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Sample records for surgical procedures minimally invasive

  1. Are minimally invasive procedures harder to acquire than conventional surgical procedures?

    Science.gov (United States)

    Hiemstra, Ellen; Kolkman, Wendela; le Cessie, Saskia; Jansen, Frank Willem

    2011-01-01

    It is frequently suggested that minimally invasive surgery (MIS) is harder to acquire than conventional surgery. To test this hypothesis, residents' learning curves of both surgical skills are compared. Residents had to be assessed using a general global rating scale of the OSATS (Objective Structured Assessment of Technical Skills) for every procedure they performed as primary surgeon during a 3-month clinical rotation in gynecological surgery. Nine postgraduate-year-4 residents collected a total of 319 OSATS during the 2 years and 3 months investigation period. These assessments concerned 129 MIS (laparoscopic and hysteroscopic) and 190 conventional (open abdominal and vaginal) procedures. Learning curves (in this study defined as OSATS score plotted against procedure-specific caseload) for MIS and conventional surgery were compared using a linear mixed model. The MIS curve revealed to be steeper than the conventional curve (1.77 vs. 0.75 OSATS points per assessed procedure; 95% CI 1.19-2.35 vs. 0.15-1.35, p < 0.01). Basic MIS procedures do not seem harder to acquire during residency than conventional surgical procedures. This may have resulted from the incorporation of structured MIS training programs in residency. Hopefully, this will lead to a more successful implementation of the advanced MIS procedures. Copyright © 2010 S. Karger AG, Basel.

  2. Acquiring minimally invasive surgical skills

    OpenAIRE

    Hiemstra, Ellen

    2012-01-01

    Many topics in surgical skills education have been implemented without a solid scientific basis. For that reason we have tried to find this scientific basis. We have focused on training and evaluation of minimally invasive surgical skills in a training setting and in practice in the operating room. This thesis has led to an enlarged insight in the organization of surgical skills training during residency training of surgical medical specialists.

  3. 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.

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

    Directory of Open Access Journals (Sweden)

    Raspe, Heiner

    2005-11-01

    there is no dependable evidence-base to recommend their use in routine clinical practice. 2. To create such a dependable evidence-base further research in two directions is needed: a The studies need to include adequate patient populations, use realistic controls (e.g. standard operative procedures or continued conservative care and use standardised measurements of meaningful outcomes after adequate periods of time. b Studies that are able to report effectiveness of the procedures under everyday practice conditions and furthermore have the potential to detect rare adverse effects are needed. In Sweden this type of data is yielded by national quality registries. On the one hand their data are used for quality improvement measures and on the other hand they allow comprehensive scientific evaluations. 3. Since the year of 2000 a continuous rise in utilisation of minimally-invasive lumbar disc surgery is observed among statutory health insurers. Examples from other areas of innovative surgical technologies (e.g. robot assisted total hip replacement indicate that the rise will probably continue - especially because there are no legal barriers to hinder introduction of innovative treatments into routine hospital care. Upon request by payers or providers the "Gemeinsamer Bundesausschuss" may assess a treatments benefit, its necessity and cost-effectiveness as a prerequisite for coverage by the statutory health insurance. In the case of minimally-invasive disc surgery it would be advisable to examine the legal framework for covering procedures only if they are provided under evaluation conditions. While in Germany coverage under evaluation conditions is established practice in ambulatory health care only (“Modellvorhaben" examples from other European countries (Great Britain, Switzerland demonstrate that it is also feasible for hospital based interventions. In order to assure patient protection and at the same time not hinder the further development of new and promising

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

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

    2016-06-01

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

  6. Thymoma and minimally invasive surgical treatment

    International Nuclear Information System (INIS)

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

    2011-01-01

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

  7. Minimally invasive myotomy for the treatment of esophageal achalasia: evolution of the surgical procedure and the therapeutic algorithm.

    Science.gov (United States)

    Bresadola, Vittorio; Feo, Carlo V

    2012-04-01

    Achalasia is a rare disease of the esophagus, characterized by the absence of peristalsis in the esophageal body and incomplete relaxation of the lower esophageal sphincter, which may be hypertensive. The cause of this disease is unknown; therefore, the aim of the therapy is to improve esophageal emptying by eliminating the outflow resistance caused by the lower esophageal sphincter. This goal can be accomplished either by pneumatic dilatation or surgical myotomy, which are the only long-term effective therapies for achalasia. Historically, pneumatic dilatation was preferred over surgical myotomy because of the morbidity associated with a thoracotomy or a laparotomy. However, with the development of minimally invasive techniques, the surgical approach has gained widespread acceptance among patients and gastroenterologists and, consequently, the role of surgery has changed. The aim of this study was to review the changes occurred in the surgical treatment of achalasia over the last 2 decades; specifically, the development of minimally invasive techniques with the evolution from a thoracoscopic approach without an antireflux procedure to a laparoscopic myotomy with a partial fundoplication, the changes in the length of the myotomy, and the modification of the therapeutic algorithm.

  8. Systems for tracking minimally invasive surgical instruments

    NARCIS (Netherlands)

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

    2007-01-01

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

  9. What is the optimal minimally invasive surgical procedure for endometrial cancer staging in the obese and morbidly obese woman?

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    Gehrig, Paola A; Cantrell, Leigh A; Shafer, Aaron; Abaid, Lisa N; Mendivil, Alberto; Boggess, John F

    2008-10-01

    Thirty-three percent of U.S. women are either obese or morbidly obese. This is associated with an increased risk of death from all causes and is also associated with an increased risk of endometrial carcinoma. We sought to compare minimally invasive surgical techniques for staging the obese and morbidly obese woman with endometrial cancer. Consecutive robotic endometrial cancer staging procedures were collected from 2005-2007 and were compared to consecutive laparoscopic cases (2000-2004). Demographics including age, weight, body mass index (BMI), operative time, estimated blood loss, lymph node retrieval, hospital stay and complications were collected and compared. During the study period, there were 36 obese and 13 morbidly obese women who underwent surgery with the DaVinci robotic system and 25 obese and 7 morbidly obese women who underwent traditional laparoscopy. For both the obese and morbidly obese patient, robotic surgery was associated with shorter operative time (p=0.0004), less blood loss (ptool for the comprehensive surgical staging of the obese and morbidly obese woman with endometrial cancer. As this patient population is at increased risk of death from all causes, including post-operative complications, all efforts should be made to improve their outcomes and minimally invasive surgery provides a useful platform by which this can occur.

  10. Systems for tracking minimally invasive surgical instruments.

    Science.gov (United States)

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

    2007-01-01

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

  11. Minimally invasive surgical treatment of valvular heart disease.

    Science.gov (United States)

    Goldstone, Andrew B; Joseph Woo, Y

    2014-01-01

    Cardiac surgery is in the midst of a practice revolution. Traditionally, surgery for valvular heart disease consisted of valve replacement via conventional sternotomy using cardiopulmonary bypass. However, over the past 20 years, the increasing popularity of less-invasive procedures, accompanied by advancements in imaging, surgical instrumentation, and robotic technology, has motivated and enabled surgeons to develop and perform complex cardiac surgical procedures through small incisions, often eliminating the need for sternotomy or cardiopulmonary bypass. In addition to the benefits of improved cosmesis, minimally invasive mitral valve surgery was pioneered with the intent of reducing morbidity, postoperative pain, blood loss, hospital length of stay, and time to return to normal activity. This article reviews the current state-of-the-art of minimally invasive approaches to the surgical treatment of valvular heart disease. Copyright © 2014 Elsevier Inc. All rights reserved.

  12. Procedures minimally invasive image-guided

    International Nuclear Information System (INIS)

    Mora Guevara, Alejandro

    2011-01-01

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

  13. Minimally invasive aesthetic procedures in young adults

    OpenAIRE

    Wollina, Uwe; Goldman, Alberto

    2011-01-01

    Uwe Wollina1, Alberto Goldman21Department of Dermatology and Allergology, Academic Teaching Hospital Dresden-Friedrichstadt, Dresden, Germany; 2Clinica Goldman, Porto Alegre, Rio Grande du Sul, BrazilAbstract: Age is a significant factor in modifying specific needs when it comes to medical aesthetic procedures. In this review we will focus on young adults in their third decade of life and review minimally invasive aesthetic procedures other than cosmetics and cosmeceuticals. Correction of asy...

  14. Minimally Invasive Surgical Treatment of Esophageal Achalasia

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

    2003-01-01

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

  15. 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 

  16. Urolift - minimally invasive surgical BPH management.

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

    2017-03-01

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

  17. Minimally invasive surgical treatment of malignant pleural effusions.

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

    2011-10-01

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

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

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    Weijun Wang

    2016-01-01

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

  19. Minimally invasive surgical approach to treat posterior urethral diverticulum

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    Ossamah Alsowayan

    2015-01-01

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

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

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

    2009-04-01

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

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

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    ZHANG Yixi

    2015-05-01

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

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

    International Nuclear Information System (INIS)

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

    2014-01-01

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

  3. 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

  4. 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

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

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

    2008-05-01

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

  6. Minimally invasive surgical approaches for temporal lobe epilepsy

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

    2016-01-01

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

  7. Coordinated Multiple Cadaver Use for Minimally Invasive Surgical Training

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

    2007-01-01

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

  8. Minimally invasive orthognathic surgery.

    Science.gov (United States)

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

    2009-02-01

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

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

    Science.gov (United States)

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

    2001-10-01

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

  10. 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.

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

    Science.gov (United States)

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

    2014-03-01

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

  12. Minimally invasive non-surgical lung volume reduction

    International Nuclear Information System (INIS)

    Shen Liming; Zhou Dayong; Shen Junkang

    2006-01-01

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

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

    Science.gov (United States)

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

    2016-03-01

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

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

    Science.gov (United States)

    Vigneswaran, Yalini; Ujiki, Michael B

    2015-01-01

    Peroral endoscopic myotomy (POEM) is an emerging minimally invasive procedure for the treatment of achalasia. Due to the improvements in endoscopic technology and techniques, this procedure allows for submucosal tunneling to safely endoscopically create a myotomy across the hypertensive lower esophageal sphincter. In the hands of skilled operators and experienced centers, the most common complications of this procedure are related to insufflation and accumulation of gas in the chest and abdominal cavities with relatively low risks of devastating complications such as perforation or delayed bleeding. Several centers worldwide have demonstrated the feasibility of this procedure in not only early achalasia but also other indications such as redo myotomy, sigmoid esophagus and spastic esophagus. Short-term outcomes have showed great clinical efficacy comparable to laparoscopic Heller myotomy (LHM). Concerns related to postoperative gastroesophageal reflux remain, however several groups have demonstrated comparable clinical and objective measures of reflux to LHM. Although long-term outcomes are necessary to better understand durability of the procedure, POEM appears to be a promising new procedure. PMID:26468336

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

    Science.gov (United States)

    Shah, Naseem; Logani, Ajay; Kumar, Vijay

    2014-01-01

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

  16. 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.

  17. 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.)

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

    International Nuclear Information System (INIS)

    Hashizume, M.; Yasunaga, T.; Konishi, K.; Tanoue, K.; Ieiri, S.; Kishi, K.; Nakamoto, H.; Ikeda, D.; Sakuma, I.; Fujie, M.; Dohi, T.

    2008-01-01

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

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

    Science.gov (United States)

    Matarasso, Alan; Nikfarjam, Jeremy; Abramowitz, Lauren

    2016-07-01

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

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

    Science.gov (United States)

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

    2012-06-01

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

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

    Science.gov (United States)

    Cassetta, M; Pandolfi, S; Giansanti, M

    2015-07-01

    Accelerating orthodontic tooth movement is a topical issue. Despite the different techniques described in the literature, the corticotomy is the only effective and safe means of accelerating orthodontic tooth movement. Although effective, the corticotomy presents significant postoperative discomfort. The aggressive nature of these particular methods, related to the elevation of mucoperiosteal flaps and to the length of the surgery, has resulted in reluctance to proceed with this technique among both patients and the dental community. To overcome the disadvantages of the corticotomy, this technical note describes an innovative, minimally invasive, flapless procedure combining piezoelectric surgical cortical micro-incisions with the use of a 3D Printed CAD/CAM surgical guide. Copyright © 2015 International Association of Oral and Maxillofacial Surgeons. Published by Elsevier Ltd. All rights reserved.

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

    Directory of Open Access Journals (Sweden)

    Gregor Rečnik

    2015-06-01

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

  3. Diagnosis with near infrared spectroscopy during minimally invasive procedures

    NARCIS (Netherlands)

    R. Nachabé (Rami)

    2012-01-01

    textabstractThe goal of this dissertation is to present the potential of diffuse optical spectroscopy technique to characterize and differentiate types of tissue, including dysplastic and cancerous tissues, when measuring the tissue spectra during a surgical or an interventional procedure under

  4. Minimally invasive surgical treatment options for patients with degenerative lumbar spine disease

    International Nuclear Information System (INIS)

    Durny, P.

    2014-01-01

    The most common cause of reduced activity in working people is degenerative disc disease and spondylosis of lumbar spine. The variety of clinical findings such as segmental lumbago or severe form of mixed radicular compression syndromes can be occurred. Neurosurgical intervention is indicated in case of failure of conservative treatment and graphical findings correlating with a clinical picture. Large decompressive surgical procedures can destabilize segments previously affected. Recommendations from recent years suggested the functional reconstruction of damaged parts of the vertebrae, intervertebral discs and joints. Continuously improving surgical procedures and instrumentations, intended for operative treatment of lumbar spine degenerative diseases is primarily an effort to improve the properties of implants while minimizing tissue damage during the approach to the target structure. To protect functions of active spine stabilizer and paraspinal muscles is an important factor for the final outcome of the operation. Depend on the nature and extent of the disease the approaches to the spine can be an anterior, lateral and posterior as open surgery or minimally invasive procedures. (author)

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

    Science.gov (United States)

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

    2013-01-01

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

  6. One-Year Surgical Outcomes and Quality of Life after Minimally Invasive Sling Procedures for the Treatment of Female Stress Urinary Incontinence: TVT SECUR® vs. CureMesh®

    Science.gov (United States)

    Joo, Young Min; Choe, Jin Ho

    2010-01-01

    Purpose We compared the efficacy and safety of two minimally invasive sling procedures used to treat female stress urinary incontinence (SUI), tension-free vaginal tape (TVT) SECUR® and CureMesh®, and assessed the 1-year surgical outcomes. Materials and Methods Sixty women with SUI were assigned to undergo either the TVT SECUR (n=38) or CureMesh (n=22) procedures between April 2007 and June 2008. Patients were monitored via outpatient visits at 1 month, 3 months, and 1 year after surgery. The efficacy of these procedures was evaluated by the cough test or by a urodynamic study. At these postoperative visits, the patients also completed several questionnaires, including incontinence quality of life, patient's perception of urgency severity, the scored form of the Bristol Female Lower Urinary Tract Symptoms, visual analog scale, and questions about perceived benefit, satisfaction, and willingness to undergo the same operation again. The objective cure rate was defined as no leakage during the cough test with a full bladder. The subjective cure rate was evaluated by self-assessment of goal achievement performed 1 year postoperatively. Results The two groups were similar in preoperative characteristics and urodynamic parameters. The objective cure rates were similar between TVT SECUR and CureMesh (68.4% vs. 77.3%). All respondents reported improvement after surgery. There were no intra-operative complications. Conclusions Our results showed that the TVT SECUR and CureMesh procedures are both safe and simple to perform and have no significant differences in efficacy. Comparative studies with long-term follow-up are warranted to determine the true efficacy of these procedures. PMID:20495697

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

    Science.gov (United States)

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

    2017-09-01

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

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

    Science.gov (United States)

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

    2016-09-01

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

  9. Procedural virtual reality simulation in minimally invasive surgery.

    Science.gov (United States)

    Våpenstad, Cecilie; Buzink, Sonja N

    2013-02-01

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

  10. Decontamination of minimally invasive surgical endoscopes and accessories.

    Science.gov (United States)

    Ayliffe, G

    2000-08-01

    (1) Infections following invasive endoscopy are rare and are usually of endogenous origin. Nevertheless, infections do occur due to inadequate cleaning and disinfection and the use of contaminated rinse water and processing equipment. (2) Rigid and flexible operative endoscopes and accessories should be thoroughly cleaned and preferably sterilized using properly validated processes. (3) Heat tolerant operative endoscopes and accessories should be sterilized using a vacuum assisted steam sterilizer. Use autoclavable instrument trays or containers to protect equipment during transit and processing. Small bench top sterilizers without vacuum assisted air removal are unsuitable for packaged and lumened devices. (4) Heat sensitive rigid and flexible endoscopes and accessories should preferably be sterilized using ethylene oxide, low temperature steam and formaldehyde (rigid only) or gas plasma (if appropriate). (5) If there are insufficient instruments or time to sterilize invasive endoscopes, or if no suitable method is available locally, they may be disinfected by immersion in 2% glutaraldehyde or a suitable alternative. An immersion time of at least 10 min should be adopted for glutaraldehyde. This is sufficient to inactivate most vegetative bacteria and viruses including HIV and hepatitis B virus (HBV). Longer contact times of 20 min or more may be necessary if a mycobacterial infection is known or suspected. At least 3 h immersion in glutaraldehyde is required to kill spores. (6) Glutaraldehyde is irritant and sensitizing to the skin, eyes and respiratory tract. Measures must be taken to ensure glutaraldehyde is used in a safe manner, i.e., total containment and/or extraction of harmful vapour and the provision of suitable personal protective equipment, i.e., gloves, apron and eye protection if splashing could occur. Health surveillance of staff is recommended and should include a pre-employment enquiry regarding asthma, skin and mucosal sensitivity problems and

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

    Science.gov (United States)

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

    2017-01-01

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

  12. Surgical case volume in Canadian urology residency: a comparison of trends in open and minimally invasive surgical experience.

    Science.gov (United States)

    Mamut, Adiel E; Afshar, Kourosh; Mickelson, Jennifer J; Macneily, Andrew E

    2011-06-01

    The application of minimally invasive surgery (MIS) has become increasingly common in urology training programs and clinical practice. Our objective was to review surgical case data from all 12 Canadian residency programs to identify trends in resident exposure to MIS and open procedures. Every year, beginning in 2003, an average of 41 postgraduate year 3 to 5 residents reported surgical case data to a secure internet relational database. Data were anonymized and extracted for the period 2003 to 2009 by measuring a set of 11 predefined index cases that could be performed in both an open and MIS fashion. 16,687 index cases were recorded by a total of 198 residents. As a proportion, there was a significant increase in MIS from 12% in 2003 to 2004 to 32% in 2008 to 2009 (P=0.01). A significant decrease in the proportion of index cases performed with an open approach was also observed from 88% in 2003 to 2004 to 68% in 2008 to 2009 (P=0.01). The majority of these shifts were secondary to the increased application of MIS for nephrectomies of all type (29%-45%), nephroureterectomy (27%-76%), adrenalectomy (15%-71%), and pyeloplasty (17%-54%) (Pfashion during the study period. MIS constitutes an increasingly significant component of surgical volume in Canadian urology residencies with a reciprocal decrease in exposure to open surgery. These trends necessitate ongoing evaluation to maintain the integrity of postgraduate urologic training.

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

    International Nuclear Information System (INIS)

    Miranda Mena, Shirley

    2011-01-01

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

  14. Surgical management of esophageal achalasia: Evolution of an institutional approach to minimally invasive repair.

    Science.gov (United States)

    Petrosyan, Mikael; Khalafallah, Adham M; Guzzetta, Phillip C; Sandler, Anthony D; Darbari, Anil; Kane, Timothy D

    2016-10-01

    Surgical management of esophageal achalasia (EA) in children has transitioned over the past 2 decades to predominantly involve laparoscopic Heller myotomy (LHM) or minimally invasive surgery (MIS). More recently, peroral endoscopic myotomy (POEM) has been utilized to treat achalasia in children. Since the overall experience with surgical management of EA is contingent upon disease incidence and surgeon experience, the aim of this study is to report a single institutional contemporary experience for outcomes of surgical treatment of EA by LHM and POEM, with regards to other comparable series in children. An IRB approved retrospective review of all patients with EA who underwent treatment by a surgical approach at a tertiary US children's hospital from 2006 to 2015. Data including demographics, operative approach, Eckardt scores pre- and postoperatively, complications, outcomes, and follow-up were analyzed. A total of 33 patients underwent 35 operative procedures to treat achalasia. Of these operations; 25 patients underwent laparoscopic Heller myotomy (LHM) with Dor fundoplication; 4 patients underwent LHM alone; 2 patients underwent LHM with Thal fundoplication; 2 patients underwent primary POEM; 2 patients who had had LHM with Dor fundoplication underwent redo LHM with takedown of Dor fundoplication. Intraoperative complications included 2 mucosal perforations (6%), 1 aspiration, 1 pneumothorax (1 POEM patient). Follow ranged from 8months to 7years (8-84months). There were no deaths and no conversions to open operations. Five patients required intervention after surgical treatment of achalasia for recurrent dysphagia including 3 who underwent between 1 and 3 pneumatic dilations; and 2 who had redo LHM with takedown of Dor fundoplication with all patients achieving complete resolution of symptoms. Esophageal achalasia in children occurs at a much lower incidence than in adults as documented by published series describing the surgical treatment in children. We

  15. Technical tips and advancements in pediatric minimally invasive surgical training on porcine based simulations.

    Science.gov (United States)

    Narayanan, Sarath Kumar; Cohen, Ralph Clinton; Shun, Albert

    2014-06-01

    Minimal access techniques have transformed the way pediatric surgery is practiced. Due to various constraints, surgical residency programs have not been able to tutor adequate training skills in the routine setting. The advent of new technology and methods in minimally invasive surgery (MIS), has similarly contributed to the need for systematic skills' training in a safe, simulated environment. To enable the training of the proper technique among pediatric surgery trainees, we have advanced a porcine non-survival model for endoscopic surgery. The technical advancements over the past 3 years and a subjective validation of the porcine model from 114 participating trainees using a standard questionnaire and a 5-point Likert scale have been described here. Mean attitude scores and analysis of variance (ANOVA) were used for statistical analysis of the data. Almost all trainees agreed or strongly agreed that the animal-based model was appropriate (98.35%) and also acknowledged that such workshops provided adequate practical experience before attempting on human subjects (96.6%). Mean attitude score for respondents was 19.08 (SD 3.4, range 4-20). Attitude scores showed no statistical association with years of experience or the level of seniority, indicating a positive attitude among all groups of respondents. Structured porcine-based MIS training should be an integral part of skill acquisition for pediatric surgery trainees and the experience gained can be transferred into clinical practice. We advocate that laparoscopic training should begin in a controlled workshop setting before procedures are attempted on human patients.

  16. Accelerating orthodontic tooth movement: A new, minimally-invasive corticotomy technique using a 3D-printed surgical template

    Science.gov (United States)

    Giansanti, Matteo

    2016-01-01

    Background A reduction in orthodontic treatment time can be attained using corticotomies. The aggressive nature of corticotomy due to the elevation of muco-periosteal flaps and to the duration of the surgery raised reluctance for its employ among patients and dental community. This study aims to provide detailed information on the design and manufacture of a 3D-printed CAD-CAM (computer-aided design and computer-aided manufacturing) surgical guide which can aid the clinician in achieving a minimally-invasive, flapless corticotomy. Material and Methods An impression of dental arches was created; the models were digitally-acquired using a 3D scanner and saved as STereoLithography ( STL ) files. The patient underwent cone beam computed tomography (CBCT): images of jaws and teeth were transformed into 3D models and saved as an STL file. An acrylic template with the design of a surgical guide was manufactured and scanned. The STLs of jaws, scanned casts, and acrylic templates were matched. 3D modeling software allowed the view of the 3D models from different perspectives and planes with perfect rendering. The 3D model of the acrylic template was transformed into a surgical guide with slots designed to guide, at first, a scalpel blade and then a piezoelectric cutting insert. The 3D STL model of the surgical guide was printed. Results This procedure allowed the manufacturing of a 3D-printed CAD/CAM surgical guide, which overcomes the disadvantages of the corticotomy, removing the need for flap elevation. No discomfort, early surgical complications or unexpected events were observed. Conclusions The effectiveness of this minimally-invasive surgical technique can offer the clinician a valid alternative to other methods currently in use. Key words:Corticotomy, orthodontics, CAD/CAM, minimally invasive, surgical template, 3D printer. PMID:27031067

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

    Science.gov (United States)

    Sun, Jingyuan; Yan, Zhiyuan; Du, Zhijiang

    2017-06-01

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

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

    Directory of Open Access Journals (Sweden)

    Korpusenko I.V

    2015-03-01

    Full Text Available Objective of our study was to increase the effectiveness of surgical treatment of bilateral destructive pulmonary tuberculosis complicated by pleural empyema by using VTS-technologies. The study was done in Dnepropetrovsk regional clinical therapeutic and prophylactic association "Phthisiology" in the period from 2008 to 2013. A retrospective analysis of 43 cases of bilateral destructive pulmonary tuberculosis complicated by pleural empyema on one side and dissemination focus or limited destructive process on contralateral side has been performed. Selected cases were divided into 2 groups: main (eighteen cases where the following procedures were done: performed transsternal occlusion of the main bronchus, sanation of empyema cavity using videothoracosopy, in 30-45 days followed by pleuropneumectomy with usage of minithoracothomy and control (nineteen cases who had undergone drainage of the empyema cavity, sanation, in 45-60 days followed by pleuropmeumectomy with usage of anterolateral access. The distribution of main and control groups for analyzed parameters was representative. Sanation of pleural cavity with videothoracosopy usage compared with Bulau’s drainage provides better antibacterial effect, effective sanitation of the pleural cavity as evidenced by following changes: significant decrease in the number of microbial cells; normalization of total white blood cells count and rod-shaped granulocytes in the peripheral blood 10 days after treatment; normalization of leukocyte intoxication index. The use of minimally invasive surgical treatment allowed to reduce intraoperative complications by 2 times, amount of intraoperative blood loss and hemotrasfusions by 1.5 times, postoperative mortality by 2.5 times. Pleural cavity sanation with videothoracoscopy usage with following pneumoectomy leads to reduce in the incidence and severity of postoperative complications. The most promising is stage-by-stage surgical approach with consecutive use

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

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    A. Yu. Drobyshev

    2017-01-01

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

  20. OPEN SURGICAL VS. MINIMALLY INVASIVE TREATMENT OF THORACOLUMBAR AO FRACTURES TYPE A AND B1 IN A REFERENCE HOSPITAL

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    José Enrique Salcedo Oviedo

    Full Text Available ABSTRACT Objective: The thoracolumbar spine trauma represents 30% of spinal diseases. To compare the minimally invasive technique with the open technique in lumbar fractures. Method: A prospective, cross-sectional, comparative observational study, which evaluated the following variables: surgery time, length of hospital stay, transoperative bleeding, postoperative pain, analyzed by SPSS software using Student's t test with statistical significance of p ≥ 0.05, with 24 patients with single-level thoracolumbar fractures, randomly treated with percutaneous pedicle screws and by open technique with a transpedicular system. Results: The surgery time was 90 minutes for the minimally invasive technique and 60 minutes for the open technique, the bleeding was on average 50 cm3 vs. 400 cm3. The mean visual analogue scale for pain at 24 hours of surgery was 5 for the minimally invasive group vs. 8 for the open group. The number of fluoroscopic projections of pedicle screws was 220 in the minimally invasive technique vs. 100 in the traditional technique. Quantified bleeding was minimal for percutaneous access vs. 340 cm3 for the traditional system. The hospital discharge for the minimally invasive group was at 24 hours and at 72 hours for those treated with open surgery. Conclusions: It is a technique that requires longer surgical time, with reports of less bleeding, less postoperative pain and less time for hospital discharge, reasons why it is supposed to be a procedure that requires a learning curve, statistical significance with respect to bleeding, visual analogue scale for pain and showed no significant difference in the variables of surgical time.

