheng


    Abstract The conventional location methods for minimally invasive spinal surgery (MISS) were mainly based on repeated fluoroscopy in a trial-and-error manner preoperatively and intraoperatively. Localization system mainly consisted of preoperative applied radiopaque frame and intraoperative guiding device, which has the potential to minimize fluoroscopy repetition in MISS. The study aimed to evaluate the efficacy of a novel lumbar localization system in reducing radiation exposure to patients. Included patients underwent minimally invasive transforaminal lumbar interbody fusion (MISTLIF) or percutaneous transforaminal endoscopic discectomy (PTED). Patients treated with novel localization system were regarded as Group A, and patients treated without novel localization system were regarded as Group B. For PTED, The estimated effective dose was 0.41 ± 0.13 mSv in Group A and 0.57 ± 0.14 mSv in Group B (P fluoroscopy exposure time of PTED was 22.18 ± 7.30 seconds in Group A and 30.53 ± 7.56 seconds in Group B (P fluoroscopy exposure time was 25.41 ± 5.52 seconds in Group A and 32.82 ± 5.03 seconds in Group B (P < .001); The estimated cancer risk was 24.90 ± 5.15 (10–6) in Group A and 31.96 ± 5.04 (10–6) in Group B (P < .001). There were also significant differences in localization time and operation time between the 2 groups either for MISTLIF or PTED. The lumbar localization system could be a potential protection strategy for minimizing radiation hazards. PMID:28538369

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

    Directory of Open Access Journals (Sweden)

    Vishwas Malik


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

  6. Myocardial Protection in Mitral Valve Surgery: Comparison Between Minimally Invasive Approach and Standard Sternotomy. (United States)

    Lebon, Jean-Sébastien; Couture, Pierre; Fortier, Annik; Rochon, Antoine G; Ayoub, Christian; Viens, Claudia; Laliberté, Éric; Bouchard, Denis; Pellerin, Michel; Deschamps, Alain


    To compare antegrade and retrograde cardioplegia administration in minimally invasive mitral valve surgery (MIMS) and open mitral valve surgery (OMS) for myocardial protection. Retrospective study. Tertiary care university hospital. The study comprised 118 patients undergoing MIMS and 118 patients undergoing OMS. The data of patients admitted for MIMS from 2006 to 2010 were reviewed. Patients undergoing isolated elective OMS from 2004 to 2006 were used as a control group. Cardioplegia in the MIMS group was delivered via the distal port of the endoaortic clamp and an endovascular coronary sinus catheter positioned using echographic and fluoroscopic guidance. Antegrade and retrograde cardioplegia were used in OMS. Data regarding myocardial infarction (MI) (creatine kinase [CK]-MB, troponin T, electrocardiography); myocardial function; and hemodynamic stability were collected. There was no difference in the perioperative MI incidence between both groups (1 in each group, p = 0.96). No statistically significant difference was found for maximal CK-MB (35.9 µg/L [25.1-50.1] v 37.9 µg/L [28.6-50.9]; p = 0.31) or the number of patients with CK-MB levels >50 µg/L (29 v 33; p = 0.55) or CK-MB >100 µg/L (3 v 4; p = 0.70) between the OMS and MIMS groups. However, maximum troponin T levels in the MIMS group were significantly lower (0.47 µg/L [0.32-0.79] v 0.65 µg/L [0.45-0.94]; p = 0.0007). No difference in the incidence of difficult weaning from bypass and intra-aortic balloon pump use between the MIMS and OMS groups was found. Antegrade and retrograde cardioplegia administration during MIMS and OMS provided comparable myocardial protection. Crown Copyright © 2017. Published by Elsevier Inc. All rights reserved.

  7. Kinematics optimization and static analysis of a modular continuum robot used for minimally invasive surgery. (United States)

    Qi, Fei; Ju, Feng; Bai, Dong Ming; Chen, Bai


    For the outstanding compliance and dexterity of continuum robot, it is increasingly used in minimally invasive surgery. The wide workspace, high dexterity and strong payload capacity are essential to the continuum robot. In this article, we investigate the workspace of a cable-driven continuum robot that we proposed. The influence of section number on the workspace is discussed when robot is operated in narrow environment. Meanwhile, the structural parameters of this continuum robot are optimized to achieve better kinematic performance. Moreover, an indicator based on the dexterous solid angle for evaluating the dexterity of robot is introduced and the distal end dexterity is compared for the three-section continuum robot with different range of variables. Results imply that the wider range of variables achieve the better dexterity. Finally, the static model of robot based on the principle of virtual work is derived to analyze the relationship between the bending shape deformation and the driven force. The simulations and experiments for plane and spatial motions are conducted to validate the feasibility of model, respectively. Results of this article can contribute to the real-time control and movement and can be a design reference for cable-driven continuum robot.

  8. Multispectral image alignment using a three channel endoscope in vivo during minimally invasive surgery (United States)

    Clancy, Neil T.; Stoyanov, Danail; James, David R. C.; Di Marco, Aimee; Sauvage, Vincent; Clark, James; Yang, Guang-Zhong; Elson, Daniel S.


    Sequential multispectral imaging is an acquisition technique that involves collecting images of a target at different wavelengths, to compile a spectrum for each pixel. In surgical applications it suffers from low illumination levels and motion artefacts. A three-channel rigid endoscope system has been developed that allows simultaneous recording of stereoscopic and multispectral images. Salient features on the tissue surface may be tracked during the acquisition in the stereo cameras and, using multiple camera triangulation techniques, this information used to align the multispectral images automatically even though the tissue or camera is moving. This paper describes a detailed validation of the set-up in a controlled experiment before presenting the first in vivo use of the device in a porcine minimally invasive surgical procedure. Multispectral images of the large bowel were acquired and used to extract the relative concentration of haemoglobin in the tissue despite motion due to breathing during the acquisition. Using the stereoscopic information it was also possible to overlay the multispectral information on the reconstructed 3D surface. This experiment demonstrates the ability of this system for measuring blood perfusion changes in the tissue during surgery and its potential use as a platform for other sequential imaging modalities. PMID:23082296

  9. Highly dexterous 2-module soft robot for intra-organ navigation in minimally invasive surgery. (United States)

    Abidi, Haider; Gerboni, Giada; Brancadoro, Margherita; Fras, Jan; Diodato, Alessandro; Cianchetti, Matteo; Wurdemann, Helge; Althoefer, Kaspar; Menciassi, Arianna


    For some surgical interventions, like the Total Mesorectal Excision (TME), traditional laparoscopes lack the flexibility to safely maneuver and reach difficult surgical targets. This paper answers this need through designing, fabricating and modelling a highly dexterous 2-module soft robot for minimally invasive surgery (MIS). A soft robotic approach is proposed that uses flexible fluidic actuators (FFAs) allowing highly dexterous and inherently safe navigation. Dexterity is provided by an optimized design of fluid chambers within the robot modules. Safe physical interaction is ensured by fabricating the entire structure by soft and compliant elastomers, resulting in a squeezable 2-module robot. An inner free lumen/chamber along the central axis serves as a guide of flexible endoscopic tools. A constant curvature based inverse kinematics model is also proposed, providing insight into the robot capabilities. Experimental tests in a surgical scenario using a cadaver model are reported, demonstrating the robot advantages over standard systems in a realistic MIS environment. Simulations and experiments show the efficacy of the proposed soft robot. Copyright © 2017 John Wiley & Sons, Ltd.

  10. Psychomotor skills assessment by motion analysis in minimally invasive surgery on an animal organ. (United States)

    Hofstad, Erlend Fagertun; Våpenstad, Cecilie; Bø, Lars Eirik; Langø, Thomas; Kuhry, Esther; Mårvik, Ronald


    A high level of psychomotor skills is required to perform minimally invasive surgery (MIS) safely. To be able to measure these skills is important in the assessment of surgeons, as it enables constructive feedback during training. The aim of this study was to test the validity of an objective and automatic assessment method using motion analysis during a laparoscopic procedure on an animal organ. Experienced surgeons in laparoscopy (experts) and medical students (novices) performed a cholecystectomy on a porcine liver box model. The motions of the surgical tools were acquired and analyzed by 11 different motion-related metrics, i.e., a total of 19 metrics as eight of them were measured separately for each hand. We identified for which of the metrics the experts outperformed the novices. In total, two experts and 28 novices were included. The experts achieved significantly better results for 13 of the 19 instrument motion metrics. Expert performance is characterized by a low time to complete the cholecystectomy, high bimanual dexterity (instrument coordination), a limited amount of movement and low measurement of motion smoothness of the dissection instrument, and relatively high usage of the grasper to optimize tissue positioning for dissection.

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

    Directory of Open Access Journals (Sweden)

    R. Beira


    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.

  12. Minimally invasive surgery training using multiple port sites to improve performance. (United States)

    White, Alan D; Giles, Oscar; Sutherland, Rebekah J; Ziff, Oliver; Mon-Williams, Mark; Wilkie, Richard M; Lodge, J Peter A


    Structural learning theory suggests that experiencing motor task variation enables the central nervous system to extract general rules regarding tasks with a similar structure - rules that can subsequently be applied to novel situations. Complex minimally invasive surgery (MIS) requires different port sites, but switching ports alters the limb movements required to produce the same endpoint control of the surgical instrument. The purpose of the present study was to determine if structural learning theory can be applied to MIS to inform training methods. A tablet laptop running bespoke software was placed within a laparoscopic box trainer and connected to a monitor situated at eye level. Participants (right-handed, non-surgeons, mean age = 23.2 years) used a standard laparoscopic grasper to move between locations on the screen. There were two training groups: the M group (n = 10) who trained using multiple port sites, and the S group (n = 10) who trained using a single port site. A novel port site was used as a test of generalization. Performance metrics were a composite of speed and accuracy (SACF) and normalized jerk (NJ; a measure of movement 'smoothness'). The M group showed a statistically significant performance advantage over the S group at test, as indexed by improved SACF (p MIS training. This may have practical applications when training junior surgeons and developing surgical simulation devices.

  13. Mechatronic design of a fully integrated camera for mini-invasive surgery. (United States)

    Zazzarini, C C; Patete, P; Baroni, G; Cerveri, P


    This paper describes the design features of an innovative fully integrated camera candidate for mini-invasive abdominal surgery with single port or transluminal access. The apparatus includes a CMOS imaging sensor, a light-emitting diode (LED)-based unit for scene illumination, a photodiode for luminance detection, an optical system designed according to the mechanical compensation paradigm, an actuation unit for enabling autofocus and optical zoom, and a control logics based on microcontroller. The bulk of the apparatus is characterized by a tubular shape with a diameter of 10 mm and a length of 35 mm. The optical system, composed of four lens groups, of which two are mobile, has a total length of 13.46 mm and an effective focal length ranging from 1.61 to 4.44 mm with a zoom factor of 2.75×, with a corresponding angular field of view ranging from 16° to 40°. The mechatronics unit, devoted to move the zoom and the focus lens groups, is implemented adopting miniature piezoelectric motors. The control logics implements a closed-loop mechanism, between the LEDs and photodiode, to attain automatic control light. Bottlenecks of the design and some potential issues of the realization are discussed. A potential clinical scenario is introduced.

  14. Development of a new 3-DOF parallel manipulator for minimally invasive surgery. (United States)

    Khalifa, Alaa; Fanni, Mohamed; Mohamed, Abdelfatah M; Miyashita, Tomoyuki


    This article proposes a novel dexterous endoscopic parallel manipulator for minimally invasive surgery. The proposed manipulator has 3 degrees of freedom (3-DOF), which consist of two rotational DOFs and one translational DOF (2R1T DOFs). The manipulator consists of 3 limbs exhibiting identical kinematic structure. Each limb contains an active prismatic joint followed by 2 consecutive passive universal joints. The proposed manipulator has a unique arrangement of its joints' axes. This unique arrangement permits large bending angles, ±90° in any direction, and a workspace almost free from interior singularities. These advantages allow the proposed manipulator to outperforms existing surgical manipulators. However, this unique arrangement makes the analysis of the robot extremely difficult. Therefore, a geometrical/analytical approach is used to facilitate its singularity analysis. Construction of the virtual prototype is accomplished using ADAMS software to validate the proposed manipulator and its bending capability. A closed-form solution for inverse kinematics is obtained analytically. Also, the forward kinematics solution is obtained numerically. Moreover, evaluation of the workspace is achieved using motion/force transmissibility indices. A practical experiment has been performed using a scaling technique and PID controller. The experimental results show the feasibility of the teleoperated surgical system using the proposed parallel manipulator as the slave. Copyright © 2018 John Wiley & Sons, Ltd.

  15. Minimally invasive surgery for young female patients with mild-to-moderate juvenile hallux valgus deformity. (United States)

    Choi, Jun Young; Ahn, Hee Chan; Kim, Sang Hee; Lee, Si Young; Suh, Jin Soo


    We aimed to compare the clinical and radiographic outcomes of minimally invasive surgery (MIS) and distal chevron metatarsal osteotomy (DCMO) for young female patients with mild-to-moderate juvenile hallux valgus deformity. We retrospectively reviewed the radiographs and clinical findings of young female patients with mild-to-moderate juvenile hallux valgus who underwent MIS (25 feet) or DCMO (30 feet). In 12 of 25 MIS feet, 2.0-mm bio-absorbable pins were used as an additional fixation device crossing the osteotomy site, and 1.4-mm Kirschner wires were used in the remaining 13 feet. Radiographic and clinical parameters preoperatively and at the final follow-up were not significantly different between the 2 groups. There were no significant differences in the increments of hallux valgus angle (HVA), distal metatarsal articular angle, medial sesamoid position, first metatarsal length, metatarsal length index, or relative second metatarsal length. Two MIS subgroups according to the additional fixation device showed no significant differences in HVA, the first to second intermetatarsal angle lateral translation ratio, or plantar offset at the final follow-up. MIS for young female patients with mild-to-moderate juvenile hallux valgus deformity had similar radiographic and clinical outcomes compared to DCMO. Regarding additional fixation crossing the osteotomy site, both temporary Kirschner wires and absorbable pins showed no radiographic differences in terms of correction maintenance. 3. Copyright © 2017 European Foot and Ankle Society. Published by Elsevier Ltd. All rights reserved.

  16. Control of an ER haptic master in a virtual slave environment for minimally invasive surgery applications

    International Nuclear Information System (INIS)

    Han, Young-Min; Choi, Seung-Bok


    This paper presents the control performance of an electrorheological (ER) fluid-based haptic master device connected to a virtual slave environment that can be used for minimally invasive surgery (MIS). An already developed haptic joint featuring controllable ER fluid and a spherical joint mechanism is adopted for the master system. Medical forceps and an angular position measuring device are devised and integrated with the joint to establish the MIS master system. In order to embody a human organ in virtual space, a volumetric deformable object is used. The virtual object is then mathematically formulated by a shape-retaining chain-linked (S-chain) model. After evaluating the reflection force, computation time and compatibility with real-time control, the haptic architecture for MIS is established by incorporating the virtual slave with the master device so that the reflection force for the object of the virtual slave and the desired position for the master operator are transferred to each other. In order to achieve the desired force trajectories, a sliding mode controller is formulated and then experimentally realized. Tracking control performances for various force trajectories are evaluated and presented in the time domain

  17. Systolic time intervals vs invasive predictors of fluid responsiveness after coronary artery bypass surgery(dagger)

    NARCIS (Netherlands)

    Smorenberg, A.; Lust, E.J.; Beishuizen, A.; Meijer, J.H.; Verdaasdonk, R.M.; Groeneveld, A.B.J.


    OBJECTIVES: Haemodynamic parameters for predicting fluid responsiveness in intensive care patients are invasive, technically challenging or not universally applicable. We compared the initial systolic time interval (ISTI), a non-invasive measure of the time interval between the electrical and

  18. Can Rural Minimally Invasive Surgery Fellowships Provide Operative Experience Similar to Urban Programs? (United States)

    Ryan, James Patrick; Borgert, Andrew J; Kallies, Kara J; Carlson, Lea M; McCollister, Howard; Severson, Paul A; Kothari, Shanu N


    Operative experience in rural fellowship programs is largely unknown. The 2 of the most rural minimally invasive surgery (MIS)/bariatric fellowships are located in the upper Midwest. We hypothesized that these 2 programs would offer a similar operative experience to other U.S. programs in more urban locations. The 2011 to 2012 and 2012 to 2013 fellowship case logs from 2 rural Midwest programs were compared with case logs from 23 U.S. MIS/bariatric programs. All rural Midwest fellowship graduates completed a survey describing their fellowship experience and current practice. Statistical analysis included Wilcoxon rank-sum test. Setting included the 2 rural Midwest U.S. MIS/bariatric fellowship programs. Graduates from MIS/bariatric fellowship programs participated in the study. Mean volumes for bariatric, foregut, abdominal wall, small intestine, and hepatobiliary cases for rural Midwest fellows vs. other U.S. programs were 123.8 ± 23.7 vs. 150.2 ± 49.2 (p = 0.20); 44.3 ± 19.4 vs. 66.3 ± 35.5 (p = 0.18); 48.3 ± 28.0 vs. 57.9 ± 27.8 (p = 0.58); 11.3 ± 1.9 vs. 12.0 ± 8.7 (p = 0.58); and 55.0 ± 34.8 vs. 48.1 ± 42.6 (p = 0.63), respectively. Mean endoscopy volume was significantly higher among rural Midwest fellows (451.0 ± 395.2 vs. 99.7 ± 83.4; p = 0.05). All rural Midwest fellows reported an adequate number of cases as operating surgeon during fellowship. A total of 60% of fellows currently practice in a rural area. In all, 87% and 13% reported that their fellowship training was extremely or somewhat beneficial to their current practice, respectively. Rural MIS fellowship programs offer a similar operative experience to other U.S. programs. A greater volume of endoscopy cases was observed in rural Midwest fellowships. Copyright © 2016 Association of Program Directors in Surgery. Published by Elsevier Inc. All rights reserved.

  19. An application of structural equation modeling to detect response shifts and true change in quality of life data from cancer patients undergoing invasive surgery

    NARCIS (Netherlands)

    Oort, Frans J.; Visser, Mechteld R. M.; Sprangers, Mirjam A. G.


    The objective is to show how structural equation modeling can be used to detect reconceptualization, reprioritization, and recalibration response shifts in quality of life data from cancer patients undergoing invasive surgery. A consecutive series of 170 newly diagnosed cancer patients,

  20. Comparative effects of snoring sound between two minimally invasive surgeries in the treatment of snoring: a randomized controlled trial.

    Directory of Open Access Journals (Sweden)

    Li-Ang Lee

    Full Text Available 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

  1. A study of psychomotor skills in minimally invasive surgery: what differentiates expert and nonexpert performance. (United States)

    Hofstad, Erlend Fagertun; Våpenstad, Cecilie; Chmarra, Magdalena Karolina; Langø, Thomas; Kuhry, Esther; Mårvik, Ronald


    A high level of psychomotor skills is required to perform minimally invasive surgery (MIS) safely. To assure high quality of skills, it is important to be able to measure and assess these skills. For that, it is necessary to determine aspects that indicate the difference between performances at various levels of proficiency. Measurement and assessment of skills in MIS are best done in an automatic and objective way. The goal of this study was to investigate a set of nine motion-related metrics for their relevance to assess psychomotor skills in MIS during the performance of a labyrinth task. Thirty-two surgeons and medical students were divided into three groups according to their level of experience in MIS; experts (>500 MIS procedures), intermediates (31-500 MIS), and novices (no experience in MIS). The participants performed the labyrinth task in the D-box Basic simulator (D-Box Medical, Lier, Norway). The task required bimanual maneuvering and threading a needle through a labyrinth of 10 holes. Nine motion-related metrics were used to assess the MIS skills of each participant. Experts (n = 7) and intermediates (n = 14) performed significantly better than the novices (n = 11) in terms of time and parameters measuring the amount of instrument movement. The experts had significantly better bimanual dexterity, which indicated that they made more simultaneous movements of the two instruments compared to the intermediates and novices. The experts also performed the task with a shorter instrument path length with the nondominant hand than the intermediates. The surgeon's performance in MIS can be distinguished from a novice by metrics such as time and path length. An experienced surgeon in MIS can be differentiated from a less experienced one by the higher ability to control the instrument in the nondominant hand and the higher degree of simultaneous (coordinated) movements of the two instruments.

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

    Directory of Open Access Journals (Sweden)

    Yi-Zhong Sun


    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.

  3. Validation of the three web quality dimensions of a minimally invasive surgery e-learning platform. (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


    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

  4. Repeated surgeries in invasive lobular breast cancer with preoperative MRI: Role of additional carcinoma in situ and background parenchymal enhancement. (United States)

    Preibsch, H; Richter, V; Bahrs, S D; Hattermann, V; Wietek, B M; Bier, G; Kloth, C; Blumenstock, G; Hahn, M; Staebler, A; Nikolaou, K; Wiesinger, B


    Analysing the influence of additional carcinoma in situ (CIS) and background parenchymal enhancement (BPE) in preoperative MRI on repeated surgeries in patients with invasive lobular carcinoma (ILC) of the breast. Retrospective analysis of 106 patients (mean age 58.6±9.9years) with 108 ILC. Preoperative tumour size as assessed by MRI, mammography and sonography was recorded and compared to histopathology. In contrast-enhanced MRI, the degree of BPE was categorised by two readers. The influence of additionally detected CIS and BPE on the rate of repeated surgeries was analysed. Additional CIS was present in 45.4% of the cases (49/108). The degree of BPE was minimal or mild in 80% of the cases and moderate or marked in 20% of the cases. In 17 cases (15.7%) at least one repeated surgery was performed. In n=15 of these cases, repeated surgery was performed after BCT (n=9 re-excisions, n=6 conversions to mastectomy), in n=2 cases after initial mastectomy. The initial surgical procedure (p=0.008) and additional CIS (p=0.046) significantly influenced the rate of repeated surgeries, while tumour size, patient age and BPE did not (p=ns). Additional CIS was associated with a higher rate of repeated surgeries, whereas BPE had no influence. Copyright © 2017 Elsevier B.V. All rights reserved.

  5. [Risk Factors for Predicting the Need for Additional Surgery for Symptomatic Adjacent Segment Disease after Minimally Invasive Surgery-Transforaminal Lumbar Interbody Fusion]. (United States)

    Fukaya, Kenji; Hasegawa, Mitsuhiro; Shirato, Mitsuru; Teshima, Takashi


    To determine the incidence of and risk factors for symptomatic adjacent segment disease(SASD)requiring additional surgery in patients previously treated with minimally invasive surgery-transforaminal lumbar interbody fusion(MIS-TLIF)for degenerative lumbar disease. A series of 467 consecutive patients who had undergone MIS-TLIF of one or two segments to treat degenerative lumbar disease was identified. The mean age of the patients at the time of the index operation was 67.7 years and the mean follow-up period was 33.2 months(range, 6.0-110.1 months). The incidence rate of SASD surgeries was calculated using the Kaplan-Meier method. The log-rank test and Cox regression analysis were used for risk factor analysis based on age, sex, number of fused segments, presence of laminectomy adjacent to index fusion, and L1 plumb line. The overall incidence rate of SASD requiring additional surgery was 2.8%. Kaplan-Meier analysis predicted a disease-free rate of adjacent segments in 94.3% of the patients at 4 years and in 90.8% of the patients at 8 years after the index operation. In the analysis of risk factors, a negative L1 plumb line was associated with a 5.6 times higher incidence of SASD requiring additional surgery than that associated with a positive L1 plumb line(p=0.0096). There was no significant difference in the survival rates based on age, sex, number of fused segments, and concomitant laminectomy to adjacent segment. Approximately 9.2% of the patients were predicted to undergo additional surgery for treating SASD within 8 years of MIS-TLIF. In this study, presence of a negative L1 plumb line indicated higher incidence of additional SASD associated surgeries than that shown by a positive L1 plumb line. Therefore, surgeons should carefully consider this factor while performing MIS-TLIF.

  6. Patients with Invasive Lobular Breast Cancer Are Less Likely to Undergo Breast-Conserving Surgery: A Population Based Study in The Netherlands

    NARCIS (Netherlands)

    Truin, W.; Roumen, R.M.; Siesling, Sabine; van der Heiden-van der Loo, M.; Duijm, E.M.; Tjan-Heijnen, V.C.G.; Voogd, A.C.


    Purpose The aim of this study was to compare the frequency of breast-conserving surgery (BCS) between early-stage invasive ductal (IDC) and invasive lobular breast cancer (ILC). Methods Women with primary non-metastatic pT1 and pT2 IDC or ILC diagnosed between 1990 and 2010 were selected from the

  7. Drug, devices, technologies, and techniques for blood management in minimally invasive and conventional cardiothoracic surgery: a consensus statement from the International Society for Minimally Invasive Cardiothoracic Surgery (ISMICS) 2011. (United States)

    Menkis, Alan H; Martin, Janet; Cheng, Davy C H; Fitzgerald, David C; Freedman, John J; Gao, Changqing; Koster, Andreas; Mackenzie, G Scott; Murphy, Gavin J; Spiess, Bruce; Ad, Niv


    The objectives of this consensus conference were to evaluate the evidence for the efficacy and safety of perioperative drugs, technologies, and techniques in reducing allogeneic blood transfusion for adults undergoing cardiac surgery and to develop evidence-based recommendations for comprehensive perioperative blood management in cardiac surgery, with emphasis on minimally invasive cardiac surgery. The consensus panel short-listed the potential topics for review from a comprehensive list of potential drugs, devices, technologies, and techniques. The process of short-listing was based on the need to prioritize and focus on the areas of highest importance to surgeons, anesthesiologists, perfusionists, hematologists, and allied health care involved in the management of patients who undergo cardiac surgery whether through the conventional or minimally invasive approach. MEDLINE, Cochrane Library, and Embase databases were searched from their date of inception to May 2011, and supplemental hand searches were also performed. Detailed methodology and search strategies are outlined in each of the subsequently published systematic reviews. In general, all relevant synonyms for drugs (antifibrinolytic, aprotinin, [Latin Small Letter Open E]-aminocaproic acid, tranexamic acid [TA], desmopressin, anticoagulants, heparin, antiplatelets, anti-Xa agents, adenosine diphosphate inhibitors, acetylsalicylic acid [ASA], factor VIIa [FVIIa]), technologies (cell salvage, miniaturized cardiopulmonary bypass (CPB) circuits, biocompatible circuits, ultrafiltration), and techniques (transfusion thresholds, minimally invasive cardiac or aortic surgery) were searched and combined with terms for blood, red blood cells, fresh-frozen plasma, platelets, transfusion, and allogeneic exposure. The American Heart Association/American College of Cardiology system was used to label the level of evidence and class of each recommendation. Database search identified more than 6900 articles, with 4423 full

  8. Clinical comparison of robotic minimally invasive surgery and transcatheter interventional occlusion for adult secundum atrial septal defect

    Directory of Open Access Journals (Sweden)

    Cheng WANG


    Full Text Available Objective  To assess the safety and efficiency of robotic minimally invasive surgery and transcatheter interventional occlusion for treatment of adult secundum atrial septal defect (ASD by comparing the early and recent postoperative follow-up results of the two minimally invasive surgery. Methods  Thirty adult patients with secundum ASD, who admitted to the General Hospital of PLA from Jan. 2008 to Dec. 2014 and received treatment of da Vinci Surgical System, were recruited as TEASD-R group, meanwhile, another 30 adult patients who received transcatheter interventional occlusion were recruited under the strict 1:1 criterion as TIASD-O group. The early postoperative complications, in-hospital conditions, recent postoperative follow-up results and the quality of life 30d and 6 months after operation were compared and retrospectively analyzed between the two groups. Results  The success rates of surgery were 100% in the both groups, no early and recent postoperative complications (residual shunt, pericardial effusion, cerebral infarction, peripheral vascular embolism, new arrhythmia, etc. were found in TEASD-R group. While some of corresponding complications existed in TISAD-O group, and the differences were of statistical significance (P<0.05 between the two groups in the incidence of postoperative new arrhythmia, tricuspid incompetence and pulmonary hypertension, as well as in the early size of right atrium and in-hospital time. SF-36 quality of life questionnaire showed that the difference of somatic pain 30d after operation was of statistical significance (P<0.05 between the two groups, but the difference disappeared 6 months after operation. Conclusion  Robotic minimally invasive surgery for adult secundum ASD is feasible, safe and efficacious since no postoperative complications occurred such as tricuspid incompetence and pulmonary hypertension, but the longer operative and inhosptial time are the shortages of the operation. DOI: 10

  9. The role of minimally invasive spine surgery in the management of pyogenic spinal discitis

    Directory of Open Access Journals (Sweden)

    Mazda K Turel


    Conclusions: MIS surgery provides an opportunity for early pain relief in patients with discitis, osteomyelitis, spondylodiscitis, and/or epidural abscess by directly addressing the primary cause of pain. MIS surgery for discitis provides a higher diagnostic yield to direct antibiotic treatment. MIS surgery results in good long-term recovery.

  10. The role of technology in minimally invasive surgery: state of the art, recent developments and future directions. (United States)

    Tonutti, Michele; Elson, Daniel S; Yang, Guang-Zhong; Darzi, Ara W; Sodergren, Mikael H


    The diffusion of minimally invasive surgery has thrived in recent years, providing substantial benefits over traditional techniques for a number of surgical interventions. This rapid growth has been possible due to significant advancements in medical technology, which partly solved some of the technical and clinical challenges associated with minimally invasive techniques. The issues that still limit its widespread adoption for some applications include the limited field of view; reduced manoeuvrability of the tools; lack of haptic feedback; loss of depth perception; extended learning curve; prolonged operative times and higher financial costs. The present review discusses some of the main recent technological advancements that fuelled the uptake of minimally invasive surgery, focussing especially on the areas of imaging, instrumentation, cameras and robotics. The current limitations of state-of-the-art technology are identified and addressed, proposing future research directions necessary to overcome them. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to

  11. Ionic Polymer-Metal Composites (IPMCs) as dexterous manipulators and tactile sensors for minimally invasive robotic surgery (United States)

    Bahramzadeh, Y.; Shahinpoor, M.


    Robot-assisted surgery provides the surgeons with new tools to perform sophisticated surgical operations in a minimally invasive manner. Small robotic end-effectors at the tip of the surgical forceps are the key advantage of robotic surgery over laparoscopic surgery and any improvement on the design of these small robots can significantly improve the overall functionality of the surgical robots. In this sense, novel bio-compatible electro-active polymeric actuators can improve the design and functionality of these robotic end-effectors particularly by introducing smaller and more flexible robotic tools. Here, we introduce the applications of IPMCs as flexible actuators with embedded tactile and force feedback sensors in minimally-invasive robotic surgery. A new design for the robotic manipulation of the organs is presented in which a two dimensional IPMC actuator is replaced with the rigid robotic distal tip. It is shown that with a customized design, IPMC actuators maintain the required dexterity for two-dimensional bending of robotic distal tip. The overall design of the robot could be considered as a hybrid robot with the combination of rigid robotic links and flexible IPMC actuator with two degrees of freedom. On the other hand with the current robotic distal tips, no tactile force feedback is available during surgery and the surgeons rely solely on vision feedback. With the proposed design of actuator, the IPMC based distal tip could be used to deliver force feedback data by using an embedded IPMC tactile sensor. Design considerations, kinematics and chemo-electro-mechanical model of the proposed actuator is presented.

  12. Minimally invasive extracorporeal circulation: excellent outcome and life expectancy after coronary artery bypass grafting surgery. (United States)

    Winkler, Bernhard; Heinisch, Paul Philipp; Zuk, Grzegorz; Zuk, Katarzyna; Gahl, Brigitta; Jenni, Hans-Jörg; Kadner, Alexander; Huber, Christoph; Carrel, Thierry


    Coronary artery bypass grafting (CABG) remains the gold standard for complex revascularisation in multivessel disease. The concept of the minimally invasive extracorporeal circulation circuit (MiECC) was introduced to minimise pathophysiological side effects of conventional extracorporeal circulation. This study presents early and long-term outcomes after CABG with use of MiECC in a single-centre consecutive patient cohort. From 1 January 2005 to 31 December 2010, 2130 patients underwent isolated CABG with MiECC at our centre. We evaluated morbidity and mortality follow-up data with a median follow-up of 3.6 years. Kaplan-Meier curves and estimates of the primary end-point for all-cause mortality were compared with the life expectancy of the general population. Mortality in CABG patients was comparable to the general population beginning 1 year after surgery for the whole observation period. All-cause 30-day mortality was 0.8%. The mean estimated logistic EuroSCORE and EuroSCORE II were 5.8 ± 8.6 and 3.0 ± 5.1, respectively. Mean perfusion time was 71.1 ± 23.8 min with a cross-clamp time of 44.9 ± 16.3 min. Mortality was predicted by the presence of diabetes mellitus (odds ratio [OR] 1.85, 95% confidence interval [CI] 1.40-2.46; p <0.001), peripheral arterial disease (OR 2.36, 95% CI 1.64-3.38; p <0.001), severe obstructive pulmonary disease (OR 3.21, 1.42-7.24; p = 0.005), chronic renal failure (OR 3.68, 2.49-5.43; p <0.001) and transfusion of more than one unit of erythrocyte concentrate in the perioperative period (OR 1.46, 1.09-1.95; p = 0.015). Cerebrovascular events occurred in 36 patients (1.7%). CABG with use of MiECC is associated with a mortality rate comparable to the overall life expectancy of the general population. MiECC is the first choice for routine and emergency CABG at our centre with a 30-day mortality rate of 0.8% and a low complication rate.

  13. Anatomy of anterior talofibular ligament and calcaneofibular ligament for minimally invasive surgery: a systematic review. (United States)

    Matsui, Kentaro; Takao, Masato; Tochigi, Yuki; Ozeki, Satoru; Glazebrook, Mark


    To gain a better understanding of the precise anatomy of the lateral ligaments of the ankle through a systematic review of published cadaveric studies in order to improve anatomical minimally invasive surgery (MIS) for treatment of chronic ankle instability (CAI). A systematic review of the literature was performed using the PubMed, EMBASE, Cochrane databases and Web of Science on June 2015 with the two search concepts: "lateral ligament of the ankle" and "anatomy". Anatomical studies that reported gross anatomy of the anterior talar fibular ligament (ATFL) and calcaneal fibular ligament (CFL) in English were included to assess the morphology and origins and insertions of the ligaments. All records found in the literature search were screened by title and abstract. Potentially relevant articles were selected for full-text review. Each of the identified articles was reviewed and included in qualitative synthesis. The following data were abstracted from the included articles: authors, date of publication, sample size, mean age, the length and the width of the each ligament, number of bundle of the ATFL and the location and the footprint of the origins and insertions for the ATFL and CFL. Sixteen studies were identified indicating the length of the ATFL and CFL was 12-24.8 and 18.5-35.8 mm, respectively, while the width was 5-11.1 and 4.6-7.6 mm, respectively. Fibular origins of the ATFL and CFL were located on the anterior border of distal fibula at a distance of 10-13.8 and 5.3-8.5 mm proximal to the tip of the fibula, respectively. The talar insertion of the ATFL was located 14.2-18.1 mm to the subtalar joint or 11.3-14.8 mm to the anterolateral corner of the talar body. The calcaneal insertion of the CFL was located 12.1-13 mm to the subtalar joint or 13.2-27.1 mm to the peroneal tubercle on the lateral wall of calcaneus. Systematic review of the literature of the research for the ATFL and CFL has identified the morphology of the ligaments and their

  14. Early chest tube removal following cardiac surgery is associated with pleural and/or pericardial effusions requiring invasive treatment. (United States)

    Andreasen, Jan J; Sørensen, Gustav V B; Abrahamsen, Emil R; Hansen-Nord, Erika; Bundgaard, Kristian; Bendtsen, Mette D; Troelsen, Pernille


    Different opinions exist as to when chest tube removal should be performed following cardiac surgery. The aim of this study was to compare early chest tube removal with removal of the tubes in the morning day 1 postoperatively. Primary combined end point was the risk of postoperative accumulation of fluid in the pericardial and/or pleural cavities requiring invasive treatment. A retrospective observational cohort study was performed among patients undergoing coronary artery bypass grafting (CABG) and/or conventional valve surgery between July 2010 and June 2013. Patients in whom chest tube output was tubes removed around midnight on the day of surgery, whereas Group 2 kept their tubes until next morning. Using Poisson regression, we estimated crude and adjusted relative risks (RRs) for developing postoperative pleural and/or pericardial effusion within 14 days requiring interventional treatment. A total of 1232 patients underwent CABG, conventional valve or combined surgery during the study period. Of these, 782 patients fulfilled the criteria for early chest tube removal, which was performed in 385 of the patients. A total of 76 patients in Group 1 (20%) and 51 patients in Group 2 (13%) developed postoperative pleural and/or pericardial effusions requiring invasive treatment (P = 0.011). A positive association between early chest tube removal and the development of pleural and/or pericardial effusions was seen [crude RR: 1.54 (95% CI: 1.11-2.13); adjusted RR: 1.70 (95% CI: 1.24-2.33)]. The association became stronger investigating pleural effusions alone (adjusted RR = 1.77; 95% CI: 1.27-2.46), whereas the association with pericardial effusions was less clear. Removal of all chest tubes around midnight on the day of surgery is associated with an increased risk of postoperative pleural and/or pericardial effusions requiring invasive treatment even if chest tube output during the last 4 h is tubes next morning. © The Author 2015. Published by Oxford University

  15. Comparison of intraoperative frozen section analysis for sentinel lymph node biopsy during breast cancer surgery for invasive lobular carcinoma and invasive ductal carcinoma

    Directory of Open Access Journals (Sweden)

    Povoski Stephen P


    Full Text Available Abstract Background Sentinel lymph node (SLN biopsy is the standard of care for the surgical assessment of the axilla during breast cancer surgery. However, the diagnostic accuracy of intraoperative frozen section analysis for confirming metastatic involvement of SLNs in cases of invasive lobular carcinoma (ILC versus that of invasive ductal carcinoma (IDC has generated controversy secondary to a frequently low-grade cytologic appearance and an often discohesive pattern displayed by metastatic lymph nodes in ILC. In the current report, we present a comparison of intraoperative frozen section analysis for confirming the presence of metastatic disease within SLNs during breast cancer surgery for ILC and IDC. Methods We evaluated the results of 131 consecutive cases of ILC from 1997 to 2008 and 133 cases of IDC (selected by a random sequence generator program from amongst 1163 consecutive cases of IDC from the same time period. All cases had at least one SLN that had both intraoperative frozen section analysis and confirmatory permanent section analysis performed. Results No statistically significant difference was found in the sensitivity (67% vs. 75%, P = 0.385, specificity (100% vs. 100%, accuracy (86% vs. 92%, P = 0.172, false negative rate (33% vs. 25%, P = 0.385, negative predictive value (81% vs. 89%, P = 0.158, and positive predictive value (100% vs. 100% for frozen section analysis for confirming the presence of metastatic disease within SLNs during breast cancer surgery for ILC and IDC. Conclusion Since there was no statistically significant difference in sensitivity, specificity, accuracy, false negative rate, negative predictive value, and positive predictive value between frozen section analysis of SLNs for patients with ILC and IDC, the clinical accuracy of confirming metastatic involvement of SLNs on frozen section analysis for ILC should not be considered inferior to the clinical accuracy for IDC. Therefore, frozen section analysis

  16. Incidence, Results, and Our Current Intraoperative Technique to Control Major Vascular Injuries During Minimally Invasive Robotic Thoracic Surgery. (United States)

    Cerfolio, Robert J; Bess, Kyle M; Wei, Benjamin; Minnich, Douglas J


    Our objective is to report our incidence, results, and technique for the control of major vascular injuries during minimally invasive robotic thoracic surgery. This is a consecutive series of patients who underwent a planned robotic thoracic operation by one surgeon. Between February 2009 and September 2015, 1,304 consecutive patients underwent a robotic operation (lobectomy, n = 502; segmentectomy, n = 130; mediastinal resection, n = 115; Ivor Lewis, n = 103; thymectomy, n = 97; and others, n = 357) by one surgeon. Conversion to thoracotomy occurred in 61 patients (4.7%) and in 14 patients (1.1%) for bleeding (pulmonary artery, n = 13). The incidence of major vascular injury during anatomic pulmonary resection was 2.4% (15 of 632). Of these, 13 patients required thoracotomy performed in a nonurgent manner while the injury was displayed on a monitor, 2 had the vessel repaired minimally invasively, 2 required blood transfusion (0.15%), and 1 patient had 30-day mortality (0.16%). Techniques used to minimize morbidity include having a sponge available during vessel dissection and stapling, applying immediate pressure, delaying the opening until the bleeding is controlled without external pressure, and ensuring there is no bleeding while the chest is opened. Major vascular injuries can be safely managed during minimally invasive robotic surgery. Our evolving technique features initial packing of the bleeding for several minutes, maintaining calmness to provide time to prepare for thoracotomy, and reexamination of the injured vessel. If repair is not possible minimally invasively, the vessel is repacked and a nonhurried, elective thoracotomy is performed while the injury is displayed on a monitor to ensure active bleeding is not occurring. Copyright © 2016 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.

