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Sample records for surgery minimally invasive

  1. Minimally invasive surgery. Future developments.

    OpenAIRE

    1994-01-01

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

  2. Minimally invasive paediatric cardiac surgery.

    Science.gov (United States)

    Bacha, Emile; Kalfa, David

    2014-01-01

    The concept of minimally invasive surgery for congenital heart disease in paediatric patients is broad, and has the aim of reducing the trauma of the operation at each stage of management. Firstly, in the operating room using minimally invasive incisions, video-assisted thoracoscopic and robotically assisted surgery, hybrid procedures, image-guided intracardiac surgery, and minimally invasive cardiopulmonary bypass strategies. Secondly, in the intensive-care unit with neuroprotection and 'fast-tracking' strategies that involve early extubation, early hospital discharge, and less exposure to transfused blood products. Thirdly, during postoperative mid-term and long-term follow-up by providing the children and their families with adequate support after hospital discharge. Improvement of these strategies relies on the development of new devices, real-time multimodality imaging, aids to instrument navigation, miniaturized and specialized instrumentation, robotic technology, and computer-assisted modelling of flow dynamics and tissue mechanics. In addition, dedicated multidisciplinary co-ordinated teams involving congenital cardiac surgeons, perfusionists, intensivists, anaesthesiologists, cardiologists, nurses, psychologists, and counsellors are needed before, during, and after surgery to go beyond apparent technological and medical limitations with the goal to 'treat more while hurting less'.

  3. Robotic assisted minimally invasive surgery

    Directory of Open Access Journals (Sweden)

    Palep Jaydeep

    2009-01-01

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

  4. Minimally Invasive Forefoot Surgery in France.

    Science.gov (United States)

    Meusnier, Tristan; Mukish, Prikesht

    2016-06-01

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

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

    Science.gov (United States)

    Feußner, H; Wilhelm, D

    2016-03-01

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

  6. Economic impact of minimally invasive lumbar surgery

    Science.gov (United States)

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

    2015-01-01

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

  7. Minimally invasive surgery for Achilles tendon pathologies

    Directory of Open Access Journals (Sweden)

    Nicola Maffulli

    2010-07-01

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

  8. Mitral valve surgery - minimally invasive

    Science.gov (United States)

    ... Saunders; 2012:chap 61. Otto CM, Bonow RO. Valvular heart disease. In: Mann DL, Zipes DP, Libby P, Bonow ... Editorial team. Related MedlinePlus Health Topics Heart Surgery Heart Valve Diseases Mitral Valve Prolapse Browse the Encyclopedia A.D. ...

  9. Heart bypass surgery - minimally invasive

    Science.gov (United States)

    ... help. Contact your doctor if you have a cold, flu, fever, herpes breakout, or any other illness. Prepare your home so you can move around easily when you return from the hospital. The day before your surgery: Shower and shampoo well. You may be asked to ...

  10. Minimal Invasive Urologic Surgery and Postoperative Ileus

    Directory of Open Access Journals (Sweden)

    Fouad Aoun

    2015-07-01

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

  11. Minimal Invasive Surgery for Esophageal Cancer

    Institute of Scientific and Technical Information of China (English)

    A.H.Hoelscher; Ch.Gutschow

    2004-01-01

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

  12. Minimally invasive surgery for esophageal cancer.

    Science.gov (United States)

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

    2008-10-01

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

  13. Esophageal surgery in minimally invasive era

    Institute of Scientific and Technical Information of China (English)

    2016-01-01

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

  14. Minimally invasive pediatric surgery: Our experience

    Directory of Open Access Journals (Sweden)

    Saravanan K

    2008-01-01

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

  15. Surgeons' musculoskeletal pain in minimally invasive surgery

    DEFF Research Database (Denmark)

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

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

  16. Minimally invasive surgery for esophageal achalasia

    Institute of Scientific and Technical Information of China (English)

    Luigi Bonavina

    2006-01-01

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

  17. Minimally invasive surgery for atrial fibrillation.

    Science.gov (United States)

    Zembala, Michael O; Suwalski, Piotr

    2013-11-01

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

  18. Minimally invasive "pocket incision" aortic valve surgery.

    Science.gov (United States)

    Yakub, M A; Pau, K K; Awang, Y

    1999-02-01

    A minimally invasive approach to aortic valve surgery through a transverse incision ("pocket incision") at the right second intercostal space was examined. Sixteen patients with a mean age of 30 years underwent this approach. The third costal cartilage was either excised (n = 5) or dislocated (n = 11). The right internal mammary artery was preserved. Cardiopulmonary bypass (CPB) was established with aortic-right atrial cannulation in all except the first case. Aortic valve replacements (AVR) were performed in 15 patients and one had aortic valve repair with concomitant ventricular septal defect closure. There was no mortality and no major complications. The aortic cross-clamp, CPB and operative times were 72 +/- 19 mins, 105 +/- 26 mins and 3 hrs 00 min +/- 29 mins respectively. The mean time to extubation was 5.7 +/- 4.0 hrs, ICU stay of 27 +/- 9 hrs and postoperative hospital stay of 5.1 +/- 1.2 days. Minimally invasive "pocket incision" aortic valve surgery is technically feasible and safe. It has the advantages of central cannulation for CPB, preservation of the internal mammary artery and avoiding sternotomy. This approach is cosmetically acceptable and allows rapid patient recovery.

  19. Emerging robotic platforms for minimally invasive surgery.

    Science.gov (United States)

    Vitiello, Valentina; Lee, Su-Lin; Cundy, Thomas P; Yang, Guang-Zhong

    2013-01-01

    Recent technological advances in surgery have resulted in the development of a range of new techniques that have reduced patient trauma, shortened hospitalization, and improved diagnostic accuracy and therapeutic outcome. Despite the many appreciated benefits of minimally invasive surgery (MIS) compared to traditional approaches, there are still significant drawbacks associated with conventional MIS including poor instrument control and ergonomics caused by rigid instrumentation and its associated fulcrum effect. The use of robot assistance has helped to realize the full potential of MIS with improved consistency, safety and accuracy. The development of articulated, precision tools to enhance the surgeon's dexterity has evolved in parallel with advances in imaging and human-robot interaction. This has improved hand-eye coordination and manual precision down to micron scales, with the capability of navigating through complex anatomical pathways. In this review paper, clinical requirements and technical challenges related to the design of robotic platforms for flexible access surgery are discussed. Allied technical approaches and engineering challenges related to instrument design, intraoperative guidance, and intelligent human-robot interaction are reviewed. We also highlight emerging designs and research opportunities in the field by assessing the current limitations and open technical challenges for the wider clinical uptake of robotic platforms in MIS.

  20. Inverse Kinematics of a Manipulator for Minimally Invasive Surgery

    OpenAIRE

    Hermann Mayer; Istvan Nagy; Alois Knoll

    2017-01-01

    In this report we describe the inverse kinematics of our robotic system for minimally invasive surgery. Special respect is given to an intuitive operability of the user interface. Therefore we apply the concept of so-called trocar kinematics. Meaning that the manipulator (in our case an instrument for minimally invasive surgery) has to pass a fixed opening through the surface of the patient's body. It is the principle idea of minimally invasive surgery to perform all surgical tasks through sm...

  1. Minimally invasive cardiac surgery and transesophageal echocardiography

    Directory of Open Access Journals (Sweden)

    Ajay Kumar Jha

    2014-01-01

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

  2. Minimal invasive surgery in pediatric solid tumors.

    Science.gov (United States)

    Chan, Kin Wai; Lee, K H; Tam, Y H; Yeung, C K

    2007-12-01

    There is only limited experience of using the minimally invasive surgery (MIS) technique in resecting pediatric solid tumors. In this paper, we report our experience of using the MIS technique in the management of pediatric solid tumors. A retrospective review was undertaken on all children who had undergone MIS for their solid tumors between 1995 and 2005. Over a 10-year period, there were 38 patients who had undergone MIS for tumor resection. The mean age at the time of surgery was 7.5 years (range, 1 day to 15 years). There were 22 ovarian tumors, 4 sacrococcygeal tumors, 3 adrenal tumors, 3 retroperitoneal tumors, 1 kidney tumor, 1 liver mass, 1 intra-abdominal testicular tumor, and 3 intrathoracic masses. Thirty of 38 patients had undergone a successful resection using the MIS technique (78.9%). Eight patients required a conversion to the open procedure because of limited intraperitoneal space in 7 and excessive bleeding in 1. Of the 28 successfully MIS-resected intra-abdominal tumors, 18 required enlargement of the umbilical incision and 5 required an additional Pfannenstiel incision for tumor retrieval. Enlargement of the thoracic port site for specimen retrieval was required in the 2 successfully MIS-resected intrathoracic masses. The mean operation time was 171 minutes (range, 45-275). There was no postoperative complication encountered. On an average follow-up of 3.1 years, there was no recurrence observed, even in the 7 patients with malignant tumors, and all patients with successful MIS tumor excision had good cosmetic results. With the advance of laparoscopic instruments and techniques, a variety of pediatric solid tumors can be resected safely by the MIS technique. This has the potential benefit of a more rapid postoperative recovery and better cosmetic results. The role of the MIS technique in resecting malignant tumors is uncertain, as the number of cases in the current series is too small to draw any conclusion.

  3. Minimally invasive surgery colloidal cystic thyroid nodules

    Directory of Open Access Journals (Sweden)

    V G Petrov

    2013-12-01

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

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

    Science.gov (United States)

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

    1998-12-01

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

  5. Minimally Invasive Surgery Survey: A Survey of Surgical Team Members' Perceptions for Successful Minimally Invasive Surgery.

    Science.gov (United States)

    Yurteri-Kaplan, Ladin A; Andriani, Leslie; Kumar, Anagha; Saunders, Pamela A; Mete, Mihriye M; Sokol, Andrew I

    2017-07-08

    To develop a valid and reliable survey to measure surgical team members' perceptions regarding their institution's requirements for successful minimally invasive surgery (MIS). Questionnaire development and validation study (Canadian Task Force classification II-2). Three hospital types: rural, urban/academic, and community/academic. Minimally invasive staff (team members). Development and validation of a minimally invasive surgery survey (MISS). Using the Safety Attitudes questionnaire as a guide, we developed questions assessing study participants' attitudes regarding the requirements for successful MIS. The questions were closed-ended and responses based on a 5-point Likert scale. The large pool of questions was then given to 4 focus groups made up of 3 to 6 individuals. Each focus group consisted of individuals from a specific profession (e.g., surgeons, anesthesiologists, nurses, and surgical technicians). Questions were revised based on focus group recommendations, resulting in a final 52-question set. The question set was then distributed to MIS team members. Individuals were included if they had participated in >10 MIS cases and worked in the MIS setting in the past 3 months. Participants in the trial population were asked to repeat the questionnaire 4 weeks later to evaluate internal consistency. Participants' demographics, including age, gender, specialty, profession, and years of experience, were captured in the questionnaire. Factor analysis with varimax rotation was performed to determine domains (questions evaluating similar themes). For internal consistency and reliability, domains were tested using interitem correlations and Cronbach's α. Cronbach's α > .6 was considered internally consistent. Kendall's correlation coefficient τ closer to 1 and with p high test-retest reliability (τ = .3-.7, p < .05). The final questionnaire was made up of 29 questions from the original 52 question set. The MISS is a reliable and valid tool that

  6. Appendicitis/diverticulitis: minimally invasive surgery.

    Science.gov (United States)

    Mutter, D; Marescaux, J

    2013-01-01

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

  7. Early outcome of minimally invasive mitral valve surgery

    Directory of Open Access Journals (Sweden)

    Shawky Fareed

    2016-08-01

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

  8. Minimally Invasive Liver Surgery for Hepatic Colorectal Metastases.

    Science.gov (United States)

    Nassour, Ibrahim; Polanco, Patricio M

    2016-04-01

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

  9. Manual Control for Medical Instruments in Minimally Invasive Surgery

    NARCIS (Netherlands)

    Fan, C.

    2014-01-01

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

  10. Minimally Invasive Cardiac Surgery: Transapical Aortic Valve Replacement

    Directory of Open Access Journals (Sweden)

    Ming Li

    2012-01-01

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

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

    Science.gov (United States)

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

    2008-01-20

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

  12. Minimal invasive gastric surgery: A systematic review

    Directory of Open Access Journals (Sweden)

    Kirti Bushan

    2015-01-01

    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.

  13. ACTIVE ROBOTIC ENDOSCOPE FOR MINIMALLY INVASIVE SURGERY

    Institute of Scientific and Technical Information of China (English)

    2002-01-01

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

  14. MIS Score: Prediction Model for Minimally Invasive Surgery.

    Science.gov (United States)

    Hu, Yuanyuan; Cao, Jingwei; Hou, Xianzeng; Liu, Guangcun

    2017-03-01

    Reports suggest that patients with spontaneous intracerebral hemorrhage (ICH) can benefit from minimally invasive surgery, but the inclusion criterion for operation is controversial. This article analyzes factors affecting the 30-day prognoses of patients who have received minimally invasive surgery and proposes a simple grading scale that represents clinical operation effectiveness. The records of 101 patients with spontaneous ICH presenting to Qianfoshan Hospital were reviewed. Factors affecting their 30-day prognosis were identified by logistic regression. A clinical grading scale, the MIS score, was developed by weighting the independent predictors based on these factors. Univariate analysis revealed that the factors that affect 30-day prognosis include Glasgow coma scale score (P MIS score was developed accordingly; 39 patients with 0-1 MIS scores had favorable prognoses, whereas only 9 patients with 2-5 MIS scores had poor prognoses. The MIS score is a simple grading scale that can be used to select patients who are suited for minimal invasive drainage surgery. When MIS score is 0-1, minimal invasive surgery is strongly recommended for patients with spontaneous cerebral hemorrhage. The scale merits further prospective studies to fully determine its efficacy. Copyright © 2016 Elsevier Inc. All rights reserved.

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

    Directory of Open Access Journals (Sweden)

    Terrence T. Kim

    2016-01-01

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

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

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    Yu-Kai Huang

    2013-01-01

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

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

    Science.gov (United States)

    Pinzon, David; Byrns, Simon; Zheng, Bin

    2016-08-01

    Background The amount of direct hand-tool-tissue interaction and feedback in minimally invasive surgery varies from being attenuated in laparoscopy to being completely absent in robotic minimally invasive surgery. The role of haptic feedback during surgical skill acquisition and its emphasis in training have been a constant source of controversy. This review discusses the major developments in haptic simulation as they relate to surgical performance and the current research questions that remain unanswered. Search Strategy An in-depth review of the literature was performed using PubMed. Results A total of 198 abstracts were returned based on our search criteria. Three major areas of research were identified, including advancements in 1 of the 4 components of haptic systems, evaluating the effectiveness of haptic integration in simulators, and improvements to haptic feedback in robotic surgery. Conclusions Force feedback is the best method for tissue identification in minimally invasive surgery and haptic feedback provides the greatest benefit to surgical novices in the early stages of their training. New technology has improved our ability to capture, playback and enhance to utility of haptic cues in simulated surgery. Future research should focus on deciphering how haptic training in surgical education can increase performance, safety, and improve training efficiency. © The Author(s) 2016.

  18. Complications Associated With Femoral Cannulation During Minimally Invasive Cardiac Surgery.

    Science.gov (United States)

    Lamelas, Joseph; Williams, Roy F; Mawad, Maurice; LaPietra, Angelo

    2017-06-01

    Different types of cannulation techniques are available for minimally invasive cardiac surgery. At our institution, we favor a femoral platform for most minimally invasive cardiac procedures. Here, we review our results utilizing this cannulation approach. We retrospectively reviewed all minimally invasive valve surgeries that were performed at our institution between January 2009 and January 2015. Operative times, lengths of stay, postoperative complications, and mortality were analyzed. We identified 2,645 consecutive patients. The mean age was 69.7 ± 12.77 years, and 1,412 patients (53.4%) were male. Three hundred fifty-eight patients (13.5%) had a history of cerebrovascular accident, 422 (16%) had previous heart surgery, and 276 (10.4%) had a history of peripheral vascular disease. The procedures performed were isolated aortic valve replacements (42.1%), isolated mitral valve operations (40.6%), tricuspid valve repairs (0.57%), double valve surgery (15%), triple valve surgery (0.3%), and ascending aortic aneurysm resection with and without circulatory arrest (5%). Femoral cannulation and central cannulation were utilized in 2,400 patients (90.7%) and 244 patients (9.3%), respectively. The median aortic cross-clamp time and cardiopulmonary bypass time were 81 minutes (interquartile range, 65 to 105) and 113 minutes (interquartile range, 92 to 142), respectively. The median postoperative hospital length of stay was 6 days (interquartile range, 5 to 9). There were 31 cerebrovascular accidents (1.17%), no aortic dissections, two compartment syndromes, two femoral arterial pseudoaneurysms, and 174 (6.65%) groin wound seromas. The overall 30-day mortality was 57 patients (2.15%). Minimally invasive cardiac surgical procedures utilizing femoral cannulation techniques have a low risk of complications. Copyright © 2017 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.

  19. Force Feedback Control of Robotic Forceps for Minimally Invasive Surgery

    Science.gov (United States)

    Ishii, Chiharu; Kamei, Yusuke

    2008-06-01

    Recently, the robotic surgical support systems are in clinical use for minimally invasive surgery. For improvement in operativity and safety of minimally invasive surgery, the development of haptic forceps manipulator is in demand to help surgeon's immersion and dexterity. We have developed a multi-DOF robotic forceps manipulator using a novel omni-directional bending mechanism, so far. In this paper, in order to control the developed robotic forceps as a slave manipulator, joy-stick type master manipulator with force feedback mechanism for remote control is designed and built, and force feedback bilateral control system was constructed for grasping and bending motions of the robotic forceps. Experimental works were carried out and experimental results showed the effectiveness of the proposed control system.

  20. Application of minimally invasive surgery in traumatic brain injury

    Directory of Open Access Journals (Sweden)

    Liu Baiyun

    2014-12-01

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

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

    Science.gov (United States)

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

    2016-08-19

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

  2. Primary Dural Repair in Minimally Invasive Spine Surgery

    Directory of Open Access Journals (Sweden)

    Raqeeb M. Haque

    2013-01-01

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

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

    Science.gov (United States)

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

    2012-01-01

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

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

    Science.gov (United States)

    Virk, Sohrab S; Yu, Elizabeth

    2017-04-01

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

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

    Directory of Open Access Journals (Sweden)

    Chia-Jen Wu

    2015-02-01

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

  6. Minimally invasive approach for redo mitral valve surgery.

    Science.gov (United States)

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

    2013-11-01

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

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

    Science.gov (United States)

    Misfeld, Martin; Davierwala, Piroze

    2012-01-01

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

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

    Science.gov (United States)

    Lemma, Massimo; Atanasiou, Thanos; Contino, Monica

    2013-01-01

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

  9. [Minimally Invasive Surgery in Pediatric Oncology. Tertiary center experience].

    Science.gov (United States)

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

    2015-07-20

    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.

  10. Minimally Invasive Surgery for Pectus Excavatum: Park Technique

    Directory of Open Access Journals (Sweden)

    Hyung Park

    2011-09-01

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

  11. Design of teleoperated surgical instruments for minimally invasive surgery

    Science.gov (United States)

    Madhani, Akhil Jiten

    1998-12-01

    Minimally invasive surgery (MIS) is performed today using hand held instruments passed through small incisions into the body. The internal surgical site and instruments are viewed remotely on a monitor using images obtained with an endoscopic camera. It is well recognized that the marked therapeutic benefits of MIS must be weighed against the increased technical difficulty for the surgeon and the ensuing risk of surgical errors. Here I describe the design, construction, and operation of teleoperated surgical instruments that solve several key problems in current minimally invasive surgical practice. These improvements are primarily achieved through (1) an increase in dexterity and degrees of freedom, (2) force feedback to allow surgeons to feel instrument-tissue interactions, and (3) the elimination of geometrical discrepancies between actual and observed tool motions. I present the design of two teleoperator slave manipulators for minimally invasive surgery, the seven- degree-of-freedom Silver Falcon and the eight-degree-of- freedom Black Falcon. Both systems were tested using an existing PHANToM TM haptic interface which was modified for use as a master manipulator. Position based bilateral force-reflecting teleoperation was implemented using sound cable design principles, without force sensors. Through the design of system dynamics that accommodate a macro-micro control scheme, a substantial reduction was achieved in slave endpoint inertia and friction reflected to the user. The Black Falcon was successfully used to drive surgical sutures along arbitrarily oriented paths, a task which is rarely feasible using today's instruments. This test demonstrates successful kinematic design and range of motion, although the quality of force reflection was not sufficient to be helpful when suturing soft tissue. Force reflection was found to be more useful during rigid contact tasks where force information is not already available to the operator via visual cues. (Copies

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

    Institute of Scientific and Technical Information of China (English)

    Badri Shrestha

    2016-01-01

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

  13. Vacuum grasping as a manipulation technique for minimally invasive surgery

    Science.gov (United States)

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

    2010-01-01

    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

  14. Videoscope-assisted minimally invasive periodontal surgery (V-MIS).

    Science.gov (United States)

    Harrel, Stephen K; Abraham, Celeste M; Rivera-Hidalgo, Francisco; Shulman, Jay D; Nunn, Martha E

    2014-09-01

    Small incision surgery has become routine in many areas of medicine but has not been widely accepted in periodontal therapy. A videoscope to assist minimally invasive surgery (MIS) has been developed. The clinical outcomes from MIS performed using this videoscope (V-MIS) are reported. Patients were evaluated for residual defects following non-surgical therapy consisting of root planing with local anaesthetic. Thirty patients having 110 sites with residual pocket probing depth (PPD) of at least 5 mm, 2 mm loss of clinical attachment level (CAL), and radiographic evidence of bone loss were surgically treated. V-MIS was performed utilizing the videoscope for surgical visualization. At re-evaluation 6 months post surgery, there was a statistically significant improvement (p MIS, in the authors' opinion, appears to be favourable when compared to previously reported results of periodontal regenerative surgery. The lack of post-surgical recession following V-MIS has not been reported with traditional regenerative surgery. © 2014 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

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

    Science.gov (United States)

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

    2013-06-01

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

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

    Directory of Open Access Journals (Sweden)

    Richa Sharma

    2014-01-01

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

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

    Institute of Scientific and Technical Information of China (English)

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

    2016-01-01

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

  18. Pyeloplasty techniques using minimally invasive surgery (MIS) in pediatric patients.

    Science.gov (United States)

    Turrà, Francesco; Escolino, Maria; Farina, Alessandra; Settimi, Alessandro; Esposito, Ciro; Varlet, François

    2016-10-01

    Hydronephrosis is the most common presentation of ureteropelvic junction (UPJ) obstruction. We reviewed literature, collecting data from Medline, to evaluate the current status of minimally invasive surgery (MIS) approach to pyeloplasty. Since the first pyeloplasty was described in 1939, several techniques has been applied to correct UPJ obstruction, but Anderson-Hynes dismembered pyeloplasty is established as the gold standard, to date also in MIS technique. According to literature several studies underline the safety and effectiveness of this approach for both trans- and retro-peritoneal routes, with a success rate between 81-100% and an operative time between 90-228 min. These studies have demonstrated the safety and efficacy of this procedure in the management of UPJ obstruction in children. Whether better the transperitoneal, than the retroperitoneal approach is still debated. A long learning curve is needed especially in suturing and knotting.

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

    Science.gov (United States)

    Xu, Zhaohong; Song, Chengli; Wu, Wenwu

    2012-06-01

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

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

    Directory of Open Access Journals (Sweden)

    Richter GM

    2016-01-01

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

  1. Percutaneous Iliac Screws for Minimally Invasive Spinal Deformity Surgery

    Directory of Open Access Journals (Sweden)

    Michael Y. Wang

    2012-01-01

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

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

    Science.gov (United States)

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

    2016-02-01

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

  3. [Minimally invasive ENT surgery. Progress due to modern technology].

    Science.gov (United States)

    Plinkert, P K; Schurr, M O; Kunert, W; Flemming, E; Buess, G; Zenner, H P

    1996-06-01

    Three fundamentals have to be fulfilled to optimize minimally, invasive surgery: three-dimensional imaging, free maneuverability of the instruments, sensorial feedback. Projection of two pictures from a stereoendoscope and subsequent separation with a LCD shutter allows three-dimensional videoendoscopy to be performed. A high-frequency shutter technique (100/120 Hz) presents pictures from the two video cameras to the right and left eye, respectively, so that the surgeon has spatial vision of the operative field. Steerable instruments have four component: a control unit, rigid shaft, steerable multi-joints, distal effector. The steerable multi-joints give two additional degrees of freedom compared to conventional rigid instruments in endoscopic surgery. For intuitive movements, however, an electronic control system is necessary that is comparable to the "master-slave" principle in remote technology. A remote manipulator system with six degrees of freedom is now available. Additionally, a multifunctional distal tip permits different surgical steps to be performed without changing the instrument. For better control of the instrument and the operative procedure tactile feedback can be achieved with appropriate microsensor systems. Recent projects suggest that an artificial sensor system can be established within the foreseeable future.

  4. Automation of a suturing device for minimally invasive surgery.

    Science.gov (United States)

    Göpel, Tobias; Härtl, Felix; Schneider, Armin; Buss, Martin; Feussner, Hubertus

    2011-07-01

    In minimally invasive surgery, hand suturing is categorized as a challenge in technique as well as in its duration. This calls for an easily manageable tool, permitting an all-purpose, cost-efficient, and secure viscerosynthesis. Such a tool for this field already exists: the Autosuture EndoStitch(®). In a series of studies the potential for the EndoStitch to accelerate suturing has been proven. However, its ergonomics still limits its applicability. The goal of this study was twofold: propose an optimized and partially automated EndoStitch and compare the conventional EndoStitch to the optimized and partially automated EndoStitch with respect to the speed and precision of suturing. Based on the EndoStitch, a partially automated suturing tool has been developed. With the aid of a DC motor, triggered by a button, one can suture by one-fingered handling. Using the partially automated suturing manipulator, 20 surgeons with different levels of laparoscopic experience successfully completed a continuous suture with 10 stitches using the conventional and the partially automated suture manipulator. Before that, each participant was given 1 min of instruction and 1 min for training. Absolute suturing time and stitch accuracy were measured. The quality of the automated EndoStitch with respect to manipulation was tested with the aid of a standardized questionnaire. To compare the two instruments, t tests were used for suturing accuracy and time. Of the 20 surgeons with laparoscopic experience (fewer than 5 laparoscopic interventions, n=9; fewer than 20 laparoscopic interventions, n=7; more than 20 laparoscopic interventions, n=4), there was no significant difference between the two tested systems with respect to stitching accuracy. However, the suturing time was significantly shorter with the Autostitch (P=0.01). The difference in accuracy and speed was not statistically significant considering the laparoscopic experience of the surgeons. The weight and size of the

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

    Science.gov (United States)

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

    2008-12-01

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

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

    Directory of Open Access Journals (Sweden)

    Donald A. Ross

    2014-01-01

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

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

    Directory of Open Access Journals (Sweden)

    Fader Amanda

    2011-01-01

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

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

    Science.gov (United States)

    Park, Adrian; Witzke, Donald; Donnelly, Michael

    2002-01-01

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

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

    Science.gov (United States)

    Matern, U; Waller, P

    1999-02-01

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

  10. Design of Micro Robot for Minimally Invasive Surgery

    Directory of Open Access Journals (Sweden)

    Deiva Ganesh A

    2012-09-01

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

  11. Depth Perception of Surgeons in Minimally Invasive Surgery.

    Science.gov (United States)

    Bogdanova, Rositsa; Boulanger, Pierre; Zheng, Bin

    2016-10-01

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

  12. A bioinspired soft manipulator for minimally invasive surgery.

    Science.gov (United States)

    Ranzani, T; Gerboni, G; Cianchetti, M; Menciassi, A

    2015-05-13

    This paper introduces a novel, bioinspired manipulator for minimally invasive surgery (MIS). The manipulator is entirely composed of soft materials, and it has been designed to provide similar motion capabilities as the octopus's arm in order to reach the surgical target while exploiting its whole length to actively interact with the biological structures. The manipulator is composed of two identical modules (each of them can be controlled independently) with multi-directional bending and stiffening capabilities, like an octopus arm. In the authors' previous works, the design of the single module has been addressed. Here a two-module manipulator is presented, with the final aim of demonstrating the enhanced capabilities that such a structure can have in comparison with rigid surgical tools currently employed in MIS. The performances in terms of workspace, stiffening capabilities, and generated forces are characterized through experimental tests. The combination of stiffening capabilities and manipulation tasks is also addressed to confirm the manipulator potential employment in a real surgical scenario.

  13. PARASURG hybrid parallel robot for minimally invasive surgery.

    Science.gov (United States)

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

    2011-01-01

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

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

    Directory of Open Access Journals (Sweden)

    Nancy E Epstein

    2014-01-01

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

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

    DEFF Research Database (Denmark)

    Kibsgaard, Martin; Kraus, Martin

    2016-01-01

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

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

    NARCIS (Netherlands)

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

    2008-01-01

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

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

    NARCIS (Netherlands)

    Velde, E. A. te; Bax, N. M. A.; Tytgat, S. H. A. J.; de Jong, J. R.; Travassos, D. Vieira; Kramer, W. L. M.; van der Zee, D. C.

    Background: 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 retrospective

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

    OpenAIRE

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

    2014-01-01

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

  19. A Computational Investigation Of Minimal Invasive Spine Surgery

    DEFF Research Database (Denmark)

    Rasmussen, Sten; Rasmussen, John

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

  20. Anaesthesia for minimally invasive gastric and bowel surgery

    DEFF Research Database (Denmark)

    Lund, Claus

    2002-01-01

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

  1. Anaesthesia for minimally invasive gastric and bowel surgery

    DEFF Research Database (Denmark)

    Lund, Claus

    2002-01-01

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

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

    Science.gov (United States)

    Delucia, Patricia R.; Griswold, John A.

    2011-01-01

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

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

    Science.gov (United States)

    Delucia, Patricia R.; Griswold, John A.

    2011-01-01

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

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

    Science.gov (United States)

    Zheng, Minhua; Ma, Junjun

    2017-06-25

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

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

    Science.gov (United States)

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

    2014-05-01

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

  6. Why have we embraced minimally invasive surgery and ignored enhanced recovery after surgery?

    Directory of Open Access Journals (Sweden)

    Aditya J Nanavati

    2016-01-01

    Full Text Available There has been a lot of enthusiasm about minimally invasive surgery (MIS in the surgical community in recent times. Some of the main reasons for this are an unmatched appeal to patients, doctors and healthcare systems alike. Push from the industry also serves as an important reason for its popularity. 'Enhanced recovery after surgery' (ERAS is a programme of implementing multimodal interventions in the perioperative period to promote faster recovery. Even though MIS is an important component of ERAS protocols, the latter has not seen the reception the former has received. In this article, the authors present their personal viewpoint on the matter. The authors intend to highlight issues surrounding an increasing emphasis on MIS and to caution against the MIS operative technique superseding comprehensive perioperative care.

  7. [Current problems in training of minimally invasive surgery: vision of residents in pediatric surgery].

    Science.gov (United States)

    Corona, C; Cano, I; Peláez, D; Fuentes, S; Tardáguila, A R

    2013-01-01

    Minimally Invasive Surgery (MIS) is getting more and more important in our specialty. However, the formation of the residents on MIS is, in many cases, irregular. The purpose of this study is to assess the state of training in MIS among the residents of Pediatric Surgery and their potential weaknesses. An electronic survey was distributed among 71 residents of Pediatric Surgery from 17 national hospitals. The response rate was 70.2%.100% of the residents are interested in a broadening of training activities in MIS. The main areas of interest are gastrointestinal (92%) and thoracic (47%) surgery. Only 57% have access to training facilities and less than half of them attend to courses and conferences. 80% believe that they are not given adequate attention from specialized associations. 52% think they should do rotations at referral centers, 86% that courses and seminars should be enhanced, and 44% that the responsibility of the resident in surgery should be increased. The main defects encountered in their training are scarce volume of patients, lack of financial support and overcoming the learning curve of surgeons in their services. Despite the advance of the MIS, resident's training in this discipline still has shortcomings, as expressed in their views. Knowledge of the current state of training should be the starting point for designing a training strategy that ensures adequate skills.

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

    Directory of Open Access Journals (Sweden)

    Gambassi Melanie

    2011-08-01

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

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

    Science.gov (United States)

    Cabrilo, Ivan; Schaller, Karl; Bijlenga, Philippe

    2015-04-01

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

  10. Multiple video sequences synchronization during minimally invasive surgery

    Science.gov (United States)

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

    2016-03-01

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

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

    NARCIS (Netherlands)

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

    2012-01-01

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

  12. Design of an articulated manipulator for enhanced dexterity in minimally invasive surgery

    OpenAIRE

    Ray, Jerry DeWane, II

    1996-01-01

    Approved for public release; distribution is unlimited. A current limitation in minimally invasive surgical (MIS) procedures is the lack of an articulated mechanism which will provide dexterity inside the torso while supporting a surgical tool. The tool could be a pair of scissors or an optical device such as a camera, or both. To overcome this limitation we have designed an Articulated Manipulator for Minimally Invasive Surgery (AMMIS). The AMMIS is expected to provide surgeons with impro...

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

    OpenAIRE

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

    2015-01-01

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

  14. External force estimation and implementation in robotically assisted minimally invasive surgery.

    Science.gov (United States)

    Sang, Hongqiang; Yun, Jintian; Monfaredi, Reza; Wilson, Emmanuel; Fooladi, Hadi; Cleary, Kevin

    2017-06-01

    Robotically assisted minimally invasive surgery can offer many benefits over open surgery and laparoscopic minimally invasive surgery. However, currently, there is no force sensing and force feedback. This research was implemented using the da Vinci research kit. An external force estimation and implementation method was proposed based on dynamics and motor currents. The dynamics of the Patient Side Manipulator was modeled. The dynamic model was linearly parameterized. The estimation principle of external force was derived. The dynamic parameters were experimentally identified using a least squares method. Several experiments including dynamic parameter identification, joint torque estimation, and external force estimation were performed. The results showed that the proposed method could implement force estimation without using a force sensor. The force estimation method was proposed and implemented and experimental results showed the method worked and was feasible. This method could be used for force sensing in minimally invasive surgical robotics in the future. Copyright © 2017 John Wiley & Sons, Ltd.

  15. [Macro surgery: a merge of minimal invasive surgery, membrane anatomy, and industry].

    Science.gov (United States)

    Gong, Jianping

    2015-08-01

    Minimal invasive surgery (MIS), which is presented by laparoscopy, has developed for more than a quarter of century. More and more surgical operations can be finished by laparoscopy, not only for cholecystectomy, but also for some complex operations, even radical operation for gastrointestinal cancer, such as radical rectectomy, D3 colectomy, D2 gastrectomy. These operations have small incisions only, but with extensive injury and bleeding in the abdomen. Meanwhile, total mesorectal excision (TME) for rectal cancer and complete mesocolic excision (CME) for colon cancer have been proposed by surgeons in the field of open surgery. During those procedures, they suggested that it is very important to find out a "space", then expand it to a "holly plane", to achieve resection en bloc and less bleeding, namely "plane surgery". In fact, the "plane" is consisted of two membranes under laparoscopy, that is the membranes (fascia or serous) which come from the mesentery in broad sense(or tissue bloc) and its bed. Understanding of the membrane anatomy we proposed, which includes the mesentery in broad sense(or tissue bloc) and the mesentery bed, will help the surgeons identify the correct anatomy or plane intentionally or accurately, and perform operations more easily, more precisely with less bleeding, more radically and less side injury. However, It is not easy to identify the membrane anatomy by naked eyes or traditional laparoscopy. It is not only dependent on the development of knowledge of membrane anatomy, but also the instruments developed by industry. Now, it seems to become possible when industry of optic or glass developed some instruments, such as 3D laparoscopy, binocular loupe, which have the proper magnifying power and high density resolution, and can identify the membrane anatomy at macro level (not micro level). Wearing these instruments, based on the membrane anatomy(macro anatomy), the classical operations, which include traditional laparoscopy or open

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

    DEFF Research Database (Denmark)

    Kibsgaard, Martin; Kraus, Martin

    2016-01-01

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

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

    Science.gov (United States)

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

    2013-06-01

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

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

    Directory of Open Access Journals (Sweden)

    Miloslav Duda

    2011-03-01

    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

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

    Directory of Open Access Journals (Sweden)

    A. Attia

    2016-07-01

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

  20. An Isolator System for minimally invasive surgery: the new design

    NARCIS (Netherlands)

    Horeman, T.; Jansen, F.W.; Dankelman, J.

    2010-01-01

    Background - The risk of obtaining a postsurgical infection depends highly on the air quality surrounding the exposed tissue, surgical instruments, and materials. Many isolators for open surgery have been invented to create a contained sterile volume around the exposed tissue. With the use of an iso

  1. MINIMALLY-INVASIVE SURGERY FOR COLLORECTAL CANCER IN ELDERLY PATIENTS

    Directory of Open Access Journals (Sweden)

    I. L. Chernikovskiy

    2016-01-01

    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

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

    Science.gov (United States)

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

    2015-01-01

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

  3. Segmentation of Arteries in Minimally Invasive Surgery Using Change Detection

    Science.gov (United States)

    Akbari, Hamed; Kosugi, Yukio; Kojima, Kazuyuki

    In laparoscopic surgery, the lack of tactile sensation and 3D visual feedback make it difficult to identify the position of a blood vessel intraoperatively. An unintentional partial tear or complete rupture of a blood vessel may result in a serious complication; moreover, if the surgeon cannot manage this situation, open surgery will be necessary. Differentiation of arteries from veins and other structures and the ability to independently detect them has a variety of applications in surgical procedures involving the head, neck, lung, heart, abdomen, and extremities. We have used the artery's pulsatile movement to detect and differentiate arteries from veins. The algorithm for change detection in this study uses edge detection for unsupervised image registration. Changed regions are identified by subtracting the systolic and diastolic images. As a post-processing step, region properties, including color average, area, major and minor axis lengths, perimeter, and solidity, are used as inputs of the LVQ (Learning Vector Quantization) network. The output results in two object classes: arteries and non-artery regions. After post-processing, arteries can be detected in the laparoscopic field. The registration method used here is evaluated in comparison with other linear and nonlinear elastic methods. The performance of this method is evaluated for the detection of arteries in several laparoscopic surgeries on an animal model and on eleven human patients. The performance evaluation criteria are based on false negative and false positive rates. This algorithm is able to detect artery regions, even in cases where the arteries are obscured by other tissues.

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

    Science.gov (United States)

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

    2002-04-01

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

  5. Pediatric minimally invasive surgery in Africa: limitations and current situation.

    Science.gov (United States)

    Loveland, Jerome; Numanoglu, Alp; Hay, Sameh Abdel

    2012-05-01

    The second largest and most populous continent, with an exploding pediatric population, Africa has an overwhelming burden on its very limited pediatric surgical services. In an international environment of progressively advancing endoscopic and robotic surgical techniques, the authors focus on the current role of endoscopic surgery on the continent and explore the potential reasons for its delayed acceptance and implementation. They proceed to document the spectrum of what is available and, using their "African experience," expand on financially viable models of further rolling out these techniques, including discussion around suitable training models for surgeons and their teams. Copyright © 2012 Elsevier Inc. All rights reserved.

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

    Science.gov (United States)

    Shennib, H

    1999-11-01

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

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

    NARCIS (Netherlands)

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

    2008-01-01

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

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

    DEFF Research Database (Denmark)

    Jørgensen, Martin Kibsgaard; Kraus, Martin

    2017-01-01

    visual communication in training for robot-assisted minimally invasive surgery with da Vinci surgical systems. To make sure that our augmented reality system provides the best possible user experience, we investigated the video latency of the da Vinci surgical system and how the components of our system...

  9. Total Arterial Minimally Invasive Direct Coronary Artery Bypass Surgery Facilitated by the Trinity Clip Connector

    NARCIS (Netherlands)

    Stecher, David; Bronkers, Glenn; Höfer, Imo E.|info:eu-repo/dai/nl/267105649; Pasterkamp, Gerard|info:eu-repo/dai/nl/138488304; Buijsrogge, Marc P|info:eu-repo/dai/nl/24420098X

    2015-01-01

    OBJECTIVE: This pilot study evaluated the feasibility of total arterial minimally invasive direct coronary artery bypass surgery by using the Trinity Clip anastomotic connector in an acute porcine model. METHODS: In 3 pigs, the left and right internal thoracic arteries (LITA and RITA) were harvested

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

    Directory of Open Access Journals (Sweden)

    Tamer El Banna

    2014-03-01

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

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

    NARCIS (Netherlands)

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

    2008-01-01

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

  12. Minimally Invasive Dentistry

    Science.gov (United States)

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

  13. A magnetic levitation robotic camera for minimally invasive surgery: Useful for NOTES?

    Science.gov (United States)

    Di Lorenzo, Nicola; Cenci, Livia; Simi, Massimiliano; Arcudi, Claudio; Tognoni, Valeria; Gaspari, Achille Lucio; Valdastri, Pietro

    2017-06-01

    Minimally invasive surgery (MIS) is rising in popularity generating a revolution in operative medicine during the past few decades. Although laparoscopic techniques have not significantly changed in the last 10 years, several advances have been made in visualization devices and instrumentation. Our team, composed of surgeons and biomedical engineers, developed a magnetic levitation camera (MLC) with a magnetic internal mechanism dedicated to MIS. Three animal trials were performed. Porcine acute model has been chosen after animal ethical committee approval, and laparoscopic cholecystectomy, nephrectomy and hernioplastic repair have been performed. MLC permits to complete efficiently several two-port laparoscopy surgeries reducing patients' invasiveness and at the same time saving surgeon's dexterity. We strongly believe that insertable and softly tethered devices like MLS camera will be an integral part of future surgical systems, thus improving procedures efficiency, minimizing invasiveness and enhancing surgeon dexterity and versatility of visions angles.