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

    Directory of Open Access Journals (Sweden)

    Marcio Aurélio Aita

    2016-02-01

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

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

    Science.gov (United States)

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

    2016-06-01

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

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

    Science.gov (United States)

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

    2011-09-01

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

  4. Is minimally invasive surgical treatment justified for severe acute necrotizing pancreatitis patients with dysfunction of two or more organ systems?

    Science.gov (United States)

    Šileikis, Audrius; Pečiulytė, Emilija; Misenkienė, Agnė; Klimašauskas, Andrius; Beiša, Virgilijus; Strupas, Kęstutis

    2017-09-01

    When minimally invasive therapy was introduced, it became possible to cure some patients without open surgery, or at least delay the operation for longer than a month. To determine the optimal timing to operate on patients with severe acute necrotizing pancreatitis based on the severity of organ insufficiency. A retrospective analysis was performed in all severe acute necrotizing pancreatitis patients treated in Vilnius University Hospital Santaros Klinikos (VUL SK) from 2007 to 2016. The patients were divided into groups based on the number of dysfunctional organ systems (one or more) and whether the minimally invasive step-up approach to treatment was used. The patients with one organ dysfunction had a delay of 35 (without the step-up approach) and 36 (with the step-up approach) days before the open surgery, while the patients with two or more organ systems' dysfunction had almost an identical delay of 28 days, using both surgical treatment methods. The mortality of the patients who had one organ dysfunction and in whom the step-up approach was used was 0%, while in patients without the step-up approach it was 41.7%. In the two or more organ systems' dysfunction group, the mortality for those treated with a step-up approach was 64.3%, and without it 70.7%. The surgical treatment should be initiated with a minimally invasive procedure. Additionally, the surgery on patients with two or more organ systems' dysfunction should not be delayed for more than one month.

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

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    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.

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

    Science.gov (United States)

    Fouilloux, Virginie; Gran, Célia; Kreitmann, Bernard

    2014-10-01

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

  7. Lateral Interbody Fusion for Treatment of Discogenic Low Back Pain: Minimally Invasive Surgical Techniques

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    Luis Marchi

    2012-01-01

    Full Text Available Low back pain is one of the most common ailments in the general population, which tends to increase in severity along with aging. While few patients have severe enough symptoms or underlying pathology to warrant surgical intervention, in those select cases treatment choices remain controversial and reimbursement is a substancial barrier to surgery. The object of this study was to examine outcomes of discogenic back pain without radiculopathy following minimally-invasive lateral interbody fusion. Twenty-two patients were treated at either one or two levels (28 total between L2 and 5. Discectomy and interbody fusion were performed using a minimallyinvasive retroperitoneal lateral transpsoas approach. Clinical and radiographic parameters were analyzed at standard pre- and postoperative intervals up to 24 months. Mean surgical duration was 72.1 minutes. Three patients underwent supplemental percutaneous pedicle screw instrumentation. Four (14.3% stand-alone levels experienced cage subsidence. Pain (VAS and disability (ODI improved markedly postoperatively and were maintained through 24 months. Segmental lordosis increased significantly and fusion was achieved in 93% of levels. In this series, isolated axial low back pain arising from degenerative disc disease was treated with minimally-invasive lateral interbody fusion in significant radiographic and clinical improvements, which were maintained through 24 months.

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

    International Nuclear Information System (INIS)

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

    2004-01-01

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

  9. Minimally Invasive Surgical Staging for Ovarian Carcinoma: A Propensity-Matched Comparison With Traditional Open Surgery.

    Science.gov (United States)

    Ditto, Antonino; Bogani, Giorgio; Martinelli, Fabio; Signorelli, Mauro; Chiappa, Valentina; Scaffa, Cono; Indini, Alice; Leone Roberti Maggiore, Umberto; Lorusso, Domenica; Raspagliesi, Francesco

    2017-01-01

    Growing evidence supports the safety of a laparoscopic approach for patients affected by apparent early-stage ovarian cancer. However, no well-designed studies comparing laparoscopic and open surgical staging are available. In the present investigation we aimed to provide a balanced long-term comparison between these 2 approaches. Retrospective study (Canadian Task Force classification II-2). Tertiary center. Data of consecutive patients affected by early-stage ovarian cancer who had laparoscopic staging were matched 1:1 with a cohort of patients undergoing open surgical staging. The matching was conducted by a propensity-score comparison. Laparoscopic and open surgical staging. Fifty patient pairs (100 patients: 50 undergoing laparoscopic staging vs 50 undergoing open surgical staging) were included. Demographic and baseline oncologic characteristics were balanced between groups (p > .2). We observed that patients undergoing laparoscopic staging experienced longer operative time (207.2 [71.6] minutes vs 180.7 [47.0] minutes; p = .04), lower blood loss (150 [52.7] mL vs 339.8 [225.9] mL; p < .001), and shorter length of hospital stay (4.0 [2.6] days vs 6.1 [1.6] days; p < .001) compared with patients undergoing open surgical staging. No conversion to open surgery occurred. Complication rate was similar between groups. No difference in survival outcomes were observed, after a mean (SD) follow-up of 49.5 (64) and 52.6 (31.7) months after laparoscopic and open surgical staging, respectively. Our findings suggest that the implementation of minimally invasive staging does not influence survival outcomes of patients affected by early-stage ovarian cancer. Laparoscopic staging improved patient outcomes, reducing length of hospital stay. Further large prospective studies are warranted. Copyright © 2016 AAGL. Published by Elsevier Inc. All rights reserved.

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

    Science.gov (United States)

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

    2014-07-01

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

  11. Takotsubo Cardiomyopathy after Spinal Anesthesia for a Minimally Invasive Urologic Procedure

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    Emmanuel Lilitsis

    2017-01-01

    Full Text Available We present the case of a patient who suffered from Takotsubo cardiomyopathy (TCM immediately after the initiation of subarachnoid anesthesia for a minimally invasive urologic procedure (tension-free vaginal tape (TVT surgery for stress urine incontinence. TCM mimics acute coronary syndrome and is caused by an exaggerated sympathetic reaction to significant emotional or physical stress. Our patient suffered from chest pain, palpitations, dyspnea, and hemodynamic instability immediately following subarachnoid anesthesia and later in the postanesthesia care unit. Blood troponin was elevated and new electrocardiographic changes appeared indicative of cardiac ischemia. Cardiac ultrasound indicated left ventricular apical akinesia and ballooning with severely affected contractility. The patient was admitted to coronary intensive care for the proper care and finally was discharged. TCM was attributed to high emotional preoperative stress for which no premedication had been administered to the patient. In conclusion, adequate premedication and anxiety management are not only a measure to alleviate psychological stress of surgical patients, but, more importantly, an imperative mean to suppress sympathetic nerve system response and its cardiovascular consequences.

  12. Guidelines on the facilities required for minor surgical procedures and minimal access interventions.

    LENUS (Irish Health Repository)

    Humphreys, H

    2012-02-01

    There have been many changes in healthcare provision in recent years, including the delivery of some surgical services in primary care or in day surgery centres, which were previously provided by acute hospitals. Developments in the fields of interventional radiology and cardiology have further expanded the range and complexity of procedures undertaken in these settings. In the face of these changes there is a need to define from an infection prevention and control perspective the basic physical requirements for facilities in which such surgical procedures may be carried out. Under the auspices of the Healthcare Infection Society, we have developed the following recommendations for those designing new facilities or upgrading existing facilities. These draw upon best practice, available evidence, other guidelines where appropriate, and expert consensus to provide sensible and feasible advice. An attempt is also made to define minimal access interventions and minor surgical procedures. For minimal access interventions, including interventional radiology, new facilities should be mechanically ventilated to achieve 15 air changes per hour but natural ventilation is satisfactory for minor procedures. All procedures should involve a checklist and operators should be appropriately trained. There is also a need for prospective surveillance to accurately determine the post-procedure infection rate. Finally, there is a requirement for appropriate applied research to develop the evidence base required to support subsequent iterations of this guidance.

  13. Perioperative surgical complications and learning curve associated with minimally invasive transforaminal lumbar interbody fusion: a single-institute experience.

    Science.gov (United States)

    Park, Yung; Lee, Soo Bin; Seok, Sang Ok; Jo, Byung Woo; Ha, Joong Won

    2015-03-01

    As surgical complications tend to occur more frequently in the beginning stages of a surgeon's career, knowledge of perioperative complications is important to perform a safe procedure, especially if the surgeon is a novice. We sought to identify and describe perioperative complications and their management in connection with minimally invasive transforaminal lumbar interbody fusion (TLIF). We performed a retrospective chart review of our first 124 patients who underwent minimally invasive TLIF. The primary outcome measure was adverse events during the perioperative period, including neurovascular injury, implant-related complications, and wound infection. Pseudarthroses and adjacent segment pathologies were not included in this review. Adverse events that were not specifically related to spinal surgery and did not affect recovery were also excluded. Perioperative complications occurred in 9% of patients (11/124); including three cases of temporary postoperative neuralgia, two deep wound infections, two pedicle screw misplacements, two cage migrations, one dural tear, and one grafted bone extrusion. No neurologic deficits were reported. Eight complications occurred in the first one-third of the series and only 3 complications occurred in the last two-thirds of the series. Additional surgeries were performed in 6% of patients (7/124); including four reoperations (two for cage migrations, one for a misplaced screw, and one for an extruded graft bone fragment) and three hardware removals (one for a misplaced screw and two for infected cages). We found perioperative complications occurred more often in the early period of a surgeon's experience with minimally invasive TLIF. Implant-related complications were common and successfully managed by additional surgeries in this series. We suggest greater caution should be exercised to avoid the potential complications, especially when surgeon is a novice to this procedure.

  14. The establishment of enteral nutrition with minimally-invasive interventional procedure under endoscopic or imaging guidance

    International Nuclear Information System (INIS)

    Li Feng; Cheng Yingsheng

    2010-01-01

    For patients unable to get the necessary nutrition orally, a variety of techniques,including surgical way, to make gastrostomy with tube placement have been employed. For recent years, gastrostomy and tube placement with the help of endoscopic guidance or percutaneous interventional management has been developed, which is superior to surgical procedure in minimizing injuries, decreasing cost and reducing complications. In certain clinical situations, both endoscopic method and interventional method can be employed. This paper aims to make a comprehensive review of the indications, techniques and skills, advantages and disadvantages of both the endoscopy-guided and the imaging-guided percutaneous gastrojejunostomy for the establishment of enteral nutrition. (authors)

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

    Directory of Open Access Journals (Sweden)

    Wollina U

    2013-09-01

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

  16. Aging well--the role of minimally invasive aesthetic dermatological procedures in women over 65.

    Science.gov (United States)

    Wollina, Uwe; Payne, Christopher Rowland

    2010-03-01

    The western world is getting older. Aging well has become the new target of preventative medicine. Aesthetic dermatology can contribute to this quest. Females over 65 represent an important and growing group of consumers of cosmetic procedures. In this group, there is a paucity of scientific evaluation of aesthetic procedures. To review the use of minimally invasive procedures for facial rejuvenation in women over 65. Drawing from both the literature and personal experience, the opportunities, modifications, and limitations of minimally invasive techniques for facial rejuvenation in older women are considered. In this older age group, dermal fillers, chemical and laser peels, and nonablative photorejuvenation remain useful and can each be used as stand-alone treatments. In this age group, botulinum toxin (BTX) injections are more often used in combination with other procedures. With respect to aesthetic procedures, women over 65 are different from younger women. More scientific investigation is necessary to better meet needs of this growing part of the population. Available data suggest that aesthetic dermatology can make a major contribution to the complex matter of aging well.

  17. Minimally Invasive Parathyroidectomy

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    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.

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

    Science.gov (United States)

    Berhouma, M; Jacquesson, T; Jouanneau, E

    2014-12-01

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

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

    Science.gov (United States)

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

    2017-05-01

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

  20. Minimally Invasive Surgical Staging in Early-stage Ovarian Carcinoma: A Systematic Review and Meta-analysis.

    Science.gov (United States)

    Bogani, Giorgio; Borghi, Chiara; Leone Roberti Maggiore, Umberto; Ditto, Antonino; Signorelli, Mauro; Martinelli, Fabio; Chiappa, Valentina; Lopez, Carlos; Sabatucci, Ilaria; Scaffa, Cono; Indini, Alice; Ferrero, Simone; Lorusso, Domenica; Raspagliesi, Francesco

    Few studies investigated the efficacy and safety of minimally invasive surgery for the treatment of early-stage epithelial ovarian cancer (eEOC). In this context, we aimed to review the current evidence comparing laparoscopy and the laparotomic approach for staging procedures in eEOC. This systematic review was registered in the International Prospective Register of Systematic Reviews. Overall, 3065 patients were included: 1450 undergoing laparoscopy and 1615 undergoing laparotomic staging. Patients undergoing laparoscopy experienced a longer (but not statistically significant) operative time (weighted mean difference [WMD] = 28.3 minutes; 95% confidence interval [CI], -2.59 to 59.2), a lower estimated blood loss (WMD = -156.5 mL; 95% CI, -216.4 to -96.5), a shorter length of hospital stay (WMD = -3.7 days; 95% CI, -5.2 to -2.1), and a lower postoperative complication rate (odds ratio [OR] = 0.48; 95% CI, 0.29-0.81) than patients undergoing laparotomy. The upstaging (OR = 0.81; 95% CI, 0.55-1.20) and cyst rupture (OR = 1.32; 95% CI, 0.52-3.38) rates were similar between groups. Laparoscopic staging is associated with a shorter time to chemotherapy than laparotomic procedures (WMD = -5.16 days; 95% CI, -8.68 to -1.64). Survival outcomes were not influenced by the route of surgery. Pooled data suggested that the minimally invasive surgical approach is equivalent to laparotomy for the treatment of eEOC and may be superior in terms of perioperative outcomes. However, because of the low level of evidence of the included studies, further randomized trials are warranted. Copyright © 2017 AAGL. Published by Elsevier Inc. All rights reserved.

  1. Minimally invasive mitral valve surgery expands the surgical options for high-risks patients.

    Science.gov (United States)

    Petracek, Michael R; Leacche, Marzia; Solenkova, Natalia; Umakanthan, Ramanan; Ahmad, Rashid M; Ball, Stephen K; Hoff, Steven J; Absi, Tarek S; Balaguer, Jorge M; Byrne, John G

    2011-10-01

    A simplified minimally invasive mitral valve surgery (MIMVS) approach avoiding cross-clamping and cardioplegic myocardial arrest using a small (5 cm) right antero-lateral incision was developed. We hypothesized that, in high-risk patients and in patients with prior sternotomy, this approach would yield superior results compared to those predicted by the Society of Thoracic Surgeons (STS) algorithm for standard median sternotomy mitral valve surgery. Five hundred and four consecutive patients (249 males/255 females), median age 65 years (range 20-92 years) underwent MIMVS between 1/06 and 8/09. Median preoperative New York Heart Association function class was 3 (range 1-4). Eighty-two (16%) patients had an ejection fraction ≤35%. Forty-seven (9%) had a STS predicted mortality ≥10%. Under cold fibrillatory arrest (median temperature 28°C) without aortic cross-clamp, mitral valve repair (224/504, 44%) or replacement (280/504, 56%) was performed. Thirty-day mortality for the entire cohort was 2.2% (11/504). In patients with a STS predicted mortality ≥ 10% (range 10%-67%), the observed 30-day mortality was 4% (2/47), lower than the mean STS predicted mortality of 20%. Morbidity in this high-risk group was equally low: 1 of 47 (2%) patients underwent reexploration for bleeding, 1 of 47 (2%) patients suffered a permanent neurologic deficit, none had wound infection. The median length of stay was 8 days (range 1-68 days). This study demonstrates that MIMVS without aortic cross-clamp is reproducible with low mortality and morbidity rates. This approach expands the surgical options for high-risk patients and yields to superior results than the conventional median sternotomy approach.

  2. Primary hyperparathyroidism surgical management since the introduction of minimally invasive parathyroidectomy: Mayo Clinic experience.

    Science.gov (United States)

    Grant, Clive S; Thompson, Geoffrey; Farley, David; van Heerden, Jon

    2005-05-01

    Minimally invasive parathyroidectomy (MIP) for primary hyperparathyroidism (HPT) has equal cure and recurrence rates as standard cervical exploration. Changes in the management of primary HPT have occurred since introducing MIP including localization, anesthesia, intraoperative parathyroid hormone monitoring, and indications for parathyroidectomy. Cohort analysis of 1361 consecutive patients with primary HPT operated on at the Mayo Clinic, Rochester, Minn, from June 1998 through March 2004. Mean follow-up, 25 months. Tertiary referral center. One thousand three hundred sixty-one patients operated on for primary HPT, excluding 160 patients who were reoperated on. Standard cervical exploration MIP. Cure, recurrence, localization, anesthesia, hospitalization, intraoperative parathyroid hormone level monitoring, contraindications to MIP, surgical indications, assessment of osteoporosis and osteopenia, postoperative patient assessment of general patient health, and operative satisfaction. Cure of primary HPT for both conventional exploration and MIP was 97%; only 1 patient who underwent MIP had a potential recurrence. Imaging sensitivity and positive predictive values were as follows: sestamibi scintigraphy, 86% and 93%; ultrasonography, 61% and 87%, respectively. Usage of general vs local anesthesia with intravenous sedation was 46% and 49%, respectively, in patients w ho underwent MIP; 46% were dismissed as outpatients, 49% had single-night stays. The accuracy of intraoperative parathyroid hormone level monitoring was as follows: 98% (8% had true-negative results); the frequency of multiple gland disease was 13%. Accounting for causes precluding MIP, an estimated 60% to 70% of all patients would be eligible for MIP. By preoperative assessment, 79% had osteoporosis-osteopenia; 58% with postoperative bone mineral density measurements were improved. More than 85% were satisfied with the results of their operation. With high-quality localization and intraoperative

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

    LENUS (Irish Health Repository)

    McDermott, F D

    2014-01-01

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

  4. TVT versus TVT-O for minimally invasive surgical correction of stress urinary incontinence

    OpenAIRE

    Sola, Vicente; Pardo, Jack; Ricci, Paolo; Guiloff, Enrique; Chiang, Humberto

    2007-01-01

    OBJECTIVE: The present work describes our experience in surgical correction of stress urinary incontinence, comparing both the TVT and the TVT-O techniques. METHOD: Between October 2001 and March 2004, 76 patients underwent the TVT procedure. Between January 2004 and January 2005, 98 surgical corrections of urinary incontinence were carried out using the TVT-O technique. RESULTS: Median operative time was 28 minutes for TVT and 7 minutes for TVT-O. Intraoperative complications for TVT occurre...

  5. Motivations for seeking minimally invasive cosmetic procedures in an academic outpatient setting.

    Science.gov (United States)

    Sobanko, Joseph F; Taglienti, Anthony J; Wilson, Anthony J; Sarwer, David B; Margolis, David J; Dai, Julia; Percec, Ivona

    2015-11-01

    The demand for minimally invasive cosmetic procedures has continued to rise, yet few studies have examined this patient population. This study sought to define the demographics, social characteristics, and motivations of patients seeking minimally invasive facial cosmetic procedures. A prospective, single-institution cohort study of 72 patients was conducted from 2011 through 2014 at an urban academic medical center. Patients were aged 25 through 70 years; presented for botulinum toxin or soft tissue filler injections; and completed demographic, informational, and psychometric questionnaires before treatment. Descriptive statistics were conducted using Stata statistical software. The average patient was 47.8 years old, was married, had children, was employed, possessed a college or advanced degree, and reported an above-average income. Most patients felt that the first signs of aging occurred around their eyes (74.6%), and a similar percentage expressed this area was the site most desired for rejuvenation. Almost one-third of patients experienced a "major life event" within the preceding year, nearly half had sought prior counseling from a mental health specialist, and 23.6% were being actively prescribed psychiatric medication at the time of treatment. Patients undergoing injectable aesthetic treatments in an urban outpatient academic center were mostly employed, highly educated, affluent women who believed that their procedure would positively impact their appearance. A significant minority experienced a major life event within the past year, which an astute clinician should address during the initial patient consultation. This study helps to better understand the psychosocial factors characterizing this patient population. 4 Therapeutic. © 2015 The American Society for Aesthetic Plastic Surgery, Inc. Reprints and permission: journals.permissions@oup.com.

  6. 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.

  7. Surgeon-tool force/torque signatures--evaluation of surgical skills in minimally invasive surgery.

    Science.gov (United States)

    Rosen, J; MacFarlane, M; Richards, C; Hannaford, B; Sinanan, M

    1999-01-01

    The best method of training for laparoscopic surgical skills is controversial. Some advocate observation in the operating room, while others promote animal and simulated models or a combination of surgical related tasks. The mode of proficiency evaluation common to all of these methods has been subjective evaluation by a skilled surgeon. In order to define an objective means of evaluating performance, an instrumented laparoscopic grasper was developed measuring the force/torque at the surgeon hand/tool interface. The measured database demonstrated substantial differences between experienced and novice surgeon groups. Analyzing forces and torques combined with the state transition during surgical procedures allows an objective measurement of skill in MIS. Teaching the novice surgeon to limit excessive loads and improve movement efficiency during surgical procedures can potentially result in less injury to soft tissues and less wasted time during laparoscopic surgery. Moreover the force/torque database measured in this study may be used for developing realistic virtual reality simulators and optimization of medical robots performance.

  8. Outcome of the TURP-TUVP sandwich procedure for minimally invasive surgical treatment of benign prostatic hyperplasia with volume larger than 40cc over a 4-year period in Nigeria

    Directory of Open Access Journals (Sweden)

    O.I. Aisuodionoe-Shadrach

    2013-03-01

    Conclusions: The sandwich combination of TURP and TUVP for the surgical treatment of BPH with volume larger than 40cc had satisfactory patient safety profile and resulted in significant improvement in IPSS, Qmax and PVR on follow-up at 3 months.

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

    Directory of Open Access Journals (Sweden)

    María Mercedes López

    2016-02-01

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

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

    Science.gov (United States)

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

    2017-10-01

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

  11. 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.

  12. TVT versus TVT-O for minimally invasive surgical correction of stress urinary incontinence

    Directory of Open Access Journals (Sweden)

    Vicente Sola

    2007-04-01

    Full Text Available OBJECTIVE: The present work describes our experience in surgical correction of stress urinary incontinence, comparing both the TVT and the TVT-O techniques. METHOD: Between October 2001 and March 2004, 76 patients underwent the TVT procedure. Between January 2004 and January 2005, 98 surgical corrections of urinary incontinence were carried out using the TVT-O technique. RESULTS: Median operative time was 28 minutes for TVT and 7 minutes for TVT-O. Intraoperative complications for TVT occurred in 4 patients (6.6%: urinary bladder perforation in 3 patients (5%, p = 0.0228 and parietal peritoneum perforation in 1 case (1.6%. No intraoperative complications took place during TVT-O. Immediate postoperative complications: transient urinary retention in TVT, 2 cases (2.6% and overcorrection in TVT-O (1% which was readjusted within 24 hours. There were no late complications after TVT. There were 2 cases (2.04% with late complications in TVT-O. TVT and TVT-O resulted in correction of incontinence in 100% of the patients. CONCLUSION: TVT and TVT-O are two effective techniques for the correction of stress urinary incontinence. TVT-O would seem to be a technique much easier to perform resulting in less intraoperative complications.

  13. Surgical Value of Elective Minimally Invasive Gallbladder Removal: A Cost Analysis of Traditional 4-Port vs Single-Incision and Robotically Assisted Cholecystectomy.