  17. [Minimally invasive surgery for treating of complicated fronto-ethmoidal sinusitis]. (United States)

    Pomar Blanco, P; Martín Villares, C; San Román Carbajo, J; Fernández Pello, M; Tapia Risueño, M


    Functional endoscopic sinus surgery (FESS) is nowadays the "gold standard" for frontal sinus pathologies, but management of acute situations and the aproach and/or the extent of the surgery perfomed in the frontal recess remains controversial nowadays. We report our experience in 4 patients with orbital celulitis due to frontal sinusitis who underwent combined external surgery (mini-trephination) and endoscopic sinus surgery. All patients managed sinus patency without any complications. We found this combined sinusotomy as an easy, effective and reproductible technique in order to resolve the difficult surgical management of complicated frontal sinusitis.

  18. Reoperation Rates in Ductal Carcinoma In Situ vs Invasive Breast Cancer After Wire-Guided Breast-Conserving Surgery

    DEFF Research Database (Denmark)

    Langhans, Linnea; Jensen, Maj-Britt; Talman, Maj-Lis M


    to be established for comparison, as previous studies on this procedure include a variety of malignant and benign breast lesions. Objectives: To determine the reoperation rate after wire-guided BCS in patients with histologically verified nonpalpable invasive breast cancer (IBC) or ductal carcinoma in situ (DCIS......Importance: New techniques for preoperative localization of nonpalpable breast lesions may decrease the reoperation rate in breast-conserving surgery (BCS) compared with rates after surgery with the standard wire-guided localization. However, a valid reoperation rate for this procedure needs.......9 [8.7] years). A total of 725 patients (17.6%) underwent a reoperation: 593 were reexcisions (14.4%) and 132 were mastectomies (3.2%). Significantly more patients with DCIS (271 of 727 [37.3%]) than with IBC (454 of 3391 [13.4%]) underwent a reoperation (adjusted odds ratio, 3.82; 95% CI, 3.19-4.58; P...

  19. 4-mm-diameter three-dimensional imaging endoscope with steerable camera for minimally invasive surgery (3-D-MARVEL). (United States)

    Bae, Sam Y; Korniski, Ronald J; Shearn, Michael; Manohara, Harish M; Shahinian, Hrayr


    High-resolution three-dimensional (3-D) imaging (stereo imaging) by endoscopes in minimally invasive surgery, especially in space-constrained applications such as brain surgery, is one of the most desired capabilities. Such capability exists at larger than 4-mm overall diameters. We report the development of a stereo imaging endoscope of 4-mm maximum diameter, called Multiangle, Rear-Viewing Endoscopic Tool (MARVEL) that uses a single-lens system with complementary multibandpass filter (CMBF) technology to achieve 3-D imaging. In addition, the system is endowed with the capability to pan from side-to-side over an angle of [Formula: see text], which is another unique aspect of MARVEL for such a class of endoscopes. The design and construction of a single-lens, CMBF aperture camera with integrated illumination to generate 3-D images, and the actuation mechanism built into it is summarized.

  20. Limited-Access Heart Surgery (United States)

    ... Surgery Menu Topics Topics FAQs Limited-Access Heart Surgery Article Info En español Thousands of heart surgeries ... with cardiovascular disease. What is minimally invasive heart surgery? In minimally invasive heart surgery, surgeons take steps ...

  1. Robot-assisted minimally invasive surgery for pediatric solid tumors: a systematic review of feasibility and current status. (United States)

    Cundy, Thomas P; Marcus, Hani J; Clark, James; Hughes-Hallett, Archie; Mayer, Erik K; Najmaldin, Azad S; Yang, Guang-Zhong; Darzi, Ara


    Open surgery remains the primary technique for resection of pediatric solid tumors despite the popularity of minimally invasive surgery (MIS) for oncological indications in adults and nononcological indications in children. Robot-assisted surgery offers technical and ergonomic advantages that might make MIS more achievable in this setting, permitting benefits for both the patient and surgeon. The aim of this study is to critically appraise the current status of robot-assisted MIS for pediatric solid tumors. A systematic search of multiple electronic literature databases was undertaken, supplemented by several relevant secondary sources. A total of 23 publications met eligibility criteria, reporting 40 cases overall. Indications for surgery were widely varied, with over 20 different pathologies described. One-third of tumors were classified as malignant. Most procedures involved abdominal or retroperitoneal located tumors in adolescent patients (age range, 1-18 years). The collective complication and conversion rates were 10% and 12.5%, respectively. Oncological adverse events involved two isolated events of tumor spillage and residual disease. The evidence is limited to case reports and small case series only. For the diverse and highly selective cases in this review, robot-assisted MIS seems safe and feasible. Current status is low volume, in a relatively static state of adoption, and without any apparent index pathology or procedure. The benefits of robot assistance seem well suited but remain unsubstantiated by evidence. Higher quality studies are needed to determine true safety and efficacy. Georg Thieme Verlag KG Stuttgart · New York.

  2. Underestimation of risk due to exposure misclassification

    DEFF Research Database (Denmark)

    Grandjean, Philippe; Budtz-Jørgensen, Esben; Keiding, Niels


    . These findings illustrate that measurement error may be greatly underestimated if judged solely from reproducibility or laboratory quality data. Adjustment by sensitivity analysis is meaningful only if realistic measurement errors are applied. When exposure measurement errors are overlooked or underestimated...

  3. Mathematical Modeling of the Consumption of Low Invasive Plastic Surgery Practices: The Case of Spain

    Directory of Open Access Journals (Sweden)

    E. De la Poza


    Full Text Available Plastic surgery practice grows continuously among the women in Western countries due to their body image dissatisfaction, aging anxiety, and an ideal body image propagated by the media. The consumption growth is so important that plastic surgery is becoming a normal practice among women, like any other cosmetic product, with the risk of suffering psychopathology disorders in the sense that plastic surgery could be employed as an instrument to recover personal self-esteem or even happiness. Plastic surgery practice depends on economic, demographic, and social contagion factors. In this paper, a mathematical epidemiological model to forecast female plastic surgery consumption in Spain is fully constructed. Overconsumer subpopulation is predicted and simulated. Robustness of the model versus uncertain parameters is studied throughout a sensitivity analysis.

  4. Identification of the boundary between normal breast tissue and invasive ductal carcinoma during breast-conserving surgery using multiphoton microscopy (United States)

    Deng, Tongxin; Nie, Yuting; Lian, Yuane; Wu, Yan; Fu, Fangmeng; Wang, Chuan; Zhuo, Shuangmu; Chen, Jianxin


    Breast-conserving surgery has become an important way of surgical treatment for breast cancer worldwide nowadays. Multiphoton microscopy (MPM) has the ability to noninvasively visualize tissue architectures at the cellular level using intrinsic fluorescent molecules in biological tissues without the need for fluorescent dye. In this study, MPM is used to image the microstructures of terminal duct lobular unit (TDLU), invasive ductal carcinoma and the boundary region between normal and cancerous breast tissues. Our study demonstrates that MPM has the ability to not only reveal the morphological changes of the cuboidal epithelium, basement membrane and interlobular stroma but also identify the boundary between normal breast tissue and invasive ductal carcinoma, which correspond well to the Hematoxylin and Eosin (H and E) images. Predictably, MPM can monitor surgical margins in real time and provide considerable accuracy for resection of breast cancerous tissues intraoperatively. With the development of miniature, real-time MPM imaging technology, MPM should have great application prospects during breast-conserving surgery.

  5. The impact of the alexander technique on improving posture and surgical ergonomics during minimally invasive surgery: pilot study. (United States)

    Reddy, Pramod P; Reddy, Trisha P; Roig-Francoli, Jennifer; Cone, Lois; Sivan, Bezalel; DeFoor, W Robert; Gaitonde, Krishnanath; Noh, Paul H


    One of the main ergonomic challenges during surgical procedures is surgeon posture. There have been reports of a high number of work related injuries in laparoscopic surgeons. The Alexander technique is a process of psychophysical reeducation of the body to improve postural balance and coordination, permitting movement with minimal strain and maximum ease. We evaluated the efficacy of the Alexander technique in improving posture and surgical ergonomics during minimally invasive surgery. We performed a prospective cohort study in which subjects served as their own controls. Informed consent was obtained. Before Alexander technique instruction/intervention subjects underwent assessment of postural coordination and basic laparoscopic skills. All subjects were educated about the Alexander technique and underwent post-instruction/intervention assessment of posture and laparoscopic skills. Subjective and objective data obtained before and after instruction/intervention were tabulated and analyzed for statistical significance. All 7 subjects completed the study. Subjects showed improved ergonomics and improved ability to complete FLS™ as well as subjective improvement in overall posture. The Alexander technique training program resulted in a significant improvement in posture. Improved surgical ergonomics, endurance and posture decrease surgical fatigue and the incidence of repetitive stress injuries to laparoscopic surgeons. Further studies of the influence of the Alexander technique on surgical posture, minimally invasive surgery ergonomics and open surgical techniques are warranted to explore and validate the benefits for surgeons. Copyright © 2011 American Urological Association Education and Research, Inc. Published by Elsevier Inc. All rights reserved.

  6. Beyond 2D telestration: an evaluation of novel proctoring tools for robot-assisted minimally invasive surgery. (United States)

    Jarc, Anthony M; Shah, Swar H; Adebar, Troy; Hwang, Eric; Aron, Monish; Gill, Inderbir S; Hung, Andrew J


    Experienced surgeons commonly mentor trainees as they move through their initial learning curves. During robot-assisted minimally invasive surgery, several tools exist to facilitate proctored cases, such as two-dimensional telestration and a dual surgeon console. The purpose of this study was to evaluate the utility and efficiency of three, novel proctoring tools for robot-assisted minimally invasive surgery, and to compare them to existing proctoring tools. Twenty-six proctor-trainee pairs completed validated, dry-lab training exercises using standard two-dimensional telestration and three, new three-dimensional proctoring tools called ghost tools. During each exercise, proctors mentored trainees by correcting trainee technical errors. Proctors and trainees completed post-study questionnaires to compare the effectiveness of the proctoring tools. Proctors and trainees consistently rated the ghost tools as effective proctoring tools. Both proctors and trainees preferred 3DInstruments and 3DHands over standard two-dimensional telestration (proctors p  0.05). In summary, ghost tools and three-dimensional vision were preferred over standard two-dimensional telestration and two-dimensional vision, respectively, by both proctors and trainees. Proctoring tools-such as ghost tools-have the potential to improve surgeon training by enabling new interactions between a proctor and trainee.

  7. Development and application of the near-infrared and white-light thoracoscope system for minimally invasive lung cancer surgery (United States)

    Mao, Yamin; Wang, Kun; He, Kunshan; Ye, Jinzuo; Yang, Fan; Zhou, Jian; Li, Hao; Chen, Xiuyuan; Wang, Jun; Chi, Chongwei; Tian, Jie


    In minimally invasive surgery, the white-light thoracoscope as a standard imaging tool is facing challenges of the low contrast between important anatomical or pathological regions and surrounding tissues. Recently, the near-infrared (NIR) fluorescence imaging shows superior advantages over the conventional white-light observation, which inspires researchers to develop imaging systems to improve overall outcomes of endoscopic imaging. We developed an NIR and white-light dual-channel thoracoscope system, which achieved high-fluorescent signal acquisition efficiency and the simultaneously optimal visualization of the NIR and color dual-channel signals. The system was designed to have fast and accurate image registration and high signal-to-background ratio by optimizing both software algorithms and optical hardware components for better performance in the NIR spectrum band. The system evaluation demonstrated that the minimally detectable concentration of indocyanine green (ICG) was 0.01 μM, and the spatial resolution was 35 μm. The in vivo feasibility of our system was verified by the preclinical experiments using six porcine models with the intravenous injection of ICG. Furthermore, the system was successfully applied for guiding the minimally invasive segmentectomy in three lung cancer patients, which revealed that our system held great promise for the clinical translation in lung cancer surgeries.

  8. Routine use of minimally invasive surgery for pectus excavatum in adults

    DEFF Research Database (Denmark)

    Pilegaard, Hans K; Licht, Peter B


    BACKGROUND: The Nuss operation, a minimally invasive repair of pectus excavatum, is considered the treatment of choice in children. It is controversial in adults, but smaller series have been published. We have used the Nuss operation routinely in adults since 2003. METHODS: The indication for op...

  9. Minimally invasive surgery for lumbar disc herniation: a systematic review and meta-analysis

    NARCIS (Netherlands)

    Kamper, S.J.; Ostelo, R.W.J.G.; Rubinstein, S.M.; Nellensteijn, J.M.; Peul, W.C.; Arts, M.P.; van Tulder, M.W.


    Purpose: Assessing the benefits of surgical treatments for sciatica is critical for clinical and policy decision-making. To compare minimally invasive (MI) and conventional microdiscectomy (MD) for patients with sciatica due to lumbar disc herniation. Methods: A systematic review and meta-analysis

  10. 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.


    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

  11. 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.


    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

  12. Clinical and radiological outcome of minimally invasive posterior lumbar interbody fusion in primary versus revision surgery

    NARCIS (Netherlands)

    Hentenaar, B.; Spoor, A. B.; Malefijt, J. de Waal; Diekerhof, C. H.; den Oudsten, B. L.


    Purpose The aim of this study is to compare the clinical and radiological outcome of minimally invasive posterior lumbar interbody fusion (MI-PLIF) in revision and primary cases. Methods In a retrospective study, we compared the clinical and radiological results of MI-PLIF for lytic

  13. Mohs Micrographic Surgery Using MART-1 Immunostain in the Treatment of Invasive Melanoma and Melanoma In Situ. (United States)

    Valentín-Nogueras, Sheila M; Brodland, David G; Zitelli, John A; González-Sepúlveda, Lorena; Nazario, Cruz M


    Mohs micrographic surgery (MMS) with melanoma antigen recognized by T-cell (MART-1) immunostaining is an effective treatment of cutaneous melanoma. To determine the efficacy of MMS with MART-1 immunostain in the management of invasive and in situ melanoma. A retrospective cohort study evaluated 2,114 melanomas in 1,982 patients excised using MMS and MART-1 immunostain. The margins required for excision were calculated based on Breslow thickness, location, and size. Survival and local recurrence rates were calculated and compared with those of historical controls. The mean follow-up period was 3.73 years. Local recurrence was identified in 0.49% (7/1,419) of primary melanomas. Approximately 82% of melanomas were excised with ≤6-mm margins. The surgical margin was significantly related to tumor location and size but not to Breslow thickness. The five-year Kaplan-Meier local recurrence and disease-specific survival rates were 0.59 ± 0.30 and 98.53 ± 0.42, respectively. Mohs micrographic surgery with MART-1 immunostain achieved lower local recurrence rates and equivalent or higher Kaplan-Meier survival rates than conventional wide local excision. Mohs micrographic surgery with MART-1 immunostain is an effective treatment of melanoma as evidenced by low local recurrence rates. It offers the advantage of more tissue-conserving margins than those recommended for conventional excision.

  14. Minimally invasive video-assisted thyroidectomy: four-year experience of a single team in a General Surgery Unit. (United States)

    Scerrino, G; Paladino, N C; Di Paola, V; Morfino, G; Inviati, A; Amodio, E; Gulotta, G; Bonventre, S


    Minimally invasive video-assisted thyroidectomy (MIVAT) is a surgical technique that has showed increasingly good results, particularly in endocrine surgery centers. The aim of this prospective, non-randomized study was to evaluate feasibility, advantages and critical aspects of MIVAT in a general surgery unit. Two hundred twenty-four patients underwent total thyroidectomy for benign thyroid disease from May, 2008 to April, 2011. They were divided into two groups: one underwent conventional thyroidectomy (CT), and the other underwent MIVAT. The inclusion criteria were thyroid volume ≤35 mL and main nodule size ≤35 mm. For each patient, socio-demographic variables, hospitalization data and outcome measures (complication rate, operating time, post-operative pain, observer and patient scar assessment scale [OSAS and PSAS, respectively]) were collected. Multivariate regression analyses were done to assess the principal covariates affecting these outcome measures. There were 125 MIVATs and 99 CTs performed. The two groups were characterized by difference in age (38.4 vs. 50.9 years) and thyroid volume (18.6 vs. 23.3 mL). OSAS/PSAS scores were statistically significant in the MIVAT group (Pcosmetic results. It can be performed in younger patients and in all cases in which there is a clear indication for the procedure. Its advantages were confirmed in a general surgery unit where correct indications were followed.

  15. Maxillofacial trauma - Underestimation of cervical spine injury. (United States)

    Reich, Waldemar; Surov, Alexey; Eckert, Alexander Walter


    Undiagnosed cervical spine injury can have devastating results. The aim of this study was to analyse patients with primary maxillofacial trauma and a concomitant cervical spine injury. It is hypothetised that cervical spine injury is predictable in maxillofacial surgery. A monocentric clinical study was conducted over a 10-year period to analyse patients with primary maxillofacial and associated cervical spine injuries. Demographic data, mechanism of injury, specific trauma and treatments provided were reviewed. Additionally a search of relevant international literature was conducted in PubMed by terms "maxillofacial" AND "cervical spine" AND "injury". Of 3956 patients, n = 3732 (94.3%) suffered from craniomaxillofacial injuries only, n = 174 (4.4%) from cervical spine injuries only, and n = 50 (1.3%) from both craniomaxillofacial and cervical spine injuries. In this study cohort the most prevalent craniofacial injuries were: n = 41 (44%) midfacial and n = 21 (22.6%) skull base fractures. Cervical spine injuries primarily affected the upper cervical spine column: n = 39 (58.2%) vs. n = 28 (41.8%). Only in 3 of 50 cases (6%), the cervical spine injury was diagnosed coincidentally, and the cervical spine column was under immobilised. The operative treatment rate for maxillofacial injuries was 36% (n = 18), and for cervical spine injuries 20% (n = 10). The overall mortality rate was 8% (n = 4). The literature search yielded only 12 papers (11 retrospective and monocentric cohort studies) and is discussed before our own results. In cases of apparently isolated maxillofacial trauma, maxillofacial surgeons should be aware of a low but serious risk of underestimating an unstable cervical spine injury. Copyright © 2016 European Association for Cranio-Maxillo-Facial Surgery. Published by Elsevier Ltd. All rights reserved.

  16. Comparison of minimally invasive spine surgery using intraoperative computed tomography integrated navigation, fluoroscopy, and conventional open surgery for lumbar spondylolisthesis: a prospective registry-based cohort study. (United States)

    Wu, Meng-Huang; Dubey, Navneet Kumar; Li, Yen-Yao; Lee, Ching-Yu; Cheng, Chin-Chang; Shi, Chung-Sheng; Huang, Tsung-Jen


    To date, the surgical approaches for the treatment of lumbar spondylolisthesis by transforaminal lumbar interbody fusion (TLIF) using minimally invasive spine surgery assisted with intraoperative computed tomography image-integrated navigation (MISS-iCT), fluoroscopy (MISS-FS), and conventional open surgery (OS) are debatable. This study compared TLIF using MISS-iCT, MISS-FS, and OS for treatment of one-level lumbar spondylolisthesis. This is a prospective, registry-based cohort study that compared surgical approaches for patients who underwent surgical treatment for one-level lumbar spondylolisthesis. One hundred twenty-four patients from January 2010 to March 2012 in a medical center were recruited. The outcome measures were clinical assessments, including Short-Form 12, visual analog scale (VAS), Oswestry Disability Index, Core Outcome Measurement Index, and patient satisfaction, and blood loss, hospital stay, operation time, postoperative pedicle screw accuracy, and superior-level facet violation. All surgeries were performed by two senior surgeons together. Ninety-nine patients (40M, 59F) who had at least 2 years' follow-up were divided into three groups according to the operation methods: MISS-iCT (N=24), MISS-FS (N=23), and OS (N=52) groups. Charts and surgical records along with postoperative CT images were assessed. MISS-iCT and MISS-FS demonstrated a significantly lowered blood loss and hospital stay compared with OS group (p2 mm) was found. However, a lower superior-level facet violation rate was observed in the MISS-iCT and OS groups (p=.049). MISS-iCT TLIF demonstrated reduced operation time, blood loss, superior-level facet violation, hospital stay, and improved functional outcomes compared with the MISS-FS and OS approaches. Copyright © 2017 Elsevier Inc. All rights reserved.

  17. Abdominal Trauma: Never Underestimate It

    Directory of Open Access Journals (Sweden)

    Aakash N. Bodhit


    Full Text Available Introduction. We present a case of a sports injury. The initial presentation and clinical examination belied serious intra-abdominal injuries. Case Presentation. A 16-year-old male patient came to emergency department after a sports-related blunt abdominal injury. Though on clinical examination the injury did not seem to be serious, FAST revealed an obscured splenorenal window. The CT scan revealed a large left renal laceration and a splenic laceration that were managed with Cook coil embolization. Patient remained tachycardic though and had to undergo splenectomy, left nephrectomy, and a repair of left diaphragmatic rent. Patient had no complication and had normal renal function at 6-month followup. Conclusion. The case report indicates that management of blunt intra-abdominal injury is complicated and there is a role for minimally invasive procedures in management of certain patients. A great deal of caution is required in monitoring these patients, and surgical intervention is inevitable in deteriorating patients.

  18. Superciliary keyhole surgery for unruptured posterior communicating artery aneurysms with oculomotor nerve palsy: maximizing symptomatic resolution and minimizing surgical invasiveness. (United States)

    Park, Jaechan; Kang, Dong-Hun; Chun, Bo-Young


    For oculomotor nerve palsy (ONP) induced by unruptured posterior communicating artery (PCoA) aneurysms, the authors performed surgical clipping via a superciliary keyhole approach as an optimal treatment modality with high efficiency and low invasiveness. In this study, they then evaluated the technical feasibility, safety, clinical outcomes, including recovery from ONP as well as cosmetic results, and durability of the procedure. Thirteen patients presenting with complete (7 patients) or incomplete (6 patients) ONP underwent surgery via a superciliary approach. The operative video record was used to evaluate the technical feasibility, neurological examinations and CT were performed to analyze the safety of the treatment, and neuroophthalmological examinations and 3D CT angiography were undertaken to determine the effectiveness and durability of the treatment. In all cases, the aneurysms were successfully clipped using a 3.5-cm eyebrow incision and supraorbital minicraniotomy. The mean operative time was 108 ± 24 minutes. Twelve (92.3%) of the 13 patients showed complete resolution of the ONP. All 6 patients (100%) with incomplete ONP recovered completely within 1-2 months after surgery, whereas 6 (85.7%) of the 7 patients with complete ONP recovered completely within 1-6 months after surgery. Cosmetic results for the operative wounds were excellent without frontalis palsy. The durability of the treatment was ascertained based on 3D CT angiograms obtained 1 year after surgery. Surgical clipping via a superciliary keyhole approach can be an optimal treatment modality for PCoA aneurysms inducing ONP because it is effective, safe, and durable.

  19. Nuclear Imaging and Minimally Invasive Surgery in the Management of Hyperparathyroidism* (United States)

    Judson, Benjamin L.; Shaha, Ashok R.


    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

  20. 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.


    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.)

  1. Combination antifungal therapy and surgery for the treatment of invasive pulmonary aspergillosis after hematopoietic stem cell transplantation

    Directory of Open Access Journals (Sweden)

    Tiziana Toffolutti


    Full Text Available An 8-year old boy, affected by severe aplastic anemia, developed a probable pulmonary invasive aspergillosis (IA early after a second unrelated allogeneic hematopoietic stem cell transplant (HSCT. He was treated promptly with the combination of liposomal amphotericin B and caspofungin. Despite the initial stabilization, the patient deteriorated and the antifungal therapy was switched to voriconazole and caspofungin. The patient gradually improved and was discharged home on day +29 post-HSCT on oral voriconazole. On day +119, a sudden episode of hemoptysis occurred and a right superior lobectomy was decided to remove the residual aspergilloma. The patient is now alive and well more than 24 months from HSCT. This case demonstrated that antifungal combination therapy and surgery are valid options to cure pulmonary IA even in patients at high-risk and severely immunosuppressed.

  2. Unconventional Implant Placement IV. Implant Placement through Impacted Teeth to Avoid Invasive Surgery. Long-term Results of 3 Cases (United States)

    Mithridade, Davarpanah; Serge, Szmukler-Moncler; Keyvan, Davarpanah; Nedjoua, Capelle-Ouadah; Georgy, Demurashvili; Philippe, Rajzbaum


    This paper presents the long-term data of patients that have been treated with an unconventional implant placement protocol to avoid an invasive surgery when edentulism was caused by an impacted tooth. In 2009, the follow-up of this unconven-tional protocol was 2 to 3.5 years; this article documents now the long-term 5- to 8-year follow-up of 3 patients and 5 im-plants. Over this period of time, implant stability was maintained without complications. This unconventional protocol opens intriguing possibilities; however, more patients with long-term follow-up are warranted before endorsing it in routine appli-cation. Nonetheless, it might suggest that there is still room to revisit one of the leading concepts in dental implantology. PMID:25674167

  3. Application of Intraoperative CT-Guided Navigation in Simultaneous Minimally Invasive Anterior and Posterior Surgery for Infectious Spondylitis

    Directory of Open Access Journals (Sweden)

    Meng-Huang Wu


    Full Text Available This study was aimed at evaluating the safety and efficacy of using intraoperative computed tomography- (iCT- guided navigation in simultaneous minimally invasive anterior and posterior surgery for infectious spondylitis. Nine patients with infectious spondylitis were enrolled in this study. The average operative time was 327.6 min (range, 210–490 and intraoperative blood loss was 407 cc (range, 50–1,200. The average duration of hospital stay was 48.9 days (range, 11–76. Out of a total of 54 pedicle screws employed, 53 screws (98.1% were placed accurately. A reduced visual analog scale on back pain (from 8.2 to 2.2 and Oswestry disability index (from 67.1% to 25.6% were found at the 2-year follow-up. All patients had achieved resolution of spinal infection with reduced average erythrocyte sedimentation rate (from 83.9 to 14.1 mm/hr and average C-reactive protein (from 54.4 to 4.8 mg/dL. Average kyphotic angle correction was 10.5° (range, 8.4°–12.6° postoperatively and 8.5° (range, 6.9°–10.1° after 2 years. In conclusion, the current iCT-guided navigation approach has been demonstrated to be an alternative method during simultaneous minimally invasive anterior and posterior surgery for infectious spondylitis. It can provide a good intraoperative orientation and visualization of anatomic structures and also a high pedicle screw placement accuracy in patient’s lateral decubitus position.

  4. Clinicopathological study of response to preoperative chemoradiotherapy and applicability for minimum invasive surgery on advanced tongue carcinomas

    International Nuclear Information System (INIS)

    Ohgi, Kazuhiko; Kirita, Tadaaki; Sugimura, Masahito


    Forty patients who received chemoradiotherapy followed by surgery for advanced tongue carcinoma were studied clinically and histopathologically, and the minimally invasive treatment for advanced tongue carcinoma was evaluated. Clinical effects on the primary tumor were CR in 22 (55.0%), PR in 15 (37.5%), and NC in 3 (7.5%). The CR rate was nearly 60%, and the overall response rate was 92.5%; the treatment was highly effective. Histological effects on the primary tumor were Grade II b or above, i.e. effective, in 31 (8.6%), and Grade IV, i.e. pathological CR, in 18 (51.4%). The treatment was also very effective histologically, and a correlation was observed between clinical effects and histological effects. Concerning the relationship between histological effects and the regression rate, a regression rate of 85% or higher was needed to obtain a histological effect of Grade II b or above, and a regression rate of 95% or higher was needed to obtain a histological effect of Grade III or above. Investigation of residual tumors showed persistence of cancer cells primarily in the center of the tumor, but both the horizontal and vertical residual rates were low, and cancer cells tended to be limited to the superficial layer of the central area of the primary tumor in the patients who showed a regression rate of 85% or higher. Histopathological malignancy, tumor vessel density (CD31), and p53 were suggested to be potential predictive factors of the effectiveness of preoperative therapy. The residual tumor Grade (R Grade) in the resected specimen is considered to be useful as a prognostic factor after resection of the primary tumor. Histological effects were also satisfactory in patients who showed a clinical effect of 85% or higher on this preoperative therapy. In such patients, minimum invasive surgery is considered to be applicable even in advanced cases, and improvements in the postoperative QOL are expected by oral organ/function preservation. (author)

  5. Stereoscopic Augmented Reality System for Supervised Training on Minimal Invasive Surgery Robots

    DEFF Research Database (Denmark)

    Matu, Florin-Octavian; Thøgersen, Mikkel; Galsgaard, Bo


    the need for efficient training. When training with the robot, the communication between the trainer and the trainee is limited, since the trainee often cannot see the trainer. To overcome this issue, this paper proposes an Augmented Reality (AR) system where the trainer is controlling two virtual robotic...... the procedure, and thereby enhances the training experience. The virtual overlay was also found to work as a good and illustrative approach for enhanced communication. However, the delay of the prototype made it difficult to use for actual training.......Training in the use of robot-assisted surgery systems is necessary before a surgeon is able to perform procedures using these systems because the setup is very different from manual procedures. In addition, surgery robots are highly expensive to both acquire and maintain --- thereby entailing...

  6. Anesthesia for minimally invasive chest wall reconstructive surgeries: Our experience and review of literature


    Shah, Shagun Bhatia; Hariharan, Uma; Bhargava, Ajay Kumar; Darlong, Laleng M.


    Minimal access procedures have revolutionized the field of surgery and opened newer challenges for the anesthesiologists. Pectus carinatum or pigeon chest is an uncommon chest wall deformity characterized by a protruding breast bone (sternum) and ribs caused by an overgrowth of the costal cartilages. It can cause a multitude of problems, including severe pain from an intercostal neuropathy, respiratory dysfunction, and psychologic issues from the cosmetic disfigurement. Pulmonary function ind...

  7. Comparison of pain perception between open and minimally invasive surgery in total knee arthroplasty


    Moretti, Biagio; Vitale, Elsa; Esposito, Antonio; Colella, Antonio; Cassano, Maria; Notarnicola, Angela


    Biagio Moretti, Elsa Vitale , Antonio Esposito, Antonio Colella, Maria Cassano, Angela NotarnicolaDepartment of Clinical Methodology and Surgical Techniques, Orthopedics Section, Faculty of Medicine and Surgery of University of Bari, General Hospital, Bari, ItalyAbstract: Total knee arthroplasty (TKA) was a well-established procedure that had shown excellent long-term results in terms of reduced pain and increased mobility. Pain was one of the most important outcome measures that contributed ...

  8. Minimally invasive spine surgery in lumbar spondylodiscitis: a retrospective single-center analysis of 67 cases. (United States)

    Tschugg, Anja; Hartmann, Sebastian; Lener, Sara; Rietzler, Andreas; Sabrina, Neururer; Thomé, Claudius


    Minimally invasive surgical techniques have been developed to minimize tissue damage, reduce narcotic requirements, decrease blood loss, and, therefore, potentially avoid prolonged immobilization. Thus, the purpose of the present retrospective study was to assess the safety and efficacy of a minimally invasive posterior approach with transforaminal lumbar interbody debridement and fusion plus pedicle screw fixation in lumbar spondylodiscitis in comparison to an open surgical approach. Furthermore, treatment decisions based on the patient´s preoperative condition were analyzed. 67 patients with lumbar spondylodiscitis treated at our department were included in this retrospective analysis. The patients were categorized into two groups based on the surgical procedure: group (MIS) minimally invasive lumbar spinal fusion (n = 19); group (OPEN) open lumbar spinal fusion (n = 48). Evaluation included radiological parameters on magnetic resonance imaging (MRI), laboratory values, and clinical outcome. Preoperative MRI showed higher rates of paraspinal abscess (35.5 vs. 5.6%; p = 0.016) and multilocular location in the OPEN group (20 vs. 0%, p = 0.014). Overall pain at discharge was less in the MIS group: NRS 2.4 ± 1 vs. NRS 1.6 ± 1 (p = 0.036). The duration of hospital stay was longer in the OPEN than the MIS group (19.1 ± 12 days vs. 13.7 ± 5 days, p = 0.018). The open technique is effective in all varieties of spondylodiscitis inclusive in epidural abscess formation. MIS can be applied safely and effectively as well in selected cases, even with epidural abscess.

  9. Status of robotic assistance--a less traumatic and more accurate minimally invasive surgery? (United States)

    Kenngott, H G; Fischer, L; Nickel, F; Rom, J; Rassweiler, J; Müller-Stich, B P


    Robotic assistance is considered one innovation within abdominal surgery over the past decade that has the potential to compensate for the drawbacks of conventional laparoscopy, such as limited degree of freedom, 2D vision, fulcrum, and pivoting effect. Robotic systems provide corresponding solutions as 3D view, intuitive motion and enable additional degrees of freedom. This review provides an overview of the history of medical robotics, experimental studies, clinical state-of-the-art and economic impact. The Medline database was searched for the terms "robot, telemanipulat, and laparoscop." A total of 2,573 references were found. All references were considered for information on robotic assistance in advanced laparoscopy. Further references were obtained through cross-referencing the bibliography cited in each work. In experimental studies, current robotic systems showed superior handling and ergonomics compared to conventional laparoscopic techniques. In gynecology especially for hysterectomy and in urology especially for prostatectomy, two procedures formerly performed via an open approach, the robot enables a laparoscopic approach. This results in reduced need for pain medication, less blood loss, and shorter hospital stay. Within abdominal surgery, clinical studies were generally unable to prove a benefit of the robot. While the benefit still remains open to discussion, robotic systems are spreading and are available worldwide in tertiary centers. Robotic assistance will remain an intensively discussed subject since clinical benefits for most procedures have not yet been proven. The most promising procedures are those in which the robot enables a laparoscopic approach where open surgery is usually required.

  10. Transurethral surgery in the treatment of invasive bladder cancer (T1 and T2)

    DEFF Research Database (Denmark)

    Wolf, H; Iversen, H G; Rosenkilde, P


    of them did not have local disease when treated. Twenty-five % of the total patient population did not within five years get a new tumour. They were cured by the first transurethral resection. 30% of the patients experienced new non-invasive tumour growth that could be managed by repeated resections...... at risk of getting a progressive bladder cancer disease. 5-year survival of these patients was about 50%. We conclude that transitional cell bladder tumours of category T1 and some of category T2 are well treated by transurethral resection....

  11. The development and current status of minimally invasive surgery to manage urological complications after renal transplantation

    Directory of Open Access Journals (Sweden)

    Ravindra B Sabnis


    Conclusion: Minimally invasive techniques have a critical role in the management of urological complications after renal transplantation. Urinary leakage should be managed with complete decompression. Percutaneous drainage should be the first line of treatment for lymphocele that is symptomatic or causing ureteric obstruction. Laparoscopic lymphocele deroofing is successful in aspiration-resistant cases. Deflux is highly successful for the management of complicated low-grade kidney transplant reflux. The principles of stone management in a native solitary kidney are applied to the transplanted kidney. Early identification and treatment of bladder outlet obstruction after renal transplantation can prevent urinary leakage and obstructive uropathy.

  12. From the operating room of the present to the operating room of the future. Human-factors lessons learned from the minimally invasive surgery revolution. (United States)

    Gallagher, Anthony G; Smith, C Daniel


    The minimally invasive surgical revolution has changed the way surgery is practiced. It has also helped surgical innovators to break the tethers that anchored the practice of surgery in an early 20th century operating room environment. To some in surgery, the Operating Room of the Future will be seen as a revolution but to others, an inevitable evolution of the changes ushered in by the adoption of minimally invasive surgery. Although minimally invasive surgery has conferred considerable advantages on the patient, it has imposed significant difficulties on the surgeon, which in turn, have impacted outcomes. These difficulties were primarily human factor in nature and were poorly understood by critical groups such as device manufacturers, surgeons, and surgery educators and trainers. This article details what these human factors were, how they related to the practice of minimally invasive surgery, and how they will impact on the practice of surgery in the Operating Room of the Future. Much of the technology for the Operating Room of the Future currently exists (eg, surgical robotics, virtual reality, and telemedicine). However, for it to function optimally it must be integrated in a fashion that takes on board the human factor strengths and limitations of the surgeon. These advanced technologies should then be harnessed to optimize surgical practice. In some cases, this will involve rethinking existing technologies (ie, three-dimensional camera systems), applying technologies that currently exist in a manner that is more systematic and better managed (ie, surgical robots and virtual reality), and a reconsideration of who should be applying these technologies for the practice of surgery in the 21st century. In all cases, there will be education and training implications for the practitioner. Lastly, there must be unequivocal demonstration that these changes bring about positive benefits for patients in terms of better outcomes and for surgeons in terms of ability and

  13. The value of haptic feedback in conventional and robot-assisted minimal invasive surgery and virtual reality training: a current review

    NARCIS (Netherlands)

    van der Meijden, O. A. J.; Schijven, M. P.


    BACKGROUND: Virtual reality (VR) as surgical training tool has become a state-of-the-art technique in training and teaching skills for minimally invasive surgery (MIS). Although intuitively appealing, the true benefits of haptic (VR training) platforms are unknown. Many questions about haptic

  14. Design and static calibration of a six-dimensional force/torque sensor for minimally invasive surgery. (United States)

    Yu, Hailong; Jiang, Jun; Xie, Le; Liu, Lin; Shi, Yunyong; Cai, Ping


    The use of surgery robotics is getting more and more important worldwide. In the present study, we propose a novel small-size six-dimensional force/torque sensor with the structure of double cross beams. This technology can be applied in robotic tele-operation systems used in minimally invasive surgery (MIS) robotic systems. The proposed sensor is made of duralumin which totally meets the stiffness requirement. The output voltage of the sensor will alter with the deformation of the elastic body and strain gauges. The feasibility was discussed by finite element analysis (FEA) and the coupling coefficient matrix was established with dimension reduced according to FEA. In addition, we designed a calibration platform and completed static calibration for the sensor. The methods and principles of measurements and data analysis were provided. The calibration curves and coupling coefficient matrix were acquired by using the least squares method (LSM). Experimental tests and calibration error analysis showed that the proposed sensor has high accuracy, appropriate range, and played a role in promoting the application of force feedback technology in MIS.

  15. Tool Sequence Trends in Minimally Invasive Surgery: Statistical Analysis and Implications for Predictive Control of Multifunction Instruments

    Directory of Open Access Journals (Sweden)

    Carl A. Nelson


    Full Text Available This paper presents an analysis of 67 minimally invasive surgical procedures covering 11 different procedure types to determine patterns of tool use. A new graph-theoretic approach was taken to organize and analyze the data. Through grouping surgeries by type, trends of common tool changes were identified. Using the concept of signal/noise ratio, these trends were found to be statistically strong. The tool-use trends were used to generate tool placement patterns for modular (multi-tool, cartridge-type surgical tool systems, and the same 67 surgeries were numerically simulated to determine the optimality of these tool arrangements. The results indicate that aggregated tool-use data (by procedure type can be employed to predict tool-use sequences with good accuracy, and also indicate the potential for artificial intelligence as a means of preoperative and/or intraoperative planning. Furthermore, this suggests that the use of multifunction surgical tools can be optimized to streamline surgical workflow.

  16. Significance of aggressive surgery for an invasive carcinoma derived from an intraductal papillary mucinous neoplasm diagnosed preoperatively as borderline resectable. (United States)

    Aimoto, Takayuki; Mizutani, Satoshi; Kawano, Youichi; Suzuki, Hideyuki; Uchida, Eiji


    We investigated the clinicopathological features of borderline resectable invasive carcinomas (BRICs) derived from intraductal papillary mucinous neoplasms (IPMNs) and examined the significance of the aggressive "surgery first" approach compared with the treatment of conventional borderline resectable pancreatic ductal adenocarcinomas (BRPDAs). We retrospectively studied 7 patients with BRICs derived from IPMNs and 14 patients with conventional BRPDAs. Several factors were reviewed: initial symptoms, preoperative imaging, serum level of CA19-9, perioperative factors, pathological findings, adjuvant chemotherapy, and outcome. All BRICs derived from IPMN were huge tumors (more than 3 cm in diameter) suspected to involve BRICs derived from IPMNs were larger than those of conventional BRPDAs (pBRICs derived from IPMN less frequently metastasized to lymph nodes (pBRICs derived from IPMNs (100%) than for conventional BRPDAs (19%, pBRICs derived from an intestinal or gastric IPMN are less aggressive than conventional BRPDAs and have a more favorable prognosis. In addition, aggressive "surgery first" approach may contribute to this better prognosis.

  17. Minimally Invasive Percutaneous Nephrolithotomy versus Retrograde Intrarenal Surgery for Upper Urinary Stones: A Systematic Review and Meta-Analysis

    Directory of Open Access Journals (Sweden)

    Hongyang Jiang


    Full Text Available Minimally invasive percutaneous nephrolithotomy (mini-PCNL and retrograde intrarenal surgery (RIRS are both alternatives for PCNL to treat renal calculi. This study is aimed at comparing the stone-free rate (SFR and other surgery parameters of two approaches for treating upper urinary calculi. We performed this meta-analysis in September 2016 by searching studies about mini-PCNL and RIRS for treating upper urinary calculi in various databases, and RevMan v.5.3 was applied. Three randomized controlled trials and ten nonrandomized trials were included, involving a total of 1317 patients. Meta-analysis showed that mini-PCNL group led to a higher SFR [odds ratio: 1.96; 95% confidence interval: 1.46–2.64; P<0.00001] but brought a larger postoperative decrease in hemoglobin levels compared with RIRS. RIRS provided a shorter hospital time. There was no significant difference in operation time. Higher postoperative complications were detected in the mini-PCNL, but the difference was not significant. Grade I and III complications did not vary between two procedures, but grade II complications were of lower incidence in RIRS group. In the light of these results, compared with RIRS, mini-PCNL provided significantly higher SFR and efficiency quotient for managing calculi; however, it resulted in higher incidence of postoperative complications, larger hemoglobin drops, and longer hospital stay.