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

    Science.gov (United States)

    Rothenberg, Steven S

    2015-02-01

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

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

    Science.gov (United States)

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

    2015-06-01

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

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

    Science.gov (United States)

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

    2015-01-01

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

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

    Directory of Open Access Journals (Sweden)

    Abbi Hamed

    2012-01-01

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

  18. From four-parathyroid gland exploration to a minimally invasive technique. Minimally invasive parathyroidectomy as a current approach in surgery for primary hyperparathyroidism.

    Science.gov (United States)

    Kobiela, Jarek; Łaski, Dariusz; Stróżyk, Aneta; Proczko-Markuszewska, Monika; Stefaniak, Tomasz; Sworczak, Krzysztof; Łachiński, Andrzej J; Śledziński, Zbigniew

    2014-01-01

    Complete surgical resection of hyperfunctioning parathyriod tissue is essential for the treatment of primary hyperparathyroidism. During recent years, minimally invasive surgery has been successfully applied in neck exploration, because of significant developments of guidance by intraoperative scans, the use of quick, intraoperative PTH assay, and also preoperative imaging procedures such as high resolution ultrasonography and sestamibi scintigraphy. The results of operations which are performed with minimally invasive techniques are comparable to those of conventional surgery, and provide advantages with regard to cosmetic result, length of hospitalisation, and reduced post-operative pain.

  19. [MITRAL VALVE REPAIR WITH MINIMALLY INVASIVE CARDIAC SURGERY APPROACH AS ROUTINE PRACTICE].

    Science.gov (United States)

    Okamoto, Kazuma; Kudo, Mikihiko; Shimizu, Hideyuki

    2016-03-01

    Although minimally invasive cardiac surgery (MICS) via right minithoracotomy is attracting attention as a minimally invasive approach in cardiac surgery, it has not become a standard, routine approach for mitral valve repair. Although it has spread rapidly in Germany (43%) and USA (20.4%), the proportion of MICS in isolated mitral valve repair still comprises only 15.6% of mitral valve repair surgeries in Japan. For safe, assured introduction of MICS as a routine approach under quality control for good surgical and mid- and long-term results, surgeons experienced in mitral valve repair who perform at least 10 mitral valve repairs per year are necessary. A team approach with surgeons, anesthesiologists, perfusionists, and nurses who are highly motivated is also important.

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

    Directory of Open Access Journals (Sweden)

    Maria Nau-Hermes

    2014-01-01

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

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

    Directory of Open Access Journals (Sweden)

    Pankaj Kandwal

    2012-01-01

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

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

    Directory of Open Access Journals (Sweden)

    Кipshidze A.A.

    2013-12-01

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

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

    OpenAIRE

    Beira, R.; L. Santos-Carreras; Rognini, G.; H. Bleuler; Clavel, R.

    2011-01-01

    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 cen...

  4. Variable Admittance Control Based on Fuzzy Reinforcement Learning for Minimally Invasive Surgery Manipulator

    OpenAIRE

    Du, Zhijiang; Wang, Wei; Yan, Zhiyuan; Dong, Wei; Wang, Weidong

    2017-01-01

    In order to get natural and intuitive physical interaction in the pose adjustment of the minimally invasive surgery manipulator, a hybrid variable admittance model based on Fuzzy Sarsa(?)-learning is proposed in this paper. The proposed model provides continuous variable virtual damping to the admittance controller to respond to human intentions, and it effectively enhances the comfort level during the task execution by modifying the generated virtual damping dynamically. A fuzzy partition de...

  5. Large Deflection Shape Sensing of a Continuum Manipulator for Minimally-Invasive Surgery

    OpenAIRE

    Liu, Hao; Farvardin, Amirhossein; Pedram, Sahba Aghajani; Iordachita, Iulian; TAYLOR, RUSSELL H.; Armand, Mehran

    2015-01-01

    Shape sensing techniques utilizing Fiber Bragg grating (FBG) arrays can enable real-time tracking and control of dexterous continuum manipulators (DCM) used in minimally invasive surgeries. For many surgical applications, the DCM may need to operate with much larger curvatures than what current shape sensing methods can detect. This paper proposes a novel shape sensor, which can detect a radius of curvature of 15 mm for a 35 mm long DCM. For this purpose, we used FBG sensors along with nitino...

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

    Science.gov (United States)

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

    2007-01-01

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

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

    Science.gov (United States)

    Best, Sara L; Cadeddu, Jeffery A

    2010-07-01

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

  8. The current role and the future of minimally invasive temporomandibular joint surgery.

    Science.gov (United States)

    González-García, Raúl

    2015-02-01

    Several open surgeries have been proposed for the treatment of internal derangement (ID) of the temporomandibular joint (TMJ), although minimally invasive temporomandibular joint surgery (MITMJS) plays a major role in the treatment of ID and has been widely used for the treatment of ID of the TMJ. Arthrocentesis, arthroscopic lysis and lavage, and operative or advanced arthroscopy are the 3 most relevant techniques for MITMJS; clear indications for their application and a detailed description of each technique are presented. Also, clinical outcomes for each technique from the most relevant studies in the literature are reported. Copyright © 2015 Elsevier Inc. All rights reserved.

  9. MIS-behavior: practical heuristics for precise pediatric minimally invasive surgery.

    Science.gov (United States)

    Blinman, Thane A

    2015-02-01

    Minimally invasive surgery (MIS) has changed pediatric urology and general surgery, offering less morbidity and new surgical options for many procedures. This promise goes unrealized when technical methods lag. Application of MIS in children is uneven after more than 2 decades of application. Principles of versatile and proficient technique may remain unstated and implicit in surgical training, often leaving surgical training an exercise in inference and imitation. This article describes some essential practical principles of precision MIS applied to patients of any size. Copyright © 2015 Elsevier Inc. All rights reserved.

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

    Institute of Scientific and Technical Information of China (English)

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

    2004-01-01

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

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

    Institute of Scientific and Technical Information of China (English)

    Philipp--Alexander Neumann; Emile Rijcken

    2016-01-01

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

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

    Science.gov (United States)

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

    2007-06-01

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

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

    LENUS (Irish Health Repository)

    Kavanagh, Dara O

    2012-05-01

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

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

    Science.gov (United States)

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

    2011-01-01

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

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

    Directory of Open Access Journals (Sweden)

    Feza Y Karakayali

    2015-01-01

    Full Text Available Background: Transanal endoscopic microsurgery is a minimally invasive technique that allows full-thickness resection and suture closure of the defect for large rectal adenomas, selected low-risk rectal cancers, or small cancers in patients who have a high risk for major surgery. Our aim, in the given prospective study was to report our initial clinical experience with TAMIS, and to evaluate its effects on postoperative anorectal functions. Materials and Methods: In 10 patients treated with TAMIS for benign and malignant rectal tumors, preoperative and postoperative anorectal function was evaluated with anorectal manometry and Cleveland Clinic Incontinence Score. Results: The mean distance of the tumors from the anal verge was 5.6 cm, and mean tumor diameter was 2.6 cm. All resection margins were tumor free. There was no difference in preoperative and 3-week postoperative anorectalmanometry findings; only mean minimum rectal sensory volume was lower at 3 weeks after surgery. The Cleveland Clinic Incontinence Score was normal in all patients except one which resolved by 6 weeks after surgery.The mean postoperative follow-up was 28 weeks without any recurrences. Conclusion: Transanal minimally invasive surgery is a safe and effective procedure for treatment of rectal tumors and can be performed without impairing anorectal functions.

  16. A fuzzy neural network sliding mode controller for vibration suppression in robotically assisted minimally invasive surgery.

    Science.gov (United States)

    Sang, Hongqiang; Yang, Chenghao; Liu, Fen; Yun, Jintian; Jin, Guoguang

    2016-12-01

    It is very important for robotically assisted minimally invasive surgery to achieve a high-precision and smooth motion control. However, the surgical instrument tip will exhibit vibration caused by nonlinear friction and unmodeled dynamics, especially when the surgical robot system is attempting low-speed, fine motion. A fuzzy neural network sliding mode controller (FNNSMC) is proposed to suppress vibration of the surgical robotic system. Nonlinear friction and modeling uncertainties are compensated by a Stribeck model, a radial basis function (RBF) neural network and a fuzzy system, respectively. Simulations and experiments were performed on a 3 degree-of-freedom (DOF) minimally invasive surgical robot. The results demonstrate that the FNNSMC is effective and can suppress vibrations at the surgical instrument tip. The proposed FNNSMC can provide a robust performance and suppress the vibrations at the surgical instrument tip, which can enhance the quality and security of surgical procedures. Copyright © 2016 John Wiley & Sons, Ltd.

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

    Science.gov (United States)

    Hollensteiner, Marianne; Fuerst, David; Schrempf, Andreas

    2014-01-01

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

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

    NARCIS (Netherlands)

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

    2002-01-01

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

  19. National trends in minimally invasive and open operative experience of graduating general surgery residents: implications for surgical skills curricula development?

    Science.gov (United States)

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

    2011-12-01

    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 pediatric surgery (P 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.

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

    Science.gov (United States)

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

    2017-03-01

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

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

    Directory of Open Access Journals (Sweden)

    J. Bredow

    2014-01-01

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

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

    Directory of Open Access Journals (Sweden)

    Allison Wyman

    2012-01-01

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

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

    Science.gov (United States)

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

    2013-03-01

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

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

    Science.gov (United States)

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

    2012-02-01

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

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

    Science.gov (United States)

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

    2017-04-01

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

  6. Shape Sensing Techniques for Continuum Robots in Minimally Invasive Surgery: A Survey.

    Science.gov (United States)

    Shi, Chaoyang; Luo, Xiongbiao; Qi, Peng; Li, Tianliang; Song, Shuang; Najdovski, Zoran; Fukuda, Toshio; Ren, Hongliang

    2017-08-01

    Continuum robots provide inherent structural compliance with high dexterity to access the surgical target sites along tortuous anatomical paths under constrained environments and enable to perform complex and delicate operations through small incisions in minimally invasive surgery. These advantages enable their broad applications with minimal trauma and make challenging clinical procedures possible with miniaturized instrumentation and high curvilinear access capabilities. However, their inherent deformable designs make it difficult to realize 3-D intraoperative real-time shape sensing to accurately model their shape. Solutions to this limitation can lead themselves to further develop closely associated techniques of closed-loop control, path planning, human-robot interaction, and surgical manipulation safety concerns in minimally invasive surgery. Although extensive model-based research that relies on kinematics and mechanics has been performed, accurate shape sensing of continuum robots remains challenging, particularly in cases of unknown and dynamic payloads. This survey investigates the recent advances in alternative emerging techniques for 3-D shape sensing in this field and focuses on the following categories: fiber-optic-sensor-based, electromagnetic-tracking-based, and intraoperative imaging modality-based shape-reconstruction methods. The limitations of existing technologies and prospects of new technologies are also discussed.

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

    Institute of Scientific and Technical Information of China (English)

    李进华; 王雪生; 邢元; 王树新; 李建民; 梁科

    2016-01-01

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

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

    Science.gov (United States)

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

    2016-03-01

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

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

    Institute of Scientific and Technical Information of China (English)

    Bradley J Champagne; Rohit Makhija

    2011-01-01

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

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

    Science.gov (United States)

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

    2015-03-01

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

  11. A review of medical robotics for minimally invasive soft tissue surgery.

    Science.gov (United States)

    Dogangil, G; Davies, B L; Rodriguez y Baena, F

    2010-01-01

    This paper provides an overview of recent trends and developments in medical robotics for minimally invasive soft tissue surgery, with a view to highlight some of the issues posed and solutions proposed in the literature. The paper includes a thorough review of the literature, which focuses on soft tissue surgical robots developed and published in the last five years (between 2004 and 2008) in indexed journals and conference proceedings. Only surgical systems were considered; imaging and diagnostic devices were excluded from the review. The systems included in this paper are classified according to the following surgical specialties: neurosurgery; eye surgery and ear, nose, and throat (ENT); general, thoracic, and cardiac surgery; gastrointestinal and colorectal surgery; and urologic surgery. The systems are also cross-classified according to their engineering design and robotics technology, which is included in tabular form at the end of the paper. The review concludes with an overview of the field, along with some statistical considerations about the size, geographical spread, and impact of medical robotics for soft tissue surgery today.

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

    Directory of Open Access Journals (Sweden)

    Diana Michele

    2011-01-01

    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.

  13. Patient body image, self-esteem, and cosmetic results of minimally invasive robotic cardiac surgery.

    Science.gov (United States)

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

    2017-03-01

    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.

  14. Pancreas-related complications following gastrectomy: systematic review and meta-analysis of open versus minimally invasive surgery.

    Science.gov (United States)

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

    2017-04-04

    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.

  15. Surgery Averted Using a Novel, Minimally Invasive Approach to Treat Very Severe Radial Artery Spasm

    Directory of Open Access Journals (Sweden)

    Anthony A. Cochet

    2017-01-01

    Full Text Available A 42-year-old male admitted with a non-ST elevation myocardial infarction was referred for invasive angiographic assessment. Based on preprocedural assessment, the right radial artery approach was selected. Despite possessing none of the consensus risk factors for radial artery spasm, in addition to receiving standard arterial spasm prophylaxis and conscious sedation, the patient suffered very severe radial artery spasm with initial catheter placement, resulting in entrapment of a 5 Fr pigtail catheter within the left ventricle. After exhausting traditional methods for resolution of radial artery spasm, surgical intervention appeared to be the only remaining option for removal of the entrapped catheter. Prior to committing to surgery, use of an axillary nerve block to hinder sympathetic vascular tone was suggested and attempted. This intervention resulted in atraumatic catheter removal. We present a case of very severe radial artery spasm refractory to customary interventions, alleviated with a novel, minimally invasive technique, which spared surgical intervention.

  16. Surgery Averted Using a Novel, Minimally Invasive Approach to Treat Very Severe Radial Artery Spasm.

    Science.gov (United States)

    Cochet, Anthony A; Bellin, Daniel A

    2017-01-01

    A 42-year-old male admitted with a non-ST elevation myocardial infarction was referred for invasive angiographic assessment. Based on preprocedural assessment, the right radial artery approach was selected. Despite possessing none of the consensus risk factors for radial artery spasm, in addition to receiving standard arterial spasm prophylaxis and conscious sedation, the patient suffered very severe radial artery spasm with initial catheter placement, resulting in entrapment of a 5 Fr pigtail catheter within the left ventricle. After exhausting traditional methods for resolution of radial artery spasm, surgical intervention appeared to be the only remaining option for removal of the entrapped catheter. Prior to committing to surgery, use of an axillary nerve block to hinder sympathetic vascular tone was suggested and attempted. This intervention resulted in atraumatic catheter removal. We present a case of very severe radial artery spasm refractory to customary interventions, alleviated with a novel, minimally invasive technique, which spared surgical intervention.

  17. Development and testing of a compact endoscope manipulator for minimally invasive surgery.

    Science.gov (United States)

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

    2005-01-01

    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.

  18. Gaze-contingent soft tissue deformation tracking for minimally invasive robotic surgery.

    Science.gov (United States)

    Mylonas, George P; Stoyanov, Danail; Deligianni, Fani; Darzi, Ara; Yang, Guang-Zhong

    2005-01-01

    The introduction of surgical robots in Minimally Invasive Surgery (MIS) has allowed enhanced manual dexterity through the use of microprocessor controlled mechanical wrists. Although fully autonomous robots are attractive, both ethical and legal barriers can prohibit their practical use in surgery. The purpose of this paper is to demonstrate that it is possible to use real-time binocular eye tracking for empowering robots with human vision by using knowledge acquired in situ. By utilizing the close relationship between the horizontal disparity and the depth perception varying with the viewing distance, it is possible to use ocular vergence for recovering 3D motion and deformation of the soft tissue during MIS procedures. Both phantom and in vivo experiments were carried out to assess the potential frequency limit of the system and its intrinsic depth recovery accuracy. The potential applications of the technique include motion stabilization and intra-operative planning in the presence of large tissue deformation.

  19. Transanal Minimally Invasive Surgery (TAMIS) to Treat Vesicorectal Fistula: A New Approach

    Science.gov (United States)

    Tobias-Machado, Marcos; Mattos, Pablo Aloisio Lima; Reis, Leonardo Oliveira; Juliano, César Augusto Braz; Pompeo, Antonio Carlos Lima

    2015-01-01

    ABSTRACT Purpose: Vesicorectal fistula is one of the most devastating postoperative complications after radical prostatectomy. Definitive treatment is difficult due to morbidity and recurrence. Despite many options, there is not an unanimous accepted approach. This article aimed to report a new minimally invasive approach as an option to reconstructive surgery. Materials and Methods: We report on Transanal Minimally Invasive Surgery (TAMIS) with miniLap devices for instrumentation in a 65 year old patient presenting with vesicorectal fistula after radical prostatectomy. We used Alexis® device for transanal access and 3, 5 and 11 mm triangulated ports for the procedure. The surgical steps were as follows: cystoscopy and implant of guide wire through fistula; patient at jack-knife position; transanal access; Identification of the fistula; dissection; vesical wall closure; injection of fibrin glue in defect; rectal wall closure. Results: The operative time was 240 minutes, with 120 minutes for reconstruction. No perioperative complications or conversion were observed. Hospital stay was two days and catheters were removed at four weeks. No recurrence was observed. Conclusions: This approach has low morbidity and is feasible. The main difficulties consisted in maintaining luminal dilation, instrumental manipulation and suturing. PMID:26689530

  20. Design of a piezoelectric inchworm actuator and compliant end effector for minimally invasive surgery

    Science.gov (United States)

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

    1999-06-01

    Recent advances in robotics, tele-robotics, smart material actuators, and mechatronics raise new possibilities for innovative developments in millimeter-scale robotics capable of manipulating objects only fractions of a millimeter in size. These advances can have a wide range of applications in the biomedical community. A potential application of this technology is in minimally invasive surgery (MIS). The focus of this paper is the development of a single degree of freedom prototype to demonstrate the viability of smart materials, force feedback and compliant mechanisms for minimally invasive surgery. The prototype is a compliant gripper that is 7-mm by 17-mm, made from a single piece of titanium that is designed to function as a needle driver for small scale suturing. A custom designed piezoelectric `inchworm' actuator drives the gripper. The integrated system is computer controlled providing a user interface device capable of force feedback. The design methodology described draws from recent advances in three emerging fields in engineering: design of innovative tools for MIS, design of compliant mechanisms, and design of smart materials and actuators. The focus of this paper is on the design of a millimeter-scale inchworm actuator for use with a compliant end effector in MIS.

  1. Myocardial protection during minimally invasive cardiac surgery through right mini-thoracotomy.

    Science.gov (United States)

    De Palo, Micaela; Guida, Pietro; Mastro, Florinda; Nanna, Daniela; Quagliara, Teresa A P; Rociola, Ruggiero; Lionetti, Giosuè; Paparella, Domenico

    2017-04-01

    Myocardial damage is an independent predictor of adverse outcome following cardiac surgery and myocardial protection is one of the key factors to achieve successful outcomes. Cardioplegia with Custodiol is currently the most used cardioplegia during minimally invasive cardiac surgery (MICS). Different randomized controlled trials compared blood and Custodiol cardioplegia in the context of traditional cardiac surgery. No data are available for MICS. The aim of this study was to compare the efficacy of cold blood versus Custodiol cardioplegia during MICS. We retrospectively evaluated 90 patients undergoing MICS through a right mini-thoracotomy in a three-year period. Myocardial protection was performed using cold blood (44 patients, CBC group) or Custodiol (46 patients, Custodiol group) cardioplegia, based on surgeon preference and complexity of surgery. The primary outcomes were post-operative cardiac troponin I (cTnI) and creatine kinase MB (CKMB) serum release and the incidence of Low Cardiac Output Syndrome (LCOS). Aortic cross-clamp and cardiopulmonary bypass times were higher in the Custodiol group. No difference was observed in myocardial injury enzyme release (peak cTnI value was 18±46 ng/ml in CBC and 21±37 ng/ml in Custodiol; p=0.245). No differences were observed for mortality, LCOS, atrial or ventricular arrhythmias onset, transfusions, mechanical ventilation time duration, intensive care unit and total hospital stay. Custodiol and cold blood cardioplegic solutions seem to assure similar myocardial protection in patients undergoing cardiac surgery through a right mini-thoracotomy approach.

  2. MINIMALLY INVASIVE SPINE SURGERY IN THE NUEVO HOSPITAL CIVIL DE GUADALAJARA "DR. JUAN I. MENCHACA"

    Directory of Open Access Journals (Sweden)

    MIGUEL ÁNGEL ANDRADE-RAMOS

    Full Text Available ABSTRACT Objective: To describe our experience on a case series treated with minimal invasive techniques in spine surgery, with short-term follow-up and identify complications. Methods: A prospective analysis was performed on 116 patients operated on by the same team from September 2015 to June 2016. Evaluating the short-term follow-up we registered the surgical time, bleeding, complications, hospital stay, pre- and postoperatively neurological status, as well as scales of disability and quality of life. Demographic and surgical procedure data were analyzed with SPSS version 20 program. Results: A total of 116 patients with a mean age of 49.7 + 15.7 (21-85 years underwent surgery being 76 (65% with lumbar conditions and 37 (32% with cervical conditions. The most common procedures were tubular discectomies (31, tubular bilateral decompression (17, lumbar MI-TLIFs (7, and anterior cervical discectomy and fusion (35. The mean blood loss was 50.6 cc, the hospital stay was 1.7 day, pre- and postoperative pain VAS were 7.4 % and 2.3%, respectively, pre- and postoperative Oswestry (ODI were 64.6% and 13.1%, respectively, pre- and postoperative SF-36 of 37.8% and 90.3%. There were no major complications, except for a surgical wound infection in diabetic patient and three incidental durotomies, one of these being a contained fistula, treated conservatively. Conclusions: The current tendency towards minimally invasive surgery has been justified on multiple studies in neoplastic and degenerative diseases, with the preservation of the structures that support the spine biomechanics. The benefits should not replace the primary objectives of surgery and its usefulness depends on the skills of the surgeon, pathology and the adequate selection of the techniques. We found that the tubular access allows developing techniques such as discectomy, corpectomy and fusion without limiting exposure, avoiding manipulation of adjacent structures, reducing complications and

  3. MINIMALLY INVASIVE SURGERY FOR GASTRIC CANCER: TIME TO CHANGE THE PARADIGM.

    Science.gov (United States)

    Barchi, Leandro Cardoso; Jacob, Carlos Eduardos; Bresciani, Cláudio José Caldas; Yagi, Osmar Kenji; Mucerino, Donato Roberto; Lopasso, Fábio Pinatel; Mester, Marcelo; Ribeiro-Júnior, Ulysses; Dias, André Roncon; Ramos, Marcus Fernando Kodama Pertille; Cecconello, Ivan; Zilberstein, Bruno

    2016-01-01

    Minimally invasive surgery widely used to treat benign disorders of the digestive system, has become the focus of intense study in recent years in the field of surgical oncology. Since then, the experience with this kind of approach has grown, aiming to provide the same oncological outcomes and survival to conventional surgery. Regarding gastric cancer, surgery is still considered the only curative treatment, considering the extent of resection and lymphadenectomy performed. Conventional surgery remains the main modality performed worldwide. Notwithstanding, the role of the minimally invasive access is yet to be clarified. To evaluate and summarize the current status of minimally invasive resection of gastric cancer. A literature review was performed using Medline/PubMed, Cochrane Library and SciELO with the following headings: gastric cancer, minimally invasive surgery, robotic gastrectomy, laparoscopic gastrectomy, stomach cancer. The language used for the research was English. 28 articles were considered, including randomized controlled trials, meta-analyzes, prospective and retrospective cohort studies. Minimally invasive gastrectomy may be considered as a technical option in the treatment of early gastric cancer. As for advanced cancer, recent studies have demonstrated the safety and feasibility of the laparoscopic approach. Robotic gastrectomy will probably improve outcomes obtained with laparoscopy. However, high cost is still a barrier to its use on a large scale. A cirurgia minimamente invasiva amplamente usada para tratar doenças benignas do aparelho digestivo, tornou-se o foco de intenso estudo nos últimos anos no campo da oncologia cirúrgica. Desde então, a experiência com este tipo de abordagem tem crescido, com o objetivo de fornecer os mesmos resultados oncológicos e sobrevivência à cirurgia convencional. Em relação ao câncer gástrico, o tratamento cirúrgico ainda é considerado o único tratamento curativo, considerando a extensão da

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

    Science.gov (United States)

    Denis, Daniel R; Hirt, Daniel; Shah, Saumya; Lu, Daniel C; Holly, Langston T

    2016-01-01

    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. Clinical and radiological outcomes of lumbar synovial cyst patients with and without spondylolisthesis were retrospectively compared. Pain outcomes were assessed with modified Macnab criteria. 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. 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.

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

    Science.gov (United States)

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

    2016-01-01

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

  6. [Evaluation of new minimally invasive techniques in gastrointestinal surgery and contemplation on health economics].

    Science.gov (United States)

    Wang, Xishan

    2017-07-25

    With the widespread introduction of minimally invasive surgery (MIS) in late 1987 by laparoscopic cholecystectomy, the practice and expectation of general surgery were changed forever. As the development of scientific technology, new techniques of MIS have sprung up all around the world. 3D laparoscopy surgery, natural orifice transluminal endoscopic surgery, da Vinci surgical system and other new technologies also need time to be verified, and this is the only way all new things should get though. They are very unique in their own right, and all have advantages and disadvantages. None of them is the best, but all of them can be the most suitable technology for a single patient, so we should keep an open mind instead of judging too much. At the same time we should be cautious, but do not exaggerate the advantages and obscure the drawbacks. Identifying the indications and the contraindications is the only way we can benefit the patients. In the pursuit of MIS ideas, as a surgeon, we should rely on advanced medical concepts, technology and equipment, under the premise of being beneficial to the patients, innovating in the norms, practicing in the innovation, seeking the truth in the practice, and moving on forever. In this chapter, author illustrates the history of MIS, evaluates some new gastrointestinal MIS techniques from various angles and makes some discussions on health economics, on purpose to offer some new understandings of new gastrointestinal MIS techniques, eventually benefiting the patients.

  7. Comparative study on early period of recovery between minimally invasive surgery total knee arthroplasty and minimally invasive surgery-quadriceps sparing total knee arthroplasty in Chinese patients

    Institute of Scientific and Technical Information of China (English)

    YU Jia-kuo; YU Chang-long; AO Ying-fang; GONG Xi; WANG Yong-jian; WANG Shu; XING Xie; CHEN Lian-xu; JU Xiao-dong

    2008-01-01

    Background Different kinds of minimally invasive surgery (MIS) procedures have now been used in total knee arthroplasty (TKA). Compared with traditional TKA procedure with a long skin incision, clinical studies showed MIS procedures had some advantages. Quadriceps sparing (QS) procedures are the most minimally invasive MIS procedure until now. This study was aimed to find the insertion types for Chinese patients' vastus medialis and if the QS procedure had some advantages in patients' early recovery.Methods Between February 2006 and May 2007, 120 consecutive patients underwent unilateral primary TKA under general anesthesia, among whom 14 patients were lost to follow-up, the remaining 106 cases were enrolled in this study. Among the 106 cases there were 85 right knees, 21 left knees (15 men and 91 women, with a mean age of 65.1±7.4 years); osteoarthritis in 97 patients (91.5%) and rheumatoid arthritis in 9 patients (8.5%). MIS TKA was performed in 49 cases (MIS TKA group), while MIS-QS TKA in 57 cases (MIS-QS TKA group). During the operation, the type Ⅰ, Ⅱ and Ⅲ insertions of the vastus medialis for all patients were recorded. Each knee was rated post-operatively according to the Hospital of Special Surgery (HSS) scoring system. Clinical follow-up was undertaken at 1 week, 2, 6, 12 and 24 weeks. Operating time and complications were recorded.Results There was no statistically significant difference between the two groups for gender distribution, age, left or right knee incidence, pre-operative diagnosis, incidence of varus or valgus deformity. Of the 106 cases there was 1 (0.9%) case with a type Ⅰ insertion of the vastus medialis, 4 (3.8%) cases with type Ⅱ insertions, 101 (95.3%) cases with type Ⅲ insertions. The HSS scoring was significantly different between the MIS-QS TKA group and MIS TKA group within the first two weeks post operation. From 2 weeks later to 24 weeks, no significant difference was found. The average operating time was (53.3±12

  8. [Minimally invasive surgery in pediatric patients within a general urology department].

    Science.gov (United States)

    Ríos, Jorge Subirá; Zalabardo, José Manuel Sánchez; Gil, Joaquín Navarro; Conejos, José Ignacio Hijazo; Alonso, Jesús García-Magariño; Calero, David García; López, José Antonio López; Uría, José Gabriel Valdivia

    2008-01-01

    The advances of minimally invasive surgery in urology over the last years have enabled a progressive and constant implementation of endourology and laparoscopy in pediatric patients. We perform a review of our experience, as a general hospital, with minimally invasive surgery performed in pediatric patients over the last ten years. We retrospectively analyzed the endourological and laparoscopic operations performed between 1997 and 2007 in children up to the age of 16 years, collecting data about patient's age and gender, type of disease, techniques, anesthesia, and perioperative events. seventy-two surgical operations were performed in patients with an age range between 28 days and 16 years, with a mean age of 6.8 years. 56% of the patients were boys and 44% girls. Indications for surgery was vesicoureteral reflux (VUR) in 28 cases (38.8%); lithiasis 17 cases (23.6%) which were distributed in 4 cystolithotripsies, 9 ureterorenoscopy with lithotripsy, one pure percutaneous nephrolithotomy and three mixed; ureterocele 9 cases (12.5%); urethral obstruction 7 cases (9.7%); 3 diagnostic laparoscopies for cryptorchidism (4. 1%), 2 laparoscopic procedures for cystic pathology (2.7%), another 2 laparoscopic renal biopsies (2.7%), and one laparoscopic repair of a ureteropyelic junction syndrome; 1 case of emergency percutaneous nephrostomy in the supine position after open pyeloplasty with subsequent reoperation with percutaneous resection of a granuloma; and 1 case of botulin toxin injection into the detrusor muscle. The consolidation of pediatric endourology in our department, and more recently laparoscopy, has contributed to improve the quality of care in pediatric patients; it has been achieved thanks to our previous know-how in general endourological techniques and the existence of adequate technical and human resources.

  9. Minimally invasive periodontal therapy.

    Science.gov (United States)

    Dannan, Aous

    2011-10-01

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

  10. Laparoscopic endoscopic cooperative surgery as a minimally invasive treatment for gastric submucosal tumor

    Institute of Scientific and Technical Information of China (English)

    Tsutomu; Namikawa; Kazuhiro; Hanazaki

    2015-01-01

    Laparoscopic wedge resection is a useful procedure fortreating patients with submucosal tumor(SMT) including gastrointestinal stromal tumor(GIST) of the stomach. However, resection of intragastric-type SMTs can be problematic due to the difficulty in accurately judging the location of endoluminal tumor growth, and often excessive amounts of healthy mucosa are removed; thus, full-thickness local excision using laparoscopic and endoscopic cooperative surgery(LECS) is a promising procedure for these cases. Our experience with LECS has confirmed this procedure to be a safe, feasible, and minimally invasive treatment method for gastric GISTs less than 5 cm in diameter, with outcomes similar to conventional laparoscopic wedge resection. The important advantage of LECS is the reduction in the resected area of the gastric wall compared to that in conventional laparoscopic wedge resection using a linear stapler. Early gastric cancer fits the criteria for endoscopic resection; however, if performing endoscopic submucosal dissection is difficult, the LECS procedure might be a good alternative. In the future, LECS is also likely to be indicated for duodenal tumors, as well as gastric tumors. Furthermore, developments in endoscopic and laparoscopic technology have generated various modified LECS techniques, leading to even less invasive surgery.

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

    Energy Technology Data Exchange (ETDEWEB)

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

    2008-04-15

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

  12. Variable Admittance Control Based on Fuzzy Reinforcement Learning for Minimally Invasive Surgery Manipulator.

    Science.gov (United States)

    Du, Zhijiang; Wang, Wei; Yan, Zhiyuan; Dong, Wei; Wang, Weidong

    2017-04-12

    In order to get natural and intuitive physical interaction in the pose adjustment of the minimally invasive surgery manipulator, a hybrid variable admittance model based on Fuzzy Sarsa(λ)-learning is proposed in this paper. The proposed model provides continuous variable virtual damping to the admittance controller to respond to human intentions, and it effectively enhances the comfort level during the task execution by modifying the generated virtual damping dynamically. A fuzzy partition defined over the state space is used to capture the characteristics of the operator in physical human-robot interaction. For the purpose of maximizing the performance index in the long run, according to the identification of the current state input, the virtual damping compensations are determined by a trained strategy which can be learned through the experience generated from interaction with humans, and the influence caused by humans and the changing dynamics in the robot are also considered in the learning process. To evaluate the performance of the proposed model, some comparative experiments in joint space are conducted on our experimental minimally invasive surgical manipulator.

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

    Science.gov (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

    2008-09-01

    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. Video-atlas on minimally invasive mitral valve surgery-The David Adams technique.

    Science.gov (United States)

    Castillo, Javier G; Milla, Federico; Anyanwu, Anelechi C; Adams, David H

    2013-11-01

    Median sternotomy has unquestionably evolved over recent decades. Modern sternotomy involves a 7-8 cm lower midline skin incision, tunneling of the subcutaneous tissues with subsequent creation of myocutaneous flaps, full sternotomy, and standard cardiopulmonary bypass techniques with central cannulation. In experienced centers, modern sternotomy may achieve all the goals of minimally invasive surgery, including excellent cosmesis, excellent postoperative pain control, low rates of bleeding and transfusion (our re-exploration rate for bleeding is <1%), and the ability to perform any reconstructive technique that would be used in a standard sternotomy, with very high repair rates (our most recent series documented a repair rate exceeding 99% in an all-comers population of degenerative disease regardless of complexity).

  15. Minimally invasive coronary bypass surgery: postoperative pain management using intermittent bupivacaine infiltration.

    Science.gov (United States)

    Borges, M F; Coulson, A S

    1998-04-01

    Minimally invasive direct coronary artery bypass grafting (MIDCAB) is becoming a popular adjunct to standard cardiac bypass surgery in selected patients with accessible single or double vessel disease. However, the limited anterior thoracotomy used to access the heart involves trauma to the muscle tissue during removal of the fourth costal cartilage and a small piece of connected rib, perhaps leading to more severe postoperative pain compared with patients undergoing routine sternotomy. Intrathecal opioids can be used but have limited therapeutic duration and there is concern regarding anticoagulation. We present a case where soft tissue catheters were placed into the depths of the surgical wounds and pain was diminished greatly by intermittent regular infiltration with bupivacaine.

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

    Science.gov (United States)

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

    2007-06-01

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

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

    Science.gov (United States)

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

    2012-05-01

    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. Design and preliminary in vivo validation of a robotic laparoscope holder for minimally invasive surgery.

    Science.gov (United States)

    Herman, Benoît; Dehez, Bruno; Duy, Khanh Tran; Raucent, Benoît; Dombre, Etienne; Krut, Sébastien

    2009-09-01

    Manual manipulation of the camera is a major source of difficulties encountered by surgeons while performing minimally invasive laparoscopic surgery. A survey of laparoscopic procedures and a review of existing active and passive holders were conducted. Based on these analyses, essential requirements were highlighted for such devices. Pursuant to this, a novel active laparoscope manipulator was designed, paying particular attention to ergonomics and ease of use. Several trials on the pelvitrainer and a first in vivo procedure were performed to validate the original design of our device. Phantom experiments demonstrated ease of use of the robot and advantages of the intuitive joystick with omnidirectional displacements and speed control. The compactness of the device and image stability were appreciated during the surgical trial. A novel robotic laparoscope holder has been developed and produced. An in vivo trial proved its value in clinical practice, enabling surgeons to work more comfortably.

  19. Large Deflection Shape Sensing of a Continuum Manipulator for Minimally-Invasive Surgery.

    Science.gov (United States)

    Liu, Hao; Farvardin, Amirhossein; Pedram, Sahba Aghajani; Iordachita, Iulian; Taylor, Russell H; Armand, Mehran

    2015-05-26

    Shape sensing techniques utilizing Fiber Bragg grating (FBG) arrays can enable real-time tracking and control of dexterous continuum manipulators (DCM) used in minimally invasive surgeries. For many surgical applications, the DCM may need to operate with much larger curvatures than what current shape sensing methods can detect. This paper proposes a novel shape sensor, which can detect a radius of curvature of 15 mm for a 35 mm long DCM. For this purpose, we used FBG sensors along with nitinol wires as the supporting substrates to form a triangular cross section. For verification, we assembled the sensor inside the wall of the DCM. Experimental results indicate that the proposed sensor can detect the DCM's curvature with an average error of 3.14%.

  20. Minimally invasive cardiac surgery in the adult: surgical instruments, equipment, and techniques.

    Science.gov (United States)

    Kitamura, M; Uwabe, K; Hirota, J; Kawai, A; Endo, M; Koyanagi, H

    1998-09-01

    To clarify the special instruments and equipment used for minimally invasive cardiac surgery (MICS), we examined the initial experiences with MICS operations with ministernotomy or minithoracotomy at our institution. Fifty adult patients with congenital, valvular, and/or ischemic heart diseases underwent MICS operations, and all surgical procedures were completed without conversion to full sternotomy. The length of the skin incision was about 10 cm or less in all patients. Postoperative recovery was favorable, and the majority of the patients were discharged from the hospital around the end of the second postoperative week. In this series of patients, an oscillating bone saw, lifting type retractor, 2 blade spreader, cannula with a balloon, and right-angled aortic clamp among other items, were very useful for successfully performing various operations with MICS approaches and techniques. The associated results suggest that MICS with ministernotomy or minithoracotomy was feasible using special instruments and equipment and could be encouraged for adult patients with various cardiovascular diseases.

  1. Overview of Photogrammetric Measurement Techniques in Minimally Invasive Surgery Using Endoscopes

    Science.gov (United States)

    Conen, N.; Luhmann, T.

    2017-05-01

    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.

  2. Four-dimensional modeling of the heart for image guidance of minimally invasive cardiac surgeries

    Science.gov (United States)

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

    2004-05-01

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

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

    Directory of Open Access Journals (Sweden)

    Giuseppe Tortora

    2014-03-01

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

  4. Ergonomic deficiencies in the operating room: examples from minimally invasive surgery.

    Science.gov (United States)

    Matern, Ulrich

    2009-01-01

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

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

    Science.gov (United States)

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

    2016-01-01

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

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

    Directory of Open Access Journals (Sweden)

    Nicolas Wachter

    2016-01-01

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

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

    Directory of Open Access Journals (Sweden)

    Vishal Sarwahi

    2015-01-01

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

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

    Directory of Open Access Journals (Sweden)

    Chun-Hsiang Peng

    2014-05-01

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

  9. 3. Early outcomes of minimally invasive versus conventional mitral valve surgery in mitral valve diseases. A single institutional experience

    Directory of Open Access Journals (Sweden)

    E. Nourelden

    2016-07-01

    Full Text Available Minimally invasive techniques in cardiac surgery gained popularity due to many advantages like less postoperative pain, minimal blood loss, less hospital stay, less cost. Minimally invasive mitral valve surgery through right anterolateral mini thoracotomy became safe technique. In our study we compared mini-MV surgery with conventional technique regarding cross clamp time, bypass time, total blood loss, reopening for bleeding, and hospital and ICU length of stay. In our institution between 2010 and 2015, 147patients underwent minimally invasive mitral surgery through right lateral minithoracotomy 8 cm incision and 118 patient underwent conventional mitral valve surgery through median sternotomy in minimally invasive technique: mean age was 38 ± 20 vs 59 ± 21, 70.7% were female (n = 104 vs 39.8% (n = 47, 23.8% were associated with tricuspid valve regurgitation (n = 33 vs 55% in conventional technique (n = 65, 0.08% were able to use endovascular clamp (n = 12, mean Euroscore predected risk of mortality 14.7 ± 13.6% vs 8.7 ± 10.9%. Minimally invasive mitral valve repair surgery was accomplished in 77.5% (n = 114 vs 46.15% (n = 55 and replacement of mitral valve in 22.4% (n = 30 vs 53.8% (n = 64 , concomitant procedures consists of tricuspid valve surgery in 23.8% (n = 35 vs 55% (n = 65, primary mitral valve repair included implantation of rigid annuloplasty ring in 79.6% vs 38.9% (n = 46, duration of cardiopulmonary bypass in minimally invasive surgery was 123 ± 64 min vs 116 ± 62 min, cross clamp time was 64 ± 27 min vs 59 ± 23 min, postoperative mechanical ventilation time 4 ± 1.5 h vs 6.5 ± 2 h, ICU lenght of stay (LOS was 48 ± 12 h vs 3 ± 1 days. Minimally invasive mitral surgery can be performed very safely with excellent early results. mini-MV surgery can be performed with a reasonable operative time, good perioperative course with decrease in postoperative ICU and hospital

  10. Design and Fabrication of an Elastomeric Unit for Soft Modular Robots in Minimally Invasive Surgery.

    Science.gov (United States)

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

    2015-11-14

    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%.