    Science.gov (United States)

    Newman, Richard M; Umer, Affan; Bozzuto, Bethany J; Dilungo, Jennifer L; Ellner, Scott

    2016-03-01

    As the cost of health care is subjected to increasingly greater scrutiny, the assessment of new technologies must include the surgical value (SV) of the procedure. Surgical value is defined as outcome divided by cost. The cost and outcome of 50 consecutive traditional (4-port) laparoscopic cholecystectomies (TLC) were compared with 50 consecutive, nontraditional laparoscopic cholecystectomies (NTLC), between October 2012 and February 2014. The NTLC included SILS (n = 11), and robotically assisted single-incision cholecystectomies (ROBOSILS; n = 39). Our primary outcomes included minimally invasive gallbladder removal and same-day discharge. Thirty-day emergency department visits or readmissions were evaluated as a secondary outcome. The direct variable surgeon costs (DVSC) were distilled from our hospital cost accounting system and calculated on a per-case, per item basis. The average DVSC for TLC was $929 and was significantly lower than NTLC at $2,344 (p day discharge. There were no differences observed in secondary outcomes in 30-day emergency department visits (TLC [2%] vs NTLC [6%], p = 0.61) or readmissions (TLC [4%] vs NTLC [2%], p > 0.05), respectively. The relative SV was significantly higher for TLC (1) compared with NTLC (0.34) (p < 0.05), and SILS (0.66) and ROBOSILS (0.36) (p < 0.05). Nontraditional, minimally invasive gallbladder removal (SILS and ROBOSILS) offers significantly less surgical value for elective, outpatient gallbladder removal. Copyright © 2016 American College of Surgeons. Published by Elsevier Inc. All rights reserved.

  14. Micro-invasive glaucoma surgery (MIGS: a review of surgical procedures using stents

    Directory of Open Access Journals (Sweden)

    Pillunat LE

    2017-08-01

    Full Text Available Lutz E Pillunat,1 Carl Erb,2 Anselm GM Jünemann,3 Friedemann Kimmich4 1Department of Ophthalmology, University Hospital Carl Gustav Carus, Dresden, 2Augenklinik am Wittenbergplatz, Berlin, Germany; 3Department of Ophthalmology University of Rostock, Rostock, Germany; 4eyecons, Karlsruhe, Germany Abstract: Over the last decade several novel surgical treatment options and devices for glaucoma have been developed. All these developments aim to cause as little trauma as possible to the eye, to safely, effectively, and sustainably reduce intraocular pressure (IOP, to produce reproducible results, and to be easy to adopt. The term “micro-invasive glaucoma surgery (MIGS” was used for summarizing all these procedures. Currently MIGS is gaining more and more interest and popularity. The possible reduction of the number of glaucoma medications, the ab interno approach without damaging the conjunctival tissue, and the probably safer procedures compared to incisional surgical methods may explain the increased interest in MIGS. The use of glaucoma drainage implants for lowering IOP in difficult-to-treat patients has been established for a long time, however, a variety of new glaucoma micro-stents are being manufactured by using various materials and are available to increase aqueous outflow via different pathways. This review summarizes published results of randomized clinical studies and extensive case report series on these devices, including Schlemm’s canal stents (iStent®, iStent® inject, Hydrus, suprachoroidal stents (CyPass®, iStent® Supra, and subconjunctival stents (XEN. The article summarizes the findings of published material on efficacy and safety for each of these approaches. Keywords: glaucoma, micro-invasive glaucoma surgery, MIGS, iStent, iStent inject, CyPass, Hydrus, XEN

  15. Minimally invasive surgical approaches offer earlier time to adjuvant chemotherapy but not improved survival in resected pancreatic cancer.

    Science.gov (United States)

    Mirkin, Katelin A; Greenleaf, Erin K; Hollenbeak, Christopher S; Wong, Joyce

    2018-05-01

    Pancreatic surgery encompasses complex operations with significant potential morbidity. Greater experience in minimally invasive surgery (MIS) has allowed resections to be performed laparoscopically and robotically. This study evaluates the impact of surgical approach in resected pancreatic cancer. The National Cancer Data Base (2010-2012) was reviewed for patients with stages 1-3 resected pancreatic carcinoma. Open approaches were compared to MIS. A sub-analysis was then performed comparing robotic and laparoscopic approaches. Of the 9047 patients evaluated, surgical approach was open in 7511 (83%), laparoscopic in 992 (11%), and robotic in 131 (1%). The laparoscopic and robotic conversion rate to open was 28% (n = 387) and 17% (n = 26), respectively. Compared to open, MIS was associated with more distal resections (13.5, 24.3%, respectively, p offered significantly shorter LOS in all types. Multivariate analysis demonstrated no survival benefit for any MIS approach relative to open (all, p > 0.05). When adjusted for patient, disease, and treatment characteristics, TTC was not an independent prognostic factor (HR 1.09, p = 0.084). MIS appears to offer comparable surgical oncologic benefit with improved LOS and shorter TTC. This effect, however, was not associated with improved survival.

  16. Prospective Cohort Study Investigating Changes in Body Image, Quality of Life, and Self-Esteem Following Minimally Invasive Cosmetic Procedures.

    Science.gov (United States)

    Sobanko, Joseph F; Dai, Julia; Gelfand, Joel M; Sarwer, David B; Percec, Ivona

    2018-04-13

    Minimally invasive cosmetic injectable procedures are increasingly common. However, a few studies have investigated changes in psychosocial functioning following these treatments. To assess changes in body image, quality of life, and self-esteem following cosmetic injectable treatment with soft tissue fillers and neuromodulators. Open, prospective study of 75 patients undergoing cosmetic injectable procedures for facial aging to evaluate changes in psychosocial functioning within 6 weeks of treatment. Outcome measures included the Derriford appearance scale (DAS-24), body image quality of life inventory (BIQLI), and the Rosenberg self-esteem scale. Body image dissatisfaction, as assessed by the DAS-24, improved significantly 6 weeks after the treatment. Body image quality of life, as assessed by the BIQLI, improved, but the change did not reach statistical significance. Self-esteem was unchanged after the treatment. Minimally invasive cosmetic injectable procedures were associated with reductions in body image dissatisfaction. Future research, using recently developed cosmetic surgery-specific instruments, may provide further insight into the psychosocial benefits of minimally invasive procedures.

  17. Predictors of Outcome in Conservative and Minimally Invasive Surgical Management of Pain Originating From the Sacroiliac Joint

    Science.gov (United States)

    Dengler, Julius; Duhon, Bradley; Whang, Peter; Frank, Clay; Glaser, John; Sturesson, Bengt; Garfin, Steven; Cher, Daniel; Rendahl, Aaron; Polly, David

    2017-01-01

    Study Design. A pooled patient-level analysis of two multicenter randomized controlled trials and one multicenter single-arm prospective trial. Objective. The aim of this study was to identify predictors of outcome of conservative and minimally invasive surgical management of pain originating from the sacroiliac joint (SIJ). Summary of Background Data. Three recently published prospective trials have shown that minimally invasive SIJ fusion (SIJF) using triangular titanium implants produces better outcomes than conservative management for patients with pain originating from the SIJ. Due to limitations in individual trial sample size, analyses of predictors of treatment outcome were not conducted. Methods. We pooled individual patient data from the three trials and used random effects models with multivariate regression analysis to identify predictors for treatment outcome separately for conservative and minimally invasive surgical treatment. Outcome was measured using visual analogue scale (VAS), Oswestry Disability Index (ODI), and EuroQOL-5D (EQ-5D). Results. We included 423 patients assigned to either nonsurgical management (NSM, n = 97) or SIJF (n = 326) between 2013 and 2015. The reduction in SIJ pain was 37.9 points larger [95% confidence interval (95% CI) 32.5–43.4, P < 0.0001] in the SIJF group than in the NSM group. Similarly, the improvement in ODI was 18.3 points larger (95% CI 14.3–22.4), P < 0.0001). In NSM, we found no predictors of outcome. In SIJF, a reduced improvement in outcome was predicted by smoking (P = 0.030), opioid use (P = 0.017), lower patient age (P = 0.008), and lower duration of SIJ pain (P = 0.028). Conclusions. Our results support the view that SIJF leads to better treatment outcome than conservative management of SIJ pain and that a higher margin of improvement can be predicted in nonsmokers, nonopioid users, and patients of increased age and with longer pain duration. Level of Evidence: 1 PMID

  18. Robotics as a new surgical minimally invasive approach to treatment of endometriosis: a systematic review.

    Science.gov (United States)

    Carvalho, Luiz; Abrão, Mauricio Simões; Deshpande, Abhishek; Falcone, Tommaso

    2012-06-01

    This systematic review evaluates the role of robotics in the surgical treatment of endometriosis. Electronic database searches were conducted in MEDLINE, Scopus, and ISI Web of Knowledge for relevant studies over the past 10 years. Four published articles were found that used robotic assisted laparoscopy to perform endometriosis surgery. All four studies used the da Vinci Surgical System (Intuitive Surgical Inc., Sunnyvale, CA, USA). Three studies were case reports, and one was a cohort study. Robotics appears to be as effective as conventional laparoscopy in the management of endometriosis. There were no reports of any major complications. Few studies have been published and show us that robotic endometriosis surgery is feasible even in severe endometriosis cases without conversion. There is a lack of long-term outcome papers in the literature. Randomized controlled trials are necessary. Copyright © 2011 John Wiley & Sons, Ltd.

  19. Manual Control for Medical Instruments in Minimally Invasive Surgery

    NARCIS (Netherlands)

    Fan, C.

    2014-01-01

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

  20. Minimally invasive splenectomy: an update and review

    Science.gov (United States)

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

    2013-01-01

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

  1. Minimally invasive distal pancreatectomy

    NARCIS (Netherlands)

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

    2017-01-01

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

  2. Qualification guideline of the German X-ray association (DRG) und the German association for interventional radiology and minimal invasive therapy (DeGIR) for the performance of interventional-radiological minimal invasive procedures on arteries and veins

    International Nuclear Information System (INIS)

    Buecker, A.; Gross-Fengels, W.; Haage, P.; Huppert, P.; Landwehr, P.; Loose, R.; Reimer, P.; Tacke, J.; Vorwerk, D.; Fischer, J.

    2012-01-01

    The topics covered in the qualification guideline of the German X-ray association (DRG) und the German association for interventional radiology and minimal invasive therapy (DeGIR) for the performance of interventional-radiological minimal invasive procedures on arteries and veins are the following: Practical qualification: aorta iliac vessels and vessels in the upper and lower extremities, kidney and visceral arteries, head and neck arteries, dialysis shunts, veins and pulmonary arteries, aorta aneurysms and peripheral artery aneurysms. Knowledge acquisition concerning radiation protection: legal fundamentals, education and training, knowledge actualization and quality control, definition of the user and the procedure, competence preservation.

  3. The effect of minimally invasive surgical repair on the lung volumes of patients with pectus excavatum.

    Science.gov (United States)

    Sengul, Aysen Taslak; Sahin, Bunyamin; Celenk, Cetin; Basoglu, Ahmet; Sengul, Bilal

    2014-04-01

    To assess the increase in lung volume after Nuss surgery in patients with pectus excavatum (PE) by using stereological methods and to evaluate the correlation between the lung volume and spirometry findings. Twenty patients, treated for PE between 2008 and 2010, were evaluated prospectively. They underwent preoperative chest radiography, computed thorax tomography (CTT), and spirometry. Thereafter, the Haller index was calculated for each patient. In the third postoperative month, CTT and spirometry were repeated.Lung volumes and volume fractions were evaluated using CTT images, applying the Cavalieri principle for stereological methods. Then the correlation between the pre- and postoperative values of the lung volumes with spirometry findings was determined. Volumes of the right and left lungs were calculated stereologically, using CTT images. Postoperative volume increase of ∼417.6 ± 747.6 mL was detected. The maximum volume increase was observed in the left lung. In the postoperative period, the total volume increase and the volume increase detected in the left lung were found to be statistically significant (p volume in 1 second, and forced expiratory flow 25 to 75% were 0.67, 0.68, and 0.61, respectively; the postoperative r figures were 0.43, 0.42, and 0.35, respectively. Although there was a strong correlation between the preoperative lung volume and spirometry findings (p volume and spirometry findings (p > 0.05). Postoperative pulmonary volume increase occurs in patients with PE after Nuss surgery. However, postoperative spirometry findings may not reflect morphological improvement because pain restricts thoracic movements. Therefore, in patients with PE, quantitative evaluation of the results of surgical repair is possible using the CTT images through a combination of stereological methods. Georg Thieme Verlag KG Stuttgart · New York.

  4. AQUACEL® Ag Surgical Dressing Reduces Surgical Site Infection and Improves Patient Satisfaction in Minimally Invasive Total Knee Arthroplasty: A Prospective, Randomized, Controlled Study

    Directory of Open Access Journals (Sweden)

    Feng-Chih Kuo

    2017-01-01

    Full Text Available The use of modern surgical dressings to prevent wound complications and surgical site infection (SSI after minimally invasive total knee arthroplasty (MIS-TKA is lacking. In a prospective, randomized, controlled study, 240 patients were randomized to receive either AQUACEL Ag Surgical dressing (study group or a standard dressing (control group after MIS-TKA. The primary outcome was wound complication (SSI and blister. The secondary outcomes were wear time and number of dressing changes in the hospital and patient satisfaction (pain, comfort, and ease of use. In the intention-to-treat analysis, there was a significant reduction in the incidence of superficial SSI (0.8%, 95% CI∶ 0.00–2.48 in the study group compared to 8.3% (95% CI∶ 3.32–13.3 in the control group (p=0.01. There were no differences in blister and deep/organ-space SSIs between the two groups. Multivariate analysis revealed that AQUACEL Ag Surgical dressing was an independent risk factor for reduction of SSI (odds ratio: 0.07, 95% CI: 0.01–0.58, p=0.01. The study group had longer wear time (5.2±0.7 versus 1.7±0.4 days, p<0.0001 and lower number of dressing changes (1.0±0.2 versus 3.6±1.3 times, p<0.0001. Increased patient satisfaction (p<0.0001 was also noted in the study group. AQUACEL Ag Surgical dressing is an ideal dressing to provide wound care efficacy, patient satisfaction, reduction of SSI, and cost-effectiveness following MIS-TKA.

  5. Modifying gummy smile: a minimally invasive approach.

    Science.gov (United States)

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

    2014-11-01

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

  6. Comparison of open reduction versus minimally invasive surgical approaches on screw position in canine sacroiliac lag-screw fixation.

    Science.gov (United States)

    Déjardin, Loïc M; Marturello, Danielle M; Guiot, Laurent P; Guillou, Reunan P; DeCamp, Charles E

    2016-07-19

    To compare accuracy and consistency of sacral screw placement in canine pelves treated for sacroiliac luxation with open reduction and internal fixation (ORIF) or minimally invasive osteosynthesis (MIO) techniques. Unilateral sacroiliac luxations created experimentally in canine cadavers were stabilized with an iliosacral lag screw applied via ORIF or MIO techniques (n = 10/group). Dorsoventral and craniocaudal screw angles were measured using computed tomography multiplanar reconstructions in transverse and dorsal planes, respectively. Ratios between pilot hole length and sacral width (PL/SW-R) were obtained. Data between groups were compared statistically (p sacroiliac luxations provides more accurate and consistent sacral screw placement than ORIF. With proper techniques, iatrogenic neurological damage can be avoided with both techniques. The PL /SW-R, which relates to safe screw fixation, also demonstrates that screw penetration of at least 60% of the sacral width is achievable regardless of surgical approach. These findings, along with the limited dissection needed for accurate sacral screw placement, suggest that MIO of sacroiliac luxations is a valid alternative to ORIF.

  7. [Minimally invasive coronary artery surgery].

    Science.gov (United States)

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

    1999-01-01

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

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

    Science.gov (United States)

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

    2013-09-01

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

  9. Surgical data and early postoperative outcomes after minimally invasive lumbar interbody fusion: results of a prospective, multicenter, observational data-monitored study.

    Directory of Open Access Journals (Sweden)

    Paulo Pereira

    Full Text Available Minimally invasive lumbar interbody fusion (MILIF offers potential for reduced operative morbidity and earlier recovery compared with open procedures for patients with degenerative lumbar disorders (DLD. Firm conclusions about advantages of MILIF over open procedures cannot be made because of limited number of large studies of MILIF in a real-world setting. Clinical effectiveness of MILIF in a large, unselected real-world patient population was assessed in this Prospective, monitored, international, multicenter, observational study.To observe and document short-term recovery after minimally invasive interbody fusion for DLD.In a predefined 4-week analysis from this study, experienced surgeons (≥ 30 MILIF surgeries pre-study treated patients with DLD by one- or two-level MILIF. The primary study objective was to document patients' short-term post-interventional recovery (primary objective including back/leg pain (visual analog scale [VAS], disability (Oswestry Disability Index [ODI], health status (EQ-5D and Patient satisfaction.At 4 weeks, 249 of 252 patients were remaining in the study; the majority received one-level MILIF (83% and TLIF was the preferred approach (94.8%. For one-level (and two-level procedures, surgery duration was 128 (182 min, fluoroscopy time 115 (154 sec, and blood-loss 164 (233 mL. Time to first ambulation was 1.3 days and time to study-defined surgery recovery was 3.2 days. Patients reported significantly (P < 0.0001 reduced back pain (VAS: 2.9 vs 6.2, leg pain (VAS: 2.5 vs 5.9, and disability (ODI: 34.5% vs 45.5%, and a significantly (P < 0.0001 improved health status (EQ-5D index: 0.61 vs 0.34; EQ VAS: 65.4 vs 52.9 4 weeks postoperatively. One adverse event was classified as related to the minimally invasive surgical approach. No deep site infections or deaths were reported.For experienced surgeons, MILIF for DLD demonstrated early benefits (short time to first ambulation, early recovery, high patient satisfaction

  10. Minimally invasive surgical technique: Percutaneous external fixation combined with titanium elastic nails for selective treatment of tibial fractures.

    Science.gov (United States)

    Tu, Kai-Kai; Zhou, Xian-Ting; Tao, Zhou-Shan; Chen, Wei-Kai; Huang, Zheng-Liang; Sun, Tao; Zhou, Qiang; Yang, Lei

    2015-12-01

    Several techniques have been described to treat tibial fractures, which respectively remains defects. This article presents a novel intra- and extramedullary fixation technique: percutaneous external fixator combined with titanium elastic nails (EF-TENs system). The purpose of this study is to introduce this new minimally invasive surgical technique and selective treatment of tibial fractures, particularly in segmental fractures, diaphysis fractures accompanied with distal or proximal bone subfissure, or fractures with poor soft-tissue problems. Following ethical approval, thirty-two patients with tibial fractures were treated by the EF-TENs system between January 2010 and December 2012. The follow-up studies included clinical and radiographic examinations. All relevant outcomes were recorded during follow-up. All thirty-two patients were achieved follow-ups. According to the AO classification, 3 Type A, 9 Type B and 20 Type C fractures were included respectively. According to the Anderson-Gustilo classification, there were 5 Type Grade II, 3 Type Grade IIIA and 2 Type Grade IIIB. Among 32 patients, 8 of them were segmental fractures. 12 fractures accompanied with bone subfissure. Results showed no nonunion case, with an average time of 23.7 weeks (range, 14-32 weeks). Among them, there were 3/32 delayed union patients and 0/32 malunion case. 4/32 patients developed a pin track infection and no patient suffered deep infection. The external fixator was removed with a mean time of 16.7 weeks (range, 10-26 weeks). Moreover, only 1/32 patient suffered with the restricted ROM of ankle, none with the restricted ROM of knee. This preliminary study indicated that the EF-TENs system, as a novel intra- and extramedullary fixation technique, had substantial effects on selective treatment of tibial fractures. Copyright © 2015 Elsevier Ltd. All rights reserved.

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

    Science.gov (United States)

    Ding, Liang; Sun, Taicun; Huang, Yonghui

    2010-01-01

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

  12. 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.

  13. Minimally Invasive Surgery in Thymic Malignances

    Directory of Open Access Journals (Sweden)

    Wentao FANG

    2018-04-01

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

  14. Minimally Invasive Catheter Procedures to Assist Complicated Pacemaker Lead Extraction and Implantation in the Operating Room

    International Nuclear Information System (INIS)

    Kröpil, Patric; Lanzman, Rotem S.; Miese, Falk R.; Blondin, Dirk; Winter, Joachim; Scherer, Axel; Fürst, Günter

    2011-01-01

    We report on percutaneous catheter procedures in the operating room (OR) to assist complicated manual extraction or insertion of pacemaker (PM) and implantable cardioverter defibrillator leads. We retrospectively reviewed complicated PM revisions and implantations performed between 2004 and 2009 that required percutaneous catheter procedures performed in the OR. The type of interventional procedure, catheter and retrieval system used, venous access, success rates, and procedural complications were analyzed. In 41 (12 female and 29 male [mean age 62 ± 17 years]) of 3021 (1.4%) patients, standard manual retrieval of old leads or insertion of new leads was not achievable and thus required percutaneous catheter intervention for retrieval of misplaced leads and/or recanalisation of occluded central veins. Thirteen of 18 (72.2%) catheter-guided retrieval procedures for misplaced (right atrium [RA] or ventricle [RV; n = 3], superior vena cava [n = 2], brachiocephalic vein [n = 5], and subclavian vein [n = 3]) lead fragments in 16 patients were successful. Percutaneous catheter retrieval failed in five patients because there were extremely fixed or adhered lead fragments. Percutaneous transluminal angiography (PTA) of central veins for occlusion or high-grade stenosis was performed in 25 patients. In 22 of 25 patients (88%), recanalization of central veins was successful, thus enabling subsequent lead replacement. Major periprocedural complications were not observed. In the case of complicated manual PM lead implantation or revision, percutaneous catheter-guided extraction of misplaced lead fragments or recanalisation of central veins can be performed safely in the OR, thus enabling subsequent implantation or revision of PM systems in the majority of patients.

  15. 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.

  16. Smartphone-assisted minimally invasive neurosurgery.

    Science.gov (United States)

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

    2018-03-13

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

  17. Ligation of the intersphincteric fistula tract (LIFT): a minimally invasive procedure for complex anal fistula: two-year results of a prospective multicentric study.

    Science.gov (United States)

    Sileri, Pierpaolo; Giarratano, Gabriella; Franceschilli, Luana; Limura, Elsa; Perrone, Federico; Stazi, Alessandro; Toscana, Claudio; Gaspari, Achille Lucio

    2014-10-01

    The surgical management of anal fistulas is still a matter of discussion and no clear recommendations exist. The present study analyses the results of the ligation of the intersphincteric fistula tract (LIFT) technique in treating complex anal fistulas, in particular healing, fecal continence, and recurrence. Between October 2010 and February 2012, a total of 26 consecutive patients underwent LIFT. All patients had a primary complex anal fistula and preoperatively all underwent clinical examination, proctoscopy, transanal ultrasonography/magnetic resonance imaging, and were treated with the LIFT procedure. For the purpose of this study, fistulas were classified as complex if any of the following conditions were present: tract crossing more than 30% of the external sphincter, anterior fistula in a woman, recurrent fistula, or preexisting incontinence. Patient's postoperative complications, healing time, recurrence rate, and postoperative continence were recorded during follow-up. The minimum follow-up was 16 months. Five patients required delayed LIFT after previous seton. There were no surgical complications. Primary healing was achieved in 19 patients (73%). Seven patients (27%) had recurrence presenting between 4 and 8 weeks postoperatively and required further surgical treatment. Two of them (29%) had previous insertion of a seton. No patients reported any incontinence postoperatively and we did not observe postoperative continence worsening. In our experience, LIFT appears easy to perform, is safe with no surgical complication, has no risk of incontinence, and has a low recurrence rate. These results suggest that LIFT as a minimally invasive technique should be routinely considered for patients affected by complex anal fistula. © The Author(s) 2013.

  18. Robotic assisted surgery in pediatric gynecology: promising innovation in mini invasive surgical procedures.

    Science.gov (United States)

    Nakib, Ghassan; Calcaterra, Valeria; Scorletti, Federico; Romano, Piero; Goruppi, Ilaria; Mencherini, Simonetta; Avolio, Luigi; Pelizzo, Gloria

    2013-02-01

    Robotic assisted surgery is not yet widely applied in the pediatric field. We report our initial experience regarding the feasibility, safety, benefits, and limitations of robot-assisted surgery in pediatric gynecological patients. Descriptive, retrospective report of experience with pediatric gynecological patients over a period of 12 months. Department of Pediatric Surgery, IRCCS Policlinico San Matteo Foundation. Children and adolescents, with a surgical diagnosis of ovarian and/or tubal lesions. Robot assembly time and operative time, days of hospitalization, time to cessation of pain medication, complication rate, conversion rate to laparoscopic procedure and trocar insertion strategy. Six children and adolescents (2.4-15 yrs), weighing 12-55 kg, underwent robotic assisted surgery for adnexal pathologies: 2 for ovarian cystectomy, 2 for oophorectomy, 1 for right oophorectomy and left salpingo-oophorectomy for gonadal disgenesis, 1 for exploration for suspected pelvic malformation. Mean operative time was 117.5 ± 34.9 minutes. Conversion to laparatomy was not necessary in any of the cases. No intra- or postoperative complications occurred. Initial results indicate that robotic assisted surgery is safely applicable in the pediatric gynecological population, although it is still premature to conclude that it provides better clinical outcomes than traditional laparoscopic surgery. Randomized, prospective, comparative studies will help characterize the advantages and disadvantages of this new technology in pediatric patients. Copyright © 2013 North American Society for Pediatric and Adolescent Gynecology. Published by Elsevier Inc. All rights reserved.

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

    Science.gov (United States)

    Kaye, Ian David; Passias, Peter

    2018-03-01

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

  20. 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.

  1. Skill qualifications in pediatric minimally invasive surgery.

    Science.gov (United States)

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

    2011-07-01

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

  2. Minimally invasive aortic valve replacement

    DEFF Research Database (Denmark)

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

    2009-01-01

    In this descriptive prospective study, we evaluate the outcomes of surgery in 98 patients who were scheduled to undergo minimally invasive aortic valve replacement. These patients were compared with a group of 50 patients who underwent scheduled aortic valve replacement through a full sternotomy...... operations were completed as mini-sternotomies, 4 died later of noncardiac causes. The aortic cross-clamp and perfusion times were significantly different across all groups (P replacement...... is an excellent operation in selected patients, but its true advantages over conventional aortic valve replacement (other than a smaller scar) await evaluation by means of randomized clinical trial. The "extended mini-aortic valve replacement" operation, on the other hand, is a risky procedure that should...

  3. Endocanalicular diode laser dacryocystorhinostomy for nasolacrimal duct obstruction: short-term results of a new minimally invasive surgical technique.