  18. Matching Trends for the Fellowship in Minimally Invasive Gynecologic Surgery (FMIGS) Since Participation in the National Residency Match Program (NRMP). (United States)

    Vargas, Maria V; Milad, Magdy P


    To describe the level of interest in the fellowship in minimally invasive gynecologic surgery (FMIGS) using data from National Residency Match Program (NRMP) over the past 4 years. Retrospective report (Canadian Task Force Classification II-2) SETTING: Publically reported data from the NRMP PARTICIPANTS: Applicants using the NRMP to match into fellowship training. Reporting matching trends for the gynecologic surgical subspecialty programs starting in 2014, when the FMIGS programs started participating in the NRMP. From 2014 to 2017, the number of FMIGS positions increased from 28 to 37. Over the 4 application cycles, the FMIGS programs had the highest ratio of applicants to positions overall (range 1.7-2.0 for FMIGS) of the surgical gynecologic sub-specialty programs (gynecologic oncology, female pelvic medicine and reconstructive surgery, and reproductive endocrinology and infertility). Since the FMIGS programs began participating in the NRMP in 2014, the FMIGS match has been highly competitive as a gynecologic surgical subspecialty program, suggesting a high level of interest from residency graduates. This may reflect growing recognition that there is a body of knowledge that is unique to MIGS and that a well trained MIGS specialist can improve patient outcomes. Copyright © 2018. Published by Elsevier Inc.

  19. 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


    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.

  20. Simulated lumbar minimally invasive surgery educational model with didactic and technical components. (United States)

    Chitale, Rohan; Ghobrial, George M; Lobel, Darlene; Harrop, James


    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.

  1. 4D motion modeling of the coronary arteries from CT images for robotic assisted minimally invasive surgery (United States)

    Zhang, Dong Ping; Edwards, Eddie; Mei, Lin; Rueckert, Daniel


    In this paper, we present a novel approach for coronary artery motion modeling from cardiac Computed Tomography( CT) images. The aim of this work is to develop a 4D motion model of the coronaries for image guidance in robotic-assisted totally endoscopic coronary artery bypass (TECAB) surgery. To utilize the pre-operative cardiac images to guide the minimally invasive surgery, it is essential to have a 4D cardiac motion model to be registered with the stereo endoscopic images acquired intraoperatively using the da Vinci robotic system. In this paper, we are investigating the extraction of the coronary arteries and the modelling of their motion from a dynamic sequence of cardiac CT. We use a multi-scale vesselness filter to enhance vessels in the cardiac CT images. The centerlines of the arteries are extracted using a ridge traversal algorithm. Using this method the coronaries can be extracted in near real-time as only local information is used in vessel tracking. To compute the deformation of the coronaries due to cardiac motion, the motion is extracted from a dynamic sequence of cardiac CT. Each timeframe in this sequence is registered to the end-diastole timeframe of the sequence using a non-rigid registration algorithm based on free-form deformations. Once the images have been registered a dynamic motion model of the coronaries can be obtained by applying the computed free-form deformations to the extracted coronary arteries. To validate the accuracy of the motion model we compare the actual position of the coronaries in each time frame with the predicted position of the coronaries as estimated from the non-rigid registration. We expect that this motion model of coronaries can facilitate the planning of TECAB surgery, and through the registration with real-time endoscopic video images it can reduce the conversion rate from TECAB to conventional procedures.

  2. An Update on Less Invasive and Endoscopic Techniques Mimicking the Effect of Bariatric Surgery


    Verdam, Froukje J.; Schouten, Ruben; Greve, Jan Willem; Koek, Ger H.; Bouvy, Nicole D.


    Obesity (BMI 30–35 kg/m2) and its associated disorders such as type 2 diabetes, nonalcoholic fatty liver disease, and cardiovascular disease have reached pandemic proportions worldwide. For the morbidly obese population (BMI 35–50 kg/m2), bariatric surgery has proven to be the most effective treatment to achieve significant and sustained weight loss, with concomitant positive effects on the metabolic syndrome. However, only a minor percentage of eligible candidates are treated by means of bar...

  3. Pathogenetical grounds for effectiveness of mini-invasive interventions in emergency surgery

    Directory of Open Access Journals (Sweden)

    Aleksey P. Vlasov


    Full Text Available Introduction: The article deals with manifestations of the metabolic response to surgical treatment of acute destructive cholecystitis and peritonitis with various traumatization of the abdominal wall (“open” laparotomy wound or minimally invasive approach. Materials and Methods: The clinico-laboratory analysis of patients with acute cholecystitis volume and acute peritonitis was performed. All patients were operated with the necessary surgical intervention. The patients in the control groups were operated with a laparatomic operative approach, in the main groups, mini-invasive laparoscopic technology was used. The examination of patients of both groups was performed at admission and in the dynamics of the postoperative period (1st , 2nd , 4th , 6th day after the operation. In addition to routine biochemical blood tests in the patients, the intensity of endotoxemia (the plasma level was determined by the molecules of medium mass, total and effective albumin concentration, the peroxide oxidation of membrane lipids and the activity of superoxide dismutase and phospholipase A2 were assessed. Results: The decrease in the albumin toxicity index was observed with respect to control (in cholecystitis – by 25.1–37.7 % (p < 0.05, in acute peritonitis – by 25.5–39.3 % (p < 0,05, a decrease in the hydrophilic component of endotoxicosis was also recorded (for peritonitis – by 12.7 – 37.8 % (p < 0.05, with cholecystitis – 14,4–36,4 % (p < 0.05 in the early postoperative period. The index of TBA-active products in patients of the main group with cholecystitis was below the control by 16.2–27.9% (p < 0.05, with peritonitis – by 19.3–33.5% (p < 0.05. Discussion and Conclusions: In the early postoperative period the much less homeostatic disorders are noted when using minimally invasive interventions, regardless of the pathology. In particular, it is the comparatively low endotoxemia, manifested by a decrease in the accumulation of

  4. High definition in minimally invasive surgery: a review of methods for recording, editing, and distributing video. (United States)

    Kelly, Christopher R; Hogle, Nancy J; Landman, Jaime; Fowler, Dennis L


    The use of high-definition cameras and monitors during minimally invasive procedures can provide the surgeon and operating team with more than twice the resolution of standard definition systems. Although this dramatic improvement in visualization offers numerous advantages, the adoption of high definition cameras in the operating room can be challenging because new recording equipment must be purchased, and several new technologies are required to edit and distribute video. The purpose of this review article is to provide an overview of the popular methods for recording, editing, and distributing high-definition video. This article discusses the essential technical concepts of high-definition video, reviews the different kinds of equipment and methods most often used for recording, and describes several options for video distribution.

  5. Intrathecal morphine is superior to intravenous PCA in patients undergoing minimally invasive cardiac surgery

    Directory of Open Access Journals (Sweden)

    Chirojit Mukherjee


    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. A minimally invasive surgery robotic assistant for HALS-SILS techniques. (United States)

    Bauzano, E; Garcia-Morales, I; del Saz-Orozco, P; Fraile, J C; Muñoz, V F


    This paper is focused in the design and implementation of a robotic surgical motion controller. The proposed control scheme addresses the issues related to the application of a robot assistant in novel surgical scenario, which combines hand assisted laparoscopic surgery (HALS) with the single incision laparoscopic surgery (SILS) techniques. It is designed for collaborating with the surgeon in a natural way, by performing autonomous movements, in order to assist the surgeon during a surgical maneuver. In this way, it is implemented a hierarchical architecture which includes an upper auto-guide velocity planner connected to a low-level force feedback controller. The first one, based on a behavior approach, computes a collision free trajectory of the surgical instrument tip, held by the robot, for reaching a goal location inside of the abdominal cavity. On the other hand, the force feedback controller uses this trajectory for performing the instrument displacement by taking into account the holonomic movement constraints introduced by the fulcrum point. The aim of this controller is positioning the surgical instrument by minimizing the forces exerted over the abdominal wall due to the fulcrum location uncertainty. The overall system has been integrated in the control architecture of the surgical assistant CISOBOT, designed and developed at the University of Malaga. The whole architecture performance has been tested by means of in vitro trials. Copyright © 2013 Elsevier Ireland Ltd. All rights reserved.

  7. Minimally invasive decompression surgery for lumbar spinal stenosis with degenerative scoliosis: Predictive factors of radiographic and clinical outcomes. (United States)

    Minamide, Akihito; Yoshida, Munehito; Iwahashi, Hiroki; Simpson, Andrew K; Yamada, Hiroshi; Hashizume, Hiroshi; Nakagawa, Yukihiro; Iwasaki, Hiroshi; Tsutsui, Shunji; Kagotani, Ryohei; Sonekatsu, Mayumi; Sasaki, Takahide; Shinto, Kazunori; Deguchi, Tsuyoshi


    There is ongoing controversy regarding the most appropriate surgical treatment for lumbar spinal stenosis (LSS) with concurrent degenerative lumbar scoliosis (DLS): decompression alone, decompression with limited spinal fusion, or long spinal fusion for deformity correction. The coexistence of degenerative stenosis and deformity is a common scenario; Nonetheless, selecting the appropriate surgical intervention requires thorough understanding of the patients clinical symptomatology as well as radiographic parameters. Minimally invasive (MIS) decompression surgery was performed for LSS patients with DLS. The aims of this study were (1) to investigate the clinical outcomes of MIS decompression surgery in LSS patients with DLS, and (2) to identify the predictive factors for both radiographic and clinical outcomes after MIS surgery. 438 consecutive patients were enrolled in this study. Inclusion criteria was evidence of LSS and DLS with coronal curvature measuring greater than 10°. The Japanese Orthopaedic Association (JOA) score, JOA recovery rate, low back pain (LBP), and radiographic features were evaluated preoperatively and at over 2 years postoperatively. Of the 438 patients, 122 were included in final analysis, with a mean follow-up of 2.4 years. The JOA recovery rate was 47.6%. LBP was significantly improved at final follow-up. Cobb angle was maintained for 2 years postoperatively (p = 0.159). Clinical outcomes in foraminal stenosis patients were significantly related to sex, preoperative high Cobb angle and progression of scoliosis (p = 0.008). In the severe scoliosis patients, the JOA recovery was 44%, and was significantly depended on progression of scoliosis (Cobb angle: preoperation 29.6°, 2-years follow-up 36.9°) and mismatch between the pelvic incidence (PI) and the lumbar lordosis (LL) (preoperative PI-LL 35.5 ± 21.2°) (p = 0.028). This study investigated clinical outcomes of MIS decompression surgery in LSS patients with DLS. The predictive


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


    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

  9. From the ground up: building a minimally invasive aortic valve surgery program. (United States)

    Nguyen, Tom C; Lamelas, Joseph


    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.

  10. Stereotactic Laser Ablation for Medically Intractable Epilepsy: The Next Generation of Minimally Invasive Epilepsy Surgery

    Directory of Open Access Journals (Sweden)

    Michael Joseph LaRiviere


    Full Text Available Epilepsy is a common, disabling illness that is refractory to medical treatment in approximately one third of patients, particularly among those with mesial temporal lobe epilepsy. While standard open mesial temporal resection is effective, achieving seizure freedom in most patients, efforts to develop safer, minimally invasive techniques have been underway for over half a century. Stereotactic ablative techniques, in particular radiofrequency ablation, were first developed in the 1960s, with refinements in the 1990s with the advent of modern computed tomography and magnetic resonance-based imaging. In the past 5 years, the most recent techniques have used MRI-guided laser interstitial thermotherapy (LITT, whose development began in the 1980s, saw refinements in MRI thermal imaging through the 1990s, and was initially used primarily for the treatment of intracranial and extracranial tumors. The present review describes the original stereotactic ablation trials, followed by modern imaging-guided radiofrequency ablation series for mesial temporal lobe epilepsy. The development of LITT and MRI thermometry are then discussed. Finally, the two currently available MRI-guided laser interstitial thermotherapy systems are reviewed for their role in the treatment of mesial temporal lobe and other medically refractory epilepsies.

  11. Significant reduction of fluoroscopy repetition with lumbar localization system in minimally invasive spine surgery: A prospective study. (United States)

    Fan, Guoxin; Zhang, Hailong; Gu, Xin; Wang, Chuanfeng; Guan, Xiaofei; Fan, Yunshan; He, Shisheng


    The conventional location methods for minimally invasive spinal surgery (MISS) were mainly based on repeated fluoroscopy in a trial-and-error manner preoperatively and intraoperatively. Localization system mainly consisted of preoperative applied radiopaque frame and intraoperative guiding device, which has the potential to minimize fluoroscopy repetition in MISS. The study aimed to evaluate the efficacy of a novel lumbar localization system in reducing radiation exposure to patients.Included patients underwent minimally invasive transforaminal lumbar interbody fusion (MISTLIF) or percutaneous transforaminal endoscopic discectomy (PTED). Patients treated with novel localization system were regarded as Group A, and patients treated without novel localization system were regarded as Group B.For PTED, The estimated effective dose was 0.41 ± 0.13 mSv in Group A and 0.57 ± 0.14 mSv in Group B (P fluoroscopy exposure time of PTED was 22.18 ± 7.30 seconds in Group A and 30.53 ± 7.56 seconds in Group B (P fluoroscopy exposure time was 25.41 ± 5.52 seconds in Group A and 32.82 ± 5.03 seconds in Group B (P < .001); The estimated cancer risk was 24.90 ± 5.15 (10) in Group A and 31.96 ± 5.04 (10) in Group B (P < .001). There were also significant differences in localization time and operation time between the 2 groups either for MISTLIF or PTED.The lumbar localization system could be a potential protection strategy for minimizing radiation hazards.

  12. Effect of minimally invasive surgery for cerebral hematoma evacuation in different stages on motor evoked potential and thrombin in dog model of intracranial hemorrhage. (United States)

    Wu, Guofeng; Zhong, Weibin


    To observe the effect of minimally invasive surgery for cerebral hematoma evacuation in different stages on motor evoked potential (MEP) and thrombin in dog model of intracranial hemorrhage. Twenty dogs were selected to prepare the intracranial hemorrhage model, which were randomly divided into 6, 12, 18 and 24 hour groups, respectively. The animals in each group underwent a minimally invasive surgery to evacuate the cerebral hematoma after the models were prepared. Before and after procedures, Purdy score, MEP and thrombin in hematoma region were determined and compared. Significant decreases in Purdy score, latency of MEP and thrombin expression were observed in 6 and 12 hour groups as compared with the 18 and 24 hour groups (pintracranial hemorrhage, which was minimally invasive, easy to operate, highly repeated, simulating the pathological and physiological changes of clinical hypertensive intracranial hemorrhage. Both the latency of MEP and the expression of thrombin decreased after evacuation of intracranial hematoma in early stages by minimally invasive procedures, indicating that minimally invasive procedures for cerebral hematoma in ultra-early and early stages might be more effective to limit brain injury and decrease the latency of MEP and thrombin expression.

  13. Role of Intraoperative Ultrasound to Extend the Application of Minimally Invasive Surgery for Treatment of Recurrent Gynecologic Cancer. (United States)

    Mascilini, Floriana; Quagliozzi, Lorena; Moro, Francesca; Moruzzi, Maria Cristina; Gallotta, Valerio; Alletti, Salvatore Gueli; Scambia, Giovanni; Testa, Antonia Carla; Fagotti, Anna


    To describe the potential role of intraoperative ultrasound (IOUS) in the detection and localization of recurrent disease in gynecologic cancer patients during minimally invasive surgery (MIS). A prospective cohort study (Canadian Task Force classification II-1). A university hospital. Fifty-one gynecologic cancer patients with isolated recurrent disease. IOUS during secondary cytoreductive surgery (SCS) by MIS. From November 2015 to February 2017 51 gynecologic cancer patients with isolated recurrent disease and candidates for SCS were treated by MIS. Recurrent tumor was preoperatively assessed at clinical examination, transvaginal and transabdominal sonography, and radiologic evaluation in all women. Twelve of 51 women (23.5%) needed IOUS. Type of disease was ovarian in 5 women (42%), endometrial in 4 (33%), cervical in 1 (8%), vaginal cancer in 1 (8%), and uterine sarcoma in 1 (8%). Recurrence was localized deep in the pelvis in 7 cases (58%), lymph nodes in 3 (25%), and extraperitoneal in 2 cases (17%). Recurrence was dimmed in the surgical field, due to either presence of adherences, deep anatomic position, small size, and/or lack of tactile feeling. IOUS was able to identify the lesions in all women, allowing MIS (83% laparoscopy and 17% robotic) complete cytoreduction, with no conversion to laparotomy. Median operative time was 150 minutes (range, 77-280). No intraoperative/postoperative complications occurred. Histologic examination confirmed the presence of recurrence in 11 of 12 cases (92%), whereas the remaining case showed inflammatory tissue. With a median follow-up time of 15 months (range, 6-19), all patients except 2 were still alive. About 1 of 4 patients (25%) with single gynecologic cancer recurrence needs IOUS to benefit from MIS for complete secondary cytoreduction. Copyright © 2018 American Association of Gynecologic Laparoscopists. Published by Elsevier Inc. All rights reserved.

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

    Directory of Open Access Journals (Sweden)

    Cho Hwan


    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.

  15. Design and evaluation of a new ergonomic handle for instruments in minimally invasive surgery. (United States)

    Sancibrian, Ramon; Gutierrez-Diez, María C; Torre-Ferrero, Carlos; Benito-Gonzalez, Maria A; Redondo-Figuero, Carlos; Manuel-Palazuelos, Jose C


    Laparoscopic surgery techniques have been demonstrated to provide massive benefits to patients. However, surgeons are subjected to hardworking conditions because of the poor ergonomic design of the instruments. In this article, a new ergonomic handle design is presented. This handle is designed using ergonomic principles, trying to provide both more intuitive manipulation of the instrument and a shape that reduces the high-pressure zones in the contact with the surgeon's hand. The ergonomic characteristics of the new handle were evaluated using objective and subjective studies. The experimental evaluation was performed using 28 volunteers by means of the comparison of the new handle with the ring-handle (RH) concept in an instrument available on the market. The volunteers' muscle activation and motions of the hand, wrist, and arm were studied while they performed different tasks. The data measured in the experiment include electromyography and goniometry values. The results obtained from the subjective analysis reveal that most volunteers (64%) preferred the new prototype to the RH, reporting less pain and less difficulty to complete the tasks. The results from the objective study reveal that the hyperflexion of the wrist required for the manipulation of the instrument is strongly reduced. The new ergonomic handle not only provides important ergonomic advantages but also improves the efficiency when completing the tasks. Compared with RH instruments, the new prototype reduced the high-pressure areas and the extreme motions of the wrist. Copyright © 2014 Elsevier Inc. All rights reserved.

  16. Comfort and learnability assessment of a new soft robotic manipulator for minimally invasive surgery. (United States)

    Shafti, A; Andorno, F; Marchese, N; Arolfo, S; Aydin, A; Elhage, O; Noh, Y; Wurdemann, H A; Arezzo, A; Dasgupta, P; Althoefer, K


    Laparoscopic surgeons perform precise and time consuming procedures while holding awkward poses in their upper body and arms. There is an ongoing effort to produce robotic tools for laparoscopic surgery that will simplify these tasks and reduce risk of errors to help both the surgeon and the patient. STIFF-FLOP is an ongoing EU FP7 project focusing on this by creating a stiffness controllable soft robotic manipulator. This paper reports on a study to test the soft manipulator's learnability and the effort associated with its use. The tests involved a limited prototype of the manipulator with a custom built test rig and EMG acquisition system. Task times and video recordings along with EMG waveforms from the forearm muscles of participants (n=25) were measured for objective assessment. A questionnaire was also provided to the participants for subjective assessment. The data shows that in average EMG levels were 25.9% less in RMS when using the STIFF-FLOP arm than when conventional laparoscopic tools were used. In terms of learnability, from the first to the second attempt on the STIFF-FLOP manipulator, elapsed time was reduced by an average of 32.1%. Further details and analysis of the EMG signals as well as time and questionnaire results is presented in the paper.

  17. Hourglass-like constriction of the suprascapular nerve: a contraindication for minimally invasive surgery. (United States)

    Vigasio, Adolfo; Marcoccio, Ignazio


    Suprascapular nerve (SSN) entrapment is usually ascribed to static or dynamic compression. When no cause of compression is found, SSN entrapment is defined as idiopathic. Focal hourglass-like constriction (H-LC) of the SSN that results in muscle paralysis represents an unusual condition that may be misinterpreted and erroneously diagnosed as SSN entrapment or as neuralgic amyotrophy. With the aim of finding clinical and surgical clues that could differentiate the traditional form of idiopathic SSN entrapment from the rare H-LC, a series of 6 cases of SSN palsy caused by H-LC is presented. All but 1 supraspinatus muscle recovered M5 muscle strength. The Constant shoulder score was excellent in 3 patients, good in 1, fair in 1, and poor in 1. If a diagnosis is not made in time, H-LC may evolve from mild to severe nerve torsion that may require a shift in surgical procedure from epineurotomy and external neurolysis to focal resection and suture. If an incorrect therapy is chosen, the chance of recovery might be definitively compromised with the persistence of muscle palsy. Conversely, when SSN palsy persists despite notch decompression, especially when it is performed with a limited open approach or arthroscopically, concerns about the real etiology and location of nerve compression responsible for the nerve palsy may arise. When approaching SSN pathology, H-LC should be considered as a potential cause of nerve palsy, as it may represent a contraindication for a limited open approach or arthroscopic decompression. Copyright © 2017 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Elsevier Inc. All rights reserved.

  18. Advances in Bio-Tactile Sensors for Minimally Invasive Surgery Using the Fibre Bragg Grating Force Sensor Technique: A Survey

    Directory of Open Access Journals (Sweden)

    Abdulfatah A.G. Abushagur


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

  19. Advances in bio-tactile sensors for minimally invasive surgery using the fibre Bragg grating force sensor technique: a survey. (United States)

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


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

  20. Percutaneous minimally invasive fetoscopic surgery for spina bifida aperta. Part III: neurosurgical intervention in the first postnatal year. (United States)

    Graf, K; Kohl, T; Neubauer, B A; Dey, F; Faas, D; Wanis, F A; Reinges, M H T; Uhl, E; Kolodziej, M A


    To evaluate the need for postnatal neurosurgical intervention after fetoscopic patch coverage of spina bifida aperta (SBA). This was a retrospective analysis of a cohort of 71 fetuses which underwent minimally invasive fetoscopic patch coverage of SBA between 21 + 0 and 29 + 1 weeks of gestation. Postnatal neurosurgical procedures were classified into two types: re-coverage of the SBA within the first 3 months following birth, and shunt placement as treatment of associated hydrocephalus within the first year. Location of the SBA was lumbosacral in 59 cases, lumbar in seven, thoracic in three and sacral in two. In total, 20/71 (28%) patients underwent early postnatal neurosurgical intervention by means of re-coverage of the SBA. This was performed because of cerebrospinal fluid leakage in seven (35%), adhesions with functional deterioration in three (15%), incomplete coverage in five (25%) and skin defect in five (25%) cases. Ventriculoperitoneal shunt placement within 1 year was required in 32 (45%) cases and was preceded by ventriculostomy in two. Three (4%) infants needed Chiari decompression surgery in the first 12 months following birth, because of syringomyelia or gait disturbance. Fetoscopic patch coverage of SBA may require postnatal re-coverage in some cases. In most cases, conservative wound treatment shows good results, without requiring neurosurgical intervention. The low 1-year-shunt rate is comparable to data of the Management of Myelomeningocele Study and lower compared with published data of patients with postnatal only coverage of SBA. Copyright © 2015 ISUOG. Published by John Wiley & Sons Ltd.

  1. Minimally invasive videoscopic mitral valve surgery: the current role of surgical robotics. (United States)

    Chitwood, W R; Nifong, L W


    Recently, the efficacy of video-assisted mitral valve surgery has been demonstrated. The evolution of this technology has been relatively rapid. In this article we review this development and predict the future of endoscopic and robotic-enabling technology for cardiac valve operations. A new video-assisted mitral valve operation is described and results discussed. The majority of each valve operation was done through assisted vision and near endoscopically. Cardiopulmonary bypass was established via femoral cannulation, and blood cardioplegic arrest induced using a new percutaneous, transthoracic cross-clamp. A 5 to 6-cm minithoracotomy was used in each patient. Videoscopy was helpful for suture placement, chord reconstruction, leaflet resection, knot tying, and valve ring or prosthesis positioning. A voice-activated robotic arm was used to direct the camera in many instances. Thus far a total of 110 patients have undergone this operation successfully with a 0.9% operative mortality. Our early series (N = 31), published with cost data, is reviewed in detail. Cardiopulmonary perfusion and cross-clamp times for all 100 patients were longer than for conventional sternotomy patients at 158 +/- 3.9 and 110 +/- 3.6 minutes, respectively, versus 121 +/- 4.6 and 90 +/- 4.6 (N = 105); however, there have been less complications. Operative, perfusion, and arrest times have fallen progressively to 144 +/- 4.5 and 90 +/- 4.5, respectively (N = 55 Aesop 3000 cases). Complex repairs and replacements have become routine with anterior leaflet pathology addressed. Bleeding, ventilatory times, blood transfusions, and hospital stay have been reduced. One patient required reoperation for a technically failed repair and two renal patients had late endocarditis. We have used voice-activated, robotic (Aesop 3000) assistance for camera control in 51 of these patients. This addition has decreased camera motion artifact and lens cleaning, while providing direct "cerebral-eye" tracking of

  2. Effect of minimally invasive surgery combined with postoperative placenta polypeptide injection therapy on fracture healing and hemorheology in elderly patients with femoral intertrochanteric fracture

    Directory of Open Access Journals (Sweden)

    Yan-Kui Bai


    Full Text Available Objective: To analyze the effect of minimally invasive surgery combined with postoperative placenta polypeptide injection therapy on fracture healing and hemorheology in elderly patients with femoral intertrochanteric fracture. Methods: A total of 70 elderly patients with femoral intertrochanteric fracture were randomly divided into observation group and control group (n=35, control group received minimally invasive surgery alone and observation group received minimally invasive surgery combined with postoperative placenta polypeptide injection therapy. The differences in postoperative bone mineral density as well as serum inflammatory indexes, bone metabolism indexes, hemorheology parameters, femoral neck length, neck-shaft angle value and so on were compared between two groups of patients. Results: Serum TNF-α, IL-6, PCT and MCP-1 content of observation group 2 weeks after treatment were lower than those of control group while IL-10 and TGF-β content were higher than those of control group; serum PINP and 25(OHD3 content were higher than those of control group while CTX and PCT content were lower than those of control group; whole blood high shear, middle shear and low shear viscosity, plasma viscosity as well as ESR and Fib content were lower than those of control group; the femoral neck length and neck-shaft angle levels 3 months after treatment were higher than those of control group. Conclusions: Minimally invasive surgery combined with postoperative placenta polypeptide injection therapy has advantages in promoting fracture healing, restoring physiological function of lower limbs and other aspects in elderly patients with femoral intertrochanteric fracture.

  3. Description of Causes and Treatment Types Made in Teeth with Biological Space Invasion and/or in Need of Pre-Prosthetic Surgery: Case series


    Machón, Lourdes; Universidad Evangélica de El Salvador; Hernández, Morena; Universidad Evangélica de El Salvador; Espinoza, Manuel Antonio; Universidad Evangélica de El Salvador; Hidalgo de Andrade, Laura Elena; Universidad Evangélica de El Salvador; Andrade Acevedo, Roberto Antonio; Universidad Evangélica de El Salvador


    Background: The decision to rehabilitate or extract a tooth is determined by the knowledge of the causes of dental destruction affecting treatment plan and prognosis. Aim: Describe indications, surgical periodontal therapy prior to dental restoration, most affected teeth and age of the patients with invasion of biological space (IBS) and/or pre-prosthetic surgery. Methods: This is a case series report of 162 patients, male and female, who were treated at the predoctoral dental program of Univ...

  4. On the relative merits of invasive and non-invasive pre-surgical brain mapping: New tools in ablative epilepsy surgery. (United States)

    Papanicolaou, Andrew C; Rezaie, Roozbeh; Narayana, Shalini; Choudhri, Asim F; Abbas-Babajani-Feremi; Boop, Frederick A; Wheless, James W


    Cortical Stimulation Mapping (CSM) and the Wada procedure have long been considered the gold standard for localizing motor and language-related cortical areas and for determining the language and memory-dominant hemisphere, respectively. In recent years, however, non-invasive methods such as magnetoencephalography (MEG), functional magnetic resonance imaging (fMRI), and transcranial magnetic stimulation (TMS) have emerged as promising alternatives to the aforementioned procedures, particularly in cases where the invasive localization of eloquent cortex has proven to be challenging. To illustrate this point, we will first introduce the evidence of the compatibility of invasive and non-invasive methods and subsequently outline the rationale and the conditions where the latter methods are applicable. Copyright © 2017 Elsevier B.V. All rights reserved.

  5. Surgery (United States)

    ... and sterile gloves. Before the surgery begins, a time out is held during which the surgical team confirms ... the Consumer Version. DOCTORS: Click here for the Professional Version What Participants Need to Know About Clinical ...

  6. Underestimating Costs in Public Works Projects

    DEFF Research Database (Denmark)

    Flyvbjerg, Bent; Holm, Mette K. Skamris; Buhl, Søren L.


    questions of cost underestimation and escalation for different project types, different geographical regions, and different historical periods. Four kinds of explanation of cost underestimation are examined: technical, economic, psychological, and political. Underestimation cannot be explained by error......This article presents results from the first statistically significant study of cost escalation in transportation infrastructure projects. Based on a sample of 258 transportation infrastructure projects worth $90 billion (U.S.), it is found with overwhelming statistical significance that the cost...... estimates used to decide whether important infrastructure should be built are highly and systematically misleading. The result is continuous cost escalation of billions of dollars. The sample used in the study is the largest of its kind, allowing for the first time statistically valid conclusions regarding...

  7. Cost Underestimation in Public Works Projects

    DEFF Research Database (Denmark)

    Flyvbjerg, Bent; Holm, Mette K. Skamris; Buhl, Søren L.

    questions of cost underestimation and escalation for different project types, different geographical regions, and different historical periods. Four kinds of explanation of cost underestimation are examined: technical, economic, psychological, and political. Underestimation cannot be explained by error......This article presents results from the first statistically significant study of cost escalation in transportation infrastructure projects. Based on a sample of 258 transportation infrastructure projects worth $90 billion (U.S.), it is found with overwhelming statistical significance that the cost...... estimates used to decide whether important infrastructure should be built are highly and systematically misleading. The result is continuous cost escalation of billions of dollars. The sample used in the study is the largest of its kind, allowing for the first time statistically valid conclusions regarding...

  8. Underestimation of risk due to exposure misclassification

    DEFF Research Database (Denmark)

    Grandjean, Philippe; Budtz-Jørgensen, Esben; Keiding, Niels


    Exposure misclassification constitutes a major obstacle when developing dose-response relationships for risk assessment. A non-differentional error results in underestimation of the risk. If the degree of misclassification is known, adjustment may be achieved by sensitivity analysis. The purpose...... of this study was to examine the full magnitude of measurement error in determining the prenatal exposure to methylmercury. We used data from a prospective study of a Faroese birth cohort. Two biomarkers of methylmercury exposure were available, i.e., the mercury concentrations in cord blood and in maternal....... These findings illustrate that measurement error may be greatly underestimated if judged solely from reproducibility or laboratory quality data. Adjustment by sensitivity analysis is meaningful only if realistic measurement errors are applied. When exposure measurement errors are overlooked or underestimated...

  9. Minimally Invasive Surgery Combined with Regenerative Biomaterials in Treating Intra-Bony Defects: A Meta-Analysis (United States)

    Zhang, Yuanyuan; Li, Wenyang; Song, Jinlin


    Background With the popularity of minimally invasive surgery (MIS) in periodontics, numerous publications have evaluated the benefits of MIS with or without various regenerative biomaterials in the treatment of periodontal intra-bony defects. However, it is unclear if it is necessary to use biomaterials in MIS. Thus, we conducted a meta-analysis of randomized clinical trials in patients with intra-bony defects to compare the clinical outcomes of MIS with regenerative biomaterials for MIS alone. Methods The authors retrieved English publications on relevant studies from Cochrane CENTRAL, PubMed, Medline, Embase, Clinical Evidence, and (up to June 30, 2015). The main clinical outcomes were the reduction of probing pocket depths (PPDs), gain of clinical attachment level (CAL), recession of gingival margin (REC) and radiographic bone fill. Review Manager 5.2 (Cochrane Collaboration, Oxford, England) was used to calculate the heterogeneity and mean differences of the main clinical outcomes. Results In total, 464 studies in the literature were identified but only four were ultimately feasible. The results showed no significant difference regarding CAL gain (P = 0.32) and PPD reduction (P = 0.40) as well as REC increase (P = 0.81) and radiographic bone fill (P = 0.64) between the MIS plus biomaterials group and the MIS alone group. Conclusions The meta-analysis suggested no significant difference in treatment of intra-bony defects between the MIS plus biomaterials group and the MIS alone group, indicating that it is important to take costs and benefits into consideration when a decision is made about a therapeutic approach. There needs to be an in-depth exploration of the induction of intrinsic tissue healing of MIS without biomaterials to achieve optimal outcomes. PMID:26785405

  10. The Interest of Performing "On-Demand Chest X-rays" after Lung Resection by Minimally Invasive Surgery. (United States)

    Haddad, Laura; Bubenheim, Michael; Bernard, Alain; Melki, Jean; Peillon, Christophe; Baste, Jean-Marc


    Background  There is a lack of consensus in hospital centers regarding costly daily routine chest X-rays after lung resection by minimally invasive surgery. Indeed, there is no evidence that performing daily chest X-rays prevents postoperative complications. Our objective was to compare chest X-rays performed on demand when there was clinical suspicion of postoperative complications and chest X-rays performed systematically in daily routine practice. Methods  This prospective single-center study compared 55 patients who had on-demand chest X-rays and patients in the literature who had daily routine chest X-rays. Our primary evaluation criterion was length of hospitalization. Results  The length of hospitalization was 5.3 ± 3.3 days for patients who had on-demand X-rays, compared with 4 to 9.7 days for patients who had daily routine X-rays. Time to chest tube removal (4.34 days), overall complication rate (27.2%), reoperation rate (3.6%), and mortality rate (1.8%) were comparable to those in the literature. On average, our patients only had 1.22 ± 1.8 on-demand X-rays, compared with 3.3 X-rays if daily routine protocol had been applied. Patients with complications had more X-rays (3.4 ± 1.8) than patients without complications (0.4 ± 0.7). Conclusion  On-demand chest X-rays do not seem to delay the diagnosis of postoperative complications or increase morbidity-mortality rates. Performing on-demand chest X-rays could not only simplify surgical practice but also have a positive impact on health care expenses. However, a broader randomized study is warranted to validate this work and ultimately lead to national consensus. Georg Thieme Verlag KG Stuttgart · New York.

  11. Minimally invasive fibrillating heart surgery: a safe and effective approach for mitral valve and surgical ablation for atrial fibrillation. (United States)

    Massimiano, Paul S; Yanagawa, Bobby; Henry, Linda; Holmes, Sari D; Pritchard, Graciela; Ad, Niv


    Minimally invasive (MI) approaches to mitral valve surgery (MVS) and surgical ablation for atrial fibrillation (AF) are now performed routinely, and avoidance of aortic manipulation and cardioplegic arrest may further simplify the procedure. We present our experience with MI fibrillatory cardiac operations without aortic cross-clamping for MVS and AF ablation. Between January 2007 and August 2012, 292 consecutive patients underwent MVS (n = 177), surgical ablation (n = 81), or both (n= 34), with fibrillating heart through a right minithoracotomy. Baseline characteristics, perioperative outcomes, and long-term survival were evaluated. The mean age was 56.8 years (range, 20-83 years). Reoperations were performed in 25 patients (9%). The overall MV repair rate was 93.4% (198/211), including 13.1% (26/198) with anterior leaflet repair. Repair was performed in 100% of patients with myxomatous MV disease. Of isolated posterior mitral valve repairs, 60.5% underwent repair with neochords (W.L. Gore and Associates, Flagstaff, AZ), and 29.7% underwent triangular resection. There was 1 operative mortality (0.3%), no intraoperative conversions to sternotomy, 4 reoperations (1.4%), 1 stroke (0.3%), and 1 transient ischemic attack (0.3%). The 12-month return to sinus rhythm was 93%, and sinus rhythm without class I and class III antiarrhythmic medication was 85%. One- and 2-year cumulative survival was 98.5% and 97.8%, respectively. At mean follow-up of 27.3 months, our outcomes compared favorably with the 2011 Society of Thoracic Surgeons (STS) nationally reported outcomes. We demonstrated that low operative mortality and low stroke rate with MI fibrillating cardiac operations without cross-clamping allows for MVS and AF ablation. Our results suggest that the MI fibrillating heart approach is safe and effective. Copyright © 2013 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.

  12. Port Site Local Anesthetic Infiltration Vs Single-dose Intrathecal Opioid Injection to Control Perioperative Pain in Children Undergoing Minimal Invasive Surgery: A Comparative Analysis. (United States)

    Srinivasan, Arun K; Shrivastava, Dhiren; Kurzweil, Rebecca E; Weiss, Dana A; Long, Christopher J; Shukla, Aseem R


    To compare the efficacy of the intrathecal opiate vs wound site local anesthetic infiltration for perioperative pain control during and after surgery in patients undergoing minimally invasive pediatric urologic procedures. Using an Institutional Review Board-approved registry database, we identified patients who underwent minimally invasive urologic procedures at our institution between 2009 and 2013. We collected all relevant preoperative variables and postoperative outcomes. Patients in intrathecal injection of opioids (ITO) group were matched with patients who received local anesthetic infiltration (LAI) based on age, diagnosis, and procedure. Perioperative analgesic requirements were converted to morphine equivalents standardized to body weight. Statistical analysis was performed using SPSS, and parametric comparisons were completed to determine difference in morphine equivalents between the 2 groups. One hundred thirty children (78 girls and 52 boys) were included in our study. Sixty-six patients underwent ITO and 66 received LAI. Sixty-six patients underwent ureteral reimplantation, 60 underwent pyeloplasty, and 4 underwent nephrectomy. Ages ranged from 0.5 to 19.9 years. There was no significant difference in cumulative morphine equivalents or weight administered between the ITO and LAI groups for the total period of hospitalization (0.76 units vs 0.79 units, P > .05). Multivariate regression analysis predicted that older age corresponds to higher analgesic requirements. ITO does not impact total analgesic requirements during the hospital stay compared to LAI following minimally invasive surgery. Considering the potential complications of ITO, LAI may be the preferred modality for pain management for minimally invasive surgery in children. Copyright © 2016 Elsevier Inc. All rights reserved.

  13. Surgery (United States)

    ... surgery has several common causes, including the following: Infections at the operative site Lung problems such as pneumonia or collapsed lung ... the trauma of an operation. The risk of infections at the operative site, DVTs, and UTIs can be decreased by meticulous ...

  14. Minimally invasive surgery when treating endometriosis has a positive effect on health and on quality of work life of affected women. (United States)

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


    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 working performance of women suffering from moderate to severe endometriosis

  15. Minimally Invasive Surgery (United States)

    ... Psychological Component of Infertility FAQs About Cloning and Stem Cell Research SART's FAQs about In Vitro Fertilization REPRODUCTIVE HEALTH TOPICS Topics Index NEWS AND PUBLICATIONS Publications Overview News and Research Ethics Documents Practice Committee Documents Patient Fact Sheets and ...

  16. A three-arm (laparoscopic, hand-assisted, and robotic) matched-case analysis of intraoperative and postoperative outcomes in minimally invasive colorectal surgery. (United States)

    Patel, Chirag B; Ragupathi, Madhu; Ramos-Valadez, Diego I; Haas, Eric M


    Robotic-assisted laparoscopic surgery is an emerging modality in the field of minimally invasive colorectal surgery. However, there is a dearth of data comparing outcomes with other minimally invasive techniques. We present a 3-arm (conventional, hand-assisted, and robotic) matched-case analysis of intraoperative and short-term outcomes in patients undergoing minimally invasive colorectal procedures. Between August 2008 and October 2009, 70 robotic cases of the rectum and rectosigmoid were performed. Thirty of these were organized into triplets with conventional and hand-assisted cases based on the following 6 matching criteria: 1) surgeon; 2) sex; 3) body mass index; 4) operative procedure; 5) pathology; and 6) history of neoadjuvant therapy in malignant cases. Demographics, intraoperative parameters, and postoperative outcomes were assessed. Pathological outcomes were analyzed in malignant cases. Data were stratified by postoperative diagnosis and operative procedure. There was no significant difference in intraoperative complications, estimated blood loss (126.1 ± 98.5 mL overall), or postoperative morbidity and mortality among the groups. Robotic technique required longer operative time compared with conventional laparoscopic (P hand-assisted (P robotic approach results in short-term outcomes comparable to conventional and hand-assisted laparoscopic approaches for benign and malignant diseases of the rectum and rectosigmoid. With 3-dimensional visualization, additional freedom of motion, and improved ergonomics, this enabling technology may play an important role when performing colorectal procedures involving the pelvic anatomy.