  11. The design of the robot assisted magnetic resonance imaging guidance for minimally invasive surgery system

    Institute of Scientific and Technical Information of China (English)

    Shao Bing; Sun Lining; Du Zhijiang; Fu Lixin

    2005-01-01

    Robot assisted Minimally Invasive Surgery (MIS) is one of the rapidestdeveloping directions in the current surgical realm. Magnetic Resonance Imaging(MRI) is an optimal imaging modality which was applied in MIS in recent years. By combination of precise positioning to the target by intra-operative MRI guided surgery and dexterous motion by the robot, safe and smooth operation is expected to be performed. An overview of the MRI-guided robotic system for MIS is offered. The design of the intra-operative MR scanner system is described. The MR-compatible robotic system is carefully designed for safety and sterilization issues. This system unifies image information from open MRI, an optical endoscope and conventional vital-sign detectors. It helps and guides the surgeon and other medical staffs so they can make the right decisions. The high-performance manipulator can mimic the movement of the urgeon's hand precisely. And the analysis for active and passive interventional surgical instrument tracking is provided.

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

    Science.gov (United States)

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

    2015-06-01

    In this study, we developed a novel four-degrees-of-freedom haptic master using controllable magnetorheological (MR) fluid. We also integrated the haptic master with a vision device with image processing for robot-assisted minimally invasive surgery (RMIS). The proposed master can be used in RMIS as a haptic interface to provide the surgeon with a sense of touch by using both kinetic and kinesthetic information. The slave robot, which is manipulated with a proportional-integrative-derivative controller, uses a force sensor to obtain the desired forces from tissue contact, and these desired repulsive forces are then embodied through the MR haptic master. To verify the effectiveness of the haptic master, the desired force and actual force are compared in the time domain. In addition, a visual feedback system is implemented in the RMIS experiment to distinguish between the tumor and organ more clearly and provide better visibility to the operator. The hue-saturation-value color space is adopted for the image processing since it is often more intuitive than other color spaces. The image processing and haptic feedback are realized on surgery performance. In this work, tumor-cutting experiments are conducted under four different operating conditions: haptic feedback on, haptic feedback off, image processing on, and image processing off. The experimental realization shows that the performance index, which is a function of pixels, is different in the four operating conditions.

  13. Minimal invasive ear, nose and throat surgery--advances through modern technologies.

    Science.gov (United States)

    Plinkert, P K; Baumann, I

    1997-01-01

    Three fundamentals have to be fulfilled to optimize minimally invasive surgery: three-dimensional imaging, free maneuverability of the instruments, sensorial feedback. Projection of two pictures from a stereoendoscope and subsequent separation with a LCD shutter allows three-dimensional videoendoscopy to be performed. A high frequency shutter technique (100/120 Hz) presents pictures from the two video cameras to the right and left eye, respectively, so that the surgeon has spatial vision of the operative field. Steerable instruments have four components: a control unit, rigid shaft, steerable multijoint, distal effector. The steerable multijoints give two additional degrees of freedom compared to conventional rigid instruments in endoscopic surgery. For intuitive movements, however, an electronic control system is necessary that is comparable to the "master slave" priniciple in remote technology. A remote manipulator system with six degrees of freedom is now available. Additionally, a multifunctional distal tip permits different surgical steps to be performed without changing the instrument. For better control of the instrument and the operative procedure tactile feedback can be achieved with appropriate microsensor system. Recent projects suggest that an artificial sensor system can be established within the foreseeable future.

  14. Minimally invasive surgery for pyriform sinus fistula by transoral videolaryngoscopic surgery.

    Science.gov (United States)

    Kamide, Daisuke; Tomifuji, Masayuki; Maeda, Mayuka; Utsunomiya, Kazuho; Yamashita, Taku; Araki, Koji; Shiotani, Akihiro

    2015-01-01

    Pyriform sinus fistula is a rare branchial anomaly that manifests as recurrent cervical infection resulting from contamination of the fistula internal orifice in the pyriform sinus. Although open neck surgery to resect the fistula has been recommended as a definitive treatment, identifying the fistula within the scar is difficult and occasionally results in recurrence. Here, we describe a novel transoral surgical technique for pyriform sinus fistula using transoral videolaryngoscopic surgery (TOVS) as a definitive treatment to resect and close the fistula without skin incision. Needle cautery enables fine excision and delicate dissection of the fistula tract. TOVS is a safe, easy, and reliable treatment and is a suitable first line treatment.

  15. Automatic prebent customized prosthesis for pectus excavatum minimally invasive surgery correction.

    Science.gov (United States)

    Vilaça, João L; Rodrigues, Pedro L; Soares, Tony R; Fonseca, Jaime C; Pinho, António C M; Henriques-Coelho, Tiago; Correia-Pinto, Jorge

    2014-06-01

    Pectus excavatum is the most common deformity of the thorax. A minimally invasive surgical correction is commonly carried out to remodel the anterior chest wall by using an intrathoracic convex prosthesis in the substernal position. The process of prosthesis modeling and bending still remains an area of improvement. The authors developed a new system, i3DExcavatum, which can automatically model and bend the bar preoperatively based on a thoracic CT scan. This article presents a comparison between automatic and manual bending. The i3DExcavatum was used to personalize prostheses for 41 patients who underwent pectus excavatum surgical correction between 2007 and 2012. Regarding the anatomical variations, the soft-tissue thicknesses external to the ribs show that both symmetric and asymmetric patients always have asymmetric variations, by comparing the patients' sides. It highlighted that the prosthesis bar should be modeled according to each patient's rib positions and dimensions. The average differences between the skin and costal line curvature lengths were 84 ± 4 mm and 96 ± 11 mm, for male and female patients, respectively. On the other hand, the i3DExcavatum ensured a smooth curvature of the surgical prosthesis and was capable of predicting and simulating a virtual shape and size of the bar for asymmetric and symmetric patients. In conclusion, the i3DExcavatum allows preoperative personalization according to the thoracic morphology of each patient. It reduces surgery time and minimizes the margin error introduced by the manually bent bar, which only uses a template that copies the chest wall curvature.

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

    Institute of Scientific and Technical Information of China (English)

    ZHAO Jing; LUO Li; XIAO Li-jun; GU Ling-yun; SUN Tian-sheng

    2013-01-01

    Background 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.Methods 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 234adolescents 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.Results There was a significant difference in the relapse rate for funnel chest in the different age groups (x2=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<0.01),with a higher 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

  17. Technical advances in minimally invasive surgery: direct decompression for lumbar spinal stenosis.

    Science.gov (United States)

    Lauryssen, Carl

    2010-12-15

    Literature review, technique overview, prospective and retrospective data analysis. To review current minimally invasive surgery (MIS) methods of decompression for lumbar spinal stenosis and present a decompression technique using a flexible microblade shaver system. Several MIS decompression techniques for stenosis have been developed to minimize damage to soft tissues and reduce the amount of posterior element resection. Decompression using linearly configured instruments may not be able to adequately address stenosis in the neural foramen. A flexible microblade shaver system is able to traverse the foramen, removing bone and ligament, using a ventral to dorsal approach, rather than medial to lateral. This enables it to effectively decompress the lateral recess and neural foramen while sparing posterior structures. Brief literature review of current MIS decompression techniques is presented. MIS decompression using a flexible microblade shaver system is described with 1 year outcomes from a small pilot study and a retrospective chart review at 2 centers. A small postmarket pilot study (n = 9) with 1 year results showed positive patient outcomes using Visual Analog Scale (decrease by 73%), Oswestry Disability Index(50% improvement), Zurich Claudication Questionnaire physical function and symptom severity (improved by 72% and 31%, respectively), and Short-Form 36 (SF-36) Physical Component Score (36% improvement). Sixty-seven patients from a retrospective chart review at 2 centers had an average of 2 levels per patient decompressed using a flexible microblade shaver system. No patient has returned for additional surgery and there have been no cases of neurologic impairment. Current decompression techniques may result in inadequate decompression of the neural foramen or excessive resection of the facet joint. MIS decompression using a flexible microblade shaver system represents a way to perform an effective, facet-preserving decompression for patients with lumbar

  18. Minimally invasive lumbar interbody fusion via MAST Quadrant retractor versus open surgery: a prospective randomized clinical trial

    Institute of Scientific and Technical Information of China (English)

    WANG Hong-li; L(U) Fei-zhou; JIANG Jian-yuan; MA Xin; XIA Xin-lei; WANG Li-xun

    2011-01-01

    Background In recent years,a variety of minimally invasive lumbar surgery techniques have achieved desirable efficacy,but some dispute remains regarding the advantages over open surgery.This study aimed to compare minimally invasive lumbar interbody fusion via MAST Quadrant retractor with open surgery in terms of perioperative factors,postoperative back muscle function,and 24-month postoperative follow-up results.Methods From September 2006 to June 2008,patients with single-level degenerative lumbar spine disease who were not responsive to conservative treatment were enrolled in this study.Patients were randomized to undergo either minimally invasive surgery (MIS,transforaminal lumbar interbody fusion via MAST Quadrant retractor,41 cases) or open surgery (improved transforaminal lumbar interbody fusion,38 cases).Results The MIS group had longer intraoperative fluoroscopy time than the open surgery group,and the open surgery group had significantly increased postoperative drainage volume and significantly prolonged postoperative recovery time compared with the MIS group (P <0.05 for all).MRI scanning showed that the T2 relaxation time in the multifidus muscle was significantly shorter in the MIS group than in the open surgery group at 3 months after surgery (P <0.01).Surface electromyography of the sacrospinalis muscle showed that the average discharge amplitude and frequency were significantly higher in the MIS group than in the open surgery group (P <0.01).The Oswestry disability index and visual analog scale scores were better at 3,6,12 and 24 months postoperatively than preoperatively in both groups.Both groups of patients met the imaging convergence criteria at the last follow-up.Conclusions MIS can effectively reduce sacrospinalis muscle injury compared with open surgery,which is conducive to early functional recovery.In the short term,MIS is superior to open surgery,but in the long term there is no significant difference between the two procedures.

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

    NARCIS (Netherlands)

    Jaspers, J.E.N.

    2006-01-01

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

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

    NARCIS (Netherlands)

    Jaspers, J.E.N.

    2006-01-01

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

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

    NARCIS (Netherlands)

    Jaspers, J.E.N.

    2006-01-01

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

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

    Directory of Open Access Journals (Sweden)

    Saeid Amini-Nik

    comparison of wound healing responses to a conventional surgical laser, and standard mechanical instruments shows far less damage and near absence of scar formation by using PIRL laser. This new laser source appears to have achieved the long held promise of lasers in minimally invasive surgery.

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

    Science.gov (United States)

    Amini-Nik, Saeid; Kraemer, Darren; Cowan, Michael L; Gunaratne, Keith; Nadesan, Puviindran; Alman, Benjamin A; Miller, R J Dwayne

    2010-09-28

    healing responses to a conventional surgical laser, and standard mechanical instruments shows far less damage and near absence of scar formation by using PIRL laser. This new laser source appears to have achieved the long held promise of lasers in minimally invasive surgery.

  4. A study of the prevalence of musculoskeletal disorders in surgeons performing minimally invasive surgery.

    Science.gov (United States)

    Gutierrez-Diez, Maria C; Benito-Gonzalez, Maria A; Sancibrian, Ramon; Gandarillas-Gonzalez, Marco A; Redondo-Figuero, Carlos; Manuel-Palazuelos, Jose C

    2017-09-15

    Minimally invasive surgery (MIS) has shown significant benefits for patients and healthcare systems. However, due to the poor ergonomic adaptation of operating rooms and surgical instruments, most surgeons suffer from pain caused by musculoskeletal disorders (MSDs). A descriptive survey on MIS surgeons working in different surgical specialties has been carried out in Hospital Valdecilla (Spain). The aim is to determine the prevalence of MSDs using a personal interview and the standardized Nordic questionnaire. The study determines the prevalence of MSDs in different parts of the body and their relationship with epidemiological and labor variables. A questionnaire was filled out by 129 surgeons. 90% of surgeons reported MSDs. The higher prevalence appears in the most experienced surgeons. The most affected zones are the lower back (54%), neck (51%), upper back (44%), lower extremities (42%), right shoulder (29%) and right hand (28%). The prevalence of MSDs is higher in MIS surgeons than in any other occupational group. The most vulnerable group is experienced surgeons and there is a potential risk that symptoms will be increased in the future. Muscle strength is revealed as a protective factor against MSDs.

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

    Science.gov (United States)

    I, Botezatu; D, Laptoiu

    2016-01-01

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

  6. Design and control of MR haptic master/slave robot system for minimally invasive surgery

    Science.gov (United States)

    Uhm, Chang-Ho; Nguyen, Phoung Bac; Choi, Seung-Bok

    2013-04-01

    In this work, magnetorheological (MR) haptic master and slave robot for minimally invasive surgery (MIS) have been designed and tested. The proposed haptic master consists of four actuators; three MR brakes featuring gimbal structure for 3-DOF rotation motion(X, Y and Z axes) and one MR linear actuator for 1-DOF translational motion. The proposed slave robot which is connected with the haptic master has vertically multi- joints, and it consists of four DC servomotors; three for positioning endoscope and one for spinning motion. We added a fixed bar with a ball joint on the base of the slave for the endoscope position at the patient's abdomen to maintain safety. A gimbal structure at the end of the slave robotic arm for the last joint rotates freely with respect to the pivot point of the fixed bar. This master-slave system runs as if a teleoperation system through TCP/IP connection, programmed by LabVIEW. In order to achieve the desired position trajectory, a proportional-integral-derivative (PID) controller is designed and implemented. It has been demonstrated that the effective tracking control performances for the desired motion are well achieved and presented in time domain. At last, an experiment in virtual environments is undertaken to investigate the effectiveness of the MR haptic master device for MIS system.

  7. Design and Integration of a Telerobotic System for Minimally Invasive Surgery of the Throat

    Science.gov (United States)

    Simaan, Nabil; Xu, Kai; Kapoor, Ankur; Wei, Wei; Kazanzides, Peter; Flint, Paul; Taylor, Russell

    2009-01-01

    This paper presents the clinical motivation, design specifications, kinematics, statics, and actuation compensation for a newly constructed telerobotic system for Minimally Invasive Surgery (MIS) of the throat. A hybrid dual-arm telesurgical slave, with twenty joint-space Degrees of Freedom (DoF), is used in this telerobotic system to provide the necessary dexterity in deep surgical fields such as the throat. The telerobotic slave uses novel continuum robots that use multiple super-elastic backbones for actuation and structural integrity. The paper presents the kinematics of the telesurgical slave and methods for actuation compensation to cancel the effects of backlash, friction, and flexibility of the actuation lines. A method for actuation compensation is presented in order to overcome uncertainties of modeling, friction, and backlash. This method uses a tiered hierarchy of two novel approaches of actuation compensation for remotely actuated snake-like robots. The tiered approach for actuation compensation uses compensation in both joint space and configuration space of the continuum robots. These actuation hybrid compensation schemes use intrinsic model information and external data through a recursive linear estimation algorithm and involve compensation using configuration space and joint space variables. Experimental results validate the ability of our integrated telemanipulation system through experiments of suturing and knot tying in confined spaces. PMID:20160881

  8. Cirugía mínimamente invasiva en craneoestenosis Minimal invasive surgery in craniostenosis

    Directory of Open Access Journals (Sweden)

    E. Ochoa Díaz López

    2006-09-01

    Full Text Available En el presente trabajo se describe la experiencia en craneoestenosis con cirugía mínimamente invasiva, evaluando el diseño y eficacia de un nuevo craneotomo en cadáveres así como su aplicación clínica en un caso de sinostósis sagital con instrumentación endoscópica. Este procedimiento es sin duda un gran recurso en el tratamiento de las craneoestenosis brindando los beneficios de la cirugía mínimamente invasiva, eliminando la necesidad de grandes incisiones, disminuyendo el sangrado quirúrgico, reduciendo estancia hospitalaria y disminuyendo la morbilidad operatoriaIn this paper, we describe the experience with the use of endoscopic craniofacial procedures, evaluating the design and the efficacy of a new craniotome in cadavers and his clinical application in a case of sagittal synostosis for an endoscopic assisted cranioplasty. This procedure is a great option in the treatment of craniosynostosis, giving the benefits of minimal invasive surgery and eliminating the needing of big incisions, long hospital stay and reducing the postoperative morbidity

  9. A novel linear elastic actuator for minimally invasive surgery: development of a surgical gripper

    Science.gov (United States)

    Gerboni, G.; Brancadoro, M.; Tortora, G.; Diodato, A.; Cianchetti, M.; Menciassi, A.

    2016-10-01

    Minimally invasive surgery (MIS) applications require lightweight actuators that can generate a high force in a limited volume. Among pressure driven actuators, fluid elastic actuators demonstrate high potential for use in the medical field. They are characterized by nearly no friction and wear and they can be made of low-cost biocompatible elastomers. However, when compared to traditional piston-cylinder fluid actuators, fluid elastic actuators often result in smaller output forces as well as weaker return forces. This work is about the design of a linear elastic actuator (LEA) which is able to develop relevant pulling-pushing force in one direction. The LEA is composed of entirely disposable materials and it requires a simple manufacturing process. Thanks to its design, the LEA can be compared to traditional piston-cylinders actuators in terms of output forces (up to 7 N) with the advantage of using relative low working pressures (0, 2 MPa). The actuator has been used for the actuation of a gripper for MIS, as a case study. The whole range of gripping forces developed by the tool actated by the LEA has been evaluated, thus verifying that the gripping device, is able to meet the force requirements for accomplishing typical surgical tasks.

  10. Assessment parameters for a novel simulator in minimally invasive spine surgery.

    Science.gov (United States)

    Fuerst, David; Hollensteiner, Marianne; Schrempf, Andreas

    2015-01-01

    Surgical simulators provide a safe environment where novice surgeons can acquire their surgical skills. Although the number of patients with diseases of the musculoskeletal system is growing, the development of orthopedic simulators is still in it's infancy. The aim of this work was to identify simulation-based assessment parameters for a novel simulator in minimally invasive spine surgery. Apart from parameters targeting the duration and the surgeon's economy of motion during percutaneous bone access, parameters characterizing the movement smoothness were also examined with respect to their suitability. The results indicated, that the overall duration, the number of instrument movements, the number of velocity peaks and the Movement Arrest Period Ratio are the most promising predictors of expertise. Targeting performance improvement, the overall duration (p = 0.001), the number of instrument movements (p = 0.003) and the traveled instrument path length (p = 0.009) detected significant differences between subsequent trials. Using these parameters, a study can be designed targeting the validity and reliability of the simulation-based assessment.

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

    Directory of Open Access Journals (Sweden)

    R. Beira

    2011-01-01

    Full Text Available The large volume and reduced dexterity of current surgical robotic systems are factors that restrict their effective performance. To improve the usefulness of surgical robots in minimally invasive surgery (MIS, a compact and accurate positioning mechanism, named Dionis, is proposed in this paper. This spatial hybrid mechanism based on a novel parallel kinematics is able to provide three rotations and one translation for single port procedures. The corresponding axes intersect at a remote center of rotation (RCM that is the MIS entry port. Another important feature of the proposed positioning manipulator is that it can be placed below the operating table plane, allowing a quick and direct access to the patient, without removing the robotic system. This, besides saving precious space in the operating room, may improve safety over existing solutions. The conceptual design of Dionis is presented in this paper. Solutions for the inverse and direct kinematics are developed, as well as the analytical workspace and singularity analysis. Due to its unique design and kinematics, the proposed mechanism is highly compact, stiff and its dexterity fullfils the workspace specifications for MIS procedures.

  12. Rectification and Robust Matching Using Oriented Image Triplets for Minimally Invasive Surgery

    Science.gov (United States)

    Conen, N.; Jepping, C.; Luhmann, T.; Maas, H.-G.

    2016-06-01

    Stereo endoscopes for minimally invasive surgery have been available on the market for several years and are well established in some areas. In practice, they offer a stereoscopic view to the surgeon but are not yet intended for 3D measurements. However, using current knowledge about the camera system and the difficult conditions in object space, it is possible to reconstruct a highly accurate surface model of the current endoscopic view. In particular for medical interventions, a highly reliable point cloud and real-time computation are required. To obtain good reliability, a miniaturised trinocular camera system is introduced that reduces the amount of outliers. To reduce computation time, an approach for generation of rectified image triplets and their corresponding interior and exterior camera parameters has been developed. With these modified and parameterised images it is possible to directly process 3D measurements in object space. Accordingly, an efficient semi-global optimisation is implemented by the authors. In this paper the special camera system, the rectification approach and the applied methodology of matching in rectified image triplets are explained. Finally, first results are presented. In conclusion, the trinocular camera system provides more reliable point clouds than a binocular one, especially for areas with repetitive or poor texture. Currently, the benefit of the third camera is not as great as desired.

  13. A 4-DOF haptic master using ER fluid for minimally invasive surgery system application

    Science.gov (United States)

    Oh, Jong-Seok; Han, Young-Min; Lee, Sang-Rock; Choi, Seung-Bok

    2013-04-01

    This paper presents a novel 4-degrees-of-freedom (4-DOF) haptic master using a electrorheological (ER) fluid which is applicable to minimally invasive surgery (MIS) systems. By adopting a controllable ER fluid, the master can easily generate 4-DOF repulsive forces with the advantages of a simple mechanism and continuous force control capability. The proposed master consists of two actuators: an ER spherical joint for 3-DOF rotational motion and an ER piston device for 1-DOF translational motion. The generated torque/force models are mathematically derived by analyzing the mechanism geometry and using the Bingham characteristics of an ER Fluid. The haptic master is optimally designed and manufactured based on the mathematical torque/force models. The repulsive torque/force responses are experimentally evaluated and expressed by the first-order and second-order dynamic equations for each motion. A sliding mode controller (SMC), which is known to be robust to uncertainties, is then designed and empirically implemented to achieve the desired torque/force trajectories. It is demonstrated by presenting torque/force tracking results of both rotational and translational motions that the proposed 4-DOF ER haptic master integrated with the SMC can provide an effective haptic control performance for MIS applications.

  14. MEDIASSIST: medical assistance for intraoperative skill transfer in minimally invasive surgery using augmented reality

    Science.gov (United States)

    Sudra, Gunther; Speidel, Stefanie; Fritz, Dominik; Müller-Stich, Beat Peter; Gutt, Carsten; Dillmann, Rüdiger

    2007-03-01

    Minimally invasive surgery is a highly complex medical discipline with various risks for surgeon and patient, but has also numerous advantages on patient-side. The surgeon has to adapt special operation-techniques and deal with difficulties like the complex hand-eye coordination, limited field of view and restricted mobility. To alleviate with these new problems, we propose to support the surgeon's spatial cognition by using augmented reality (AR) techniques to directly visualize virtual objects in the surgical site. In order to generate an intelligent support, it is necessary to have an intraoperative assistance system that recognizes the surgical skills during the intervention and provides context-aware assistance surgeon using AR techniques. With MEDIASSIST we bundle our research activities in the field of intraoperative intelligent support and visualization. Our experimental setup consists of a stereo endoscope, an optical tracking system and a head-mounted-display for 3D visualization. The framework will be used as platform for the development and evaluation of our research in the field of skill recognition and context-aware assistance generation. This includes methods for surgical skill analysis, skill classification, context interpretation as well as assistive visualization and interaction techniques. In this paper we present the objectives of MEDIASSIST and first results in the fields of skill analysis, visualization and multi-modal interaction. In detail we present a markerless instrument tracking for surgical skill analysis as well as visualization techniques and recognition of interaction gestures in an AR environment.

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

    Directory of Open Access Journals (Sweden)

    Vishwas Malik

    2016-01-01

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

  16. Optimal Needle Grasp Selection for Automatic Execution of Suturing Tasks in Robotic Minimally Invasive Surgery

    OpenAIRE

    Liu, Taoming; Çavuşoğlu, M. Cenk

    2015-01-01

    This paper presents algorithms for optimal selection of needle grasp, for autonomous robotic execution of the minimally invasive surgical suturing task. In order to minimize the tissue trauma during the suturing motion, the best practices of needle path planning that are used by surgeons are applied for autonomous robotic surgical suturing tasks. Once an optimal needle trajectory in a well-defined suturing scenario is chosen, another critical issue for suturing is the choice of needle grasp f...

  17. Operation and force analysis of the guide wire in a minimally invasive vascular interventional surgery robot system

    Science.gov (United States)

    Yang, Xue; Wang, Hongbo; Sun, Li; Yu, Hongnian

    2015-03-01

    To develop a robot system for minimally invasive surgery is significant, however the existing minimally invasive surgery robots are not applicable in practical operations, due to their limited functioning and weaker perception. A novel wire feeder is proposed for minimally invasive vascular interventional surgery. It is used for assisting surgeons in delivering a guide wire, balloon and stenting into a specific lesion location. By contrasting those existing wire feeders, the motion methods for delivering and rotating the guide wire in blood vessel are described, and their mechanical realization is presented. A new resistant force detecting method is given in details. The change of the resistance force can help the operator feel the block or embolism existing in front of the guide wire. The driving torque for rotating the guide wire is developed at different positions. Using the CT reconstruction image and extracted vessel paths, the path equation of the blood vessel is obtained. Combining the shapes of the guide wire outside the blood vessel, the whole bending equation of the guide wire is obtained. That is a risk criterion in the delivering process. This process can make operations safer and man-machine interaction more reliable. A novel surgery robot for feeding guide wire is designed, and a risk criterion for the system is given.

  18. Operation and Force Analysis of the Guide Wire in a Minimally Invasive Vascular Interventional Surgery Robot System

    Institute of Scientific and Technical Information of China (English)

    YANG Xue; WANG Hongbo; SUN Li; YU Hongnian

    2015-01-01

    To develop a robot system for minimally invasive surgery is significant, however the existing minimally invasive surgery robots are not applicable in practical operations, due to their limited functioning and weaker perception. A novel wire feeder is proposed for minimally invasive vascular interventional surgery. It is used for assisting surgeons in delivering a guide wire, balloon and stenting into a specific lesion location. By contrasting those existing wire feeders, the motion methods for delivering and rotating the guide wire in blood vessel are described, and their mechanical realization is presented. A new resistant force detecting method is given in details. The change of the resistance force can help the operator feel the block or embolism existing in front of the guide wire. The driving torque for rotating the guide wire is developed at different positions. Using the CT reconstruction image and extracted vessel paths, the path equation of the blood vessel is obtained. Combining the shapes of the guide wire outside the blood vessel, the whole bending equation of the guide wire is obtained. That is a risk criterion in the delivering process. This process can make operations safer and man-machine interaction more reliable. A novel surgery robot for feeding guide wire is designed, and a risk criterion for the system is given.

  19. In Silico Investigation of a Surgical Interface for Remote Control of Modular Miniature Robots in Minimally Invasive Surgery

    Directory of Open Access Journals (Sweden)

    Apollon Zygomalas

    2014-01-01

    Full Text Available Aim. Modular mini-robots can be used in novel minimally invasive surgery techniques like natural orifice transluminal endoscopic surgery (NOTES and laparoendoscopic single site (LESS surgery. The control of these miniature assistants is complicated. The aim of this study is the in silico investigation of a remote controlling interface for modular miniature robots which can be used in minimally invasive surgery. Methods. The conceptual controlling system was developed, programmed, and simulated using professional robotics simulation software. Three different modes of control were programmed. The remote controlling surgical interface was virtually designed as a high scale representation of the respective modular mini-robot, therefore a modular controlling system itself. Results. With the proposed modular controlling system the user could easily identify the conformation of the modular mini-robot and adequately modify it as needed. The arrangement of each module was always known. The in silico investigation gave useful information regarding the controlling mode, the adequate speed of rearrangements, and the number of modules needed for efficient working tasks. Conclusions. The proposed conceptual model may promote the research and development of more sophisticated modular controlling systems. Modular surgical interfaces may improve the handling and the dexterity of modular miniature robots during minimally invasive procedures.

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

    NARCIS (Netherlands)

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

    2011-01-01

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

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

    NARCIS (Netherlands)

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

    2011-01-01

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

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

    NARCIS (Netherlands)

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

    2011-01-01

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

  3. Cotton-derived oxidized cellulose in minimally invasive thoracic surgery: a clinicopathological study.

    Science.gov (United States)

    Witte, Biruta; Kroeber, Stefan M; Hillebrand, Hubertus; Wolf, Michael; Huertgen, Martin

    2013-01-01

    The aim of this study was to identify resorption, clinical performance, and safety of cotton-derived oxidized cellulose gauze applied as a hemostat in minimally invasive oncologic thoracic surgery. This is a pilot prospective noncomparative observational human in vivo study. A piece of cotton-derived oxidized cellulose gauze measuring 5 × 20 cm was inserted into the subcarinal space of patients with potentially resectable lung carcinoma at the time of video-assisted mediastinoscopic lymphadenectomy and reexamined several days later for macroscopic and histologic evaluation at the time of subsequent lung resection. The primary endpoint was the local situation at the implantation site described by cellulose remnants, fluid collections, and adhesions. The secondary endpoint was safety, described by the number of adverse events and surgical reinterventions. Twenty-five consecutive eligible patients with potentially resectable lung carcinoma were included. The desired hemostatic effect was achieved in all cases. No adverse events were observed. At re-exploration 10.5 (5-28) days later, the cellulose gauze was found to lose its solid structure from the fifth day on. Remnants were last detected 14 days after insertion. The implantation site exhibited no inflammatory changes and a remarkable small amount of fluid collections and adhesions. Mediastinal application of cotton-derived oxidized cellulose is safe and effective. A piece of gauze measuring 5 × 20 cm seems to be absorbed completely within 15 days, thus precluding any interference with oncologic restaging and follow-up. The absence of relevant adhesions facilitates further surgical procedures. Larger comparative confirmatory studies are required. For large-scale resorption studies, our clinical model should be translated into a porcine model.

  4. Remote Minimally Invasive Surgery – Haptic Feedback and Selective Automation in Medical Robotics

    Directory of Open Access Journals (Sweden)

    Christoph Staub

    2011-01-01

    Full Text Available The automation of recurrent tasks and force feedback are complex problems in medical robotics. We present a novel approach that extends human-machine skill-transfer by a scaffolding framework. It assumes a consolidated working environment for both, the trainee and the trainer. The trainer provides hints and cues in a basic structure which is already understood by the learner. In this work, the scaffolding is constituted by abstract patterns, which facilitate the structuring and segmentation of information during “Learning by Demonstration” (LbD. With this concept, the concrete example of knot-tying for suturing is exemplified and evaluated. During the evaluation, most problems and failures arose due to intrinsic system imprecisions of the medical robot system. These inaccuracies were then improved by the visual guidance of the surgical instruments. While the benefits of force feedback in telesurgery has already been demonstrated and measured forces are also used during task learning, the transmission of signals between the operator console and the robot system over long-distances or across-network remote connections is still a challenge due to time-delay. Especially during incision processes with a scalpel into tissue, a delayed force feedback yields to an unpredictable force perception at the operator-side and can harm the tissue which the robot is interacting with. We propose a XFEM-based incision force prediction algorithm that simulates the incision contact-forces in real-time and compensates the delayed force sensor readings. A realistic 4-arm system for minimally invasive robotic heart surgery is used as a platform for the research.

  5. Patient-Specific Biomechanical Modeling for Guidance During Minimally-Invasive Hepatic Surgery.

    Science.gov (United States)

    Plantefève, Rosalie; Peterlik, Igor; Haouchine, Nazim; Cotin, Stéphane

    2016-01-01

    During the minimally-invasive liver surgery, only the partial surface view of the liver is usually provided to the surgeon via the laparoscopic camera. Therefore, it is necessary to estimate the actual position of the internal structures such as tumors and vessels from the pre-operative images. Nevertheless, such task can be highly challenging since during the intervention, the abdominal organs undergo important deformations due to the pneumoperitoneum, respiratory and cardiac motion and the interaction with the surgical tools. Therefore, a reliable automatic system for intra-operative guidance requires fast and reliable registration of the pre- and intra-operative data. In this paper we present a complete pipeline for the registration of pre-operative patient-specific image data to the sparse and incomplete intra-operative data. While the intra-operative data is represented by a point cloud extracted from the stereo-endoscopic images, the pre-operative data is used to reconstruct a biomechanical model which is necessary for accurate estimation of the position of the internal structures, considering the actual deformations. This model takes into account the patient-specific liver anatomy composed of parenchyma, vascularization and capsule, and is enriched with anatomical boundary conditions transferred from an atlas. The registration process employs the iterative closest point technique together with a penalty-based method. We perform a quantitative assessment based on the evaluation of the target registration error on synthetic data as well as a qualitative assessment on real patient data. We demonstrate that the proposed registration method provides good results in terms of both accuracy and robustness w.r.t. the quality of the intra-operative data.

  6. Ex vivo study of prostate cancer localization using rolling mechanical imaging towards minimally invasive surgery.

    Science.gov (United States)

    Li, Jichun; Liu, Hongbin; Brown, Matthew; Kumar, Pardeep; Challacombe, Benjamin J; Chandra, Ashish; Rottenberg, Giles; Seneviratne, Lakmal D; Althoefer, Kaspar; Dasgupta, Prokar

    2017-05-01

    Rolling mechanical imaging (RMI) is a novel technique towards the detection and quantification of malignant tissue in locations that are inaccessible to palpation during robotic minimally invasive surgery (MIS); the approach is shown to achieve results of higher precision than is possible using the human hand. Using a passive robotic manipulator, a lightweight and force sensitive wheeled probe is driven across the surface of tissue samples to collect continuous measurements of wheel-tissue dynamics. A color-coded map is then generated to visualize the stiffness distribution within the internal tissue structure. Having developed the RMI device in-house, we aim to compare the accuracy of this technique to commonly used methods of localizing prostate cancer in current practice: digital rectal exam (DRE), magnetic resonance imaging (MRI) and transrectal ultrasound (TRUS) biopsy. Final histology is the gold standard used for comparison. A total of 126 sites from 21 robotic-assisted radical prostatectomy specimens were examined. Analysis was performed for sensitivity, specificity, accuracy, and predictive value across all patient risk profiles (defined by PSA, Gleason score and pathological score). Of all techniques, pre-operative biopsy had the highest sensitivity (76.2%) and accuracy (64.3%) in the localization of tumor in the final specimen. However, RMI had a higher sensitivity (44.4%) and accuracy (57.9%) than both DRE (38.1% and 52.4%, respectively) and MRI (33.3% and 57.9%, respectively). These findings suggest a role for RMI towards MIS, where haptic feedback is lacking. While our approach has focused on urological tumors, RMI has potential applicability to other extirpative oncological procedures and to diagnostics (e.g., breast cancer screening). Crown Copyright © 2017. Published by Elsevier Ltd. All rights reserved.

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

    Science.gov (United States)

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

    2015-10-01

    Minimally invasive surgery (MIS) is being utilized more frequently as a surgical technique in general surgery and in paediatric urology. It is associated with a steep learning curve. Currently, the centre does not offer a MIS training programme. It is hypothesized that the number of MIS procedures performed in the low-volume specialty of paediatric urology will offer insufficient training potential for surgeons. To assess the MIS training potential of a highly specialized, tertiary care, paediatric urology training centre that has been accredited by the Joint Committee of Paediatric Urology (JCPU). The clinical activity of the department was retrospectively reviewed by extracting the annual number of admissions, outpatient consultations and operative procedures. The operations were divided into open procedures and MIS. Major ablative procedures (nephrectomy) and reconstructive procedures (pyeloplasty) were analysed with reference to the patients' ages. The centre policy is not to perform major MIS in children who are under 2 years old or who weigh less than 12 kg. Every year, this institution provides approximately 4300 out-patient consultations, 600 admissions, and 1300 procedures under general anaesthesia for children with urological problems. In 2012, 35 patients underwent major intricate MIS: 16 pyeloplasties, eight nephrectomies and 11 operations for incontinence (seven Burch, and four bladder neck procedures). In children ≥2 years of age, 16/21 of the pyeloplasties and 8/12 of the nephrectomies were performed laparoscopically. The remaining MIS procedures included 25 orchidopexies and one intravesical ureteral reimplantation. There is no consensus on how to assess laparoscopic training. It would be valuable to reach a consensus on a standardized laparoscopic training programme in paediatric urology. Often training potential is based on operation numbers only. In paediatric urology no minimum requirement has been specified. The number of procedures quoted

  8. The target of modern joint surgery-accurate, precise and minimally invasive surgery%微创与精准:现代关节外科追求的目标

    Institute of Scientific and Technical Information of China (English)

    章亚东

    2013-01-01

    All of the articles about the knee joint published in this issue are related to minimally invasive surgery and accurate and precise techniques. Minimally invasive surgery and accurate and precise techniques are associated with each other. Minimally invasive surgery is the means to achieve precision, and precision is the premise of minimally invasive surgery, with the same purpose of best therapeutic effects and smallest surgical injuries. Therefore, they are often referred to as the“accurate, precise and minimally invasive surgery”, which is the target of modern joint surgery. The whole clinical medicine will enter a new era driven by the minimally invasive surgery, with the endoscopic surgical technique (minimally invasive surgery in the narrow sense) as the leader. However, minimally invasive surgery not only refers to an endoscopic technique, or just about reducing the body tissue damage, but also aims to minimize the mental and psychological trauma and burden for the patients and their families. With the precise preoperative evaluation, sophisticated surgical decision-making and delicate operation procedure, excellent results could be ifnally achieved in the accurate and precise surgery. The surgical treatment gets improved in 3 dimensions, including the treatment effectiveness, operation safety and minimally invasive intervention. Accurate, precise and minimally invasive surgery helps shape the future directions of the surgery, and with great prospects. We will certainly say goodbye to the former blood-shed ifght in the traditional surgery, and pursue the ultimate goal of accurate, precise and minimally invasive surgery together in the orbit of modern surgery with the increasingly sophisticated equipment and constantly updated concepts.

  9. How to do it: importance of left atrial side retraction in robotic and minimally invasive mitral valve surgery.

    Science.gov (United States)

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

    2008-01-01

    A customized transthoracic atrial retractor was previously developed for robotic and minimally invasive mitral valve surgery, but it has sometimes failed to provide sufficient exposure of the mitral valve because some atrial tissues push away the operative field from the right side. This report describes 3 new atrial side retractors (the foldaway retractor, the spoon retractor, and the wired retractor) and their use in performing robotic mitral valve repair in fresh frozen human cadavers. These retractors provided exceptional and consistent exposure of the left atrium in robotic and minimally invasive mitral valve surgery in human cadavers without causing traumatic injury, and these retractors should be useful in live patients because they will be used in arrested hearts.

  10. Minimally Invasive Surgery Combined with Regenerative Biomaterials in Treating Intra-Bony Defects: A Meta-Analysis

    OpenAIRE

    Shan Liu; Bo Hu; Yuanyuan Zhang; Wenyang Li; Jinlin Song

    2016-01-01

    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 alon...

  11. Control and user interface design for compact manipulators in minimally-invasive surgery

    OpenAIRE

    Berkelman, Peter; Boidard, Eric; Cinquin, Philippe; Troccaz, Jocelyne

    2005-01-01

    International audience; This paper describes the control system and user command interfaces developed for a lightweight, compact, endoscope camera manipulator prototype for robot-assistedminimally invasive surgery. A complete teleoperated minimallyinvasive surgical system in development is also based on using lightweight, compact manipulators with simple, reliable, and robust controllers. The endoscope manipulator is controlled by a single-board computer and individual motor controllers. The ...