    Science.gov (United States)

    Özçimen, Muammer; Uysal, Ismail Onder; Eryılmaz, Mehmet Akif; Kal, Ali

    2010-11-01

    To evaluate the results, complications, effectiveness, and operative results of the endocanalicular laser dacryocystorhinostomy (ECL DCR) in the distal obstructions of the lacrimal drainage system. Sixty eyes of 57 patients who had a diagnosis of distal obstruction of the lacrimal drainage system were evaluated retrospectively in this study. All patients underwent ECL DCR by diode laser between October 2008 and July 2009. Forty-nine patients (86%) were females, 8 patients (14%) were males, and age distribution was between 3 and 84 years old (median, 40 y). The canaliculi were intubated by a silicone tube. The patency of the nasolacrimal system was controlled by lacrimal lavage, loss of epiphora, and endoscopic evaluation of the endonasal rhinostomy site with routine follow-up scheduled at first day and 1-week, 1-month, and 3-month postoperative intervals. After the 60 ECL DCRs, 10 patients underwent revision ECL DCR because of the persistent epiphora. The patency of the nasolacrimal duct or the decrease of the symptoms was assigned as success. There were no symptoms at all in 83.3% of the patients. The ECL DCR in the treatment of the distal obstructions of the lacrimal drainage system was easily tolerated by the patients, cosmetically preferred because there was no incision and scar formation with high success rates, and a minimally invasive alternative technique.

  4. 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.

  5. Two-Year Outcomes from a Randomized Controlled Trial of Minimally Invasive Sacroiliac Joint Fusion vs. Non-Surgical Management for Sacroiliac Joint Dysfunction

    Science.gov (United States)

    Swofford, John; Whang, Peter G.; Frank, Clay J.; Glaser, John A.; Limoni, Robert P.; Cher, Daniel J.; Wine, Kathryn D.; Sembrano, Jonathan N.

    2016-01-01

    Background Sacroiliac joint (SIJ) dysfunction is an important and underappreciated cause of chronic low back pain. Objective To prospectively and concurrently compare outcomes after surgical and non-surgical treatment for chronic SIJ dysfunction. Methods One hundred and forty-eight subjects with SIJ dysfunction were randomly assigned to minimally invasive SIJ fusion with triangular titanium implants (SIJF, n = 102) or non-surgical management (NSM, n = 46). SIJ pain (measured with a 100-point visual analog scale, VAS), disability (measured with Oswestry Disability Index, ODI) and quality of life scores were collected at baseline and at scheduled visits to 24 months. Crossover from non-surgical to surgical care was allowed after the 6-month study visit was complete. Improvements in continuous measures were compared using repeated measures analysis of variance. The proportions of subjects with clinical improvement (SIJ pain improvement ≥20 points, ODI ≥15 points) and substantial clinical benefit (SIJ pain improvement ≥25 points or SIJ pain rating ≤35, ODI ≥18.8 points) were compared. Results In the SIJF group, mean SIJ pain improved rapidly and was sustained (mean improvement of 55.4 points) at month 24. The 6-month mean change in the NSM group (12.2 points) was substantially smaller than that in the SIJF group (by 38.3 points, p<.0001 for superiority). By month 24, 83.1% and 82.0% received either clinical improvement or substantial clinical benefit in VAS SIJ pain score. Similarly, 68.2% and 65.9% had received clinical improvement or substantial clinical benefit in ODI score at month 24. In the NSM group, these proportions were <10% with non-surgical treatment only. Parallel changes were seen for EQ-5D and SF-36, with larger changes in the surgery group at 6 months compared to NSM. The rate of adverse events related to SIJF was low and only 3 subjects assigned to SIJF underwent revision surgery within the 24-month follow-up period. Conclusions In this Level

  6. Two-Year Outcomes from a Randomized Controlled Trial of Minimally Invasive Sacroiliac Joint Fusion vs. Non-Surgical Management for Sacroiliac Joint Dysfunction.

    Science.gov (United States)

    Polly, David W; Swofford, John; Whang, Peter G; Frank, Clay J; Glaser, John A; Limoni, Robert P; Cher, Daniel J; Wine, Kathryn D; Sembrano, Jonathan N

    2016-01-01

    Sacroiliac joint (SIJ) dysfunction is an important and underappreciated cause of chronic low back pain. To prospectively and concurrently compare outcomes after surgical and non-surgical treatment for chronic SIJ dysfunction. One hundred and forty-eight subjects with SIJ dysfunction were randomly assigned to minimally invasive SIJ fusion with triangular titanium implants (SIJF, n = 102) or non-surgical management (NSM, n = 46). SIJ pain (measured with a 100-point visual analog scale, VAS), disability (measured with Oswestry Disability Index, ODI) and quality of life scores were collected at baseline and at scheduled visits to 24 months. Crossover from non-surgical to surgical care was allowed after the 6-month study visit was complete. Improvements in continuous measures were compared using repeated measures analysis of variance. The proportions of subjects with clinical improvement (SIJ pain improvement ≥20 points, ODI ≥15 points) and substantial clinical benefit (SIJ pain improvement ≥25 points or SIJ pain rating ≤35, ODI ≥18.8 points) were compared. In the SIJF group, mean SIJ pain improved rapidly and was sustained (mean improvement of 55.4 points) at month 24. The 6-month mean change in the NSM group (12.2 points) was substantially smaller than that in the SIJF group (by 38.3 points, p<.0001 for superiority). By month 24, 83.1% and 82.0% received either clinical improvement or substantial clinical benefit in VAS SIJ pain score. Similarly, 68.2% and 65.9% had received clinical improvement or substantial clinical benefit in ODI score at month 24. In the NSM group, these proportions were <10% with non-surgical treatment only. Parallel changes were seen for EQ-5D and SF-36, with larger changes in the surgery group at 6 months compared to NSM. The rate of adverse events related to SIJF was low and only 3 subjects assigned to SIJF underwent revision surgery within the 24-month follow-up period. In this Level 1 multicenter prospective randomized controlled

  7. 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.

  8. Tracking-by-detection of surgical instruments in minimally invasive surgery via the convolutional neural network deep learning-based method.

    Science.gov (United States)

    Zhao, Zijian; Voros, Sandrine; Weng, Ying; Chang, Faliang; Li, Ruijian

    2017-12-01

    Worldwide propagation of minimally invasive surgeries (MIS) is hindered by their drawback of indirect observation and manipulation, while monitoring of surgical instruments moving in the operated body required by surgeons is a challenging problem. Tracking of surgical instruments by vision-based methods is quite lucrative, due to its flexible implementation via software-based control with no need to modify instruments or surgical workflow. A MIS instrument is conventionally split into a shaft and end-effector portions, while a 2D/3D tracking-by-detection framework is proposed, which performs the shaft tracking followed by the end-effector one. The former portion is described by line features via the RANSAC scheme, while the latter is depicted by special image features based on deep learning through a well-trained convolutional neural network. The method verification in 2D and 3D formulation is performed through the experiments on ex-vivo video sequences, while qualitative validation on in-vivo video sequences is obtained. The proposed method provides robust and accurate tracking, which is confirmed by the experimental results: its 3D performance in ex-vivo video sequences exceeds those of the available state-of -the-art methods. Moreover, the experiments on in-vivo sequences demonstrate that the proposed method can tackle the difficult condition of tracking with unknown camera parameters. Further refinements of the method will refer to the occlusion and multi-instrumental MIS applications.

  9. Comprehensive surgical. Orthodontic treatment of class III malocclusion in cleft patient involving minimally invasive surgery Case report and literature review.

    Science.gov (United States)

    Stojkovic, Goran; Stojkovic, Miodrag; Stojkovic, Jasna; Nikolic, Dejan; Stajcic, Zoran

    2016-12-19

    Surgical and orthodontic treatment of a teenage cleft patient. Authors describe the case of a 13 year old female cleft patient presented with class III malocclusion RESULT: The patient underwent comprehensive surgical secondary bone grafting and orthodontic treatment. Stable skeletal and occlusal class I relationship was achived and maintained in the post treatment observation period till the age of 16. Although several authors suggests primary gingivoperiosteoplasty, other advocates that such early intervention can cause later restrictions in maxillary growth. For alveolar reconstruction, maxillary growth and dental age were the main considerations in determining the timing of surgical intervention. This case showed that borderline cases of complex dentoalveolar and skeletal anomaly in cleft patients could be successfully treated with comprehensive secondary bone grafting and orthodontic treatment thus avoiding the need for orthognatic surgery. Alveolar bone grafting, Cleft, Malocclusion.

  10. A case-control study to compare the outcome of women treated by two minimally invasive procedures-ultraminilaparotomy myomectomy and laparoscopic myomectomy

    Directory of Open Access Journals (Sweden)

    Kuo-Chang Wen

    2018-04-01

    Full Text Available Objective: Ultraminilaparotomy myomectomy (UMLT-M with less 4 cm transverse skin incision and conventional 3-port wound laparoscopic myomectomy (LM approaches were proposed as alternative minimally invasive procedures in the management of women with symptomatic uterine myomas but few studies have compared the outcomes of both procedures. Materials and methods: Between January 2002 and December 2003, 71 patients undergoing UMLT-M were compared with those 71 women undergoing LM. The last data collection for all patients was done on 31 December 2016. The parameters for comparison included the characteristics of the uterine myomas, surgical parameters, morbidities, and outcomes. Surgical parameters included the operative time (minutes, estimated blood loss (milliliters, time for removal of drainage, percentage of blood transfusion and co-morbidities. Results: Mean operative time in the LM group was significantly longer than that in the UMLT-M group (208.7 ± 65.9 vs. 98.0 ± 28.2 min, p < 0.001. Intra-operative blood loss was significantly higher in the LM group than that in the UMLT-M group (210.9 ± 184.5 vs. 111.7 ± 108.4 ml, p < 0.001. However, more patients had postoperative fever in the UMLT-M group (39.4% vs. 8.5%, p < 0.001. The recurrence rate of myoma at 5-year follow-up was significantly different between two groups (35.2% of UMLT-M vs. 57.7% of LM, p = 0.007, but there was no difference when follow-up time was over ten years. The location of the myoma recurrence was different between two groups with higher recurrence rates in the fundal and lateral sides of uterus in the UMLT-M group and in the anterior wall of uterus in the LM group. However, the overall symptom control, the need of repeated myoma-related surgery and subsequent pregnancy outcome of both groups seemed to be similar in both groups. Conclusions: More operative time and more blood loss reflected that LM demanded skills, experience and equipment

  11. Assessment of minimally invasive surgical skills of pre-medical students: What can we learn from future learners?

    Science.gov (United States)

    Borahay, Mostafa A; Jackson, Mary; Tapısız, Omer L; Lyons, Elizabeth; Patel, Pooja R; Nassar, Ramsey; Kılıç, Gökhan Sami

    2014-01-01

    Knowledge of baseline laparoscopic and robotic surgical skills of future learners is essential to develop teaching strategies that best fit them. The objectives of this study are to determine baseline laparoscopic and robotic skills of high school and college students and compare them to those of current obstetrics and gynecology residents. A cross-sectional (Class II-2) pilot study. Laparoscopic and robotic surgical skills of college and high (secondary) school students were evaluated using simulators and compared to those of obstetrics and gynecology residents. In addition, questionnaire data were collected regarding video game playing and computer use. A total of 17 students, both high school (n=9) and college (n=8), in addition to 11 residents, completed the study. Overall, students performed comparably to the residents in simple exercises (p>.05). However, students took significantly longer time to complete complex exercises (p=.001). Finally, students played video games significantly more than residents (pskill set. This difference may be related to improved hand-eye coordination, possibly due to playing video games. The results of this pilot study should spur more research into surgical teaching strategies.

  12. Evaluation of a minimally invasive procedure for sacroiliac joint fusion – an in vitro biomechanical analysis of initial and cycled properties

    Directory of Open Access Journals (Sweden)

    Lindsey DP

    2014-05-01

    Full Text Available Derek P Lindsey,1 Luis Perez-Orribo,2 Nestor Rodriguez-Martinez,2 Phillip M Reyes,2 Anna Newcomb,2 Alexandria Cable,2 Grace Hickam,2 Scott A Yerby,1 Neil R Crawford21SI-BONE, Inc., San Jose, CA, USA; 2Spinal Biomechanics Research Laboratory, Barrow Neurological Institute, St Joseph's Hospital and Medical Center, Phoenix, AZ, USAIntroduction: Sacroiliac (SI joint pain has become a recognized factor in low back pain. The purpose of this study was to investigate the effect of a minimally invasive surgical SI joint fusion procedure on the in vitro biomechanics of the SI joint before and after cyclic loading.Methods: Seven cadaveric specimens were tested under the following conditions: intact, posterior ligaments (PL and pubic symphysis (PS cut, treated (three implants placed, and after 5,000 cycles of flexion–extension. The range of motion (ROM in flexion–extension, lateral bending, and axial rotation was determined with an applied 7.5 N • m moment using an optoelectronic system. Results for each ROM were compared using a repeated measures analysis of variance (ANOVA with a Holm–Šidák post-hoc test.Results: Placement of three fusion devices decreased the flexion–extension ROM. Lateral bending and axial rotation were not significantly altered. All PL/PS cut and post-cyclic ROMs were larger than in the intact condition. The 5,000 cycles of flexion–extension did not lead to a significant increase in any ROMs.Discussion: In the current model, placement of three 7.0 mm iFuse Implants significantly decreased the flexion–extension ROM. Joint ROM was not increased by 5,000 flexion–extension cycles.Keywords: biomechanics, iliosacral, arthrodesis, cadaver

  13. 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.

  14. 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.)

  15. Minimizing surgical skin incision scars with a latex surgical glove.

    Science.gov (United States)

    Han, So-Eun; Ryoo, Suk-Tae; Lim, So Young; Pyon, Jai-Kyung; Bang, Sa-Ik; Oh, Kap-Sung; Mun, Goo-Hyun

    2013-04-01

    The current trend in minimally invasive surgery is to make a small surgical incision. However, the excessive tensile stress applied by the retractors to the skin surrounding the incision often results in a long wound healing time and extensive scarring. To minimize these types of wound problems, the authors evaluated a simple and cost-effective method to minimize surgical incision scars based on the use of a latex surgical glove. The tunnel-shaped part of a powder-free latex surgical glove was applied to the incision and the dissection plane. It was fixed to the full layer of the dissection plane with sutures. The glove on the skin surface then was sealed with Ioban (3 M Health Care, St. Paul, MN, USA) to prevent movement. The operation proceeded as usual, with the retractor running through the tunnel of the latex glove. It was possible to complete the operation without any disturbance of the visual field by the surgical glove, and the glove was neither torn nor separated by the retractors. The retractors caused traction and friction during the operation, but the extent of damage to the postoperative skin incision margin was remarkably less than when the operation was performed without a glove. This simple and cost-effective method is based on the use of a latex surgical glove to protect the surgical skin incision site and improve the appearance of the postoperative scar. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

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

    Science.gov (United States)

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

    2014-06-01

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

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

    NARCIS (Netherlands)

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

    2015-01-01

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

  18. Comparison of minimally invasive surgical skills of neurosurgeons versus general surgeons: is there a difference in the first exposure to a virtual reality simulator?

    Science.gov (United States)

    Hassan, I; Bin Dayne, K; Kappus, C; Gerdes, B; Rothmund, M; Hellwig, D

    2007-04-01

    The increasing use of minimally invasive surgery, which has a longer learning curve compared to open surgery lets the necessity to develop training programs to improve endoscopic skills of trainees become ever clearer. The aim of this study was to compare the endoscopic skills of neurosurgeons versus general surgeons at first exposure to a virtual reality simulator. 72 general surgeons who visited the 122nd Conference of the German Surgeons Society (DGCH in Munich 2005) and 35 neuroendoscopic surgeons, who visited the Third World Conference of the International Study Group of Neuroendoscopy (ISGNE in Marburg 2005) participated in this study. Each participant performed the basic module "clip application" on the virtual reality simulator (LapSim). All participants were given the same pretest instructions. Time to complete the task, error score and economy of motion were recorded. The general surgeons performed the clip application faster, but with more errors than neuroendoscopic surgeons. However, the difference of both parameters was not significant. Both surgeon groups have a similar score for economy of motion. Although neuroendoscopic surgeons were exposed to a foreign procedure and unfamiliar equipment, they were able to perform virtual endoscopy with similar accuracy as general surgeons, who are adapted to these endoscopic instruments and procedures and do these daily.

  19. Waste minimization assessment procedure

    International Nuclear Information System (INIS)

    Kellythorne, L.L.

    1993-01-01

    Perry Nuclear Power Plant began developing a waste minimization plan early in 1991. In March of 1991 the plan was documented following a similar format to that described in the EPA Waste Minimization Opportunity Assessment Manual. Initial implementation involved obtaining management's commitment to support a waste minimization effort. The primary assessment goal was to identify all hazardous waste streams and to evaluate those streams for minimization opportunities. As implementation of the plan proceeded, non-hazardous waste streams routinely generated in large volumes were also evaluated for minimization opportunities. The next step included collection of process and facility data which would be useful in helping the facility accomplish its assessment goals. This paper describes the resources that were used and which were most valuable in identifying both the hazardous and non-hazardous waste streams that existed on site. For each material identified as a waste stream, additional information regarding the materials use, manufacturer, EPA hazardous waste number and DOT hazard class was also gathered. Once waste streams were evaluated for potential source reduction, recycling, re-use, re-sale, or burning for heat recovery, with disposal as the last viable alternative

  20. Minimally Invasive Spine Surgery in Small Animals.

    Science.gov (United States)

    Hettlich, Bianca F

    2018-01-01

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

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

    Directory of Open Access Journals (Sweden)

    Tanito M

    2017-12-01

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

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

    Science.gov (United States)

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

    2012-03-01

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

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

    Science.gov (United States)

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

    2010-01-01

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

  4. Minimally invasive surgery for esophageal achalasia.

    Science.gov (United States)

    Chen, Huan-Wen; Du, Ming

    2016-07-01

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

  5. Using a multimedia presentation to improve patient understanding and satisfaction with informed consent for minimally invasive vascular procedures.

    Science.gov (United States)

    Bowers, N; Eisenberg, E; Montbriand, J; Jaskolka, J; Roche-Nagle, G

    2017-02-01

    As vascular procedures become more complex, patient understanding of their treatment(s) can become more difficult. We wished to evaluate the utility of multimedia presentations (MPs) to improve patient understanding of their vascular interventions. Patients undergoing endovascular aneurysm repair (EVAR), peripheral angioplasty, Hickman catheter and peripherally inserted central catheter (PICC) insertion were randomized into a control group receiving traditional verbal consent, and a MP group that were shown a two minute simplified video of their procedure on an iPad™ computer in addition to the traditional verbal consent. After obtaining consent, all patients completed a questionnaire assessing their comprehension of the procedure, and satisfaction with the consent process. Satisfaction was rated on a 5 point Likert scale with 5 being 'very helpful' in understanding the procedure. Ninety-three patients were recruited for this study, 62% of which were male. The intervention significantly increased total comprehension in all procedure types controlling for procedure type (multimedia vs. control; F = 9.14, P = .003). A second ANOVA showed there was a significant main effect by intervention (F = 44.06, p consent process to be helpful in patient understanding and that there is improved satisfaction. Given the rapid rate of innovation in vascular interventions, increased regular use of MPs to help patients understand their procedures would be beneficial in the care of patients undergoing vascular interventions. Copyright © 2015 Royal College of Surgeons of Edinburgh (Scottish charity number SC005317) and Royal College of Surgeons in Ireland. Published by Elsevier Ltd. All rights reserved.

  6. 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.

  7. A physics-based algorithm for real-time simulation of electrosurgery procedures in minimally invasive surgery.

    Science.gov (United States)

    Lu, Zhonghua; Arikatla, Venkata S; Han, Zhongqing; Allen, Brian F; De, Suvranu

    2014-12-01

    High-frequency electricity is used in the majority of surgical interventions. However, modern computer-based training and simulation systems rely on physically unrealistic models that fail to capture the interplay of the electrical, mechanical and thermal properties of biological tissue. We present a real-time and physically realistic simulation of electrosurgery by modelling the electrical, thermal and mechanical properties as three iteratively solved finite element models. To provide subfinite-element graphical rendering of vaporized tissue, a dual-mesh dynamic triangulation algorithm based on isotherms is proposed. The block compressed row storage (BCRS) structure is shown to be critical in allowing computationally efficient changes in the tissue topology due to vaporization. We have demonstrated our physics-based electrosurgery cutting algorithm through various examples. Our matrix manipulation algorithms designed for topology changes have shown low computational cost. Our simulator offers substantially greater physical fidelity compared to previous simulators that use simple geometry-based heat characterization. Copyright © 2013 John Wiley & Sons, Ltd.

  8. 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.

  9. Transvaginal mesh in repair of pelvic organs prolapse as a minimally invasive surgical procedure

    Directory of Open Access Journals (Sweden)

    Argirović Rajka

    2011-01-01

    Full Text Available Background/Aim. Prolapse of genital organs with or without urinary stress incontinention is the most often health problem in the elderly female population tending to increase with ageing. The aim of this study was to assess the perioperative complications and short-term outcomes of prolaps repair using transvaginal polypropylene mesh (Prolift system, Gynecare, Ethicon, USA. Methods. A retrospective study was conducted evaluating 96 women from September 2006 to January 2010 who undewent vaginal repair with implatation of a soft mesh manufactured by Gynecare, Ethicon, USA. Results. All the patients had a stage 3 or stage 4 prolapse according to the POP-Q system of ICS. Total mesh was used in 12 (13% patients isolated anterior mesh in 52 (54% patients and isolated posterior mesh in 32 (33% patients. We reported one intra-operative bladder injury and no other serious complications. At 3 months, all 96 patients were available for follow-up. Vaginal erosion occured in 9 (9.3% patients, shrinkage of mesh in 6 (6.2% patients and de novo urinary incontinence in 5 (5.2% patients. Failure rate was 6.25% (recurrent prolapse stage 3 or 4 even asymptomatic. Conclusion. Our study suggests that transvaginal polypropylene mesh applied with a tensionfree technique is a safe and effective method with low intraoperative complications and low morbidity rates. However, some complications are serious and require highly specialised management.

  10. [Transvaginal mesh in repair of pelvic organs prolapse as a minimally invasive surgical procedure].

    Science.gov (United States)

    Argirović, Rajka; Berisavac, Milica; Likić-Ladević, Ivana; Kadija, Sasa; Bosković, Vladimir; Zizić, Vojislav

    2011-07-01

    Prolapse of genital organs with or without urinary stress incontinention is the most often health problem in the elderly female population tending to increase with ageing. The aim of this study was to assess the perioperative complications and short-term outcomes of prolaps repair using transvaginal polypropylene mesh (Prolift system, Gynecare, Ethicon, USA). A retrospective study was conducted evaluating 96 women from September 2006 to January 2010 who underwent vaginal repair with implatation of a soft mesh manufactured by Gynecare, Ethicon, USA. All the patients had a stage 3 or stage 4 prolapse according to the POP-Q system of ICS. Total mesh was used in 12 (13%) patients isolated anterior mesh in 52 (54%) patients and isolated posterior mesh in 32 (33%) patients. We reported one intra-operative bladder injury and no other serious complications. At 3 months, all 96 patients were available for follow-up. Vaginal erosion occured in 9 (9.3%) patients, shrinkage of mesh in 6 (6.2%) patients and de novo urinary incontinence in 5 (5.2%) patients. Failure rate was 6.25% (recurrent prolapse stage 3 or 4 even asymptomatic). Our study suggests that transvaginal polypropylene mesh applied with a tension-free technique is a safe and effective method with low intraoperative complications and low morbidity rates. However, some complications are serious and require highly specialised management.

  11. Transvaginal mesh in repair of pelvic organs prolapse as a minimally invasive surgical procedure

    OpenAIRE

    Argirović Rajka; Berisavac Milica; Likić-Lađević Ivana; Kadija Saša; Bošković Vladimir; Žižić Vojislav

    2011-01-01

    Background/Aim. Prolapse of genital organs with or without urinary stress incontinention is the most often health problem in the elderly female population tending to increase with ageing. The aim of this study was to assess the perioperative complications and short-term outcomes of prolaps repair using transvaginal polypropylene mesh (Prolift system, Gynecare, Ethicon, USA). Methods. A retrospective study was conducted evaluating 96 women from September 2006 to January 2010 who undewent...

  12. Minimally invasive brow suspension for facial paralysis.

    Science.gov (United States)

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

    2003-01-01

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

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

    Science.gov (United States)

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

    2013-11-01

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

  14. Robotic-Assisted Procedures in Pediatric Surgery: A Critical Appraisal of the Current Best Evidence in Comparison to Conventional Minimally Invasive Surgery.

    Science.gov (United States)

    Friedmacher, Florian; Till, Holger

    2015-11-01

    In recent years, the use of robotic-assisted surgery (RAS) has expanded within pediatric surgery. Although increasing numbers of pediatric RAS case-series have been published, the level of evidence remains unclear, with authors mainly focusing on the comparison with open surgery rather than the corresponding laparoscopic approach. The aim of this study was to critically appraise the published literature comparing pediatric RAS with conventional minimally invasive surgery (MIS) in order to evaluate the current best level of evidence. A systematic literature-based search for studies comparing pediatric RAS with corresponding MIS procedures was performed using multiple electronic databases and sources. The level of evidence was determined using the Oxford Centre for Evidence-based Medicine (OCEBM) criteria. A total of 20 studies met defined inclusion criteria, reporting on five different procedures: fundoplication (n=8), pyeloplasty (n=8), nephrectomy (n=2), gastric banding (n=1), and sleeve gastrectomy (n=1). Included publications comprised 5 systematic reviews and 15 cohort/case-control studies (OCEBM Level 3 and 4, respectively). No studies of OCEBM Level 1 or 2 were identified. Limited evidence indicated reduced operative time (pyeloplasty) and shorter hospital stay (fundoplication) for pediatric RAS, whereas disadvantages were longer operative time (fundoplication, nephrectomy, gastric banding, and sleeve gastrectomy) and higher total costs (fundoplication and sleeve gastrectomy). There were no differences reported for complications, success rates, or short-term outcomes between pediatric RAS and conventional MIS in these procedures. Inconsistency was found in study design and follow-up with large clinical heterogeneity. The best available evidence for pediatric RAS is currently OCEBM Level 3, relating only to fundoplication and pyeloplasty. Therefore, higher-quality studies and comparative data for other RAS procedures in pediatric surgery are required.