  17. Long Term Safety Area Tracking (LT-SAT) with online failure detection and recovery for robotic minimally invasive surgery. (United States)

    Penza, Veronica; Du, Xiaofei; Stoyanov, Danail; Forgione, Antonello; Mattos, Leonardo S; De Momi, Elena


    Despite the benefits introduced by robotic systems in abdominal Minimally Invasive Surgery (MIS), major complications can still affect the outcome of the procedure, such as intra-operative bleeding. One of the causes is attributed to accidental damages to arteries or veins by the surgical tools, and some of the possible risk factors are related to the lack of sub-surface visibilty. Assistive tools guiding the surgical gestures to prevent these kind of injuries would represent a relevant step towards safer clinical procedures. However, it is still challenging to develop computer vision systems able to fulfill the main requirements: (i) long term robustness, (ii) adaptation to environment/object variation and (iii) real time processing. The purpose of this paper is to develop computer vision algorithms to robustly track soft tissue areas (Safety Area, SA), defined intra-operatively by the surgeon based on the real-time endoscopic images, or registered from a pre-operative surgical plan. We propose a framework to combine an optical flow algorithm with a tracking-by-detection approach in order to be robust against failures caused by: (i) partial occlusion, (ii) total occlusion, (iii) SA out of the field of view, (iv) deformation, (v) illumination changes, (vi) abrupt camera motion, (vii), blur and (viii) smoke. A Bayesian inference-based approach is used to detect the failure of the tracker, based on online context information. A Model Update Strategy (MUpS) is also proposed to improve the SA re-detection after failures, taking into account the changes of appearance of the SA model due to contact with instruments or image noise. The performance of the algorithm was assessed on two datasets, representing ex-vivo organs and in-vivo surgical scenarios. Results show that the proposed framework, enhanced with MUpS, is capable of maintain high tracking performance for extended periods of time ( ≃ 4 min - containing the aforementioned events) with high precision (0

  18. The Invasive Region of Glioblastoma Defined by 5ALA Guided Surgery Has an Altered Cancer Stem Cell Marker Profile Compared to Central Tumour

    Directory of Open Access Journals (Sweden)

    Stuart J. Smith


    Full Text Available Glioblastoma, a WHO grade IV astrocytoma, is a highly aggressive and heterogeneous tumour that infiltrates deeply into surrounding brain parenchyma, making complete surgical resection impossible. Despite chemo-radiotherapy, the residual cell population within brain parenchyma post-surgery causes inevitable recurrence. Previously, the tumour core has been the focus of research and the basis for targeted therapeutic regimes, which have failed to improve survival in clinical trials. Here, we focus on the invasive margin as defined by the region with 5-aminolevulinic acid (5ALA (GliolanTM fluorescence at surgery beyond the T1 enhancing region on magnetic resonance imaging (MRI. This area is hypothesized to constitute unique microenvironmental pressures, and consequently be molecularly distinct to tumour core and enhancing rim regions. We conducted hematoxylin and eosin (H&E, array real time polymerase chain reaction (PCR, and immunohistochemistry staining on various intra-tumour regions of glioblastoma to determine molecular heterogeneity between regions. We analyzed 73 tumour samples from 21 patients and compared cellular density, cell proliferation, and the degree of vascularity. There is a statistically significant difference between the core, invasive margin and other regions for cell density (p < 0.001, cell proliferation (p = 0.029, and vascularity (p = 0.007. Aldehyde dehydrogenase 1 (ALDH1 and Nestin immunohistochemistry were used as a measure of stem-like properties, showing significantly decreased Nestin expression (p < 0.0001 in the invasive margin. Array PCR of the core, rim, and invasive regions showed significantly increased fibroblast growth factor (FGF and ALDH1 expression in the invasive zone, with elevated hypoxia inducing factor 1-alpha (HIF1α in the rim region, adjacent to the hypoxic core. The influence of varying microenvironments in the intra-tumour regions is a major key to understanding intra-tumour heterogeneity. This

  19. A study on the theoretical and practical accuracy of conoscopic holography-based surface measurements: toward image registration in minimally invasive surgery. (United States)

    Burgner, J; Simpson, A L; Fitzpatrick, J M; Lathrop, R A; Herrell, S D; Miga, M I; Webster, R J


    Registered medical images can assist with surgical navigation and enable image-guided therapy delivery. In soft tissues, surface-based registration is often used and can be facilitated by laser surface scanning. Tracked conoscopic holography (which provides distance measurements) has been recently proposed as a minimally invasive way to obtain surface scans. Moving this technique from concept to clinical use requires a rigorous accuracy evaluation, which is the purpose of our paper. We adapt recent non-homogeneous and anisotropic point-based registration results to provide a theoretical framework for predicting the accuracy of tracked distance measurement systems. Experiments are conducted a complex objects of defined geometry, an anthropomorphic kidney phantom and a human cadaver kidney. Experiments agree with model predictions, producing point RMS errors consistently holography is clinically viable; it enables minimally invasive surface scan accuracy comparable to current clinical methods that require open surgery. Copyright © 2012 John Wiley & Sons, Ltd.

  20. Minimally invasive scoliosis surgery assisted by O-arm navigation for Lenke Type 5C adolescent idiopathic scoliosis: a comparison with standard open approach spinal instrumentation. (United States)

    Zhu, Weiguo; Sun, Weixiang; Xu, Leilei; Sun, Xu; Liu, Zhen; Qiu, Yong; Zhu, Zezhang


    OBJECTIVE Recently, minimally invasive scoliosis surgery (MISS) was introduced for the correction of adult scoliosis. Multiple benefits including a good deformity correction rate and fewer complications have been demonstrated. However, few studies have reported on the use of MISS for the management of adolescent idiopathic scoliosis (AIS). The purpose of this study was to investigate the outcome of posterior MISS assisted by O-arm navigation for the correction of Lenke Type 5C AIS. METHODS The authors searched a database for all patients with AIS who had been treated with either MISS or PSF between November 2012 and January 2014. Levels of fusion, density of implants, operation time, and estimated blood loss (EBL) were recorded. Coronal and sagittal parameters were evaluated before surgery, immediately after surgery, and at the last follow-up. The accuracy of pedicle screw placement was assessed according to postoperative axial CT images in both groups. The 22-item Scoliosis Research Society questionnaire (SRS-22) results and complications were collected during follow-up. RESULTS The authors retrospectively reviewed the records of 45 patients with Lenke Type 5C AIS, 15 who underwent posterior MISS under O-arm navigation and 30 who underwent posterior spinal fusion (PSF). The 2 treatment groups were matched in terms of baseline characteristics. Comparison of radiographic parameters revealed no obvious difference between the 2 groups immediately after surgery or at the final follow-up; however, the MISS patients had significantly less EBL (p self-image using the SRS-22 showed significantly higher scores in the MISS group (p = 0.013 and 0.046, respectively) than in the PSF group. Postoperative CT showed high accuracy in pedicle placement in both groups. No deep wound infection, pseudarthrosis, additional surgery, implant failure, or neurological complications were recorded in either group. CONCLUSIONS Minimally invasive scoliosis surgery is an effective and safe

  1. Poverty Underestimation in Rural India- A Critique


    Sivakumar, Marimuthu; Sarvalingam, A


    When ever the Planning Commission of India releases the poverty data, that data is being criticised by experts and economists. The main criticism is underestimation of poverty especially in rural India by the Planning Commission. This paper focuses on that criticism and compares the Indian Planning Commission’s 2004-05 rural poverty data with the India’s 2400 kcal poverty norms, World Bank’s US $1.08 poverty concept and Asian Development Bank’s US $1.35 poverty concept.

  2. Comparison of the costs of nonoperative care to minimally invasive surgery for sacroiliac joint disruption and degenerative sacroiliitis in a United States Medicare population: potential economic implications of a new minimally-invasive technology

    Directory of Open Access Journals (Sweden)

    Ackerman SJ


    Full Text Available Stacey J Ackerman1, David W Polly Jr2, Tyler Knight3, Karen Schneider4, Tim Holt5, John Cummings61Covance Market Access Services Inc, San Diego, CA, USA; 2University of Minnesota, Orthopaedic Surgery, Minneapolis, MN, USA; 3Covance Market Access Services Inc, Gaithersburg, MD, USA; 4Covance Market Access Services Inc, Sydney, NSW, Australia; 5Montgomery Spine Center, Orthopaedic Surgery, Montgomery, AL, USA; 6Community Health Network, Neurosurgery, Indianapolis, IN, USAIntroduction: The economic burden associated with the treatment of low back pain (LBP in the United States is significant. LBP caused by sacroiliac (SI joint disruption/degenerative sacroiliitis is most commonly treated with nonoperative care and/or open SI joint surgery. New and effective minimally invasive surgery (MIS options may offer potential cost savings to Medicare.Methods: An economic model was developed to compare the costs of MIS treatment to nonoperative care for the treatment of SI joint disruption in the hospital inpatient setting in the US Medicare population. Lifetime cost savings (2012 US dollars were estimated from the published literature and claims data. Costs included treatment, follow-up, diagnostic testing, and retail pharmacy pain medication. Costs of SI joint disruption patients managed with nonoperative care were estimated from the 2005–2010 Medicare 5% Standard Analytic Files using primary International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM diagnosis codes 720.2, 724.6, 739.4, 846.9, or 847.3. MIS fusion hospitalization cost was based on Diagnosis Related Group (DRG payments of $46,700 (with major complications - DRG 459 and $27,800 (without major complications - DRG 460, weighted assuming 3.8% of patients have complications. MIS fusion professional fee was determined from the 2012 Medicare payment for Current Procedural Terminology code 27280, with an 82% fusion success rate and 1.8% revision rate. Outcomes were

  3. SLAM-based dense surface reconstruction in monocular Minimally Invasive Surgery and its application to Augmented Reality. (United States)

    Chen, Long; Tang, Wen; John, Nigel W; Wan, Tao Ruan; Zhang, Jian Jun


    While Minimally Invasive Surgery (MIS) offers considerable benefits to patients, it also imposes big challenges on a surgeon's performance due to well-known issues and restrictions associated with the field of view (FOV), hand-eye misalignment and disorientation, as well as the lack of stereoscopic depth perception in monocular endoscopy. Augmented Reality (AR) technology can help to overcome these limitations by augmenting the real scene with annotations, labels, tumour measurements or even a 3D reconstruction of anatomy structures at the target surgical locations. However, previous research attempts of using AR technology in monocular MIS surgical scenes have been mainly focused on the information overlay without addressing correct spatial calibrations, which could lead to incorrect localization of annotations and labels, and inaccurate depth cues and tumour measurements. In this paper, we present a novel intra-operative dense surface reconstruction framework that is capable of providing geometry information from only monocular MIS videos for geometry-aware AR applications such as site measurements and depth cues. We address a number of compelling issues in augmenting a scene for a monocular MIS environment, such as drifting and inaccurate planar mapping. A state-of-the-art Simultaneous Localization And Mapping (SLAM) algorithm used in robotics has been extended to deal with monocular MIS surgical scenes for reliable endoscopic camera tracking and salient point mapping. A robust global 3D surface reconstruction framework has been developed for building a dense surface using only unorganized sparse point clouds extracted from the SLAM. The 3D surface reconstruction framework employs the Moving Least Squares (MLS) smoothing algorithm and the Poisson surface reconstruction framework for real time processing of the point clouds data set. Finally, the 3D geometric information of the surgical scene allows better understanding and accurate placement AR augmentations

  4. Use of {sup 99m}Tc 2-methoxyisobutyl isonitrile in minimally invasive radioguided surgery in patients with primary hyperparathyroidism: A narrative review of the current literature

    Energy Technology Data Exchange (ETDEWEB)

    Denmeade, Kristie A [Nuclear Medicine and Ultrasound Department, Bankstown-Lidcombe Hospital, Bankstown, New South Wales (Australia); Constable, Chris [Brain and Mind Research Institute, University of Sydney, New South Wales (Australia); Reed, Warren M [Discipline of Medical Radiation Sciences, Faculty of Health Sciences, The University of Sydney, New South Wales (Australia); Nuclear Medicine and Ultrasound Department, Bankstown-Lidcombe Hospital, Bankstown, New South Wales (Australia)


    The use of technetium-99m 2-methoxyisobutyl isonitrile ({sup 99m}Tc MIBI) for assistance in minimally invasive radioguided surgery (MIRS) is growing in popularity as a safe, effective, and proficient technique used for parathyroidectomy in primary hyperparathyroidism (PHPT) treatment. Previously, the preferred treatment for PHPT was bilateral neck exploration (BNE), a very invasive, costly, and lengthy procedure. However, as a large majority (80–85% of cases of PHPT) are attributed to a single parathyroid adenoma (PA), a simpler more direct technique such as MIRS is a far better option. The following article is an exploration of the current literature concerning varied protocols utilizing {sup 99m}Tc MIBI for assistance in MIRS for patients undergoing treatment of PHPT. This technique boasts many advantageous outcomes for patients suffering from PHPT. These include a reduction in cost, operating time, and patient recovery; less evidence of post-surgical hypocalcaemia, less pain, and complications; superior cosmetic results; same-day discharge; and the possibility of local anaesthesia which is particularly beneficial in elderly patients. Better outcomes for patients with deep or ectopic PAs, reduced intra-operative complications, and improved cosmetic outcomes for patients who have previously undergone thyroid and/or parathyroid surgery are also advantageous. Of the literature reviewed it was also found that no patients suffered any major surgical complications such as laryngeal nerve palsy or permanent hypoparathyroidism using {sup 99m}Tc MIBI for assistance in MIRS.

  5. Use of 99mTc 2-methoxyisobutyl isonitrile in minimally invasive radioguided surgery in patients with primary hyperparathyroidism: A narrative review of the current literature

    International Nuclear Information System (INIS)

    Denmeade, Kristie A; Constable, Chris; Reed, Warren M


    The use of technetium-99m 2-methoxyisobutyl isonitrile ( 99m Tc MIBI) for assistance in minimally invasive radioguided surgery (MIRS) is growing in popularity as a safe, effective, and proficient technique used for parathyroidectomy in primary hyperparathyroidism (PHPT) treatment. Previously, the preferred treatment for PHPT was bilateral neck exploration (BNE), a very invasive, costly, and lengthy procedure. However, as a large majority (80–85% of cases of PHPT) are attributed to a single parathyroid adenoma (PA), a simpler more direct technique such as MIRS is a far better option. The following article is an exploration of the current literature concerning varied protocols utilizing 99m Tc MIBI for assistance in MIRS for patients undergoing treatment of PHPT. This technique boasts many advantageous outcomes for patients suffering from PHPT. These include a reduction in cost, operating time, and patient recovery; less evidence of post-surgical hypocalcaemia, less pain, and complications; superior cosmetic results; same-day discharge; and the possibility of local anaesthesia which is particularly beneficial in elderly patients. Better outcomes for patients with deep or ectopic PAs, reduced intra-operative complications, and improved cosmetic outcomes for patients who have previously undergone thyroid and/or parathyroid surgery are also advantageous. Of the literature reviewed it was also found that no patients suffered any major surgical complications such as laryngeal nerve palsy or permanent hypoparathyroidism using 99m Tc MIBI for assistance in MIRS

  6. Minimally invasive surgery versus laparotomy in women with high grade endometrial cancer: a multi-site study performed at high volume cancer centers. (United States)

    Fader, Amanda Nickles; Seamon, Leigh G; Escobar, Pedro F; Frasure, Heidi E; Havrilesky, Laura A; Zanotti, Kristine M; Secord, Angeles Alvarez; Boggess, John F; Cohn, David E; Fowler, Jeffrey M; Skafianos, Gregory; Rossi, Emma; Gehrig, Paola A


    The study aim was to compare outcomes in women with high-grade endometrial cancer (EC) who underwent surgical staging via minimally invasive surgery (MIS) versus laparotomy. This is a retrospective, multi-institutional cohort study of patients with high-grade EC who were comprehensively surgically staged by either MIS or laparotomy. Demographic, surgical variables, complications, and survival were analyzed. Three hundred and eighty-three patients met criteria: 191 underwent laparotomy and 192 MIS (65% robotic, 35% laparoscopy). Subgroups were well matched by age (mean 66 years), stage, body mass index, histology and adjuvant therapies. Median operative time was longer in the MIS group (191 vs. 135 min; plaparotomy. As this population is elderly and most will receive adjuvant therapies, minimization of surgical morbidity is of interest. When managed by expert laparoscopists or robotic surgeons, a high-risk histologic subtype is not a contraindication to minimally invasive surgery in women with apparent early-stage disease. Copyright © 2012 Elsevier Inc. All rights reserved.

  7. A controlled clinical study of serosa-invasive gastric carcinoma patients who underwent surgery plus intraperitoneal hyperthermo-chemo-perfusion (IHCP). (United States)

    Kim, J Y; Bae, H S


    Despite recent advances in the treatment of advanced gastric carcinomas, no satisfactory outcomes are available because of micrometastases and free-floating carcinoma cells already existing in the peritoneal cavity. From 1990, we started using intraperitoneal hyperthermo-chemo-perfusion (IHCP) to prevent and to treat peritoneal metastasis after surgical resection of stomach cancer. We analyzed 103 serosa-invasive gastric carcinoma patients who underwent surgical resection between 1990 and 1995. Fifty-two patients who received surgery plus IHCP were compared with 51 patients who underwent surgery only, as controls. IHCP was administered for 2 h with an automatic IHCP device (closed-circuit system) just after surgical resection, with the patient under hypothermic general anesthesia (32.4 degrees C-34.0 degrees C). As perfusate, we used 1.5% peritoneal dialysis solution mixed with 10 micrograms/ml of mitomycin-C (MMC), warmed at an inflow temperature of over 44 degrees C. The overall 5-year survival rate (5-YSR) of the 103 patients was 29.97%. The 5-YSR was higher in the IHCP group than in the control group, at 32.7% and 27.1%, respectively, but this difference was not significant. However, in the 65 serosa-invasive gastric carcinoma patients (excluding those in stage IV) the 5-YSR was significantly higher (P = 0.0379) in the IHCP group than in the control group, at 58.6% and 44.4%, respectively. On multivariate analysis of all 103 patients, depth of tumor invasion and lymph node metastasis were significant factors for survival, whereas significant factors on univariate analysis, such as combined operation, distant metastasis, and peritoneal metastasis, were not significant. The most common recurrence patterns were loco-regional in the IHCP group and peritoneal in the control group. Complete cytoreductive surgery plus IHCP is effective to prevent and to treat peritoneal metastasis, and it should lead to long-term survival for serosa-invasive gastric carcinoma patients

  8. [Effects of robot-assisted minimally invasive transforaminal lumbar interbody fusion and traditional open surgery in the treatment of lumbar spondylolisthesis]. (United States)

    Cui, G Y; Tian, W; He, D; Xing, Y G; Liu, B; Yuan, Q; Wang, Y Q; Sun, Y Q


    Objective: To compare the clinical effects of robot-assisted minimally invasive transforaminal lumbar interbody fusion (TLIF) and traditional open TLIF in the treatment of lumbar spondylolisthesis. Methods: A total of 41 patients with lumbar spondylolisthesis accepted surgical treatment in Department of Spinal Surgery of Beijing Jishuitan Hospital From July 2015 to April 2016 were retrospectively analyzed. There were 16 cases accepted robot-assisted minimally invasive TLIF and 25 accepted traditional open TLIF. The operation time, X-ray radiation exposure time, perioperative bleeding, drainage volume, time of hospitalization, time for pain relief, time for ambulatory recovery, visual analogue scale (VAS), Oswestry disability index (ODI) and complications were compared. T test and χ(2) were used to analyze data. Results: There were no significant difference in gender, age, numbers, degrees, pre-operative VAS and ODI in spondylolisthesis (all P >0.05). Compared with traditional open TLIF group, the robot-assisted minimally invasive TLIF group had less perioperative bleeding ((187.5±18.4) ml vs . (332.1±23.5) ml), less drainage volume ((103.1±15.6) ml vs . (261.3±19.8) ml), shorter hospitalization ((7.8±1.9) days vs . (10.0±1.6) days), shorter time for pain relief ((2.8±1.0) days vs . (5.2±1.1) days), shorter time for ambulatory recovery ((1.7±0.9) days vs . (2.9±1.3) days) and less VAS of the third day postoperatively (2.2±0.9 vs . 4.2±2.4) ( t =2.762-16.738, all P 0.05). The results of the post-operative CT showed that the pedicle screws in the robot-assisted minimally invasive TLIF group were more precisely placed than traditional open TLIF group (χ(2)=4.247, P =0.039). The mean follow-up time was 8 months (ranging from 3 to 12 months). There were no significant difference in outcomes between the two groups (χ(2)=0.366, P =0.545). Conclusions: In the treatment of lumbar spondylolisthesis, Robot-assisted minimally invasive TLIF can lead to less

  9. Artificial neural networks can be effectively used to model changes of intracranial pressure (ICP) during spinal surgery using different non invasive ICP surrogate estimators. (United States)

    Watad, Abdulla; Bragazzi, Nicola L; Bacigaluppi, Susanna; Amital, Howard; Watad, Samaa; Sharif, Kassem; Bisharat, Bishara; Siri, Anna; Mahamid, Ala; Abu Ras, Hakim; Nasr, Ahmed; Bilotta, Federico; Robba, Chiara; Adawi, Mohammad


    Artificial Intelligence (AI) techniques play a major role in anesthesiology, even though their importance is often overlooked. In the extant literature, AI approaches, such as Artificial Neural Networks (ANNs), have been underutilized, mainly being used to model patient's consciousness state, to predict the precise amount of anesthetic gases, the level of analgesia, or the need of anesthesiological blocks, among others. In the field of neurosurgery, ANNs have been effectively applied to the diagnosis and prognosis of cerebral tumors, seizures, low back pain, and also to the monitoring of intracranial pressure (ICP). A MultiLayer Perceptron (MLP), which is a feedforward ANN, with hyperbolic tangent as activation function in the input/hidden layers, softmax as activation function in the output layer, and cross-entropy as error function, was used to model the impact of prone versus supine position and the use of positive end expiratory pressure (PEEP) on ICP in a sample of 30 patients undergoing spinal surgery. Different non invasive surrogate estimations of ICP have been used and compared: namely, mean optic nerve sheath diameter (ONSD), non invasive estimated cerebral perfusion pressure (NCPP), pulsatility index (PI), ICP derived from PI (ICP-PI), and flow velocity diastolic formula (FVDICP). ONSD proved to be a more robust surrogate estimation of ICP, with a predictive power of 75%, whilst the power of NCPP, ICP-PI, PI, and FVDICP were 60.5%, 54.8%, 53.1%, and 47.7%, respectively. Our MLP analysis confirmed our findings previously obtained with regression, correlation, multivariate Receiving Operator Curve (multi-ROC) analyses. ANNs can be successfully used to predict the effects of prone versus supine position and PEEP on ICP in patients undergoing spinal surgery using different non invasive surrogate estimators of ICP.

  10. Effect of Interval to Definitive Breast Surgery on Clinical Presentation and Survival in Early-Stage Invasive Breast Cancer

    International Nuclear Information System (INIS)

    Vujovic, Olga; Yu, Edward; Cherian, Anil; Perera, Francisco; Dar, A. Rashid; Stitt, Larry; Hammond, A.


    Purpose: To examine the effect of clinical presentation and interval to breast surgery on local recurrence and survival in early-stage breast cancer. Methods and Materials: The data from 397 patients with Stage T1-T2N0 breast carcinoma treated with conservative surgery and breast radiotherapy between 1985 and 1992 were reviewed at the London Regional Cancer Program. The clinical presentation consisted of a mammogram finding or a palpable lump. The intervals from clinical presentation to definitive breast surgery used for analysis were 0-4, >4-12, and >12 weeks. The Kaplan-Meier estimates of the time to local recurrence, disease-free survival, and cause-specific survival were determined for the three groups. Cox regression analysis was used to evaluate the effect of clinical presentation and interval to definitive surgery on survival. Results: The median follow-up was 11.2 years. No statistically significant difference was found in local recurrence as a function of the interval to definitive surgery (p = .424). A significant difference was noted in disease-free survival (p = .040) and cause-specific survival (p = .006) with an interval of >12 weeks to definitive breast surgery. However, the interval to definitive surgery was dependent on the presentation for cause-specific survival, with a substantial effect for patients with a mammographic presentation and a negligible effect for patients with a lump presentation (interaction p = .041). Conclusion: The results of this study suggest that an interval of >12 weeks to breast surgery might be associated with decreased survival for patients with a mammographic presentation, but it appeared to have no effect on survival for patients presenting with a palpable breast lump.

  11. A Minimally Invasive Endoscopic Surgery for Infectious Spondylodiscitis of the Thoracic and Upper Lumbar Spine in Immunocompromised Patients

    Directory of Open Access Journals (Sweden)

    Hsin-Chuan Chen


    Full Text Available This study evaluates the safety and effectiveness of computed tomography- (CT- assisted endoscopic surgery in the treatment of infectious spondylodiscitis of the thoracic and upper lumbar spine in immunocompromised patients. From October 2006 to March 2014, a total of 41 patients with infectious spondylodiscitis underwent percutaneous endoscopic surgery under local anesthesia, and 13 lesions from 13 patients on the thoracic or upper lumbar spine were selected for evaluation. A CT-guided catheter was placed before percutaneous endoscopic surgery as a guide to avoid injury to visceral organs, major vessels, and the spinal cord. All 13 patients had quick pain relief after endoscopic surgery without complications. The bacterial culture rate was 77%. Inflammatory parameters returned to normal after adequate antibiotic treatment. Postoperative radiographs showed no significant kyphotic deformity when compared with preoperative films. As of the last follow-up visit, no recurrent infections were noted. Traditional transthoracic or diaphragmatic surgery with or without posterior instrumentation is associated with high rates of morbidity and mortality, especially in elderly patients, patients with multiple comorbidities, or immunocompromised patients. Percutaneous endoscopic surgery assisted by a CT-guided catheter provides a safe and effective alternative treatment for infectious spondylodiscitis of the thoracic and upper lumbar spine.

  12. Neoadjuvant Chemotherapy for Patients with Muscle-invasive Urothelial Bladder Cancer Candidates for Curative Surgery: A Prospective Clinical Trial Based on Cisplatin Feasibility. (United States)

    Schinzari, Giovanni; Monterisi, Santa; Pierconti, Francesco; Nazzicone, Giulia; Marandino, Laura; Orlandi, Armando; Racioppi, Marco; Cassano, Alessandra; Bassi, Pierfrancesco; Barone, Carlo; Rossi, Ernesto


    Neoadjuvant chemotherapy demonstrated a survival benefit versus cystectomy alone in muscle-invasive urothelial bladder cancer. Despite this advantage, preoperative chemotherapy is not widely employed. When patients are unfit for cisplatin-based regimen, they are often candidates for immediate surgery. In our study, patients with muscle-invasive bladder cancer were treated with neoadjuvant chemotherapy. The principal objective was the rate of complete pathological response (pCR). Secondary end-points were disease-free survival (DFS), overall survival (OS) and toxicity. Patients (n=72) with Eastern Cooperative Oncology Group (ECOG) performance status 0-1, clinical stage cT3-4, and/or N+ muscle-invasive bladder cancer were enrolled. The chemotherapy regimen was established according to the cisplatin feasibility. Thirty patients were treated with cisplatin/gemcitabine (Gem) and 42 with carboplatin/Gem. The rate of pCR was 29.2%, 36% with cisplatin-based treatment and 23.8% with carboplatin (p=0.3574). DFS and OS were longer in pCR patients, while no difference was reported between cisplatin/Gem and Carboplatin/Gem groups. Our results confirm the prognostic value of pCR in neoadjuvant chemotherapy for muscle-invasive bladder cancer. When the patients are not fit for cisplatin, a carboplatin/Gem regimen represents a valid option because of comparable long-term outcome. When cisplatin is not feasible, the exclusion of a preoperative treatment is not justified. Copyright© 2017, International Institute of Anticancer Research (Dr. George J. Delinasios), All rights reserved.

  13. A Critical Analysis of the Actual Role of Minimally Invasive Surgery and Active Surveillance for Kidney Cancer

    NARCIS (Netherlands)

    Heuer, Roman; Gill, Inderbir S.; Guazzoni, Giorgio; Kirkali, Ziya; Marberger, Michael; Richie, Jerome P.; de La Rosette, Jean J. M. C. H.


    CONTEXT: The incidence of renal cell carcinomas (RCCs) has increased steadily-most rapidly for small renal masses (SRMs). Paralleling the changing face of RCC in the past 2 decades, new, less invasive surgical options have been developed. Laparoscopic radical nephrectomy (LRN) is an established

  14. Fatigue - an underestimated symptom in psoriatic arthritis. (United States)

    Krajewska-Włodarczyk, Magdalena; Owczarczyk-Saczonek, Agnieszka; Placek, Waldemar


    The nature of fatigue is very complex and involves physiological, psychological and social phenomena at the same time, and the mechanisms leading to occurrence and severity of fatigue are still poorly understood. The condition of chronic inflammation associated with psoriatic arthritis can be regarded as a potential factor affecting development of fatigue. Only a few studies so far have focused on the occurrence of fatigue in psoriatic arthritis. The problem of chronic fatigue is underestimated in everyday clinical practice. Identification and analysis of subjective fatigue components in each patient can provide an objective basis for optimal fatigue treatment in daily practice. This review presents a definition of chronic fatigue and describes mechanisms that may be associated with development of fatigue, highlighting the role of chronic inflammation, selected fatigue measurement methods and relations of fatigue occurrence with clinical aspects of psoriatic arthritis.

  15. Fishermen´s underestimation of risk

    DEFF Research Database (Denmark)

    Knudsen, Fabienne; Grøn, Sisse


      Fishermen's underestimation of risk   Background: In order to understand the effect of footwear and flooring on slips, trips and falls, 1st author visited 4 fishing boats.  An important spinoff of the study was to get an in situ insight in the way, fishermen perceive risk.   Objectives......: The presentation will analyse fishermen's risk perception, its causes and consequences.   Methods: The first author participated in 3 voyages at sea on fishing vessels (from 1 to 10 days each and from 2 to 4 crewmembers) where  interviews and participant observation was undertaken. A 4th fishing boat was visited...... on dock and the crew interviewed. Based on notes, diary, interviews and photo/video documentation, records related to the fishermen's risk perception were compiled, and then analysed by means of theories of risk perception.   Results: Fishermen tend partly to underrate the risks they are running, partly...

  16. [Pica during pregnancy: a frequently underestimated problem]. (United States)

    López, Laura Beatriz; Ortega Soler, Carlos Rafael; de Portela, María Luz Pita Martín


    Pica is the compulsive intake of non-nutritive substances such as earth, clay, chalk, soap and ice. The most common forms of pica are geophagia or the intake of earth and pagophagia or the intake of ice. The description of this peculiar phenomenon dates back to the Greco-Roman civilization. Its prevalence during pregnancy is generally underestimated. Published data reveal a prevalence of between 8% and 65%. Investigations from Latin America indicate a prevalence of 23% to 44%. It is not clear yet which are the causes that predispose to pica, but they are frequently associated with anemia or iron deficiency during pregnancy. Its diagnosis, which only consists in questioning pregnant women, is generally omitted during prenatal care, probably because health professionals have no knowledge about this disorder. The identification of pica in pregnant women could contribute to the detection of a risk group where it is necessary to implement strategies as regards both the evaluation and the nutritional education.


    Gincheva, D; Gorchev, G; Tomov, S


    Concepts of medical treatment are constantly evolving and improving. This opportunity provides treatment with High Intensity Focused Ultrasound (HIFU). In Europe and Asia more than 10,000 patients with uterine fibroids have been successfully treated with HIFU technology until now. This is completely innovative technology for non-invasive extracorporeal treatment of benign and malignant tumors. Neighboring healthy tissue is not damaged. The main indication in HIFU-Center in Pleven is uterine fibroid. It is the most common solid tumor in the female pelvis and is the leading cause of hysterectomy. The methods of treatment are hysterectomy, myomectomy or embolization of uterine arteries. HIFU-methodology allows non-invasive treatment of fibroids disease.

  18. The mini-fellowship concept: a six-week focused training program for minimally invasive bariatric surgery. (United States)

    Cottam, Daniel; Holover, Spencer; Mattar, Samer G; Sharma, Sunil K; Medlin, Walt; Ramanathan, Ramesh; Schauer, Philip


    To devise a six-week hands-on training program customized to meet the needs of practicing general surgeons. The aim of this program is to provide the required training experience that will bestow the knowledge and skill necessary to implement a successful practice in laparoscopic bariatric surgery. Ten board-certified/board-eligible practicing general surgeons with no prior hands-on or formal training in laparoscopic bariatric surgery. We report on the participants training experience and the impact that the program had on their subsequent laparoscopic bariatric clinical activity. Ten surgeons completed training programs from 9/01 to 3/03. None of the trainees had prior experience in laparoscopic bariatric surgery. Program operative experience averaged 42 cases (range 29-66). Trainees were integrated into all preoperative and postoperative hospital and outpatient care on the service, including workshops and seminars. Seven graduates are in practice performing laparoscopic bariatric surgery and three are implementing new bariatric programs. The active surgeons report performing an average of 101 laparoscopic bariatric procedures (range 18-264) over a mean practice period of 10 months (range 4-16) A six-week focused mini-fellowship with hands-on operative and clinical participation enables practicing surgeons to acquire the skill and experience necessary to successfully implement a laparoscopic bariatric surgical practice.

  19. Use of a Minimally Invasive Cardiac Output Monitor to Optimise Haemodynamics in a Patient with Mitral Valve Disease Undergoing Cerebrovascular Surgery

    Directory of Open Access Journals (Sweden)

    Ali M. Al-Mashani


    Full Text Available Patients with mitral valve disease undergoing cerebrovascular surgery face increased inherent risks due to their associated cardiac comorbidities. As such, the anaesthetic management of such patients is distinctly challenging. Simultaneous consideration of both the cerebrovascular and underlying cardiac conditions determines key anaesthetic issues, as fluids and vasopressors or inotropes need to be titrated according to haemodynamic variables in order to optimise cerebral blood flow without compromising cardiac function. We report a 45-yearold female patient with mild mitral stenosis and moderate-to-severe mitral regurgitation who presented to the Khoula Hospital, Muscat, Oman, in 2016 following a ruptured anterior communicating artery aneurysm requiring urgent surgical intervention. As highlighted in this case, the VolumeView EV1000™ (Edwards Lifesciences, Irvine, California, USA system is a minimially invasive haemodynamic monitor that can help immensely in the perioperative management of such patients.

  20. [Current status and understandings in function-preserving gastrectomy under the concept of minimally invasive surgery in China, South Korea and Japan]. (United States)

    Zhao, Enhao; Zhao, Gang; Cao, Hui


    In the past few years, the early detection of gastric cancer has increased in China. The surgical treatment for early gastric cancer has gradually transformed from conventional gastrectomy with D2 lymphadenectomy to function-preserving gastrectomy which maximally preserves the anatomy and physiology of stomach to maintain the quality of life of the patient. Driven by minimally invasive techniques, function-preserving gastrectomies, including pylorus-preserving gastrectomy, proximal gastrectomy, sentinel node navigation surgery, etc. have already gained great attention especially in Japan and Korea. Although there are still many unsolved problems that need to be further discussed and explored, understanding of the clinical features of early gastric cancer and definition of gastric function preservation, launching clinical trials for solving practical problems, and emphasis of individualized and precision treatment will be the best strategies to improve the efficacy of early gastric cancer.

  1. Curative effect of minimally invasive surgery on palmar and foot hyperhidrosis and its influence on serum-related cytokines and immunoglobulins. (United States)

    Li, Wei Xi; Li, Yong Kun; Lin, Hai Tao


    The curative effect of minimally invasive surgery on palmar and foot hyperhidrosis and its influence on serum-related cytokines and immunoglobulins were investigated. Seventy-six patients with palmar and foot hyperhidrosis admitted to Yunnan University Hospital from August 2014 to July 2016 were selected and randomly divided into control group (n=38) and observation group (n=38) using a random number table. Patients in control group received drug therapy, while those in observation group underwent laparoscopic thoracic-4 sympathetic chain combined with thoracic-3 branch amputation. The therapeutic effects of patients in the two groups were compared. The levels of serum C-reactive protein (CRP), interleukin-6 (IL-6), IL-10 and tumor necrosis factor-α (TNF-α) of patients in the two groups were measured by enzyme-linked immunosorbent assay (ELISA) before treatment and at one week after treatment. The levels of immunoglobulin G (IgG), IgA and IgM were detected by immunoturbidimetry. The quality of life (QOL) in patients was evaluated by quality-of-life index (iQOL) before and after treatment. The total effective rate in the observation group was significantly higher than that in the control group (P0.05). At one week after treatment, IgG, IgM and IgA levels of patients in the two groups were remarkably increased (P0.05). After treatment, the iQQL scores of patients in the two groups were significantly decreased, and iQQL score in observation group was decreased more significantly compared with that in control group (P<0.05). Compared with drug therapy, minimally invasive surgery is more effective in the treatment of palmar and foot hyperhidrosis with smaller trauma and inflammatory reaction, and it has less influence on serum immunoglobulin levels, which is conducive to the rehabilitation of patients.

  2. Patients with invasive lobular breast cancer are less likely to undergo breast-conserving surgery: a population based study in the Netherlands. (United States)

    Truin, W; Roumen, R M; Siesling, S; van der Heiden-van der Loo, M; Duijm, L E M; Tjan-Heijnen, V C G; Voogd, A C


    The aim of this study was to compare the frequency of breast-conserving surgery (BCS) between early-stage invasive ductal (IDC) and invasive lobular breast cancer (ILC). Women with primary non-metastatic pT1 and pT2 IDC or ILC diagnosed between 1990 and 2010 were selected from the NCR. All patients underwent BCS or primary mastectomy without neoadjuvant treatment and proportions per year were calculated. Logistic regression analysis with adjustment for period, age, nodal status and tumor size was performed to determine the impact of histology on the likelihood of undergoing BCS. A total of 152,574 patients underwent surgery in the period between 1990 and 2010, of which 89 % had IDC and 11 % had ILC. In the group of IDC with pT1 and pT2 tumors combined, 54 % underwent BCS compared with 43 % of patients with ILC (p < 0.0001). The proportion of patients with IDC treated by BCS increased from 46 % in 1990 to 62 % in 2010. The BCS rate among ILC patients increased from 39 % in 1990 to 48 % in 2010. Patients with ILC were less likely to undergo BCS compared with patients with IDC (odds ratio 0.69; 95 % confidence interval 0.66-0.71). The incidence of BCS for patients with IDC or ILC is rising in The Netherlands. However, the increase of BCS is less explicit in patients with ILC, with a higher chance of undergoing mastectomy compared with patients with IDC.

  3. The presence of proliferative breast disease with atypia does not influence outcome in invasive breast cancer treated with conservative surgery and radiation

    International Nuclear Information System (INIS)

    Fowble, B.; Hanlon, A.L.; Patchefsky, A.; Hoffman, J.P.; Sigurdson, E.R.; Goldstein, L.J.


    Purpose: Atypical hyperplasia (AH) (ductal or lobular) represents a marker for an increased risk for subsequent breast cancer in either breast, especially in premenopausal women and those with a positive family history. However, the impact of the presence of AH in association with an invasive breast cancer on ipsilateral breast recurrence rates or contralateral breast cancer in women treated with conservative surgery and radiation is unknown. For a number of clinicians the presence of marked proliferative changes with atypia at the time of diagnosis of an invasive cancer is an indication for mastectomy. In an attempt to address this issue, we compared the outcome of patients (pts) with proliferative disease with atypia to those in whom this pathologic feature was absent. Materials and Methods: From 1982-1994, 1537 women with stage I-II breast cancer underwent excisional biopsy, axillary dissection and radiation. 459 of these women had pathologic evaluation of the background adjacent benign breast tissue and represent the study population. The median followup was 6.3 yrs (range .1-14.5). The median age was 55 yrs (range 24 to 88). 23% had positive axillary nodes. 25% received adjuvant chemotherapy (CMF or CAF) with (9%) or without (16%) tamoxifen. 24% received tamoxifen alone. The study population was divided into 2 groups: 131 pts with atypical hyperplasia (ductal 99 pts, lobular 20 pts, and type not specified 12 pts) and 328 pts with no proliferative changes or proliferative changes without atypia. The comparability of the 2 groups was assessed for the following factors: clinical (race, age, menopausal status, method of detection of primary, primary tumor size, and family history), pathologic (histology, final resection margin, pathologic nodal status, presence or absence of LCIS, histologic subtype DCIS when present and estrogen and progesterone receptor status) and treatment related (re-excision and adjuvant chemotherapy and/or tamoxifen). Outcome was evaluated

  4. Robotic Transversus Abdominis Release (TAR: is it possible to offer minimally invasive surgery for abdominal wall complex defects?