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

    Science.gov (United States)

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

    2016-10-27

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

  13. Robotic-assisted minimally invasive surgery for gynecologic and urologic oncology: an evidence-based analysis.

    Science.gov (United States)

    2010-01-01

    An application was received to review the evidence on the 'The Da Vinci Surgical System' for the treatment of gynecologic malignancies (e.g. endometrial and cervical cancers). Limitations to the current standard of care include the lack of trained physicians on minimally invasive surgery and limited access to minimally invasive surgery for patients. The potential benefits of 'The Da Vinci Surgical System' include improved technical manipulation and physician uptake leading to increased surgeries, and treatment and management of these cancers. The demand for robotic surgery for the treatment and management of prostate cancer has been increasing due to its alleged benefits of recovery of erectile function and urinary continence, two important factors of men's health. The potential technical benefits of robotic surgery leading to improved patient functional outcomes are surgical precision and vision. Uterine and cervical cancers represent 5.4% (4,400 of 81,700) and 1.6% (1,300 of 81,700), respectively, of incident cases of cancer among female cancers in Canada. Uterine cancer, otherwise referred to as endometrial cancer is cancer of the lining of the uterus. The most common treatment option for endometrial cancer is removing the cancer through surgery. A surgical option is the removal of the uterus and cervix through a small incision in the abdomen using a laparoscope which is referred to as total laparoscopic hysterectomy. Risk factors that increase the risk of endometrial cancer include taking estrogen replacement therapy after menopause, being obese, early age at menarche, late age at menopause, being nulliparous, having had high-dose radiation to the pelvis, and use of tamoxifen. Cervical cancer occurs at the lower narrow end of the uterus. There are more treatment options for cervical cancer compared to endometrial cancer, however total laparoscopic hysterectomy is also a treatment option. Risk factors that increase the risk for cervical cancer are multiple

  14. Implications of minimally invasive therapy

    NARCIS (Netherlands)

    Banta, H.D.; Schersten, T.; Jonsson, E.

    1993-01-01

    The field of minimally invasive therapy (MIT) raises many important issues for the future of health care. It seems inevitable that MIT will replace much conventional surgery. This trend is good for society and good for patients. The health care system, however, may find the change disruptive. The

  15. Robotic-Assisted Minimally Invasive Surgery for Gynecologic and Urologic Oncology

    Science.gov (United States)

    2010-01-01

    Executive Summary Objective An application was received to review the evidence on the ‘The Da Vinci Surgical System’ for the treatment of gynecologic malignancies (e.g. endometrial and cervical cancers). Limitations to the current standard of care include the lack of trained physicians on minimally invasive surgery and limited access to minimally invasive surgery for patients. The potential benefits of ‘The Da Vinci Surgical System’ include improved technical manipulation and physician uptake leading to increased surgeries, and treatment and management of these cancers. The demand for robotic surgery for the treatment and management of prostate cancer has been increasing due to its alleged benefits of recovery of erectile function and urinary continence, two important factors of men’s health. The potential technical benefits of robotic surgery leading to improved patient functional outcomes are surgical precision and vision. Clinical Need Uterine and cervical cancers represent 5.4% (4,400 of 81,700) and 1.6% (1,300 of 81,700), respectively, of incident cases of cancer among female cancers in Canada. Uterine cancer, otherwise referred to as endometrial cancer is cancer of the lining of the uterus. The most common treatment option for endometrial cancer is removing the cancer through surgery. A surgical option is the removal of the uterus and cervix through a small incision in the abdomen using a laparoscope which is referred to as total laparoscopic hysterectomy. Risk factors that increase the risk of endometrial cancer include taking estrogen replacement therapy after menopause, being obese, early age at menarche, late age at menopause, being nulliparous, having had high-dose radiation to the pelvis, and use of tamoxifen. Cervical cancer occurs at the lower narrow end of the uterus. There are more treatment options for cervical cancer compared to endometrial cancer, however total laparoscopic hysterectomy is also a treatment option. Risk factors that

  16. The role of technology in minimally invasive surgery: state of the art, recent developments and future directions.

    Science.gov (United States)

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

    2017-03-01

    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 http://www.bmj.com/company/products-services/rights-and-licensing/.

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

    Directory of Open Access Journals (Sweden)

    Keng-Liang Ou

    2015-01-01

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

  18. Prostate resection - minimally invasive

    Science.gov (United States)

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

  19. Minimally invasive transforaminal lumbar interbody fusion with unilateral pedicle screw fixation: comparison between primary and revision surgery.

    Science.gov (United States)

    Kang, Moo Sung; Park, Jeong Yoon; Kim, Kyung Hyun; Kuh, Sung Uk; Chin, Dong Kyu; Kim, Keun Su; Cho, Yong Eun

    2014-01-01

    Minimally invasive surgery with a transforaminal lumbar interbody fusion (MIS TLIF) is an important minimally invasive fusion technique for the lumbar spine. Lumbar spine reoperation is challenging and is thought to have greater complication risks. The purpose of this study was to compare MIS TLIF with unilateral screw fixation perioperative results between primary and revision surgeries. This was a prospective study that included 46 patients who underwent MIS TLIF with unilateral pedicle screw. The patients were divided into two groups, primary and revision MIS TLIF, to compare perioperative results and complications. The two groups were similar in age, sex, and level of operation, and were not significantly different in the length of follow-up or clinical results. Although dural tears were more common with the revision group (primary 1; revision 4), operation time, blood loss, total perioperative complication, and fusion rates were not significantly different between the two groups. Both groups showed substantial improvements in VAS and ODI scores one year after surgical treatment. Revision MIS TLIF performed by an experienced surgeon does not necessarily increase the risk of perioperative complication compared with primary surgery. MIS TLIF with unilateral pedicle screw fixation is a valuable option for revision lumbar surgery.

  20. Minimally Invasive Transforaminal Lumbar Interbody Fusion with Unilateral Pedicle Screw Fixation: Comparison between Primary and Revision Surgery

    Directory of Open Access Journals (Sweden)

    Moo Sung Kang

    2014-01-01

    Full Text Available Minimally invasive surgery with a transforaminal lumbar interbody fusion (MIS TLIF is an important minimally invasive fusion technique for the lumbar spine. Lumbar spine reoperation is challenging and is thought to have greater complication risks. The purpose of this study was to compare MIS TLIF with unilateral screw fixation perioperative results between primary and revision surgeries. This was a prospective study that included 46 patients who underwent MIS TLIF with unilateral pedicle screw. The patients were divided into two groups, primary and revision MIS TLIF, to compare perioperative results and complications. The two groups were similar in age, sex, and level of operation, and were not significantly different in the length of follow-up or clinical results. Although dural tears were more common with the revision group (primary 1; revision 4, operation time, blood loss, total perioperative complication, and fusion rates were not significantly different between the two groups. Both groups showed substantial improvements in VAS and ODI scores one year after surgical treatment. Revision MIS TLIF performed by an experienced surgeon does not necessarily increase the risk of perioperative complication compared with primary surgery. MIS TLIF with unilateral pedicle screw fixation is a valuable option for revision lumbar surgery.

  1. Development of optical fiber Bragg grating force-reflection sensor system of medical application for safe minimally invasive robotic surgery

    Science.gov (United States)

    Song, Hoseok; Kim, Kiyoung; Lee, Jungju

    2011-07-01

    Force feedback plays a very important role in medical surgery. In minimally invasive surgery (MIS), however, the very long and stiff bars of surgical instruments greatly diminish force feedback for the surgeon. In the case of minimally invasive robotic surgery (MIRS), force feedback is totally eliminated. Previous researchers have reported that the absence of force feedback increased the average force magnitude applied to the tissue by at least 50%, and increased the peak force magnitude by at least a factor of two. Therefore, it is very important to provide force information in MIRS. Recently, many sensors are being developed for MIS and MIRS, but some obstacles to their application in actual medical surgery must be surmounted. The most critical problems are size limit and sterilizability. Optical fiber sensors are among the most suitable sensors for the surgical environment. The optical fiber Bragg grating (FBG) sensor, in particular, offers an important additional advantage over other optical fiber sensors in that it is not influenced by the intensity of the light source. In this paper, we present the initial results of a study on the application of a FBG sensor to measure reflected forces in MIRS environments and suggest the possibility of successful application to MIRS systems.

  2. 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

    2016-06-01

    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

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

    Science.gov (United States)

    Ender, Jörg; Sgouropoulou, Sophia

    2013-11-01

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

  4. Optimal Needle Grasp Selection for Automatic Execution of Suturing Tasks in Robotic Minimally Invasive Surgery.

    Science.gov (United States)

    Liu, Taoming; Çavuşoğlu, M Cenk

    2015-05-01

    This paper presents algorithms for optimal selection of needle grasp, for autonomous robotic execution of the minimally invasive surgical suturing task. In order to minimize the tissue trauma during the suturing motion, the best practices of needle path planning that are used by surgeons are applied for autonomous robotic surgical suturing tasks. Once an optimal needle trajectory in a well-defined suturing scenario is chosen, another critical issue for suturing is the choice of needle grasp for the robotic system. Inappropriate needle grasp increases operating time requiring multiple re-grasps to complete the desired task. The proposed methods use manipulability, dexterity and torque metrics for needle grasp selection. A simulation demonstrates the proposed methods and recommends a variety of grasps. Then a realistic demonstration compares the performances of the manipulator using different grasps.

  5. A Novel Shape Memory Alloy Annuloplasty Ring for Minimally Invasive Surgery: Design, Fabrication, and Evaluation

    Science.gov (United States)

    Purser, Molly F.; Richards, Andrew L.; Cook, Richard C.; Osborne, Jason A.; Cormier, Denis R.; Buckner, Gregory D.

    2013-01-01

    A novel annuloplasty ring with a shape memory alloy core has been developed to facilitate minimally invasive mitral valve repair. In its activated (austenitic) phase, this prototype ring has comparable mechanical properties to commercial semi-rigid rings. In its pre-activated (martensitic) phase, this ring is flexible enough to be introduced through an 8-mm trocar and easily manipulated with robotic instruments within the confines of a left atrial model. The core is constructed of 0.50 mm diameter NiTi, which is maintained below its martensitic transition temperature (24 °C) during deployment and suturing. After suturing, the ring is heated above its austenitic transition temperature (37 °C, normal human body temperature) enabling the NiTi core to attain its optimal geometry and stiffness characteristics indefinitely. This article summarizes the design, fabrication, and evaluation of this prototype ring. Experimental results suggest that the NiTi core ring could be a viable alternative to flexible bands in robot-assisted minimally invasive mitral valve repair. PMID:20652747

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

    Directory of Open Access Journals (Sweden)

    Saavoss JD

    2016-04-01

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

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

    Directory of Open Access Journals (Sweden)

    Zdeněk Fík

    2014-01-01

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

  8. Development and application of the near-infrared and white-light thoracoscope system for minimally invasive lung cancer surgery

    Science.gov (United States)

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

    2017-06-01

    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.

  9. A new modality for minimally invasive CO2 laser surgery: flexible hollow-core photonic bandgap fibers.

    Science.gov (United States)

    Shurgalin, Max; Anastassiou, Charalambos

    2008-01-01

    Carbon dioxide (CO2) lasers have become one of the most common surgical lasers due to excellent tissue interaction properties that offer precise control of cutting and ablation depth, minimal thermal damage to surrounding tissue, and good hemostasis. However, realization of the benefits offered by using surgical CO2 lasers in many endoscopic, minimally invasive surgical procedures has been inhibited by the absence of reliable, flexible fiber laser beam delivery systems. Recently, novel hollow-core photonic bandgap optical fibers for CO2 lasers were developed that offer high flexibility and mechanical robustness with good optical performance under tight bends. These fibers can be used through rigid and flexible endoscopes and various handpieces and will allow surgeons to perform delicate and precise laser surgery procedures in a minimally invasive manner. This paper describes the basic design of laser beam delivery system, different surgical fiber designs and their characteristics, and usage with existing surgical CO2 laser models. A few examples of successful CO2 laser surgeries performed with these fibers are presented.

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

    Science.gov (United States)

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

    2014-01-01

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

  11. Fiber optical sensor system for shape and haptics for flexible instruments in minimally invasive surgery: overview and status quo

    Science.gov (United States)

    Ledermann, Christoph; Pauer, Hendrikje; Woern, Heinz

    2014-05-01

    In minimally invasive surgery, exible mechatronic instruments promise to improve the overall performance of surgical interventions. However, those instruments require highly developed sensors in order to provide haptic feedback to the surgeon or to enable (semi-)autonomous tasks. Precisely, haptic sensors and a shape sensor are required. In this paper, we present our ber optical sensor system of Fiber Bragg Gratings, which consists of a shape sensor, a kinesthetic sensor and a tactile sensor. The status quo of each of the three sensors is described, as well as the concept to integrate them into one ber optical sensor system.

  12. POSSIBILITIES OF THE MINIMALLY INVASIVE SURGERY IN THE TREATMENT OF SEVERE FOREFOOT DEFORMITIES IN THE RHEUMATOID ARTHRITIS PATIENTS

    Directory of Open Access Journals (Sweden)

    S. Y. Berezhnoy

    2016-01-01

    Full Text Available Introduction. Approximately 90% of the rheumatoid arthritis patients present with foot symptoms. Rheumatoid foot is characterized by toe dislocations and chronic wounds due to the corticosteroid treatment. In case of surgical intervention metatarsophalangeal joints excision arthroplasty remains the standard. To perform second through fifth metatarsal head resection extensive transverse plantar or longitudinal dorsal incisions are routinely used. The rate of the wound-healing problems after rheumatoid foot surgeries is 23-45%. The purpose of this study was to demonstrate the possibilities and advantages of the rheumatoid arthritis patients with severe forefoot deformities minimally invasive surgical treatment and to develop mini-invasive approach for central metatarsal heads resection. Material and methods. By the example of 23 rheumatoid arthritis female patients (30 feet surgical treatment possibilities of percutaneous techniques in severe forefoot deformities correction were demonstrated. The average age of the group was 54.5 years (range, 39 to 72. There were 24 primary surgeries and 6 repeated. Four feet had chronic wounds. Percutaneous techniques were used to correct all the forefoot deformities components but central metatarsal head resections (7 cases. To make them minimally invasive plantar approach has been developed. Surgical technique of the central metatarsal heads resection using proposed approach was presented. Decision-making algorithm for choosing appropriate surgical technique (to perform first metatarsophalangeal arthrodesis with central metatarsal heads resection or joint-preserving surgery was proposed, including functional test, performed under fluoroscopic control and tricks for the dislocated fifth toe reduction. Results. The mean follow-up was 12 months (range, 3 to 52. The average hospital stay was 1.23 days. No infectious or wound-healing problems were noted. Chronic wounds have healed in four weeks after surgery

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

    Science.gov (United States)

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

    2007-09-01

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

  14. High definition in minimally invasive surgery: a review of methods for recording, editing, and distributing video.

    Science.gov (United States)

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

    2008-09-01

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

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

    Science.gov (United States)

    Bahramzadeh, Y.; Shahinpoor, M.

    2012-04-01

    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.

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

    Science.gov (United States)

    Mukherjee, Chirojit; Koch, Eva; Banusch, Joergen; Scholz, Markus; Kaisers, Udo X; Ender, Joerg

    2012-01-01

    Aim of our study was to evaluate the beneficial effect of low dose intrathecal morphine on postoperative analgesia, over the use of intravenous patient controlled anesthesia (PCA), in patients undergoing fast track anesthesia during minimally invasive cardiac surgical procedures. A randomized controlled trial was undertaken after approval from local ethical committee. Written informed consent was obtained from 61 patients receiving mitral or tricuspid or both surgical valve repair in minimal invasive technique. Patients were assigned randomly to 2 groups. Group 1 received general anesthesia and intravenous patient controlled analgesia (PCA) pump with Piritramide (GA group). Group 2 received a single shot of intrathecal morphine (1.5 μg/kg body weight) prior to the administration of general anesthesia (ITM group). Site of puncture was confined to lumbar (L1-2 or L2-3) intrathecal space. The amount of intravenous piritramide used in post anesthesia care unit (PACU) and the first postoperative day was defined as primary end point. Secondary end points included: time for tracheal extubation, pain and sedation scores in PACU upto third postoperative day. For statistical analysis Mann-Whitney-U Test and Fishers exact test (SPSS) were used. We found that the demand for intravenous opioids in PACU was significantly reduced in ITM group (P <0.001). Pain scores were significantly decreased in ITM group until second postoperative day (P <0.01). There was no time delay for tracheal extubation in ITM group, and sedation scores did not differ in either group. We conclude that low dose single shot intrathecal morphine provides adequate postoperative analgesia, reduces the intravenous opioid consumption during the early postoperative period and does not defer early extubation.

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

    Directory of Open Access Journals (Sweden)

    Chirojit Mukherjee

    2012-01-01

    Full Text Available Aim of our study was to evaluate the beneficial effect of low dose intrathecal morphine on postoperative analgesia, over the use of intravenous patient controlled anesthesia (PCA, in patients undergoing fast track anesthesia during minimally invasive cardiac surgical procedures. A randomized controlled trial was undertaken after approval from local ethical committee. Written informed consent was obtained from 61 patients receiving mitral or tricuspid or both surgical valve repair in minimal invasive technique. Patients were assigned randomly to 2 groups. Group 1 received general anesthesia and intravenous patient controlled analgesia (PCA pump with Piritramide (GA group. Group 2 received a single shot of intrathecal morphine (1.5 μg/kg body weight prior to the administration of general anesthesia (ITM group. Site of puncture was confined to lumbar (L1-2 or L2-3 intrathecal space. The amount of intravenous piritramide used in post anesthesia care unit (PACU and the first postoperative day was defined as primary end point. Secondary end points included: time for tracheal extubation, pain and sedation scores in PACU upto third postoperative day. For statistical analysis Mann-Whitney-U Test and Fishers exact test (SPSS were used. We found that the demand for intravenous opioids in PACU was significantly reduced in ITM group (P <0.001. Pain scores were significantly decreased in ITM group until second postoperative day (P <0.01. There was no time delay for tracheal extubation in ITM group, and sedation scores did not differ in either group. We conclude that low dose single shot intrathecal morphine provides adequate postoperative analgesia, reduces the intravenous opioid consumption during the early postoperative period and does not defer early extubation.

  18. 4-mm-diameter three-dimensional imaging endoscope with steerable camera for minimally invasive surgery (3-D-MARVEL).

    Science.gov (United States)

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

    2017-01-01

    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.

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

    Directory of Open Access Journals (Sweden)

    Michael Joseph LaRiviere

    2016-12-01

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

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

    Science.gov (United States)

    Nguyen, Tom C; Lamelas, Joseph

    2015-03-01

    Minimally invasive aortic valve replacement (MIAVR) is associated with numerous advantages including improved patient satisfaction, cosmesis, decreased transfusion requirements, and cost-effectiveness. Despite these advantages, little information exists on how to build a MIAVR program from the ground up. The steps to build a MIAVR program include compiling a multi-disciplinary team composed of surgeons, cardiologists, anesthesiologists, perfusionists, operating room (OR) technicians, and nurses. Once assembled, this team can then approach hospital administrators to present a cost-benefit analysis of MIAVR, emphasizing the importance of reduced resource utilization in the long-term to offset the initial financial investment that will be required. With hospital approval, training can commence to provide surgeons and other staff with the necessary knowledge and skills in MIAVR procedures and outcomes. Marketing and advertising of the program through the use of social media, educational conferences, grand rounds, and printed media will attract the initial patients. A dedicated website for the program can function as a "virtual lobby" for patients wanting to learn more. Initially, conservative selection criteria of cases that qualify for MIAVR will set the program up for success by avoiding complex co-morbidities and surgical techniques. During the learning curve phase of the program, patient safety should be a priority.

  1. Needle Grasp and Entry Port Selection for Automatic Execution of Suturing Tasks in Robotic Minimally Invasive Surgery

    Science.gov (United States)

    Liu, Taoming; Çavuşoğlu, M. Cenk

    2016-01-01

    This paper presents algorithms for selection of needle grasp and for selection of entry ports of robotic instruments, for autonomous robotic execution of the minimally invasive surgical suturing task. A critical issue for automatic execution of surgical tasks, such as suturing, is the choice of needle grasp for the robotic system. Inappropriate needle grasp increases operating time requiring multiple regrasps to complete the desired task. In robotic minimally invasive surgery, the entry port that the surgical robot goes through into the patient’s body has a significant role on the performance of the robot. Improper entry port affects the robot’s dexterity, manipulability and reachability. The proposed methods use manipulability, dexterity and torque metrics for needle grasp selection, and employ needle grasp robustness and target location robustness metrics for port selection. The results of a case study simulation in thoracoscopic surgery is also presented to demonstrate the proposed methods. Note to Practitioners—This paper is motivated by the problem of automating low-level surgical tasks in robotic surgery, such as, suturing, retraction, dissection, and providing exposure. Specifically, this paper focuses on needle grasp and entry port selection for automating robotic surgical suturing. Selection of an appropriate way of grasping a needle is critical for successfully and robustly completing autonomous suturing. To the best authors’ knowledge, there are no earlier studies in the literature which focus on the needle grasp selection problem. The proposed approach determines how to grasp the needle by optimizing the surgical system’s manipulation performance. The existing approaches in the literature for selecting entry ports for the robotic surgical tools only consider the teleoperated robotic minimally invasive surgery, in which the surgeons directly control the robotic instruments. However, automated performance of suturing introduces additional

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

    Directory of Open Access Journals (Sweden)

    Mazda K Turel

    2017-01-01

    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.

  3. Do we have enough evidence for minimally-invasive cardiac surgery? A critical review of scientific and non-scientific information.

    Science.gov (United States)

    Doenst, Torsten; Lamelas, Joseph

    2017-08-01

    Reducing surgical trauma by minimizing skin incisions has transformed abdominal surgery resulting in significant improvements in outcome. In cardiac surgery, such efforts have also been made, but similar benefits could not be demonstrated. In addition, any potential benefit comes at the cost of increased cardiopulmonary bypass and clamp times, leading to questions regarding the safety of minimally invasive cardiac surgery (MICS). Nevertheless, outcomes have been equivalent to matched sternotomy cases and there is no doubt that the number of patients undergoing minimally-invasive mitral or aortic procedures is slowly increasing. To date almost half of all isolated mitral cases in Germany and roughly one fourth in the USA are performed through a minimized access. These numbers were less than half 10 years ago. So how can this development be justified, if the evidence for it seems to be questionable or even missing? We will attempt to provide some answers to this question by critically reviewing the available publications and by looking at the topic from other perspectives, including from a competitive and a patient standpoint. We will conclude that there is enough evidence to support minimally-invasive access as the primary approach to a valve in the majority of patients. We will further suggest that modern cardiac surgery may have difficulties to prevail in its full width, if these novel techniques are not embraced. Finally, we will demonstrate that minimally invasive cardiac surgery is associated with substantial improvements in patient care, however, in areas that are unlikely to be tested with randomized controlled trials.

  4. [Minimally invasive surgery for treating of complicated fronto-ethmoidal sinusitis].

    Science.gov (United States)

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

    2005-01-01

    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.

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

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    Meng-Huang Wu

    2017-01-01

    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.

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

    Science.gov (United States)

    Dubey, Navneet Kumar; Lee, Ching-Yu; Li, Yen-Yao; Cheng, Chin-Chang; Shi, Chung-Sheng

    2017-01-01

    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.

  7. Best practices for minimally invasive procedures.

    Science.gov (United States)

    Ulmer, Brenda C

    2010-05-01

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

  8. Minimally invasive mitral valve surgery through right mini-thoracotomy: recommendations for good exposure, stable cardiopulmonary bypass, and secure myocardial protection.

    Science.gov (United States)

    Ito, Toshiaki

    2015-07-01

    An apparent advantage of minimally invasive mitral surgery through right mini-thoracotomy is cosmetic appearance. Possible advantages of this procedure are a shorter ventilation time, shorter hospital stay, and less blood transfusion. With regard to hard endpoints, such as operative mortality, freedom from reoperation, or cardiac death, this method is reportedly equivalent, but not superior, to the standard median sternotomy technique. However, perfusion-related complications (e.g., stroke, vascular damage, and limb ischemia) tend to occur more frequently in minimally invasive technique than with the standard technique. In addition, valve repair through a small thoracotomy is technically demanding. Therefore, screening out patients who are not appropriate for performing minimally invasive surgery is the first step. Vascular disease and inadequate anatomy can be evaluated with contrast-enhanced computed tomography. Peripheral cannulation should be carefully performed, using transesophageal echocardiography guidance. Preoperative detailed planning of the valve repair process is desirable because every step is time-consuming in minimally invasive surgery. Three-dimensional echocardiography is a powerful tool for this purpose. For satisfactory exposure and detailed observation of the valve, a special left atrial retractor and high-definition endoscope are useful. Valve repair can be performed in minimally invasive surgery as long as cardiopulmonary bypass is stable and bloodless exposure of the valve is obtained.

  9. Outcomes After Minimally Invasive Esophagectomy

    Science.gov (United States)

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

    2014-01-01

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

  10. Technical innovation, standardization, and skill qualification for pediatric minimally invasive surgery in Japan.

    Science.gov (United States)

    Iwanaka, Tadashi

    2009-01-01

    This is a presentation of sharing endeavors at modifying and standardizing surgical procedures as well as establishing endoscopic surgical skill qualification in the field of pediatric surgery in Japan.

  11. Single-Stage Minimally Invasive Surgery for Synchronous Primary Pulmonary Adenocarcinoma and Left Atrial Myxoma.

    Science.gov (United States)

    van der Merwe, Johan; Beelen, Roel; Martens, Sebastiaan; Van Praet, Frank

    2015-12-01

    We report the first successful short-term outcome of single-stage combined video-assisted thoracoscopic surgery lobectomy and port access surgery in a patient with operable primary right lower lobe adenocarcinoma and a synchronous cardiac myxoma. The video-assisted thoracic surgery right lower lobectomy with systematic lymph node dissection was performed first, followed by myxoma excision by port access surgery through the same working port incision. The histopathologic analysis confirmed a pT2a N0 M0 R0 (TNM 7th edition) primary poorly differentiated pulmonary adenocarcinoma and a completely excised cardiac myxoma. Postoperative recovery was uneventful, and follow-up at 6 weeks confirmed an excellent surgical and oncologic outcome.

  12. Minimally Invasive Parathyroidectomy

    Directory of Open Access Journals (Sweden)

    Lee F. Starker

    2011-01-01

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

  13. Minimally Invasive Surgery in Treatment of Hammer Toe%微创治疗锤状趾畸形

    Institute of Scientific and Technical Information of China (English)

    赵思桥; 马顺前; 高战鳌; 顾始伟; 周文; 贾晓龙; 夏涛

    2016-01-01

    Objective To evaluate the clinical results after minimally invasive surgery in treatment of hammer toe. Methods The clinical data of 218 patients (344 toes)with hammer toe who received the minimally invasive surgery between January 2012 and January 2016 were reviewed.There were 8 males and 210 females with an average age of 59. 80 years.215 patients (309 toes)suffered from hammer toe in second toe;29 patients (31 toes)in third toe;4 patients (4 toes)in fourth toe.215 patients (338 toes)suffered from hallux valgus at the same time.ACFAS Scoring Scale for forefoot was (41.3±10.71)before surgery.Results All patients were followed for 6~30 months.ACFAS Scoring Scale for forefoot is 88.6±5.29 after surgery.The difference had statistical significance before and after surgery (P=0.000). 90.83% patients had excellent results,7.79% good,and 1.38% bad.Conclusion Hammer toe can be corrected with less trauma,faster recovery,less complications,and more satisfaction by flexibly using a variety of minimally invasive sur-gery.%目的:评价微创手术治疗锤状趾畸形的临床疗效。方法回顾分析了西安市第一医院骨科自2012年1月至2016年1月所行218例(344趾)使用微创手术技术治疗锤状趾畸形病例,其中男性8例(16趾),女性210例(328趾);平均年龄59.80岁;第2趾发病215例(309趾),第3趾发病29例(31趾),第4趾发病4例(4趾);合并拇外翻畸形215例(338趾)。这些病例均采用微创手术技术治疗。术前美国足踝外科医生学会(American college of foot and ankle surgeons,ACFAS)前足评分平均为(41.3±10.71)分。结果全部病例均获随访,随访时间6~30个月;术后ACFAS前足评分平均为(88.6±5.29)分,进行两样本t 检验发现术前术后评分之间差异有统计学意义(P=0.000)。术后疗效评价:优198例(318趾),占90.83%;良17例(21趾),占7.79%;差3例(5趾),占1

  14. Development and testing of a compact endoscope manipulator for minimally invasive surgery

    National Research Council Canada - National Science Library

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

    2005-01-01

    Objective: 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...

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

    DEFF Research Database (Denmark)

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

    2014-01-01

    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...... 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...

  16. A novel suturing approach for tissue displacement within minimally invasive periodontal plastic surgery.

    Science.gov (United States)

    Ronco, Vincent; Dard, Michel

    2016-08-01

    This paper describes a novel suturing approach that achieves harmonious and atraumatic soft tissue displacement in periodontal plastic surgery and soft tissue management around implants. The technique relies on a combination of horizontal and vertical mattress that are anchored at the splinted incisal contact points.

  17. A novel suturing approach for tissue displacement within minimally invasive periodontal plastic surgery

    OpenAIRE

    Ronco, Vincent; Dard, Michel

    2016-01-01

    Key Clinical Message This paper describes a novel suturing approach that achieves harmonious and atraumatic soft tissue displacement in periodontal plastic surgery and soft tissue management around implants. The technique relies on a combination of horizontal and vertical mattress that are anchored at the splinted incisal contact points.

  18. A new MRI-compatible optical fiber tactile sensor for use in minimally invasive robotic surgery systems

    Science.gov (United States)

    Ahmadi, Roozbeh; Dargahi, Javad; Packirisamy, Muthukumaran; Cecere, Renzo

    2010-09-01

    In conventional open surgery, using finger palpation, surgeons can distinguish between different types of tissues. However, in the current commercially available minimally invasive robotic surgery (MIRS) systems, direct tactile feedback is negligible. In the present paper, based on a novel concept, a new bend-type optical fiber tactile sensor is proposed, designed, simulated, fabricated, and tested. In both dynamic and static loading conditions, the proposed tactile sensor measures forces interacting between tissues and surgical tools whether they are distributed contact forces or concentrated contact forces, or even if these forces are in combination. As a result, the sensor can identify the size and the position of blood vessels or of abnormal tissues, one of which could be a tumorous lump within normal tissues. In addition, the static force measurement provided by the sensor allows surgeons to maintain contact stability in any static interactions between surgical tools and tissues while at the same time avoiding tissue damage because of excessive contact force. In the meantime, because the sensor is based uniquely on optical fibers, it is insensitive to electromagnetic fields. As a result, it is compatible with Magnetic Resonance Imaging (MRI) devices, which are currently in widespread use in surgical operating rooms.

  19. A structured light-based laparoscope with real-time organs' surface reconstruction for minimally invasive surgery.

    Science.gov (United States)

    Maurice, Xavier; Albitar, Chadi; Doignon, Christophe; de Mathelin, Michel

    2012-01-01

    In this paper we present a new 3-D laparoscopic device based on structured light for minimally invasive surgery. Real-time reconstruction of internal organs' surfaces is very challenging as the numerous geometric and photometric variabilities and disturbances (bloody parts, specularities, smokes,...) often occur during the surgical operation, sometimes with manipulations by several assistants. We then conceived a structured light vision system to illuminate a coded pattern by means of an external video projector device or miniaturized diffractive optical elements and a laser source. Among the structured light techniques, the spatial neighbourhood scheme is the most relevant class of approaches to deal with moving and deformable surfaces, then to capture the depth map with only one shot. Each neighbourhood (a (3 × 3) window) is representing a codeword of length 9, and is unique in the whole pattern, even if there is a lack of information. To do so, a monochromatic subperfect map-based pattern is computed, driven by a desired minimal Hamming distance, H(min), between any couple of codewords. This provides patterns with high correction capabilities (H(min) > 1). For practical considerations, each numerical codeword symbol is associated to a unique visual feature embedding the local orientation of the pattern, which is helpful for the neighbourhood retrieval during the decoding process. Together with the endoscopic device, in vivo real-time reconstructions (in mini-invasive surgical conditions) are presented to assess both the efficiency of the proposed pattern design, the decoding process and the 3-D laparoscope setup realized in the lab.

  20. Robotic patch-stabilizer using wire driven mechanism for minimally invasive fetal surgery.

    Science.gov (United States)

    Zhang, Bo; Kobayashi, Yo; Chiba, Toshio; Fujie, Masakatsu G

    2009-01-01

    The clinical target of this study is intrauterine patch coverage of fetal myelomeningocele. We propose a new surgical robotic system for intrauterine fetal surgery with patch-stabilizer and laser manipulator. The target disease of the fetal surgery is spina bifida or myelomeningocele, which is incomplete closure in the spinal column and one of the common fetal diseases. In the fetal surgery, the collagen patch is supposed to be stabilized onto the fragile fetal tissue during the laser fixation process. In this study, a prototype of the patch-stabilizer using wire driven mechanism has been developed for precise force control on the patch without damaging fetal tissue. The diameter of the patch-stabilizer's shaft is 2.4 mm. The patch-stabilizer including one ball joint and wire driven mechanism is able to bend through 40 degrees. The stabilizing part holds collagen patch with diamond shape mechanism using wire driven. In this paper, we showed that the patch-stabilizer is developed with the stabilizing force control using the tension control of wires. Results of the experiment showed that the tension of driven wires was controlled at 0.3 N to stabilize the collagen patch onto the lesion surface without the damages of fetal tissues and the influence by the amnion liquid.

  1. Virtual tool for bilaterally controlled forceps robot--for minimally invasive surgery.

    Science.gov (United States)

    Abeykoon, A M Harsha S; Ohnishi, Kouhei

    2007-09-01

    Bilateral control enables an operator to be placed away from the working environment. A slave manipulator usually works at a remote site or in a hazardous environment while the master operator senses the environment through the slave manipulator. Bilateral control can be used in surgeries. Usually doctors are very sensitive to the tactile sensation they feel through medical tools. If bilateral control is used in a surgery, ideally the doctor should perceive the sensation of both the body tissue and the reaction force from the specialized tool. Many surgical instruments are essentially similar at the tool tip while showing some structural differences at the gripping end. Therefore, it is advantageous for an expensive tool to be replaced by a virtual tool together with a simple tool. With the virtual tool, the surgeon should be able to perceive the feeling of the actual tool together with the reaction force coming from the body tissue; this may also reduce the time taken for a tool change during the surgery. In this study, above ideas were implemented in a bilaterally controlled forceps robot and experiments were carried out to test the applicability of the concept. Bilateral control is used as the method of tactile feedback. Disturbance observer is used for robust control. Reaction force observer is used in place of a force sensor. Virtual model is used in place of the special tool properties. A virtual spring acting at the end of the forceps, was implemented to a bilateral control system, so that the operator at the master side could perceive the feeling of the spring together with reaction forces from the surgical environment. Operator could feel the vivid sensation of the environment through the master manipulator. The virtual model adds a load to the system. The master and slave responses are slightly different, but the result is good enough for the application. This novel approach could be used in many master-slave applications. 2007 John Wiley & Sons, Ltd.

  2. Advances in Pediatric Surgical Education: A Critical Appraisal of Two Consecutive Minimally Invasive Pediatric Surgery Training Courses.

    Science.gov (United States)

    Gause, Colin D; Hsiung, Grace; Schwab, Ben; Clifton, Matthew; Harmon, Carroll M; Barsness, Katherine A

    2016-08-01

    Mandates for improved patient safety and increasing work hour restrictions have resulted in changes in surgical education. Educational courses increasingly must meet those needs. We sought to determine the experience, skill level, and the impact of simulation-based education (SBE) on two cohorts of pediatric surgery trainees. After Institutional Review Board (IRB) exempt determination, a retrospective review was performed of evaluations for an annual advanced minimally invasive surgery (MIS) course over 2 consecutive years. The courses included didactic content and hands-on skills training. Simulation included neonatal/infant models for rigid bronchoscopy-airway foreign body retrieval, laparoscopic common bile duct exploration, and real tissue diaphragmatic hernia (DH), duodenal atresia (DA), pulmonary lobectomy, and tracheoesophageal fistula models. Categorical data were analyzed with chi-squared analyses with t-tests for continuous data. Participants had limited prior advanced neonatal MIS experience, with 1.95 ± 2.84 and 1.16 ± 1.54 prior cases in the 2014 and 2015 cohorts, respectively. The 2015 cohort had significantly less previous experience in lobectomy (P = .04) and overall advanced MIS (P = .007). Before both courses, a significant percentage of participants were not comfortable with DH repair (39%-42%), DA repair (50%-74%), lobectomy (34%-43%), and tracheoesophageal fistula repair (54%-81%). After course completion, > 60% of participants reported improvement in comfort with procedures and over 90% reported that the course significantly improved their perceived ability to perform each operation safely. Pediatric surgery trainees continue to have limited exposure to advanced MIS during clinical training. SBE results in significant improvement in both cognitive knowledge and trainee comfort with safe operative techniques for advanced MIS.

  3. A Novel Tele-Operated Flexible Robot Targeted for Minimally Invasive Robotic Surgery

    Directory of Open Access Journals (Sweden)

    Zheng Li

    2015-03-01

    Full Text Available In this paper, a novel flexible robot system with a constrained tendon-driven serpentine manipulator (CTSM is presented. The CTSM gives the robot a larger workspace, more dexterous manipulation, and controllable stiffness compared with the da Vinci surgical robot and traditional flexible robots. The robot is tele-operated using the Novint Falcon haptic device. Two control modes are implemented, direct mapping and incremental mode. In each mode, the robot can be manipulated using either the highest stiffness scheme or the minimal movement scheme. The advantages of the CTSM are shown by simulation and experimental results.

  4. Robotics and telemanipulation technologies for endoscopic surgery. A review of the ARTEMIS project. Advanced Robotic Telemanipulator for Minimally Invasive Surgery.

    Science.gov (United States)

    Schurr, M O; Buess, G; Neisius, B; Voges, U

    2000-04-01

    In endoscopic surgery, the ability to guide the instrument is significantly decreased compared with open surgery. Rigid laparoscopic instruments offer only four of the six degrees of freedom required for the free handling of objects in space. Robotics technology can be used to restore full mobility of the endoscopic instrument. Therefore, we designed a master-slave manipulator system (ARTEMIS) for laparoscopic surgery as a prototype. The system consists of two robotic arms holding two steerable laparoscopic instruments. These two work units are controlled from a console equipped with two master arms operated by the surgeon. The systems and its components were evaluated experimentally. Laparoscopic manipulations were feasible with the ARTEMIS system. The placement of ligatures and sutures and the handling of catheters were possible in phantom models. The surgical practicability of the system was demonstrated in animal experiments. We conclude that robotic manipulators are feasible for experimental endoscopic surgery. Their clinical application requires further technical development.

  5. A new minimally invasive tubular brain retractor system for surgery of deep intracerebral hematoma

    Directory of Open Access Journals (Sweden)

    Yad R Yadav

    2011-01-01

    Full Text Available Access to deep-seated brain lesions with traditional fixed and rigid brain retractors can be difficult without causing significant trauma to the surrounding brain. Tubular retractors offer an advantage of low retracting pressure. We developed a new inexpensive and simple tubular retractor which requires very small cortisectomy. The new tubular retractor was made up of silicone with inner diameter of 15, 18 and 23 mm and outer diameter of 17, 20 and 25 mm, respectively. This tube (1 mm thick was cut in longitudinal direction. It was folded to make a small-diameter tube so that it could be introduced through a small cortisectomy. Margins of cortisectomy were gently and slowly retracted by Killian nasal speculum. Folded retractor, held by tissue forceps, was introduced inside the opened Killian nasal speculum. Tissue forceps and nasal speculum were removed leaving tubular retractor in place, which comes back to its normal tubular configuration after release. Surgery was performed using rigid Karl Storz 0° telescope (30 cm long and 4 mm in diameter or microscope. Near-total removals of intracerebral hematomas, 37 hypertensive and 3 traumatic, was done using this retractor without any complication.

  6. Design and finite element modeling of a novel optical microsystems-based tactile sensor for minimal invasive robotic surgery

    Science.gov (United States)

    Ghanbari Mardasi, Amir; Ghanbari, Mahmood; Salmani Tehrani, Mehdi

    2014-09-01

    Although recently Minimal Invasive Robotic Surgery (MIRS) has been more addressed because of its wide range of benefits, however there are still some limitations in this regard. In order to address the shortcomings of MIRS systems, various types of tactile sensors with different sensing principles have been presented in the last few years. In the present paper a MEMS-based optical sensor, which has been recently proposed by researchers, is investigated using numerical simulation. By this type of sensors real time quantification of both dynamic and statics contact forces between the tissue and surgical instrument would be possible. The presented sensor has one moving part and works based on the intensity modulation principle of optical fibers. It is electrically-passive, MRI-compatible and it is possible to be fabricated using available standard micro fabrication techniques. The behavior of the sensor has been simulated using COMSOL MULTIPHYSICS 3.5 software. Stress analysis is conducted on the sensor to assess the deflection of the moving part of the sensor due to applied force. The optical simulation is then conducted to estimate the power loss due to the moving part deflection. Using FEM modeling, the relation between force and deflection is derived which is necessary for the calibration of the sensor.

  7. Development of Cutting and Suction Device with Twist Blade Screw for Minimally Invasive Surgery: Evaluation of Suction Performance.