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

    Science.gov (United States)

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

    2014-01-01

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

  16. [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.

  17. 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.

  18. Percutaneous release of the plantar fascia. New surgical procedure.

    Science.gov (United States)

    Oliva, Francesco; Piccirilli, Eleonora; Tarantino, Umberto; Maffulli, Nicola

    2017-01-01

    Plantar fasciopathy presents with pain at the plantar and medial aspect of the heel. If chronic, it can negatively impact on quality of life. Plantar fasciopathy is not always self-limiting, and can be debilitating. Surgical management involves different procedures. We describe a percutaneous plantar fascia release. A minimally invasive access to the plantar tuberosity of the calcaneus is performed, and a small scalpel blade is used to release the fascia. With this procedure, skin healing problems, nerve injuries, infection and prolonged recovery time are minimised, allowing early return to normal activities. V.

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

    African Journals Online (AJOL)

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

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

    African Journals Online (AJOL)

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

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

    Science.gov (United States)

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

    2015-01-01

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

  2. A Novel Minimal Invasive Mouse Model of Extracorporeal Circulation

    Directory of Open Access Journals (Sweden)

    Shuhua Luo

    2015-01-01

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

  3. 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.

  4. Image-guidance for surgical procedures

    International Nuclear Information System (INIS)

    Peters, Terry M

    2006-01-01

    Contemporary imaging modalities can now provide the surgeon with high quality three- and four-dimensional images depicting not only normal anatomy and pathology, but also vascularity and function. A key component of image-guided surgery (IGS) is the ability to register multi-modal pre-operative images to each other and to the patient. The other important component of IGS is the ability to track instruments in real time during the procedure and to display them as part of a realistic model of the operative volume. Stereoscopic, virtual- and augmented-reality techniques have been implemented to enhance the visualization and guidance process. For the most part, IGS relies on the assumption that the pre-operatively acquired images used to guide the surgery accurately represent the morphology of the tissue during the procedure. This assumption may not necessarily be valid, and so intra-operative real-time imaging using interventional MRI, ultrasound, video and electrophysiological recordings are often employed to ameliorate this situation. Although IGS is now in extensive routine clinical use in neurosurgery and is gaining ground in other surgical disciplines, there remain many drawbacks that must be overcome before it can be employed in more general minimally-invasive procedures. This review overviews the roots of IGS in neurosurgery, provides examples of its use outside the brain, discusses the infrastructure required for successful implementation of IGS approaches and outlines the challenges that must be overcome for IGS to advance further. (topical review)

  5. Heart bypass surgery - minimally invasive

    Science.gov (United States)

    ... MIDCAB; Robot-assisted coronary artery bypass; RACAB; Keyhole heart surgery; CAD - MIDCAB; Coronary artery disease - MIDCAB ... To perform this surgery: The heart surgeon will make a 3- to 5-inch (8 to 13 centimeters) surgical cut in the left part of your chest ...

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

    LENUS (Irish Health Repository)

    Leonard, M

    2012-02-01

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

  7. Minimally invasive hysterectomy in Coatis ( Nasua nasua

    Directory of Open Access Journals (Sweden)

    Bruno W. Minto

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

  8. Danish surgeons' views on minimally invasive surgery

    DEFF Research Database (Denmark)

    Edwards, Hellen; Jørgensen, Lars Nannestad

    2014-01-01

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

  9. Injectable biomaterials for minimally invasive orthopedic treatments.

    Science.gov (United States)

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

    2009-06-01

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

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

    Science.gov (United States)

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

    2017-04-01

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

  11. Providing intraosseous anesthesia with minimal invasion.

    Science.gov (United States)

    Giffin, K M

    1994-08-01

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

  12. Minimally invasive spine surgery: Hurdles to be crossed

    Directory of Open Access Journals (Sweden)

    Mahesh Bijjawara

    2014-01-01

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

  13. Cost Differences Between Open and Minimally Invasive Surgery.

    Science.gov (United States)

    Fitch, Kathryn; Engel, Tyler; Bochner, Andrew

    2015-09-01

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

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

    Science.gov (United States)

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

    2017-10-01

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

  15. The first successful laparoscopic Whipple procedure at Hat Yai Hospital: surgical technique and a case report.

    Science.gov (United States)

    Khaimook, Araya; Borkird, Jumpot; Alapach, Sakda

    2010-09-01

    Whipple procedure is the most complex abdominal surgical procedure to treat periampullary carcinoma. With the benefit of minimally invasive approach, many institutes attempt to do Whipple procedure laparoscopically. However, only 146 cases of laparoscopic Whipple procedure have yet been reported in the literature worldwide between 1994 and 2008. The authors reported the first laparoscopic Whipple procedure at Hat Yai Hospital in December 2009. The patient was a 40-year-old, Thai-Muslim female, with the diagnosis of ampullary carcinoma. The operating time was 685 minutes. The patient was discharged on postoperative day 14 without serious complication. The surgical technique and postoperative progress of the patient were described.

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

    Science.gov (United States)

    Nevins, Marc L; Said, Sherif

    2017-12-28

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

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

    Science.gov (United States)

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

    2013-07-01

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

  18. Attempted establishment of proficiency levels for laparoscopic performance on a national scale using simulation: the results from the 2004 SAGES Minimally Invasive Surgical Trainer-Virtual Reality (MIST-VR) learning center study.

    Science.gov (United States)

    Van Sickle, K R; Ritter, E M; McClusky, D A; Lederman, A; Baghai, M; Gallagher, A G; Smith, C D

    2007-01-01

    The Minimally Invasive Surgical Trainer-Virtual Reality (MIST-VR) has been well validated as a training device for laparoscopic skills. It has been demonstrated that training to a level of proficiency on the simulator significantly improves operating room performance of laparoscopic cholecystectomy. The purpose of this project was to obtain a national standard of proficiency using the MIST-VR based on the performance of experienced laparoscopic surgeons. Surgeons attending the Society of American Gastrointestinal Endoscopic Surgeons (SAGES) 2004 Annual Scientific Meeting who had performed more than 100 laparoscopic procedures volunteered to participate. All the subjects completed a demographic questionnaire assessing laparoscopic and MIST-VR experience in the learning center of the SAGES 2004 meeting. Each subject performed two consecutive trials of the MIST-VR Core Skills 1 program at the medium setting. Each trial involved six basic tasks of increasing difficulty: acquire place (AP), transfer place (TP), traversal (TV), withdrawal insert (WI), diathermy task (DT), and manipulate diathermy (MD). Trial 1 was considered a "warm-up," and trial 2 functioned as the test trial proper. Subject performance was scored for time, errors, and economy of instrument movement for each task, and a cumulative total score was calculated. Trial 2 data are expressed as mean time in seconds in Table 2. Proficiency levels for laparoscopic skills have now been established on a national scale by experienced laparoscopic surgeons using the MIST-VR simulator. Residency programs, training centers, and practicing surgeons can now use these data as guidelines for performance criterion during MIST-VR skills training.

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

    Directory of Open Access Journals (Sweden)

    Lívia M. Brandão

    2013-01-01

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

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

    Science.gov (United States)

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

    2009-05-01

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

  1. 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.

  2. ANAESTHESIA FOR OPHTHALMIC SURGICAL PROCEDURES

    African Journals Online (AJOL)

    Objective: To review factors influencing the choice of anaesthesia for ophthalmic surgical procedures. ... as risk associated with general anaesthesia (8) they are more .... Wilson ME, Pandey SK, Thakur J. Paediatric cataract blindness in the ...

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

    OpenAIRE

    Lazarus, John

    2011-01-01

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

  4. Benefit from the minimally invasive sinus technique.

    Science.gov (United States)

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

    2009-02-01

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

  5. New trends in minimally invasive urological surgery

    Directory of Open Access Journals (Sweden)

    Prabhakar Rajan

    2009-10-01

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

  6. Minimally invasive treatments of uterine fibroids

    NARCIS (Netherlands)

    Voogt, M.J.

    2012-01-01

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

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

    Directory of Open Access Journals (Sweden)

    Yamin Yang

    2013-01-01

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

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

    Science.gov (United States)

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

    2014-01-01

    The mainstay of sacroiliac joint disruption/degenerative sacroiliitis therapy has been nonoperative management. This nonoperative management often includes a regimen of physical therapy, chiropractic treatment, therapeutic injections, and possibly radiofrequency ablation at the discretion of the treating physician. When these clinical treatments fail, sacroiliac joint fusion has been recommended as the standard treatment. Open and minimally invasive (MIS) surgical techniques are typical procedures. This study aims to compare the perioperative measures and Oswestry Disability Index (ODI) outcomes associated with each of these techniques. A comparative retrospective chart review of patients with sacroiliac joint fusion and a minimum of 1 year of follow-up was performed. Perioperative measures and ODI scores were compared using the Fisher's exact test and two nonparametric tests, ie, the Mann-Whitney U test and the Wilcoxon signed-rank test. The results are presented as percent or median with range, as appropriate. Forty-nine patients from two institutions underwent sacroiliac joint fusion between 2006 and 2012. Ten patients were excluded because of incomplete data, leaving 39 evaluable patients, of whom 22 underwent open and 17 underwent MIS sacroiliac joint fusion. The MIS group was significantly older (median age 66 [39-82] years) than the open group (median age 51 [34-74] years). Surgical time and hospital stay were significantly shorter in the MIS group than in the open group. Preoperative ODI was significantly greater in the open group (median 64 [44-78]) than in the MIS group (median 53 [14-84]). Postoperative improvement in ODI was statistically significant within and between groups, with MIS resulting in greater improvement. The open and MIS sacroiliac joint fusion techniques resulted in statistically and clinically significant improvement for patients with degenerative sacroiliitis refractory to nonoperative management. However, the number of patients

  9. Modification and Control of Wound Healing in Tracheobronchial Injuries Using Minimally Invasive Surgical Techniques and Biologic Growth Factors-CIC3

    National Research Council Canada - National Science Library

    Perkins, Jonathan

    1998-01-01

    .... Currently, metallic stents offer an adjunctive treatment in airway reconstruction. These stents have the capability of stabilizing the size of the airway lumen, while preventing surgical site restenosis...

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

    Science.gov (United States)

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

    2013-03-01

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

  11. Interoperative efficiency in minimally invasive surgery suites.

    Science.gov (United States)

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

    2009-10-01

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

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

    International Nuclear Information System (INIS)

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

    2006-01-01

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

  13. 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.

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

    Science.gov (United States)

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

    2014-12-01

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

  15. 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

  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......-day training units in robot- assisted minimally invasive surgery on anaesthetised pigs....

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

    Directory of Open Access Journals (Sweden)

    S. Kağan Başarslan

    2014-03-01

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

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

    Science.gov (United States)

    Kube, Richard A; Muir, Jeffrey M

    2016-01-01

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

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

    Directory of Open Access Journals (Sweden)

    Rohollah Y

    2009-09-01

    performed and led to a dramatic improvement."n"nConclusions: Endoscopic based approaches must be considered the first line intervention for pseudocyst management and its complications. Complexity and need for technical expertise for endoscopic therapy is rate limiting issue for this approach. Surgical intervention must be reserved for unresponsive patients to minimally invasive treatments. Further investigations need for more complex endoscopic procedures that promote the results.

  20. Qualification guideline of the German X-ray association (DRG) und the German association for interventional radiology and minimal invasive therapy (DeGIR) for the performance of interventional-radiological minimal invasive procedures on arteries and veins; Qualifizierungsleitlinie der Deutschen Roentgengesellschaft (DRG) und der Deutschen Gesellschaft fuer Interventionelle Radiologie und minimalinvasive Therapie (DeGIR) zur Durchfuehrung interventionell-radiologischer minimalinvasiver Verfahren an Arterien und Venen

    Energy Technology Data Exchange (ETDEWEB)

    Buecker, A. [Universitaetsklinikum des Saarlandes, Homburg/Saar (Germany); Gross-Fengels, W. [Asklepiosklinik, Hamburg-Harburg (Germany); Haage, P. [Helios-Kliniken, Wuppertal (Germany); Huppert, P. [Klinikum Darmstadt (Germany); Landwehr, P. [Henriettenstiftung, Hannover (Germany); Loose, R. [Klinikum Nuernberg-Nord (Germany); Reimer, P. [Klinikum Karlsruhe (Germany); Tacke, J. [Klinikum Passau (Germany); Vorwerk, D. [Klinikum Ingolstadt (Germany); Fischer, J.

    2012-06-15

    The topics covered in the qualification guideline of the German X-ray association (DRG) und the German association for interventional radiology and minimal invasive therapy (DeGIR) for the performance of interventional-radiological minimal invasive procedures on arteries and veins are the following: Practical qualification: aorta iliac vessels and vessels in the upper and lower extremities, kidney and visceral arteries, head and neck arteries, dialysis shunts, veins and pulmonary arteries, aorta aneurysms and peripheral artery aneurysms. Knowledge acquisition concerning radiation protection: legal fundamentals, education and training, knowledge actualization and quality control, definition of the user and the procedure, competence preservation.

  1. Minimally invasive surgery for esophageal achalasia

    OpenAIRE

    Bonavina, Luigi

    2006-01-01

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

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

    NARCIS (Netherlands)

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

    2017-01-01

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

  3. 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

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

    Science.gov (United States)

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

    2016-01-01

    Sacroiliac joint (SIJ) disorders are common in patients with chronic lower back pain. Minimally invasive surgical options have been shown to be effective for the treatment of chronic SIJ dysfunction. To determine the cost-effectiveness of minimally invasive SIJ fusion. Data from two prospective, multicenter, clinical trials were used to inform a Markov process cost-utility model to evaluate cumulative 5-year health quality and costs after minimally invasive SIJ fusion using triangular titanium implants or non-surgical treatment. The analysis was performed from a third-party perspective. The model specifically incorporated variation in resource utilization observed in the randomized trial. Multiple one-way and probabilistic sensitivity analyses were performed. SIJ fusion was associated with a gain of approximately 0.74 quality-adjusted life years (QALYs) at a cost of US$13,313 per QALY gained. In multiple one-way sensitivity analyses all scenarios resulted in an incremental cost-effectiveness ratio (ICER) dysfunction due to degenerative sacroiliitis or SIJ disruption.

  5. 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.

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

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    Rumen Nenkov

    2013-06-01

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

  7. Cost-effectiveness of minimally invasive sacroiliac joint fusion

    Science.gov (United States)

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

    2016-01-01

    Background Sacroiliac joint (SIJ) disorders are common in patients with chronic lower back pain. Minimally invasive surgical options have been shown to be effective for the treatment of chronic SIJ dysfunction. Objective To determine the cost-effectiveness of minimally invasive SIJ fusion. Methods Data from two prospective, multicenter, clinical trials were used to inform a Markov process cost-utility model to evaluate cumulative 5-year health quality and costs after minimally invasive SIJ fusion using triangular titanium implants or non-surgical treatment. The analysis was performed from a third-party perspective. The model specifically incorporated variation in resource utilization observed in the randomized trial. Multiple one-way and probabilistic sensitivity analyses were performed. Results SIJ fusion was associated with a gain of approximately 0.74 quality-adjusted life years (QALYs) at a cost of US$13,313 per QALY gained. In multiple one-way sensitivity analyses all scenarios resulted in an incremental cost-effectiveness ratio (ICER) <$26,000/QALY. Probabilistic analyses showed a high degree of certainty that the maximum ICER for SIJ fusion was less than commonly selected thresholds for acceptability (mean ICER =$13,687, 95% confidence interval $5,162–$28,085). SIJ fusion provided potential cost savings per QALY gained compared to non-surgical treatment after a treatment horizon of greater than 13 years. Conclusion Compared to traditional non-surgical treatments, SIJ fusion is a cost-effective, and, in the long term, cost-saving strategy for the treatment of SIJ dysfunction due to degenerative sacroiliitis or SIJ disruption. PMID:26719717

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

    Science.gov (United States)

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

    2017-11-01

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

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

    Science.gov (United States)

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

    2016-04-01

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

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

    Science.gov (United States)

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

    2010-04-01

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

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

    Science.gov (United States)

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

    2014-05-01

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

  12. 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

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

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    Bjelović Miloš

    2015-01-01

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

  14. Minimally Invasive versus Open Approach for Right-Sided Colectomy: A Study in 12,006 Patients from the Dutch Surgical Colorectal Audit.

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    Bosker, Robbert J I; Van't Riet, Esther; de Noo, Mirre; Vermaas, Maarten; Karsten, Tom M; Pierie, Jean-Pierre

    2018-02-07

    There is ongoing debate whether laparoscopic right colectomy is superior to open surgery. The purpose of this study was to address this issue and arrive at a consensus using data from a national database. Patients who underwent elective open or laparoscopic right colectomy for colorectal cancer during the period 2009-2013 were identified from the Dutch Surgical Colorectal Audit. Complications that occurred within 30 days after surgery and 30-day mortality rates were calculated and compared between open and laparoscopic resection. In total, 12,006 patients underwent elective open or laparoscopic surgery for right-sided colorectal cancer. Of these, 6,683 (55.7%) underwent open resection and 5,323 (44.3%) underwent laparoscopic resection. Complications occurred within 30 days after surgery in the laparoscopic group in 26.1% of patients and in 32.1% of patients in the open group (p < 0.001). Thirty-day mortality was also significantly lower in the laparoscopic group (2.2 vs. 3.6% p < 0.001). In this non-randomized, descriptive study conducted in the Netherlands, open right colectomy seems to have a higher risk for complications and mortality as compared to laparoscopic right colectomy, even after correction for confounding factors. © 2018 S. Karger AG, Basel.

  15. Technical success, technique efficacy and complications of minimally-invasive imaging-guided percutaneous ablation procedures of breast cancer: A systematic review and meta-analysis.

    Science.gov (United States)

    Mauri, Giovanni; Sconfienza, Luca Maria; Pescatori, Lorenzo Carlo; Fedeli, Maria Paola; Alì, Marco; Di Leo, Giovanni; Sardanelli, Francesco

    2017-08-01

    To systematically review studies concerning imaging-guided minimally-invasive breast cancer treatments. An online database search was performed for English-language articles evaluating percutaneous breast cancer ablation. Pooled data and 95% confidence intervals (CIs) were calculated. Technical success, technique efficacy, minor and major complications were analysed, including ablation technique subgroup analysis and effect of tumour size on outcome. Forty-five studies were analysed, including 1,156 patients and 1,168 lesions. Radiofrequency (n=577; 50%), microwaves (n=78; 7%), laser (n=227; 19%), cryoablation (n=156; 13%) and high-intensity focused ultrasound (HIFU, n=129; 11%) were used. Pooled technical success was 96% (95%CI 94-97%) [laser=98% (95-99%); HIFU=96% (90-98%); radiofrequency=96% (93-97%); cryoablation=95% (90-98%); microwave=93% (81-98%)]. Pooled technique efficacy was 75% (67-81%) [radiofrequency=82% (74-88); cryoablation=75% (51-90); laser=59% (35-79); HIFU=49% (26-74)]. Major complications pooled rate was 6% (4-8). Minor complications pooled rate was 8% (5-13%). Differences between techniques were not significant for technical success (p=0.449), major complications (p=0.181) or minor complications (p=0.762), but significant for technique efficacy (p=0.009). Tumour size did not impact on variables (p>0.142). Imaging-guided percutaneous ablation techniques of breast cancer have a high rate of technical success, while technique efficacy remains suboptimal. Complication rates are relatively low. • Imaging-guided ablation techniques for breast cancer are 96% technically successful. • Overall technique efficacy rate is 75% but largely inhomogeneous among studies. • Overall major and minor complication rates are low (6-8%).

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

    Directory of Open Access Journals (Sweden)

    Ledonio CGT

    2014-06-01

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

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

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    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.

  18. 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.

  19. Robotic, laparoscopic and open surgery for gastric cancer compared on surgical, clinical and oncological outcomes: a multi-institutional chart review. A study protocol of the International study group on Minimally Invasive surgery for GASTRIc Cancer—IMIGASTRIC

    Science.gov (United States)

    Desiderio, Jacopo; Jiang, Zhi-Wei; Nguyen, Ninh T; Zhang, Shu; Reim, Daniel; Alimoglu, Orhan; Azagra, Juan-Santiago; Yu, Pei-Wu; Coburn, Natalie G; Qi, Feng; Jackson, Patrick G; Zang, Lu; Brower, Steven T; Kurokawa, Yukinori; Facy, Olivier; Tsujimoto, Hironori; Coratti, Andrea; Annecchiarico, Mario; Bazzocchi, Francesca; Avanzolini, Andrea; Gagniere, Johan; Pezet, Denis; Cianchi, Fabio; Badii, Benedetta; Novotny, Alexander; Eren, Tunc; Leblebici, Metin; Goergen, Martine; Zhang, Ben; Zhao, Yong-Liang; Liu, Tong; Al-Refaie, Waddah; Ma, Junjun; Takiguchi, Shuji; Lequeu, Jean-Baptiste; Trastulli, Stefano; Parisi, Amilcare

    2015-01-01

    Introduction Gastric cancer represents a great challenge for healthcare providers and requires a multidisciplinary treatment approach in which surgery plays a major role. Minimally invasive surgery has been progressively developed, first with the advent of laparoscopy and recently with the spread of robotic surgery, but a number of issues are currently being debated, including the limitations in performing an effective extended lymph node dissection, the real advantages of robotic systems, the role of laparoscopy for Advanced Gastric Cancer, the reproducibility of a total intracorporeal technique and the oncological results achievable during long-term follow-up. Methods and analysis A multi-institutional international database will be established to evaluate the role of robotic, laparoscopic and open approaches in gastric cancer, comprising of information regarding surgical, clinical and oncological features. A chart review will be conducted to enter data of participants with gastric cancer, previously treated at the participating institutions. The database is the first of its kind, through an international electronic submission system and a HIPPA protected real time data repository from high volume gastric cancer centres. Ethics and dissemination This study is conducted in compliance with ethical principles originating from the Helsinki Declaration, within the guidelines of Good Clinical Practice and relevant laws/regulations. A multicentre study with a large number of patients will permit further investigation of the safety and efficacy as well as the long-term outcomes of robotic, laparoscopic and open approaches for the management of gastric cancer. Trial registration number NCT02325453; Pre-results. PMID:26482769

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

    Science.gov (United States)

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

    2014-06-01

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

  1. Readability of Invasive Procedure Consent Forms.

    Science.gov (United States)

    Eltorai, Adam E M; Naqvi, Syed S; Ghanian, Soha; Eberson, Craig P; Weiss, Arnold-Peter C; Born, Christopher T; Daniels, Alan H

    2015-12-01

    Informed consent is a pillar of ethical medicine which requires patients to fully comprehend relevant issues including the risks, benefits, and alternatives of an intervention. Given the average reading skill of US adults is at the 8th grade level, the American Medical Association (AMA) and the National Institutes of Health (NIH) recommend patient information materials should not exceed a 6th grade reading level. We hypothesized that text provided in invasive procedure consent forms would exceed recommended readability guidelines for medical information. To test this hypothesis, we gathered procedure consent forms from all surgical inpatient hospitals in the state of Rhode Island. For each consent form, readability analysis was measured with the following measures: Flesch Reading Ease Formula, Flesch-Kincaid Grade Level, Fog Scale, SMOG Index, Coleman-Liau Index, Automated Readability Index, and Linsear Write Formula. These readability scores were used to calculate a composite Text Readability Consensus Grade Level. Invasive procedure consent forms were found to be written at an average of 15th grade level (i.e., third year of college), which is significantly higher than the average US adult reading level of 8th grade (p readability guidelines for patient materials of 6th grade (p readability levels which makes comprehension difficult or impossible for many patients. Efforts to improve the readability of procedural consent forms should improve patient understanding regarding their healthcare decisions. © 2015 Wiley Periodicals, Inc.

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

    Science.gov (United States)

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

    2018-05-16

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

  3. Efficacy of the Stonehenge Technique for Minimally Invasive Aortic Valve Replacement via Right Infraaxillary Thoracotomy.

    Science.gov (United States)

    Yamazaki, Masataka; Kin, Hajime; Kitamoto, Shohei; Yamanaka, Shota; Nishida, Hidefumi; Nishigawa, Kosaku; Takanashi, Shuichiro

    2017-02-20

    Minimally invasive cardiac surgeries for aortic valve replacement (AVR) are still a technical challenge for surgeons because these procedures are undertaken through small incisions and deep surgical fields. Although AVR via vertical infraaxillary thoracotomy can be a cosmetically superior option, a disadvantage of this approach is the distance between the thoracotomy incision and the ascending aorta. Therefore, we devised a technique to perform all manipulations using the fingertips without the aid of a knot pusher or long-shafted surgical instruments. This was achieved by particular placement of several retracted sutures to the right chest wall. We named placement of these sutures the "Stonehenge technique." In conclusion, AVR via vertical infraaxillary thoracotomy with our Stonehenge technique can be safely and simply performed with superior cosmetic advantages.

  4. Does preoperative breast MRI significantly impact on initial surgical procedure and re-operation rates in patients with screen-detected invasive lobular carcinoma?

    International Nuclear Information System (INIS)

    Sinclair, K.; Sakellariou, S.; Dawson, N.; Litherland, J.