    Directory of Open Access Journals (Sweden)


    Full Text Available ABSTRACT We describe the preliminary national experience and the early results of the use of robotic surgery to perform the posterior separation of abdominal wall components by the Transversus Abdominis Release (TAR technique for the correction of complex defects of the abdominal wall. We performed the procedures between 04/2/2015 and 06/15/2015 and the follow-up time was up to six months, with a minimum of two months. The mean surgical time was five hours and 40 minutes. Two patients required laparoscopic re-intervention, since one developed hernia by peritoneal migration of the mesh and one had mesh extrusion. The procedure proved to be technically feasible, with a still long surgical time. Considering the potential advantages of robotic surgery and those related to TAR and the results obtained when these two techniques are associated, we conclude that they seem to be a good option for the correction of complex abdominal wall defects.

  5. Minimally-invasive glaucoma surgeries (MIGS) for open angle glaucoma: A systematic review and meta-analysis. (United States)

    Lavia, Carlo; Dallorto, Laura; Maule, Milena; Ceccarelli, Manuela; Fea, Antonio Maria


    MIGS have been developed as a surgical alternative for glaucomatous patients. To analyze the change in intraocular pressure (IOP) and glaucoma medications using different MIGS devices (Trabectome, iStent, Excimer Laser Trabeculotomy (ELT), iStent Supra, CyPass, XEN, Hydrus, Fugo Blade, Ab interno canaloplasty, Goniscopy-assisted transluminal trabeculotomy) as a solo procedure or in association with phacoemulsification. Randomized control trials (RCT) and non-RCT (non randomized comparative studies, NRS, and before-after studies) were included. Studies with at least one year of follow-up in patients affected by primary open angle glaucoma, pseudoexfoliative glaucoma or pigmentary glaucoma were considered. Risk of Bias assessment was performed using the Cochrane Risk of Bias and the ROBINS-I tools. The main outcome was the effect of MIGS devices compared to medical therapy, cataract surgery, other glaucoma surgeries and other MIGS on both IOP and use of glaucoma medications 12 months after surgery. Outcomes measures were the mean difference in the change of IOP and glaucoma medication compared to baseline at one and two years and all ocular adverse events. The current meta-analysis is registered on PROSPERO (reference n° CRD42016037280). Over a total of 3,069 studies, nine RCT and 21 case series with a total of 2.928 eyes were included. Main concerns about risk of bias in RCTs were lack of blinding, allocation concealment and attrition bias while in non-RCTs they were represented by patients' selection, masking of participants and co-intervention management. Limited evidence was found based on both RCTs and non RCTs that compared MIGS surgery with medical therapy or other MIGS. In before-after series, MIGS surgery seemed effective in lowering both IOP and glaucoma drug use. MIGS showed a good safety profile: IOP spikes were the most frequent complications and no cases of infection or BCVA loss due to glaucoma were reported. Although MIGS seem efficient in the

  6. Effects of non-invasive ventilation on reintubation rate: a systematic review and meta-analysis of randomised studies of patients undergoing cardiothoracic surgery. (United States)

    Olper, Luigi; Corbetta, Davide; Cabrini, Luca; Landoni, Giovanni; Zangrillo, Alberto


    To estimate the effect of non-invasive mechanical ventilation (NIV) on the rate of reintubation among patients undergoing cardiothoracic surgery. A meta-analysis of randomised trials. Medline, Embase, and the Cochrane Central Register of clinical trials were searched (April 2012) for pertinent studies by two trained investigators. International experts were contacted. Articles were assessed by two trained investigators, with divergences resolved by consensus. Inclusion criterion was random allocation to NIV versus standard treatment without restrictions on duration or modalities of the treatment delivered. Fourteen studies enrolling 1211 patients were included in the meta-analysis. NIV reduced the reintubation rate (risk ratio [RR], 0.29; 95% CI, 0.16-0.53; P for efficacy benefits of NIV are more important in patients with ongoing acute respiratory failure (RR, 0.25; 95% CI, 0.07-0.89) and in those at high risk of developing postoperative pulmonary complications (RR, 0.19; 95% CI, 0.04-0.84). Analyses including prophylactic studies in patients at low risk did not show a significant effect of NIV on reintubation rate (RR = 0.42; 95% CI, 0.12-1.48) and on any of the outcomes considered except for oxygenation. NIV seems to be effective in reducing reintubation rate after cardiothoracic surgery. The results of this meta-analysis should be confirmed by large randomised controlled studies.

  7. The comparison of minimally invasive percutaneous nephrolithotomy and retrograde intrarenal surgery for stones larger than 2 cm in patients with a solitary kidney: a matched-pair analysis. (United States)

    Zeng, Guohua; Zhu, Wei; Li, Jiasheng; Zhao, Zhijian; Zeng, Tao; Liu, Chenli; Liu, Yang; Yuan, Jian; Wan, Shaw P


    To compare the treatment outcomes between retrograde intrarenal surgery (RIRS) and minimally invasive percutaneous nephrolithotomy (MPCNL) for the management of stones larger than 2 cm in patients with solitary kidney. Between December 2012 and March 2014, 53 patients with a solitary kidney suffering from urinary stones larger than 2 cm were treated with RIRS. The outcomes of these patients were compared to a cohort of similar solitary kidney stone patients who underwent MPCNL using a matched-pair analysis (1:1 scenario). Cases were matched sequentially using the following criteria: size, number and location of stones, age, BMI, gender and previous ipsilateral open surgery. A stone-free rate (SFR) of 43.4 % was achieved after a single procedure in patients treated with RIRS and a SFR of 71.70 % in patients treated with MPCNL (p = 0.003). The operative time for RIRS was longer (p = 0.002), but the median hospital stay was shorter (p kidney suffering from stones larger than 2 cm in size who undergo MPCNL had a higher SFR than RIRS. The complications were comparable in both groups. Even though RIRS patients spent less time in hospital, this procedure might not be an effective treatment as MPCNL in solitary kidneys with larger and multiple stones.


    Schwarcz, Attila; Szakály, Péter; Büki, András; Dóczi, Tamás


    Adjacent segment disease (ASD) occurs with a probability of 30% in the lumbar spine following spinal fusion surgery. Usually advanced degenerative changes happen cranially to the fused lumbar segment. Thus, secondary spinal instability, stenosis, spodylolisthesis, foraminal stenosis can lead to the recurrence of the pain not always amenable to conservative measures. A typical surgical solution to treat ASD consists of posterior revision surgery including decompression, change or extension of the instrumentation and fusion to the rostral level. It results in a larger operation with considerable risk of complications. We present a typical case of ASD treated surgically with a new minimally invasive method not yet performed in Hungary. We use anterolateral abdominal muscle splitting approach to reach the lumbar spine through the retroperitoneum. A discectomy is performed by retracting the psoas muscle dorsally. The intervertebral bony fusion is achieved by implanting a cage with large volume that is stuffed with autologous bone or tricalcium phosphate. A cage with large volume results in excellent annulus fibrosus tension, immediate stability and provides large surface for bony fusion. A stand-alone cage construct can be supplemented with lateral screw/rod/plate fixation. The advantage of the new technique for the treatment of ASD includes minimal blood loss, short operation time, significantly less postoperative pain and much lower complication rate.

  9. Endoscope-assisted harvest of autogenous fascia lata in frontalis suspension surgery: A minimally invasive approach revisited (United States)

    Naik, Abhijit; Patel, Anamika; Bothra, Nandini; Panda, Lapam; Naik, Milind N; Rath, Suryasnata


    Purpose: To report endoscope-assisted fascia lata harvest (EAFH) as a minimally-invasive technique for correction of severe blepharoptosis. Methods: This was a retrospective case series between January 2013 and April 2017. Medical records of all consecutive patients who underwent frontalis suspension by EAFH in the study period were reviewed and outcome was analyzed. Results: Fourteen patients (10 males) were included in the study. Mean age of the group was 18.14 + 17.03 years (range 4-65 years) and 11 patients had simple congenital blepharoptosis. Blepharophimosis syndrome was seen in 3 patients. Eleven patients had bilateral blepharoptosis. The mean preoperative and postoperative MRD1 was –1.60 ± 0.87 mm and +2.12 ± 1.37 mm respectively. Mean lengths of the incision and fascial harvest were 2.25 ± 0.43 cm and 13.0 ± 2.35 cm (range 10-17 cm) respectively. The median follow-up of patients was 4.57 + 4.03 months (range 1-15 months). Complications included a wound dehiscence in two patients and these were resutured. The donor sites healed well in all patients leaving a small thigh scar and none needed scar revision. Conclusion: EAFH is a promising minimally-invasive technique performed with a small incision and achieved adequate length of fascial harvest. PMID:29480260

  10. Endoscope-assisted harvest of autogenous fascia lata in frontalis suspension surgery: A minimally invasive approach revisited

    Directory of Open Access Journals (Sweden)

    Abhijit Naik


    Full Text Available Purpose: To report endoscope-assisted fascia lata harvest (EAFH as a minimally-invasive technique for correction of severe blepharoptosis. Methods: This was a retrospective case series between January 2013 and April 2017. Medical records of all consecutive patients who underwent frontalis suspension by EAFH in the study period were reviewed and outcome was analyzed. Results: Fourteen patients (10 males were included in the study. Mean age of the group was 18.14 + 17.03 years (range 4-65 years and 11 patients had simple congenital blepharoptosis. Blepharophimosis syndrome was seen in 3 patients. Eleven patients had bilateral blepharoptosis. The mean preoperative and postoperative MRD1 was –1.60 ± 0.87 mm and +2.12 ± 1.37 mm respectively. Mean lengths of the incision and fascial harvest were 2.25 ± 0.43 cm and 13.0 ± 2.35 cm (range 10-17 cm respectively. The median follow-up of patients was 4.57 + 4.03 months (range 1-15 months. Complications included a wound dehiscence in two patients and these were resutured. The donor sites healed well in all patients leaving a small thigh scar and none needed scar revision. Conclusion: EAFH is a promising minimally-invasive technique performed with a small incision and achieved adequate length of fascial harvest.

  11. Endoscope-assisted harvest of autogenous fascia lata in frontalis suspension surgery: A minimally invasive approach revisited. (United States)

    Naik, Abhijit; Patel, Anamika; Bothra, Nandini; Panda, Lapam; Naik, Milind N; Rath, Suryasnata


    To report endoscope-assisted fascia lata harvest (EAFH) as a minimally-invasive technique for correction of severe blepharoptosis. This was a retrospective case series between January 2013 and April 2017. Medical records of all consecutive patients who underwent frontalis suspension by EAFH in the study period were reviewed and outcome was analyzed. Fourteen patients (10 males) were included in the study. Mean age of the group was 18.14 + 17.03 years (range 4-65 years) and 11 patients had simple congenital blepharoptosis. Blepharophimosis syndrome was seen in 3 patients. Eleven patients had bilateral blepharoptosis. The mean preoperative and postoperative MRD1 was -1.60 ± 0.87 mm and +2.12 ± 1.37 mm respectively. Mean lengths of the incision and fascial harvest were 2.25 ± 0.43 cm and 13.0 ± 2.35 cm (range 10-17 cm) respectively. The median follow-up of patients was 4.57 + 4.03 months (range 1-15 months). Complications included a wound dehiscence in two patients and these were resutured. The donor sites healed well in all patients leaving a small thigh scar and none needed scar revision. EAFH is a promising minimally-invasive technique performed with a small incision and achieved adequate length of fascial harvest.

  12. Post-stroke seizures are clinically underestimated. (United States)

    Bentes, Carla; Martins, Hugo; Peralta, Ana Rita; Casimiro, Carlos; Morgado, Carlos; Franco, Ana Catarina; Fonseca, Ana Catarina; Geraldes, Ruth; Canhão, Patrícia; Pinho E Melo, Teresa; Paiva, Teresa; Ferro, José M


    Cerebrovascular disease is the leading cause of epilepsy in adults, although post-stroke seizures reported frequency is variable and few studies used EEG in their identification. To describe and compare EEG and clinical epileptic manifestations frequency in patients with an anterior circulation ischaemic stroke. Prospective study of acute anterior circulation ischaemic stroke patients, consecutively admitted to a Stroke Unit over 24 months and followed-up for 1 year. All patients underwent standardized clinical and diagnostic assessment. Seizure occurrence was clinically evaluated during hospitalization and by a telephone interview at 6 months and a clinical appointment at 12 months after stroke. Video-EEG was performed in the first 72 h (1st EEG), daily after the 1st EEG for the first 7 days after the stroke, or later if neurological worsening, at discharge, and at 12 months. 151 patients were included (112 men) with a mean age of 67.4 (11.9) years. In the 1st year after stroke, 38 patients (25.2%) had an epileptic seizure. During hospitalization, 27 patients (17.9%) had epileptiform activity (interictal or ictal) in the EEG, 7 (25.9%) of them electrographic seizures. During the first week after stroke, 22 (14.6%) patients had a seizure and 4 (2.6%) non-convulsive status epilepticus criteria. Five (22.7%) acute symptomatic seizures were exclusively electrographic. At least one remote symptomatic seizure occurred in 23 (16%) patients. In the first 7 days after stroke, more than one-fifth of patients with seizures had exclusively electrographic seizures. Without a systematic neurophysiological evaluation the frequency of post-stroke seizures are clinically underestimated.

  13. A 5-year prospective study on regenerative periodontal therapy of infrabony defects using minimally invasive surgery and a collagen-enriched bovine-derived xenograft. (United States)

    De Bruyckere, Thomas; Eghbali, Aryan; Younes, Faris; Cleymaet, Roberto; Jacquet, Wolfgang; De Bruyn, Hugo; Cosyn, Jan


    The primary objective of this study was (1) to evaluate the 5-year clinical outcome of regenerative periodontal therapy (RPT) using minimally invasive surgery and a collagen-enriched bovine-derived xenograft and (2) to identify predictors for clinical attachment level (CAL) gain and vertical radiographic bone (RB) gain. Ninety-five non-smoking patients with ≤ 25% full-mouth plaque and bleeding presenting ≥ 6 months after initial periodontal therapy with ≥ 1 isolated interdental infrabony defect were recruited. Minimally invasive surgery (MIST or M-MIST) and a collagen-enriched bovine-derived xenograft were used in all patients. Patients were surgically treated by the same clinician and evaluated up to 5 years of follow-up. Multivariate analyses were used to identify predictors for CAL gain and RB gain. Before surgery, mean probing depth (PD) was 7.8 mm, CAL was 10.0 mm, and defect depth amounted to 5.2 mm. Seventy-one patients (33 men, 38 women, mean age 52) could be evaluated at 5 years. Mean PD reduction was 3.3 mm (SD 2.2), CAL gain was 3.0 mm (SD 2.1), and RB gain was 57% (SD 38). Forty-five percent showed ≥ 4 mm CAL gain, whereas 24% were considered failures (≤ 1 mm CAL gain). Forty-eight percent showed considerable RB gain (≥ 75%). Regression analyses showed that plaque was a significant predictor for CAL gain (p = 0.001) and RB gain (p = 0.005). Patients' compliance had a significant impact on RB gain (p periodontal therapy. RPT failed in 24% of the patients after 5 years. Regression analyses demonstrated a significant impact of plaque and patients' compliance on the long-term outcome. Only patients with perfect oral hygiene and excellent compliance should be considered for RPT. Patients should not be treated too soon following initial therapy, since compliance can only be reliably assessed after sufficient follow-up.

  14. Thulium fiber laser for the use in low-invasive endoscopic and robotic surgery of soft biological tissues (United States)

    Michalska, M.; Brojek, W.; Rybak, Z.; Sznelewski, P.; Mamajek, M.; Gogler, S.; Swiderski, J.


    An all-fiber, diode-pumped, continuous-wave Tm3+-doped fiber laser operated at a wavelength of 1.94 μm was developed. 37.4 W of output power with a slope efficiency as high as 57% with respect to absorbed pump power at 790 nm was demonstrated. The laser output beam quality factor M2 was measured to be 1.2. The output beam was very stable with power fluctuations system is to be implemented as a scalpel for surgery of soft biological tissues.

  15. Is there a change in the quality of life comparing the micro-invasive glaucoma surgery (MIGS) and the filtration technique trabeculectomy in glaucoma patients? (United States)

    Pahlitzsch, Milena; Klamann, Matthias K J; Pahlitzsch, Marie-Luise; Gonnermann, Johannes; Torun, Necip; Bertelmann, Eckart


    This study was conducted to assess the impact on the Quality of Life (QOL) of micro-invasive glaucoma surgery (MIGS: iStent, Trabectome) and a penetrating technique such as Trabeculectomy (TE). This study evaluated 88 eyes of 88 open angle glaucoma patients undergoing glaucoma surgery: 43 (mean age 72.8 ± 8.8y, female 59.5 %, male 40.5 %) Trabectome (NeoMedix, Inc., Tustin, CA, USA), 20 (mean age 68.6 ± 16.4y, female 60 %, male 40 %) iStent (Glaucos Corporation, Laguna Hills, CA, USA), and 25 TE patients (mean age 74.2 ± 9.1y female 58.3 %, male 41.7 %). The National Eye Institute-Visual Functioning Questionnaire (VFQ-25) survey was used to assess the QOL at 6 months post surgery. The following 12 QOL parameters were evaluated: general health, ocular pain, general vision, near and distance activities, mental health, social functioning, role difficulties, dependency, driving, color vision, and peripheral vision. Intraocular pressure (IOP), number of topical medications, and visual acuity (VA) were examined preoperatively, 1 day, 6 weeks, 3 months, and 6 months post surgery. Statistical data were calculated using SPSS (v20.0, SPSS, Inc.). There was no significant difference between TE and MIGS in the quality of life 6 months postoperatively. IOP was significantly lower in TE compared to MIGS at 6 weeks and 3 months postoperatively (p = 0.046 and p = 0.046). Number of medications was significantly decreased in TE compared to MIGS (p < 0.001). A significant difference in VA between TE and MIGS could be assessed at day 1 post-op (p = 0.011). In this study cohort, the QOL can be maintained by all three surgical techniques. Patients, however, need lower numbers of topical medication in TE, which would impact QOL even though it is not included in the NEI-VFQ-25. The decision of the most appropriate surgical technique should be made by including single QOL categories, IOP and glaucoma medication outcome.

  16. Low minute ventilation episodes during anesthesia recovery following intraperitoneal surgery as detected by a non-invasive respiratory volume monitor. (United States)

    Cavalcante, Alexandre N; Martin, Yvette N; Sprung, Juraj; Imsirovic, Jasmin; Weingarten, Toby N


    An electrical impedance-based noninvasive respiratory volume monitor (RVM) accurately reports minute volume, tidal volume and respiratory rate. Here we used the RVM to quantify the occurrence of and evaluate the ability of clinical factors to predict respiratory depression in the post-anesthesia care unit (PACU). RVM generated respiratory data were collected from spontaneously breathing patients following intraperitoneal surgeries under general anesthesia admitted to the PACU. Respiratory depression was defined as low minute ventilation episode (LMVe, respiratory rate (respiratory rate was a poor predictor of LMVe (sensitivity = 11.8%). Other clinical variables (e.g., obstructive sleep apnea) were not found to be predictors of LMVe. Using RVM we identified that mild, clinically nondetectable, respiratory depression prior to opioid administration in the PACU was associated with the development of substantial subsequent respiratory depression during the PACU stay.

  17. A novel flapless approach versus minimally invasive surgery in periodontal regeneration with enamel matrix derivative proteins: a 24-month randomized controlled clinical trial. (United States)

    Aimetti, Mario; Ferrarotti, Francesco; Mariani, Giulia Maria; Romano, Federica


    This investigation was designed to compare the effectiveness of enamel matrix derivative (EMD) proteins in combination with flapless or flap procedure in periodontal regeneration of deep intrabony defects. Thirty chronic periodontitis patients who had at least one residual periodontal defect with an intrabony component of ≥3 mm were consecutively enrolled. Defects were randomly assigned to test or control treatments which both consisted of the use of EMD to reach periodontal regeneration. Test sites (n = 15) were treated according to a novel flapless approach, whereas control sites (n = 15) by means of minimally invasive surgery (MIST). Clinical and radiographic parameters were recorded at baseline, 12 and 24 months post-operatively. Both therapeutic modalities yielded similar probing depth (PD) reduction and clinical attachment level (CAL) gain at 24 months. In flapless-treated sites, a mean PD reduction of 3.6 ± 1.0 mm and a CAL gain of 3.2 ± 1.1 mm were observed. In the MIST group, they were 3.7 ± 0.6 and 3.6 ± 0.9 mm. The operative chair time was twice as long in the MIST compared to the flapless group, whereas comparable patient-oriented outcomes were observed. The flapless procedure may be successfully applied in the regenerative treatment of deep intrabony defects reaching clinical outcomes comparable with those of minimally invasive surgical approaches and may present important advantages in terms of reduction of operative chair time. The use of EMD as an adjunct to non-surgical periodontal treatment may be considered a suitable option to treat defects mainly in the anterior sextants.

  18. Prevention of malignant seeding at drain sites after invasive procedures (surgery and/or thoracoscopy) by hypofractionated radiotherapy in patients with pleural mesothelioma

    Energy Technology Data Exchange (ETDEWEB)

    Di Salvo, Maurizio; Gambaro, Giuseppina; Pagella, Simonetta; Manfredda, Irene; Casadio, Caterina; Krengli, Marco (Radiotherapy, Univ. of Piemonte Orientale-Hospital Maggiore della Carit, Novara (Italy))


    Introduction. Literature data show that mesothelioma cells can implant along the surgical pathway of invasive procedures such as thoracotomy and thoracoscopy. We investigated the use of hypofractionated radiotherapy for preventing such malignant seeding. Material and methods. Thirty-two consecutive patients diagnosed with pleural mesothelioma were included in the present retrospective study. All patients underwent surgery and/or thoracoscopy for diagnosis, staging or talc pleurodesis. They were treated with electron external beam radiation therapy (21 Gy in 3 fractions over 1 week), directed to the surgical pathway after the invasive procedure. After completion of radiation treatment, 20 of 32 patients (63%) underwent chemotherapy. Results. After a mean follow-up of 13.6 months (range 3-41) from the end of radiation therapy, no patient had tumour progression in the treated area. The treatment was well tolerated, as only erythema grade I (Radiation Therapy Oncology Group, RTOG, scale) was noted in 11 patients. Seventeen patients died of disease with local progression after a mean survival time of 12.6 months (range 3-27); thirteen patients are alive with disease after a mean follow-up of 13.9 months (range 4-41); two patients are alive without evidence of disease after a mean follow-up of 16.50 months (range 6-27). Discussion. The present study shows the efficacy and safety of local radiotherapy in preventing malignant seeding after thoracoscopy in patients with pleural mesothelioma although larger prospective trials are probably still needed to validate this treatment approach.

  19. Comparative Study of C-arms for Intraoperative 3-dimensional Imaging and Navigation in Minimally Invasive Spine Surgery Part I: Applicability and Image Quality. (United States)

    Klingler, Jan-Helge; Sircar, Ronen; Scheiwe, Christian; Kogias, Evangelos; Volz, Florian; Krüger, Marie T; Hubbe, Ulrich


    This was a retrospective analysis. This study compares 2 different 3-dimensional (3D) C-arm devices for intraoperative imaging and navigation with regard to clinical applicability and image quality. Minimally invasive spine surgery requires intraoperative imaging techniques to adequately visualize the unexposed spine. For this purpose, mobile 3D C-arms became available along with the evolution of intraoperative navigation techniques. The C-arm devices Siremobil Iso-C 3D (Siemens) and Vision FD Vario 3D (Ziehm) perform an automated orbital rotation around the patient acquiring a 3D image set out of multiple successive fluoroscopic images. We report on technical specifications of the C-arms and our daily experience regarding clinical applicability. Furthermore, 5 spine surgeons evaluated blinded triplanar planes of 40 cervical, thoracic, and lumbar 3D scans that were obtained during routine surgery regarding usability for navigation. We assessed the delineation of cortical bone, artifacts, and overall image quality using a 0-10 numeric rating scale. The Siremobil Iso-C 3D requires 128 seconds for its 190-degree scanning arc with equidistant isocenter. The Vision FD Vario 3D performs an elliptical scanning arc and completes its 135-degree scan in 64 seconds; furthermore, it features a flat panel detector and fully digital imaging. The smaller dimensions of the Vision FD Vario 3D made it easier to maneuver in the operating room compared with the more bulky Siremobil Iso-C 3D. With respect to image quality in cervical 3D scans, the Siremobil Iso-C 3D reached significantly higher scores in all categories. The Vision FD Vario 3D revealed less artifacts in lumbar 3D scans. The Siremobil Iso-C 3D provides high-quality 3D scans in slender spine regions (eg, cervical spine), whereas the Vision FD Vario 3D appears to have advantages in the lumbar spine. Further evolution and novel devices are needed to optimize image quality and handling.

  20. Effectiveness of prophylactic non-invasive ventilation on respiratory function in the postoperative phase of pediatric cardiac surgery: a randomized controlled trial

    Directory of Open Access Journals (Sweden)

    Camilla R. S. Silva

    Full Text Available ABSTRACT Objective To evaluate the effectiveness of prophylactic, non-invasive ventilation (NIV on respiratory function in seven- to 16-year-old children in the post-operative phase of cardiac surgery. Method A randomized, controlled trial with 50 children who had undergone cardiac surgery with median sternotomy. After extubation, patients were randomly assigned to one of two groups: control group (n=26, which received instructions regarding posture, early ambulation, and cough stimulation, and CPAP group (continuous positive airway pressure; n=24, which received the same instructions as the control group and CPAP=10 cmH20 twice daily for 30 minutes from the 1st to the 5th post-operative day (POD. As a primary outcome, lung function was evaluated before and on the 1st, 3rd, and 5th PODs with measures of respiratory rate (RR, tidal volume (TV, slow vital capacity (SVC, inspiratory capacity (IC, minute volume (MV, peak expiratory flow (PEF, and maximal inspiratory pressure (MIP. As secondary outcomes, the time of hospitalization and intensive care were recorded. A mixed, linear regression model and z-test were used to analyze respiratory function, considering p<0.05. Results All variables, except RR and MV, showed a significant drop on the 1st POD, with gradual recovery; however, only MIP had returned to pre-operative values on the 5th POD in both groups. The RR showed a significant increase on the 1st POD, with a gradual reduction but without returning to baseline. In the intergroup analysis, significant improvement (p=0.04 was observed only in PEF in the CPAP group on the 1st DPO. The length of hospitalization and intensive care showed no significant differences. Conclusion NIV was safe and well accepted in this group of patients, and the protocol used was effective in improving PEF on the 1st DPO in the CPAP group.

  1. A novel method for texture-mapping conoscopic surfaces for minimally invasive image-guided kidney surgery. (United States)

    Ong, Rowena; Glisson, Courtenay L; Burgner-Kahrs, Jessica; Simpson, Amber; Danilchenko, Andrei; Lathrop, Ray; Herrell, S Duke; Webster, Robert J; Miga, Michael; Galloway, Robert L


    Organ-level registration is critical to image-guided therapy in soft tissue. This is especially important in organs such as the kidney which can freely move. We have developed a method for registration that combines three-dimensional locations from a holographic conoscope with an endoscopically obtained textured surface. By combining these data sources clear decisions as to the tissue from which the points arise can be made. By localizing the conoscope's laser dot in the endoscopic space, we register the textured surface to the cloud of conoscopic points. This allows the cloud of points to be filtered for only those arising from the kidney surface. Once a valid cloud is obtained we can use standard surface registration techniques to perform the image-space to physical-space registration. Since our methods use two distinct data sources we test for spatial accuracy and characterize temporal effects in phantoms, ex vivo porcine and human kidneys. In addition we use an industrial robot to provide controlled motion and positioning for characterizing temporal effects. Our initial surface acquisitions are hand-held. This means that we take approximately 55 s to acquire a surface. At that rate we see no temporal effects due to acquisition synchronization or probe speed. Our surface registrations were able to find applied targets with submillimeter target registration errors. The results showed that the textured surfaces could be reconstructed with submillimetric mean registration errors. While this paper focuses on kidney applications, this method could be applied to any anatomical structures where a line of sight can be created via open or minimally invasive surgical techniques.

  2. Playing to your skills: a randomised controlled trial evaluating a dedicated video game for minimally invasive surgery. (United States)

    Harrington, Cuan M; Chaitanya, Vishwa; Dicker, Patrick; Traynor, Oscar; Kavanagh, Dara O


    Video gaming demands elements of visual attention, hand-eye coordination and depth perception which may be contiguous with laparoscopic skill development. General video gaming has demonstrated altered cortical plasticity and improved baseline/acquisition of minimally invasive skills. The present study aimed to evaluate for skill acquisition associated with a commercially available dedicated laparoscopic video game (Underground) and its unique (laparoscopic-like) controller for the Nintendo®Wii U™ console. This single-blinded randomised controlled study was conducted with laparoscopically naive student volunteers of limited (video gaming backgrounds. Baseline laparoscopic skills were assessed using four basic tasks on the Virtual Reality (VR) simulator (LAP Mentor TM , 3D systems, Colorado, USA). Twenty participants were randomised to two groups; Group A was requested to complete 5 h of video gaming (Underground) per week and Group B to avoid gaming beyond their normal frequency. After 4 weeks participants were reassessed using the same VR tasks. Changes in simulator performances were assessed for each group and for intergroup variances using mixed model regression. Significant inter- and intragroup performances were present for the video gaming and controls across four basic tasks. The video gaming group demonstrated significant improvements in thirty-one of the metrics examined including dominant (p ≤ 0.004) and non-dominant (p video gaming group demonstrated significant (p game enjoyment (33.3%), lack of available time (22.2%) and entertainment distractions (11.1%). Our work revealed significant value in training using a dedicated laparoscopic video game for acquisition of virtual laparoscopic skills. This novel serious game may provide foundations for future surgical developments on game consoles in the home environment.

  3. Comparison of 3D C-arm fluoroscopy and 3D image-guided navigation for minimally invasive pelvic surgery. (United States)

    Li, Bin; He, Jiliang; Zhu, Zexing; Zhou, Dongsheng; Hao, Zhenhai; Wang, Yonghui; Li, Qinghu


    This study aims to compare the efficacy and accuracy of percutaneous screw fixation using three-dimensional [Formula: see text] navigation and conventional C-arm fluoroscopy in pelvic fracture surgery. This was a retrospective study of 81 patients with pelvic fractures treated using percutaneous screw fixation between June 2005 and January 2011. All pelvic fractures were treated with closed reduction, small open reduction, or medium open reduction. Intraoperative radiation exposure, fixation, surgical outcome, and functional recovery were compared based on the fluoroscopy navigation method used during screw fixation. Radiographic follow-up was assessed at 1, 3, 6, and 9 months postoperatively, and a CT scan was completed at 9 months postoperatively. A total of 130 cannulated screws were placed. Average screw fixation time and fluoroscopy exposure time in [Formula: see text] group were lower than the C-arm fluoroscopy group ([Formula: see text] vs [Formula: see text]) [Formula: see text]. Seventy-four of the 81 patients made a full recovery. Successful outcome was confirmed with radiological imaging and postoperative follow-up at 6-24 months. No delayed union or nonunion was detected. No significant difference in functional recovery at 6 months postoperative was found due to the fluoroscopy imaging technique. Percutaneous screw fixation using the [Formula: see text] navigational system minimizes the fluoroscope exposure and screw insertion time, while improving screw insertion accuracy. Moreover, the [Formula: see text] navigational system provided a reliable method for fluoroscopy imaging in pelvic fractures.

  4. Incremental value of combined 99MTc tetrofosmin parathyroid scintigraphy, rapid intra operative PTH assays and minimally invasive radio-guided surgery (MIRS) in optimizing parathyroidectomies

    International Nuclear Information System (INIS)

    Padma, S.; Kumar, S.; Babu, T.; Kumar, H.; Nair, V.; Nair, G.K.


    Objective: Aim of our study was to evaluate incremental diagnostic value of 99mTc Tetrofosmin parathyroid SPECT (TPSPECT), rapid intra operative quick parathyroid hormone measurement (QPTH) combined with radio guidance provided by scintillation probe (Minimally Invasive Radio guided Surgery MIRS) in parathyroid surgeries. While TPSPECT is an established investigation in preoperative workup of hyperparathyroidism patients , MIRS is a relatively new concept in Indian subcontinent. Methods: 29 pts (M: F = 18: 11), age range 16- 65 yrs (mean 41+ 9 yrs) having clinical and biochemical hyperparathyroidism underwent TPSPECT between Jan 02 -04, using 20 mci IV 99mTc Tetrofosmin. Pts with familial hyperparathyroidism , previous nodular goiters and previous neck irradiation were excluded from study. Scintigraphy comprised of immediate, delayed planar and SPECT imaging of neck and chest. Imagewise abnormal, persistent tracer uptake was considered positive for adenoma and diffuse uptake for hyperplasia. 26 pts underwent exploration (22 adenomas and 4 hyperplasias).18 pts had benefit of intraoperative QPTH. A select group (after Dec 2003) i.e. 9 pts got the assistance of radioguided probing. Peroperatively NM physician used cordless handheld gamma probe (Gamma Finder, World of Medicine, Germany) in neck and mediastinum to detect parathyroid adenoma / hyperplasias. A five fold increase in radioactive counts perceived by probe when compared to background was considered positive for parathyroid adenoma / hyperplasia. If PTH levels fell from baseline by at least 50%, the surgery was concluded as complete. Results: In all 22 pts suspected to have primary hyperparathyroidism TPSPECT identified adenomas (100 % sensitivity). While planar imaging had a sensitivity of 90.1% (20/22 pts), SPECT identified the adenoma in all pts. Interestingly only 3/22 pts had ectopic glands while 5 had more than one adenomas. The most commonly involved gland was left inferior. In secondary

  5. Multidetector-row computed tomography for prosthetic heart valve dysfunction: is concomitant non-invasive coronary angiography possible before redo-surgery?

    Energy Technology Data Exchange (ETDEWEB)

    Tanis, Wilco [Haga Teaching Hospital, Department of Cardiology, The Hague (Netherlands); Haga Teaching Hospital, The Hague (Netherlands); Sucha, Dominika; Habets, Jesse [University Medical Center Utrecht, Department of Radiology, Utrecht (Netherlands); Laufer, Ward; Chamuleau, Steven [University Medical Center Utrecht, Department of Cardiology, Utrecht (Netherlands); Herwerden, Lex.A. van [University Medical Center Utrecht, Department of Cardiothoracic Surgery, Utrecht (Netherlands); Symersky, Petr [Vrije Universiteit, Department of Cardiothoracic Surgery, Amsterdam (Netherlands); Budde, Ricardo P.J. [Erasmus Medical Center, Department of Radiology, Rotterdam (Netherlands)


    Retrospective ECG-gated multidetector-row computed tomography (MDCT) is increasingly used for the assessment of prosthetic heart valve (PHV) dysfunction, but is also hampered by PHV-related artefacts/cardiac arrhythmias. Furthermore, it is performed without nitroglycerine or heart rate correction. The purpose was to determine whether MDCT performed before potential redo-PHV surgery is feasible for concomitant coronary artery stenosis assessment and can replace invasive coronary angiography (CAG). PHV patients with CAG and MDCT were identified. Based on medical history, two groups were created: (I) patients with no known coronary artery disease (CAD), (II) patients with known CAD. All images were scored for the presence of significant (>50 %) stenosis. CAG was the reference test. Fifty-one patients were included. In group I (n = 38), MDCT accurately ruled out significant stenosis in 19/38 (50 %) patients, but could not replace CAG in the remaining 19/38 (50 %) patients due to non-diagnostic image quality (n = 16) or significant stenosis (n = 3) detection. In group II (n = 13), MDCT correctly found no patients without significant stenosis, requiring CAG imaging in all. MDCT assessed patency in 16/19 (84 %) grafts and detected a hostile anatomy in two. MDCT performed for PHV dysfunction assessment can replace CAG (100 % accurate) in approximately half of patients without previously known CAD. (orig.)

  6. Tracking-by-detection of surgical instruments in minimally invasive surgery via the convolutional neural network deep learning-based method. (United States)

    Zhao, Zijian; Voros, Sandrine; Weng, Ying; Chang, Faliang; Li, Ruijian


    Worldwide propagation of minimally invasive surgeries (MIS) is hindered by their drawback of indirect observation and manipulation, while monitoring of surgical instruments moving in the operated body required by surgeons is a challenging problem. Tracking of surgical instruments by vision-based methods is quite lucrative, due to its flexible implementation via software-based control with no need to modify instruments or surgical workflow. A MIS instrument is conventionally split into a shaft and end-effector portions, while a 2D/3D tracking-by-detection framework is proposed, which performs the shaft tracking followed by the end-effector one. The former portion is described by line features via the RANSAC scheme, while the latter is depicted by special image features based on deep learning through a well-trained convolutional neural network. The method verification in 2D and 3D formulation is performed through the experiments on ex-vivo video sequences, while qualitative validation on in-vivo video sequences is obtained. The proposed method provides robust and accurate tracking, which is confirmed by the experimental results: its 3D performance in ex-vivo video sequences exceeds those of the available state-of -the-art methods. Moreover, the experiments on in-vivo sequences demonstrate that the proposed method can tackle the difficult condition of tracking with unknown camera parameters. Further refinements of the method will refer to the occlusion and multi-instrumental MIS applications.

  7. Hybrid piezoresistive-optical tactile sensor for simultaneous measurement of tissue stiffness and detection of tissue discontinuity in robot-assisted minimally invasive surgery (United States)

    Bandari, Naghmeh M.; Ahmadi, Roozbeh; Hooshiar, Amir; Dargahi, Javad; Packirisamy, Muthukumaran


    To compensate for the lack of touch during minimally invasive and robotic surgeries, tactile sensors are integrated with surgical instruments. Surgical tools with tactile sensors have been used mainly for distinguishing among different tissues and detecting malignant tissues or tumors. Studies have revealed that malignant tissue is most likely stiffer than normal. This would lead to the formation of a sharp discontinuity in tissue mechanical properties. A hybrid piezoresistive-optical-fiber sensor is proposed. This sensor is investigated for its capabilities in tissue distinction and detection of a sharp discontinuity. The dynamic interaction of the sensor and tissue is studied using finite element method. The tissue is modeled as a two-term Mooney-Rivlin hyperelastic material. For experimental verification, the sensor was microfabricated and tested under the same conditions as of the simulations. The simulation and experimental results are in a fair agreement. The sensor exhibits an acceptable linearity, repeatability, and sensitivity in characterizing the stiffness of different tissue phantoms. Also, it is capable of locating the position of a sharp discontinuity in the tissue. Due to the simplicity of its sensing principle, the proposed hybrid sensor could also be used for industrial applications.

  8. Spontaneous Pyogenic Spondylodiscitis in the Thoracic or Lumbar Spine: A Retrospective Cohort Study Comparing the Safety and Efficacy of Minimally Invasive and Open Surgery Over a Nine-Year Period. (United States)

    Viezens, Lennart; Schaefer, Christian; Helmers, Rachel; Vettorazzi, Eik; Schroeder, Malte; Hansen-Algenstaedt, Nils


    Pyogenic spondylodiscitis is a rare disease, but its incidence is increasing. Over the last decade, spinal surgery has been modified to become minimally invasive. In degenerative spinal disorders, such minimally invasive surgery (MIS) reduces blood loss, muscular trauma, and the hospital stay. However, it is not known whether MIS also confers these benefits to patients with pyogenic spondylodiscitis. This retrospective cohort study compared the safety and efficacy of MIS and the conventional open surgical procedure in patients with pyogenic spondylodiscitis. The study cohort consisted of all consecutive patients who underwent surgery for thoracic or lumbar pyogenic spondylodiscitis that was not caused by previous surgery or tuberculosis in our tertiary-care institution between January 2003 and December 2011. Of the 148 eligible patients, 75 and 73 underwent MIS and open surgery, respectively. The 2 groups did not differ in terms of age, body mass index, American Society of Anaesthesiologists score, comorbidities, septic disease, or preoperative neurologic deficit. The 2 methods were associated with similar postoperative stays in the intensive care unit, overall hospital stays, complication rates, and postoperative survival. However, MIS was associated with a significantly shorter operating time, a lower perioperative need for blood products, and, as expected, an increased intraoperative fluoroscopy duration. Our 9-year experience suggests that MIS is safe and effective for spontaneous pyogenic thoracic and lumbar spondylodiscitis. Copyright © 2017 Elsevier Inc. All rights reserved.