    Science.gov (United States)

    Fujii, Yusuke; Suzuki, Takashi; Tamura, Manabu; Muragaki, Yoshihiro; Iseki, Hiroshi

    2015-01-01

    In this study, we aim to develop a narrow-diameter and long-bore device for minimally invasive surgery that achieves the simultaneous cutting and suction of body tissue such as the diseased part of an organ. In this paper, we propose a screw made of a thin metal plate, and we developed a prototype device using this screw. For smooth operation, the suction performance must be superior to the cutting performance. Therefore, we performed experiments and evaluated the suction performance of the developed device assuming the crushed tissue pieces correspond to a highly viscous fluid. From the results, we confirmed that the suction volume is almost proportional to the rotation speed of the screw in the low speed range, and the device has an upper limit of suction volume at a certain rotation speed. Considering practical use, its proportional speed range is suitable for the device controllability of cutting and suction volume, and the size of the device tip needs to be 1 mm or more. Based on these conditions, we are planning to examine the shape of the cutting edge for realizing efficient cutting and suction and we will complete the device.

  8. Miniature 6-axis force/torque sensor for force feedback in robot-assisted minimally invasive surgery

    Institute of Scientific and Technical Information of China (English)

    李坤; 潘博; 高文朋; 封海波; 付宜利; 王树国

    2015-01-01

    In order to restore force sensation to robot-assisted minimally invasive surgery (RMIS), design and performance evaluation of a miniature 6-axis force/torque sensor for force feedback is presented. Based on the resistive sensing method, a flexural-hinged Stewart platform is designed as the flexible structure, and a straightforward optimization method considering the force and sensitivity isotropy of the sensor is proposed to determine geometric parameters which are best suited for the given external loads. The accuracy of this method is preliminarily discussed by finite element methods (FEMs). The sensor prototype is fabricated with the development of the electronic system. Calibration and dynamic loading tests for this sensor prototype are carried out. The working ranges of this sensor prototype are 30 N and 300 N·mm, and resolutions are 0.08 N in radial directions, 0.25 N in axial direction, and 2.4 N·mm in rotational directions. It also exhibits a good capability for a typical dynamic force sensing at a frequency close to the normal heart rate of an adult. The sensor is compatible with surgical instruments for force feedback in RMIS.

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

    Science.gov (United States)

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

    2014-04-09

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

  10. Spherical mechanism analysis of a surgical robot for minimally invasive surgery -- analytical and experimental approaches.

    Science.gov (United States)

    Rosen, Jacob; Lum, Mitch; Trimble, Denny; Hannaford, Blake; Sinanan, Mika

    2005-01-01

    Recent advances in technology have led to the fusion of MIS techniques and robot devices. However, current systems are large and cumbersome. Optimizing the surgical robot mechanism will eventually lead to its integration into the operating room (OR) of the future becoming the extended presence of the surgeon and nurses in a room occupied by the patient alone. By optimizing a spherical mechanism using data collected in-vivo during MIS procedures, this study is focused on a bottom-up approach to developing a new class of surgical robotic arms while maximizing their performance and minimizing their size. The spherical mechanism is a rotational manipulator with all axes intersecting at the center of the sphere. Locating the rotation center of the mechanism at the MIS port makes this class of mechanism a suitable candidate for the first two links of a surgical robot for MIS. The required dexterous workspace (DWS) is defined as the region in which 95% of the tool motions are contained based on in-vivo measurements. The extended dexterous workspace (EDWS) is defined as the entire abdominal cavity reachable by a MIS instruments. The DWS is defined by a right circular cone with a vertex angle of 60 degrees and the EDWS is defined by a cone with an elliptical cross section created by two orthogonal vertex angles of 60 degrees and 90 degrees. A compound function based on the mechanism's isotropy and the mechanism stiffness was considered as the performance metric cost function. Optimization across both the DWS and the EDWS lead to a serial mechanism configuration with link length angles of 74 degrees and 60 degrees for a serial configuration. This mechanism configuration maximized the kinematic performance in the DWS while keeping the EDWS as its reachable workspace. Surgeons, using a mockup of two mechanisms in a MIS setup, validated these results experimentally. From these experiments the serial configuration was deemed most applicable for MIS robotic applications compared

  11. Minimally invasive versus open surgery for acute Achilles tendon rupture: a systematic review of overlapping meta-analyses.

    Science.gov (United States)

    Li, Qingbo; Wang, Chuanying; Huo, Yanqing; Jia, Zhiwei; Wang, Xiqian

    2016-06-06

    A number of meta-analyses have been carried out to evaluate the effects of minimally invasive surgery (MIS) versus open surgery (OS) for acute Achilles tendon rupture. However, discordant findings were seen in these meta-analyses. The present study, performing a systematic review of overlapping meta-analyses regarding MIS versus OS of acute Achilles tendon rupture, aimed to assist decision-makers interpret and choose among conflicting meta-analyses, as well as to offer treatment recommendations based on current best evidence. The literature search was performed to identify systematic reviews comparing MIS with OS for Achilles tendon rupture. Meta-analyses only comprising randomized controlled trials (RCTs) were included. Two authors individually evaluated the quality of meta-analysis and extracted data. The Jadad decision algorithm was conducted to ascertain which meta-analysis offered the best evidence. A total of four meta-analyses was included. All these meta-analyses comprised RCTs or quasi-RCTs and were determined as Level-II evidence. The scores of the Assessment of Multiple Systematic Reviews (AMSTAR) ranged from 7 to 10 (median 9.5). The Jadad algorithm indicated that the best meta-analysis should be chosen according to the search strategies and application of selection. A high-quality meta-analysis with more RCTs was chosen, which suggested that there was no statistically significant difference between MIS and OS regarding rerupture rate, tissue adhesion, sural nerve injury, deep infection, and deep vein thrombosis. However, MIS could decrease superficial infection rate, and had a better patient satisfaction for good to excellent outcomes in comparison to OS. Based on the best available evidence, MIS may be superior to OS for treating acute Achilles tendon rupture. However, due to some limitations, this should be cautiously interpreted, and further high-quality studies are needed.

  12. Recent application of minimally invasive robotic cardiac surgery%机器人微创心脏手术的应用现状

    Institute of Scientific and Technical Information of China (English)

    杨明; 高长青

    2011-01-01

    The minimally invasive approach is the direction of cardiac surgery.With the development of telemanipulation and computer technology,the minimally robotic surgery has become reality.As the one of the most minimally invasive cardiac surgery,the robotic surgical system provides cardiac surgeons with less invasive manner and dexterity manipulation.Robotic cardiac surgery is an evolutionary process and has resulted in a substantial increased attention to surgeons and patients.This review is to introduce the recent clinical application of robotic technology in cardiac surgery.%微创是心脏外科的发展方向之一.随着自动机械和计算机技术的进步,机器人微创外科手术已成为现实.机器人微创心脏手术具有创伤小、操作精细等优点,是微创心脏外科的前沿技术之一.作为一种革新的手术方式,机器人辅助下微创心脏手术得到了极大的关注,本文就机器人心脏手术的临床应用及手术效果作一综述.

  13. 微创技术对胃癌个体化手术的影响%Inlfuence of minimally invasive techniques on individualized surgery for gastric cancer

    Institute of Scientific and Technical Information of China (English)

    蔡清萍; 张鑫

    2014-01-01

    胃癌是危害人类健康的严重疾病之一,个体化手术成为当代胃癌外科治疗的发展要求,而科学技术的飞速发展推动了微创技术在胃肠外科中的应用。本文探讨微创技术对胃癌个体化手术的影响,包括微创外科的特征、个体化治疗对胃癌手术的要求和胃癌微创手术的变化趋势,重点论述基于多学科团队(multidisciplinary team)模式的术前分期在胃癌个体化手术选择中的地位,胃癌术式的多样性及循证医学下的个体化术式的选择,基于动脉导航(arterial navigation)的现有胃癌淋巴清扫的个体化要求,术中再分期、方案再制定及落实等术者经验与决策对胃癌个体化手术的重要影响。%Gastric cancer is a major global health problem. Individualized surgery has become a requirement for the development of surgical treatment for gastric cancer. The rapid development of science and technology promotes the application of minimally invasive techniques in gastrointestinal surgery. In this review, we aim to explore the inlfuence of minimally invasive techniques on individualized surgery for gastric cancer, including the characteristics of the era of minimally invasive surgery, request of individualized treatment on surgery of gastric cancer and the development trend of minimally invasive surgery for gastric cancer. Particularly, we would discuss the guiding importance of preoperative staging based on multidisciplinary treatment for the option of individualized surgery for gastric cancer, the diversity of surgical method in the era of minimally invasive surgery and the option of surgical methods based on evidenced-based medicine, individual requirements for current lymph node dissection strategy based on arterial navigation, and the important role of the operator’s experience in individualized surgery, including intraoperative re-staging, and the reenacting and implement of surgical methods.

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

    Science.gov (United States)

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

    2009-06-01

    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 feedback in the different areas of surgical skills (training) need to be answered before adding costly haptic feedback in VR simulation for MIS training. This study was designed to review the current status and value of haptic feedback in conventional and robot-assisted MIS and training by using virtual reality simulation. A systematic review of the literature was undertaken using PubMed and MEDLINE. The following search terms were used: Haptic feedback OR Haptics OR Force feedback AND/OR Minimal Invasive Surgery AND/OR Minimal Access Surgery AND/OR Robotics AND/OR Robotic Surgery AND/OR Endoscopic Surgery AND/OR Virtual Reality AND/OR Simulation OR Surgical Training/Education. The results were assessed according to level of evidence as reflected by the Oxford Centre of Evidence-based Medicine Levels of Evidence. In the current literature, no firm consensus exists on the importance of haptic feedback in performing minimally invasive surgery. Although the majority of the results show positive assessment of the benefits of force feedback, results are ambivalent and not unanimous on the subject. Benefits are least disputed when related to surgery using robotics, because there is no haptic feedback in currently used robotics. The addition of haptics is believed to reduce surgical errors resulting from a lack of it, especially in knot tying. Little research has been performed in the area of robot-assisted endoscopic surgical training, but results seem promising. Concerning VR training, results indicate that haptic feedback is important during the early phase of psychomotor skill acquisition.

  15. Minimally invasive aortic valve replacement

    DEFF Research Database (Denmark)

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

    2009-01-01

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

  16. A Comparative Study Between an Improved Novel Air-Cushion Sensor and a Wheeled Probe for Minimally Invasive Surgery

    Science.gov (United States)

    Challacombe, Benjamin; Li, Jichun; Seneviratne, Lakmal; Althoefer, Kaspar; Dasgupta, Prokar; Murphy, Declan

    2010-01-01

    Abstract Purpose We describe a comparative study between an enhanced air-cushion tactile sensor and a wheeled indentation probe. These laparoscopic tools are designed to rapidly locate soft-tissue abnormalities during minimally invasive surgery (MIS). Materials and Methods The air-cushion tactile sensor consists of an optically based sensor with a 7.8 mm sphere “floating” on a cushion of air at the tip of a shaft. The wheeled indentation probe is a 10 mm wide and 5 mm in diameter wheel mounted to a force/torque sensor. A continuous rolling indentation technique is used to pass the sensors over the soft-tissue surfaces. The variations in stiffness of the viscoelastic materials that are detected during the rolling indentations are illustrated by stiffness maps that can be used for tissue diagnosis. The probes were tested by having to detect four embedded nodules in a silicone phantom. Each probe was attached to a robotic manipulator and rolled over the silicone phantom in parallel paths. The readings of each probe collected during the process of rolling indentation were used to achieve the final results. Results The results show that both sensors reliably detected the areas of variable stiffness by accurately identifying the location of each nodule. These are illustrated in the form of two three-dimensional spatiomechanical maps. Conclusions These probes have the potential to be used in MIS because they could provide surgeons with information on the mechanical properties of soft tissue, consequently enhancing the reduction in haptic feedback. PMID:20624084

  17. Minimally invasive measurement of cardiac output during surgery and critical care: a meta-analysis of accuracy and precision.

    Science.gov (United States)

    Peyton, Philip J; Chong, Simon W

    2010-11-01

    When assessing the accuracy and precision of a new technique for cardiac output measurement, the commonly quoted criterion for acceptability of agreement with a reference standard is that the percentage error (95% limits of agreement/mean cardiac output) should be 30% or less. We reviewed published data on four different minimally invasive methods adapted for use during surgery and critical care: pulse contour techniques, esophageal Doppler, partial carbon dioxide rebreathing, and transthoracic bioimpedance, to assess their bias, precision, and percentage error in agreement with thermodilution. An English language literature search identified published papers since 2000 which examined the agreement in adult patients between bolus thermodilution and each method. For each method a meta-analysis was done using studies in which the first measurement point for each patient could be identified, to obtain a pooled mean bias, precision, and percentage error weighted according to the number of measurements in each study. Forty-seven studies were identified as suitable for inclusion: N studies, n measurements: mean weighted bias [precision, percentage error] were: pulse contour N = 24, n = 714: -0.00 l/min [1.22 l/min, 41.3%]; esophageal Doppler N = 2, n = 57: -0.77 l/min [1.07 l/min, 42.1%]; partial carbon dioxide rebreathing N = 8, n = 167: -0.05 l/min [1.12 l/min, 44.5%]; transthoracic bioimpedance N = 13, n = 435: -0.10 l/min [1.14 l/min, 42.9%]. None of the four methods has achieved agreement with bolus thermodilution which meets the expected 30% limits. The relevance in clinical practice of these arbitrary limits should be reassessed.

  18. Minimally Invasive Surgery Combined with Regenerative Biomaterials in Treating Intra-Bony Defects: A Meta-Analysis.

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    Shan Liu

    Full Text Available 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.The authors retrieved English publications on relevant studies from Cochrane CENTRAL, PubMed, Medline, Embase, Clinical Evidence, and ClinicalTrials.gov (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.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.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.

  19. 机器人在微创外科手术中的应用%Research on minimally invasive robotic surgery

    Institute of Scientific and Technical Information of China (English)

    徐兆红; 宋成利; 闫士举

    2011-01-01

    背景:微创外科手术机器人具有稳定性好、操作灵活、运动精准、手眼协调等特点,是微创手术未来发展的方向.目的:分析微创外科手术机器人的现状,探讨微创外科手术机器人的关键技术.方法:分别从体外手术机器人与体内手术机器人等方面,详细分析和介绍了国内外近年来的主要研究成果,并对微创外科手术机器人的力反馈、主从控制策略等关键技术进行了探讨.结果与结论:综合国内外微创外科机器人的研究情况来看,微型体内手术机器人是手术机器人领域的研究热点,特别是微型机器人的灵巧性设计、手术机器人的定位、运动规划与控制、操作力的实时测量与力反馈等关键技术.主从操控技术是手术机器人进行遥操作和微操作的关键环节.%BACKGROUND: With the rapid development of robotics technology, minimally invasive robotic surgery (MIRS) has been investigated in various surgical procedures due to its high accuracy, fine manipulation capability, good repeatability, high reliability,lack of fatigue, tele-operation.OBJECTIVE: To analyze the status of MIRS, and to study the key technology of MIRS.METHODS: According to the characteristics and clinical application of MIRS, from in vitro and robotic surgery, some key technologies are discussed in detail.RESULTS AND CONCLUSION: Haptic (mainly force) feedback plays a significant role in MIRS. The proposed key technologies could be used to tele-robotic system and clinical application.

  20. Minimally invasive surgical techniques in periodontal regeneration.

    Science.gov (United States)

    Cortellini, Pierpaolo

    2012-09-01

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

  1. Cirugía mínimamente invasiva de tiroides y paratiroides Minimally invasive surgery of thyroids and parathyroids

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    D. Casanova

    2005-01-01

    Full Text Available Bajo el término de cirugía mínimamente invasiva de tiroides y paratiroides se engloban una serie de procedimientos terapéuticos orientados a la solución de la patología endocrina responsable de la enfermedad, con una agresión quirúrgica limitada y con resultados estéticos y confort postoperatorio superior al estándar del abordaje convencional. Su aplicación ha venido de la mano del desarrollo de nuevos métodos de imagen y de instrumentos que permitan realizar disección, en espacios muy limitados. A diferencia de la cirugía clásica de tiroides y paratiroides donde la técnica quirúrgica tiene amplias posibilidades de aplicación, en el abordaje cervicoscópico las indicaciones son más limitadas y se establecen en relación con las características de cada paciente. Con respecto a la patología tiroidea el tamaño del nódulo constituye el principal factor limitante, ya que en tamaños superiores a 3 cm los beneficios del procedimiento no son tan evidentes. Sin embargo, en la cirugía paratiroidea se dispone de un potencial superior dado que el adenoma responsable de la enfermedad se encuentra con frecuencia en posiciones anatómicas muy asequibles para este tipo de procedimientos. Por tanto, en pacientes con ausencia de patología tiroidea asociada, con patología unilateral basada en la información de la gammagrafía sestamibi y preferentemente en localizaciones inferiores, el abordaje cervicoscópico puede cumplir los requisitos antes expresados de eficacia, confort postoperatorio y corta estancia.The term minimally invasive surgery of thyroids and parathyroids encompasses a series of therapeutic procedures aimed at solving the endocrinal pathology responsible for the disease, with limited surgical aggression and aesthetic results and postoperative comfort on a par with the conventional approach. Its application has become possible with the development of new methods of imaging and instruments that make it possible to carry

  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

    2013-11-01

    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. A review of medical robotics for minimally invasive surgery%医用机器人在微创手术领域的发展概况

    Institute of Scientific and Technical Information of China (English)

    钱文文; 郑建; 何涛

    2014-01-01

    Medical robotics as one of novel medical devices , have been successfully applied to a variety of minimally invasive sur-gery.This paper provides an overview of medical robotics for minimally invasive surgery on ophthalmological surgery , neurosurgery , cardio-thoracic surgery , gastrointestinal surgery and urological surgery.Technology developments and clinical applications of RO-BODOC system and Da Vinci surgical system which are the most typical medical robotics are also included in this paper .%医用机器人作为一种新型医疗器械,已经被成功应用于各类微创手术中。本文对医用机器人在眼科、神经外科、心胸外科、肠胃外科和泌尿外科五个重要微创领域的国内外研究发展情况做了详细介绍。同时还介绍了两个成功的商业化医用机器人ROBODOC和Da Vinci的技术发展和临床应用情况。

  4. Minimally invasive procedures on the lumbar spine

    Science.gov (United States)

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

    2015-01-01

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

  5. Combined minimally invasive percutaneous nephrolithotomy and retrograde intrarenal surgery for staghorn calculi in patients with solitary kidney.

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    Dehui Lai

    Full Text Available BACKGROUND: To present our experience with simultaneous combined minimally invasive percutaneous nephrolithotomy (MPCNL and retrograde intrarenal surgery (RIRS to manage patients with staghorn calculi in solitary kidney, and evaluate the safety, efficiency and feasibility of this approach. METHODOLOGY/PRINCIPAL FINDINGS: The study included 20 patients with staghorn calculi in solitary kidney. Demographic characteristics, stone location and surface area were recorded. After informed consent, the patients underwent one stage MPCNL firstly. Combined second stage MPCNL and RIRS simultaneously were performed at postoperative 5-7 days. Operative parameters, stone-free rate (SFR, stone analyses and complications were evaluated. Serum creatinine (Scr, glomerular filtration rate (GFR and chronic kidney disease (CKD were measured preoperatively, postoperatively at 1 month, and each follow-up visit. All patients had staghorn stones involving multiple calyces. The mean stone burden was 1099.9 ± 843.95 mm(2. All patients had only one percutaneous access tract. The mean whole operative duration was 154.37 ± 32.45 min. The mean blood loss was 64 (12-140 ml. The final SFR was 90%. During the 1-month follow-up study period, four patients improved in CKD stage. Two patients who had CKD (stage 5 still needed dialysis postoperatively. Mean Scr of the rest patients preoperatively was 187.16 ± 94.12 compared to 140.99 ± 57.92 umol/L by the end of 1-month follow-up period (p = 0.019. The same findings were observed in GFR in that preoperatively it was 43.80 ± 24.74 ml/min and by the end of the 1-month follow-up it was 49.55 ± 21.18 ml/min (p = 0.05. CONCLUSIONS/SIGNIFICANCE: Combined MPCNL and RIRS management effectively decrease the number and size of percutaneous access tracts, which is safe, feasible, and efficient for managing staghorn calculi in solitary kidney with satisfactory SFR and reducing blood loss, potential morbidity associated with multiple

  6. 微创时代外科医生的成长与挑战%Surgeons in the era of,minimally invasive surgery

    Institute of Scientific and Technical Information of China (English)

    黄志强

    2009-01-01

    Since the Success of the first case of laparoscopic cholecystectomy in 1987,minimally invasive surgery has become the most active field in all the branches of surgery.The traditional concept of surgery needs to be changed as the rapid development of surgical procedures,medical materials and devices,and the requirement of biopsychosocial model of medieine also poses great challenges to today's surgeons.Traditionally trained surgeons may find it difficult to adapt to the new developments.While,on the other hand,young laparoscopists may be at a loss when facing the difficulties encountered during the laparoscopic operation.The surgeons of tomorrow should have profound base of the knowledge of surgery and skillful in laparoscopy at the same time.

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

    Science.gov (United States)

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

    2016-01-01

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

  8. Minimally invasive surgery for benign intradural extramedullary spinal meningiomas: experience of a single institution in a cohort of elderly patients and review of the literature

    Directory of Open Access Journals (Sweden)

    Iacoangeli M

    2012-12-01

    Full Text Available Maurizio Iacoangeli, Maurizio Gladi, Alessandro Di Rienzo, Mauro Dobran, Lorenzo Alvaro, Niccolò Nocchi, Lucia Giovanna Maria Di Somma, Roberto Colasanti, Massimo ScerratiDepartment of Neurosurgery, Università Politecnica delle Marche, Umberto I General Hospital, Ancona, ItalyAbstract: Meningiomas of the spine are the most common benign intradural extramedullary lesions and account for 25%–46% of all spinal cord tumors in adults. The goal of treatment is complete surgical resection while preserving spinal stability. Usually, these lesions occur in the thoracic region and in middle-aged women. Clinical presentation is usually nonspecific and the symptoms could precede the diagnosis by several months to years, especially in older people, in whom associated age-related diseases can mask the tumor for a long time. We report a series of 30 patients, aged 70 years or more, harboring intradural extramedullary spinal meningiomas. No subjects had major contraindications to surgery. A minimally invasive approach (hemilaminectomy and preservation of the outer dural layer was used to remove the tumor, while preserving spinal stability and improving the watertight dural closure. We retrospectively compared the outcomes in these patients with those in a control group subjected to laminectomy or laminotomy with different dural management. In our experience, the minimally invasive approach allows the same chances of complete tumor removal, while providing a better postoperative course than in a control group.Keywords: spinal meningioma, elderly, hemilaminectomy, outer dural layer, inner dural layer, minimally invasive surgery

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

    Science.gov (United States)

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

    2011-02-01

    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 arm case-matched series, the 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.

  10. [Invasive and minimally invasive hemodynamic monitoring].

    Science.gov (United States)

    Hansen, Matthias

    2016-10-01

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

  11. 微创手术时代胸外科进修医师培训体会%Experiences of Training Refresher Doctors in Thoracic Surgery in Minimally Invasive Surgery Era

    Institute of Scientific and Technical Information of China (English)

    郭俊唐; 梁朝阳; 刘阳

    2016-01-01

    Minimally invasive surgery such as video-assisted thoracoscopic surgery (VATS) and robotic-assisted surgery have developed widely in thoracic surgery. In this minimally invasive surgery era, it is an important task to train refresher doctors learning thoracic minimally invasive surgery effectively and legally. Systematic employee orientation and "three basic"training including basal knowledge and basal theories, the basal skills are important foundations for clinical practice. At the same time, the teachers implemented minimally invasive surgery skills training step by step. Several study types by mobile internet were also recommended. During daily clinical practice, prevent and management of complication was trained. The training process was proved to shorten the learning curve signiifcantly and be an effective teaching method.%以胸腔镜和机器人外科为代表的微创手术逐步在胸外科普及,如何高效、规范地对进修医师进行微创手术技能培训是临床教学中一个重要课题。我们通过进行临床三基训练,分阶梯进行微创外科技能的训练,让进修医师接受互联网时代多种学习方式,以及进行并发症预防和处理的培训等,提高了学习效率,缩短了学习曲线,是一种值得推广的临床教学方法。

  12. The effectiveness of rigid pericardial endoscopy for minimally invasive minor surgeries: cell transplantation, epicardial pacemaker lead implantation, and epicardial ablation

    Directory of Open Access Journals (Sweden)

    Kimura Takehiro

    2012-11-01

    Full Text Available Abstract Background The efficacy and safety of rigid pericardial endoscopy as the promising minimally invasive approach to the pericardial space was evaluated. Techniques for cell transplantation, epicardial pacemaker lead implantation, and epicardial ablation were developed. Methods Two swine and 5 canines were studied to evaluate the safety and efficacy of rigid pericardial endoscopy. After a double pericardiocentesis, a transurethral rigid endoscope was inserted into the pericardial space. The technique to obtain a clear visual field was examined, and acute complications such as hemodynamic changes and the effects on intra-pericardial pressure were evaluated. Using custom-made needles, pacemaker leads, and forceps, the applications for cell transplantation, epicardial pacemaker lead implantation, and epicardial ablation were also evaluated. Results The use of air, the detention of a stiff guide wire in the pericardial space, and the stretching of the pericardium with the rigid endoscope were all useful to obtain a clear visual field. A side-lying position also aided observation of the posterior side of the heart. As a cell transplantation methodology, we developed an ultrasonography-guided needle, which allows for the safe visualization of transplantation without major complications. Pacemaker leads were safely and properly implanted, which provides a better outcome for cardiac resynchronizing therapy. Furthermore, the success of clear visualization of the pulmonary veins enabled us to perform epicardial ablation. Conclusions Rigid pericardial endoscopy holds promise as a safe method for minimally invasive cell transplantation, epicardial pacemaker lead implantation, and epicardial ablation by allowing clear visualization of the pericardial space.

  13. [Effects of robot-assisted minimally invasive transforaminal lumbar interbody fusion and traditional open surgery in the treatment of lumbar spondylolisthesis].

    Science.gov (United States)

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

    2017-07-01

    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 Probot-assisted minimally invasive TLIF group: (11.8 ± 2.8) mm vs. (7.5 ± 1.9) mm, traditional open TLIF group: (12.7 ± 2.5) mm vs. (7.9±2.0) mm), and so was the lumbar lordosis angle (robot-assisted minimally invasive TLIF group: (48.7±9.2)°vs. (39.6±7.9)°, traditional open TLIF group: (50.1±10.8)°vs. (41.4±8.8)°), the lordosis angle of the slippage segment (robot-assisted minimally invasive TLIF group: (18.7±5.6)°vs. (10.9±3.8)°, traditional open TLIF group: (17.6±6.1)°vs.(8.7±3.2)

  14. Minimally invasive surgery using intraoperative electron-beam radiotherapy for the treatment of soft tissue sarcoma of the extremities with tendon involvement.

    Science.gov (United States)

    Matsumine, Akihiko; Tsujii, Masaya; Nakamura, Tomoki; Asanuma, Kunihiro; Matsubara, Takao; Kakimoto, Takuya; Yada, Yuki; Takada, Akinori; Ii, Noriko; Nomoto, Yoshihito; Sudo, Akihiro

    2016-08-12

    When a soft tissue sarcoma (STS) is located at the distal part of an extremity and involves the tendon, a wide excision usually causes severe functional disability. We therefore developed a minimally invasive surgical technique using intraoperative electron-beam radiotherapy (IOERT) to reduce the incidence of post-operative functional disability in patients with peri-/intra-tendinous STS. We assessed the clinical outcomes of the novel minimally invasive surgery. The study population included five patients who received treatment for distal extremity STSs. After elevating the tumor mass, including the tendon and nerve from the tumor bed with a wide margin, a lead board was inserted beneath the tumor mass to shield the normal tissue. IOERT (25-50 Gy) was then applied, and the tumor excised with care taken to maintain the continuity of the tendon. In a desmoid patient, local recurrence was observed outside the irradiated field. No cases of neuropathy or bone necrosis were observed. The mean limb function score was excellent in all patients. None of the high-grade sarcoma patients had local recurrence or distant metastasis. Although the current study is only a pilot study with a small number of patients, it shows that this minimally invasive procedure has the potential to become a standard treatment option for selected patients. H17-250 (registered 2 November 2005) and H25-250 (modified from H17-250, registered 5 December 2013).

  15. 澳大利亚微创胆道外科%Minimally Invasive Bile Duct Surgery in Australia

    Institute of Scientific and Technical Information of China (English)

    David I Watson; John W Chen; Huiqi Yang

    2007-01-01

    目的 从20世纪末期以来,澳大利亚腹腔镜手术已经快速发展进步并且逐渐扩展到各个外科手术领域.一些外科医生也完成并发表了关于腹腔镜胆总管探查技术的报道.在本文中,作者介绍了目前澳大利亚的微创外科手术治疗胆管疾病的现状,包括:常规或选择性胆管造影;胰腺胆道疾病中ERCP的作用;腹腔镜胆总管探查术的手术技巧以及胆源性胰腺炎的治疗.作者还介绍了澳大利亚目前胆总管探查的现状,并且提到他们倾向于每例腹腔镜胆囊切除术都进行术中胆道造影.如果胆总管内发现小结石而且胆囊管足够粗,则进行经胆囊管的胆总管探查术.然而,如果狭窄的胆总管内有较大的结石,则进行术后ERCP治疗.作者还进一步介绍了胆道疾病相关的其他的微创治疗手术方法.总的来说,腹腔镜手术进行胆总管取石是可行和安全的.在有足够经验的医疗中心,这种手术方法可以常规使用.同时,成功进行腹腔镜胆总管探查术也需要多种方法综合进行.ERCP也没有被腹腔镜胆总管探查术所取代,而且成为一种重要的补充性的胆总管结石治疗方法.%Laparoscopic techniques have been developed, evolved and expanded rapidly since the late of 21 century in Australia. Some surgeons also developed and published descriptions of techniques for laparoscopic common bile duct exploration. In this article, the author induced the current situation of minimally invasive surgery treatments of bile duct diseases in Australia, such as the choice of Routine or selective cholangiography;the constantly-changing role of ERCP for pancreatic-biliary diseases;techniques for laparoscopic exploration of the common bile duct which include transcystic common bile duct exploration and laparoscopic choledochotomy;and treatment of biliary pancreatitis. The author also introduced current status of common duct exploration in Australia, and mentioned that

  16. Acquiring minimally invasive surgical skills

    NARCIS (Netherlands)

    Hiemstra, Ellen

    2012-01-01

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

  17. What is minimally invasive dentistry?

    Science.gov (United States)

    Ericson, Dan

    2004-01-01

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

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

    Science.gov (United States)

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

    2015-03-01

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

  19. 肛瘘微创手术的治疗进展%The Treatment Progress of Minimally-invasive Surgery for Anal Fistula

    Institute of Scientific and Technical Information of China (English)

    蒋捷

    2013-01-01

    The basic surgical treatment for anal fistula is the anal fistula incision and the anal fistula resection.The anal defect and the anal incontinence are the commonest complications during the treatment of anal fistula.Protecting the function of anus should be put in the first place of the treatment.Nowadays, most surgical treatments damage the function of anus, and along with the emerging of the minimally-invasive surgery, the protection of anal function is getting more and more concerned, so here is to make a review of the minimally-invasive surgery in anal fistula both in China and abroad.%肛瘘最基本的手术是肛瘘切开术和肛瘘切除术,肛瘘治疗过程中最常见的并发症为肛门缺损和肛门失禁.对肛瘘治疗来讲,保护肛门功能应该放在所有治疗目标的第一位.目前肛瘘治疗的术式多存在对肛门功能保护不足的现象,随着微创手术的兴起,目前对肛瘘的治疗越来越倡导肛门功能的保护,由此对国内外以微创手术方法治疗肛瘘的相关文献进行综述.

  20. Nursing management in robotic minimally invasive cardiac surgeries%机器人微创心脏手术的护理管理

    Institute of Scientific and Technical Information of China (English)

    赵悦; 孙建荷; 李丽霞; 郭丽

    2012-01-01

    Objective To observe the clinical application of robotic (da Vinic S) minimally invasive cardiac surgeries and to summarize the method of the nursing management.Methods 431 patients accepted robotic minimally invasive cardiac surgeries from January 2007 to July 2011. The preoperative preparation,nursing cooperation during operation and postoperation management was retrospectively analyzed.Results With effective preoperative preparation,nursing cooperation during operation and postoperation management,all 431 cases of robotic cardiac surgeries were successful. No thoracotomy was carried out during operation.Duration of preparation and operation was significantly shorter than before.Conclusions Sufficient preoperative preparation,practiced nursing cooperation during operation and proficient machine manipulation are prerequisite to the implementation of robotic cardiac surgery.%目的 观察机器人微创心脏手术的临床应用,总结其护理管理方案.方法 回顾分析431例使用“达芬奇S”全机器人手术系统完成微创心脏手术患者的术前准备、手术配合过程及术后机器的管理方法.结果 经过完善的术前准备、术中配合和术后管理,成功完成了431例全机器人心脏手术,无术中中转开胸,术前准备时间和手术时间明显缩短.结论 充分的术前准备、默契的手术配合及熟练的机器操作是机器人手术顺利进行的前提条件.

  1. Fluorescence-based enhanced reality (FLER) for real-time estimation of bowel perfusion in minimally invasive surgery

    Science.gov (United States)

    Diana, Michele

    2016-03-01

    Pre-anastomotic bowel perfusion is a key factor for a successful healing process. Clinical judgment has limited accuracy to evaluate intestinal microperfusion. Fluorescence videography is a promising tool for image-guided intraoperative assessment of the bowel perfusion at the future anastomotic site in the setting of minimally invasive procedures. The standard configuration for fluorescence videography includes a Near-Infrared endoscope able to detect the signal emitted by a fluorescent dye, more frequently Indocyanine Green (ICG), which is administered by intravenous injection. Fluorescence intensity is proportional to the amount of fluorescent dye diffusing in the tissue and consequently is a surrogate marker of tissue perfusion. However, fluorescence intensity alone remains a subjective approach and an integrated computer-based analysis of the over-time evolution of the fluorescence signal is required to obtain quantitative data. We have developed a solution integrating computer-based analysis for intra-operative evaluation of the optimal resection site, based on the bowel perfusion as determined by the dynamic fluorescence intensity. The software can generate a "virtual perfusion cartography", based on the "fluorescence time-to-peak". The virtual perfusion cartography can be overlapped onto real-time laparoscopic images to obtain the Enhanced Reality effect. We have defined this approach FLuorescence-based Enhanced Reality (FLER). This manuscript describes the stepwise development of the FLER concept.

  2. Antegrade and retrograde perfusion in minimally invasive mitral valve surgery with transthoracic aortic clamping: a single-institution experience with 1632 patients over 12 years.

    Science.gov (United States)

    Murzi, Michele; Cerillo, Alfredo G; Gasbarri, Tommaso; Margaryan, Rafik; Kallushi, Enkel; Farneti, Pierandrea; Solinas, Marco

    2017-03-01

    The aim of the present study was to evaluate the impact of a retrograde arterial perfusion (RAP) strategy versus an antegrade arterial perfusion (AAP) strategy in a consecutive, large cohort of patients who underwent minimally invasive mitral valve surgery with transthoracic aortic clamping through a right minithoracotomy. Between 2003 and 2015, 1632 consecutive patients underwent first-time minimally invasive mitral valve surgery with transthoracic aortic clamping at our institution; 141 (8.6%) of these patients received retrograde perfusion with femoral artery cannulation, whereas 1421 (91.4%) received antegrade perfusion with ascending aorta cannulation. Logistic regression was used to evaluate outcomes and risk factors for death and stroke between groups. The overall frequency of 30-day mortality was 0.7% (13/1632) and was similar between groups (retrograde arterial perfusion RAP 0.7% vs AAP 0.8%; P  = 0.903). The overall postoperative stroke rate was 1.3% (22/1632). The stroke rate was significantly higher in patients receiving retrograde perfusion (3.5% vs 1.1%; P  = 0.005). Risk factors for death were advanced age (odds ratio (OR) = 1.3; P  = 0.004), mitral valve replacement (OR = 3.9; P  = 0.05), emergent procedure (OR = 3.4; P  = 0.014) and conversion to sternotomy (OR = 3.7; P  = 0.001). Multivariable regression analysis revealed that retrograde perfusion was an independent risk factor for stroke (OR = 3.3; P  = 0.004). Other risk factors were conversion to sternotomy (OR = 12; P  = 0.001), active endocarditis (OR = 5.8; P  = 0.07) and hypercholesterolaemia (OR = 2.4; P  = 0.048). Interaction modelling revealed that the only significant risk factor for a neurological event was the use of retrograde perfusion in patients older than 70 years with an atherosclerotic burden (OR = 6.4; P  = 0.033). Minimally invasive mitral valve procedures can be performed with low morbidity and

  3. Minimally invasive surgical approach to pancreatic malignancies

    Institute of Scientific and Technical Information of China (English)

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

    2015-01-01

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

  4. Learning Curves in Pediatric Minimally Invasive Surgery: A Systematic Review of the Literature and a Framework for Reporting.

    Science.gov (United States)

    Macdonald, Alexander L; Haddad, Munther; Clarke, Simon A

    2016-08-01

    There exists a learning curve (LC) with the adoption of any minimally invasive surgical (MIS) technique with implications for training, implementation, and evaluation. A standardized approach to describing and analyzing LCs in pediatric MIS is lacking. We sought to determine how pediatric MIS LCs are quantified and present a framework for reporting. Systematic search of MEDLINE and EMBASE 1985-October 2015 for articles describing MIS in the pediatric population and presenting formal analysis of the LC. Articles screened by two independent reviewers. Twenty-nine articles (n = 17 general abdominal/thoracic, n = 12 urological) from an 18-year period (1997-2015) were included representing 3345 procedures (n = 3116 laparoscopic, n = 10 thoracoscopic, n = 219 robotic). Seven (24%) were prospective, three multicenter. Twenty-two (76%) presented data pertaining to >1 operating surgeon. Operative time was the most commonly employed surrogate of proficiency (n = 26 [90%] studies). Twenty (69%) described >1 LC outcome measure. Sixteen additional measures were described, including conversion (n = 12 studies); blood loss (n = 4 studies); complications (n = 10 studies); and postoperative outcomes (n = 14 studies). Three studies assessed impact of LC on trainees and one considered economic impact. LCs were presented in tabular form (n = 14 studies) and graphically (n = 19). Eleven (38%) studies undertook statistical appraisal utilizing comparative statistics (n = 8 studies) and regression analysis (n = 4 studies). Multiple outcome measures of proficiency are employed in reporting pediatric MIS experience and analysis of LCs is inconsistent. A standardized multioutcome approach to reporting should be encouraged. In addition, attempts should be made to quantify the impact on trainee involvement. We present an idealized framework for reporting.

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

    Science.gov (United States)

    Ackerman, Stacey J; Polly, David W; Knight, Tyler; Schneider, Karen; Holt, Tim; Cummings, John

    2014-01-01

    Low back pain is common and treatment costly with substantial lost productivity and lost wages in the working-age population. Chronic low back pain originating in the sacroiliac (SI) joint (15%-30% of cases) is commonly treated with nonoperative care, but new minimally invasive surgery (MIS) options are also effective in treating SI joint disruption. We assessed whether the higher initial MIS SI joint fusion procedure costs were offset by decreased nonoperative care costs from a US commercial payer perspective. An economic model compared the costs of treating SI joint disruption with either MIS SI joint fusion or continued nonoperative care. Nonoperative care costs (diagnostic testing, treatment, follow-up, and retail pharmacy pain medication) were from a retrospective study of Truven Health MarketScan(®) data. MIS fusion costs were based on the Premier's Perspective™ Comparative Database and professional fees on 2012 Medicare payment for Current Procedural Terminology code 27280. The cumulative 3-year (base-case analysis) and 5-year (sensitivity analysis) differentials in commercial insurance payments (cost of nonoperative care minus cost of MIS) were $14,545 and $6,137 per patient, respectively (2012 US dollars). Cost neutrality was achieved at 6 years; MIS costs accrued largely in year 1 whereas nonoperative care costs accrued over time with 92% of up front MIS procedure costs offset by year 5. For patients with lumbar spinal fusion, cost neutrality was achieved in year 1. Cost offsets from new interventions for chronic conditions such as MIS SI joint fusion accrue over time. Higher initial procedure costs for MIS were largely offset by decreased nonoperative care costs over a 5-year time horizon. Optimizing effective resource use in both nonoperative and operative patients will facilitate cost-effective health care delivery. The impact of SI joint disruption on direct and indirect costs to commercial insurers, health plan beneficiaries, and employers

  6. Minimally invasive PCNL-MIP.

    Science.gov (United States)

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

    2017-01-01

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

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

    Institute of Scientific and Technical Information of China (English)

    赵青川; 李纪鹏; 洪流

    2014-01-01

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

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

    Science.gov (United States)

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

    2017-04-01

    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 scoliosis surgery is an effective and safe alternative to open surgery for patients with Lenke Type 5C AIS. Compared with results of the open approach, the outcomes of MISS are promising, with reduced morbidity. Before the routine use of MISS, however, long-term data are needed.

  9. 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)

    2013-06-15

    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.