    2016-01-01

    Aim: To investigate whether magnetic resonance imaging (MRI) changes the management of patients with screen-detected invasive lobular carcinoma (ILC). Materials and methods: A retrospective, controlled, single-centre analysis of 138 cases of screen-detected ILC was performed. All patients were assessed by a single multidisciplinary team as to whether preoperative MRI altered the initial management decision or reduced re-operation rates. Results: Forty-three percent of patients had preoperative MRI. MRI guided surgical management in 40.7% patients. Primary mastectomy rates were not significantly different between the MRI and non-MRI groups (32% and 30% respectively, p=0.71). The MRI group had a lower secondary surgery rate (6.8% versus 15.2%); however, the results did not reach statistical significance, and there were no unnecessary mastectomies. Conclusion: MRI can be used appropriately to guide primary surgery in screen-detected ILC cases and affects the initial management decision in 40.7% of patients. It does not significantly affect the overall mastectomy rate or re-operation rates, but reduces the likelihood of the latter. As a result of this review, the authors' local policy for the use of MRI in screen-detected ILC patients has been modified. For patients undergoing mastectomy for ILC, MRI is no longer performed routinely to search for contralateral malignancy as this has no proven added benefit. - Highlights: • Breast magnetic resonance imaging (MRI) allows more accurate tumour assessment and detects additional foci of disease in invasive lobular carcinoma (ILC). • Over the study's 3 year time frame, MRI guided surgical management of 40.7% screen-detected ILC patients scanned. • No statistically significant difference in mastectomy rates between MRI and non MRI groups. • Observed lower re-operation rate (6.8%-v-15.2%) in MRI group not statistically significant. • No MRI benefit for contralateral disease detection in ILC patients for

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

    Science.gov (United States)

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

    2010-08-01

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

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

    Science.gov (United States)

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

    2015-10-01

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

  7. Neither pre-operative education or a minimally invasive procedure have any influence on the recovery time after total hip replacement.

    Science.gov (United States)

    Biau, David Jean; Porcher, Raphael; Roren, Alexandra; Babinet, Antoine; Rosencher, Nadia; Chevret, Sylvie; Poiraudeau, Serge; Anract, Philippe

    2015-08-01

    The purpose of this study was to evaluate pre-operative education versus no education and mini-invasive surgery versus standard surgery to reach complete independence. We conducted a four-arm randomized controlled trial of 209 patients. The primary outcome criterion was the time to reach complete functional independence. Secondary outcomes included the operative time, the estimated total blood loss, the pain level, the dose of morphine, and the time to discharge. There was no significant effect of either education (HR: 1.1; P = 0.77) or mini-invasive surgery (HR: 1.0; 95 %; P = 0.96) on the time to reach complete independence. The mini-invasive surgery group significantly reduced the total estimated blood loss (P = 0.0035) and decreased the dose of morphine necessary for titration in the recovery (P = 0.035). Neither pre-operative education nor mini-invasive surgery reduces the time to reach complete functional independence. Mini-invasive surgery significantly reduces blood loss and the need for morphine consumption.

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

    Science.gov (United States)

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

    2011-02-01

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

  9. 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

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

    Science.gov (United States)

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

    2013-02-01

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

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

    Science.gov (United States)

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

    2016-10-01

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

  12. Minimally Invasive Implantation of HeartWare Assist Device and Simultaneous Tricuspid Valve Reconstruction Through Partial Upper Sternotomy.

    Science.gov (United States)

    Hillebrand, Julia; Hoffmeier, Andreas; Djie Tiong Tjan, Tonny; Sindermann, Juergen R; Schmidt, Christoph; Martens, Sven; Scherer, Mirela

    2017-05-01

    Left ventricular assist device (LVAD) implantation is a well-established therapy to support patients with end-stage heart failure. However, the operative procedure is associated with severe trauma. Third generation LVADs like the HeartWare assist device (HeartWare, Inc., Framingham, MA, USA) are characterized by enhanced technology despite smaller size. These devices offer new minimally invasive surgical options. Tricuspid regurgitation requiring valve repair is frequent in patients with the need for mechanical circulatory support as it is strongly associated with ischemic and nonischemic cardiomyopathy. We report on HeartWare LVAD implantation and simultaneous tricuspid valve reconstruction through minimally invasive access by partial upper sternotomy to the fifth left intercostal space. Four male patients (mean age 51.72 ± 11.95 years) suffering from chronic heart failure due to dilative (three patients) and ischemic (one patient) cardiomyopathy and also exhibiting concomitant tricuspid valve insufficiency due to annular dilation underwent VAD implantation and tricuspid valve annuloplasty. Extracorporeal circulation was established via the ascending aorta, superior vena cava, and right atrium. In all four cases the LVAD implantation and tricuspid valve repair via partial median sternotomy was successful. During the operative procedure, no conversion to full sternotomy was necessary. One patient needed postoperative re-exploration because of pericardial effusion. No postoperative focal neurologic injury was observed. New generation VADs are advantageous because of the possibility of minimally invasive implantation procedure which can therefore minimize surgical trauma. Concomitant tricuspid valve reconstruction can also be performed simultaneously through partial upper sternotomy. Nevertheless, minimally invasive LVAD implantation is a challenging operative technique. © 2016 International Center for Artificial Organs and Transplantation and Wiley Periodicals

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

    Science.gov (United States)

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

    2017-09-01

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

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

    Directory of Open Access Journals (Sweden)

    B. Chandrashekar

    2012-01-01

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

  15. Minimally invasive soft tissue release of foot and ankle contracture secondary to stroke.

    Science.gov (United States)

    Boffeli, Troy J; Collier, Rachel C

    2014-01-01

    Lower extremity contracture associated with stroke commonly results in a nonreducible, spastic equinovarus deformity of the foot and ankle. Rigid contracture deformity leads to gait instability, pain, bracing difficulties, and ulcerations. The classic surgical approach for stroke-related contracture of the foot and ankle has been combinations of tendon lengthening, tendon transfer, osteotomy, and joint fusion procedures. Recovery after traditional foot and ankle reconstructive surgery requires a period of non-weightbearing that is not typically practical for these patients. Little focus has been given in published studies on minimally invasive soft tissue release of contracture. We present the case of a 61-year-old female with an equinovarus foot contracture deformity secondary to stroke. The patient underwent Achilles tendon lengthening, posterior tibial tendon Z lengthening, and digital flexor tenotomy of each toe with immediate weightbearing in a walking boot, followed by transition to an ankle-foot orthosis. The surgical principles and technique tips are presented to demonstrate our minimally invasive approach to release of foot and ankle contracture secondary to stroke. The main goal of this approach is to improve foot and ankle alignment for ease of bracing, which, in turn, will improve gait, reduce the risk of falls, decrease pain, and avoid the development of pressure sores. Copyright © 2014 American College of Foot and Ankle Surgeons. Published by Elsevier Inc. All rights reserved.

  16. 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.

  17. Robot-assisted "Santosh-Post Graduate Institute tubularized flap pyelovesicostomy" in a solitary functioning kidney with giant hydronephrosis: A minimally invasive salvage procedure.

    Science.gov (United States)

    Kumar, Santosh; Singh, Shivanshu; Kumar, Navneet

    2016-03-01

    We describe a case of a solitary functioning kidney with giant hydronephrosis secondary to ureteropelvic junction obstruction in a young girl who underwent successful robot-assisted tubularized flap pyelovesicostomy. The aim of this report was to highlight the feasibility and efficacy of this technique in salvaging such renal moieties and to present a brief review of the surgical options available for the management of giant hydronephrosis.

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

    Science.gov (United States)

    Ross, J W; Preston, M R

    2009-06-01

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

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

    Science.gov (United States)

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

    2014-01-01

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

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

    Directory of Open Access Journals (Sweden)

    Michael Woods

    2014-01-01

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

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

    Science.gov (United States)

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

    2018-05-01

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

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

    Science.gov (United States)

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

    2016-03-01

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

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

    Science.gov (United States)

    Harris, Michael J

    2003-09-01

    Localized prostate cancer is a common disease for which minimally invasive treatment methods are being explored. Perineal prostatectomy, as a historical open procedure, is modified to incorporate contemporary surgical ideas. There is relatively little in the literature regarding modern adaptations of perineal prostatectomy. This method of anatomic radical perineal prostatectomy has been developed to accomplish a minimally invasive method of achieving goals of disease control and preservation of genito-urinary functions. Prospective outcome data is accumulated on 508 consecutive radical perineal prostatectomies by a single surgeon. Pathologic stage and PSA detectability are measures of cancer control. Pad use and ability to complete intercourse measure urinary and sexual function. General complications and other outcome measures are evaluated. Freedom from PSA detectability by pathologic stage is 96.3%, 79.4%, and 69.4% for organ confined, specimen confined and margin positive in the absence of seminal vesical invasion with an average 4 years follow up (3-114 months). Margins are positive in 18% of cases. The average cancer size is 9.4g and 36% of cases have extracapsular invasion. By the first, third, sixth months and one year, 38%, 65%, 88% and 96% are free of pad use and report being dry. While over 80% of nerve-spared patients enjoy the return of spontaneous erectile function, the men with bilateral nerve preservation note earlier and more complete return of function. There are no cardiopulmonary complications or deaths. Transfusions occurred in 1%, none in the past 400 cases. Average total hospital charges are USD$4889.00 in 1999 and 2000. Anterior urethral strictures, anastomotic strictures and fecal urgency/stress flatus occur 2%, 2% and 2-4%, respectively. This method of prostatectomy is able to achieve complete cancer resection while preserving urinary and sexual function as well as laparoscopic or retropubic prostatectomy. The simplicity and minimally

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

    Science.gov (United States)

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

    2016-11-01

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

  6. Minimally invasive repair of pectus excavatum deformity.

    Science.gov (United States)

    Krasopoulos, George; Goldstraw, Peter

    2011-02-01

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

  7. [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.

  8. The Role of Minimally Invasive Plate Osteosynthesis in Rib Fixation: A Review

    Science.gov (United States)

    Bemelman, Michael; van Baal, Mark; Yuan, Jian Zhang; Leenen, Luke

    2016-01-01

    More than a century ago, the first scientific report was published about fracture fixation with plates. During the 1950’s, open reduction and plate fixation for fractures were standardized by the founders of Arbeitsgemeinschaft für osteosynthesefragen/Association for the Study of Internal Fixation. Since the introduction of plate fixation for fractures, several plates and screws have been developed, all with their own characteristics. To accomplice more fracture stability, it was thought the bigger the plate, the better. The counter side was a compromised blood supply of the bone, often resulting in bone necrosis and ultimately delayed or non-union. With the search and development of new materials and techniques for fracture fixation, less invasive procedures have become increasingly popular. This resulted in the minimally invasive plate osteosynthesis (MIPO) technique for fracture fixation. With the MIPO technique, procedures could be performed with smaller incisions and thus with less soft tissue damage and a better preserved blood supply. The last 5 years rib fixation has become increasingly popular, rising evidence has become available suggesting that surgical rib fixation improves outcome of patients with a flail chest or isolated rib fractures. Many surgical approaches for rib fixation have been described in the old literature, however, most of these techniques are obscure nowadays. Currently mostly large incisions with considerable surgical insult are used to stabilize rib fractures. We think that MIPO deserves a place in the surgical treatment of rib fractures. We present the aspects of diagnosis, preoperative planning and operative techniques in regard to MIPO rib fixation. PMID:26889439

  9. The Role of Minimally Invasive Plate Osteosynthesis in Rib Fixation: A Review

    Directory of Open Access Journals (Sweden)

    Michael Bemelman

    2016-02-01

    Full Text Available More than a century ago, the first scientific report was published about fracture fixation with plates. During the 1950’s, open reduction and plate fixation for fractures were standardized by the founders of Arbeitsgemeinschaft für osteosynthesefragen/Association for the Study of Internal Fixation. Since the introduction of plate fixation for fractures, several plates and screws have been developed, all with their own characteristics. To accomplice more fracture stability, it was thought the bigger the plate, the better. The counter side was a compromised blood supply of the bone, often resulting in bone necrosis and ultimately delayed or non-union. With the search and development of new materials and techniques for fracture fixation, less invasive procedures have become increasingly popular. This resulted in the minimally invasive plate osteosynthesis (MIPO technique for fracture fixation. With the MIPO technique, procedures could be performed with smaller incisions and thus with less soft tissue damage and a better preserved blood supply. The last 5 years rib fixation has become increasingly popular, rising evidence has becomeavailable suggesting that surgical rib fixation improves outcome of patients with a flail chest or isolated rib fractures. Many surgical approaches for rib fixation have been described in the old literature, however, most of these techniques are obscure nowadays. Currently mostly large incisions with considerable surgical insult are used to stabilize rib fractures. We think that MIPO deserves a place in the surgical treatment of rib fractures. We present the aspects of diagnosis, preoperative planning and operative techniques in regard to MIPO rib fixation.

  10. Long-term professional performance of minimally invasive surgery post-graduates

    Directory of Open Access Journals (Sweden)

    Marcelo de Paula Loureiro

    Full Text Available OBJECTIVE: to evaluate the contribution of a post-graduation program in surgeons professional careers. METHODS: participants were asked to answer a questionnaire with questions related to possible changes in their professional performance after the end of the course. RESULTS: forty-three (76.7% of the 56 participants eligible for the study responded to the questionnaires. Most participants, 32 (74.4%, had previous contact with laparoscopic surgery; however, only 14 (32.5% reported the experience as primary surgeon. The expectations on the course were reached or exceeded for 36 (83.7% participants. Thirty-seven (86% incorporated minimally invasive procedures in their daily surgical practice, 37 (86% reported improvements in their income above 10% and 12% reported income increase of over 100%, directly related to their increase of laparoscopic activity. CONCLUSION: the program in minimally invasive surgery provides a high level of satisfaction to its participants, enables them to perform more complex technical procedures, such as sutures, and improves their professional economic performance.

  11. 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.

  12. Navicular stress fractures treated with minimally invasive fixation

    Directory of Open Access Journals (Sweden)

    Korula Mani Jacob

    2013-01-01

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

  13. Management of pilonidal sinus by Kshar Sutra, a minimally invasive treatment.

    Science.gov (United States)

    Dwivedi, Amar P

    2010-04-01

    A Pilonidal sinus (PNS) occurs in the cleavage between the buttocks (natal cleft) and can cause discomfort, embarrassment and absence from work. It is more common in men (as they have more hair) than in women. The most commonly used surgical techniques for this disorder include excision and primary closure and excision with reconstructive flap. However, the risk of recurrence or of developing an infection of the wound after the operation is high. Also, the patient requires longer hospitalization, and the procedure is expensive. There is a similarity between Shalyaj Nadi Vran described in Sushruta Samhita and Pilonidal sinus. Sushruta has advocated a minimally invasive para-surgical treatment, viz., Kshar Sutra procedure, for nadi vran. Hence this therapy was tried in Pilonidal sinus, and is described in this case report. Kshar Sutra treatment not only minimizes complications and recurrence but also enables the patient to resume work quicker and with less discomfort, impact upon body image and self-esteem as well as reduced cost.

  14. Minimally invasive distal first metatarsal osteotomy can be an option for recurrent hallux valgus.

    Science.gov (United States)

    Magnan, Bruno; Negri, Stefano; Maluta, Tommaso; Dall'Oca, Carlo; Samaila, Elena

    2018-01-12

    Recurrence rate of surgical treatment of hallux valgus ranges in the literature from 2.7% to 16%, regardless of used procedure. In this study, long-term results of a minimally invasive distal osteotomy of the first metatarsal bone for treatment of recurrent hallux valgus are described. 32 consecutive percutaneous distal osteotomies of the first metatarsal were performed in 26 patients for treatment of recurrent hallux valgus. Primary surgery had been soft tissue procedures in 8 cases (25%), first metatarsal or phalangeal osteotomies in 19 cases (59.4%) and Keller procedures in 5 cases (15.6%). Patients were assessed with a mean follow-up of 9.8±4.3 years. All patients reported the disappearance or reduction of the pain. The mean overall AOFAS score improved from 46.9±17.8 points to 85.2±14.9 at final follow-up. The mean hallux valgus angle decreased from 26.1±9.1 to 9.7±5.4°, the intermetatarsal angle decreased from 11.5±4.5 to 6.7±4.0°. No major complications were recorded with a re-recurrence rate of 3.1% (1 case). Percutaneous distal osteotomy of the first metatarsal can be a reliable and safe surgical option in the recurrent hallux valgus with low complication rate and the advantages of a minimally invasive surgery. IV, Retrospective Case Series. Copyright © 2018 European Foot and Ankle Society. Published by Elsevier Ltd. All rights reserved.

  15. Video content analysis of surgical procedures.

    Science.gov (United States)

    Loukas, Constantinos

    2018-02-01

    In addition to its therapeutic benefits, minimally invasive surgery offers the potential for video recording of the operation. The videos may be archived and used later for reasons such as cognitive training, skills assessment, and workflow analysis. Methods from the major field of video content analysis and representation are increasingly applied in the surgical domain. In this paper, we review recent developments and analyze future directions in the field of content-based video analysis of surgical operations. The review was obtained from PubMed and Google Scholar search on combinations of the following keywords: 'surgery', 'video', 'phase', 'task', 'skills', 'event', 'shot', 'analysis', 'retrieval', 'detection', 'classification', and 'recognition'. The collected articles were categorized and reviewed based on the technical goal sought, type of surgery performed, and structure of the operation. A total of 81 articles were included. The publication activity is constantly increasing; more than 50% of these articles were published in the last 3 years. Significant research has been performed for video task detection and retrieval in eye surgery. In endoscopic surgery, the research activity is more diverse: gesture/task classification, skills assessment, tool type recognition, shot/event detection and retrieval. Recent works employ deep neural networks for phase and tool recognition as well as shot detection. Content-based video analysis of surgical operations is a rapidly expanding field. Several future prospects for research exist including, inter alia, shot boundary detection, keyframe extraction, video summarization, pattern discovery, and video annotation. The development of publicly available benchmark datasets to evaluate and compare task-specific algorithms is essential.

  16. Minimally invasive plate osteosynthesis for humerus diaphyseal fractures

    Directory of Open Access Journals (Sweden)

    M Shantharam Shetty

    2011-01-01

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

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

    Science.gov (United States)

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

    2016-11-01

    The purpose of this case-control study was to evaluate the impact of hybrid minimally invasive esophagectomy for cancer on surgical stress response and nutritional status. All 34 consecutive patients undergoing hybrid minimally invasive esophagectomy for cancer at our surgical unit between 2008 and 2013 were retrospectively compared with 34 patients undergoing esophagectomy with open gastric tubulization (open), matched for neoadjuvant therapy, pathological stage, gender and age. Demographic data, tumor features and postoperative course (including quality of life and systemic inflammatory and nutritional status) were compared. Postoperative course was similar in terms of complication rate. Length of stay in intensive care unit was shorter in patients undergoing hybrid minimally invasive esophagectomy (P = 0.002). In the first postoperative day, patients undergoing hybrid minimally invasive esophagectomy had lower C-reactive protein levels (P = 0.001) and white cell blood count (P = 0.05), and higher albumin serum level (P = 0.001). In this group, albumin remained higher also at third (P = 0.06) and seventh (P = 0.008) postoperative day, and C-reactive protein resulted lower at third post day (P = 0.04). Hybrid minimally invasive esophagectomy significantly improved the systemic inflammatory and catabolic response to surgical trauma, contributing to a shorter length of stay in intensive care unit. © 2015 International Society for Diseases of the Esophagus.

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

    Science.gov (United States)

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

    2013-01-01

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

  19. Heart bypass surgery - minimally invasive - discharge

    Science.gov (United States)

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

  20. Chronic Morel-Lavallée Lesion: A Novel Minimally Invasive Method of Treatment.

    Science.gov (United States)

    Mettu, Ramireddy; Surath, Harsha Vardhan; Chayam, Hanumantha Rao; Surath, Amaranth

    2016-11-01

    A Morel-Lavallée lesion is a closed internal degloving injury resulting from a shearing force applied to the skin. The etiology of this condition may be motor vehicle accidents, falls, contact sports (ie, football, wrestling),1 and iatrogenic after mammoplasty or abdominal liposuction.2 Common sites of the lesions include the pelvis and/or thigh.3 Isolated Morel-Lavallée lesions without underlying fracture are likely to be missed, which result in chronicity. Management of this condition often requires extensive surgical procedures such as debridement, sclerotherapy, serial percutaneous drainage, negative pressure wound therapy (NPWT), and skin grafting.4,5 The authors wish to highlight a minimally invasive technique for the treatment of chronic Morel-Lavallée lesions.

  1. Temporal trends and predictors of pelvic lymph node dissection in open or minimally invasive radical prostatectomy.

    Science.gov (United States)

    Feifer, Andrew H; Elkin, Elena B; Lowrance, William T; Denton, Brian; Jacks, Lindsay; Yee, David S; Coleman, Jonathan A; Laudone, Vincent P; Scardino, Peter T; Eastham, James A

    2011-09-01

    Pelvic lymph node dissection (PLND) is an important component of prostate cancer staging and treatment, especially for surgical patients who have high-risk tumor features. It is not clear how the shift from open radical prostatectomy (ORP) to minimally invasive radical prostatectomy (MIRP) has affected the use of PLND. The objectives of this study were to identify predictors of PLND and to assess the impact of surgical technique in a contemporary, population-based cohort. In Surveillance, Epidemiology, and End Results (SEER) cancer registry data linked with Medicare claims, the authors identified men who underwent ORP or MIRP for prostate cancer during 2003 to 2007. The impact of surgical approach on PLND was evaluated, and interactions were examined between surgical procedure, prostate-specific antigen (PSA), and Gleason score with the analysis controlled for patient and tumor characteristics. Of 6608 men who underwent ORP or MIRP, 70% (n = 4600) underwent PLND. The use of PLND declined over time both overall and within subgroups defined by procedure type. PLND was 5 times more likely in men who underwent ORP than in men who underwent MIRP when the analysis was controlled for patient and tumor characteristics. Elevated PSA and biopsy Gleason score, but not clinical stage, were associated with a greater odds of PLND in both the ORP group and the MIRP group. However, the magnitude of the association between these factors and PLND was significantly greater for patients in the ORP group. PLND was less common among men who underwent MIRP, independent of tumor risk factors. A decline in PLND rates was not fully explained by an increase in MIRP. The authors concluded that these trends may signal a surgical approach-dependent disparity in prostate cancer staging and therapy. Cancer 2011 © 2011 American Cancer Society.

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

    Science.gov (United States)

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

    2014-01-01

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

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

    Directory of Open Access Journals (Sweden)

    Pertl, Daniela

    2014-10-01

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

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

    OpenAIRE

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

    2015-01-01

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

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

    NARCIS (Netherlands)

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

    2015-01-01

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

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

    OpenAIRE

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

    2014-01-01

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

  7. A 3D virtual reality simulator for training of minimally invasive surgery.

    Science.gov (United States)

    Mi, Shao-Hua; Hou, Zeng-Gunag; Yang, Fan; Xie, Xiao-Liang; Bian, Gui-Bin

    2014-01-01

    For the last decade, remarkable progress has been made in the field of cardiovascular disease treatment. However, these complex medical procedures require a combination of rich experience and technical skills. In this paper, a 3D virtual reality simulator for core skills training in minimally invasive surgery is presented. The system can generate realistic 3D vascular models segmented from patient datasets, including a beating heart, and provide a real-time computation of force and force feedback module for surgical simulation. Instruments, such as a catheter or guide wire, are represented by a multi-body mass-spring model. In addition, a realistic user interface with multiple windows and real-time 3D views are developed. Moreover, the simulator is also provided with a human-machine interaction module that gives doctors the sense of touch during the surgery training, enables them to control the motion of a virtual catheter/guide wire inside a complex vascular model. Experimental results show that the simulator is suitable for minimally invasive surgery training.

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

    Science.gov (United States)

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

    2016-01-01

    Sacroiliac joint (SIJ) dysfunction is associated with a marked decrease in quality of life. Increasing evidence supports minimally invasive SIJ fusion as a safe and effective procedure for the treatment of chronic SIJ dysfunction. The impact of SIJ fusion on worker productivity is not known. Regression modeling using data from the National Health Interview Survey was applied to determine the relationship between responses to selected interview questions related to function and economic outcomes. Regression coefficients were then applied to prospectively collected, individual patient data in a randomized trial of SIJ fusion (INSITE, NCT01681004) to estimate expected differences in economic outcomes across treatments. Patients who receive SIJ fusion using iFuse Implant System(®) have an expected increase in the probability of working of 16% (95% confidence interval [CI] 11%-21%) relative to nonsurgical patients. The expected change in earnings across groups was US $3,128 (not statistically significant). Combining the two metrics, the annual increase in worker productivity given surgical vs nonsurgical care was $6,924 (95% CI $1,890-$11,945). For employees with chronic, severe SIJ dysfunction, minimally invasive SIJ fusion may improve worker productivity compared to nonsurgical treatment.

  9. 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

  10. Theory of invasion extinction dynamics in minimal food webs

    Science.gov (United States)

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

    2018-02-01

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

  11. 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.

  12. Minimally Invasive, Organ-preserving Surgery for Large Submucosal Tumors in the Abdominal Esophagus.

    Science.gov (United States)

    Kanehira, Eiji; Tanida, Takashi; Kamei, Aya; Takahashi, Kodai

    2017-06-01

    Surgical resection of submucosal tumors (SMTs) in the abdominal esophagus is not standardized. Enucleation may be a minimally invasive option, whereas its oncological validity is not very clear. Moreover, how to treat the esophageal wall defect after enucleation and necessity of additional antireflux procedure are also undetermined. In 13 patients with a SMT originating the abdominal esophagus laparoscopic enucleation was performed with preserving the integrity of submucosa. When the muscular layer defect was esophagus was dissected posteriorly or the myotomy was not closed. Tumors were resected en-bloc without rupture in all cases. In 5 patients myotomy was closed, whereas in the remaining 8 it was left open. In 11 patients fundoplication was added (Toupet in 5 and Dor in 6). The patients developed neither regurgitation nor stenosis postoperatively. The histopathologic findings revealed leiomyoma in 9 patients, whereas the other 4 were miscellaneous. The average tumor size was 5.5 cm (range, 2.8 to 8.8). Microscopically surgical margin was negative in all cases. Laparoscopic enucleation of SMTs in the abdominal esophagus seems to be safe, reproducible operation enabling preservation of function of the lower esophagus and esophagogastric junction. Even when the muscular defect is not approximated additional fundoplication can minimize the risk of postoperative reflux disease.