  9. The presence of proliferative breast disease with atypia does not significantly influence outcome in early-stage invasive breast cancer treated with conservative surgery and radiation

    International Nuclear Information System (INIS)

    Fowble, B.; Hanlon, A.L.; Patchefsky, A.; Freedman, G.; Hoffman, J.P.; Sigurdson, E.R.; Goldstein, L.J.


    Purpose: To evaluate the influence of the benign background breast-tissue change of atypical hyperplasia (AH) on outcome in patients with early-stage invasive breast cancer treated with conservative surgery and radiation. Materials and Methods: Four hundred and sixty women with Stage I--II breast cancer treated with conservative surgery and radiation from 1982-1994 had pathologic assessment of their background adjacent benign breast tissue. The median follow-up was 5.6 years (range 0.1-15). The median age was 55 years (range 24-88). Of these, 23% had positive axillary nodes; 25% received adjuvant chemotherapy (CMF or CAF) with (9%) or without (17%) tamoxifen. Of the total, 24% received adjuvant tamoxifen alone. The patients were divided into 2 groups: 131 patients with atypical hyperplasia (ductal, 99 patients; lobular, 20 pts; and type not specified, 12 pts), and 329 patients with no proliferative changes or proliferative changes without atypia. Result: A statistically significant difference was observed between the 2 groups for method of detection, primary tumor size, presence of lobular carcinoma in situ (LCIS), pathologic nodal status, region(s) treated with radiation, and type of adjuvant therapy. Patients with atypical hyperplasia (AH) had smaller primary tumors (T1 80% vs. 70%) more often detected solely by mammography (51% vs. 36%) with negative axillary nodes (87% vs. 73%) and radiation treatment to the breast only (93% vs. 78%). LCIS was observed in 9% of the patients with AH and 3% of those without AH. Patients with AH more often received tamoxifen alone (32% vs. 21%), rather than chemotherapy (15% vs. 29%). There were no statistically significant differences between the 2 groups for race, age, menopausal status, family history, histology, histologic subtype DCIS when present, the presence or absence of an extensive intraductal component, final margin status, estrogen or progesterone receptor status, use of re-excision, or total radiation dose to the

  10. Development and selection of Asian-specific humeral implants based on statistical atlas: toward planning minimally invasive surgery. (United States)

    Wu, K; Daruwalla, Z J; Wong, K L; Murphy, D; Ren, H


    The commercial humeral implants based on the Western population are currently not entirely compatible with Asian patients, due to differences in bone size, shape and structure. Surgeons may have to compromise or use different implants that are less conforming, which may cause complications of as well as inconvenience to the implant position. The construction of Asian humerus atlases of different clusters has therefore been proposed to eradicate this problem and to facilitate planning minimally invasive surgical procedures [6,31]. According to the features of the atlases, new implants could be designed specifically for different patients. Furthermore, an automatic implant selection algorithm has been proposed as well in order to reduce the complications caused by implant and bone mismatch. Prior to the design of the implant, data clustering and extraction of the relevant features were carried out on the datasets of each gender. The fuzzy C-means clustering method is explored in this paper. Besides, two new schemes of implant selection procedures, namely the Procrustes analysis-based scheme and the group average distance-based scheme, were proposed to better search for the matching implants for new coming patients from the database. Both these two algorithms have not been used in this area, while they turn out to have excellent performance in implant selection. Additionally, algorithms to calculate the matching scores between various implants and the patient data are proposed in this paper to assist the implant selection procedure. The results obtained have indicated the feasibility of the proposed development and selection scheme. The 16 sets of male data were divided into two clusters with 8 and 8 subjects, respectively, and the 11 female datasets were also divided into two clusters with 5 and 6 subjects, respectively. Based on the features of each cluster, the implants designed by the proposed algorithm fit very well on their reference humeri and the proposed

  11. Domestic exotics and the perception of invasibility (United States)

    Qinfeng Guo; Robert Ricklefs


    Susceptibility of an area to invasion by exotic species is often judged by the fraction of introduced species in the local biota. However, the degree of invasion, particularly in mainland areas, has often been underestimated because of the exclusion of ‘domestic exotics’ (those introduced to internal units from within the national border) in calculations. Because all...

  12. Transauricular embolization of the rabbit coronary artery for experimental myocardial infarction: comparison of a minimally invasive closed-chest model with open-chest surgery

    Directory of Open Access Journals (Sweden)

    Katsanos Konstantinos


    Full Text Available Abstract Introduction To date, most animal studies of myocardial ischemia have used open-chest models with direct surgical coronary artery ligation. We aimed to develop a novel, percutaneous, minimally-invasive, closed-chest model of experimental myocardial infarction (EMI in the New Zealand White rabbit and compare it with the standard open-chest surgical model in order to minimize local and systemic side-effects of major surgery. Methods New Zealand White rabbits were handled in conformity with the "Guide for the Care and Use of Laboratory Animals" and underwent EMI under intravenous anesthesia. Group A underwent EMI with an open-chest method involving surgical tracheostomy, a mini median sternotomy incision and left anterior descending (LAD coronary artery ligation with a plain suture, whereas Group B underwent EMI with a closed-chest method involving fluoroscopy-guided percutaneous transauricular intra-arterial access, superselective LAD catheterization and distal coronary embolization with a micro-coil. Electrocardiography (ECG, cardiac enzymes and transcatheter left ventricular end-diastolic pressure (LVEDP measurements were recorded. Surviving animals were euthanized after 4 weeks and the hearts were harvested for Hematoxylin-eosin and Masson-trichrome staining. Results In total, 38 subjects underwent EMI with a surgical (n = 17 or endovascular (n = 21 approach. ST-segment elevation (1.90 ± 0.71 mm occurred sharply after surgical LAD ligation compared to progressive ST elevation (2.01 ± 0.84 mm;p = 0.68 within 15-20 min after LAD micro-coil embolization. Increase of troponin and other cardiac enzymes, abnormal ischemic Q waves and LVEDP changes were recorded in both groups without any significant differences (p > 0.05. Infarct area was similar in both models (0.86 ± 0.35 cm in the surgical group vs. 0.92 ± 0.54 cm in the percutaneous group;p = 0.68. Conclusion The proposed model of transauricular coronary coil embolization avoids

  13. Near-infrared fluorescence imaging for real-time intraoperative anatomical guidance in minimally invasive surgery: a systematic review of the literature. (United States)

    Schols, Rutger M; Connell, Niels J; Stassen, Laurents P S


    Near-infrared fluorescence (NIRF) imaging, using contrast agents with fluorescent characteristics in the near-infrared (NIR: 700-900 nm) window, is considered to possess great potential for clinical practice in the future of minimally invasive surgery (MIS), given its capacity for intraoperative, real-time anatomical navigation, and identification. The aim of this review is to provide an overview of the literature concerning the current and potential future applications of fluorescence imaging in supporting anatomical guidance during MIS, and thereby guiding future research. A systematic literature search was performed in the PubMed and Embase databases. All identified articles were screened and checked for eligibility by two authors. In addition, literature was sought by screening references of eligible articles. After administration of a fluorescent dye (e.g., indocyanine green), NIRF imaging can be helpful to improve the visualization of vital anatomical structures during MIS. Extra-hepatic bile ducts, arteries, ureters, sentinel lymph nodes, and lymph vessels have successfully been identified using NIRF imaging. A uniform approach regarding timing and route of dye administration has not yet been established. Optimization of both imaging systems and fluorescent dyes is needed to improve current shortcomings. New preclinical dyes are considered for optimization of NIRF imaging. Future implementation of new intraoperative optical methods, such as NIRF, could significantly contribute to intraoperative anatomy navigation and facilitate critical decision-making in MIS. Further research (i.e., large multi-center randomized controlled trials) is needed to establish the true value of this innovative optical imaging technique in standard clinical practice.

  14. INVESTIGATE-I (INVasive Evaluation before Surgical Treatment of Incontinence Gives Added Therapeutic Effect?): a mixed-methods study to assess the feasibility of a future randomised controlled trial of invasive urodynamic testing prior to surgery for stress urinary incontinence in women. (United States)

    Hilton, Paul; Armstrong, Natalie; Brennand, Catherine; Howel, Denise; Shen, Jing; Bryant, Andrew; Tincello, Douglas G; Lucas, Malcolm G; Buckley, Brian S; Chapple, Christopher R; Homer, Tara; Vale, Luke; McColl, Elaine


    The position of invasive urodynamic testing in the diagnostic pathway for urinary incontinence (UI) is unclear. Systematic reviews have called for further trials evaluating clinical utility, although a preliminary feasibility study was considered appropriate. To inform the decision whether or not to proceed to a definitive randomised trial of invasive urodynamic testing compared with clinical assessment with non-invasive tests, prior to surgery in women with stress UI (SUI) or stress predominant mixed UI (MUI). A mixed-methods study comprising a pragmatic multicentre randomised pilot trial; economic evaluation; survey of clinicians' views about invasive urodynamic testing; qualitative interviews with clinicians and trial participants. Urogynaecology, female urology and general gynaecology units in Newcastle, Leicester, Swansea, Sheffield, Northumberland, Gateshead and South Tees. Trial recruits were women with SUI or stress predominant MUI who were considering surgery after unsuccessful conservative treatment. Relevant clinicians completed two online surveys. Subsets of survey respondents and trial participants took part in separate qualitative interview studies. Pilot trial participants were randomised to undergo clinical assessment with non-invasive tests (control arm); or assessment as controls, plus invasive urodynamic testing (intervention arm). Confirmation that units can identify and recruit eligible women; acceptability of investigation strategies and data collection tools; acquisition of outcome data to determine the sample size for a definitive trial. The proposed primary outcome for the definitive trial was International Consultation on Incontinence Modular Questionnaire (ICIQ) Female Lower Urinary Tract Symptoms (ICIQ-FLUTS) (total score) 6 months after surgery or the start of non-surgical treatment; secondary outcomes included: ICIQ-FLUTS (subscales); ICIQ Urinary Incontinence Short Form; ICIQ Lower Urinary Tract Symptoms Quality of Life; Urogenital

  15. Heart bypass surgery - minimally invasive (United States)

    ... revascularization. In: Antman EM, Sabatine MS, eds. Cardiovascular Therapeutics: A Companion to Braunwald's Heart Disease . 4th ed. Philadelphia, PA: Elsevier Saunders; 2013:chap 11. Hillis LD, Smith PK, Anderson JL, et al. 2011 ACCF/AHA guideline ...

  16. Underestimation of hepatic glucose production by radioactive and stable tracers

    International Nuclear Information System (INIS)

    Argoud, G.M.; Schade, D.S.; Eaton, R.P.


    Although negative hepatic glucose production rates are physiologically impossible, they have been observed when hepatic glucose production is measured with the tracer-dilution technique during the hyperinsulinemic, euglycemic glucose clamp. Because hepatic glucose production is determined from the difference between tracer-derived glucose disposal and the known exogenous glucose infusion rate, the negative values for hepatic glucose production must result from an underestimation of glucose disposal by the tracer technique. In the current investigation, tracer-derived glucose disposal was measured in 25 subjects undergoing hyperinsulinemic, euglycemic clamps. Glucose disposal was measured with both radioactive and stable isotopes that utilize different methodologies, to determine whether discriminant metabolism of the isotopes versus methodological error leads to underestimation of tracer-derived glucose disposal. Both the radioactive and stable methodologies underestimated the exogenous glucose infusion rate during the hyperinsulinemic euglycemic clamp by 27 and 17%, respectively. Mean hepatic glucose production was -2.1 +/- 0.2 and -1.3 +/- 0.2 mg X kg-1 X min-1 as determined by the radioactive and stable isotope methodologies, respectively. Methodological error was an unlikely cause of this underestimation because it occurred with two different methodologies. The most likely explanation for underestimated rates of glucose disposal determined by the two types of isotope methodologies is discrepant metabolism of glucose tracers in comparison with unlabeled glucose

  17. Volume CT with a flat-panel detector on a mobile, isocentric C-arm: pre-clinical investigation in guidance of minimally invasive surgery. (United States)

    Siewerdsen, J H; Moseley, D J; Burch, S; Bisland, S K; Bogaards, A; Wilson, B C; Jaffray, D A


    A mobile isocentric C-arm (Siemens PowerMobil) has been modified in our laboratory to include a large area flat-panel detector (in place of the x-ray image intensifier), providing multi-mode fluoroscopy and cone-beam computed tomography (CT) imaging capability. This platform represents a promising technology for minimally invasive, image-guided surgical procedures where precision in the placement of interventional tools with respect to bony and soft-tissue structures is critical. The image quality and performance in surgical guidance was investigated in pre-clinical evaluation in image-guided spinal surgery. The control, acquisition, and reconstruction system are described. The reproducibility of geometric calibration, essential to achieving high three-dimensional (3D) image quality, is tested over extended time scales (7 months) and across a broad range in C-arm angulation (up to 45 degrees), quantifying the effect of improper calibration on spatial resolution, soft-tissue visibility, and image artifacts. Phantom studies were performed to investigate the precision of 3D localization (viz., fiber optic probes within a vertebral body) and effect of lateral projection truncation (limited field of view) on soft-tissue detectability in image reconstructions. Pre-clinical investigation was undertaken in a specific spinal procedure (photodynamic therapy of spinal metastases) in five animal subjects (pigs). In each procedure, placement of fiber optic catheters in two vertebrae (L1 and L2) was guided by fluoroscopy and cone-beam CT. Experience across five procedures is reported, focusing on 3D image quality, the effects of respiratory motion, limited field of view, reconstruction filter, and imaging dose. Overall, the intraoperative cone-beam CT images were sufficient for guidance of needles and catheters with respect to bony anatomy and improved surgical performance and confidence through 3D visualization and verification of transpedicular trajectories and tool placement

  18. Role of {sup 99m}Tc-sestamibi SPECT in accurate selection of primary hyperparathyroid patients for minimally invasive radio-guided surgery

    Energy Technology Data Exchange (ETDEWEB)

    Rubello, Domenico; Massaro, Arianna; Cittadin, Silvia; Rampin, Lucia [Istituto Oncologico Veneto (IOV), Nuclear Medicine Service - PET Unit, ' S. Maria della Misericordia' Hospital, Rovigo (Italy); Al-Nahhas, Adil [Hammersmith Hospital, Department of Nuclear Medicine, London (United Kingdom); Boni, Giuseppe; Mariani, Giuliano [University of Pisa Medical School, Regional Center of Nuclear Medicine, Pisa (Italy); Pelizzo, Maria R. [University of Padova Medical School, Department of Special Surgery, Padova (Italy)


    A prerequisite for optimum minimally invasive radio-guided surgery (MIRS) for primary hyperparathyroidism (PHPT) is the demonstration of significant uptake of {sup 99m}Tc-sestamibi in a parathyroid adenoma (PA). The aim of this study was to evaluate the clinical role or {sup 99m}Tc-sestamibi SPECT in selecting patients for this procedure. Fifty-four consecutive PHPT patients were evaluated by single-session {sup 99m}Tc-pertechnetate/{sup 99m}Tc-sestamibi planar subtraction scintigraphy, followed by {sup 99m}Tc-sestamibi SPECT acquisition to localise hyperfunctioning PAs and assist in planning the surgical approach. Scintigraphy showed the presence of a solitary PA in 47/54 patients (87%) and two or more PAs in four patients (7.4%); it was negative in the remaining three patients (5.6%). The overall sensitivity of {sup 99m}Tc-sestamibi scintigraphy was 94.6%. In 7/54 patients, the PA was located deep in the para-oesophageal/paratracheal space. So far, 22 patients with scintigraphic evidence of a solitary PA (in four of whom the PA was located deep in the neck) have undergone successful MIRS using the low 37 MBq (1 mCi) {sup 99m}Tc-sestamibi dose protocol. Intraoperative quick parathyroid hormone (QPTH) assay demonstrated a fall in all 22 patients, thus confirming successful removal of the hyperfunctioning PA. No major surgical complications were observed. After a period of follow-up ranging between 6 and 27 months (median 13 months), no case of persistent/recurrent PHPT was recorded. When comparing the parathyroid to background (P/B) ratio measured at planar and SPECT preoperative scintigraphy with that measured intraoperatively with the gamma probe, a good linear correlation was found between the SPECT and the intraoperative gamma probe measurements (r=0.89; p<0.01) but no correlation was found with planar scintigraphic data. Our preliminary data suggest that measurement of the P/B ratio by means of {sup 99m}Tc-sestamibi SPECT is more accurate in predicting the

  19. The accuracy of postoperative, non-invasive Air-Test to diagnose atelectasis in healthy patients after surgery: a prospective, diagnostic pilot study. (United States)

    Ferrando, Carlos; Romero, Carolina; Tusman, Gerardo; Suarez-Sipmann, Fernando; Canet, Jaume; Dosdá, Rosa; Valls, Paola; Villena, Abigail; Serralta, Ferran; Jurado, Ana; Carrizo, Juan; Navarro, Jose; Parrilla, Cristina; Romero, Jose E; Pozo, Natividad; Soro, Marina; Villar, Jesús; Belda, Francisco Javier


    To assess the diagnostic accuracy of peripheral capillary oxygen saturation (SpO 2 ) while breathing room air for 5 min (the 'Air-Test') in detecting postoperative atelectasis. Prospective cohort study. Diagnostic accuracy was assessed by measuring the agreement between the index test and the reference standard CT scan images. Postanaesthetic care unit in a tertiary hospital in Spain. Three hundred and fifty patients from 12 January to 7 February 2015; 170 patients scheduled for surgery under general anaesthesia who were admitted into the postsurgical unit were included. The Air-Test was performed in conscious extubated patients after a 30 min stabilisation period during which they received supplemental oxygen therapy via a venturi mask. The Air-Test was defined as positive when SpO 2 was ≤96% and negative when SpO 2 was ≥97%. Arterial blood gases were measured in all patients at the end of the Air-Test. In the subsequent 25 min, the presence of atelectasis was evaluated by performing a CT scan in 59 randomly selected patients. The primary study outcome was assessment of the accuracy of the Air-Test for detecting postoperative atelectasis compared with the reference standard. The secondary outcome was the incidence of positive Air-Test results. The Air-Test diagnosed postoperative atelectasis with an area under the receiver operating characteristic curve of 0.90 (95% CI 0.82 to 0.98) with a sensitivity of 82.6% and a specificity of 87.8%. The presence of atelectasis was confirmed by CT scans in all patients (30/30) with positive and in 5 patients (17%) with negative Air-Test results. Based on the Air-Test, postoperative atelectasis was present in 36% of the patients (62 out of 170). The Air-Test may represent an accurate, simple, inexpensive and non-invasive method for diagnosing postoperative atelectasis. NCT02650037. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is

  20. Robotic liver surgery (United States)

    Leung, Universe


    Robotic surgery is an evolving technology that has been successfully applied to a number of surgical specialties, but its use in liver surgery has so far been limited. In this review article we discuss the challenges of minimally invasive liver surgery, the pros and cons of robotics, the evolution of medical robots, and the potentials in applying this technology to liver surgery. The current data in the literature are also presented. PMID:25392840

  1. BMI may underestimate the socioeconomic gradient in true obesity

    NARCIS (Netherlands)

    van den Berg, G.; van Eijsden, M.; Vrijkotte, T. G. M.; Gemke, R. J. B. J.


    Body mass index (BMI) does not make a distinction between fat mass and lean mass. In children, high fat mass appears to be associated with low maternal education, as well as low lean mass because maternal education is associated with physical activity. Therefore, BMI might underestimate true obesity

  2. Factors associated with parental underestimation of child's weight status. (United States)

    Warkentin, Sarah; Mais, Laís A; Latorre, Maria do Rosário D O; Carnell, Susan; Taddei, José Augusto A C


    The aim of this study was to examine the prevalence of parental misperception of child weight status, and identify socioeconomic, anthropometric, behavioral and dietary factors associated with underestimation. Cross-sectional study. Data was collected in 14 Brazilian private schools. Parents of children aged 2-8 years (n=976) completed a self-reported questionnaire assessing their perception of their child's weight status, and sociodemographic, anthropometric, behavioral and dietary information. To measure the agreement between parental perception about child weight status and actual child weight status, the Kappa coefficient was estimated, and to investigate associations between parental underestimation and independent variables, chi-squared tests were performed, followed by multiple logistic regression, considering p≤0.05 for statistical significance. Overall, 48.05% of the parents incorrectly classified their child's weight. Specifically, 45.08% underestimated their child's weight status, with just 3% of parents overestimating. Children with higher body mass index (OR=2.03; p<0.001) and boys (OR=1.70; p<0.001) were more likely to have their weight status underestimated by parents. Since awareness of weight problems is essential for prevention and treatment, clinical practitioners should help parents at high risk of misperception to correctly evaluate their child's weight status. Copyright © 2017 Sociedade Brasileira de Pediatria. Published by Elsevier Editora Ltda. All rights reserved.

  3. Long-term results of breast conserving surgery vs. mastectomy for early stage invasive breast cancer: 20-year follow-up of the Danish randomized DBCG-82TM protocol

    DEFF Research Database (Denmark)

    Blichert-Toft, M.; Nielsen, M.; During, M.


    The main objective of the present study aims at comparing the long-term efficacy of breast conserving surgery (BCS) vs. mastectomy (M) based on a randomized design. The Danish Breast Cancer Cooperative Group (DBCG) conducted the trial (DBCG-82TM) from January 1983 to March 1989 recruiting 1154...... patients with invasive breast carcinoma. Follow-up time ended 1(st) May 2006 with a median follow-up time of 19.6 years (time span 17.1-23.3 years). Eligibility criteria included a one-sided, unifocal, primary operable breast carcinoma, patient age below 70 years, probability of satisfactory cosmetic......% of the complete series. 10-year recurrence free survival (RFS) and 20-year overall survival (OS) based on intent to treat did not reveal significant differences in outcome between breast conserving surgery vs. mastectomy, p=0.95 and p=0.10, respectively. Including the complete series comprising 1133 eligible...

  4. Mechanism for underestimation of isotopically determined glucose disposal

    International Nuclear Information System (INIS)

    Yki-Jaervinen, H.C.; Consoli, A.; Nurjhan, N.; Young, A.A.; Gerich, J.E.


    Use of [3H]glucose and a one-compartment model to determine glucose kinetics frequently underestimates the rate of glucose production (Ra). To assess to what extent an isotope effect, a tracer contaminant, or inadequacy of the model was responsible, we measured glucose Ra and forearm clearance of tracer and unlabeled glucose at various concentrations of plasma insulin (approximately 50, approximately 160, and approximately 1800 microU/ml) and plasma glucose (approximately 90, approximately 160, approximately 250, and approximately 400 mg/dl) under steady-state and non-steady-state conditions. Under isotopic steady-state conditions, the clearances of tracer and unlabeled glucose across the forearm were identical, and exogenous glucose infusion rates did not differ significantly from the isotopically determined glucose Ra (10.0 +/- 1.3 vs. 10.5 +/- 1.0 fat-free mass.min-1, respectively). However, under isotopic non-steady-state conditions, the isotopically determined Ra was significantly lower than the glucose infusion rate (11.5 +/- 1.3 vs. 13.7 +/- 1.5 fat-free mass.min-1, respectively, P less than .001), and the underestimation was related to the deviation from the isotopic steady state. When [3H]glucose specific activity of plasma samples from experiments with the greatest underestimation of Ra was determined by high-performance liquid chromatography, less than 7% of the underestimation could be accounted for by a contaminant. These results indicate that inadequacy of the one-compartment model is responsible for underestimation of glucose Ra under non-steady-state conditions and that there is no detectable isotopic effect or appreciable contaminant of [3-3H]glucose. We conclude that under isotopic steady-state conditions, [3-3H]glucose is a reliable tracer for glucose kinetic studies in humans

  5. Regenerative periodontal therapy of infrabony defects using minimally invasive surgery and a collagen-enriched bovine-derived xenograft: a 1-year prospective study on clinical and aesthetic outcome. (United States)

    Cosyn, Jan; Cleymaet, Roberto; Hanselaer, Lore; De Bruyn, Hugo


    To evaluate the clinical and aesthetic outcome of regenerative periodontal therapy (RPT) using minimally invasive surgery and a collagen-enriched bovine-derived xenograft (1); to identify risk factors for failure (clinical attachment level (CAL) gain ≤ 1 mm) and advanced gingival recession (REC) increase (>1 mm) (2). Ninety-five non-smoking patients, with ≤ 25% full-mouth plaque and bleeding presenting ≥ 6 months after initial periodontal therapy with ≥ 1 isolated inter-dental infrabony defect were recruited. Patients were consecutively treated by the same clinician using minimally invasive surgery and a collagen-enriched bovine-derived xenograft. Clinical, radiographic and aesthetic data were collected before surgery and up to 1 year. Multivariate analyses were used to identify risk factors for failure and advanced REC increase. Eighty-four patients (39 men, 45 women; mean age 53) complied and demonstrated mean probing depth (PD) of 7.8 mm, CAL of 10.0 mm and defect depth of 5.2 mm before surgery. At 1 year, postsurgery mean PD reduction was 3.5 mm (range 0.0-8.0), CAL gain was 3.1 mm (range 0.0-7.0) and radiographic defect fill was 53% (range 0-100). Forty-nine percentage showed ≥ 4 mm CAL gain, whereas 15% were considered failures. Mean inter-dental and midfacial REC increase was 0.3 mm (range-2.0-2.0) and 0.5 mm (range-1.5-2.0) respectively. Midfacial REC increase and contour deterioration contributed most to a small, yet significant reduction in the Pink Esthetic Score from 10.06 to 9.42 (p = 0.002). Risk factors for failure included defects with a non-supportive anatomy (OR: ≥ 10.4), plaque (OR: 14.7) and complication(s) (OR: 12.0). Risk factors for advanced midfacial REC increase included defects with a non-supportive anatomy (OR: 58.8) and a thin-scalloped gingival biotype (OR: 76.9). RPT using minimally invasive surgery and a collagen-enriched bovine-derived xenograft demonstrated favourable clinical outcome after 1 year, even though soft

  6. A comparison of non-invasive versus invasive methods of ...

    African Journals Online (AJOL)

    Puneet Khanna

    for Hb estimation from the laboratory [total haemoglobin mass (tHb)] and arterial blood gas (ABG) machine (aHb), using ... A comparison of non-invasive versus invasive methods of haemoglobin estimation in patients undergoing intracranial surgery. 161 .... making decisions for blood transfusions based on these results.

  7. Robust Underestimation of Speed During Driving: A Field Study. (United States)

    Schütz, Alexander C; Billino, Jutta; Bodrogi, Peter; Polin, Dmitrij; Khanh, Tran Q; Gegenfurtner, Karl R


    Traffic reports consistently identify speeding as a substantial source of accidents. Adequate driving speeds require reliable speed estimation; however, there is still a lack of understanding how speed perception is biased during driving. Therefore, we ran three experiments measuring speed estimation under controlled driving and lighting conditions. In the first experiment, participants had to produce target speeds as drivers or had to judge driven speed as passengers. Measurements were performed at daylight and at night. In the second experiment, participants were required to produce target speeds at dusk, under rapidly changing lighting conditions. In the third experiment, we let two cars approach and pass each other. Drivers were instructed to produce target speeds as well as to judge the speed of the oncoming vehicle. Here measurements were performed at daylight and at night, with full or dipped headlights. We found that passengers underestimated driven speed by about 20% and drivers went over the instructed speed by roughly the same amount. Interestingly, the underestimation of speed extended to oncoming cars. All of these effects were independent of lighting conditions. The consistent underestimation of speed could lead to potentially fatal situations where drivers go faster than intended and judge oncoming traffic to approach slower than it actually is. © The Author(s) 2015.

  8. Prime incision: A minimally invasive approach to breast cancer surgical treatment-A 2 cohort retrospective comparison with conventional breast conserving surgery.

    Directory of Open Access Journals (Sweden)

    Silvio Eduardo Bromberg

    Full Text Available The prime incision technique is an oncoplastic surgery aimed to remove both the breast tumor and the sentinel lymph node through one incision, thus providing better aesthetic results than the conventional breast conservative two incision technique. We retrospectively evaluated 2 cohorts of 60 consecutive breast cancer patients operated by either conventional breast conservative surgery (N = 26 or one incision surgery (N = 34. There were no recurrence or death events observed in any group. No difference was seen regarding the incidence of surgical complications. In the prime incision group the breast volume removed was significantly lower than in the conventional surgery group as well as was the surgical time and the number of dissected lymph nodes. Aesthetical results were better in the one incision group. Further prospective studies are needed to validate the one incision technique as a surgical option for selected early stage breast cancer patients.

  9. Symptomatic pneumocephalus occurring years after transphenoidal surgery and radiation therapy for an invasive pituitary tumor: a case report and review of the literature. (United States)

    Rao, Ganesh; Apfelbaum, Ronald I


    We present the unusual case of a patient who experienced a CSF leak and subsequent pneumocephalus several years after transphenoidal surgery and radiation treatment for an ACTH secreting pituitary tumor. This patient underwent aggressive management including placement of a lumbar drain, and reoperation to stop her leak. Despite these efforts, her leak persisted resulting in significant tension pneumocephalus. Pneumocephalus is a rare but important potential complication of transphenoidal surgery. Here we discuss our management of this patient's condition, and review the existing literature.

  10. Non-invasive hemoglobin monitoring. (United States)

    Joseph, Bellal; Haider, Ansab; Rhee, Peter


    Technology has transformed the practice of medicine and surgery in particular over the last several decades. This change in practice has allowed diagnostic and therapeutic tests to be performed less invasively. Hemoglobin monitoring remains one of the most commonly performed diagnostic tests in the United States. Recently, non-invasive hemoglobin monitoring technology has gained popularity. The aim of this article is to review the principles of how this technology works, pros and cons, and the implications of non-invasive hemoglobin technology particularly in trauma surgery. Copyright © 2015 IJS Publishing Group Ltd. Published by Elsevier Ltd. All rights reserved.

  11. Invasive predators and global biodiversity loss. (United States)

    Doherty, Tim S; Glen, Alistair S; Nimmo, Dale G; Ritchie, Euan G; Dickman, Chris R


    Invasive species threaten biodiversity globally, and invasive mammalian predators are particularly damaging, having contributed to considerable species decline and extinction. We provide a global metaanalysis of these impacts and reveal their full extent. Invasive predators are implicated in 87 bird, 45 mammal, and 10 reptile species extinctions-58% of these groups' contemporary extinctions worldwide. These figures are likely underestimated because 23 critically endangered species that we assessed are classed as "possibly extinct." Invasive mammalian predators endanger a further 596 species at risk of extinction, with cats, rodents, dogs, and pigs threatening the most species overall. Species most at risk from predators have high evolutionary distinctiveness and inhabit insular environments. Invasive mammalian predators are therefore important drivers of irreversible loss of phylogenetic diversity worldwide. That most impacted species are insular indicates that management of invasive predators on islands should be a global conservation priority. Understanding and mitigating the impact of invasive mammalian predators is essential for reducing the rate of global biodiversity loss.

  12. Laparoscopic surgery in colorectal cancer

    International Nuclear Information System (INIS)

    Bressler Hernandez, Norlan; Martinez Perez, Elliot; Fernandez Rodriguez, Leopoldo; Torres Core, Ramiro


    In the current age of minimally invasive surgery, laparoscopic surgery for colon cancer has been established as oncologically equivalent to conventional open surgery. The advantages of laparoscopic surgery have translated into smaller incisions and shorter recovery. Since the advent of laparoscopy, surgeons have been fueled to develop less invasive operative methods as feasible alternatives to traditional procedures. As techniques evolved and technology advanced, laparoscopy became more widely accepted and is now more commonly used in many institutions. Recently, a trend toward less invasive surgery, driven by patient and surgeon alike, has been a major objective for many institutions because of the ability of laparoscopic surgery to reduce postoperative pain, achieve a quicker recovery time, and improve cosmetic outcomes. Although still evolving, traditional laparoscopy has served as a foundation for even further refinements in the minimally invasive approach and as a result, more advanced equipment and newer techniques have arisen

  13. Minimally invasive prediction of ScvO2 in high-risk surgery : The introduction of a model Index of Oxygenation

    NARCIS (Netherlands)

    de Grooth, Harm-Jan S.; Vos, Jaap Jan; Scheeren, Thomas; van Beest, Paul


    INTRODUCTION: The purpose of this study was to examine the trilateral relationship between cardiac index (CI), tissue oxygen saturation (StO2) and central venous oxygen saturation (ScvO2) and subsequently develop a model to predict ScvO2 on minimal invasive manner in patients undergoing major

  14. [Breast cancer surgery]. (United States)

    Vlastos, Georges; Berclaz, Gilles; Langer, Igor; Pittet-Cuenod, Brigitte; Delaloye, Jean-François


    Breast conserving surgery followed by radiation therapy is the treatment of choice for early breast cancer. For patients who choice or need a mastectomy, breast reconstruction provides an acceptable alternative. Breast cancer surgery has been evolving through minimally invasive approaches. Sentinel node biopsy has already remplaced axillary lymph node dissection in the evaluation of the axilla. Local ablation of the tumor may be a valuable alternative to surgery in the future.

  15. Individuals underestimate moderate and vigorous intensity physical activity.

    Directory of Open Access Journals (Sweden)

    Karissa L Canning

    Full Text Available BACKGROUND: It is unclear whether the common physical activity (PA intensity descriptors used in PA guidelines worldwide align with the associated percent heart rate maximum method used for prescribing relative PA intensities consistently between sexes, ethnicities, age categories and across body mass index (BMI classifications. OBJECTIVES: The objectives of this study were to determine whether individuals properly select light, moderate and vigorous intensity PA using the intensity descriptions in PA guidelines and determine if there are differences in estimation across sex, ethnicity, age and BMI classifications. METHODS: 129 adults were instructed to walk/jog at a "light," "moderate" and "vigorous effort" in a randomized order. The PA intensities were categorized as being below, at or above the following %HRmax ranges of: 50-63% for light, 64-76% for moderate and 77-93% for vigorous effort. RESULTS: On average, people correctly estimated light effort as 51.5±8.3%HRmax but underestimated moderate effort as 58.7±10.7%HRmax and vigorous effort as 69.9±11.9%HRmax. Participants walked at a light intensity (57.4±10.5%HRmax when asked to walk at a pace that provided health benefits, wherein 52% of participants walked at a light effort pace, 19% walked at a moderate effort and 5% walked at a vigorous effort pace. These results did not differ by sex, ethnicity or BMI class. However, younger adults underestimated moderate and vigorous intensity more so than middle-aged adults (P<0.05. CONCLUSION: When the common PA guideline descriptors were aligned with the associated %HRmax ranges, the majority of participants underestimated the intensity of PA that is needed to obtain health benefits. Thus, new subjective descriptions for moderate and vigorous intensity may be warranted to aid individuals in correctly interpreting PA intensities.

  16. Functional and radiographic outcomes of hallux valgus correction by mini-invasive surgery with Reverdin-Isham and Akin percutaneous osteotomies: a longitudinal prospective study with a 48-month follow-up. (United States)

    Biz, Carlo; Fosser, Michele; Dalmau-Pastor, Miki; Corradin, Marco; Rodà, Maria Grazia; Aldegheri, Roberto; Ruggieri, Pietro


    Minimally invasive surgery (MIS) represents one of the most innovative surgical treatments of hallux valgus (HV). However, long-term outcomes still remain a matter of discussion within the orthopaedic community. The purpose of this longitudinal prospective study was to evaluate radiographic and functional outcomes in patients with mild-to-severe HV who underwent Reverdin-Isham and Akin percutaneous osteotomy, following exostosectomy and lateral release. Eighty patients with mild-to-severe symptomatic HV were treated by MIS. Clinical evaluation was assessed preoperatively, as well as at 3 and 12 months after surgery and at final follow-up of 48 months, using the American Orthopaedic Foot and Ankle Society (AOFAS) hallux grading system. Patient satisfaction and complications were recorded. Computer-assisted measurement of antero-posterior radiographs was taken preoperatively, as well as at 3 and 12 months after surgery and at 48-month follow-up, analysing the intermetatarsal angle (IMA), the hallux valgus angle (HVA), the distal metatarsal articular angle (DMAA) and the tibial sesamoid position. Also, the bridging bone/callus formation was evaluated at the different radiographic follow-ups, while the articular surface congruency and the metatarsal index were calculated only preoperatively and at the last follow-up. Patient satisfaction was assessed using the visual analogue score (VAS). Statistical analysis was carried out using the paired t test. Statistical significance was set at p surgery with Reverdin-Isham and Akin percutaneous osteotomy, in combination with previous exostosectomy and subsequent lateral soft-tissue release, is a safe, effective and reliable procedure for correction of mild-to-moderate HV. However, it requires a long learning curve because of the inherent difficulty of the mixed different surgical procedures. PRS Protocol Registration and Results System: NCT02886221.

  17. A Randomized Study of Minimally Invasive Percutaneous Nephrolithotomy (MPCNL) with the aid of a patented suctioning sheath in the treatment of renal calculus complicated by pyonephrosis by one surgery. (United States)

    Huang, Jianrong; Song, Leming; Xie, Donghua; Li, Monong; Deng, Xiaolin; Hu, Min; Peng, Zuofeng; Liu, Tairong; Du, Chuance; Yao, Lei; Liu, Shengfeng; Guo, Shulin; Zhong, Jiuqing


    Calculus pyonephrosis is difficult to manage. The aim of this study is to explore the value of a patented suctioning sheath assisted minimally invasive percutaneous nephrolithotomy (MPCNL) in the treatment of calculus pyonephrosis. One hundred and eighty two patients with calculus pyonephrosis were randomizely divided into observation group (n = 91) and control group (n = 91). The control group was treated with MPCNL traditionally using peel-away sheath while the observation group was treated with MPCNL using the patented suctioning sheath. All the patients in the observation group underwent one stage surgical treatment, 14 patients in the control group underwent first-stage surgery with the rest of the group underwent one stage surgery. The complication rate was 12.1% in the observation group, significantly lower than the rate in the control group which was 51.6%; One surgery stone clearance in the observation group was 96.7% while it was 73.6% in the control group; operative time in the observation group was (54.5 ± 14.5) min, compared to (70.2 ± 11.7) min in the control group; the bleeding amount in the observation group was (126.4 ± 47.2) ml, compared to (321.6 ± 82.5) ml in the control group; the hospitalization duration for the observation group was (6.4 ± 2.3) days, compared to (10.6 ± 3.7) days in the control group. Comparison of the above indicators, the observation group was better than the control group with significant difference (p calculus pyonephrosis in one surgery is economic, practical, and warrants clinical promotion. This study was registered with Chinese Clinical Trial Registry on May 18, 2016 (retrospective registration) with a trial registration number of ChiCTR-IOR-16008490 .

  18. Consequences of Underestimating Impalement Bicycle Handlebar Injuries in Children. (United States)

    Ramos-Irizarry, Carmen T; Swain, Shakeva; Troncoso-Munoz, Samantha; Duncan, Malvina

    Impalement bicycle handlebar trauma injuries are rare; however, on initial assessment, they have the potential of being underestimated. We reviewed our prospective trauma database of 3,894 patients for all bicycle injuries from January 2010 to May 2015. Isolated pedal bike injuries were reported in 2.6% (N = 101) of the patients who were admitted to the trauma service. Fifteen patients suffered direct handlebar trauma. Patients were grouped into blunt trauma (n = 12) and impalement trauma (n = 3). We examined gender, age, injury severity score (ISS), Glasgow Coma Scale score, use of protective devices, need for surgical intervention, need for intensive care (ICU), and hospital length of stay. Mean age was 9.6 years. All children with penetrating injuries were males. Mean ISS was less than 9 in both groups. None of the children were wearing bicycle helmets. Three patients who sustained blunt injuries required ICU care due to associated injuries. All of the children with impalement injuries required several surgical interventions. These injuries included a traumatic direct inguinal hernia, a medial groin and thigh laceration with resultant femoral hernia, and a lateral deep thigh laceration. Impalement bicycle handlebar injuries must be thoroughly evaluated, with a similar importance given to blunt injuries. A high index of suspicion must be maintained when examining children with handlebar impalement injuries, as they are at risk for missed or underestimation of their injuries.

  19. Invasive Species (United States)

    Invasive species have significantly changed the Great Lakes ecosystem. An invasive species is a plant or animal that is not native to an ecosystem, and whose introduction is likely to cause economic, human health, or environmental damage.