  10. Mechatronic Feasibility of Minimally Invasive, Atraumatic Cochleostomy

    Directory of Open Access Journals (Sweden)

    Tom Williamson

    2014-01-01

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

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

    Energy Technology Data Exchange (ETDEWEB)

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

    1995-01-01

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

  12. 退行性腰椎滑脱的微创治疗进展%The progress of minimally invasive surgery for degenerative lumbar spondylolisthesis

    Institute of Scientific and Technical Information of China (English)

    左艮乐; 常峰

    2016-01-01

    In this paper,based on the latest domestic and foreign literatures,segmental stability in degenera-tive spondylolisthesis,therapeutic principles,indications and new progress of many minimally invasive surgery of this disease are described in detail.Minimally invasive surgical procedures for degenerative lumbar spondylolisthesis is diversity,so we should choose the best treatment for every patient according to the age,basic diseases,the degree of slipped levels,segmental stability of slipped vertebraes,ecnomic factors in patients,combined with operation skills of surgeons.%该研究以查阅最新国内外文献为基础,对退行性腰椎滑脱的节段稳定性、治疗原则、适应证及多种微创手术方式的最近进展进行了详细阐述。退行性腰椎滑脱的微创治疗方式多样,要根据患者的年龄、有无基础疾病、滑脱的程度、有无椎体节段不稳、患者的经济状况等因素综合分析患者的情况,结合医师自身的操作技巧,从而选择适合每一个患者的最佳治疗方案。

  13. Minimally invasive techniques in Acoustic Neurinoma Microneurosurgery

    Institute of Scientific and Technical Information of China (English)

    2001-01-01

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

  14. [TREATMENT OF POST-SPONDYLODESIS, ADJACENT-SEGMENT DISEASE WITH MINIMALLY INVASIVE, ANTEROLATERAL SURGERY ON THE LUMBAR SPINE: IS THERE IS NO NEED FOR DORSAL OPERATION?].

    Science.gov (United States)

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

    2015-07-30

    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.

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

    Directory of Open Access Journals (Sweden)

    Weijun Wang

    2016-01-01

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

  16. Cirugía mínimamente invasiva de la hernia inguinal Minimally invasive surgery of the inguinal hernia

    Directory of Open Access Journals (Sweden)

    J. M. Olea

    2005-01-01

    Full Text Available El abordaje mínimamente invasivo de la hernia inguinal presenta ventajas respecto a los abordajes convencionales anteriores en las hernias inguinales bilaterales y recurrentes, si bien los resultados iniciales fueron malos, se sumaron nuevos problemas derivados del abordaje laparoscópico. El objetivo de este artículo es describir la técnica quirúrgica y analizar los resultados preliminares de nuestra serie de 600 hernioplastias totalmente extraperitoneales realizadas en la Clínica Universitaria de Navarra. La complicación intraoperatoria más frecuente (25,7% fue la apertura accidental del peritoneo. No hubo complicaciones intrabdominales asociadas. En el seguimiento hubo 9 (1,5% recidivas y 13 reintervenciones. Once (1,8% pacientes desarrollaron dolor neuropático transitorio en el territorio del fémoro-cutáneo. En nuestra experiencia el abordaje totalmente extraperitoneal es una técnica especialmente indicada en hernias recidivadas y bilaterales. Las ventajas presentes en cuanto a dolor y disconfort postoperatorio, recuperación de la actividad física y laboral, y los buenos resultados en cuanto a recidivas y dolor neuropático nos animan a indicarla no sólo en las hernias inguinales recidivadas o bilaterales sino en las primarias.The minimally invasive approach to the inguinal hernia shows advantages with respect to previous conventional approaches in bilateral and recurrent inguinal hernias; while the initial results were bad, new problems were added deriving from the laparoscopic approach. The aim of this article is to describe the surgical technique and analyse the preliminary results of our series of 600 totally extra-peritoneal hernioplasties, performed at the University Clinic of Navarra. The most frequent complication (25.7% was the accidental rupture of the peritonea. There were no associated intra-abdominal complications. In the follow-up there were 9 relapses (1.5% and 13 reinterventions. Eleven (1.8% of the patients

  17. 微创技术在牙槽外科的临床应用%Clinical Application of Minimally Invasive Technique in Alveolar Surgery

    Institute of Scientific and Technical Information of China (English)

    鲍海

    2015-01-01

    目的:探讨微创技术在牙槽外科的临床应用。方法:选取2012年6月-2014年6月在笔者所在医院进行牙槽外科治疗的210例患者,按照随机数字表法将其分为观察组108例和对照组102例。观察组采用微创技术治疗,对照组采用传统拔牙技术治疗,观察比较两组患者的拔牙手术时间、术中畏惧及疼痛情况、拔牙窝完整性以及术后感染情况,并且进行拔牙效果评价。结果:观察组的拔牙手术时间明显短于对照组,术中畏惧率、术中疼痛率、术后感染率均明显低于对照组,拔牙窝完整性明显优于对照组,差异均有统计学意义(P<0.05)。观察组的拔牙效果评价为Ⅰ级的比例为69.4%,明显高于对照组的22.5%;而Ⅲ级的比例为2.8%,明显低于对照组的12.7%,差异均有统计学意义(P<0.05)。结论:微创拔牙技术具有微创、无痛、安全的优点,拔牙效果显著,值得临床推广应用。%Objective:To explore the clinical application of minimally invasive technique in alveolar surgery.Method:210 patients with alveolar surgery treatment in our hospital from June 2012 to June 2014 were selected,they were divided into the observation group for 108 cases and the control group for 102 cases according to the random number table method.The observation group was treated with painless minimally invasive technique,the control group was treated with traditional tooth extraction technique.The tooth extraction surgical time,the fear and pain during the surgery,extraction socket completeness and postoperative infections between the two groups were observed and compared,and the tooth extraction effects were evaluated. Result:The tooth extraction surgical time of observation group was significantly shorter than control group,the fear rate,pain rate in surgery and postoperative infection rate in observation group were significantly lower than those in the control group,and the extraction

  18. Design and optimization of minimally invasive surgery robotic passive joint%微创手术机器人被动式关节设计和优化

    Institute of Scientific and Technical Information of China (English)

    方婉霏; 潘博; 付宜利

    2013-01-01

    设计一种用于微创手术机器人的被动式关节,实现了机械结构和控制驱动的一体化设计;关节可以实现回转运动并实现手术中关节在任意位置的可靠锁紧;锁紧机构采用步进电机驱动,通过压力传感器检测锁紧力矩大小,力矩可调.%A passive joint which integrates mechanism and control system,used for minimally invasive surgery,was designed in this paper.This joint could execute rotary motion and could be locked at any angle.The locking mechanism was driven by a stepping motor.A force sensor was used to detect the locking torque which was adjustable.

  19. Robotic-assisted minimally invasive liver resection

    Directory of Open Access Journals (Sweden)

    Yao-Ming Wu

    2014-04-01

    Conclusion: Robotic assistance increased the percentage of minimally invasive liver resections and the percentage of major minimally invasive liver resections with comparable perioperative results. Robotic-assisted minimally invasive liver resection is feasible, but its role needs more accumulated experience to clarify.

  20. Role and outcome of conventional surgery in the treatment of pyogenic liver abscess in the modern era of minimally invasive therapy

    Institute of Scientific and Technical Information of China (English)

    Simon Siu-Man Ng; Janet Fung-Yee Lee; Paul Bo-San Lai

    2008-01-01

    AIM:To evaluate the role and outcome of conventional surgery in the treatment of pyogenic liver abscess in the modern era of minimally invasive therapy.METHODS:The medical records of thirteen patients with pyogenic liver abscess who underwent surgical treatment between January 1995 and December 2002 were retrospectively reviewed to determine the clinical presentation,indication and nature of surgery,and out-come of surgery.RESULTS:The patients were predominantly women (10/13) with a mean age of 65±17 years.Their main presenting symptoms were abdominal pain (100%) and fever (77%).The aetiologies included biliary (n = 6),cryptogenic (n = 3),portal (n = 2),and trauma (n = 2).Seven patients underwent percutaneous drainage as the initial treatment.Of these,three patients developed peritonitis secondary to peritoneal spillage.Another four patients failed to respond because of multilocula-tion.Salvage surgery was required in these patients.Six patients proceeded to straight laparotomy:two had marked sepsis and multiloculated abscess that precluded percutaneous drainage,and four presented with perito-nitis of uncertain pathology.Surgical procedures included deroofment and drainage (n = 9),liver resection (n = 3),peritoneal lavage (n = 2),cholecystectomy (n = 4),and exploration of common bile duct (n = 2).One patient required reoperation because of bleeding.Three patients required further percutaneous drainage after surgery.The overall mortality was 46%.Four patients died of multiorgan failure and two patients died of pulmonary embolism.CONCLUSION:Surgical treatment of pyogenic liver ab-scess is occasionally needed when percutaneous drain-age has failed due to various reasons.Mortality rate in this group of patients has remained high.

  1. 生殖相关输卵管疾病的微创手术进展%Progress of Minimally Invasive Surgery for Reproductive Related Tubal Diseases

    Institute of Scientific and Technical Information of China (English)

    张松英; 林小娜; 徐文治

    2014-01-01

    The goal of infertile couples are to achieve pregnancy via exploring all reasonable attempts. The infertile couples who are due to tubal disease, account for more than 20%of all infertile couples, have two options to achieve this goal:minimally invasive tubal surgery and in vitro fertilization (IVF). In most cases, the decision-making process requires detailed and effective discussion on the curative effect, side effect and cost of the procedures. The available evidence shows that tubal surgery can be more effective for cases of tubal adhesions, mild distal tubal occlusion, proximal obstruction and ectopic pregnancy. A successful tubal reconstructive surgery can not only make infertile couples to avoid further treatment, but also obtain the psychological advantage to conceive naturally. Before or during IVF treatment, individualized minimally invasive surgery treatment which according to tubal pathological changes, can improve the curative effect of IVF, intrauterine pregnancy rate and live birth rates. The incidence of ectopic pregnancy (EP) in IVF cycle is higher than that of natural population, minimally invasive surgery treatment for EP not only less trauma, but also can reduce the impact on subsequent IVF as far as possible. Now the most pragmatic viewpoint is to consider reproductive surgery and in vitro fertilization as complementary options that are directed towards increasing the overall probability of achieving a pregnancy in the most efficient manner.%任何不孕夫妇都希望通过寻求一切合理的治疗手段来实现妊娠。其中20%以上夫妇是由于输卵管因素导致的不孕,这部分患者面临的治疗选择有:微创手术和体外受精(IVF)。大多数情况下,在这一决策过程中必须切实有效地比较这两种方法的疗效、不良反应及费用。目前证据显示,微创手术对于输卵管疏松粘连、轻微的远端输卵管梗阻、近端输卵管梗阻及输卵管妊娠的治疗更加有效。

  2. Transanal minimally invasive surgery for total mesorectal excision (ETM) through transanal approach (TaETM) with robotic and Transanal Endoscopic Operations (TEO) combined access: step by step surgery.

    Science.gov (United States)

    Mendes, Carlos Ramon Silveira; Valadão, Marcus; Araújo, Rodrigo; Linhares, Eduardo; Jesus, José Paulo

    2015-01-01

    In the treatment of colorectal cancer, from 1982 Heald proposed standardization of the total mesorectal excision, with a significant reduction in the recurrence rate. But the treatment of lower rectal lesions is still a challenge. To describe the association of robotic low anterior resection- TATA (Transanal Abdominal Transanal Resection), with transanal access using Transanal Endoscopic Operations - TEO in the treatment of lower rectal cancer. The TATA performs robotic abdominal approach and the TEO performs the perineal approach, developing total mesorectal excision (TME) transanally (TaETM). The TaETM technique was applied in a woman with rectal adenocarcinoma 5 cm from the anal verge that had been submitted to chemoradiation. The procedure was performed with satisfatory operative time and favorable oncological outcome (grade 3 mesorectal excision). This is a promising minimally invasive procedure in the armamentarium of rectal cancer treatment, specially in challenging scenarios such as narrow pelvis, obesity and very low rectal tumors.

  3. Re-evaluation of the role of image guidance in minimally invasive pituitary surgery: benefits and outcomes

    National Research Council Canada - National Science Library

    Patel, Samip N; Youssef, A. Samy; Vale, Fernando L; Padhya, Tapan A

    2011-01-01

    Objective: To evaluate the utility of performing endonasal transsphenoidal pituitary surgery with computer-based neuronavigation, and to examine the efficacy of computer-based neuronavigation compared to fluoroscopy. Patients...

  4. 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

    2015-01-01

    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.

  5. 虚拟腹部微创手术操作平台的设计%Design of a virtual platform for minimally invasive abdominal surgery

    Institute of Scientific and Technical Information of China (English)

    梁书立; 张子明; 施远征; 杨延雷; 卢旺

    2012-01-01

    针对医学模拟教学和微创手术技能培训开发了虚拟腹部微创手术操作平台,可非常逼真地描绘腹部微创手术的真实环境并符合医学基本伦理,能够模拟常用手术器械和腹腔内器官组织,实现人机实时交互。平台分为硬件设计和软件设计两大部分。硬件设计包括主控制器、数据采集单元和操作平台结构单元。硬件部分主要负责数据采集及处理。软件设计包括主机单元、几何建模单元和碰撞检测单元。软件部分主要负责手术器械和器官以及病例的选择、几何建模,包括常用手术器械,例如手术剪刀、手术钳以及腹腔内器官组织。实验结果证明,虚拟腹部微创手术操作平台适用于高校的医学教学和医疗机构人员的培训,能提高我国医学模拟教学水平并与国际接轨。%A virtual platform for minimally invasive abdominal surgery has been developed for medical simulation teaching and training of minimally invasive surgical skills. The platform can describe realistic environment of minimally invasive abdominal surgery and accord with basic medical ethics. It can also simulate commonly used surgical instruments as well as intra-abdominal organs organization, achieving real-time human-computer interactions. The platform is divided into two parts, i.e., hardware design and sottware design. The hardware design consists of a main controller, a data acquisition unit and an operating platform structure unit. The hardware part is mainly responsible for data acquisition and processing. The software design consists of a host unit, a geometric modeling unit and a collision detection unit. The software part is mainly responsible for choices of the major organs and surgical instruments and cases, and geometric modeling which includes surgical instruments, such as surgical scissors, forceps as well as intra-abdominal organs organization. Experimental results show that the virtual platform for

  6. 微创外科时代胆道外科的前程与归宿%Prospect and destination of biliary surgery in the era of minimally invasive surgery

    Institute of Scientific and Technical Information of China (English)

    黄志强

    2015-01-01

    Bile duct has great attraction to surgeons due to its special anatomical location,unique biological features and origin of complicate diseases.Minimally invasive surgery,represented by laparoscopic cholecystectomy and Davinci robotic surgical system,has brought technic revolutions to traditional biliary surgery.In order to understand the prospect and regression of biliary surgery in the new era,we need to upgrade the knowledge of the biliary system,and systemically investigate the anatomy and development of bile duct.The study of biliary system should follow the path of extrahepatic system to hilar and then to the intrahepatic system,and the intrahepatic biliary disease should be emphasised in this new era.

  7. 微创外科时代胆道外科的前程与归宿%Prospect and destination of biliary surgery in the era of minimally invasive surgery

    Institute of Scientific and Technical Information of China (English)

    黄志强

    2012-01-01

    Bile duct has great attraction to surgeons due to its special anatomical location,unique biological features and origin of complicate diseases. Minimally invasive surgery,represented by laparoscopic cholecystectomy and Davinci robotic surgical system,has brought technic revolutions to traditional biliary surgery.In order to understand the prospect and regression of biliary surgery in the new era,we need to upgrade the knowledge of the biliary system,and systemically investigate the anatomy and development of bile duct. The study of biliary system should follow the path of extrahepatic system to hilar and then to the intrahepatic system,and the intrahepatic biliary disease should be emphasised in this new era.

  8. Re-evaluation of the role of image guidance in minimally invasive pituitary surgery: benefits and outcomes.

    Science.gov (United States)

    Patel, Samip N; Youssef, A Samy; Vale, Fernando L; Padhya, Tapan A

    2011-01-01

    To evaluate the utility of performing endonasal transsphenoidal pituitary surgery with computer-based neuronavigation, and to examine the efficacy of computer-based neuronavigation compared to fluoroscopy. We conducted a retrospective review of patients who underwent pituitary surgery between September 1998 and September 2008. Of 120 consecutive patients, 70 met inclusion criteria and were fully examined. The inclusion criteria were that patients had undergone endonasal transsphenoidal pituitary surgery performed by the same neurosurgeon at the same institution. Nineteen of the patients were treated using intraoperative fluoroscopy and 48 were treated using the BrainLAB VectorVision neuronavigation system. Preparation times, surgical times and associated complications were analyzed. Our results indicate that image guidance reduces the overall operating room time and complication rate. Average preparation time for fluoroscopy and computer-based neuronavigation was 70.3 and 67.3 min, respectively (p = 0.3299). Average surgical time with fluoroscopy and BrainLAB was 131 and 107.9 min, respectively (p = 0.0079). The results were also analyzed with regard to other parameters such as associated complications, age and diagnoses. Computer guided endoscopic endonasal transsphenoidal surgery provides a three-dimensional image to the surgeon, allowing for greater visual accuracy and surgical precision and a faster procedure without radiation exposure or the need for additional personnel.

  9. Minimally invasive surgery for children with unstable of humerus epicondyle fractures%微创治疗儿童肱骨髁上不稳定骨折

    Institute of Scientific and Technical Information of China (English)

    沈建业; 谭志胜; 郑彩平; 李有生; 梁炳生

    2009-01-01

    目的 探讨以生物学固定及间接复位技术为基础,微创治疗儿童肱骨髁上不稳定骨折的临床疗效.方法 对86例儿童肱骨髁上不稳定骨折采用闭合复位,部分加内侧小切口,然后经皮克氏针交叉固定辅加石膏托外固定进行治疗.结果 术后随访时间为6个月至5年(平均2.5年),骨折全部愈合,平均愈合时间为1.2个月.参照Flum临床功能评定标准评定:优78例,良6例,可2例;优良率为98%.结论 以微创为原则闭合复位,经皮交叉克氏针内固定治疗儿童肱骨髁上不稳定骨折,该方法 符合生物学固定的观点,创伤小,并发症少,恢复快,疗效满意.%Objective To explore the clinical trestment outcomes d minimally invasive surgery for children with unstable humerus epicondyle fractures using biological internal fixation arid indirect reduction. Methods This series involved 86 children with unstable humerus epicondyle fractures. They were treated with close reduction and percutaneous Kirschner wire cross fixation assisted with small incisions on the medial side. Immobilization was supplemented with a plaster cast. Results Postoperative follow up ranged from 6 months to 5 years (average 2.5 years). All fractures healed. The average time of fracture healing was 1.2 month. According to Flum clinical functional assessment standard, 78 cases had excellent results, 6 cases good and 2 cases fair. The gcod-excellent rate was 98%. Conclusion Minimally invasive surgery for children with unstable humerus epicondyle fractures including close reduction and percutaneous fixation by cross K-wires. It obeys biomechanical laws, causes minimal trauma and few complications, achieves rapid recovery and leads to satisfactory treatment outcome.

  10. A minimally invasive smile enhancement.

    Science.gov (United States)

    Peck, Fred H

    2014-01-01

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

  11. [MINIMALLY INVASIVE AORTIC VALVE REPLACEMENT].

    Science.gov (United States)

    Tabata, Minoru

    2016-03-01

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

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

    Directory of Open Access Journals (Sweden)

    MARIA VITÓRIA FRANÇA DO AMARAL

    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.

  13. More nerve root injuries occur with minimally invasive lumbar surgery, especially extreme lateral interbody fusion: A review

    Directory of Open Access Journals (Sweden)

    Nancy E Epstein

    2016-01-01

    Conclusions: This review indicates that MIS (TLIF/PLIF/ALIF/XLIF lumbar surgery resulted in a higher incidence of root injuries, radiculitis, or plexopathy versus open lumbar surgical techniques. Furthermore, even a cursory look at the XLIF data demonstrated the greater danger posed to neural tissue by this newest addition to the MIS lumbar surgical armamentariu. The latter should prompt us as spine surgeons to question why the XLIF procedure is still being offered to our patients?

  14. Minimally invasive colopexy for pediatric Chilaiditi syndrome.

    Science.gov (United States)

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

    2011-03-01

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

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

    Science.gov (United States)

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

    2017-01-01

    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

  16. Comparison of minimally invasive surgery and mini-incision technique for total hip arthroplasty: a sub-group meta-analysis

    Institute of Scientific and Technical Information of China (English)

    ZHAO Xiang; LIN Tiao; CAI Xun-zi; YAN Shi-gui

    2011-01-01

    Background It is well accepted that the minimally invasive surgery (MIS) for total hip arthroplasty (THA) should combine with less or no muscle damage and is different from mini-incision technique and MIS should have better outcomes than mini-incision surgery.The aim of current analysis was to apply an explicitly defined sub-group analysis to confirm whether this hypothesis is true.Methods A computerized literature search was applied to find any data concerning MIS or mini-incision THAs.A multistage screening was then performed to identify randomized studies fulfilling the inclusive criteria for the analysis.The data were extracted,and sub-group analyses of MIS or mini-incision surgery for different kinds of outcomes were carried out.The P(sub) value for difference between MIS sub-group and mini-incision sub-group was also calculated.Results Eleven studies that fulfilling the inclusion criteria were included,with 472 cases in the study group (MIS or mini-incision) and 492 cases in the conventional group.The overall analysis showed the study group would achieve less surgical duration (P=0.037),intraoperative blood (P <0.001) and incision length (P <0.001) than conventional group.The difference between sub-groups showed,the MIS would achieve shorter incision length (P(sub) <0.05) and bigger cup abduction angle (P(sub) <0.05),and cause more blood loss (P (sub) <0.05) than mini-incision technique.Other indexeswere comparable between the two sub-groups.Conclusions Though further high quality studies are still needed,the result of current analysis offered an initial conclusion that MIS THA failed to achieve a better clinical outcome than mini-incision technique.The exact definition of MIS still needs to be improved.

  17. Adult spinal deformity treated with minimally invasive surgery. Description of surgical technique, radiological results and literature review.

    Science.gov (United States)

    Domínguez, I; Luque, R; Noriega, M; Rey, J; Alía, J; Urda, A; Marco, F

    2017-09-06

    The prevalence of adult spinal deformity has been increasing exponentially over time. Surgery has been credited with good radiological and clinical results. The incidence of complications is high. MIS techniques provide good results with fewer complications. This is a retrospective study of 25 patients with an adult spinal deformity treated by MIS surgery, with a minimum follow-up of 6 months. Radiological improvement was SVA from 5 to 2cm, coronal Cobb angle from 31° to 6°, and lumbar lordosis from 18° to 38°. All of these parameters remained stable over time. We also present the complications that appeared in 4 patients (16%). Only one patient needed reoperation. We describe the technique used and review the references on the subject. We conclude that the MIS technique for treating adult spinal deformity has comparable results to those of the conventional techniques but with fewer complications. Copyright © 2017 SECOT. Publicado por Elsevier España, S.L.U. All rights reserved.

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

    Institute of Scientific and Technical Information of China (English)

    王永光; 裘法祖; 何兴图

    2004-01-01

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

  19. Isolated subtalar arthrodesis through minimal incision surgery.

    Science.gov (United States)

    Carranza-Bencano, A; Tejero-García, S; Del Castillo-Blanco, G; Fernández-Torres, J J; Alegrete-Parra, A

    2013-08-01

    In recent years there has been an increase in the use of minimally invasive techniques, such as arthroscopy, percutaneous, and minimally invasive incisions, for foot and ankle surgery. The purpose of this study was to analyze the fusion rate and clinical results of isolated subtalar arthrodesis (ISA) using the novel and original technique of minimal incision surgery (MIS). There were a total of 77 feet in 76 patients who underwent ISA and were followed for 50 months on average (range, 15-108). The first 30 cases were evaluated retrospectively, and 47 cases were evaluated prospectively. MIS without tourniquet was used in all cases and fusion was assessed radiographically and clinically. Clinical outcome measures used were the Angus and Cowell Scoring System, AOFAS Ankle-Hindfoot, the SF-36, and a patient satisfaction questionnaire 12 months after the intervention. Radiographic and clinical consolidation was achieved in 92% of cases. Main outcomes were "good" in 57 patients as determined by the Angus and Cowell criteria, with 13 "fair" and 7 "poor" results. In the prospective group, AOFAS scores improved by 47.6 points (95% CI: 50.7-42.5) 12 months after surgical intervention. SF-36 outcomes improved by 14.5 points (95% CI: 11.58-17.31) in the mental summary component and 4.2 points (95% CI: 2.2-6.1) in the physical summary component. We recorded no cases of early complications such as wound infections, neurovascular damage, or delayed wound healing. To our knowledge, the present series represents the largest study on subtalar arthrodesis using minimally invasive surgery. The data obtained showed a similar rate of bony union and clinical outcomes compared with the literature, but without early wound complications. ISA using the MIS technique was a good option for patients at greater risk of wound healing complications. Level IV, case series.

  20. The trend towards minimally invasive surgery (MIS) for endometrial cancer: an ACS-NSQIP evaluation of surgical outcomes.

    Science.gov (United States)

    Scalici, Jennifer; Laughlin, Brittney B; Finan, Michael A; Wang, Bin; Rocconi, Rodney P

    2015-03-01

    Our objective was to evaluate the surgical trend towards increased MIS in the management of endometrial cancer in regard to improvements in patient outcomes. Using the American College of Surgeons-National Surgical Quality Improvement Project's database, patients who underwent hysterectomy for endometrial cancer from 2006-2010 were identified and categorized into exploratory laparotomy (XLAP) or MIS. Comparative analyses were performed and stratified by year of surgery to evaluate demographics, surgical outcomes, and 30-day surgical morbidity. A total of 2076 patients (1269 XLAP and 807 MIS) underwent hysterectomy for endometrial cancer between 2006 and 2010. Longer operative times were seen in MIS compared to XLAP (192 vs. 148 min; pMIS (pMIS group (total 396 vs. 91; pMIS increased from 16% in 2006 to 48% in 2010, which correlated to decreases in complications and hospital stays. Each 10% increase in MIS would save $2.8 million and 41 postoperative complications. If used exclusively, MIS would save 6434 hospital days and 416 complications. Despite increases in operative times, MIS for the treatment of endometrial cancer significantly reduces perioperative complications and hospital stay. Considering the improvements in patient outcomes and the potential savings to the health care system, MIS should be the preferred route for the surgical treatment of this disease when feasible. Copyright © 2014. Published by Elsevier Inc.

  1. Clinical results of reversed V-shaped high tibial corticotomy with minimally invasive surgery without internal fixation devices.

    Science.gov (United States)

    Madadi, Firooz; Eajazi, Alireza; Madadi, Firoozeh; Daftari Besheli, Laleh; Rokni, Reza; Abbasian, Mohammad Reza; Bigdeli, Mohammad Reza

    2010-06-09

    High tibial osteotomy is a method of treating knee osteoarthritis due to genu varum in advanced stages. High tibial osteotomy-associated problems continue to be reported. The purpose of this study was to investigate the clinical results of a new, innovative method of high tibial osteotomy with 3- to 13-year follow-up. Between 1996 and 2006, our new surgical method was performed on 293 patients with medial compartment osteoarthritis and genu varum. All patients were examined preoperatively, 6 months postoperatively, and at final follow-up. The Hospital for Special Surgery Knee Scoring System (HSS) was used at final follow-up, and limb alignment and patient satisfaction were reassessed. Immediate postoperative complications included varus recurrence, knee instability, and peroneal nerve palsy, and no signs of tibial nonunion or infection were observed. At final follow-up, 3 cases of genu recurvatum, 2 cases of peroneal nerve palsy, and 25 cases of loss of correction were observed. Average postoperative HSS score was 85 (range, 47-97), and 97.8% of the patients were satisfied. This new method is a good alternative for the correction of genu varum because it requires a small incision, is soft tissue friendly, is a corticotomy instead of an osteotomy, requires no internal or external fixation devices, has a shorter duration and an acceptable complication and recurrence rate, and results in satisfactory HSS scores and higher patient satisfaction rates.

  2. Impact of minimally invasive/bariatric surgery fellowship on perioperative complications and outcomes in the first year of practice

    Directory of Open Access Journals (Sweden)

    Iswanto Sucandy

    2013-01-01

    Full Text Available Background: Several reports have described worse perioperative outcomes of laparoscopic gastric bypass procedure during learning curve, which improved after completion of one-year fellowship training. Aims: The aim of this study was to evaluate the immediate impact of fellowship training on perioperative complications and outcomes of various bariatric procedures. Materials and Methods: One hundred initial patients who underwent laparoscopic gastric banding, laparoscopic Roux-en-Y gastric bypass, laparoscopic vertical sleeve gastrectomy, and robotically-assisted laparoscopic biliopancreatic diversion with duodenal switch by a single fellowship trained surgeon were analyzed. Results: Overall average Body Mass Index (BMI of the patients was 45.9 kg/m 2 , age was 47.5 years, and the American Society of Anesthesiologist Score was 2.89. There were no intraoperative, major 30-day complications, or open conversions. Average operative time was 62 minutes in gastric banding, 160 minutes in gastric bypass, 119 minutes in vertical sleeve gastrectomy, and 320 minutes in biliopancreatic diversion. Length of stay ranged from 0.5 day after gastric banding to 3.9 days after biliopancreatic diversion. The perioperative complications and outcomes are comparable with those reported by experienced surgeons. No mortality occurred in this series. Conclusions: Bariatric fellowship ensured skills acquisition for new surgeons to safely and effectively perform various types of bariatric operations, with minimal perioperative complications and excellent outcomes.

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

    Science.gov (United States)

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

    2009-09-01

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

  4. A modular force-controlled robotic instrument for minimally invasive surgery - efficacy for being used in autonomous grasping against a variable pull force.

    Science.gov (United States)

    Khadem, Seyed Mohsen; Behzadipour, Saeed; Mirbagheri, Alireza; Farahmand, Farzam

    2016-12-01

    Many deficiencies of minimally invasive robotic surgery systems can be eliminated by using automated laparoscopic tools with force measurement and control capability. A fully modular, automated laparoscopic instrument with a proximal force sensory system was designed and fabricated. The efficacy of the instrument was evaluated experimentally when functioning in an autonomous force-controlled grasping scheme. The designed instrument was shown to work easily with standard laparoscopic tools, with the whole distal part detachable for autoclave sterilization. The root mean squared error (RMSE) of the actual pinch force from the target ramp was 0.318 N; it was 0.402 N for a sinusoidal pull force, which dropped by 21% using a static friction compensation. A secure grasping condition was achieved, in spite of this error, by applying a sufficiently large margin from the slip boundary. With a simple and practical design, the instrument enjoys affordability, versatility and autoclave sterilizability for clinical usage, with an acceptable performance for being used in an auto-grasping control scheme. Copyright © 2016 John Wiley & Sons, Ltd. Copyright © 2016 John Wiley & Sons, Ltd.

  5. Minimally invasive colorectal resection is associated with a transient increase in plasma hepatocyte growth factor levels early after surgery for colon cancer.

    Science.gov (United States)

    Shantha Kumara, H M C; Tohme, Samer T; Kim, Ik Y; Kim, Donald G; Kalady, Matthew F; Luchtefeld, Martin; Hoffman, Keith; Dimaggio, Vincent; Whelan, Richard L

    2011-09-01

    Surgery's impact on blood levels of hepatocyte growth factor (HGF), a potent angiogenic factor, is unknown. Preoperative (PreOp) HGF blood levels are elevated in patients with colorectal cancer (CRC) and correlate with disease stage and prognosis. This study's purpose was to determine plasma HGF levels after minimally invasive colorectal resection (MICR) in patients with CRC. Clinical and operative data were collected. Blood samples were obtained in all patients PreOp and on postoperative day (POD) 1 and 3; in some, samples were taken during weeks 2 and 3 after MICR. Late samples were bundled into 7-day time blocks. HGF levels were determined via enzyme-linked immunosorbent assay in duplicate. Student's t test was used to analyze the data (significance, P MICR were studied. Most had right, sigmoid, or left segmental colectomy. The mean plasma HGF level was higher on POD 1 (2417 ± 1476 pg/mL, P MICR for CRC is associated with a 1.9- to 2.3-fold increase in plasma HGF levels during the first 3 PODs after which levels normalize. This transient increase may briefly promote angiogenesis and the growth of residual tumor cells.

  6. Reconstruction of a 3D surface from video that is robust to missing data and outliers: application to minimally invasive surgery using stereo and mono endoscopes.

    Science.gov (United States)

    Hu, Mingxing; Penney, Graeme; Figl, Michael; Edwards, Philip; Bello, Fernando; Casula, Roberto; Rueckert, Daniel; Hawkes, David

    2012-04-01

    Minimally invasive surgery (MIS) offers great benefits to patients compared with open surgery. Nevertheless during MIS surgeons often need to contend with a narrow field-of-view of the endoscope and obstruction from other surgical instruments. He/she may also need to relate the surgical scene to information derived from previously acquired 3D medical imaging. We thus present a new framework to reconstruct the 3D surface of an internal organ from endoscopic images which is robust to measurement noise, missing data and outliers. This can provide 3D surface with a wide field-of-view for surgeons, and it can also be used for 3D-3D registration of the anatomy to pre-operative CT/MRI data for use in image guided interventions. Our proposed method first removes most of the outliers using an outlier removal method that is based on the trilinear constraints over three images. Then data that are missing from one or more of the video images (missing data) and 3D structure are recovered using the structure from motion (SFM) technique. Evolutionary agents are applied to improve both the efficiency of data recovery and robustness to outliers. Furthermore, an incremental bundle adjustment strategy is used to refine the camera parameters and 3D structure and produce a more accurate 3D surface. Experimental results with synthetic data show that the method is able to reconstruct surfaces in the presence of feature tracking errors (up to 5 pixel standard deviation) and a large amount of missing data (up to 50%). Experiments on a realistic phantom model and in vivo data further demonstrate the good performance of the proposed approach in terms of accuracy (1.7 mm residual phantom surface error) and robustness (50% missing data rate, and 20% outliers in in vivo experiments). Copyright © 2010 Elsevier B.V. All rights reserved.

  7. Effectiveness of computer-navigated minimally invasive total hip surgery compared to conventional total hip arthroplasty: design of a randomized controlled trial

    Directory of Open Access Journals (Sweden)

    Bulstra Sjoerd K

    2007-01-01

    Full Text Available Abstract Background Moderate to severe osteoarthrosis is the most common indication for Total Hip Arthroplasty (THA. Minimally Invasive Total Hip Surgery (MIS and computer-navigated surgery were introduced several years ago. However, the literature lacks well-designed studies that provide evidence of superiority of computer-navigated MIS over a conventional THA technique. Hence, the purpose of this study is to compare (costeffectiveness of computer-navigated MIS with a conventional technique for THA. It is our hypothesis that computer-navigated MIS will lead to a quicker recovery during the early postoperative period (3 months, and to an outcome at least as good 6 months postoperatively. We also hypothesize that computer-navigated MIS leads to fewer perioperative complications and better prosthesis positioning. Furthermore, cost advantages of computer-navigated MIS over conventional THA technique are expected. Methods/design A cluster randomized controlled trial will be executed. Patients between the ages of 18 and 75 admitted for primary cementless unilateral THA will be included. Patients will be stratified using the Charnley classification. They will be randomly allocated to have computer-navigated MIS or conventional THA technique. Measurements take place preoperatively, perioperatively, and 6 weeks and 3 and 6 months postoperatively. Degree of limping (gait analysis, self-reported functional status and health-related quality of life (questionnaires will be assessed preoperatively as well as postoperatively. Perioperative complications will be registered. Radiographic evaluation of prosthesis positioning will take place 6 weeks postoperatively. An evaluation of costs within and outside the healthcare sector will focus on differences in costs between computer-navigated MIS and conventional THA technique. Discussion Based on studies performed so far, few objective data quantifying the risks and benefits of computer-navigated MIS are available

  8. Transdermal Photopolymerization for Minimally Invasive Implantation

    Science.gov (United States)

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

    1999-03-01

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

  9. Contemporary review of minimally invasive pancreaticoduodenectomy.

    Science.gov (United States)

    Dai, Rui; Turley, Ryan S; Blazer, Dan G

    2016-12-27

    To assess the current literature describing various minimally invasive techniques for and to review short-term outcomes after minimally invasive pancreaticoduodenectomy (PD). PD remains the only potentially curative treatment for periampullary malignancies, including, most commonly, pancreatic adenocarcinoma. Minimally invasive approaches to this complex operation have begun to be increasingly reported in the literature and are purported by some to reduce the historically high morbidity of PD associated with the open technique. In this systematic review, we have searched the literature for high-quality publications describing minimally invasive techniques for PD-including laparoscopic, robotic, and laparoscopic-assisted robotic approaches (hybrid approach). We have identified publications with the largest operative experiences from well-known centers of excellence for this complex procedure. We report primarily short term operative and perioperative results and some short term oncologic endpoints. Minimally invasive techniques include laparoscopic, robotic and hybrid approaches and each of these techniques has strong advocates. Consistently, across all minimally invasive modalities, these techniques are associated less intraoperative blood loss than traditional open PD (OPD), but in exchange for longer operating times. These techniques are relatively equivalent in terms of perioperative morbidity and short term oncologic outcomes. Importantly, pancreatic fistula rate appears to be comparable in most minimally invasive series compared to open technique. Impact of minimally invasive technique on length of stay is mixed compared to some traditional open series. A few series have suggested that initiation of and time to adjuvant therapy may be improved with minimally invasive techniques, however this assertion remains controversial. In terms of short-terms costs, minimally invasive PD is significantly higher than that of OPD. Minimally invasive approaches to PD show

  10. Minimally Invasive Management of Ectopic Pancreas.

    Science.gov (United States)

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

    2017-03-01

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

  11. Process optimized minimally invasive total hip replacement

    Directory of Open Access Journals (Sweden)

    Philipp Gebel

    2012-02-01

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

  12. Minimally invasive total hip arthroplasty: in opposition.

    Science.gov (United States)

    Hungerford, David S

    2004-06-01

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

  13. Aortic valve surgery - minimally invasive

    Science.gov (United States)

    ... Saunders; 2012:chap 61. Otto CM, Bonow RO. Valvular heart disease. In: Mann DL, Zipes DP, Libby P, Bonow ... A.M. Editorial team. Related MedlinePlus Health Topics Heart Valve Diseases Browse the Encyclopedia A.D.A.M., Inc. ...

  14. 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

    2014-01-01

    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 electi

  15. Laparoscopic colonic resection in inflammatory bowel disease: minimal surgery, minimal access and minimal hospital stay.

    LENUS (Irish Health Repository)

    Boyle, E

    2008-11-01

    Laparoscopic surgery for inflammatory bowel disease (IBD) is technically demanding but can offer improved short-term outcomes. The introduction of minimally invasive surgery (MIS) as the default operative approach for IBD, however, may have inherent learning curve-associated disadvantages. We hypothesise that the establishment of MIS as the standard operative approach does not increase patient morbidity as assessed in the initial period of its introduction into a specialised unit, and that it confers earlier postoperative gastrointestinal recovery and reduced hospitalisation compared with conventional open resection.

  16. CONDUCCIÓN ANESTÉSICA DE LA CIRUGÍA CARDIACA MÍNIMAMENTE INVASIVA. ESTUDIO PRELIMINAR / Anesthetic management of minimally invasive cardiac surgery. Preliminary study

    Directory of Open Access Journals (Sweden)

    Miguel Ángel Carrasco Molina

    2012-10-01

    Full Text Available Resumen Introducción y objetivos: La cirugía cardíaca mínimamente invasiva ofrece muchas ventajas para los pacientes de alto riesgo; pero las dificultades de estos procedimientos no solo dependen de la técnica quirúrgica, sino de la conducta anestésica, lo que constituye un reto para el anestesiólogo cardiovascular. El objetivo de esta investigación fue demostrar la factibilidad de la conducta anestésica diseñada en el Cardiocentro CIMEQ para las técnicas quirúrgicas video−asistidas, y comparar el comportamiento de algunas variables en dos grupos de estudio. Método: Se realizó un estudio retrospectivo de los pacientes operados de corazón en los últimos tres años en el Cardiocentro CIMEQ. Se dividieron en dos grupos, según la técnica quirúrgica empleada. Los pacientes operados mediante cirugía cardíaca convencional (esternotomía media se incluyeron en el grupo 1, y los de cirugía cardíaca mínimamente invasiva se incluyeron en el grupo 2, en los que se utilizó una técnica anestésica diseñada al efecto. Resultados: El tiempo anestésico, quirúrgico, de circulación extracorpórea y de pinzamiento aórtico, así como el número de unidades de glóbulos rojos transfundidas por paciente fue significativamente menor en el grupo de cirugía cardíaca video−asistida. De forma similar se comportó la estadía en la Unidad de Cuidados Intensivos y en la Sala de Cardiología; y de igual manera, el inicio de la deambulación y las complicaciones posquirúrgicas. Conclusiones: La conducción anestésica con este protocolo de trabajo es segura y factible. Los pacientes operados por esta técnica tienen muy buena recuperación, con pocas complicaciones postoperatorias, y menor estadía hospitalaria; además, es una buena opción para los pacientes de alto riesgo necesitados de cirugía, que no cumplen los criterios para el tratamiento percutáneo. / Abstract Introduction and Objectives: Minimally invasive cardiac surgery

  17. Haptic Tracking Control for Minimally Invasive Robotic Surgery%微创外科机器人力反馈跟踪控制

    Institute of Scientific and Technical Information of China (English)

    徐兆红; 宋成利; 吴文武

    2012-01-01

    针对微创外科机器人(MIRS)力觉反馈缺失问题,构建了主从机器人力反馈控制系统,采用Newton-Euler法建立了力反馈机器人的动力学模型,提出了实时力反馈控制策略.实验验证了该系统及其方法的有效性,具有理论研究和临床应用价值,可用于外科机器人的远程手术.%Haptic feedback plays a significant role in minimally invasive robotic surgery (MIRS), A major deficiency of the current M1RS is the lack of haptic perception for the surgeon, including the commercially available robot da Vinci surgical system. In this paper, a dynamics model of a haptic robot is established based on Newton-Euler method. Because it took some period of time in exact dynamics solution, we used a digital PID arithmetic dependent on robot dynamics to ensure real-time bilateral control, and it could improve tracking precision and real-time control efficiency. To prove the proposed method, an experimental system in which two Novint Falcon haptic devices acting as master-slave system has been developed. Simulations and experiments showed proposed methods could give instrument force feedbacks to operator, and bilateral control strategy is an effective method to master-slave MIRS. The proposed methods could be used to tele-robotic system.