  13. Non-technical skills in minimally invasive surgery teams

    DEFF Research Database (Denmark)

    Gjeraa, Kirsten; Spanager, Lene; Konge, Lars

    2016-01-01

    BACKGROUND: Root cause analyses show that up to 70 % of adverse events are caused by human error. Strong non-technical skills (NTS) can prevent or reduce these errors, considerable numbers of which occur in the operating theatre. Minimally invasive surgery (MIS) requires manipulation of more...... complex equipment than open procedures, likely requiring a different set of NTS for each kind of team. The aims of this study were to identify the MIS teams' key NTS and investigate the effect of training and assessment of NTS on MIS teams. METHODS: The databases of PubMed, Cochrane Library, Embase, Psyc...... were included. All were observational studies without blinding, and they differed in aims, types of evaluation, and outcomes. Only two studies evaluated patient outcomes other than operative time, and overall, the studies' quality of evidence was low. Different communication types were encountered...

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

    Science.gov (United States)

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

    2016-03-01

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

  15. Minimally Invasive Treatment of Male Lower Urinary Tract Symptoms

    NARCIS (Netherlands)

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

    2008-01-01

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

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

    Science.gov (United States)

    Hsiao, Kenneth C.; Machaidze, Zurab

    2004-01-01

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

  17. 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

    2015-01-01

    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%. PMID:26650236

  18. 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%.

  19. 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.

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

    Science.gov (United States)

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

    2010-09-28

    Lasers have in principle the capability to cut at the level of a single cell, the fundamental limit to minimally invasive procedures and restructuring biological tissues. To date, this limit has not been achieved due to collateral damage on the macroscale that arises from thermal and shock wave induced collateral damage of surrounding tissue. Here, we report on a novel concept using a specifically designed Picosecond IR Laser (PIRL) that selectively energizes water molecules in the tissue to drive ablation or cutting process faster than thermal exchange of energy and shock wave propagation, without plasma formation or ionizing radiation effects. The targeted laser process imparts the least amount of energy in the remaining tissue without any of the deleterious photochemical or photothermal effects that accompanies other laser wavelengths and pulse parameters. Full thickness incisional and excisional wounds were generated in CD1 mice using the Picosecond IR Laser, a conventional surgical laser (DELight Er:YAG) or mechanical surgical tools. Transmission and scanning electron microscopy showed that the PIRL laser produced minimal tissue ablation with less damage of surrounding tissues than wounds formed using the other modalities. The width of scars formed by wounds made by the PIRL laser were half that of the scars produced using either a conventional surgical laser or a scalpel. Aniline blue staining showed higher levels of collagen in the early stage of the wounds produced using the PIRL laser, suggesting that these wounds mature faster. There were more viable cells extracted from skin using the PIRL laser, suggesting less cellular damage. β-catenin and TGF-β signalling, which are activated during the proliferative phase of wound healing, and whose level of activation correlates with the size of wounds was lower in wounds generated by the PIRL system. Wounds created with the PIRL systsem also showed a lower rate of cell proliferation. Direct comparison of wound

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

    Directory of Open Access Journals (Sweden)

    Saeid Amini-Nik

    2010-09-01

    Full Text Available Lasers have in principle the capability to cut at the level of a single cell, the fundamental limit to minimally invasive procedures and restructuring biological tissues. To date, this limit has not been achieved due to collateral damage on the macroscale that arises from thermal and shock wave induced collateral damage of surrounding tissue. Here, we report on a novel concept using a specifically designed Picosecond IR Laser (PIRL that selectively energizes water molecules in the tissue to drive ablation or cutting process faster than thermal exchange of energy and shock wave propagation, without plasma formation or ionizing radiation effects. The targeted laser process imparts the least amount of energy in the remaining tissue without any of the deleterious photochemical or photothermal effects that accompanies other laser wavelengths and pulse parameters. Full thickness incisional and excisional wounds were generated in CD1 mice using the Picosecond IR Laser, a conventional surgical laser (DELight Er:YAG or mechanical surgical tools. Transmission and scanning electron microscopy showed that the PIRL laser produced minimal tissue ablation with less damage of surrounding tissues than wounds formed using the other modalities. The width of scars formed by wounds made by the PIRL laser were half that of the scars produced using either a conventional surgical laser or a scalpel. Aniline blue staining showed higher levels of collagen in the early stage of the wounds produced using the PIRL laser, suggesting that these wounds mature faster. There were more viable cells extracted from skin using the PIRL laser, suggesting less cellular damage. β-catenin and TGF-β signalling, which are activated during the proliferative phase of wound healing, and whose level of activation correlates with the size of wounds was lower in wounds generated by the PIRL system. Wounds created with the PIRL systsem also showed a lower rate of cell proliferation. Direct

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

    Science.gov (United States)

    Hernández-Alfaro, Federico; Guijarro-Martínez, Raquel

    2012-05-01

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

  3. Minimally invasive surgery for esophageal motility disorders.

    Science.gov (United States)

    Balaji, Nagammapudur S; Peters, Jeffrey H

    2002-08-01

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

  4. Uniportal thoracoscopy combined with laparoscopy as minimally invasive treatment of esophageal cancer.

    Science.gov (United States)

    Caronia, Francesco Paolo; Arrigo, Ettore; Failla, Andrea Valentino; Sgalambro, Francesco; Giannone, Giorgio; Lo Monte, Attilio Ignazio; Cajozzo, Massimo; Santini, Mario; Fiorelli, Alfonso

    2018-04-01

    A 67-year-old man was referred to our attention for management of esophageal adenocarcinoma, localized at the level of the esophagogastric junction and obstructed the 1/3 of the esophageal lumen. Due to the extension of the disease (T3N1M0-Stage IIIA), the patient underwent neo-adjuvant chemo-radiation therapy and he was then scheduled for a minimally invasive surgical procedure including laparoscopic gastroplasty, uniportal thoracoscopic esophageal dissection and intrathoracic end-to-end esophago-gastric anastomosis. No intraoperative and post-operative complications were seen. The patient was discharged in post-operative day 9. Pathological study confirmed the diagnosis of adenocarcinoma (T2N1M0-Stage IIB) and he underwent adjuvant chemotherapy. At the time of present paper, patient is alive and well without signs of recurrence or metastasis. Our minimally approach compared to standard open procedure would help reduce post-operative pain and favours early return to normal activity. However, future experiences with a control group are required before our strategy can be widely used.

  5. Minimally Invasive Epicardial Pacemaker Implantation in Neonates with Congenital Heart Block.

    Science.gov (United States)

    Costa, Roberto; Silva, Katia Regina da; Martinelli Filho, Martino; Carrillo, Roger

    2017-10-01

    Few studies have characterized the surgical outcomes following epicardial pacemaker implantation in neonates with congenital complete atrioventricular block (CCAVB). This study sought to assess the long-term outcomes of a minimally invasive epicardial approach using a subxiphoid access for pacemaker implantation in neonates. Between July 2002 and February 2015, 16 consecutive neonates underwent epicardial pacemaker implantation due to CCAVB. Among these, 12 (75.0%) had congenital heart defects associated with CCAVB. The patients had a mean age of 4.7 ± 5.3 days and nine (56.3%) were female. Bipolar steroid-eluting epicardial leads were implanted in all patients through a minimally invasive subxiphoid approach and fixed on the diaphragmatic ventricular surface. The pulse generator was placed in an epigastric submuscular position. All procedures were successful, with no perioperative complications or early deaths. Mean operating time was 90.2 ± 16.8 minutes. None of the patients displayed pacing or sensing dysfunction, and all parameters remained stable throughout the follow-up period of 4.1 ± 3.9 years. Three children underwent pulse generator replacement due to normal battery depletion at 4.0, 7.2, and 9.0 years of age without the need of ventricular lead replacement. There were two deaths at 12 and 325 days after pacemaker implantation due to bleeding from thrombolytic use and progressive refractory heart failure, respectively. Epicardial pacemaker implantation through a subxiphoid approach in neonates with CCAVB is technically feasible and associated with excellent surgical outcomes and pacing lead longevity.

  6. 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.

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

    Science.gov (United States)

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

    2016-06-01

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

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

    Science.gov (United States)

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

    2001-01-01

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

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

    Directory of Open Access Journals (Sweden)

    Aaron Raney

    2017-10-01

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

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

    Directory of Open Access Journals (Sweden)

    Carl A. Nelson

    2012-01-01

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

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

    Directory of Open Access Journals (Sweden)

    A. V. Goncharov

    2017-01-01

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

  12. Surgical correction of gynecomastia with minimal scarring.

    Science.gov (United States)

    Lee, Jun-Ho; Kim, Il-Kug; Kim, Tae-Gon; Kim, Yong-Ha

    2012-12-01

    Gynecomastia is a benign, excessive development of the male breast that occurs at an overall incidence of 32-36 %. The authors effectively removed peripheral fat tissues with power-assisted liposuction (PAL) and periareolar glandular tissues with a cartilage shaver in a series of patients. The small periareolar incisions were not easily recognized. Between February 2010 and April 2012, the charts of 15 patients (28 breasts) treated with PAL and a cartilage shaver were retrospectively reviewed. The mean volume of fat tissue removed with liposuction was 319 mL, and the mean volume of glandular tissue removed with the cartilage shaver was 70 mL. The mean follow-up period was 11.2 months. No infection, nipple-areola complex necrosis, nipple retraction, or saucer deformity was encountered in this series. Intraoperative bleeding occurred in one patient. Mild asymmetries developed in three patients. Use of PAL and a cartilage shaver for the treatment of gynecomastia allows for effective removal of both the fat and the glandular tissue of the breast through a minimal periareolar incision. This technique can achieve excellent aesthetic results with inconspicuous scarring. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

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

    Science.gov (United States)

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

    2018-04-18

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

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

    Science.gov (United States)

    Mulholland, R Stephen

    2011-07-01

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

  15. Transanal minimally-invasive surgery (TAMIS: Technique and results from an initial experience

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    Carlos Ramon Silveira Mendes

    2013-10-01

    tamanho médio do tumor foi de 3,8 (1,8-8 cm. Distância média de borda anal foi de 6,3 (3-12 cm. O tempo médio de operação foi de 53,73 (28-118 min. Taxa de complicação pós-operatória foi de 9,1%. Não houve readmissões. A mortalidade foi nula. Achados patológicos foram de adenoma em 4, adenocarcinoma invasivo em 2, carcinoma neuroendócrino em três, e nenhuma lesão residual em um caso. TAMIS é um procedimento minimamente invasivo, com baixa morbidade pós-operatória durante a experiência inicial. TAMIS é curativo para as lesões benignas e de cânceres selecionados. É útil após a terapia neoadjuvante para casos de câncer rigorosamente selecionados, enquanto os resultados de estudos multi-institucionais são aguardados. Keywords: Rectal neoplasms, Adenomatous polyps, Minimally-invasive surgical procedures, Palavras-chave: Neoplasias retais, Pólipos adenomatosos, Procedimentos cirúrgicos minima- mente invasivos

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

    Science.gov (United States)

    Tian, Yonghao; Liu, Xinyu

    2016-10-01

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

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

    Science.gov (United States)

    Hanson, Willard L.

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

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

    Science.gov (United States)

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

    2014-02-01

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

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

    Directory of Open Access Journals (Sweden)

    Li Z

    2017-01-01

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

  20. 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.

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

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    Azami Denas Azinar

    2017-11-01

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

  2. 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.

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

    Science.gov (United States)

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

    2018-01-07

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

  4. Characterization of aerosols produced by surgical procedures

    Energy Technology Data Exchange (ETDEWEB)

    Yeh, H.C.; Muggenburg, B.A.; Lundgren, D.L.; Guilmette, R.A.; Snipes, M.B.; Jones, R.K. [Inhalation Toxicology Research Institute, Albuquerque, NM (United States); Turner, R.S. [Lovelace Health Systems, Albuquerque, NM (United States)

    1994-07-01

    In many surgeries, especially orthopedic procedures, power tools such as saws and drills are used. These tools may produce aerosolized blood and other biological material from bone and soft tissues. Surgical lasers and electrocautery tools can also produce aerosols when tissues are vaporized and condensed. Studies have been reported in the literature concerning production of aerosols during surgery, and some of these aerosols may contain infectious material. Garden et al. (1988) reported the presence of papilloma virus DNA in the fumes produced from laser surgery, but the infectivity of the aerosol was not assessed. Moon and Nininger (1989) measured the size distribution and production rate of emissions from laser surgery and found that particles were generally less than 0.5 {mu}m diameter. More recently there has been concern expressed over the production of aerosolized blood during surgical procedures that require power tools. In an in vitro study, the production of an aerosol containing the human immunodeficiency virus (HIV) was reported when power tools were used to cut tissues with blood infected with HIV. Another study measured the size distribution of blood aerosols produced by surgical power tools and found blood-containing particles in a number of size ranges. Health care workers are anxious and concerned about whether surgically produced aerosols are inspirable and can contain viable pathogens such as HIV. Other pathogens such as hepatitis B virus (HBV) are also of concern. The Occupational Safety and Health funded a project at the National Institute for Inhalation Toxicology Research Institute to assess the extent of aerosolization of blood and other tissues during surgical procedures. This document reports details of the experimental and sampling approach, methods, analyses, and results on potential production of blood-associated aerosols from surgical procedures in the laboratory and in the hospital surgical suite.

  5. 100 consecutive minimally invasive Heller myotomies: lessons learned.

    Science.gov (United States)

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

    2002-05-01

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

  6. 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.

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

    Science.gov (United States)

    Miller, Larry E; Block, Jon E

    2014-01-01

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

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

    Science.gov (United States)

    Judson, Benjamin L.; Shaha, Ashok R.

    2013-01-01

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

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

    Science.gov (United States)

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

    2018-03-01

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

  10. Is the femoral cannulation for minimally invasive aortic valve replacement necessary?

    Science.gov (United States)

    Cuenca, J; Rodriguez-Delgadillo, M A; Valle, J V; Campos, V; Herrera, J M; Rodriguez, F; Portela, F; Sorribas, F; Juffe, A

    1998-10-01

    sizes were 19, 21,23, and 25 mm in diameter were placed in four, nine, nine, and one of the cases, respectively. All patients underwent AVR electively and a transesophageal echocardiography probe is made. During surgery, conversion to median sternotomy was not required in any patient. Mean aortic cross-clamp time was 68 min (range 38-90 min). Mean total bypass time was 87 min (range 50-120 min). Mean postoperative bleeding was 434 ml. (range 200-850 ml). Perioperative blood transfusion was required in 17% of the patients. Mean mechanical ventilation time was 7.3 h (range 3-24 h), with a mean ICU stay of 18 h. Mean postoperative hospital stay was 4.5 days (range 3-10 days). In all cases, transthoracic and transesophageal echocardiography were performed postoperatively Prosthetic valve dysfunction was not observed. On the other hand, just one patient (4%) died 5 days after operation due to sudden cardiac death. Further, in two patients (8%), during follow-up, pericardial effusion is detected. In one case, cardiac tamponade with hemodynamic instability required a pericardial window procedure. In addition, in two patients (8%), non-infectious sternal dehiscence required reinforced sternal closure. Minimally invasive AVR surgery without femoral vessel cannulation is a safe procedure with less surgical aggression. After a learning curve, benefits on fast-track programs will be accomplished.

  11. Minimally invasive basilic vein transposition in the arm or forearm for autogenous haemodialysis access: A less morbid alternative to the conventional technique

    Directory of Open Access Journals (Sweden)

    Ankush Jairath

    2017-06-01

    Conclusion: Minimally invasive dissection of the basilic vein for vascular access transposition is a safe, reliable procedure with patency and functional outcomes comparable with those of conventional BVT.

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

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    Jia Ke

    2016-01-01

    Conclusions: This exploratory study demonstrated the safety of the newly developed image-guided minimally invasive cochlear implantation assisted by the bi-planar device and established the operational procedures. Further, more in vitro experiments are needed to improve the system operation and its safety.

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

    Directory of Open Access Journals (Sweden)

    Saulat Hasnain Fatimi

    2017-01-01

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

  14. Conditional long-term survival following minimally invasive robotic mitral valve repair: a health services perspective.

    Science.gov (United States)

    Efird, Jimmy T; Griffin, William F; Gudimella, Preeti; O'Neal, Wesley T; Davies, Stephen W; Crane, Patricia B; Anderson, Ethan J; Kindell, Linda C; Landrine, Hope; O'Neal, Jason B; Alwair, Hazaim; Kypson, Alan P; Nifong, Wiley L; Chitwood, W Randolph

    2015-09-01

    Conditional survival is defined as the probability of surviving an additional number of years beyond that already survived. The aim of this study was to compute conditional survival in patients who received a robotically assisted, minimally invasive mitral valve repair procedure (RMVP). Patients who received RMVP with annuloplasty band from May 2000 through April 2011 were included. A 5- and 10-year conditional survival model was computed using a multivariable product-limit method. Non-smoking men (≤65 years) who presented in sinus rhythm had a 96% probability of surviving at least 10 years if they survived their first year following surgery. In contrast, recent female smokers (>65 years) with preoperative atrial fibrillation only had an 11% probability of surviving beyond 10 years if alive after one year post-surgery. In the context of an increasingly managed healthcare environment, conditional survival provides useful information for patients needing to make important treatment decisions, physicians seeking to select patients most likely to benefit long-term following RMVP, and hospital administrators needing to comparatively assess the life-course economic value of high-tech surgical procedures.

  15. 3T MR-guided minimally-invasive penile fracture repair

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    Giovanni Rosi

    2016-03-01

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

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

    OpenAIRE

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

    2007-01-01

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

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

    Science.gov (United States)

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

    2013-02-01

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

  18. Minimally invasive piezosurgery for a safe placement of blade dental implants in jaws with severe bone loss

    Directory of Open Access Journals (Sweden)

    F. Rossi

    2014-10-01

    Full Text Available Aim :Severe atrophies of edentulous jaws require major reconstructive bone surgery in order to allow the placement of root-form implants with standard diameter. These bone augmentation techniques represent the best option reported in the literature, but they are often rejected by patients because of their high economic and biological costs in addition to the possibility of failure in the short and/or long term. In the maxilla regenerative methods (onlay, inlay, and distraction have high success rates, whereas in the mandible, especially in the distal atrophic area, they are not so predictable. In such situations an alternative technique for fixed prosthethic rebilitation is the insertion of platform blade implants, which have their elective indication for atrophic bone ridges with reduced width, owing to their reduced thickness. The aim of this study is to assess the effectiveness of the use of piezoelectric ultrasonic handpieces, in order to simplify the placement of blade implants, making it safer and less traumatic than with conventional surgical procedures. Materials and methods: Platform blade implants are extension implant functionally and aesthetically reliable, even if they require a more difficult surgical technique compared with the one currently in use for screw implants. A minimally invasive procedure by means of piezosurgery that was performed on 142 subjects is presented and a case is reported which highlights the successful results. Results: and conclusion The use of piezoelectric ultrasonic handpieces simplifies the surgical procedure for the placement of blade implant, making it safer and less traumatic.

  19. Rational decision making in a wide scenario of different minimally invasive lumbar interbody fusion approaches and devices.

    Science.gov (United States)

    Pimenta, Luiz; Tohmeh, Antoine; Jones, David; Amaral, Rodrigo; Marchi, Luis; Oliveira, Leonardo; Pittman, Bruce C; Bae, Hyun

    2018-03-01

    With the proliferation of a variety of modern MIS spine surgery procedures, it is mandatory that the surgeon dominate all aspects involved in surgical indication. The information related to the decision making in patient selection for specific procedures is mandatory for surgical success. The objective of this study is to present decision-making criteria in minimally invasive surgery (MIS) selection for a variety of patients and pathologies. In this article, practicing surgeons who specialize in various MIS approaches for spinal fusion were engaged to provide expert opinion and literature review on decision making criteria for several MIS procedures. Pros, cons, relative limitations, and case examples are provided for patient selection in treatment with MIS posterolateral fusion (MIS-PLF), mini anterior lumbar interbody fusion (mini-ALIF), lateral interbody fusion (LLIF), MIS posterior lumbar interbody fusion (MIS-PLIF) and MIS transforaminal lumbar interbody fusion (MIS-TLIF). There is a variety of aspects to consider when deciding which modern MIS surgical approach is most appropriate to use based on patient and pathologic characteristics. The surgeon must adapt them to the characteristic of each type of patients, helping them to choose the most effective and efficient therapeutic option for each case.

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

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    Alireza Tavassoli

    2016-11-01

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

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

    Science.gov (United States)

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

    2016-07-01

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

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

    Science.gov (United States)

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

    2017-07-01

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

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

    Science.gov (United States)

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

    2017-05-16

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

  4. Surgical Procedures for BPH/LUTS: Impact on Male Sexual Health.

    Science.gov (United States)

    Becher, Edgardo F; McVary, Kevin T

    2014-01-01

    Lower urinary tract symptoms (LUTS) because of benign prostatic hyperplasia (BPH) are a highly prevalent condition in men over 50 years old, and their incidence increases with age. The relationship between LUTS and erectile dysfunction (ED) has received increased attention recently because both diseases are highly prevalent, frequently co-associated in the same aging male group, and contribute significantly to the overall quality of life. In this review, we will examine the literature to assess the impact of surgical and minimally invasive treatments for LUTS/BPH on the male's sexual health. The impact of the various surgical and minimally invasive treatments for LUTS/BPH was reviewed to ascertain the impact on erectile and ejaculatory function. Sexual side effects of treatment for LUTS/BPH are underappreciated by urologists but likely play a prominent role in patient decision making, creating a disparity between provider and patient. Almost all accepted therapies for LUTS (surgical or medical) can affect some aspect of sexual health, making it imperative that health-care professionals understand their patients' concerns and motivations in these two linked diseases. The incidence of newly diagnosed postoperative ED in patients treated with monopolar transurethral resection (TURP) is around 14%, with reported values in various studies ranging from 0-32.5%, 7.7%, 6.5%, 17%, to 14%. Importantly, there is no significant difference reported between bipolar and monopolar TURP on sexual function. The risk of sexual side effects is an important one to consider in discussing the implications for any LUTS intervention as they play a prominent role in patient motivation, acceptance of bother and decision making concerning surgical intervention, thus creating a potential disparity between provider and patient. Becher EF and McVary KT. Surgical procedures for BPH/LUTS: Impact on male sexual health. Sex Med Rev 2014;2:47-55. Copyright © 2014 International Society for Sexual

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

    Science.gov (United States)

    Lorio, Morgan P.

    2016-01-01

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

  6. Minimally invasive diagnostics and immunotherapy of lung cancer

    NARCIS (Netherlands)

    Talebian-Yazdi, M.

    2017-01-01

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

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

    NARCIS (Netherlands)

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

    2004-01-01

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

  8. Minimally Invasive Technique for PMMA Augmentation of Fenestrated Screws

    Directory of Open Access Journals (Sweden)

    Jan-Helge Klingler

    2015-01-01

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

  9. A true minimally invasive approach for cochlear implantation: high accuracy in cranial base navigation through flat-panel-based volume computed tomography.

    Science.gov (United States)

    Majdani, Omid; Bartling, Soenke H; Leinung, Martin; Stöver, Timo; Lenarz, Minoo; Dullin, Christian; Lenarz, Thomas

    2008-02-01

    High-precision intraoperative navigation using high-resolution flat-panel volume computed tomography makes feasible the possibility of minimally invasive cochlear implant surgery, including cochleostomy. Conventional cochlear implant surgery is typically performed via mastoidectomy with facial recess to identify and avoid damage to vital anatomic landmarks. To accomplish this procedure via a minimally invasive approach--without performing mastoidectomy--in a precise fashion, image-guided technology is necessary. With such an approach, surgical time and expertise may be reduced, and hearing preservation may be improved. Flat-panel volume computed tomography was used to scan 4 human temporal bones. A drilling channel was planned preoperatively from the mastoid surface to the round window niche, providing a margin of safety to all functional important structures (e.g., facial nerve, chorda tympani, incus). Postoperatively, computed tomographic imaging and conventional surgical exploration of the drilled route to the cochlea were performed. All 4 specimens showed a cochleostomy located at the scala tympani anterior inferior to the round window. The chorda tympani was damaged in 1 specimen--this was preoperatively planned as a narrow facial recess was encountered. Using flat-panel volume computed tomography for image-guided surgical navigation, we were able to perform minimally invasive cochlear implant surgery defined as a narrow, single-channel mastoidotomy with cochleostomy. Although this finding is preliminary, it is technologically achievable.

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

    Energy Technology Data Exchange (ETDEWEB)

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

    2013-06-15

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

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

    International Nuclear Information System (INIS)

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

    2013-01-01

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

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

    Science.gov (United States)

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

    2017-08-01

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

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

    DEFF Research Database (Denmark)

    Jørgensen, Martin Kibsgaard; Kraus, Martin

    2017-01-01

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

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

    DEFF Research Database (Denmark)

    Jørgensen, Martin Kibsgaard; Kraus, Martin

    2017-01-01

    Minimal latency is important for augmented reality systems and teleoperation interfaces as even small increases in latency can affect user performance. Previously, we have developed an augmented reality system that can overlay stereoscopic video streams with computer graphics in order to improve....... The latency of the da Vinci S surgical system was on average 62 ms. None of the components of our overlay system (separately or combined) significantly affected the latency. However, the latency of the assistant's monitor increased by 14 ms. Passing the video streams through CPU or GPU memory increased...... visual communication in training for robot-assisted minimally invasive surgery with da Vinci surgical systems. To make sure that our augmented reality system provides the best possible user experience, we investigated the video latency of the da Vinci surgical system and how the components of our system...

  15. Minimally invasive or interventional repair of atrial septal defects in children: experience in 171 cases and comparison with conventional strategies.