  20. Society of Surgical Oncology–American Society for Radiation Oncology Consensus Guideline on Margins for Breast-Conserving Surgery With Whole-Breast Irradiation in Stages I and II Invasive Breast Cancer

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    Moran, Meena S. [Department of Therapeutic Radiology, Yale School of Medicine, Yale University, New Haven, Connecticut (United States); Schnitt, Stuart J. [Department of Pathology, Harvard Medical School, Boston, Massachusetts (United States); Giuliano, Armando E. [Department of Surgery, Cedars Sinai Medical Center, Los Angeles, California (United States); Harris, Jay R. [Department of Radiation Oncology, Harvard Medical School, Boston, Massachusetts (United States); Khan, Seema A. [Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois (United States); Horton, Janet [Department of Radiation Oncology, Duke University Medical Center, Durham, North Carolina (United States); Klimberg, Suzanne [Department of Surgery, University of Arkansas for Medical Sciences, Fayetteville, Arkansas (United States); Chavez-MacGregor, Mariana [Department of Medical Oncology, University of Texas MD Anderson Cancer Center, Houston, Texas (United States); Freedman, Gary [Department of Radiation Oncology, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania (United States); Houssami, Nehmat [School of Public Health, Sydney Medical School, University of Sydney, Sydney, New South Wales (Australia); Johnson, Peggy L. [Advocate in Science, Susan G. Komen, Wichita, Kansas (United States); Morrow, Monica, E-mail: [Breast Service, Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, New York (United States)


    Purpose: To convene a multidisciplinary panel of breast experts to examine the relationship between margin width and ipsilateral breast tumor recurrence (IBTR) and develop a guideline for defining adequate margins in the setting of breast conserving surgery and adjuvant radiation therapy. Methods and Materials: A multidisciplinary consensus panel used a meta-analysis of margin width and IBTR from a systematic review of 33 studies including 28,162 patients as the primary evidence base for consensus. Results: Positive margins (ink on invasive carcinoma or ductal carcinoma in situ) are associated with a 2-fold increase in the risk of IBTR compared with negative margins. This increased risk is not mitigated by favorable biology, endocrine therapy, or a radiation boost. More widely clear margins than no ink on tumor do not significantly decrease the rate of IBTR compared with no ink on tumor. There is no evidence that more widely clear margins reduce IBTR for young patients or for those with unfavorable biology, lobular cancers, or cancers with an extensive intraductal component. Conclusions: The use of no ink on tumor as the standard for an adequate margin in invasive cancer in the era of multidisciplinary therapy is associated with low rates of IBTR and has the potential to decrease re-excision rates, improve cosmetic outcomes, and decrease health care costs.

  1. Intracorneal and Intraocular Invasion of Ocular Surface Squamous Neoplasia after Intraocular Surgery: Report of Two Cases and Review of the Literature. (United States)

    Murillo, Juan C; Galor, Anat; Wu, Michael C; Kye, Natasha K; Wong, James; Ahmed, Ibrahim O; Joag, Madhura; Shalabi, Nabeel; Lahners, William; Dubovy, Sander; Karp, Carol L


    The aim of this paper was to describe 2 cases of ocular surface squamous neoplasia (OSSN) of the conjunctiva with intracorneal and intraocular extension following intraocular surgery. We conducted a clinical pathological retrospective case series. Case 1 underwent cataract surgery in the setting of an unnoticed adjacent OSSN. An excisional biopsy with cryotherapy and intraoperative mitomycin C was subsequently performed, confirming OSSN. The patient had two recurrences treated topically with resolution. While the conjunctiva remained clear, a corneal haze emanating from the cataract incision site was noted. Penetrating keratoplasty (PK) for this haze revealed midstromal infiltrative carcinoma. Case 2 had a history of herpes simplex keratitis that ultimately required corneal grafts. Fifteen years later, he developed an OSSN treated with excisional biopsy and had clear margins. Eight months later, he presented with a recurrence of his OSSN and was treated briefly with topical interferon for 4 weeks; however, he developed an infectious keratitis with a corneal perforation requiring another PK. Four months after PK, low-grade inflammation was noted. Cytology of the anterior chamber aspirate revealed neoplastic squamous cells. Another PK was then performed. Pathology confirmed extensive intraocular neoplasia. Limited exenteration was performed. Patients with a history of OSSN may be at increased risk of neoplastic intraocular extension following intraocular surgery.

  2. Underestimating our influence over others' unethical behavior and decisions. (United States)

    Bohns, Vanessa K; Roghanizad, M Mahdi; Xu, Amy Z


    We examined the psychology of "instigators," people who surround an unethical act and influence the wrongdoer (the "actor") without directly committing the act themselves. In four studies, we found that instigators of unethical acts underestimated their influence over actors. In Studies 1 and 2, university students enlisted other students to commit a "white lie" (Study 1) or commit a small act of vandalism (Study 2) after making predictions about how easy it would be to get their fellow students to do so. In Studies 3 and 4, online samples of participants responded to hypothetical vignettes, for example, about buying children alcohol and taking office supplies home for personal use. In all four studies, instigators failed to recognize the social pressure they levied on actors through simple unethical suggestions, that is, the discomfort actors would experience by making a decision that was inconsistent with the instigator's suggestion.

  3. The underestimated potential of solar energy to mitigate climate change (United States)

    Creutzig, Felix; Agoston, Peter; Goldschmidt, Jan Christoph; Luderer, Gunnar; Nemet, Gregory; Pietzcker, Robert C.


    The Intergovernmental Panel on Climate Change's fifth assessment report emphasizes the importance of bioenergy and carbon capture and storage for achieving climate goals, but it does not identify solar energy as a strategically important technology option. That is surprising given the strong growth, large resource, and low environmental footprint of photovoltaics (PV). Here we explore how models have consistently underestimated PV deployment and identify the reasons for underlying bias in models. Our analysis reveals that rapid technological learning and technology-specific policy support were crucial to PV deployment in the past, but that future success will depend on adequate financing instruments and the management of system integration. We propose that with coordinated advances in multiple components of the energy system, PV could supply 30-50% of electricity in competitive markets.

  4. The integration of minimally invasive surgery in surgical practice in a Canadian setting: results from 2 consecutive province-wide practice surveys of general surgeons over a 5-year period (United States)

    Hallet, Julie; Mailloux, Olivier; Chhiv, Mony; Grégoire, Roger C.; Gagné, Jean-Pierre


    Background Although minimally invasive surgery (MIS) has been quickly embraced, the introduction of advanced procedures appears more complex. We assessed the evolution of MIS in the province of Quebec over a 5-year period to identify areas for improvement in the modern surgical era. Methods We developed, test-piloted and conducted a self-administered questionnaire among Quebec general surgeons in 2007 and 2012 to examine stated MIS practice, MIS training and barriers and facilitators to the use of MIS. Results Response rates were 51.3% (251 of 489) in 2007 and 31.3% (153 of 491) in 2012. A significant increase was observed for performance of most advanced MIS procedures, especially for colectomy for benign (66.0% v. 84.3%, p surgery for malignancy (21.0% v. 54.6%, p general surgeons in Québec. This technique appears well established in current surgical practice. The growing place of MIS in residency training seems to be a paramount part of this development. Results from this study could be used as a baseline for studies focusing on ways to further improve the MIS practice. PMID:25598180

  5. Robotic Surgery in Gynecologic Oncology (United States)

    DeBernardo, Robert; Starks, David; Barker, Nichole; Armstrong, Amy; Kunos, Charles A.


    Robotic surgery for the management of gynecologic cancers allows for minimally invasive surgical removal of cancer-bearing organs and tissues using sophisticated surgeon-manipulated, robotic surgical instrumentation. Early on, gynecologic oncologists recognized that minimally invasive surgery was associated with less surgical morbidity and that it shortened postoperative recovery. Now, robotic surgery represents an effective alternative to conventional laparotomy. Since its widespread adoption, minimally invasive surgery has become an option not only for the morbidly obese but for women with gynecologic malignancy where conventional laparotomy has been associated with significant morbidity. As such, this paper considers indications for robotic surgery, reflects on outcomes from initial robotic surgical outcomes data, reviews cost efficacy and implications in surgical training, and discusses new roles for robotic surgery in gynecologic cancer management. PMID:22190946

  6. Avulsion of the left internal mammary artery graft after minimally invasive coronary surgery: fatal complication or medical error? A case report. (United States)

    Viel, Guido; Balmaceda, Ute; Sperhake, Jan P


    Minimally invasive direct coronary artery bypass (MIDCAB) is performed through a left anterior mini-thoracotomy without the use of a cardiopulmonary bypass and offers greater potential for more rapid recovery, reduced pain and a decreased need for blood transfusion than conventional coronary artery bypass grafting. Few major complications of the MIDCAB procedure have been reported in the literature since the first intervention was performed in 1995, but the most serious one is avulsion of the left internal mammary artery (LIMA) graft near the site of anastomosis with the left anterior descending coronary artery. Forensic issues regarding the role of the surgeon in causing this life-threatening emergency condition have not been discussed. We report here the case of a 48-year-old man who died 18 days after a MIDCAB of massive thoracic bleeding due to the avulsion of the LIMA graft. We discuss the probable etiopathogenesis of this fatal complication from a forensic point of view.

  7. Robotic surgery (United States)

    Robot-assisted surgery; Robotic-assisted laparoscopic surgery; Laparoscopic surgery with robotic assistance ... Robotic surgery is similar to laparoscopic surgery. It can be performed through smaller cuts than open surgery. ...

  8. Body Size Estimation from Early to Middle Childhood: Stability of Underestimation, BMI, and Gender Effects

    Directory of Open Access Journals (Sweden)

    Silje Steinsbekk


    Full Text Available Individuals who are overweight are more likely to underestimate their body size than those who are normal weight, and overweight underestimators are less likely to engage in weight loss efforts. Underestimation of body size might represent a barrier to prevention and treatment of overweight; thus insight in how underestimation of body size develops and tracks through the childhood years is needed. The aim of the present study was therefore to examine stability in children’s underestimation of body size, exploring predictors of underestimation over time. The prospective path from underestimation to BMI was also tested. In a Norwegian cohort of 6 year olds, followed up at ages 8 and 10 (analysis sample: n = 793 body size estimation was captured by the Children’s Body Image Scale, height and weight were measured and BMI calculated. Overall, children were more likely to underestimate than overestimate their body size. Individual stability in underestimation was modest, but significant. Higher BMI predicted future underestimation, even when previous underestimation was adjusted for, but there was no evidence for the opposite direction of influence. Boys were more likely than girls to underestimate their body size at ages 8 and 10 (age 8: 38.0% vs. 24.1%; Age 10: 57.9% vs. 30.8% and showed a steeper increase in underestimation with age compared to girls. In conclusion, the majority of 6, 8, and 10-year olds correctly estimate their body size (prevalence ranging from 40 to 70% depending on age and gender, although a substantial portion perceived themselves to be thinner than they actually were. Higher BMI forecasted future underestimation, but underestimation did not increase the risk for excessive weight gain in middle childhood.

  9. Body Size Estimation from Early to Middle Childhood: Stability of Underestimation, BMI, and Gender Effects. (United States)

    Steinsbekk, Silje; Klöckner, Christian A; Fildes, Alison; Kristoffersen, Pernille; Rognsås, Stine L; Wichstrøm, Lars


    Individuals who are overweight are more likely to underestimate their body size than those who are normal weight, and overweight underestimators are less likely to engage in weight loss efforts. Underestimation of body size might represent a barrier to prevention and treatment of overweight; thus insight in how underestimation of body size develops and tracks through the childhood years is needed. The aim of the present study was therefore to examine stability in children's underestimation of body size, exploring predictors of underestimation over time. The prospective path from underestimation to BMI was also tested. In a Norwegian cohort of 6 year olds, followed up at ages 8 and 10 (analysis sample: n = 793) body size estimation was captured by the Children's Body Image Scale, height and weight were measured and BMI calculated. Overall, children were more likely to underestimate than overestimate their body size. Individual stability in underestimation was modest, but significant. Higher BMI predicted future underestimation, even when previous underestimation was adjusted for, but there was no evidence for the opposite direction of influence. Boys were more likely than girls to underestimate their body size at ages 8 and 10 (age 8: 38.0% vs. 24.1%; Age 10: 57.9% vs. 30.8%) and showed a steeper increase in underestimation with age compared to girls. In conclusion, the majority of 6, 8, and 10-year olds correctly estimate their body size (prevalence ranging from 40 to 70% depending on age and gender), although a substantial portion perceived themselves to be thinner than they actually were. Higher BMI forecasted future underestimation, but underestimation did not increase the risk for excessive weight gain in middle childhood.

  10. The risk of sustained sexual transmission of Zika is underestimated.

    Directory of Open Access Journals (Sweden)

    Antoine Allard


    Full Text Available Pathogens often follow more than one transmission route during outbreaks-from needle sharing plus sexual transmission of HIV to small droplet aerosol plus fomite transmission of influenza. Thus, controlling an infectious disease outbreak often requires characterizing the risk associated with multiple mechanisms of transmission. For example, during the Ebola virus outbreak in West Africa, weighing the relative importance of funeral versus health care worker transmission was essential to stopping disease spread. As a result, strategic policy decisions regarding interventions must rely on accurately characterizing risks associated with multiple transmission routes. The ongoing Zika virus (ZIKV outbreak challenges our conventional methodologies for translating case-counts into route-specific transmission risk. Critically, most approaches will fail to accurately estimate the risk of sustained sexual transmission of a pathogen that is primarily vectored by a mosquito-such as the risk of sustained sexual transmission of ZIKV. By computationally investigating a novel mathematical approach for multi-route pathogens, our results suggest that previous epidemic threshold estimates could under-estimate the risk of sustained sexual transmission by at least an order of magnitude. This result, coupled with emerging clinical, epidemiological, and experimental evidence for an increased risk of sexual transmission, would strongly support recent calls to classify ZIKV as a sexually transmitted infection.

  11. Evidence that protein requirements have been significantly underestimated. (United States)

    Elango, Rajavel; Humayun, Mohammad A; Ball, Ronald O; Pencharz, Paul B


    This review discusses recent evidence that suggests a significant underestimation of protein requirements in adult humans. Traditionally, total protein requirements for humans have been determined using nitrogen balance. The recent Dietary Reference Intake recommendations for mean and population-safe intakes of 0.66 and 0.8 g/kg/day, respectively, of high-quality protein in adult humans are based on a meta-analysis of nitrogen balance studies using single linear regression analysis. We reanalyzed existing nitrogen balance studies using two-phase linear regression analysis and obtained mean and safe protein requirements of 0.91 and 0.99 g/kg/day, respectively. The two-phase linear regression analysis is considered more appropriate for biological analysis of dose-response curves. Considering the inherent problems associated with the nitrogen balance method, we developed an alternative method, the indicator amino acid oxidation technique, to determine protein requirements The mean and population-safe requirements in adult men were determined to be 0.93 and 1.2 g/kg/day and are 41 and 50%, respectively, higher than the current Dietary Reference Intakes recommendations. The indicator amino acid oxidation-based requirement values of 0.93 and 1.2 g protein/kg/day and the reanalysis of existing nitrogen balance studies are significantly higher than current recommendations. Therefore, there is an urgent need to reassess recommendations for protein intake in adult humans.

  12. Does I-131-MIBG underestimate skeletal disease burden in neuroblastoma?

    Directory of Open Access Journals (Sweden)

    Barai Sukanta


    Full Text Available Background: Controversy persists as to the need for both MIBG and bone scanning in routine evaluation of neuroblastoma. Aim: To compare the efficacy of I-131- metaiodobenzylguanidine (MIBG scan against that of conventional Tc99m- methylene diphosphonate (MDP bone scan for the detection of skeletal deposition of neuroblastoma. Methods and Material: The study included 57 patients (36 boys, 21 girls: age range 1-14 years of neuroblastoma who underwent both bone scan with Tc99m-MDP and I-131-MIBG scan within 15 days of each other at presentation and during follow-up. Results: At presentation 11(19.2% patients had evidence of skeletal metastases on MDP scan against 7 patients who showed bony secondaries on MIBG scan. Of the 7 patients, with positive MIBG and MDP scans, MDP scan detected 11 sites whereas MIBG scan detected 7 sites. On follow-up study, 3 patients with initial abnormal MDP scan but normal MIBG scan, developed skeletal metastases detectable on MIBG scan, whereas 3 of the 46 patients who had normal MDP and MIBG scan at presentation; developed skeletal metastases detectable on MDP scan. MIBG scan was concordant in 2 of them but was normal in the third patient. Conclusion: I-131-MIBG underestimates skeletal disease burden in neuroblastoma. Therefore, Tc99m-MDP bone scan should remain a part of routine assessment of patients with neuroblastoma.

  13. The underestimation of egocentric distance: evidence from frontal matching tasks (United States)

    Li, Zhi; Phillips, John


    There is controversy over the existence, nature, and cause of error in egocentric distance judgments. One proposal is that the systematic biases often found in explicit judgments of egocentric distance along the ground may be related to recently observed biases in the perceived declination of gaze (Durgin & Li, Attention, Perception, & Psychophysics, in press), To measure perceived egocentric distance nonverbally, observers in a field were asked to position themselves so that their distance from one of two experimenters was equal to the frontal distance between the experimenters. Observers placed themselves too far away, consistent with egocentric distance underestimation. A similar experiment was conducted with vertical frontal extents. Both experiments were replicated in panoramic virtual reality. Perceived egocentric distance was quantitatively consistent with angular bias in perceived gaze declination (1.5 gain). Finally, an exocentric distance-matching task was contrasted with a variant of the egocentric matching task. The egocentric matching data approximate a constant compression of perceived egocentric distance with a power function exponent of nearly 1; exocentric matches had an exponent of about 0.67. The divergent pattern between egocentric and exocentric matches suggests that they depend on different visual cues. PMID:21735313

  14. Congenital cytomegalovirus infection in Central Germany: an underestimated risk. (United States)

    Rütten, Hannah; Rissmann, Anke; Brett, Birgit; Costa, Serban-Dan; Doßow, Birgit; Färber, Jacqueline; Fest, Stefan; Fritzsch, Christiane; Lux, Anke; Päge, Ilona; Spillner, Claudia; Redlich, Anke


    This is the first study to determine the cytomegalovirus (CMV) seronegativity rate for women of childbearing age in Saxony-Anhalt and to determine the prevalence of clinically relevant congenital CMV (cCMV) infection in Central Germany, because there are no valid data available. The retrospective study was undertaken between January 2005 and December 2015. For the first time in Germany, the following seven data sources were used to analyze the prevalence of clinically relevant cCMV infection and the rate of CMV seronegative women of childbearing age: CMV Screening in maternity unit, University Women's Hospital, Social Paediatrics Centre (SPC), Malformation Monitoring Centre (MMC), Newborn Hearing Screening (NHS), Neonatal Intensive Care Unit (NICU), and In-house Doctor Department. Key parameters were anti-CMV IgG and IgM, CMV PCR of urine, and clinically relevant symptoms caused by CMV. Between 46 and 52% of women of childbearing age were CMV seronegative. The prevalence of clinically relevant cCMV infection was between 0.008 and 0.04%. The CMV seronegativity rate of women of childbearing age was confirmed to be in the middle range of estimated data from other sources in Germany. Data from the NICU, SPC, NHS, and MMC show the prevalence of clinically relevant cCMV infection. The risk of all cCMV infections is underestimated. Thus, the true prevalence of clinically relevant and subclinical cCMV infections is >0.04%.

  15. Did the Stern Review underestimate US and global climate damages?

    International Nuclear Information System (INIS)

    Ackerman, Frank; Stanton, Elizabeth A.; Hope, Chris; Alberth, Stephane


    The Stern Review received widespread attention for its innovative approach to the economics of climate change when it appeared in 2006, and generated controversies that have continued to this day. One key controversy concerns the magnitude of the expected impacts of climate change. Stern's estimates, based on results from the PAGE2002 model, sounded substantially greater than those produced by many other models, leading several critics to suggest that Stern had inflated his damage figures. We reached the opposite conclusion in a recent application of PAGE2002 in a study of the costs to the US economy of inaction on climate change. This article describes our revisions to the PAGE estimates, and explains our conclusion that the model runs used in the Stern Review may well underestimate US and global damages. Stern's estimates from PAGE2002 implied that mean business-as-usual damages in 2100 would represent just 0.4 percent of GDP for the United States and 2.2 percent of GDP for the world. Our revisions and reinterpretation of the PAGE model imply that climate damages in 2100 could reach 2.6 percent of GDP for the United States and 10.8 percent for the world.

  16. Midlatitude Summer Drying: An Underestimated Threat in CMIP5 Models? (United States)

    Douville, H.; Plazzotta, M.


    Early assessments of the hydrological impacts of global warming suggested both an intensification of the global water cycle and an expansion of dry areas. Yet these alarming conclusions were challenged by a number of latter studies emphasizing the lack of evidence in observations and historical simulations, as well as the large uncertainties in climate projections from the fifth phase of the Coupled Model Intercomparison Project (CMIP5). Here several aridity indices and a two-tier attribution strategy are used to demonstrate that a summer midlatitude drying has recently emerged over the northern continents, which is mainly attributable to anthropogenic climate change. This emerging signal is shown to be the harbinger of a long-term drying in the CMIP5 projections. Linear trends in the observed aridity indices can therefore be used as observational constraints and suggest that the projected midlatitude summer drying was underestimated by most CMIP5 models. Mitigating global warming therefore remains a priority to avoid dangerous impacts on global water and food security.

  17. Are We Underestimating Microplastic Contamination in Aquatic Environments? (United States)

    Conkle, Jeremy L.; Báez Del Valle, Christian D.; Turner, Jeffrey W.


    Plastic debris, specifically microplastic in the aquatic environment, is an escalating environmental crisis. Efforts at national scales to reduce or ban microplastics in personal care products are starting to pay off, but this will not affect those materials already in the environment or those that result from unregulated products and materials. To better inform future microplastic research and mitigation efforts this study (1) evaluates methods currently used to quantify microplastics in the environment and (2) characterizes the concentration and size distribution of microplastics in a variety of products. In this study, 50 published aquatic surveys were reviewed and they demonstrated that most ( 80%) only account for plastics ≥ 300 μm in diameter. In addition, we surveyed 770 personal care products to determine the occurrence, concentration and size distribution of polyethylene microbeads. Particle concentrations ranged from 1.9 to 71.9 mg g-1 of product or 1649 to 31,266 particles g-1 of product. The large majority ( > 95%) of particles in products surveyed were less than the 300 μm minimum diameter, indicating that previous environmental surveys could be underestimating microplastic contamination. To account for smaller particles as well as microfibers from synthetic textiles, we strongly recommend that future surveys consider methods that materials < 300 μm in diameter.

  18. Comparative Study of C-Arms for Intraoperative 3-dimensional Imaging and Navigation in Minimally Invasive Spine Surgery Part II: Radiation Exposure. (United States)

    Klingler, Jan-Helge; Sircar, Ronen; Scheiwe, Christian; Kogias, Evangelos; Krüger, Marie T; Scholz, Christoph; Hubbe, Ulrich


    A radiation exposure study in vitro. This study aimed to compare the radiation exposure of 2 different 3-dimensional (3D) C-arm devices on an anthropomorphic phantom. Minimally invasive pedicle screw placement requires intraoperative imaging techniques for visualization of the unexposed spine. Mobile 3D C-arms compose a 3D image data set out of multiple successive fluoroscopic images. We compared the 3D C-arm devices Siremobil Iso-C 3D (Siemens Sector Healthcare, Erlangen, Germany) and Vision FD Vario 3D (Ziehm Imaging, Nuremberg, Germany) regarding their radiation exposure. For this purpose, dosimeters were attached on an anthropomorphic phantom at various sites (eye lenses, thyroid gland, female, and male gonads). With each C-arm, 10 automated 3D scans as well as 400 fluoroscopic images were performed on the cervical and lumbar spine, respectively. The Vision FD Vario 3D generally causes higher radiation exposures than the Siremobil Iso-C 3D. Significantly higher radiation exposures were assessed at the eye lenses performing cervical (294.1 vs. 84.6 μSv) and lumbar 3D scans (22.5 vs. 11.2 μSv) as well as at the thyroid gland performing cervical 3D scans (4405.2 vs. 2761.9 μSv). Moreover, the Vision FD Vario 3D caused significantly higher radiation exposure at the eye lenses for standard cervical fluoroscopic images (3.2 vs. 0.4 μSv). 3D C-arms facilitate minimally invasive and accurate pedicle screw placement by providing 3D image datasets for intraoperative 3D imaging and navigation. However, the hereby potentially increased radiation exposure has to be considered. In particular, the Vision FD Vario 3D appears to generally evoke higher radiation exposures than the Siremobil Iso-C 3D. Well-indicated application of ionizing radiation and compliance with radiation protection principles remain mandatory to keep radiation exposure to patient and staff as low as reasonably achievable.

  19. Short-term results of microhook ab interno trabeculotomy, a novel minimally invasive glaucoma surgery in Japanese eyes: initial case series. (United States)

    Tanito, Masaki; Sano, Ichiya; Ikeda, Yoshifumi; Fujihara, Etsuko


    To report the first early postoperative results and safety profile after microhook ab interno trabeculotomy (μLOT). This initial retrospective observational case series included 24 consecutive glaucomatous eyes of 17 Japanese patients (7 men, 10 women; mean age ± standard deviation, 66.7 ± 17.9 years) who underwent μLOT. The trabeculotomy extent, surgical time, perioperative complications, interventions for complications and additional glaucoma surgeries during the follow-up for more than 3 months were collected by reviewing the medical and surgical records. The intraocular pressure (IOP), numbers of antiglaucoma medications, logarithm of the minimum angle of resolution visual acuity (VA), anterior chamber (AC) flare and corneal endothelial cell density (CECD) were compared preoperatively and postoperatively. The trabecular meshwork was incised for a mean of 3.6 ± 0.5 clock hours temporally, 3.7 ± 0.5 clock hours nasally and total 7.3 ± 0.6 clock hours during the 6.2 ± 1.6-min surgery. The mean preoperative IOP of 25.9 ± 14.3 mmHg and number of antiglaucoma medication of 3.3 ± 1.0 decreased significantly (p = 0.0002 and p = 0.005, respectively) to 14.7 ± 3.6 mmHg and 2.8 ± 0.8 at the final visit at 188.6 ± 68.8 days postoperatively. Compared with preoperatively, the final VA, AC flare and CECD did not change significantly. Hyphema with niveau formation (nine eyes, 38%) and washout of hyphema (two eyes, 8%) were the most common postoperative complication and intervention, respectively. At the final visit, 19 eyes (79%) achieved successful IOP control of 18 mmHg or less and a 15% reduction or greater. Microhook trabeculotomy normalizes the IOP during the early postoperative period in patients with glaucoma. © 2016 Acta Ophthalmologica Scandinavica Foundation. Published by John Wiley & Sons Ltd.

  20. Surgery for Acute Pancreatitis


    Navadgi, Suresh; Pandanaboyana, Sanjay; Windsor, John A.


    Surgery for acute pancreatitis has undergone significant changes over the last 3 decades. A better understanding of the pathophysiology has contributed to this, but the greatest driver for change has been the rise of less invasive interventions in the fields of laparoscopy, endoscopy and radiology. Surgery has a very limited role in the diagnosis of acute pancreatitis. The most common indication for intervention in acute pancreatitis is for the treatment of complications and most notably the ...

  1. Tundra water budget and implications of precipitation underestimation (United States)

    Liljedahl, Anna K.; Hinzman, Larry D.; Kane, Douglas L.; Oechel, Walter C.; Tweedie, Craig E.; Zona, Donatella


    Difficulties in obtaining accurate precipitation measurements have limited meaningful hydrologic assessment for over a century due to performance challenges of conventional snowfall and rainfall gauges in windy environments. Here, we compare snowfall observations and bias adjusted snowfall to end-of-winter snow accumulation measurements on the ground for 16 years (1999-2014) and assess the implication of precipitation underestimation on the water balance for a low-gradient tundra wetland near Utqiagvik (formerly Barrow), Alaska (2007-2009). In agreement with other studies, and not accounting for sublimation, conventional snowfall gauges captured 23-56% of end-of-winter snow accumulation. Once snowfall and rainfall are bias adjusted, long-term annual precipitation estimates more than double (from 123 to 274 mm), highlighting the risk of studies using conventional or unadjusted precipitation that dramatically under-represent water balance components. Applying conventional precipitation information to the water balance analysis produced consistent storage deficits (79 to 152 mm) that were all larger than the largest actual deficit (75 mm), which was observed in the unusually low rainfall summer of 2007. Year-to-year variability in adjusted rainfall (±33 mm) was larger than evapotranspiration (±13 mm). Measured interannual variability in partitioning of snow into runoff (29% in 2008 to 68% in 2009) in years with similar end-of-winter snow accumulation (180 and 164 mm, respectively) highlights the importance of the previous summer's rainfall (25 and 60 mm, respectively) on spring runoff production. Incorrect representation of precipitation can therefore have major implications for Arctic water budget descriptions that in turn can alter estimates of carbon and energy fluxes.


    Directory of Open Access Journals (Sweden)

    José Eustáquio de Sene


    Full Text Available ABSTRACT: This article will address the textbook as a specific cultural production of school disciplines having as reference the theoretical debate that opposed the conceptions of "didactic transposition" (CHEVALLARD, 1997 and "school culture" (CHERVEL, 1990. Based on this debate, characteristic of the curriculum field, this article aims to understand why, historically, the textbook has been underestimated and even considered a "less important work” within the limits of the academy (BITTENCOURT, 2004. The examples used will always be of the Geography discipline – both school and academic, as well as the relations between this two fields – having in mind their "multiplicity of paradigms" (LESTEGÁS, 2002. The analysis will also take into account the historic process of institutionalization of academic Geography based on "Layton’s stages" (GOODSON, 2005. RESUMO: Este artigo abordará o livro didático como uma produção cultural específica das disciplinas escolares tendo como referência o debate teórico que opõem as concepções de “transposição didática” (CHEVALLARD, 1997 e de “cultura escolar” (CHERVEL, 1990. Com base em tal debate, próprio do campo curricular, procurará compreender porque historicamente o livro didático tem sido pouco valorizado e até mesmo considerado uma “obra menor” nos limites da academia (BITTENCOURT, 2004. Os exemplos utilizados serão sempre da disciplina Geografia – tanto a escolar quanto a acadêmica, assim como das relações entre ambas – tendo em vista sua “multiplicidade de paradigmas” (LESTEGÁS, 2002. A análise também levará em conta o histórico processo de institucionalização da Geografia acadêmica com base nos “estágios de Layton” (GOODSON, 2005.

  3. Completeness of revascularization and its impact on the outcomes of a staged approach of percutaneous coronary intervention followed by minimally invasive valve surgery for patients with concomitant coronary artery and valvular heart disease. (United States)

    Pineda, Andrés M; Chandra, Ramesh; Gowani, Saqib A; Santana, Orlando; Mihos, Christos G; Kirtane, Ajay J; Stone, Gregg W; Kurlansky, Paul; Smith, Craig R; Beohar, Nirat


    A staged approach of percutaneous coronary intervention (PCI) followed by minimally invasive valve surgery (MIVS) is an alternative to the conventional combined coronary artery bypass and valve surgery for patients with concomitant coronary artery and valve disease. Limited data exist on degree of the completeness of revascularization achieved with this approach and its impact on outcomes. A total of 138 patients, who underwent a staged approach between January 2009 and June 2013, were retrospectively evaluated. Coronary angiograms were reviewed by two cardiologists blinded to outcomes and were then categorized into two groups: complete or incomplete revascularization, which was defined as ≥1 major epicardial coronary arteries of at least 2.0 mm diameter with ≥70% untreated obstruction after the index PCI and before MIVS. Complete and incomplete revascularization was achieved in 105 (76%) and 33 (24%) patients, respectively. The patients with incomplete revascularization had a lower ejection fraction, a higher STS score, and more prior myocardial infarctions and multi-vessel coronary artery disease. There were no differences in the post-operative complications, 30-day mortality, or 3-year survival (84 vs. 83%, P = 0.68). After a median follow-up of 29 months, incompletely revascularized patients had a higher incidence of acute coronary syndrome (2.9 vs. 12.9%, P = 0.05). In patients undergoing a staged approach of PCI followed by MIVS, incomplete revascularization did not significantly impact the short or mid-term survival, but was associated with an increased incidence of acute coronary syndrome at follow-up. © 2015 Wiley Periodicals, Inc. © 2015 Wiley Periodicals, Inc.

  4. Comparative study on three surgical techniques for intra-articular calcaneal fractures: open reduction with internal fixation using a plate, external fixation and minimally invasive surgery

    Directory of Open Access Journals (Sweden)

    Missa Takasaka


    Full Text Available ABSTRACT OBJECTIVE: To evaluate, compare and identify the surgical technique with best results for treating intra-articular calcaneal fractures, taking into account postoperative outcomes, complications and scoring in the Aofas questionnaire. METHODS: This was a retrospective study on 54 patients with fractures of the calcaneus who underwent surgery between 2002 and 2012 by means of the following techniques: (1 open reduction with extended L-shaped lateral incision and fixation with double-H plate of 3.5 mm; (2 open reduction with minimal incision lateral approach and percutaneous fixation with wires and screws; and (3 open reduction with minimal incision lateral approach and fixation with adjustable monoplanar external fixator. RESULTS: Patients treated using a lateral approach, with fixation using a plate had a mean Aofas score of 76 points; those treated through a minimal incision lateral approach with screw and wire fixation had a mean score of 71 points; and those treated through a minimal incision lateral approach with an external fixator had a mean score of 75 points. The three surgical techniques were shown to be effective for treating intra-articular calcaneal fractures, without any evidence that any of the techniques being superior. CONCLUSION: Intra-articular calcaneal fractures are complex and their treatment should be individualized based on patient characteristics, type of fracture and the surgeon's experience with the surgical technique chosen.

  5. Invasive thymoma: CT diagnosis and evaluation

    International Nuclear Information System (INIS)

    Sun Zhonghua; Yu Hong; Liu Hengshun; Yan Hongzhen; Zhang Shurong


    Purpose: To study the CT manifestation of invasive thymoma for staging and treatment planning. Materials and methods: The authors reviewed and analyzed the CT scans of 26 patients with invasive thymoma confirmed by surgery and pathology with emphasis on lesion density, invasion of adjacent mediastinal structures, pleural seeding mediastinal nodes and extra-mediastinal metastases. Results: In 26 cases of invasive thymoma, all CT scans demonstrated the soft tissue mass in anterior mediastinum, with heterogeneous density in 16 patients. Irregular invasion to adjacent organs was found in 24 patients. The main findings were mediastinal pleura invasion in 7, lung invasion 9, pleural implants 3, cardiovascular involvement in 20, and cardiophrenic and abdominal invasion in 3. CT is especially effective in detecting the involvement of pleura, pericardium and lung. Conclusion: Computed tomography provides the most reliable assessment of the extent of the disease. Conventional CT scan allows accurate staging and treatment planning

  6. Panoramic radiographs underestimate extensions of the anterior loop and mandibular incisive canal

    Energy Technology Data Exchange (ETDEWEB)

    De Brito, Ana Caroline Ramos; Nejaim, Yuri; De Freitas, Deborah Queiroz [Dept. of Oral Diagnosis, Division of Oral Radiology, Piracicaba Dental School, University of Campinas, Sao Paulo (Brazil); De Oliveira Santos, Christiano [Dept. of Stomatology, Public Oral Health and Forensic Dentistry, School of Dentistry of Ribeirao Preto, University of Sao Paulo, Sao Paulo (Brazil)


    The purpose of this study was to detect the anterior loop of the mental nerve and the mandibular incisive canal in panoramic radiographs (PAN) and cone-beam computed tomography (CBCT) images, as well as to determine the anterior/mesial extension of these structures in panoramic and cross-sectional reconstructions using PAN and CBCT images. Images (both PAN and CBCT) from 90 patients were evaluated by 2 independent observers. Detection of the anterior loop and the incisive canal were compared between PAN and CBCT. The anterior/mesial extension of these structures was compared between PAN and both cross-sectional and panoramic CBCT reconstructions. In CBCT, the anterior loop and the incisive canal were observed in 7.7% and 24.4% of the hemimandibles, respectively. In PAN, the anterior loop and the incisive canal were detected in 15% and 5.5% of cases, respectively. PAN presented more difficulties in the visualization of structures. The anterior/mesial extensions ranged from 0.0 mm to 19.0 mm on CBCT. PAN underestimated the measurements by approximately 2.0 mm. CBCT appears to be a more reliable imaging modality than PAN for preoperative workups of the anterior mandible. Individual variations in the anterior/mesial extensions of the anterior loop of the mental nerve and the mandibular incisive canal mean that is not prudent to rely on a general safe zone for implant placement or bone surgery in the interforaminal region.

  7. Capnocytophaga canimorsus - An underestimated cause of periprosthetic joint infection? (United States)

    Orth, Marcel; Orth, Patrick; Anagnostakos, Konstantinos


    Periprosthetic joint infection (PJI) is a major clinical problem in orthopedic surgery. Capnocytophaga canimorsus (C. canimorsus) is an unusual and hardly detectable bacterium. A review of the literature indicates that C. canimorsus affects mainly immunocompromised patients. It has not been reported to cause periprosthetic joint infections in immunocompetent patients so far. This case report aims to raise awareness of C. canimorsus in orthopedic surgery with special regard to joint arthroplasty. We report a case of a 54-year-old immunocompetent patient with a late infection after total knee arthroplasty caused by C. canimorsus. The patient underwent two-stage revision with prosthesis explantation, implantation of an antibiotic-impregnated static spacer, intravenous antimicrobial therapy for four weeks with cefuroxime followed by oral antimicrobial therapy with ciprofloxacin for further two weeks and secondary revision total knee arthroplasty. In the present case, we could demonstrate that adequate treatment of C. canimorsus was capable to successfully treat periprosthetic joint infection caused by C. canimorsus in an immunocompetent patient. We feel that C. canimorsus has to be taken into account as a potential pathogen causing periprosthetic joint infection - regardless of the immunological status of the patient and especially when the detection of a pathogen does not succeed. Copyright © 2017 Elsevier B.V. All rights reserved.

  8. Cosmetic Surgery (United States)

    ... Body Looking and feeling your best Cosmetic surgery Cosmetic surgery Teens might have cosmetic surgery for a number ... about my body? What are the risks of cosmetic surgery? top People who have cosmetic surgery face many ...

  9. The role of recalibration response shift in explaining bodily pain in cancer patients undergoing invasive surgery: an empirical investigation of the Sprangers and Schwartz model. (United States)

    Visser, Mechteld R M; Oort, Frans J; van Lanschot, J Jan B; van der Velden, Jacobus; Kloek, Jaap J; Gouma, Dirk J; Schwartz, Carolyn E; Sprangers, Mirjam A G


    This study aims to explain bodily pain using the Sprangers and Schwartz theoretical model (1999) on quality of life (QL) and response shift in its entirety. Response shift refers to the phenomenon that the meaning of a person's self-evaluation changes over time. In this model, response shift mediates effects of changes in health status (catalysts), stable characteristics of the person (antecedents), and coping mechanisms (mechanisms) on QL. Cancer patients (202) were assessed prior to and 3 months following surgery. Measures were for catalysts: type of operation and possibility of tumor resection; for antecedents: age, duration of pain, optimism, and rigidity; for mechanisms: post-traumatic growth, social comparisons, social support, denial, and acceptance; and for QL: bodily pain; for response shift: the pretest-minus-thentest bodily pain score, further referred to as recalibration response shift. Structural equation modeling and sequential regression analyses were used. The final model reached close fit (RMSEA = 0.03; 90% CI = 0.000-0.071; χ2 (18) = 21.13; p = 0.27). Significant effects were found for catalysts on mechanisms, antecedents on mechanisms, mechanisms on response shift, and response shift on bodily pain. Four extra model effects had to be permitted. Using sequential regression analysis, recalibration response shift added 4.4% to the total amount of 29.8% explained variance of bodily pain. Many effects as hypothesized by the model were found. Recalibration response shift had a unique albeit small contribution to the explanation of bodily pain. Copyright © 2012 John Wiley & Sons, Ltd.