  18. Validation of an inanimate low cost model for training minimal invasive surgery (MIS) of esophageal atresia with tracheoesophageal fistula (AE/TEF) repair.

    Science.gov (United States)

    Maricic, Maximiliano Alejo; Bailez, María Marcela; Rodriguez, Susana P

    2016-09-01

    We present the results of the validation of an inanimate model created for training thoracoscopic treatment of esophageal atresia with lower tracheoesophageal fistula (EA/TEF). We used different domestic materials such as a piece of wood (support), corrugated plastic tubes (PVC) of different sizes to simulate ribs, intercostal spaces, trachea and spine and tubular latex balloons to simulate the esophagus and lungs to make the basic model. This device was inserted into the thoracic cavity of a rubber dummy simulating a 3kg newborn with a work area volume of 50ml. The model was designed taking into account the experience of doing this procedure in neonates. The cost of the materials used was 50 US$. Regular video endoscopic equipment and 3mm instruments were used. Thirty-nine international faculty or pediatric surgeons attending hands on courses with different levels of training in minimal invasive surgery (MIS) repair of EA/TEF performed the procedure in the model. We compared the performance of the practitioners with their experience in thoracoscopic repair of EA. A Likert-type scale was used to evaluate results. Previous experience in MIS, anatomical appearance of the model, surgical anatomy compared to a real patient, and utility as a training method were analyzed. We also used a checklist to assess performance. We evaluated: number of errors and types of injuries, quality of the anastomosis, and duration of procedure. To analyze the results we used a T-test, chi-square test and Excel® database to match up some results. Thirty-nine questionnaires were completed. Seven surgeons were experts (≥30 TEF/EA repairs as surgeon), 10 had intermediate level of experience (5 to 29 repairs as surgeon) and 22 were beginners (less than 5 repairs). To simplify the analysis we divided the respondents into low experience LE (MIS operative room setting and team work. Copyright © 2016 Elsevier Inc. All rights reserved.

  19. Minimally Invasive Surgery for Unstable Posterior Pelvic Ring Injured in Earthquake%地震伤骨盆骨折后环不稳的微创治疗

    Institute of Scientific and Technical Information of China (English)

    曾参军; 樊仕才; 金大地; 赵畅; 李涛

    2011-01-01

    Objective To investigate the technical points and efficacy of minimally invasive surgery in treating patients with unstable posterior pelvic ring injured in the earthquake. Methods Nine patients with unstable posterior pelvic ring received anterior ring open reduction internal fixation at first, and then received pelvic posterior ring fixation with eannulated lag screw guided under C-arm X-ray.Results The cannulated lag screw was successfully implanted into sacroiliac joint percutaneously guided under C-arm X-ray. All the patients achieved satisfied reduction with less bleeding and less damage. Conclusion It is an optimum choice for treating unstable posterior pelvic ring with anterior ring open reduction internal fixation combined with cannulated lag screw percutaneously implanted under C-arm X-ray.%目的 探讨地震伤骨盆骨折后环不稳微创治疗的技术要点及疗效.方法对9例地震伤骨盆骨折后环不稳,采用前环钢板内固定后环在C型臂X线机引导下经皮微创置入骶髂空心拉力螺钉内固定.结果 骨盆骨折后环不稳患者在C型臂X线机引导下经皮微创置入骶髂空心拉力螺钉内固定,疗效满意.结论 掌握经皮骶髂关节置钉技术要点,采用骶髂拉力螺钉微创固定后环是地震伤骨盆骨折后环不稳的最佳治疗方法之一.

  20. Providing haptic feedback in robot-assisted minimally invasive surgery: a direct optical force-sensing solution for haptic rendering of deformable bodies.

    Science.gov (United States)

    Ehrampoosh, Shervin; Dave, Mohit; Kia, Michael A; Rablau, Corneliu; Zadeh, Mehrdad H

    2013-01-01

    This paper presents an enhanced haptic-enabled master-slave teleoperation system which can be used to provide force feedback to surgeons in minimally invasive surgery (MIS). One of the research goals was to develop a combined-control architecture framework that included both direct force reflection (DFR) and position-error-based (PEB) control strategies. To achieve this goal, it was essential to measure accurately the direct contact forces between deformable bodies and a robotic tool tip. To measure the forces at a surgical tool tip and enhance the performance of the teleoperation system, an optical force sensor was designed, prototyped, and added to a robot manipulator. The enhanced teleoperation architecture was formulated by developing mathematical models for the optical force sensor, the extended slave robot manipulator, and the combined-control strategy. Human factor studies were also conducted to (a) examine experimentally the performance of the enhanced teleoperation system with the optical force sensor, and (b) study human haptic perception during the identification of remote object deformability. The first experiment was carried out to discriminate deformability of objects when human subjects were in direct contact with deformable objects by means of a laparoscopic tool. The control parameters were then tuned based on the results of this experiment using a gain-scheduling method. The second experiment was conducted to study the effectiveness of the force feedback provided through the enhanced teleoperation system. The results show that the force feedback increased the ability of subjects to correctly identify materials of different deformable types. In addition, the virtual force feedback provided by the teleoperation system comes close to the real force feedback experienced in direct MIS. The experimental results provide design guidelines for choosing and validating the control architecture and the optical force sensor.

  1. Minimally invasive surgical treatment of valvular heart disease.

    Science.gov (United States)

    Goldstone, Andrew B; Joseph Woo, Y

    2014-01-01

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

  2. EFFECTIVENESS OF MINIMALLY INVASIVE SURGERY FOR PECTUS EXCAVATUM IN ADULTS%微创外科治疗成人漏斗胸疗效观察

    Institute of Scientific and Technical Information of China (English)

    刘吉福; 刘涛; 徐波; 裴迎新

    2012-01-01

    Objective To investigate the effect of anterior chest wall depression on the cardiac function and the effectiveness of minimally invasive surgery for pectus excavatum by comparing cardiac function and morphology between pre-and post-operation. Methods Between August 2009 and December 2010, 102 adult patients with pectus excavatum were treated with minimally invasive surgery, including the primary operation in 95 cases and the reoperation in 7 cases. There were 84 males and 18 females, aged 18-57 years (mean, 23.4 years). The haller index (HI) was 4.59 ± 1.51. Of 102 patients, 59 were classified as pectus excavatum type I and 43 as type II; 42 had clinical symptoms and 19 had the physical sign of heart. The preoperative chest CT examination showed cardiac compression in all patients and heart displacement in 74 patients. The left ventricular ejection fraction (LVEF) was 68,9% ± 6.2%. Results The procedure was successful in all patients, and no death or serious complication occurred. The patients were followed up 12-28 months (mean, 21 months). The clinical symptoms and cardiac physical sign of the patients disappeared after operation. HI was 2.70 ± 0.33 at 12 months after operation, showing significant difference when compared with preoperative HI (t=5.83, P=0.00). According to Nuss's evaluation method, the results were excellent in 99 patients and good in 3 patients. CT examination showed complete relief of cardiac compression in 101 patients and mild cardiac compression in 1 patient; the heart position was normal at 12 months after operation. Electrocardiogram returned to normal in 4 patients having abnormal electrocardiogram. LVEF was 70.5% ± 4.8% after operation, showing no significant difference when compared with preoperative LVEF (t=L08, P-0.30). Conclusion The main effects of pectus excavatum in adults on heart are compression and displacement. Cardiac compression may be relieved efficiently and the patient's clinical symptoms can be abated by minimally

  3. 复发性腰椎间盘突出症的微创手术治疗%The minimally invasive surgery for treating recurrent lumbar disc protrusion

    Institute of Scientific and Technical Information of China (English)

    吴辉; 胡凌云; 林宏

    2014-01-01

    目的:探讨微创手术通道下治疗复发性腰椎间盘突出症的临床效果。方法回顾性分析2009年7月到2013年7月行微创椎间盘切除术治疗的30例腰椎间盘突出症术后复发患者的临床资料,患者复发节段腰34(L34)1例,腰45(L45)10例,腰5骶1(L5S1)19例;统计描述患者的年龄、体质量指数、复发节段、手术时间、术中失血量、术后无痛行走的时间,采用疼痛视觉模拟评分(VAS)评估微创手术治疗的临床疗效。结果手术时间50~100min,平均65min;术中失血量100~180mL,平均145mL;住院时间9~16d,平均13d;平均住院费用7300元;术后无痛行走时间7~15d,平均11d;术后从事非体力劳动的时间27.3d,VAS分值由术前的(7.3±1.3)分降低到术后(3.1±0.9)分,末次随访时为(2.2±0.6)分,术后、末次随访VAS分值与术前比较,差异均有统计学意义(P<0.05)。获得随访时间6~33个月,平均16.5个月。疗效优16例,良7例,可5例,差2例,优良率76%。结论微创手术是治疗复发性腰椎间盘突出症的有效方法之一。%Objective To study the clinical effect of the minimally invasive surgery for treating recurrent lumbar disc protrusion . Methods Thirty operative cases of recurrent lumbar disc protrusion treated with the minimally invasive surgery from July 2009 to July 2013 were retrospectively analyzed for statistically describing the age ,body mass index ,recurrent segment ,operating time ,intr-aoperative bleeding volume and postoperative painless walking time .The recurrence segments were 1 case of L34 ,10 cases of L45 and 19 cases of L5 S1 ;the visual analogue scale (VAS) was adopted to evaluate the operative effect .Results The operating time was 65 min on average (50-100)min;mean intraoperative bleeding volume was 145 mL(100-180)mL ;average length of hospital stay was 13 d (9-16)d;average hospitalization

  4. Minimally Invasive Transcatheter Aortic Valve Replacement (TAVR)

    Medline Plus

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

  5. Minimally Invasive Transcatheter Aortic Valve Replacement (TAVR)

    Medline Plus

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

  6. The advantages of minimally invasive dentistry.

    Science.gov (United States)

    Christensen, Gordon J

    2005-11-01

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

  7. Application of enhanced recovery after surgery in ;minimally invasive colorectal surgery%加速康复外科在结直肠癌微创手术中的应用

    Institute of Scientific and Technical Information of China (English)

    朱德祥; 许剑民

    2016-01-01

    加速康复外科(ERAS)理念,应用现代麻醉、镇痛和营养代谢支持等技术,采取有循证医学证据的一系列围手术期优化措施,包括术前准备、术中麻醉配合和术后处理,减少手术创伤所致的应激反应,术后尽早采取积极措施使患者机体和胃肠道恢复正常。一系列临床研究及 Meta 分析已证实,ERAS方案可加速结直肠癌手术患者术后康复。而腹腔镜结直肠癌手术等微创技术日趋成熟,较开腹手术具有创伤小、出血少、术后恢复快等优势,且手术范围和远期肿瘤疗效与开腹手术相当,有望成为结直肠癌手术的标准术式,此外,3D腹腔镜和机器人结直肠癌手术克服常规腹腔镜手术的局限,逐步推广应用。因此,ERAS方案联合腹腔镜结直肠癌手术等微创技术是否具有累加优势备受关注。已有多项研究及Meta分析证实,ERAS方案联合腹腔镜结直肠癌手术,可以缩短住院时间,减少并发症发生,可作为择期手术的最佳围手术期方案。%ERAS combines modern anesthesia, pain control, and nutritional support technologies, and contains a series of evidence-based perioperative optimization measures , including preoperative preparation, intraoperative anesthesia and postoperative care, to reduce surgical stress and enhance recovery. Several clinical studies and meta-analysis have demonstrated that ERAS can accelerate postoperative rehabilitation in colorectal patients. In addition, minimally invasive colorectal surgery has the advantages of less trauma, less bleeding, and faster postoperative recovery, compared with open surgery. It has become the standard operation for colon resection. Recently 3D laparoscopic and robotic colorectal surgery, which overcomes limitations of conventional laparoscopic surgery, is increasingly used. Therefore, whether ERAS combined with minimally invasive colorectal surgery causes a cumulative advantage

  8. A retrospective comparative study of minimally invasive extracorporeal circulation versus conventional extracorporeal circulation in emergency coronary artery bypass surgery patients: a single surgeon analysis.

    Science.gov (United States)

    Rufa, Magdalena; Schubel, Jens; Ulrich, Christian; Schaarschmidt, Jan; Tiliscan, Catalin; Bauer, Adrian; Hausmann, Harald

    2015-07-01

    At the moment, the main application of minimally invasive extracorporeal circulation (MiECC) is reserved for elective cardiac operations such as coronary artery bypass grafting (CABG) and/or aortic valve replacement. The purpose of this study was to compare the outcome of emergency CABG operations using either MiECC or conventional extracorporeal circulation (CECC) in patients requiring emergency CABG with regard to the perioperative course and the occurrence of major adverse cardiac and cerebral events (MACCE). We analysed the emergency CABG operations performed by a single surgeon, between January 2007 and July 2013, in order to exclude the differences in surgical technique. During this period, 187 emergency CABG patients (113 MiECC vs 74 CECC) were investigated retrospectively with respect to the following parameters: in-hospital mortality, MACCE, postoperative hospital stay and perioperative transfusion rate. The mean logistic European System for Cardiac Operative Risk Evaluation was higher in the CECC group (MiECC 12.1 ± 16 vs CECC 15.0 ± 20.8, P = 0.15) and the number of bypass grafts per patient was similar in both groups (MiECC 2.94 vs CECC 2.93). There was no significant difference in the postoperative hospital stay or in major postoperative complications. The in-hospital mortality was higher in the CECC group 6.8% versus MiECC 4.4% (P = 0.48). The perioperative transfusion rate was lower with MiECC compared with CECC (MiECC 2.6 ± 3.2 vs CECC 3.8 ± 4.2, P = 0.025 units of blood per patient). In our opinion, the use of MiECC in urgent CABG procedures is safe, feasible and shows no disadvantages compared with the use of CECC. Emergency operations using the MiECC system showed a significantly lower blood transfusion rate and better results concerning the unadjusted in-hospital mortality. © The Author 2015. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. All rights reserved.

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

    Science.gov (United States)

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

    2007-12-01

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

  10. Minimally invasive percutaneous posterior lumbar interbody fusion.

    Science.gov (United States)

    Khoo, Larry T; Palmer, Sylvain; Laich, Daniel T; Fessler, Richard G

    2002-11-01

    any of the patients. All screw and graft placements were confirmed. A complete PLIF procedure can be safely and effectively performed using minimally invasive techniques, thereby potentially reducing the pain and morbidity associated with standard open surgery. Prospective, randomized outcome studies will be required to validate the efficacy of this exciting new surgical technique.

  11. Multiexpandable cage for minimally invasive posterior lumbar interbody fusion

    Science.gov (United States)

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

    2016-01-01

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

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

    Institute of Scientific and Technical Information of China (English)

    Marco Zoccali; Alessandro Fichera

    2012-01-01

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

  13. 微创直视二尖瓣置换术与传统正中开胸手术的比较%Comparative study of minimally invasive mitral valve replacement and conventional thoracotomy surgery

    Institute of Scientific and Technical Information of China (English)

    许李力; 尤斌; 高峰; 李平; 徐屹; 刘硕; 李光

    2014-01-01

    Objective Discuss the different between minimally invasive and conventional thoracotomy mitral valve replacement surgery.Methods Select 141 cases from February 2009 to December 2012 in our hospital suffer mitral valve replacement surgery.69 cases minimally invasive surgery and the 72 cases conventional thoracotomy mitral valve replacement surgery,mechanical valve 90 cases,the bioprosthesis 51 cases.The establishment of cardiopulmonary bypass is through the femoral artery and vein and the right jugular vein with cannulation.Under the guide of transesophageal echocardiography (TEE) and adjust the the intubation position to the inferior vena cava and superior vena cava junction.Double-lumen endotracheal intubation in trachea.Transthoracic approach through the right side of the stemum 4 intercostal,the left lung unilateral breathing and fight lung collapse.Open the pericardium with minimally invasive surgical instruments away 2 cm from the phrenic nerve.Transthoracic chitwood clamp blocking the ascending aorta,HTK or crystalloid cardioplegia aortic root perfusion.Arrest heart minimally invasive mitral valve replacement surgery.After CPB,unplug the femoral artery and vein catheter,6-0 prolene suture femoral artery reconstruction pathway.Results Minimally invasive compared to the conventional median thoracotomy mitral valve replacement surgery have no significant difference in operative time,cardiopulmonary bypass time,aortic clamping timeand the intensive care unit (ICU) time.Conclusion Overcome the learning curve,minimally invasive mitral valve surgery have many advantages than the conventional median thoracotomy surgery is a safe,effective,and easy to spread surgery.%目的 回顾性分析直视微创手术与传统正中开胸二尖瓣置换手术患者资料,探讨直视微创手术的优势.方法 2009年2月至2012年12月,141例患者行单纯二尖瓣置换手术,其中直视微创手术69例,传统正中开胸手术72例;置换机械瓣膜90例,生物瓣膜51

  14. Minimal Invasive Repair of Pectus Excavatum and Carinatum

    DEFF Research Database (Denmark)

    Pilegaard, Hans; Licht, Peter Bjørn

    2017-01-01

    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...... of patients who seek help continues to rise, primarily for cosmetic reasons. Pectus carinatum is much less frequent than pectus excavatum. Over the past decade surgery has largely been replaced by compression techniques that use a brace, and cosmetic results are good. Rare combinations of pectus excavatum...

  15. Minimally Invasive Evaluation and Treatment of Colorectal Liver Metastases

    Directory of Open Access Journals (Sweden)

    Anton L. Gueorguiev

    2011-01-01

    Full Text Available Minimally invasive techniques used in the evaluation and treatment of colorectal liver metastases (CRLMs include ultrasonography (US, computed tomography, magnetic resonance imaging, percutaneous and operative ablation therapy, standard laparoscopic techniques, robotic techniques, and experimental techniques of natural orifice endoscopic surgery. Laparoscopic techniques range from simple staging laparoscopy with or without laparoscopic intraoperative US, through intermediate techniques including simple liver resections (LRs, to advanced techniques such as major hepatectomies. Hereins, we review minimally invasive evaluation and treatment of CRLM, focusing on a comparison of open LR (OLR and minimally invasive LR (MILR. Although there are no randomized trials comparing OLR and MILR, nonrandomized data suggest that MILR compares favorably with OLR regarding morbidity, mortality, LOS, and cost, although significant selection bias exists. The future of MILR will likely include expanding criteria for resectability of CRLM and should include both a patient registry and a formalized process for surgeon training and credentialing.

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

    Science.gov (United States)

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

    2009-01-01

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

  17. Medial displacement calcaneal osteotomy using minimally invasive technique.

    Science.gov (United States)

    Kheir, Ehab; Borse, Vishal; Sharpe, Jon; Lavalette, David; Farndon, Mark

    2015-03-01

    Medial displacement calcaneal osteotomy is a common procedure often used as part of pes planovalgus deformity correction. Traditionally the osteotomy is performed using a direct lateral or extended lateral approach, which may carry the risk of wound problems, infection and neurovascular injury. The authors describe a minimally invasive technique to perform the osteotomy and achieve the desired correction. The article illustrates our experience and learning curve with the use of this technique as an option for calcaneal osteotomy. We retrospectively reviewed the records of a sequential series of patients since 2011 whose calcaneal osteotomies were performed by 2 surgeons, after cadaveric training using a minimally invasive operative approach. Prior to 2011, similar surgeries, performed by the senior authors, were undertaken using a direct lateral approach. Thirty cases were identified; 29 had tibialis posterior reconstruction coupled with calcaneal osteotomy for acquired flexible planovalgus deformity and 1 patient had surgery for a malunited calcaneal fracture. Radiological and clinical union occurred in all 30 cases (100%). The radiographs of all cases were reviewed by a specialist musculoskeletal radiologist. There were no neurovascular or wound complications. All patients had restoration of neutral hindfoot alignment. One patient required screw removal after union, resolving all symptoms. This series suggests that minimally invasive calcaneal osteotomy surgery can achieve excellent union rates aiding correction of deformity with no observed neurovascular or soft tissue complications. For surgeons experienced in open surgery, there is a short learning curve after appropriate training. © The Author(s) 2014.

  18. Minimally invasive treatments for perforator vein insufficiency.

    Science.gov (United States)

    Kuyumcu, Gokhan; Salazar, Gloria Maria; Prabhakar, Anand M; Ganguli, Suvranu

    2016-12-01

    Incompetent superficial veins are the most common cause of lower extremity superficial venous reflux and varicose veins; however, incompetent or insufficient perforator veins are the most common cause of recurrent varicose veins after treatment, often unrecognized. Perforator vein insufficiency can result in pain, skin changes, and skin ulcers, and often merit intervention. Minimally invasive treatments have replaced traditional surgical treatments for incompetent perforator veins. Current minimally invasive treatment options include ultrasound guided sclerotherapy (USGS) and endovascular thermal ablation (EVTA) with either laser or radiofrequency energy sources. Advantages and disadvantages of each modality and knowledge on these treatments are required to adequately address perforator venous disease.

  19. Minimally invasive restorative dentistry: a biomimetic approach.

    Science.gov (United States)

    Malterud, Mark I

    2006-08-01

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

  20. Study the Minimally Invasive Orthopedic Surgery and Regional Anatomy Teaching Design%微创骨科手术与局部解剖学教学设计之研究

    Institute of Scientific and Technical Information of China (English)

    宛磊; 代彭威; 王伟

    2015-01-01

    Minimally invasive orthopedic surgery and closely related to regional anatomy for the two disciplines, and all have high conscientiousness. With the development of the society, such as fracture happened frequently, however the orthopaedic minimally invasive surgery has developed rapidly, especially in minimally invasive spine and arthroscopic surgery, these two departments are the characteristics of small trauma, surgical incision can be up to 2 cm, compared with the traditional surgery, the effect is more optimized. But as a result of such close sexual knowledge and regional anatomy, bring a series of dififculties to the clinical teaching, brings certain difficulty for the practice teaching, the students often can not understand in the operation and key points of anatomical connections, for the relevant researchers for such problem for minimally invasive bone surgery should be effectively combined with regional anatomy teaching, optimize the curriculum design.%微创骨科手术与局部解剖学为两种关系密切的学科,且均具较高严谨性。随着社会的发展,骨折等事件频发,然而骨科微创手术发展迅速,尤其是微创脊柱科与关节镜外科,上述两大科室均具创伤小的特性,手术切口可达2 cm,较传统手术而言,效果更加优化。但由于此类知识与局部解剖学的密切性,给临床实习教学带来一系列的困难,学生时常无法理解手术中与解剖学连接的关键点,针对此类问题相关研究人员将微创骨科手术与局部解剖学得教学有效的结合起来,优化课程设计。

  1. 从腹腔镜胰腺手术谈成立“微创胰胃外科学”之必要%The Necessity to Found "Minimal Invasive Surgery in Pancreas and Stomach" from Laparoscopic Pancreatic Surgery

    Institute of Scientific and Technical Information of China (English)

    牟一平; 周育成; 朱正纲; 严加费; 金巍巍

    2015-01-01

    胰腺和胃在解剖上紧密相连,腹腔镜胰胃手术技术上相辅相成。成立“微创胰胃外科学”,让富有创新精神的外科医师同时开展腹腔镜胃癌手术和胰腺手术,并进行认真的临床研究,必将有助于进一步提高腹腔镜胃癌根治术和腹腔镜胰腺手术的水平,使更多患者从现代高新技术中获益。%The pancreas is closed to the stomach in the aspect of anatomy and the laparoscopic skills in laparoscopic pancreatectomy and laparoscopic gastrectomy could be complementary to each other . Establishing "Minimal Invasive Surgery in Pancreas and Stomach" makes it possible for surgeon with laparoscopic skills to operate laparoscopic pancreatectomy and laparoscopic gastrectomy and to do the clinic research ,thus promoting the development of laparoscopic skill in pancreatectomy and gastrectomy to benefit more patients .

  2. 多模式镇痛在脊柱外科微创手术中的应用①%Application of Multimodal Analgesia in Minimally Invasive Surgery for Patients in Spine Surgery

    Institute of Scientific and Technical Information of China (English)

    杨同文; 王强; 王增春; 白金柱; 洪毅; 张军卫

    2013-01-01

    Objective To apply the multimodal analgesia (MMA) in minimally invasive surgery (MIS) for patients in spine surgery. Methods 21 patients undergoing MIS were selected to be reviewed, including haemodynamics, respiratory parameters, analgesia and seda-tion scale, side effects, satisfaction of operators and patients in the course of the operation. Results All the MIS was successful with excel-lent analgesia, conscious sedation, stable haemodynamics, unsuppressed respiratory function, and satisfaction of operators and patients. Con-clusion Patients under MMA would accept MIS in a comfortable state and the communication between patients and operators would not be inhibited.%  目的探讨多模式镇痛在脊柱外科微创手术中的应用。方法选择21例在多模式镇痛模式下接受脊柱外科微创手术的患者,观察术中血流动力学、呼吸监测指标、镇痛镇静评分、不良反应事件、术者及患者对手术过程满意度评价。结果手术过程顺利,血流动力学稳定,呼吸功能无抑制,患者及术者对手术过程满意。结论多模式镇痛能够使患者在最舒适的环境下接受脊柱外科微创手术,同时不影响术者与患者在术中进行交流。

  3. HCPT Minimally Invasive Surgery in the Treatment of Anal Fistula in 40 Cases%HCPT微创术治疗肛瘘40例

    Institute of Scientific and Technical Information of China (English)

    王宏波; 闫树勋; 薄超刚; 周秀芳; 谢桂珍; 王艳梅

    2013-01-01

    Objective:To investigate the multi-functional therapeutic instrument ( HCPT) methods and clinical efficacy in the treat-ment of anal fistula .Methods:40 patients in need of anal fistula operation were treated using HCPT minimally invasive surgery .We ob-serve the operation time , stool bleeding ,and recovery time , postoperative follow-up one year , clinical observation .Results:All patients in this group operation time is 10 ~20min, an average of 16min.No intraoperative bleeding, no postoperative pain, postoperative 24h defecation, defecation no bleeding , no pain.Recovery time is 7 ~11d, an average of 9D, the cure rate of 100%.All patients recovered to normal work, study and life, no complications, no cases of infection, anal function properly.Follow-up of 1 years, no recurrence to achieve radical purposes .Conclusion:multifunctional anorectal therapeutic apparatus in the treatment of anal fistula operation is simple , shorter operative time, less bleeding, no pain, patients do not need hospitalization , low cost, quick recovery, no obvious scars after re-covery without sequels and complications , efficacy, it is worthy of popularization and application .%目的:探讨多功能肛肠治疗仪( HCPT )治疗肛瘘的方法和临床疗效。方法:将需要手术的肛瘘患者40例采用HCPT微创术进行治疗,观察其手术时间、大便出血情况、及恢复时间,随访1年,观察疗效。结果:本组全部患者手术时间为10~20分钟,平均16分钟。术中无出血,术后无疼痛,术后24小时排便,排便后无出血、无疼痛。恢复时间7~11天,平均9天,治愈率100%。全部患者恢复正常的工作、学习和生活,无并发症,无感染病例,肛门功能正常。术后随访1年,无1例复发,达到根治目的。结论:多功能肛肠治疗仪治疗肛瘘操作简单、手术时间短、不出血、无痛苦,患者不需住院,费用低廉,恢复快,且恢复后无明显瘢痕

  4. 鼻整形术中微创小切口自体肋软骨切取术%Self Costal Cartilage for Surgery with Minimal Invasive Minimal Cutting in Rhinoplasty

    Institute of Scientific and Technical Information of China (English)

    刘玉丽; 王廷金

    2013-01-01

    Objective To explore the minimal cutting,the minimal and injury,and get costicartilage farthest without the influence of thorax shape and significant scar,etc. Methods 60 cases with corrective rhinoplasty of cutting costal cartilage from 2010 to 2013 were selected with 15 male cases and 45 female cases,and from eighteen-years old to thirty-two years old. 40 cases got successful operation for the first time,and 20 cases had repair. Costicartilage cutting places were all on the right side. Costicartilage was got through the seventh costicartilage photography incision,with 1.5~3cm incision cut. Operational part can be removed through drag hook removing up and down,with 7cm as the longest distance. During the operation,the released cartilage debris left by carving cartilage was transplanted back into perichondrium. Perichondrium was sutured firmly,and organizations were sutured hierarchically. Reliable fixation was used. Result 60 cases had the primary healing cutting with no complication of hematoma. In six month and one year’s flow- up,there were no visible scars,and no visible trasformation of the struction. Conclusion Self costal cartilage for surgery with minimal invasive minimal cutting in rhinoplasty is worthy of promotion with less pain,no obvious scar and no influence of thorax shape.%目的:探索一种尽可能小的切口,尽可能小的损伤,最大限度获取肋软骨,且不影响胸廓形状,不遗留明显瘢痕等并发症的方法。方法:选择2010年7月~2013年7月行鼻整形术供区肋软骨切取患者共60例,男性15列,女性45例;年龄18~32岁;初次手术者40例,二次修复者20例。肋软骨切取均为右侧。取肋软骨取平行于第七肋软骨体表投影切口,切口长度在1.5~3cm之间.借助于拉钩上下移动暴露手术野,最长可获得长达7cm的软骨量。术中将雕刻软骨剩余的软骨碎片回植到封闭的软骨膜内,坚实缝合软骨膜,分层缝合组织。并

  5. Minimally Invasive Osteotomies of the Calcaneus.

    Science.gov (United States)

    Guyton, Gregory P

    2016-09-01

    Osteotomies of the calcaneus are powerful surgical tools, representing a critical component of the surgical reconstruction of pes planus and pes cavus deformity. Modern minimally invasive calcaneal osteotomies can be performed safely with a burr through a lateral incision. Although greater kerf is generated with the burr, the effect is modest, can be minimized, and is compatible with many fixation techniques. A hinged jig renders the procedure more reproducible and accessible. Copyright © 2016 Elsevier Inc. All rights reserved.

  6. MICROSURGICAL LANDMARKS IN MINIMALLY INVASIVE TRANSFORAMINAL LUMBAR INTERBODY FUSION

    Directory of Open Access Journals (Sweden)

    Javier Quillo-Olvera

    2015-12-01

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

  7. TRUNK MOBILITY AFTER MINIMALLY INVASIVE ONE-LEVEL LUMBAR INSTRUMENTATION

    Directory of Open Access Journals (Sweden)

    MARCELO SIMONI SIMÕES

    Full Text Available ABSTRACT Objective: To evaluate the impact of a minimally invasive lumbar one-level fixation on trunk mobility and quality of life compared with the preoperative condition in 26 consecutive patients. Methods: The following data were collected preoperatively and postoperatively for the statistical analysis: maximal trunk extension and flexion angles, Visual Analog Scale of pain and Oswestry Disability Index scores. Results: There was improvement in all variables. Statistical significance was observed in trunk extension, pain, and Oswestry Disability Index. Although mobility in trunk flexion was higher in average values after surgery, this difference was not statistically demonstrated. Conclusion: Minimally invasive one-level lumbar fixation does not cause reduction of trunk flexibility in comparison to the mobility before surgery.

  8. Flexible Sensors for Minimally Invasive Medical Instruments

    NARCIS (Netherlands)

    Mimoun, B.A.Z.

    2013-01-01

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

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

    DEFF Research Database (Denmark)

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

    2013-01-01

    , with the focus on large-scale and preferably randomized studies, available via PubMed search in authors' files, using appropriate searches and keywords. Main Findings: In large centers with experienced hands, minimally invasive approaches appear effective and safe. At present, percutaneous ethanol injection...... evaluation. These techniques have also been applied to recurrent locoregional cervical thyroid cancer with encouraging initial results, although still limited data. Conclusions: Surgery and radioiodine remain as conventional and established treatments for nodular goiters. However, the new image...

  10. Minimally invasive endoscopic ulnar nerve assessment and surgery for cubital tunnel syndrome patients—Relation between endoscopic nerve findings and clinical symptoms

    Directory of Open Access Journals (Sweden)

    Aya Yoshida

    2014-07-01

    Full Text Available To minimize damage to healthy tissues, we have been performing endoscopically assisted cubital tunnel syndrome surgery based on endoscopic nerve findings since 1995. This is the first study to focus on endoscopic surgery for cubital tunnel syndrome based on endoscopic ulnar nerve findings and the subsequent postoperative clinical results. We analysed 82 upper extremities of 74 cubital tunnel syndrome patients who had undergone endoscopically assisted release surgery using the Universal Subcutaneous Endoscope system. Endoscopic observations of the ulnar nerve were made from a single 1- to 3-cm endoscopic portal incision at the cubital tunnel to 10 cm proximal and 10 cm distal. The abnormal nerve areas were identified and released based on nerve degeneration findings under endoscopic observation. The abnormal areas spread eccentrically from the entrapment point(s. In 82 diseased upper extremities, ulnar nerve entrapment occurred at the cubital tunnel. However, one extremity suffered from entrapment at the arcade of Struthers' in addition to the cubital tunnel. All patients showed improved clinical symptoms following surgery. There is no statistical relation between pre- and postoperative clinical scores of Dellon's Staging and abnormal nerve length findings. Cubital tunnel syndrome is usually caused by entrapment at the cubital tunnel; however, in some cases, there are other point entrapment(s. Our endoscopically assisted procedure avoids any damage to healthy tissues because the surgeon can observe the entrapment point(s prior to release. Postoperative clinical recovery results clearly indicate that endoscopic nerve findings reveal entrapment points and ulnar nerve degeneration can spread maximally 10 cm distally and proximally from the entrapment point(s, even in clinically mild severity cases. All other possible entrapment points should, therefore, be observed and released using our procedure.

  11. 微侵袭神经外科的历史、现状与展望%Minimal invasive neuro-surgery:history, current concept and the future

    Institute of Scientific and Technical Information of China (English)

    周定标

    2009-01-01

    1990年Wickham Fitzpatrick首先提出“微侵袭外科”的概念。1992年德国学者Bauer和Hellwig进一步提出“微侵袭神经外科”(minimally invasive neurosurgery,MINS)的称谓。MINS的本意是应用微侵袭技术以较小的创伤治疗神经外科疾病,达到既安全有效地去除病患、又最大程度保护重要结构功能的目的。MINS是现代神经外科发展史上的第二个里程碑,

  12. Clinical research on the application of minimally invasive plastic surgery to repair facial fresh trauma%应用微创整形外科技术修复颜面部新鲜创伤的临床研究

    Institute of Scientific and Technical Information of China (English)

    丛占中; 赵志强; 刘金富

    2014-01-01

    Objective:To study the effect of the clinical research on the application of minimally invasive plastic surgery to repair facial fresh trauma.Methods:65 patients with fresh facial trauma were selected.All of them were used minimally invasive orthopedic surgical techniques,stitching and repair original mouth treatment.Results:65 cases of facial fresh wound were repaired.59 cases were followed up for more than half a year,among which 57 cases(96.6%)were slight scar and 2 cases(3.4%)were slightly obvious scar.Conclusion:The application of minimally invasive techniques of plastic surgery to repair facial trauma,the scar is slight,and it has no deformity,good effect.It is easy to master and extension.%目的:探讨应用微创整形外科技术修复颜面部新鲜创伤的临床效果。方法:收治颜面部新鲜创伤患者65例,均应用微创整形外科手术技术缝合和修复原创口进行治疗。结果:修复颜面新鲜创伤伤口65例,术后随访半年以上59例,其中瘢痕轻微57例(96.6%),瘢痕稍明显2例(3.4%)。结论:应用微创整形外科技术修复颜面创伤瘢痕轻微、无畸形、效果好,此技术易掌握,宜推广。

  13. Minimally invasive lateral transpsoas approach for spinal discitis and osteomyelitis.

    Science.gov (United States)

    Patel, Neal B; Dodd, Zachary H; Voorhies, Jason; Horn, Eric M

    2015-11-01

    We present a series of patients with discitis and osteomyelitis who were surgically treated via a minimally invasive lateral transpsoas approach to the lumbar spine. Surgical treatment for spinal discitis and osteomyelitis presents challenges because of comorbidities that are common in patients undergoing this procedure. A retrospective review found six patients who met strict operative criteria including instability, intractable pain, neurological deficit, and disease progression. All patients were non-ambulatory before surgery because of intractable back pain. The patients underwent standard lateral minimally invasive surgery using either the extreme lateral interbody fusion (NuVasive, San Diego, CA, USA) or direct lateral interbody fusion (Medtronic Sofamor Danek, Memphis, TN, USA) system. The patients underwent debridement with a discectomy and partial or complete corpectomy, with polyetheretherketone or titanium cage placement. Two patients had additional posterior fixation with percutaneous pedicle screws, and none had immediate perioperative complications. The postoperative CT scans demonstrated satisfactory debridement and hardware placement. All patients experienced significant pain improvement and could ambulate within a few days of surgery. So far, the 1 year follow-up data have demonstrated stable hardware with solid fusion and continued pain improvements. One patient demonstrated hardware failure secondary to refractory infection, 2 months postoperatively, and required additional posterior decompression and debridement with pedicle screw fixation. The lateral transpsoas approach permits debridement and fixation coupled with percutaneous pedicle screw fixation to further stabilize the spine in a minimally invasive fashion. Due to the significant comorbidities in this patient population, a minimally invasive approach is a suitable surgical technique. A close follow-up period is necessary to detect early hardware failure which may necessitate more

  14. Minimally invasive surgical therapies for benign prostatic hypertrophy: The rise in minimally invasive surgical therapies

    Directory of Open Access Journals (Sweden)

    Daniel Christidis

    2017-06-01

    The role of minimally invasive surgical therapies in the treatment of BPH is still yet to be strongly defined. Given the experimental nature of many of the modalities, further study is required prior to their recommendation as alternatives to invasive surgical therapy. More mature evidence is required for the analysis of durability of effect of these therapies to make robust conclusions of their effectiveness.

  15. The concept of minimally invasive dentistry.

    Science.gov (United States)

    Ericson, Dan

    2007-01-01

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

  16. 一日病房脊柱微创手术患者围手术期的心理护理%Preoperative psychological nursing of patients in minimally invasive spine surgery in one-day hospital ward

    Institute of Scientific and Technical Information of China (English)

    张有皓; 徐淑娟; 蒋爱庭

    2011-01-01

    Objective To explore the specific model of preoperative psychological nursing of patients in minimally invasive spine surgery in one-day hospital ward. Methods The characteristics of preoperative psychological nursing of 584 patients in minimally invasive spine surgery in one-day hospital ward were summarized and effective psychological nursing were performed on them. Results Patients under the local anesthesia could initiatively cooperate in the surgery, recognize the outcomes of operations and accept training at home after surgery. Conclusions Good perioperative psychological nursing can effectively promote the surgical safety, help patients to build confidence, improve their initiative in the operation and surgical efficacy, increase patients' satisfaction.%目的 探讨一日病房脊柱微创手术患者围手术期心理护理的具体模式.方法 总结584例一日病房脊柱微创手术患者的围手术期心理护理特点,实施有效心理护理措施.结果 本组患者在局麻下积极配合手术治疗,认可手术效果,接受手术后回家修养.结论 优质的围手术期心理护理可以有效地促进手术患者的手术安全.能帮助患者树立信心,提高其参与手术的积极性,提高疗效,增加患者的满意度.

  17. Minimally Invasive Procedures for Nasal Aesthetics

    OpenAIRE

    Alessio Redaelli; Pietro Limardo

    2012-01-01

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

  18. Robots for minimally invasive diagnosis and intervention

    OpenAIRE

    Huda, Nazmul; YU, Hongnian; Cang, Shuang

    2016-01-01

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

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

    Science.gov (United States)

    Inoue, Haruhiro

    2016-07-01

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

  20. Minimally invasive local therapies for liver cancer

    Institute of Scientific and Technical Information of China (English)

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

    2014-01-01

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

  1. Minimally Invasive Strip Craniectomy Simplifies Anesthesia Practice in Patients With Isolated Sagittal Synostosis

    NARCIS (Netherlands)

    van Nunen, Daan P F; Stubenitsky, Bart M.; Woerdeman, Peter A.; Han, Kuo Sen; Breugem, Corstiaan C.; Mink van der Molen, Aebele B; de Graaff, Jurgen C.