  10. Associated lumbar scoliosis does not affect outcomes in patients undergoing focal minimally invasive surgery-transforaminal lumbar interbody fusion (MISTLIF) for neurogenic symptoms-a minimum 2-year follow-up study. (United States)

    Tay, Kae Sian; Bassi, Anupreet; Yeo, William; Yue, Wai Mun


    There is no current literature comparing outcomes of patients with and without lumbar scoliosis having neurologic symptoms undergoing minimally invasive surgery-transforaminal lumbar interbody fusion (MISTLIF) technique. This study aimed to determine whether associated lumbar scoliosis will result in different clinical, radiological, and operative outcomes in patients undergoing focal MISTLIF for neurogenic symptoms, without specific correction of the scoliosis. A retrospective case comparison study from prospectively collected hospital registry data was carried out. Two hundred and thirty eligible patients were evaluated and divided into two groups: Scoliosis Group (SG; n=57) with Cobb angle >10 degrees on anterioposterior (AP) plain lumbar spine radiographs and Non-Scoliosis Group (NSG; n=173) consisting of the remaining patients. Clinical outcomes were assessed using the Oswestry Disability Index, the North American Spine Society (NASS) Neurogenic Symptom Score, the NASS Satisfaction with Surgery Rating, the 36-Item Short-Form Health Survey (SF-36), and the Numerical Pain Rating Scale for back and leg pain. Radiological findings included Cobb angle, fusion, implant failure or loosening, and adjacent segment degeneration (ASD). Both groups were compared for demographics, perioperative parameters, complications, clinical, and radiological outcomes. Interobserver agreement (kappa statistics) for measurement of Cobb angle was calculated on all cases of both groups by two authors. Patients were evaluated preoperatively, at 6 months, and 2 years after surgery. The average follow-up was 2.88±1.47 years in the SG and 2.71±1.34 years in the NSG (p=.444). Differences in mean age (SG: 62.9±10.9 years and NSG: 57.6±13.1 years), estimated related risk of death (SG: 3.05±2.13 and NSG: 2.41±1.74), and gender (female=SG: 87.7% and NSG: 64.2%) were statistically significant (p.05). Preoperative and postoperative clinical outcomes were similar in both groups (p>.05) except

  11. The valve of CT in diagnosing the invasive and non-invasive thymoma

    International Nuclear Information System (INIS)

    Tang Wenyan; Jiang Kuiming; Song Ting; Lin Wenjian; Chen Zhanhang


    Objective: To Study CT features of thymoma and its value in differentiating the invasive from non-invasive thymoma. Methods: CT findings of 17 cases with thymoma (11 non-invasive and 6 invasive) confirmed by surgery and pathology were analyzed retrospectively. Results: 11 cases were non-invasive thymoma. On CT, the tumors were round or oval in 6 cases, lobulate in 4 cases, and irregular in 1 case. The lesions showed homogeneous density and mild enhancement in 9 cases. 10 of them showed complete capsules without invasion. The mass-cardiovascular interface was: convex type in 5 cases, flat type in 3 cases and concave type in 2 cases. 6 cases were invasive thymoma, tumors were irregular and heterogeneous in 5 cases. Significant and inhomogeneous enhancement on post contrast CT was found. Conclusion: The CT features of thymoma was specific, and CT is of great value in differentiating the invasive from non-invasive thymoma. (authors)

  12. What Pacific tsunamis tell us about underestimating hazard and risk (United States)

    Goff, J. R.


    occurred in prehistory than have occurred in historic time. Larger events have occurred in prehistory than have been modelled in any probabilistic tsunami hazard assessment. This talk presents work that draws together much of the geological, TEK and archaeological evidence for such events and makes one key point - palaeotsunamis have had significant impact upon prehistoric coastal settlements and culture. We are currently underestimating the hazard and this does little to help in our assessment of the risk.

  13. Robotic Surgery by G Watanabe

    African Journals Online (AJOL)

    Arun Kumar Agnihotri

    Robotic Surgery is the next big innovation after Minimally Invasive. Surgery. Emerging within a generation of each other, the two have synergized to show the way to the future, where soft advantages like patient comfort and convenience and surgeon ergonomics meld seamlessly with hard considerations like safety,.

  14. Single port laparoscopic surgery

    DEFF Research Database (Denmark)

    Springborg, Henrik; Istre, Olav


    potential benefits. Theoretically, cosmetic outcomes, postoperative pain and complication rates could be improved with use of single site surgery. This study describes introduction of the method in a private hospital in Denmark, in which 40 patients have been treated for benign gynecologic conditions......LESS, or laparo-endoscopic single site surgery, is a promising new method in minimally invasive surgery. An increasing number of surgical procedures are being performed using this technique, however, its large-scale adoption awaits results of prospective randomized controlled studies confirming...

  15. Novel prototype sewing device, EndoSew®, for minimally invasive surgery: an extracorporeal ileal conduit construction pilot study in 10 patients. (United States)

    Roth, Beat; Birkhäuser, Frédéric D; Thalmann, George N; Zehnder, Pascal


    WHAT'S KNOWN ON THE SUBJECT? AND WHAT DOES THE STUDY ADD?: The EndoSew(®) prototype was first tested in a porcine model several years ago. The investigators found it both simple to master and reliable, its greatest advantage being a 2.4-fold time saving compared with straight laparoscopic suturing. In addition to that publication, there is a single case report describing the performance of an open EndoSew(®) suture to close parts (16 cm) of an ileal neobladder. The time for suturing the 16 cm ileum was 25 min, which is in line with our experience. The knowledge on this subject is limited to these two publications. We report on the first consecutive series of ileal conduits performed in humans using the novel prototype sewing device EndoSew(®). The study shows that the beginning and the end of the suture process represent the critical procedural steps. It also shows that, overall, the prototype sewing machine has the potential to facilitate the intracorporeal suturing required in reconstructive urology for construction of urinary diversions. To evaluate the feasibility and safety of the novel prototype sewing device EndoSew(®) in placing an extracorporeal resorbable running suture for ileal conduits. We conducted a prospective single-centre pilot study of 10 consecutive patients undergoing ileal conduit, in whom the proximal end of the ileal conduit was closed extracorporeally using an EndoSew(®) running suture. The primary endpoint was the safety of the device and the feasibility of the sewing procedure which was defined as a complete watertight running suture line accomplished by EndoSew(®) only. Watertightness was assessed using methylene blue intraoperatively and by loopography on postoperative days 7 and 14. Secondary endpoints were the time requirements and complications ≤30 days after surgery. A complete EndoSew(®) running suture was feasible in nine patients; the suture had to be abandoned in one patient because of mechanical failure. In three

  16. Robot-assisted surgery for gastric cancer (United States)

    Procopiuc, Livia; Tudor, Ştefan; Mănuc, Mircea; Diculescu, Mircea; Vasilescu, Cătălin


    Minimally invasive surgery for gastric cancer is a relatively new research field, with convincing results mostly stemming from Asian countries. The use of the robotic surgery platform, thus far assessed as a safe procedure, which is also easier to learn, sets the background for a wider spread of minimally invasive technique in the treatment of gastric cancer. This review will cover the literature published so far, analyzing the pros and cons of robotic surgery and highlighting the remaining study questions. PMID:26798433

  17. X-ray computed microtomography characterizes the wound effect that causes sap flow underestimation by thermal dissipation sensors. (United States)

    Marañón-Jiménez, S; Van den Bulcke, J; Piayda, A; Van Acker, J; Cuntz, M; Rebmann, C; Steppe, K


    Insertion of thermal dissipation (TD) sap flow sensors in living tree stems causes damage of the wood tissue, as is the case with other invasive methods. The subsequent wound formation is one of the main causes of underestimation of tree water-use measured by TD sensors. However, the specific alterations in wood anatomy in response to inserted sensors have not yet been characterized, and the linked dysfunctions in xylem conductance and sensor accuracy are still unknown. In this study, we investigate the anatomical mechanisms prompting sap flow underestimation and the dynamic process of wound formation. Successive sets of TD sensors were installed in the early, mid and end stage of the growing season in diffuse- and ring-porous trees, Fagus sylvatica (Linnaeus) and Quercus petraea ((Mattuschka) Lieblein), respectively. The trees were cut in autumn and additional sensors were installed in the cut stem segments as controls without wound formation. The wounded area and volume surrounding each sensor was then visually determined by X-ray computed microtomography (X-ray microCT). This technique allowed the characterization of vessel anatomical transformations such as tyloses formation, their spatial distribution and quantification of reduction in conductive area. MicroCT scans showed considerable formation of tyloses that reduced the conductive area of vessels surrounding the inserted TD probes, thus causing an underestimation in sap flux density (SFD) in both beech and oak. Discolored wood tissue was ellipsoidal, larger in the radial plane, more extensive in beech than in oak, and also for sensors installed for longer times. However, the severity of anatomical transformations did not always follow this pattern. Increased wound size with time, for example, did not result in larger SFD underestimation. This information helps us to better understand the mechanisms involved in wound effects with TD sensors and allows the provision of practical recommendations to reduce

  18. Maze Surgery (United States)

    ... Center > Maze Surgery Menu Topics Topics FAQs Maze Surgery Article Info En español Electrical impulses in your ... called an arrhythmia. Why do I need Maze surgery? Maze surgery is also called the Maze procedure. ...

  19. Uncharismatic Invasives

    Directory of Open Access Journals (Sweden)

    Clark, Jonathan L.


    Full Text Available Although philosophers have examined the ethics of invasive species management, there has been little research approaching this topic from a descriptive, ethnographic perspective. In this article I examine how invasive species managers think about the moral status of the animals they seek to manage. I do so through a case study of Oregon’s efforts to manage the invasive species that are rafting across the Pacific attached to tsunami debris in the wake of the Japanese tsunami of 2011. Focusing on the state’s response to a dock that washed ashore on Agate Beach with various marine invertebrates attached to it, I argue that these animals’ position on two intersecting scales of moral worth—the sociozoologic scale and the phylogenetic scale—rendered them unworthy of moral consideration.

  20. Citation analysis may severely underestimate the impact of clinical research as compared to basic research. (United States)

    van Eck, Nees Jan; Waltman, Ludo; van Raan, Anthony F J; Klautz, Robert J M; Peul, Wilco C


    Citation analysis has become an important tool for research performance assessment in the medical sciences. However, different areas of medical research may have considerably different citation practices, even within the same medical field. Because of this, it is unclear to what extent citation-based bibliometric indicators allow for valid comparisons between research units active in different areas of medical research. A visualization methodology is introduced that reveals differences in citation practices between medical research areas. The methodology extracts terms from the titles and abstracts of a large collection of publications and uses these terms to visualize the structure of a medical field and to indicate how research areas within this field differ from each other in their average citation impact. Visualizations are provided for 32 medical fields, defined based on journal subject categories in the Web of Science database. The analysis focuses on three fields: Cardiac & cardiovascular systems, Clinical neurology, and Surgery. In each of these fields, there turn out to be large differences in citation practices between research areas. Low-impact research areas tend to focus on clinical intervention research, while high-impact research areas are often more oriented on basic and diagnostic research. Popular bibliometric indicators, such as the h-index and the impact factor, do not correct for differences in citation practices between medical fields. These indicators therefore cannot be used to make accurate between-field comparisons. More sophisticated bibliometric indicators do correct for field differences but still fail to take into account within-field heterogeneity in citation practices. As a consequence, the citation impact of clinical intervention research may be substantially underestimated in comparison with basic and diagnostic research.

  1. The versatility of median sternotomy in general paediatric surgery ...

    African Journals Online (AJOL)

    Background. While common in cardiac surgery, median sternotomy (MS) is rarely required in general paediatric surgery. In the era of advancing endoscopic techniques, sternotomy is perceived as an extremely invasive incision, associated with prolonged postoperative recovery and significant morbidity. Methods.

  2. Radiofrequency Physics for Minimally Invasive Aesthetic Surgery. (United States)

    Levy, Adam S; Grant, Robert T; Rothaus, Kenneth O


    Radiofrequency energy has a wide range of medical applications, including noninvasive treatment of wrinkles and body contouring. This technology works by differential heating of skin and soft tissue layers causing dermal remodeling or adipolysis, ultimately leading to observable effects. This article reviews the physics of radiofrequency as applied clinically. Copyright © 2016 Elsevier Inc. All rights reserved.

  3. Surgeons' musculoskeletal pain in minimally invasive surgery

    DEFF Research Database (Denmark)

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

    on the existing literature on musculoskeletal pain in surgeons. Methods: A systematic literature search was employed. In total, 1.849 titles were scrutinized and 24 articles were found relevant. Due to the diversity of data, a narrative synthesis method was applied. Results: The prevalence of musculoskeletal pain...... 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....

  4. Robotics in Colorectal Surgery. (United States)

    Weaver, Allison; Steele, Scott


    Over the past few decades, robotic surgery has developed from a futuristic dream to a real, widely used technology. Today, robotic platforms are used for a range of procedures and have added a new facet to the development and implementation of minimally invasive surgeries. The potential advantages are enormous, but the current progress is impeded by high costs and limited technology. However, recent advances in haptic feedback systems and single-port surgical techniques demonstrate a clear role for robotics and are likely to improve surgical outcomes. Although robotic surgeries have become the gold standard for a number of procedures, the research in colorectal surgery is not definitive and more work needs to be done to prove its safety and efficacy to both surgeons and patients.

  5. The Perception of Time Is Underestimated in Adolescents With Anorexia Nervosa

    Directory of Open Access Journals (Sweden)

    Carmelo M. Vicario


    Full Text Available Research has revealed reduced temporal discounting (i.e., increased capacity to delay reward and altered interoceptive awareness in anorexia nervosa (AN. In line with the research linking temporal underestimation with a reduced tendency to devalue a reward and reduced interoceptive awareness, we tested the hypothesis that time duration might be underestimated in AN. Our findings revealed that patients with AN displayed lower timing accuracy in the form of timing underestimation compared with controls. These results were not predicted by clinical, demographic factors, attention, and working memory performance of the participants. The evidence of a temporal underestimation bias in AN might be clinically relevant to explain their abnormal motivation in pursuing a long-term restrictive diet, in line with the evidence that increasing the subjective temporal proximity of remote future goals can boost motivation and the actual behavior to reach them.

  6. Stress Underestimation and Mental Health Outcomes in Male Japanese Workers: a 1-Year Prospective Study. (United States)

    Izawa, Shuhei; Nakamura-Taira, Nanako; Yamada, Kosuke Chris


    Being appropriately aware of the extent of stress experienced in daily life is essential in motivating stress management behaviours. Excessive stress underestimation obstructs this process, which is expected to exert adverse effects on health. We prospectively examined associations between stress underestimation and mental health outcomes in Japanese workers. Web-based surveys were conducted twice with an interval of 1 year on 2359 Japanese male workers. Participants were asked to complete survey items concerning stress underestimation, depressive symptoms, sickness absence, and antidepressant use. Multiple logistic regression analysis revealed that high baseline levels of 'overgeneralization of stress' and 'insensitivity to stress' were significantly associated with new-onset depressive symptoms (OR = 2.66 [95 % CI, 1.54-4.59], p stress underestimation, including stress insensitivity and the overgeneralization of stress, could exert adverse effects on mental health.

  7. Standing equine dental surgery. (United States)

    Menzies, Robert A; Easley, Jack


    Dental surgeries refer to procedures that affect the dental tissues or their supporting structures. With the development of specific, efficacious, and conservative treatments, morbidity risks have been lowered and chances of benefiting the health of equids improved. Advances in quality of sedation, analgesia, and locoregional anesthesia allow a majority of dental surgeries to be performed in the standing patient. This update focuses on an orthograde endodontic technique, a minimally invasive buccotomy technique, with the potential to combine it with a transbuccal screw extraction technique, and revisits the AO pinless external fixator for fractures of the body of the mandible. Copyright © 2014 Elsevier Inc. All rights reserved.

  8. Stress underestimation and mental health literacy of depression in Japanese workers: A cross-sectional study. (United States)

    Nakamura-Taira, Nanako; Izawa, Shuhei; Yamada, Kosuke Chris


    Appropriately estimating stress levels in daily life is important for motivating people to undertake stress-management behaviors or seek out information on stress management and mental health. People who exhibit high stress underestimation might not be interested in information on mental health, and would therefore have less knowledge of it. We investigated the association between stress underestimation tendency and mental health literacy of depression (i.e., knowledge of the recognition, prognosis, and usefulness of resources of depression) in Japanese workers. We cross-sectionally surveyed 3718 Japanese workers using a web-based questionnaire on stress underestimation, mental health literacy of depression (vignettes on people with depression), and covariates (age, education, depressive symptoms, income, and worksite size). After adjusting for covariates, high stress underestimation was associated with greater odds of not recognizing depression (i.e., choosing anything other than depression). Furthermore, these individuals had greater odds of expecting the case to improve without treatment and not selecting useful sources of support (e.g. talk over with friends/family, see a psychiatrist, take medication, see a counselor) compared to those with moderate stress underestimation. These relationships were all stronger among males than among females. Stress underestimation was related to poorer mental health literacy of depression. Copyright © 2018 Elsevier B.V. All rights reserved.

  9. Non-invasive extending prosthesis


    Meswania, Jayantilal Mohanlal


    Most sarcomas of the bone occur in patients of a relatively young age including skeletally immature patients. Approximately 50 child sarcomas are treated with limb salvage surgery per year in the United Kingdom. These children need an extendible implant that can be lengthened periodically to keep pace with the growth in the opposite limb. Surgically, invasive devices have been used for the past thirty years with intrinsic problems of infection and long-term recurrent trauma to the patient. To...

  10. Turbinate surgery (United States)

    Turbinectomy; Turbinoplasty; Turbinate reduction; Nasal airway surgery; Nasal obstruction - turbinate surgery ... There are several types of turbinate surgery: Turbinectomy: All or ... This can be done in several different ways, but sometimes a ...

  11. Nanotechnology in Thoracic Surgery* (United States)

    Schulz, Morgan D.; Khullar, Onkar; Frangioni, John V.; Grinstaff, Mark W.; Colson, Yolonda L.


    Nanotechnology is an exciting and rapidly progressive field offering potential solutions to multiple challenges in the diagnosis and treatment of lung cancer, with the potential for improving imaging and mapping techniques, drug delivery and ablative therapy. With promising preclinical results in many applications directly applicable to thoracic oncology, it is possible that the frontiers of minimally invasive thoracic surgery will eventually be explored on a nanoscale. PMID:20494008

  12. Application of Gelatin Sponge Impregnated with a Mixture of 3 Drugs to Intraoperative Nerve Root Block Combined with Robot-Assisted Minimally Invasive Transforaminal Lumbar Interbody Fusion Surgery in the Treatment of Adult Degenerative Scoliosis: A Clinical Observation Including 96 Patients. (United States)

    Du, Jin Peng; Fan, Yong; Liu, Ji Jun; Zhang, Jia Nan; Chang Liu, Shi; Hao, Dingjun


    Application of nerve root block is mainly for diagnosis with less application in intraoperative treatment. The aim of this study was to observe clinical and imaging outcomes of application of gelatin sponge impregnated with a mixture of 3 drugs to intraoperative nerve root block combined with robot-assisted minimally invasive transforaminal lumbar interbody fusion surgery in to treat adult degenerative lumbar scoliosis. From January 2012 to November 2014, 108 patients with adult degenerative lumbar scoliosis were treated with robot-assisted minimally invasive transforaminal lumbar interbody fusion surgery combined with intraoperative gelatin sponge impregnated with a mixture of 3 drugs. Visual analog scale and Oswestry Disability Index scores were used to evaluate postoperative improvement of back and leg pain, and clinical effects were assessed according to the 36-Item Short-Form Health Survey. Imaging was obtained preoperatively, 1 week and 3 months postoperatively, and at the last follow-up. Fusion status, complications, and other outcomes were assessed. Follow-up was complete for 96 patients. Visual analog scale scores of leg and back pain on postoperative days 1-7 were decreased compared with preoperatively. At 1 week postoperatively, 3 months postoperatively, and last follow-up, visual analog scale score, Oswestry Disability Index score, coronal Cobb angle, and coronal and sagittal deviated distance decreased significantly (P = 0.000) and lumbar lordosis angle increased (P = 0.000) compared with preoperatively. Improvement rate of Oswestry Disability Index was 81.8% ± 7.4. Fusion rate between vertebral bodies was 92.7%. Application of gelatin sponge impregnated with 3 drugs combined with robot-assisted minimally invasive transforaminal lumbar interbody fusion for treatment of adult degenerative lumbar scoliosis is safe and feasible with advantages of good short-term analgesia effect, minimal invasiveness, short length of stay, and good long-term clinical

  13. Laparoscopic revolution in bariatric surgery


    Sundbom, Magnus


    The history of bariatric surgery is investigational. Dedicated surgeons have continuously sought for an ideal procedure to relieve morbidly obese patients from their burden of comorbid conditions, reduced life expectancy and low quality of life. The ideal procedure must have low complication risk, both in short- and long term, as well as minimal impact on daily life. The revolution of laparoscopic techniques in bariatric surgery is described in this summary. Advances in minimal invasive techn...

  14. Robotic Surgery for Oropharyngeal Cancer

    Directory of Open Access Journals (Sweden)

    Shivani Shah


    Full Text Available Oropharyngeal cancer represents a growing proportion of head and neck malignancies. This has been associated with the increase in infection of the oropharynx by oncogenic strains of human papillomavirus (HPV. Transoral robotic surgery (TORS has opened the door for minimally invasive surgery for HPV-related and non-HPV-related oropharyngeal cancer. Compared to traditional open surgical approaches, TORS has been shown to improve functional outcomes in speech and swallowing, while maintaining good oncologic outcomes.

  15. Controversies in Facial Cosmetic Surgery. (United States)

    Retana, Armando


    Facial cosmetic surgery techniques are constantly updated to meet the expectations of patients who demand less invasive procedures and less recovery time. Current trends in lower eyelid surgery call for periorbital fat repositioning instead of excision of fat. Controversies still exist in chin augmentations regarding osseous genioplasty versus alloplastic chin implant. The benefits, disadvantages, and considerations of these procedures are discussed. Copyright © 2017 Elsevier Inc. All rights reserved.

  16. Academic self-concept, learning motivation, and test anxiety of the underestimated student. (United States)

    Urhahne, Detlef; Chao, Sheng-Han; Florineth, Maria Luise; Luttenberger, Silke; Paechter, Manuela


    BACKGROUND. Teachers' judgments of student performance on a standardized achievement test often result in an overestimation of students' abilities. In the majority of cases, a larger group of overestimated students and a smaller group of underestimated students are formed by these judgments. AIMS. In this research study, the consequences of the underestimation of students' mathematical performance potential were examined. SAMPLE. Two hundred and thirty-five fourth grade students and their fourteen mathematics teachers took part in the investigation. METHOD. Students worked on a standardized mathematics achievement test and completed a self-description questionnaire about motivation and affect. Teachers estimated each individual student's potential with regard to mathematics test performance as well as students' expectancy for success, level of aspiration, academic self-concept, learning motivation, and test anxiety. The differences between teachers' judgments on students' test performance and students' actual performance were used to build groups of underestimated and overestimated students. RESULTS. Underestimated students displayed equal levels of test performance, learning motivation, and level of aspiration in comparison with overestimated students, but had lower expectancy for success, lower academic self-concept, and experienced more test anxiety. Teachers expected that underestimated students would receive lower grades on the next mathematics test, believed that students were satisfied with lower grades, and assumed that the students have weaker learning motivation than their overestimated classmates. CONCLUSION. Teachers' judgment error was not confined to test performance but generalized to motivational and affective traits of the students. © 2010 The British Psychological Society.

  17. Anesthesia for minimally invasive neurosurgery. (United States)

    Prabhakar, Hemanshu; Mahajan, Charu; Kapoor, Indu


    With an ultimate aim of improving patients overall outcome and satisfaction, minimally invasive surgical approach is becoming more of a norm. The related anesthetic evidence has not expanded at the same rate as surgical and technological advancement. This article reviews the recent evidence on anesthesia and perioperative concerns for patients undergoing minimally invasive neurosurgery. Minimally invasive cranial and spinal surgeries have been made possible only by vast technological development. Points of surgical interest can be precisely located with the help of stereotaxy and neuronavigation and special endoscopes which decrease the tissue trauma. The principles of neuroanethesia remain the same, but few concerns are specific for each technique. Dexmedetomidine has a favorable profile for procedures carried out under sedation technique. As the new surgical techniques are coming up, lesser known anesthetic concerns may also come into light. Over the last year, little new information has been added to existing literature regarding anesthesia for minimally invasive neurosurgeries. Neuroanesthesia goals remain the same and less invasive surgical techniques do not translate into safe anesthesia. Specific concerns for each procedure should be taken into consideration.

  18. Minimally invasive versus open pancreatic enucleation. Systematic review and meta-analysis of surgical outcomes. (United States)

    Guerra, Francesco; Giuliani, Giuseppe; Bencini, Lapo; Bianchi, Paolo P; Coratti, Andrea


    Parenchymal sparing procedures are gaining interest in pancreatic surgery and recent studies have reported that minimally invasive pancreatic enucleation may be associated with enhanced outcomes when compared with traditional surgery. By meta-analyzing the available data from the literature, minimally invasive surgery is not at higher risk of pancreatic fistula and offers a number of advantages over conventional surgery for pancreatic enucleation. © 2018 Wiley Periodicals, Inc.

  19. Misery Has More Company Than People Think: Underestimating the Prevalence of Others’ Negative Emotions (United States)

    Jordan, Alexander H.; Monin, Benoît; Dweck, Carol S.; Lovett, Benjamin J.; John, Oliver P.; Gross, James J.


    Four studies document underestimations of the prevalence of others’ negative emotions, and suggest causes and correlates of these erroneous perceptions. In Study 1A, participants reported that their negative emotions were more private or hidden than their positive emotions; in Study 1B, participants underestimated the peer prevalence of common negative, but not positive, experiences described in Study 1A. In Study 2, people underestimated negative emotions and overestimated positive emotions even for well-known peers, and this effect was partially mediated by the degree to which those peers reported suppression of negative (vs. positive) emotions. Study 3 showed that lower estimations of the prevalence of negative emotional experiences predicted greater loneliness and rumination and lower life satisfaction, and that higher estimations for positive emotional experiences predicted lower life satisfaction. Taken together, these studies suggest that people may think they are more alone in their emotional difficulties than they really are. PMID:21177878

  20. Maternal Underestimation of Child's Weight Status and Health Behaviors as Risk Factors for Overweight in Children. (United States)

    Vallejo, Maite; Cortes-Rodríguez, Beatriz A; Colin-Ramirez, Eloisa


    To evaluate children's risk of being overweight associated with maternal underestimation of weight status and health behaviors. One hundred forty mother-child dyads were included. Children whose weight status was underestimated by their mothers were at greater risks of being overweight compared to those whose weigh status was correctly perceived (adjusted OR 2.31, 95% CI 1.11-4.81). Less television viewing time was associated with a 63% reduced risk of being overweight (adjusted OR .37, 95% CI .17-.83). Maternal underestimation of weight status was common among overweight and normal-weight children, and it was associated with an increased children's risk of being overweight. Copyright © 2015 Elsevier Inc. All rights reserved.

  1. Do small samples underestimate mean abundance? It depends on what type of bias we consider. (United States)

    Reiczigel, Jeno; Rozsa, Lajos


    Former authors claimed that, due to parasites' aggregated distribution, small samples underestimate the true population mean abundance. Here we show that this claim is false or true, depending on what is meant by 'underestimate' or, mathematically speaking, how we define 'bias'. The 'how often' and 'on average' views lead to different conclusions because sample mean abundance itself exhibits an aggregated distribution: most often it falls slightly below the true population mean, while sometimes greatly exceeds it. Since the several small negative deviations are compensated by a few greater positive ones, the average of sample means approximates the true population mean.

  2. Calorie Underestimation When Buying High-Calorie Beverages in Fast-Food Contexts. (United States)

    Franckle, Rebecca L; Block, Jason P; Roberto, Christina A


    We asked 1877 adults and 1178 adolescents visiting 89 fast-food restaurants in New England in 2010 and 2011 to estimate calories purchased. Calorie underestimation was greater among those purchasing a high-calorie beverage than among those who did not (adults: 324 ±698 vs 102 ±591 calories; adolescents: 360 ±602 vs 198 ±509 calories). This difference remained significant for adults but not adolescents after adjusting for total calories purchased. Purchasing high-calorie beverages may uniquely contribute to calorie underestimation among adults.

  3. Calorie Underestimation When Buying High-Calorie Beverages in Fast-Food Contexts (United States)

    Block, Jason P.; Roberto, Christina A.


    We asked 1877 adults and 1178 adolescents visiting 89 fast-food restaurants in New England in 2010 and 2011 to estimate calories purchased. Calorie underestimation was greater among those purchasing a high-calorie beverage than among those who did not (adults: 324 ±698 vs 102 ±591 calories; adolescents: 360 ±602 vs 198 ±509 calories). This difference remained significant for adults but not adolescents after adjusting for total calories purchased. Purchasing high-calorie beverages may uniquely contribute to calorie underestimation among adults. PMID:27196648

  4. Dental Implant Surgery (United States)

    ... here to find out more. Dental Implant Surgery Dental Implant Surgery Dental implant surgery is, of course, surgery, ... here to find out more. Dental Implant Surgery Dental Implant Surgery Dental implant surgery is, of course, surgery, ...

  5. Corrective Jaw Surgery

    Medline Plus

    Full Text Available ... here to find out more. Dental Implant Surgery Dental Implant Surgery Dental implant surgery is, of course, surgery, ... here to find out more. Dental Implant Surgery Dental Implant Surgery Dental implant surgery is, of course, surgery, ...

  6. Corrective Jaw Surgery

    Medline Plus

    Full Text Available ... to find out more. Dental Implant Surgery Dental Implant Surgery Dental implant surgery is, of course, surgery, ... to find out more. Dental Implant Surgery Dental Implant Surgery Dental implant surgery is, of course, surgery, ...

  7. The evolution of robotic general surgery. (United States)

    Wilson, E B


    Surgical robotics in general surgery has a relatively short but very interesting evolution. Just as minimally invasive and laparoscopic techniques have radically changed general surgery and fractionated it into subspecialization, robotic technology is likely to repeat the process of fractionation even further. Though it appears that robotics is growing more quickly in other specialties, the changes digital platforms are causing in the general surgical arena are likely to permanently alter general surgery. This review examines the evolution of robotics in minimally invasive general surgery looking forward to a time where robotics platforms will be fundamental to elective general surgery. Learning curves and adoption techniques are explored. Foregut, hepatobiliary, endocrine, colorectal, and bariatric surgery will be examined as growth areas for robotics, as well as revealing the current uses of this technology.

  8. Minimally invasive approach for lesions involving the frontal sinus ...

    African Journals Online (AJOL)

    Background: Traditional open surgery for frontal sinus pathology and cerebrospinal fluid (CSF) leaks is complex and involves a craniotomy. Minimally invasive options offer an alternate solution. We describe and assess the outcome of a minimally invasive approach for lesions and defects involving the frontal sinus.

  9. Invasive cervical carcinoma (Stages IB-IIB)

    International Nuclear Information System (INIS)

    Sironi, S.; Zanello, A.; Rodighiero, M.G.; Vanzulli, A.; Del Maschio, A.; Taccagni, G.L.; Belloni, C.


    In the patients with invasive cervical carcinoma, the accurate assessment of parametrial invasion greatly affects the therapeutic choice between surgery and radiation therapy. As a matter of fact, surgery is usually performed only in the patients with carcinoma confined to the cervix, whereas those with parametrial involvement, or more advanced stages, are treated with radiation therapy. This prospective study was aimed at investigating the comparative adequecy of CT and MR imaging in assessing parametrial status in the patients with invasive cervical cancer. Twenty-one consecutive patients, with histologic diagnosis of cervical carcinoma, were investigated. All of them were clinically considered as having invasive cervical cancer (FIGO stage IB-IIB) and subsequently underwent surgery. In all cases, detailed histology of the parametrium was obtained. Pathological data were compared with CT and MR findings in all cases. As for assessing parametrial involvement by cancer, CT had 62% accuracy, 63% sensitivity, and 60% specificity, versus MR imaging 81% accuracy, 69% sensitivity, and 80% specificify. Therefore, MR imaging appears to be superior to CT in assessing the parametrial status of patients with invasive cervical carcinoma; the method yields valuable information for treatment planning

  10. Invasive amebiasis. (United States)

    Grecu, F; Bulgariu, Teodora; Blanaru, Oana; Dragomir, C; Lunca, Claudia; Stratan, I; Manciuc, Carmen; Luca, V


    Digestive amoebiasis with his invasive form is an unusual pathology encountered in the temperate zone. This could lead to a life threatening complication: systemic amoebiasis. A 55-year-old male was treated successfully of systemic amoebiasis in a third referral hospital. The diagnosis was established based on epidemiology data and microscopical identification of trophozoites of Entamoeba histolytica. The amoebicidal, antibiotic and supportive treatments was firstly administrated. The clinical picture of intestinal amoebiasis raised from dysenteric syndrome to necrotizing enteritis. The bowel perforation with localized peritonitis was followed by chronic enteric fistula. Amoebic liver abscess, as the most frequent extraintestinal complication, was concomitantly diagnosed and treated. Urinary amoebiasis was considered as complication in the context of systemic dissemination: any other location could become a site of an amoebic abscess. Multidisciplinary approach was the successful key in the management of the patient, including antiparasitic therapy and antibiotic prophylaxis, intensive care and multiple surgical approaches. The diagnosis of digestive amoebiasis and systemic complication may be delayed in nonendemic areas, leading to advanced and complicated stages of the disease. The surgical approach is most efficiently to treat a large liver amoebic abscess and intraperitoneal collections.

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

    Directory of Open Access Journals (Sweden)

    Weijun Wang


    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.

  12. Innovations in Bariatric Surgery. (United States)

    Zhu, Catherine; Pryor, Aurora D


    Surgery has consistently been demonstrated to be the most effective long-term therapy for the treatment of obesity. However, despite excellent outcomes with current procedures, most patients with obesity- and weight-related comorbidities who meet criteria for surgical treatment choose not to pursue surgery out of fear of operative risks and complications or concerns about high costs. Novel minimally invasive procedures and devices may offer alternative solutions for patients who are hesitant to pursue standard surgical approaches. These procedures may be used for primary treatment of obesity, early intervention for patients approaching morbid obesity, temporary management prior to bariatric surgery, or revision of bypass surgery associated with weight regain. Novel bariatric procedures can in general be divided into four categories: endoluminal space-occupying devices, gastric suturing and restrictive devices, absorption-limiting devices, and neural-hormonal modulating devices. Many of these are only approved as short-term interventions, but these devices may be effective for patients desiring low-risk procedures or a transient effect. We will see the expansion of indications and alternatives for metabolic surgery as these techniques gain approval.

  13. Robotic surgery in gynecology. (United States)

    Alkatout, Ibrahim; Mettler, Liselotte; Maass, Nicolai; Ackermann, Johannes


    Robotic surgery is the most dynamic development in the sector of minimally invasive operations currently. It should not be viewed as an alternative to laparoscopy, but as the next step in a process of technological evolution. The advancement of robotic surgery, in terms of the introduction of the Da Vinci Xi, permits the variable use of optical devices in all four trocars. Due to the new geometry of the "patient cart," an operation can be performed in all spatial directions without re-docking. Longer instruments and the markedly narrower mechanical elements of the "patient cart" provide greater flexibility as well as access similar to those of traditional laparoscopy. Currently, robotic surgery is used for a variety of indications in the treatment of benign gynecological diseases as well as malignant ones. Interdisciplinary cooperation and cooperation over large geographical distances have been rendered possible by telemedicine, and will ensure comprehensive patient care in the future by highly specialized surgery teams. In addition, the second operation console and the operation simulator constitute a new dimension in advanced surgical training. The disadvantages of robotic surgery remain the high costs of acquisition and maintenance as well as the laborious training of medical personnel before they are confident with using the technology.

  14. Hemorrhoid surgery (United States)

    ... surgery. Hemorrhoid surgery may involve: Putting a small rubber band around a hemorrhoid to shrink it by blocking blood flow. Stapling a hemorrhoid to block blood flow, causing it to shrink. Using a ...

  15. Robotic liver surgery is the optimal approach as bridge to transplantation. (United States)

    Magistri, Paolo; Tarantino, Giuseppe; Ballarin, Roberto; Coratti, Andrea; Di Benedetto, Fabrizio


    The role of minimally invasive liver surgery as a bridge to transplantation is very promising but still underestimated. However, it should be noted that surgical approach for hepatocellular carcinomas (HCC) is not merely a technical or technological issue. Nowadays, the epidemiology of HCC is evolving due to the increasing role of non-alcoholic fatty-liver-disease, and the emerging concerns on direct-acting antivirals against hepatitis C virus in terms of HCC incidence. Therefore, a fully multidisciplinary study of the cirrhotic patient is currently more important than ever before, and the management of those patients should be reserved to tertiary referral hepatobiliary centers. In particular, minimally invasive approach to the liver showed several advantages compared to the classical open procedure, in terms of: (1) the small impact on abdominal wall; (2) the gentle manipulation on the liver; (3) the limited surgical trauma; and (4) the respect of venous shunts. Therefore, more direct indications should be outlined also in the Barcelona Clinic Liver Cancer model. We believe that treatment of HCC in cirrhotic patients should be reserved to tertiary referral hepatobiliary centers, that should offer patient-tailored approaches to the liver disease, in order to provide the best care for each case, according to the individual comorbidities, risk factors, and personal quality of life expectations.

  16. Effects of Bariatric Surgery on Non-alcoholic Fatty Liver Disease: Magnetic Resonance Imaging Is an Effective, Non-invasive Method to Evaluate Changes in the Liver Fat Fraction. (United States)

    Hedderich, Dennis M; Hasenberg, Till; Haneder, Stefan; Schoenberg, Stefan O; Kücükoglu, Özlem; Canbay, Ali; Otto, Mirko


    Non-alcoholic fatty liver disease (NAFLD) is considered the most common liver disease worldwide and is highly associated with obesity. The prevalences of both conditions have markedly increased in the Western civilization. Bariatric surgery is the most effective treatment for morbid obesity and its comorbidities such as NAFLD. Measure postoperative liver fat fraction (LFF) in bariatric patients by using in-opposed-phase MRI, a widely available clinical tool validated for the quantification of liver fat METHODS: Retrospective analyses of participants, who underwent laparoscopic Roux-Y-gastric-bypass (17) or laparoscopic sleeve gastrectomy (2) were performed using magnetic resonance imaging (MRI), bioelectrical impedance analysis (BIA), and anthropometric measurements 1 day before surgery, as well as 6, 12, and 24 weeks after surgery, LFF was calculated from fat-only and water-only MR images. Six months after surgery, a significant decrease of LFF and liver volume has been observed along with weight loss, decreased waist circumference, and parameters obtained by body fat measured by BIA. LFF significantly correlated with liver volume in the postoperative course. MRI including in-opposed-phase imaging of the liver can detect the quantitative decrease of fatty infiltration within the liver after bariatric surgery and thus could be a valuable tool to monitor NAFLD/NASH postoperatively.

  17. Plastic Surgery (United States)

    ... idea for teens? As with everything, there are right and wrong reasons to have surgery. Cosmetic surgery is unlikely to change your life. Most board-certified plastic surgeons spend a lot of time ... the right reasons. Many plastic surgery procedures are just that — ...

  18. Minimal Invasive Repair of Pectus Excavatum and Carinatum

    DEFF Research Database (Denmark)

    Pilegaard, Hans; Licht, Peter Bjørn


    Minimal invasive surgery has become the gold standard for surgical repair of pectus excavatum. The procedure can be performed as fast-track surgery and cosmetic results are excellent. In addition, cardiac performance improves after correction. With increased awareness on the Internet, the number ...

  19. Invasive Scedosporium sternal osteomyelitis following lung transplant: Cured

    Directory of Open Access Journals (Sweden)

    E.J. Denton


    Full Text Available Scedosporium is an important pathogen in cystic fibrosis (CF and post-transplant but rarely causes invasive infection. Treatment remains challenging, particularly due to inherent resistance to multiple antifungal agents. We present a young man with CF who developed invasive sternal and rib infection 10-months following lung transplant. The infection has been clinically and radiologically cured with extensive surgery and triazole therapy. This case highlights the importance of adjunctive surgery in addition to prolonged triazole treatment to manage invasive Scedosporium infections in immunosuppressed patients.

  20. Cirurgia valvar mitral e da comunicação interatrial: abordagem minimamente invasiva ou por esternotomia Mitral valve and atrial septal defect surgery: minimally invasive or sternotomy approach

    Directory of Open Access Journals (Sweden)

    Josué V. Castro Neto


    Full Text Available FUNDAMENTO: Para diminuir o trauma cirúrgico em procedimentos cardiovasculares, técnicas Minimamente Invasivas (MI foram alternativamente introduzidas. OBJETIVO: Comparar o acesso cirúrgico MI com a Esternotomia Mediana (EM para tratar a cardiopatia valvar mitral (VM e a Comunicação Interatrial (CIA. MÉTODOS: Estudo prospectivo onde quarenta pacientes foram submetidos a cirurgia para correção de cardiopatia VM ou CIA. Foram divididos em: grupo A (GA (n = 20, de acesso por minitoracotomia direita com videoassistência, e grupo B (GB (n = 20, de acesso por EM. Comparamos: tempo de pinçamento aórtico e circulação extracorpórea, tempo de permanência na Unidade de Terapia Intensiva (UTI, tempo de hospitalização e morbidade. RESULTADOS: Quinze pacientes foram submetidos a procedimento VM e 5 a correção de CIA, em cada grupo. Houve nove trocas mitrais (sete bioprotéticas e duas mecânicas e seis reconstruções no GA, e 10 trocas (todas bioprotéticas e cinco reconstruções no GB. As médias de tempo de pinçamento aórtico e circulação extracorpórea, em minutos, foram 65,1 ± 29,3 no GA, e 50,2 ± 21,4 no GB (p = 0,074; e 91,8 ± 35 no GA, e 63,7 ± 27,3 no GB (p = 0,008. As médias de tempo de UTI, em horas, foram 51,7 ± 16,3 no GA, e 55,8 ± 17,5 no GB (p = 0,45. Os tempos de hospitalização, em dias, foram 5,2 ± 1 no GA, e 6,4 ± 1,5 no GB (p = 0,009. CONCLUSÃO: O acesso MI para correção da cardiopatia VM e da CIA implicaram em maior tempo de circulação extracorpórea para a finalização do procedimento principal sem, no entanto, afetar a recuperação do paciente. Os pacientes tratados de forma MI tiveram alta hospitalar mais cedo que os pacientes tratados com esternotomia.BACKGROUND: To decrease the surgical trauma in heart procedures, minimally invasive (MI techniques were alternatively introduced. OBJECTIVE: To compare MI surgical access with me