    Background: Traditional open corrective surgery for isolated sagittal synostosis entails significant blood loss, transfusion rates, morbidity, and a lengthy hospitalization. Minimally invasive strip craniectomy (MISC) was introduced to avoid the disadvantages of open techniques. Objectives: The aim

  2. Acute Achilles tendon rupture: minimally invasive surgery versus non operative treatment, with immediate full weight bearing. Design of a randomized controlled trial

    Directory of Open Access Journals (Sweden)

    Verleisdonk Egbert-Jan MM

    2007-11-01

    Full Text Available Abstract Background We present the design of an open randomized multi-centre study on surgical versus conservative treatment of acute Achilles tendon ruptures. The study is designed to evaluate the effectiveness of conservative treatment in reducing complications when treating acute Achilles tendon rupture. Methods/Design At least 72 patients with acute Achilles tendon rupture will be randomized to minimally invasive surgical repair followed by functional rehabilitation using tape bandage or conservative treatment followed by functional rehabilitation with use of a functional bracing system. Both treatment arms use a 7 weeks post-rupture rehabilitation protocol. Four hospitals in the Netherlands will participate. Primary end-point will be reduction in complications other than re-rupture. Secondary end-point will be re-rupturing, time off work, sporting activity post rupture, functional outcome by Leppilahti score and patient satisfaction. Patient follow-up will be 12 month. Discussion By making this design study we wish to contribute to more profound research on AT rupture treatment and prevent publication bias for this open-labelled randomized trial. Trial registration ISRCTN50141196

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

    Science.gov (United States)

    Subhas, Gokulakkrishna; Mittal, Vijay K

    2011-01-01

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

  4. Multiexpandable cage for minimally invasive posterior lumbar interbody fusion

    Directory of Open Access Journals (Sweden)

    Coe JD

    2016-09-01

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

  5. 微创与传统膝关节置换术失血量比较%Comparative study of blood loss in minimally invasive surgery and conventional total knee arthroplasty

    Institute of Scientific and Technical Information of China (English)

    王志强; 黄伟; 梁熙; 胡宁; 徐伟; 林良波; 符纯峰; 程强

    2013-01-01

    目的 比较微创全膝关节置换术(minimally invasive surgery total knee arthroplasty,MIS-TKA)与传统全膝关节置换术(conventional total knee arthroplasty,C-TKA)围术期失血量的差异. 方法 回顾性分析2009年1月-2012年1月收治的84例单侧TKA患者围术期失血量,按手术方式分为微创组(42例)和传统组(42例),计算围术期失血量(显性失血量+隐性失血量),对两组患者的失血量和输血量进行比较. 结果 传统组围术期失血量为(1 466±493)ml,输血量为(223±208)ml;微创组围术期失血量为(1 379±475) ml,输血量为(257±239) ml(P>0.05). 结论 MIS-TKA不能减少围术期失血量.%Objective To compare difference of perioperative blood loss between minimally invasive surgery total knee arthroplasty (MIS-TKA) and conventional TKA (C-TKA).Methods A retrospective study was conducted on perioperative bleeding volume in 84 patients undergone unilateral TKA from January 2009 to January 2012.The patients were divided to minimally invasive group (42 patients) and conventional group (42 patients),according to surgical approaches.Perioperative blood loss (evident + occult hemorrhage) was calculated.Blood loss and blood requirement in the two groups were analyzed and compared as well.Results Mean blood loss was (1 466 ± 493) ml in the conventional group and (1 379 ± 475) ml in the minimally invasive group (P > 0.05).Moreover,mean blood requirement in the two groups was (223 ± 208) ml and (257 ± 239) ml respectively (P > 0.05).Conclusion MIS-TKA can not reduce perioperative blood loss.

  6. Surgical technique for minimally invasive fibula fracture fixation.

    Science.gov (United States)

    Carlile, G S; Giles, N C L

    2011-09-01

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

  7. Minimally invasive dentistry: a review and update.

    Science.gov (United States)

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

    2006-06-01

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

  8. 微创手术联合同期植皮治疗下肢静脉曲张性溃疡%Minimally invasive surgery combined with skin graft on the treatment of varicose veins of lower limb ulcer

    Institute of Scientific and Technical Information of China (English)

    张平; 贺亮; 姜英令; 张浩

    2013-01-01

    Objective To evaluate the curative effect of minimally invasive surgery (endovenous laser treatment + subfascial endoscopic perforator vein surgery) combined with skin graft on the treatment of varicose veins of lower limb ulcer. Methods Totally 43 limbs with varicose veins of ulcer were treated in this study from May 2008 to April 2013. Results The physical symptoms of limbs improved postoperatively with ulcer healing, and no complication or recurrence was observed during the follow-up study. Conclusion Minimally invasive surgery combined with skin graft for the treatement of varicose veins of lower limb ulcer has such advantages as little trauma, fast recovery, and non recurrence, and it is worth to spread in clinic.%目的 探讨腔内激光+腔镜深筋膜下交通支静脉离断术联合植皮术治疗下肢静脉曲张性溃疡的效果.方法 自2008年5月至2013年4月,对下肢静脉曲张伴小腿溃疡的43条肢体施行微创手术联合同期植皮术.结果 本组患者28例,术后肢体症状改善,溃疡愈合,无手术并发症,随访6~18个月,无复发.结论 微创手术联合同期植皮治疗下肢静脉曲张性溃疡具有创伤小、恢复快、不易复发的特点,值得临床推广.

  9. Children supernumerary tooth extraction surgery using minimally invasive techniques Effect%儿童埋伏多生牙拔除术中采用微创技术的效果观察

    Institute of Scientific and Technical Information of China (English)

    李继东

    2016-01-01

    Objective To investigate the minimally invasive technique used in children supernumerary tooth extraction surgery patients. Methods in our hospital from November 2013 to November 2015 admitted supernumerary teeth in children 60 cases were randomly divided into two groups, 30 cases each. The control group using traditional extraction, minimally invasive extraction observation group, two groups were compared operative time, intraoperative complications incidence and fear. Results The operative time was shorter than the control group, the difference was significant (P<0.05); the observation group surgery fear was lower than the control group, the difference was significant (P <0.05); the observation group postoperative pain, adjacent teeth damage and soft tissue swelling rate than the control group, the difference was significant (P<0.05). Conclusion The minimally invasive technique used in children supernumerary tooth extraction surgery can significantly shorten the operation time and reduce postoperative pain in children, reduce the incidence of complications.%目的:探讨微创技术应用于儿童埋伏多生牙拔除术中的疗效。方法选取我院2013年11月至2015年11月收治的埋伏多生牙患儿60例,随机分为两组,各30例。对照组采用传统拔牙,观察组采用微创拔牙,对比两组手术时间、术中畏惧发生率和并发症情况。结果观察组手术时间短于对照组,差异显著(P<0.05);观察组术中畏惧发生率低于对照组,差异显著(P<0.05);观察组术后疼痛、邻牙损伤和软组织肿胀发生率低于对照组,差异显著(P<0.05)。结论微创技术应用于儿童埋伏多生牙拔除术中可明显缩短手术时间,减轻患儿术后疼痛,降低并发症发生率。

  10. Clinical efficacy of suspension laryngeal endoscopy and powered laryngeal system in minimally invasive surgery%支撑喉内镜联合动力系统在喉微创手术中的临床疗效

    Institute of Scientific and Technical Information of China (English)

    刘建兵; 李曼; 柏正群

    2014-01-01

    Abatract:Objective To evaluate the clinical effects of laryngeal endoscopy and powered laryngeal system in minimal-ly invasive surgery.Methods 215 patients with vocal cord lesions were treated with powered laryngeal instruments un-der laryngeal endoscopy, Clinical efficacy was evaluated before and after the surgery, including laryngoscopy and self-assessment of Voice Handicap Index (VHI-10).Results The surgical exposure was excellent and the operational cut was precise and less invasive.The vocal function in 215 patients was satisfying.The voice handicap index were differ-ent between pre-operative and four weeks postoperative (P<0.05).Conclusion Laryngeal endoscopy combined with powered laryngeal system is ideal in minimally invasive surgery.%目的:探讨支撑喉内镜下联合喉动力系统在喉微创手术中的临床疗效。方法声带病变患者215例,在支撑喉内镜数字显像系统的监视下,与动力系统驱动下的切割刀头联合运用切除声带病变,观察临床疗效并对手术前后临床检查结果以及患者嗓音障碍指数( VHI-10)进行比较。结果215例声带病变一次切除,全部手术过程顺利,术后随访发现患者发音功能得到很好的恢复,声嘶改善满意。手术前后VHI量表评分变化有统计学意义( P<0.05)。结论支撑喉内镜数字显像系统联合动力系统可以常规应用于喉微创手术中,具有相对安全、视野清晰、操作精确、创伤小等优点,疗效满意。

  11. 硬膜外联合腰麻在泌尿科微创手术中的应用效果观察%The application effect of Epidural combined with lumbar anaesthetizing in urological minimally invasive surgery

    Institute of Scientific and Technical Information of China (English)

    袁春梅; 罗明; 谢伦雄; 罗小玲

    2015-01-01

    目的:为了探讨硬膜外联合腰麻在泌尿科微创手术中的应用效果。方法选取156例泌尿科微创手术患者为研究对象,随机对患者进行分组,分成硬-腰联合麻醉组和连续硬膜外麻醉组。对两组患者的麻醉起效时间、用药总量以及临床整体麻醉效果进行观察和比较。结果(1)硬-腰联合麻醉组患者的麻醉起效时间短于连续硬膜外麻醉组,麻醉药物用量少于连续硬膜外麻醉组;(2)硬-腰联合麻醉组患者的麻醉效果优秀比例显著高于连续硬膜外麻醉组。结论临床针对泌尿科实施微创手术的过程中,采用硬膜外联合腰麻的临床麻醉效果显著,是临床应用于泌尿科微创手术中的理想麻醉方式之一。%Objective To investigate the application of epidural combined with lumbar anaesthetizing in urological minimally invasive surgery.Methods Chose 156 cases of urological minimally invasive surgery patients as the research object, and randomly divided into hard -waist joint anesthesia group and continuous epidural anesthesia group.Total anesthesia working time in patients, medication and clinical overall anaesthesia effect were observed and compared.Results Hard -waist joint anesthesia group present short effective time than continuous epidural anesthesia group, however, the dosage of anesthetic was less than the continuous epidural anesthesia group.Good proportion of anesthesia effect in Hard -waist joint anesthesia group was significantly higher than continuous epidural anesthesia group.Conclusions Epidural combined with lumbar anaesthetizing is an ideal anesthesia method in clinical minimally invasive surgery.

  12. Minimally Invasive Approach of a Retrocaval Ureter

    Science.gov (United States)

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

    2016-01-01

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

  13. Resin composites in minimally invasive dentistry.

    Science.gov (United States)

    Jacobsen, Thomas

    2004-01-01

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

  14. Minimal Invasive Decompression for Lumbar Spinal Stenosis

    Directory of Open Access Journals (Sweden)

    Victor Popov

    2012-01-01

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

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

    Directory of Open Access Journals (Sweden)

    Renata Tosoni Rodrigues Ferreira

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

  16. Radiofrequency Ablation: A Minimally Invasive Approach in Kidney Tumor Management

    Energy Technology Data Exchange (ETDEWEB)

    Salagierski, Maciej, E-mail: maciej.salagierski@umed.lodz.pl [I Urology Department, Medical University of Lodz (Poland); Salagierski, Marek S. [II Urology Department, Medical University of Lodz (Poland)

    2010-11-17

    The management and diagnosis of renal tumors have changed significantly over the last decade. Due to advances in imaging techniques, more than 50% of kidney tumors are discovered incidentally and many of them represent an early stage lesion. This has stimulated the development of nephron-sparing surgery and of the minimally invasive treatment options including ablative techniques, i.e., radiofrequency ablation (RFA) and cryoablation. The objective of the minimally invasive approach is to preserve the renal function and to lower the perioperative morbidity. RFA involves inducing the coagulative necrosis of tumor tissue. Being probably one of the least invasive procedures in kidney tumor management, RFA may be performed percutaneously under ultrasound (US), computed tomography (CT) or magnetic resonance (MR) guidance. Most of the studies show that the RFA procedure is efficient, safe and has a low complication rate. Due to the still limited data on the oncological outcome of RFA, the indication for this intervention remains limited to selected patients with small organ-confined renal tumors and contraindication to surgery or who have a solitary kidney. The aim of our study is to review the literature on RFA of kidney tumors.

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

    Directory of Open Access Journals (Sweden)

    Jarno Riikonen

    2015-01-01

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

  18. Minimally invasive surgical therapies for benign prostatic hypertrophy: The rise in minimally invasive surgical therapies.

    Science.gov (United States)

    Christidis, Daniel; McGrath, Shannon; Perera, Marlon; Manning, Todd; Bolton, Damien; Lawrentschuk, Nathan

    2017-06-01

    The prevalence of benign prostatic hypertrophy (BPH) causing bothersome lower urinary tract symptoms increases with our ageing population. Treatment of BPH traditionally begins with medical therapy and surgical intervention is then considered for those whose symptoms progress despite treatment. Minimally invasive surgical therapies have been developed as an intermediary in the treatment of BPH with the aim of decreasing the invasiveness of interventions. These therapies also aim to reduce morbidity and dysfunction related to invasive surgical procedures. Multiple treatment options exist in this group including mechanical and thermo-ablative strategies. Emerging therapies utilizing differing technologies range from the established to the experimental. We review the current literature related to these minimally invasive therapies and the evidence of their effectiveness in treating BPH. The role of minimally invasive surgical therapies in the treatment of BPH is still yet to be strongly defined. Given the experimental nature of many of the modalities, further study is required prior to their recommendation as alternatives to invasive surgical therapy. More mature evidence is required for the analysis of durability of effect of these therapies to make robust conclusions of their effectiveness.

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

    Directory of Open Access Journals (Sweden)

    Magdy Gomaa

    2016-12-01

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

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

    Science.gov (United States)

    Jiang, H W

    2016-08-01

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

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

    Science.gov (United States)

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

    2013-01-01

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

  2. Minimally invasive treatment options in fixed prosthodontics.

    Science.gov (United States)

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

    2016-03-01

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

  3. 用于微创外科手术的遥控机器人系统研究现状及趋势%OVERVIEW OF THE STATE OF ARTS ON CONTROL OF SCALED TELEMANIPULATED SYSTEM FOR MINIMALLY INVASIVE SURGERY

    Institute of Scientific and Technical Information of China (English)

    刘少强; 黄惟一; 王爱民; 宋爱国

    2002-01-01

    用于微创外科手术(Minimally Invasive Surgery 简称MIS)的主从式遥控机器人系统是医疗中的MIS技术与遥操作技术的结合, 本文主要对具有力觉临场感的比率遥控机器人用于MIS时的控制特点要求和控制理论技术的研究现状进行了综述,强调了用于MIS和用于生物工程、微机械等领域的遥控机器人系统在控制上的异同, 对用于MIS的比率遥控机器人系统控制中有待研究的一些关键问题提出了见解.

  4. Minimally invasive procedures for nasal aesthetics

    Directory of Open Access Journals (Sweden)

    Alessio Redaelli

    2012-01-01

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

  5. Minimally invasive procedures for nasal aesthetics.

    Science.gov (United States)

    Redaelli, Alessio; Limardo, Pietro

    2012-04-01

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

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

    Directory of Open Access Journals (Sweden)

    Lauren L Levy

    2012-01-01

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

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

    Directory of Open Access Journals (Sweden)

    Emiliano Vialle

    2015-12-01

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

  8. Surgery cooperation experience of minimally invasive bypass surgery of lumbar disc in the treatment of discogenic low back pain%微创腰椎间盘分流术治疗椎间盘源性腰痛的手术配合体会

    Institute of Scientific and Technical Information of China (English)

    张新梅; 杨惠林; 宋良琤

    2015-01-01

    目的:探讨微创腰椎间盘分流术治疗椎间盘源性腰痛的手术配合和护理要点。方法回顾分析15例微创腰椎间盘分流术的术中配合和护理过程。结果15例患者均安全完成手术,效果满意,无并发症发生。结论认真做好术前准备和评估,正确摆放体位,掌握手术配合步骤,加强术中护理配合,严格执行无菌操作,可保证手术安全顺利地完成。%Objective To explore the surgery cooperation and nursing highlights of minimally invasive bypass surgery of lumbar disc in the treatment of discogenic low back pain.MethodsIntraoperative coordination and nursing process of 15 cases of minimally invasive bypass surgeries of lumbar disc were retrospective analyzed. Results15 patients were all undergone surgeries successfully without complications, and they were all satisfied with the clinical effect.ConclusionSafe and successful surgery is guaranteed by careful preoperative preparation and evaluation, appropriate body position, grasp of surgical cooperation procedure, strengthening of intraoperative nursing coordination and strict performance of aseptic technique.

  9. Analysis of Factors Influencing Postoperative Complications of Lung Cancer Treated with Minimally Invasive Surgery%肺癌微创手术术后并发症发生的影响因素分析

    Institute of Scientific and Technical Information of China (English)

    耿耿; 陈荣林; 李勇

    2014-01-01

    目的:探讨肺癌微创手术切除术后,患者发生并发症的相关影响因素。方法所选53例肺癌患者均应用电视胸腔镜辅助进行肺癌切除术治疗。回顾性分析患者的临床资料,统计患者并发症发生情况,并应用单因素及多因素Logistic分析微创手术行肺癌切除术后,患者发生并发症的相关影响因素。结果53例患者术后出现并发症10例,发生率为18.87%。单因素分析显示,肺癌微创手术后发生并发症与年龄、FEV1%、吸烟指数、合并冠心病与糖尿病有关,而与其他合并症、手术时间、手术类型、性别无关。经Logistic多因素筛选后分析,70岁以上、FEV1%≤60%、合并冠心病为肺癌微创手术后发生并发症的独立危险因素。结论70岁以上、FEV1%≤60%、合并冠心病的肺癌患者,在微创手术后好发术后并发症,围手术期内应对上述患者进行危险评估并提供积极的干预。%Objective To explore influnece factors of postoperative complications of lung cancer treated with minimally invasive resection .Methods 53 cases of lung cancer patients received video-assisted thoracoscopic lung resection .Clinical data of patients and complications were retrospectively analyzed ,univariate and multivariate logistic regression were used to analyze in-flunece factors of postoperative complications of lung cancer treated with minimally invasive resection .Results In the 53 pa-tients,there had 10 cases of postoperative complications ,the incidence rate was 18.87%.Univariate analysis showed that postop-erative lung complications were related with age ,FEV1%,smoking index ,coronary heart disease and diabetes ,but not related with other complications,operative time,type of surgery and gender.Multivariate logistic analysis showed that over 70,FEV1% ≤60%,coronary heart disease were independent risk factors for complications after minimally invasive lung surgery .Conclusion Lung

  10. Present status of biliary surgery in the era of minimally invasive surgery%微创外科时代的胆道外科——胆囊切除术尚非平安无事

    Institute of Scientific and Technical Information of China (English)

    黄志强

    2011-01-01

    improved the result in the early, nodal negative patients. At present, many traditional surgical operations will be scrutinized according to the present-day surgical theme of minimal invasiveness.

  11. Cost-effectiveness of minimally invasive sacroiliac joint fusion

    Directory of Open Access Journals (Sweden)

    Cher DJ

    2015-12-01

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

  12. Minimally invasive aesthetic procedures in young adults

    Directory of Open Access Journals (Sweden)

    Wollina U

    2011-03-01

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

  13. 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.

    Science.gov (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

    2016-12-08

    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 .

  14. 微创时代的膀胱根治性切除和尿流改道术%Radical cystectomy and urinary diversion in the era of minimally invasive surgery

    Institute of Scientific and Technical Information of China (English)

    姜昊文; 丁强

    2014-01-01

    ABSTARCT Open radical cystectomy is the gold standard treatment of locally muscle-invasive and high-grade recurrent bladder cancer. Currently, laparoscopic radical cystectomy has been a popular procedure for its advantages of decreased blood loss, postoperative pain, surgical wound and better recovery. Additionally, laparoendoscopic single-site surgery and robot-assisted laparoscopic techniques are undergoing a development in this field. The minimally invasive techniques present a promising application whereas the efifcacy and safety require further validation.%传统开放性膀胱根治性切除术是治疗肌层浸润的局限性膀胱癌和复发性高级别膀胱癌的金标准。目前,腹腔镜膀胱根治性切除术因其出血少、术后疼痛轻、恢复快和切口小、美观性好等优点,越来越多地应用于临床。此外,单通道腹腔镜与机器人辅助腹腔镜技术也逐渐发展起来并应用于该领域。这些微创技术显示出广阔应用前景,但安全性和有效性仍需进一步证实。

  15. Surgical efficacy of minimally invasive thoracic discectomy.

    Science.gov (United States)

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

    2015-11-01

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

  16. Minimally invasive approach of panfacial fractures

    Directory of Open Access Journals (Sweden)

    Yudi Wijaya

    2017-08-01

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

  17. High-dosage tamoxifen as neoadjuvant treatment in minimally invasive surgery for Dupuytren disease in patients with a strong predisposition toward fibrosis: a randomized controlled trial.

    Science.gov (United States)

    Degreef, Ilse; Tejpar, Sabine; Sciot, Raf; De Smet, Luc

    2014-04-16

    Tamoxifen, a synthetic nonsteroidal anti-estrogen known to modulate the production of transforming growth factor-beta (TGF-β), has demonstrated effectiveness on fibroblast activity in vitro and in vivo. The main purpose of this study was to investigate the effect of tamoxifen on the outcome of surgery for Dupuytren contractures in patients with a strong predisposition toward fibrosis. We used a prospective, randomized, double-blind study protocol (conforming to the CONSORT standards) to investigate the influence of tamoxifen compared with placebo on the total passive extension deficit in the finger and patient satisfaction after subtotal fasciectomy in thirty patients with a strong predisposition toward fibrosis (grade, >4 according to the Abe scale). High-dosage tamoxifen (80 mg/day) was administered from six weeks prior until twelve weeks after surgery, and patients were monitored for two years. Three months after surgery, patients in the tamoxifen group had a smaller total passive extension deficit and higher satisfaction compared with the placebo group. This positive effect was lost over the two years following cessation of the medication. This study demonstrated that the short-term outcome of Dupuytren disease treatment could be influenced by use of tamoxifen as a neoadjuvant from six weeks prior to three months after subtotal fasciectomy in patients with a strong predisposition toward fibrosis. However, the beneficial effect disappeared within two years after surgery, with worsening of the contractures after the medication was discontinued. Thus, tamoxifen may have a short-term effect on the outcome of surgery for Dupuytren disease.

  18. 尿路结石微创手术的护理危险因素与预防措施%Nursing Risk Factors of Urinary Calculi Treated by Minimally Invasive Surgery and the Corresponding Preventive Measures

    Institute of Scientific and Technical Information of China (English)

    段光兰; 刘金芳

    2015-01-01

    尿路结石是临床上常见的疾病,这种疾病机制复杂,诱因也比较多,患者发病后临床上主要表现为:排尿困难、尿流变细、中断等,对于感染患者甚至出现尿频、尿急等,影响患者生活质量。目前,医学界对于这种疾病缺乏理想的治疗方法,常规方法主要微创手术治疗为主,但是患者在患者在手术治疗过程中风险因素较大,部分患者手术后容易产生不良反应或并发症等,影响患者治疗预后。该文将以尿路结石为起点,分析尿路结石微创手术的护理危险因素,并根据其危险因素提出针对性的解决措施,提高患者手术成功率及患者生活质量。%Urinary calculi is a clinical common disease with complex mechanisms and many incentives. The main clinical manifestations of the disease are as follows: dysuria, thinning or intermittency of urinary stream and so on; those with infection even have urinary frequency, urgency and so forth, which affect the quality of life. At present, there is no ideal treatment method for the disease. And the conventional treatment method is mainly minimally invasive surgical treatment, however, the patient has many risk factors during the surgery, and some patients are prone to adverse reactions or complications, which in turn affect the treatment and prognosis. This paper analyzes the nursing risk factors of minimally invasive surgery for urinary calculi, and puts forward corresponding countermeasures so as to improve the success rate of surgery and the quality of life of the patients.

  19. Minimally invasive colon resection for malignant colonic conditions is associated with a transient early increase in plasma sVEGFR1 and a decrease in sVEGFR2 levels after surgery.

    Science.gov (United States)

    Shantha Kumara, H M C; Cabot, J C; Hoffman, A; Luchtefeld, M; Kalady, M F; Hyman, N; Feingold, D; Baxter, R; Whelan, R L

    2010-02-01

    Plasma VEGF levels increase after minimally invasive colorectal resection (MICR) and remain elevated for 2-4 weeks. VEGF induces physiologic and pathologic angiogenesis by binding to endothelial cell (EC) bound VEGF-Receptor-1 (VEGFR1) and VEGFR2. Soluble forms of these receptors sequester plasma VEGF, decreasing the amount available to bind to EC-bound receptors. Ramifications of surgery-related plasma VEGF changes partially depend on plasma levels of sVEGFR1 and sVEGFR2. This study assessed perioperative sVEGFR1 and sVEGFR2 levels after MICR in patients with colorectal cancer. Forty-five patients were studied; blood samples were taken from all patients preoperatively (preop) and on postoperative days (POD) 1 and 3; in most a fourth sample was drawn between POD 7-30. Late samples were bundled into two time points: POD 7-13 and POD 14-30. sVEGFR1 and sVEGFR2 levels were measured via ELISA. sVEGFR2 data are reported as mean +/- SD and were assessed with the paired samples t test. sVEGFR1 data were not normally distributed. They are reported as median and 95% confidence interval (CI) and were assessed with the Wilcoxon signed-Rank test (p MICR; sVEGFR2 changes dominate due to their much larger magnitude. The net result is less plasma VEGF bound by soluble receptors and more plasma VEGF available to bind to ECs early after surgery.

  20. Analysis of the Mammotome minimally invasive operation in ambulatory surgery center%乳腺Mammotome微创旋切系统在日间手术中心的应用分析

    Institute of Scientific and Technical Information of China (English)

    陈荣恒; 甄作均; 谭家驹; 杨胜利; 黄伟俊

    2014-01-01

    目的探讨乳腺微创手术旋切系统在日间手术中心的应用。方法回顾性分析2012年1月至2013年6月600例在日间手术中心用麦默通(Mammotome)微创活检乳腺病变组织,同时在超声引导下对一些良性肿瘤完整切除患者(研究组)的临床资料。选取同期500例常规住院患者作为对照组。结果研究组患者住院费用[(3204.5±215.6)元v s (7352.6±541.7)元]、在院时间[(13.7±3.4)h v s(86.7±12.3)h]明显优于对照组,差异有统计学意义(P<0.05)。研究组并发症发生率与对照组比较差异无统计学意义(2%v s 1.8%)。结论应用乳腺微创手术旋切系统可在日间手术中心完成乳腺病变组织快速活检及乳腺良性实性肿块切除术,具有损伤极小、疼痛轻、方便快捷等特点。%Objective To explore the efficacy of application of Mammotome minimally invasive operation in the ambulatory surgery center. Methods The clinical data of 600 cases (research group) of inpatients admitted to our hospital from January 2012 to June 2013 with breast benign mass was retrospectively reviewed. 500 cases of normal hospitalized patients were selected as control group during the same period. Results The hospitalization costs and length of hospital stay between the two groups had statistically significant difference. There was no statistically significant difference between the two groups at the complication rates. Conclusion The application of minimally invasive breast operation cutting system of breast lesions were successfully used for rapid biopsy of breast lesions and breast benign tumor resection in the ambulatory surgery center with many advantages, especially of minimal damage, less pain, and convenience.

  1. Contemporary role of minimally invasive thoracic surgery in the management of pulmonary arteriovenous malformations: report of two cases and review of the literature

    Science.gov (United States)

    Wang, Stephani C.; Rosen, Jonathan M.

    2016-01-01

    Pulmonary arteriovenous malformations (PAVM) can have potentially serious neurological and cardiac consequences if left untreated. Embolization has supplanted surgical resection as the first line treatment modality. However, this technique is not always successful and carries risks of air embolism, migration of the coil, myocardial rupture, vascular injury, pulmonary hypertension, and pulmonary infarction. We present two patients with symptomatic PAVM despite multiple embolizations: the first one with recurrent and persistent hemoptysis who underwent a thoracoscopic lobectomy, and the second one with chronic debilitating pleuritic pain subsequent to embolization who underwent a thoracoscopic wedge resection. Video-assisted thoracoscopic surgery (VATS) with lung resection was successfully performed in both patients, with complete resolution of their symptoms. We also review the literature regarding the contemporary role of surgery in PAVM, particularly thoracoscopy. PMID:26904229

  2. Contemporary role of minimally invasive thoracic surgery in the management of pulmonary arteriovenous malformations: report of two cases and review of the literature.

    Science.gov (United States)

    Bakhos, Charles T; Wang, Stephani C; Rosen, Jonathan M

    2016-01-01

    Pulmonary arteriovenous malformations (PAVM) can have potentially serious neurological and cardiac consequences if left untreated. Embolization has supplanted surgical resection as the first line treatment modality. However, this technique is not always successful and carries risks of air embolism, migration of the coil, myocardial rupture, vascular injury, pulmonary hypertension, and pulmonary infarction. We present two patients with symptomatic PAVM despite multiple embolizations: the first one with recurrent and persistent hemoptysis who underwent a thoracoscopic lobectomy, and the second one with chronic debilitating pleuritic pain subsequent to embolization who underwent a thoracoscopic wedge resection. Video-assisted thoracoscopic surgery (VATS) with lung resection was successfully performed in both patients, with complete resolution of their symptoms. We also review the literature regarding the contemporary role of surgery in PAVM, particularly thoracoscopy.

  3. Application of minimal invasive technique in periodontal flap surgery%微创技术在牙周翻瓣术中的应用

    Institute of Scientific and Technical Information of China (English)

    章立群; 刘学; 肖莉; 黄佩珍

    2015-01-01

    目的:评价微创技术在牙周翻瓣术中的效果. 方法:选择需进行牙周翻瓣术( PFS)的患者35例,采用自身对照法,随机将患者口内一侧上、下2个区作为实验组,用微创法进行PFS,另一侧上、下2个区为对照组,用传统方式进行PFS. 比较术后1、3、7 d疼痛度、肿胀度及3、6、12个月菌斑指数、牙周袋深度、牙周附着丧失等牙周指标. 结果:实验组疼痛度治疗后1、3、7 d均显著低于对照组(P0. 05),第12个月两组各项指标均有统计学差异(P0. 05). At the end of 12 month after surgery, all parameters in test group were lower than those in control group (P<0. 05). CONCLUSION: Periodontal micro flap surgery has advantage over conventional periodontal flap surgery.

  4. Comparative study on different minimally invasive surgery ofr hypertensive cerebral hemorrhage%不同微创钻孔手术治疗高血压性脑出血的疗效对比

    Institute of Scientific and Technical Information of China (English)

    崔杰; 李树祥; 乔柏林; 崔福义; 黄春刚; 徐常亮

    2014-01-01

    Objective To compare the efficacy of different minimally invasive operation on hypertensive cerebral hemor-rhage.Methods One hundred patients with hypertensive cerebral hemorrhage were chosen.Case-control retrospective study was used.Treatment group (n= 50) was treated by the minimally invasive puncture hematoma suction ,urokinase was used af-ter operation. The control group(n= 50) was treated by small bone window craniotomy for removal of hematoma. NIHSS score ,GOS scores ,and the differences of overall curative effect of two groups were compared. Results The length of stay in hospital ,and NIHSS score of the treatment group were lower than those of the control group (P< 0.05).At the 1 stday thechange of postoperative hematoma of the treatment group ,was more obvious than that of the control group ,but at the 7th day after surgery ,the changes of postoperative hematoma between the two groups had a statistical significance (P<0.05). The volume of finally residual hematoma of the treatment group was less than that of the control group.Conclusion The minimally invasive puncture hematoma suction combined with urokinase is an effective intervention and treatment of hypertensive cerebral hemorrhage ,and is worth of clinical popularization.%目的:比较不同微创钻孔手术治疗高血压性脑出血的临床疗效。方法纳入合格的高血压性脑出血患者100例。试验组(n=50)采用微创穿刺血肿抽吸术,术后用尿激酶。对照组(n=50)行小骨窗开颅血肿清除术。比较2组NIHSS评分、GOS评分以及疗效。结果试验组住院时间、NIHSS评分低于对照组(P<0.05)。术后1 d血肿变化,试验组明显多于对照组,但术后7 d时,2组比较差异有统计学意义(P<0.05)。试验组最终残留血肿量低于对照组。结论微创穿刺血肿抽吸术联合尿激酶是有效干预和治疗高血压性脑出血的手术方案,值得在临床中推广。

  5. 微创上颌窦外提升与不翻瓣种植联合手术的临床观察%Minimally invasive maxillary sinus ascension and not double disc planting combined surgery clinical observation

    Institute of Scientific and Technical Information of China (English)

    张春光; 高菊荣; 高瑞; 张婧; 白茹; 刘捷; 贺祎

    2016-01-01

    Objective:Explore minimally invasive maxillary sinus ascension and planting the clinical efficacy of combined surgery, not double disc.Methods: Choice 32 patients with dentition defect beind maxillary dental area in March 2012 to February 2014, alveolar bone height 3.0~3.0 mm, 45 implanted implants in same period of maxillary sinus ascension, after 10 months to complete the permanent repair. Clinical examination and X-ray follow-up observation for 12-35 months.Results: 32 cases of minimally invasive maxillary sinus combination of ascension and not double disc planting operation smoothly, 1 case of maxillary sinus mucosa damage, after 10~12 months crescent root slices of new bone formation around the implant. After the implant prosthesis follow-up observations, implants saved rate was 100%.Conclusion: Minimally invasive maxillary sinus combination of ascension and not double disc planting after surgical method applied in maxillary teeth missing, small surgical trauma, quicker recovery, clinical effect is stable and satisfaction.%目的:探讨微创上颌窦外提升与不翻瓣种植联合手术的临床疗效。方法:选择32例上颌后牙区骨量不足的牙列缺损患者,其牙槽骨高度为3.0~5.0 mm,上颌窦外提升术后同期植入45颗种植体,术后10个月完成永久修复。随访12~35个月,采用临床检查和X射线检查观察临床疗效。结果:32例微创上颌窦外提升与不翻瓣种植联合手术顺利,无1例上颌窦黏膜破损,术后10~12个月牙根尖片显示种植体周围有新骨生成。种植修复后随访观察结果显示种植体存留率为100%。结论:微创上颌窦外提升与不翻瓣种植联合手术方法应用于上颌后牙缺失,手术创伤小,术后恢复快,临床效果稳定。

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

    Directory of Open Access Journals (Sweden)

    Tyler A. Gonzalez

    2017-01-01

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

  7. Minimally Invasive Transpalpebral Endoscopic-Assisted Amygdalohippocampectomy.

    Science.gov (United States)

    Mandel, Mauricio; Figueiredo, Eberval Gadelha; Mandel, Suzana Abramovicz; Tutihashi, Rafael; Teixeira, Manoel Jacobsen

    2017-02-01

    Although anterior temporal lobectomy may be a definitive surgical treatment for epileptic patients with mesial temporal sclerosis, it often results in verbal, visual, and cognitive dysfunction. Studies have consistently reported the advantages of selective procedures compared with a standard anterior temporal lobectomy, mainly in terms of neuropsychological outcomes. To describe a new technique to perform a selective amygdalohippocampectomy (SAH) through a transpalpebral approach with endoscopic assistance. A mini fronto-orbitozygomatic craniotomy through an eyelid incision was performed in 8 patients. Both a microscope and neuroendoscope were used in the surgeries. An anterior SAH was performed in 5 patients who had the diagnosis of temporal lobe epilepsy with mesial temporal sclerosis. One patient had a mesial temporal lesion suggesting a ganglioglioma. Two patients presented mesial temporal cavernomas with seizures originating from the temporal lobe. The anterior approach allowed removal of the amygdala and hippocampus. The image-guided system and postoperative evaluation confirmed that the amygdala may be accessed and completely removed through this route. The hippocampus was partially resected. All patients have discontinued medication with no more epileptic seizures. The patients with cavernomas and ganglioglioma also had their lesions completely removed. One-year follow-up has shown no visible scars. The anterior route for SAH is a rational and direct approach to the mesial temporal lobe. Anterior SAH is a safe, less invasive procedure that provides early identification of critical vascular and neural structures in the basal cisterns. The transpalpebral approach provides a satisfactory cosmetic outcome.

  8. Design of a multi-DOF cable-driven mechanism of a miniature serial manipulator for robot-assisted minimally invasive surgery

    OpenAIRE

    Tzemanaki, A.; Fracczak, L.; Gillatt, D; Koupparis, A.; Melhuish, C; Persad, R; Rowe, E; Pipe, A.G.; Dogramadzi, S.

    2016-01-01

    While multi-fingered robotic hands have been developed for decades, none has been used for surgical operations. MicroAngelo is an anthropomorphic master-slave system for tele-operated robot-assisted surgery. As part of this system, this paper focuses on its slave instrument, a miniature three-digit hand. The design of the mechanism of such a manipulator poses a challenge due to the required miniaturization and the many active degrees of freedom. As the instrument has a human-centered design, ...

  9. Treatment of 50 Cases with Congenial Heart Disease by Minimal Invasive Surgery%微创心脏手术治疗先天性心脏病50例临床分析

    Institute of Scientific and Technical Information of China (English)

    裴韶华; 缪华新; 姚俊红

    2012-01-01

    Objective:To explore the clinical efficacy of the minimally invasive cardiac surgery to treat the congenial heart disease . Methods: The clinical data of 50 patients who accepted the minimally invasive car -diac surgery were retrospectively summarized . Among them ,20 in 21 VSD ( Ventricular Septal Defect ) patients accepted the interference shutoff operation , 1 VSD patient underwent the repair operation under right oxter little incision. 18 PDA( Patent duktus arteriosus ) patients accepted the interference shutoff operation ; 6 in 10 ASD (atrial septal defect) patients accepted the interference shutoff operation under the UCG (cardiac color ultra-sonography) bedside with little incision. Those patients were central ASD. The rest ASD patients with ASD diameter beyond 30mm accepted the repair operation via cardiopulmonary bypass without heartbeat halted under right oxter little incision. 1 aortic sinus hump patient accepted the operation of interference shutoff operation un -der the fiuoroscopy. Results:All patients were alive. 50 patients were followed up 2 ~6 months. All patients had no cardiac souffi e and the remnants of detour. All heart functions were Grade I and the effect was satisfy -ing. Conclusions : Little incision and interference shutoff operation have the superiority of little incision ( or no incision) ,less bleeding ,less time in hospital, minimally invasive surgery and good shape . Therefore, this operation formula has wide prospect.%目的:探讨微创心脏手术(MICS)治疗先天性心脏病的临床疗效.方法:采用微创心脏手术中小切口和介入封堵术治疗先天性心脏病患者50例.21例VSD中20例在电透下行介入封堵术,1例封堵失败改行右腋下小切口体外循环下修补术;18例PDA全部行介入封堵术;10例ASD中,6例中央型行小切口直视下配合床边心超封堵术,4例非中央型或长径在30 mm以上病例行右腋下小切口体外循环心脏不停跳下修补术; 1例主动脉窦瘤在

  10. Olfactory neuroblastoma (esthesioneuroblastoma): towards minimally invasive surgery and multi-modality treatment strategies - an updated critical review of the current literature.

    Science.gov (United States)

    Papacharalampous, G X; Vlastarakos, P V; Chrysovergis, A; Saravakos, P K; Kotsis, G P; Davilis, D I

    2013-01-01

    Olfactory neuroblastoma (esthesioneuroblastoma) was first described by Berger and Luc in 1924. It is considered to be an uncommon malignancy of the nasal cavity. The tumor arises from the specialized sensory epithelial olfactory cells, normally situated at the upper part of the nasal cavity, including the superior nasal concha, the roof of the nose and the cribriform plate. The imaging modalities of choice are computed tomography (CT) and magnetic resonance imaging (MRI). Combination of surgery and radiotherapy (either conventional radiotherapy or stereotactic radiosurgery), with or without chemotherapy is considered to be the standard of care for primary site disease by the majority of researchers. Combined transfacial and neurosurgical conventional approaches are also adopted in many reported cases, mainly due to the endocranial extension and the close anatomic relationship of esthesioneuroblastomas with the ethmoid roof and cribriform plate. Recent literature supports that endoscopic resection correlates with similar oncologic control rates compared with conventional open surgery, provided that basic oncologic surgical principles with clearance of margins and intradural dissection (when required) are completely maintained.

  11. Minimally invasive dentistry and the dental enterprise.

    Science.gov (United States)

    Rossomando, Edward F

    2007-03-01

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