    Science.gov (United States)

    Formigari, R; Di Donato, R M; Mazzera, E; Carotti, A; Rinelli, G; Parisi, F; Pasquini, L; Ballerini, L

    2001-05-01

    The goal of this study was to evaluate percutaneous interventional and minimally invasive surgical closure of secundum atrial septal defect (ASD) in children. Concern has surrounded abandoning conventional midline sternotomy in favor of the less invasive approaches pursuing a better cosmetic result and a more rational resource utilization. A retrospective analysis was performed on the patients treated from June 1996 to December 1998. One hundred seventy-one children (median age 5.8 years, median weight 22.1 kg) underwent 52 device implants, 72 minimally invasive surgical operations and 50 conventional sternotomy operations. There were no deaths and no residual left to right shunt in any of the groups. The overall complication rate causing delayed discharge was 12.6% for minimally invasive surgery, 12.0% for midline sternotomy and 3.8% for transcatheter device closure (p appeal of the percutaneous and minimally invasive approaches must be weighed against their greater exposure to technical pitfalls. Adequate training is needed if a strategy of surgical or percutaneous minimally invasive closure of ASD in children is planned in place of conventional surgery.

  16. Control of bleeding in surgical procedures: critical appraisal of HEMOPATCH (Sealing Hemostat

    Directory of Open Access Journals (Sweden)

    Lewis KM

    2015-12-01

    Full Text Available Kevin Michael Lewis,1 Carl Erik Kuntze,2 Heinz Gulle3 1Preclinical Safety and Efficacy, Baxter Healthcare Corporation, Deerfield, IL, USA; 2Medical Affairs, Baxter Healthcare SA, Zurich, Switzerland; 3Surgical Sciences and Engineering, Baxter Medical Products GmbH, Vienna, Austria Abstract: The need for advanced hemostatic agents increases with the complexity of surgical procedures and use of anticoagulation and antiplatelet treatments. HEMOPATCH (Sealing Hemostat is a novel, advanced hemostatic pad that is composed of a synthetic, protein-reactive monomer and a collagen backing. The active side is covered with a protein-reactive monomer: N-hydroxysuccinimide functionalized polyethylene glycol (NHS-PEG. NHS-PEG rapidly affixes the collagen pad to tissue to promote and maintain hemostasis. The combined action of the NHS-PEG and collagen is demonstrated to have benefit relative to other hemostatic agents in surgery and preclinical surgical models. This paper reviews the published investigations and case reports of the hemostatic efficacy of HEMOPATCH, wherein HEMOPATCH is demonstrated to be an effective, easy-to-use hemostatic agent in open and minimally invasive surgery of patients with thrombin- or platelet-induced coagulopathies. Keywords: HEMOPATCH, hemostasis, surgical hemostasis, sealing, surgical sealant

  17. New trends in minimally invasive urological surgery: what is beyond the robot?

    Science.gov (United States)

    Micali, Salvatore; Pini, Giovannalberto; Teber, Dogu; Sighinolfi, Maria Chiara; De Stefani, Stefano; Bianchi, Giampaolo; Rassweiler, Jens

    2013-06-01

    To review the minimal-invasive development of surgical technique in urology focusing on nomenclature, history and outcomes of Laparo-Endoscopic Single-site Surgery (LESS), Natural Orifice Translumenal Endoscopic Surgery (NOTES) and Computer-Assisted Surgery (CAS). A comprehensive literature search was conducted in order to find article related to LESS, NOTES and CAS in urology. The most relevant papers over the last 10 years were selected in base to the experience from the panel of experts, journal, authorship and/or content. Seven hundred and fifty manuscripts were found. Papers on LESS describe feasibility/safety in most of the procedures with a clinical experience of more than 300 cases and five compared results to standard laparoscopy without showing significant differences. NOTES accesses have been proved their feasibility/safety in experimental study. In human, the only procedures performed are on kidney and through a hybrid-Transvaginal route. New robots overcome the main drawbacks of the DaVinci® platform. The use of CAS is increasing its popularity in urology. LESS has been applied in clinical practice, but only ongoing technical and instrumental refinement will define its future role and overall benefit. The transition to a clinical application of NOTES seems at present only possible with multiple NOTES access and transvaginal access. Robot and Soft Tissue Navigation appear to be important to improve surgical skills. We are already witness to the advantages offered by the former even if costs need to be redefined based on pending long-term results. The latter will probably upgrade the quality of surgery in a near future.

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

    Directory of Open Access Journals (Sweden)

    Irfan Qamruddin

    2015-01-01

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

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

    Science.gov (United States)

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

    2016-04-01

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

  20. A randomized multicenter trial of minimally invasive rapid deployment versus conventional full sternotomy aortic valve replacement.

    Science.gov (United States)

    Borger, Michael A; Moustafine, Vadim; Conradi, Lenard; Knosalla, Christoph; Richter, Markus; Merk, Denis R; Doenst, Torsten; Hammerschmidt, Robert; Treede, Hendrik; Dohmen, Pascal; Strauch, Justus T

    2015-01-01

    Minimally invasive surgical procedures (MIS) may offer several advantages over conventional full sternotomy (FS) aortic valve replacement (AVR). A novel class of aortic valve prostheses has been developed for rapid-deployment AVR (RDAVR). We report a randomized, multicenter trial comparing the outcomes for MIS-RDAVR with those of conventional FS-AVR. A total of 100 patients with aortic stenosis were enrolled in a prospective, multicenter, randomized comparison trial (CADENCE-MIS). Exclusion criteria included ejection fraction below 25%, AVR requiring concomitant procedures, and recent myocardial infarction or stroke. Patients were randomized to undergo MIS-RDAVR through an upper hemisternotomy (n = 51) or AVR by FS with a conventional stented bioprosthesis (n = 49). Three patients were excluded before the procedure, and 3 more patients who were randomized to undergo RDAVR were excluded because of their anatomy. Procedural, early clinical outcomes, and functional outcomes were assessed for the remaining 94 patients. Hemodynamic performance was assessed by an echocardiography core laboratory. Implanted valve sizes were similar between groups (22.9 ± 2.1 vs 23.0 ± 2.1 mm, p = 0.9). MIS-RDAVR was associated with significantly reduced aortic cross-clamp times compared with FS-AVR (41.3 ± 20.3 vs 54.0 ± 20.3 minutes, p quality of life measures. The RDAVR patients had a significantly lower mean transvalvular gradient (8.5 vs 10.3 mm Hg, p = 0.044) and a lower prevalence of patient-prosthesis mismatch (0% vs 15.0%, p = 0.013) 3 months postoperatively compared with the FS-AVR patients. RDAVR by the MIS approach is associated with significantly reduced myocardial ischemic time and better valvular hemodynamic function than FS-AVR with a conventional stented bioprosthesis. Rapid deployment valves may facilitate the performance of MIS-AVR. Copyright © 2015 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.

  1. Intensive care unit audit: invasive procedure surveillance

    Directory of Open Access Journals (Sweden)

    Mariama Amaral Michels

    2013-01-01

    Full Text Available Rationale and objective: currently, Healthcare-associated Infections (HAIs constitute a serious public health problem. It is estimated that for every ten hospitalized patients, one will have infection after admission, generating high costs resulting from increased length of hospitalization, additional diagnostic and therapeutic interventions. The intensive care unit (ICU, due to its characteristics, is one of the most complex units of the hospital environment, a result of the equipment, the available technology, the severity of inpatients and the invasive procedures the latter are submitted to. The aim of the study was to evaluate the adherence to specifi c HAI prevention measures in invasive ICU procedures. Methods: This study had a quantitative, descriptive and exploratory approach. Among the risk factors for HAIs are the presence of central venous access, indwelling vesical catheter and mechanical ventilation, and, therefore, the indicators were calculated for patients undergoing these invasive procedures, through a questionnaire standardized by the Hospital Infection Control Commission (HICC. Results: For every 1,000 patients, 15 had catheter-related bloodstream infection, 6.85 had urinary tract infection associated with indwelling catheter in the fi rst half of 2010. Conclusion: most HAIs cannot be prevented, for reasons inherent to invasive procedures and the patients. However, their incidence can be reduced and controlled. The implementation of preventive measures based on scientifi c evidence can reduce HAIs signifi cantly and sustainably, resulting in safer health care services and reduced costs. The main means of prevention include the cleaning of hands, use of epidemiological block measures, when necessary, and specifi c care for each infection site. KEYWORDS Nosocomial infection. Intensive care units.

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

    Energy Technology Data Exchange (ETDEWEB)

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

    2015-05-15

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

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

    International Nuclear Information System (INIS)

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

    2015-01-01

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

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

    Science.gov (United States)

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

    2008-08-01

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

  5. Minimally Invasive Follicular Thyroid Carcinoma in Pediatric Age

    International Nuclear Information System (INIS)

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

    2009-01-01

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

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

    DEFF Research Database (Denmark)

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

    2013-01-01

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

  7. Ergonomics of disposable handles for minimally invasive surgery.

    Science.gov (United States)

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

    2010-05-01

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

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

    Science.gov (United States)

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

    2009-05-01

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

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

    OpenAIRE

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

    2017-01-01

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

  10. Tracked "Pick-Up" Ultrasound for Robot-Assisted Minimally Invasive Surgery.

    Science.gov (United States)

    Schneider, Caitlin; Nguan, Christopher; Rohling, Robert; Salcudean, Septimiu

    2016-02-01

    We present a novel "pick-up" ultrasound transducer for intraabdominal robot-assisted minimally invasive surgery. Such a "pick-up" ultrasound transducer is inserted through an abdominal incision at the beginning of the procedure and remains in the abdominal cavity throughout, eliminating the need for a dedicated port or a patient bedside surgical assistant. The transducer has a handle that can be grasped in a repeatable manner using a da Vinci Prograsp tool, allowing the transducer to be accurately manipulated by the surgeon using the da Vinci Robot. This is one way to enable 3-D tracking of the transducer, and, thus, mapping of the vasculature. The 3-D vascular images can be used to register preoperative CT to intraoperative camera images. To demonstrate the feasibility of the approach, we use an ultrasound vessel phantom to register a CT surface model to extracted ultrasound vessel models. The 3-D vascular phantom images are generated by segmenting B-mode images and tracking the pick-up ultrasound transducer with the da Vinci kinematics, internal electromagnetic sensor, or visible fiducials suitable for camera tracking. Reconstruction results using da Vinci kinematics for tracking give a target registration error of 5.4 ± 1.7 mm.

  11. 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.

  12. Psychomotor skills assessment by motion analysis in minimally invasive surgery on an animal organ.

    Science.gov (United States)

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

    2017-08-01

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

  13. 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.

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

    Science.gov (United States)

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

    2013-06-01

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

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

    International Nuclear Information System (INIS)

    Shini, Mohanad; Rubinsky, Boris

    2008-01-01

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

  16. 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.

  17. 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.

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

    Directory of Open Access Journals (Sweden)

    Miller LE

    2014-05-01

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

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

    Science.gov (United States)

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

    2014-01-01

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

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

    Science.gov (United States)

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

    2017-01-01

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

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

    Directory of Open Access Journals (Sweden)

    Shaoqi Tian

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

  2. Surgical Masculinization of the Breast: Clinical Classification and Surgical Procedures.

    Science.gov (United States)

    Cardenas-Camarena, Lazaro; Dorado, Carlos; Guerrero, Maria Teresa; Nava, Rosa

    2017-06-01

    Aesthetic breast area improvements for gynecomastia and gender dysphoria patients who seek a more masculine appearance have increased recently. We present our clinical experience in breast masculinization and a classification for these patients. From July 2003 to May 2014, 68 patients seeking a more masculine thorax underwent surgery. They were divided into five groups depending on three factors: excess fatty tissue, breast tissue, and skin. A specific surgical treatment was assigned according to each group. The surgical treatments included thoracic liposuction, subcutaneous mastectomy, periareolar skin resection in one or two stages, and mastectomy with a nipple areola complex graft. The evaluation was performed 6 months after surgery to determine the degree of satisfaction and presence of complications. Surgery was performed on a total of 68 patients, 45 male and 22 female, with ages ranging from 18 to 49 years, and an average age of 33 years. Liposuction alone was performed on five patients; subcutaneous mastectomy was performed on eight patients; subcutaneous mastectomy combined with liposuction was performed on 27 patients; periareolar skin resection was performed on 11 patients; and mastectomy with NAC free grafts was performed on 16 patients. The surgical procedure satisfied 94% of the patients, with very few complications. All patients who wish to obtain a masculine breast shape should be treated with only one objective regardless patient's gender: to obtain a masculine thorax. We recommend a simple mammary gland classification for determining the best surgical treatment for these patients LEVEL OF EVIDENCE V: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

  3. Minimally invasive versus open spine surgery: What does the best evidence tell us?

    Directory of Open Access Journals (Sweden)

    Shearwood McClelland

    2017-01-01

    Full Text Available Background: Spine surgery has been transformed significantly by the growth of minimally invasive surgery (MIS procedures. Easily marketable to patients as less invasive with smaller incisions, MIS is often perceived as superior to traditional open spine surgery. The highest quality evidence comparing MIS with open spine surgery was examined. Methods: A systematic review of randomized controlled trials (RCTs involving MIS versus open spine surgery was performed using the Entrez gateway of the PubMed database for articles published in English up to December 28, 2015. RCTs and systematic reviews of RCTs of MIS versus open spine surgery were evaluated for three particular entities: Cervical disc herniation, lumbar disc herniation, and posterior lumbar fusion. Results: A total of 17 RCTs were identified, along with six systematic reviews. For cervical disc herniation, MIS provided no difference in overall function, arm pain relief, or long-term neck pain. In lumbar disc herniation, MIS was inferior in providing leg/low back pain relief, rehospitalization rates, quality of life improvement, and exposed the surgeon to >10 times more radiation in return for shorter hospital stay and less surgical site infection. In posterior lumbar fusion, MIS transforaminal lumbar interbody fusion (TLIF had significantly reduced 2-year societal cost, fewer medical complications, reduced time to return to work, and improved short-term Oswestry Disability Index scores at the cost of higher revision rates, higher readmission rates, and more than twice the amount of intraoperative fluoroscopy. Conclusion: The highest levels of evidence do not support MIS over open surgery for cervical or lumbar disc herniation. However, MIS TLIF demonstrates advantages along with higher revision/readmission rates. Regardless of patient indication, MIS exposes the surgeon to significantly more radiation; it is unclear how this impacts patients. These results should optimize informed

  4. Minimally Invasive versus Open Spine Surgery: What Does the Best Evidence Tell Us?

    Science.gov (United States)

    McClelland, Shearwood; Goldstein, Jeffrey A

    2017-01-01

    Spine surgery has been transformed significantly by the growth of minimally invasive surgery (MIS) procedures. Easily marketable to patients as less invasive with smaller incisions, MIS is often perceived as superior to traditional open spine surgery. The highest quality evidence comparing MIS with open spine surgery was examined. A systematic review of randomized controlled trials (RCTs) involving MIS versus open spine surgery was performed using the Entrez gateway of the PubMed database for articles published in English up to December 28, 2015. RCTs and systematic reviews of RCTs of MIS versus open spine surgery were evaluated for three particular entities: Cervical disc herniation, lumbar disc herniation, and posterior lumbar fusion. A total of 17 RCTs were identified, along with six systematic reviews. For cervical disc herniation, MIS provided no difference in overall function, arm pain relief, or long-term neck pain. In lumbar disc herniation, MIS was inferior in providing leg/low back pain relief, rehospitalization rates, quality of life improvement, and exposed the surgeon to >10 times more radiation in return for shorter hospital stay and less surgical site infection. In posterior lumbar fusion, MIS transforaminal lumbar interbody fusion (TLIF) had significantly reduced 2-year societal cost, fewer medical complications, reduced time to return to work, and improved short-term Oswestry Disability Index scores at the cost of higher revision rates, higher readmission rates, and more than twice the amount of intraoperative fluoroscopy. The highest levels of evidence do not support MIS over open surgery for cervical or lumbar disc herniation. However, MIS TLIF demonstrates advantages along with higher revision/readmission rates. Regardless of patient indication, MIS exposes the surgeon to significantly more radiation; it is unclear how this impacts patients. These results should optimize informed decision-making regarding MIS versus open spine surgery

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

    Science.gov (United States)

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

    2018-04-17

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

  6. Minimally invasive versus open fusion for Grade I degenerative lumbar spondylolisthesis: analysis of the Quality Outcomes Database.

    Science.gov (United States)

    Mummaneni, Praveen V; Bisson, Erica F; Kerezoudis, Panagiotis; Glassman, Steven; Foley, Kevin; Slotkin, Jonathan R; Potts, Eric; Shaffrey, Mark; Shaffrey, Christopher I; Coric, Domagoj; Knightly, John; Park, Paul; Fu, Kai-Ming; Devin, Clinton J; Chotai, Silky; Chan, Andrew K; Virk, Michael; Asher, Anthony L; Bydon, Mohamad

    2017-08-01

    OBJECTIVE Lumbar spondylolisthesis is a degenerative condition that can be surgically treated with either open or minimally invasive decompression and instrumented fusion. Minimally invasive surgery (MIS) approaches may shorten recovery, reduce blood loss, and minimize soft-tissue damage with resultant reduced postoperative pain and disability. METHODS The authors queried the national, multicenter Quality Outcomes Database (QOD) registry for patients undergoing posterior lumbar fusion between July 2014 and December 2015 for Grade I degenerative spondylolisthesis. The authors recorded baseline and 12-month patient-reported outcomes (PROs), including Oswestry Disability Index (ODI), EQ-5D, numeric rating scale (NRS)-back pain (NRS-BP), NRS-leg pain (NRS-LP), and satisfaction (North American Spine Society satisfaction questionnaire). Multivariable regression models were fitted for hospital length of stay (LOS), 12-month PROs, and 90-day return to work, after adjusting for an array of preoperative and surgical variables. RESULTS A total of 345 patients (open surgery, n = 254; MIS, n = 91) from 11 participating sites were identified in the QOD. The follow-up rate at 12 months was 84% (83.5% [open surgery]; 85% [MIS]). Overall, baseline patient demographics, comorbidities, and clinical characteristics were similarly distributed between the cohorts. Two hundred fifty seven patients underwent 1-level fusion (open surgery, n = 181; MIS, n = 76), and 88 patients underwent 2-level fusion (open surgery, n = 73; MIS, n = 15). Patients in both groups reported significant improvement in all primary outcomes (all p open surgical groups. However, change in functional outcome scores for patients undergoing 2-level fusion was notably larger in the MIS cohort for ODI (-27 vs -16, p = 0.1), EQ-5D (0.27 vs 0.15, p = 0.08), and NRS-BP (-3.5 vs -2.7, p = 0.41); statistical significance was shown only for changes in NRS-LP scores (-4.9 vs -2.8, p = 0.02). On risk-adjusted analysis for 1

  7. 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.

  8. 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.

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

    Science.gov (United States)

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

    1998-01-01

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

  10. On mixed reality environments for minimally invasive therapy guidance: Systems architecture, successes and challenges in their implementation from laboratory to clinic

    Science.gov (United States)

    Linte, Cristian A.; Davenport, Katherine P.; Cleary, Kevin; Peters, Craig; Vosburgh, Kirby G.; Navab, Nassir; Edwards, Philip “Eddie”; Jannin, Pierre; Peters, Terry M.; Holmes, David R.; Robb, Richard A.

    2013-01-01

    Mixed reality environments for medical applications have been explored and developed over the past three decades in an effort to enhance the clinician’s view of anatomy and facilitate the performance of minimally invasive procedures. These environments must faithfully represent the real surgical field and require seamless integration of pre- and intra-operative imaging, surgical instrument tracking, and display technology into a common framework centered around and registered to the patient. However, in spite of their reported benefits, few mixed reality environments have been successfully translated into clinical use. Several challenges that contribute to the difficulty in integrating such environments into clinical practice are presented here and discussed in terms of both technical and clinical limitations. This article should raise awareness among both developers and end-users toward facilitating a greater application of such environments in the surgical practice of the future. PMID:23632059

  11. On mixed reality environments for minimally invasive therapy guidance: systems architecture, successes and challenges in their implementation from laboratory to clinic.

    Science.gov (United States)

    Linte, Cristian A; Davenport, Katherine P; Cleary, Kevin; Peters, Craig; Vosburgh, Kirby G; Navab, Nassir; Edwards, Philip Eddie; Jannin, Pierre; Peters, Terry M; Holmes, David R; Robb, Richard A

    2013-03-01

    Mixed reality environments for medical applications have been explored and developed over the past three decades in an effort to enhance the clinician's view of anatomy and facilitate the performance of minimally invasive procedures. These environments must faithfully represent the real surgical field and require seamless integration of pre- and intra-operative imaging, surgical instrument tracking, and display technology into a common framework centered around and registered to the patient. However, in spite of their reported benefits, few mixed reality environments have been successfully translated into clinical use. Several challenges that contribute to the difficulty in integrating such environments into clinical practice are presented here and discussed in terms of both technical and clinical limitations. This article should raise awareness among both developers and end-users toward facilitating a greater application of such environments in the surgical practice of the future. Copyright © 2013 Elsevier Ltd. All rights reserved.

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

    Science.gov (United States)

    Heiney, Jake; Capobianco, Robyn; Cher, Daniel

    2015-01-01

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

  13. Natural language generation of surgical procedures.

    Science.gov (United States)

    Wagner, J C; Rogers, J E; Baud, R H; Scherrer, J R

    1999-01-01

    A number of compositional Medical Concept Representation systems are being developed. Although these provide for a detailed conceptual representation of the underlying information, they have to be translated back to natural language for used by end-users and applications. The GALEN programme has been developing one such representation and we report here on a tool developed to generate natural language phrases from the GALEN conceptual representations. This tool can be adapted to different source modelling schemes and to different destination languages or sublanguages of a domain. It is based on a multilingual approach to natural language generation, realised through a clean separation of the domain model from the linguistic model and their link by well defined structures. Specific knowledge structures and operations have been developed for bridging between the modelling 'style' of the conceptual representation and natural language. Using the example of the scheme developed for modelling surgical operative procedures within the GALEN-IN-USE project, we show how the generator is adapted to such a scheme. The basic characteristics of the surgical procedures scheme are presented together with the basic principles of the generation tool. Using worked examples, we discuss the transformation operations which change the initial source representation into a form which can more directly be translated to a given natural language. In particular, the linguistic knowledge which has to be introduced--such as definitions of concepts and relationships is described. We explain the overall generator strategy and how particular transformation operations are triggered by language-dependent and conceptual parameters. Results are shown for generated French phrases corresponding to surgical procedures from the urology domain.

  14. 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

  15. A multicenter prospective cohort study on camera navigation training for key user groups in minimally invasive surgery

    NARCIS (Netherlands)

    Graafland, Maurits; Bok, Kiki; Schreuder, Henk W. R.; Schijven, Marlies P.

    2014-01-01

    Untrained laparoscopic camera assistants in minimally invasive surgery (MIS) may cause suboptimal view of the operating field, thereby increasing risk for errors. Camera navigation is often performed by the least experienced member of the operating team, such as inexperienced surgical residents,

  16. Minimally invasive vacuum-assisted closure therapy in the management of complex pleural empyema.

    Science.gov (United States)

    Sziklavari, Zsolt; Grosser, Christian; Neu, Reiner; Schemm, Rudolf; Szöke, Tamas; Ried, Michael; Hofmann, Hans-Stefan

    2013-07-01

    The pool of potential candidates for pleural empyema is expanding. In a previous technical report, we tested the feasibility of the minimally invasive insertion of a vacuum-assisted closure (Mini-VAC) system without the insertion of an open-window thoracostomy (OWT). In this study, we describe a consecutive case series of complex pleural empyemas that were managed by this Mini-VAC therapy. In this retrospective study, we investigated 6 patients with multimorbidity (Karnofsky index ≤ 50%) who were consecutively treated with Mini-VAC for a primary, postoperative or recurrent pleural empyema between January 2011 and February 2012. Local control of the infection and control of sepsis were satisfactory in all 6 of the patients treated by Mini-VAC therapy. The suction used did not create any air leaks or bleeding from the lung or mediastinal structures. Mini-VAC therapy allowed a reduction of the empyema cavity and improved the re-expansion of the residual lung. Mini-VAC therapy resulted in a rapid eradication of the empyema. The chest wall was closed in all patients during the first hospital stay. All patients left the hospital in good health (Karnofsky index >70%) and with a non-infected pleural cavity at a mean of 22 ± 11 days after Mini-VAC installation. Pleural empyema was not detected in any of the 6 patients at the 3-month follow-up appointment. The Mini-VAC procedure with the abdication of an OWT offers a rapid treatment for complex pleural empyema with minimal surgical effort and the opportunity for a primary closure of the empyema cavity.

  17. Veterinary Students' Recollection Methods for Surgical Procedures

    DEFF Research Database (Denmark)

    Langebaek, Rikke; Tanggaard, Lene; Berendt, Mette

    2016-01-01

    When veterinary students face their first live animal surgeries, their level of anxiety is generally high and this can affect their ability to recall the procedure they are about to undertake. Multimodal teaching methods have previously been shown to enhance learning and facilitate recall; however......, student preferences for recollection methods when translating theory into practice have not been documented. The aim of this study was to investigate veterinary students' experience with recollection of a surgical procedure they were about to perform after using multiple methods for preparation. From...... a group of 171 veterinary students enrolled in a basic surgery course, 26 students were randomly selected to participate in semi-structured interviews. Results showed that 58% of the students used a visual, dynamic method of recollection, mentally visualizing the video they had watched as part...

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

    Science.gov (United States)

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

    2017-05-15

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

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

    Science.gov (United States)

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

    2003-08-01

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

  20. Nitrousoxide as a conscious sedative in minor oral surgical procedure.

    Science.gov (United States)

    Mohan, Rakesh; Asir, Vigil Dev; Shanmugapriyan; Ebenezr, Vijay; Dakir, Abu; Balakrishnan; Jacob, Jeffin

    2015-04-01

    Nitrous oxide (N2O) is the most commonly used inhalation anesthetic in dentistry and is commonly used in emergency centers and ambulatory surgery centers as well. When used alone, it is incapable of producing general anesthesia reliably. However, as a single agent, it has an impressive safety and is excellent for providing minimal and moderate sedation for apprehensive minor oral surgical procedure. In this article, action of N2O in overcoming the anxiety and pain of the patient during the minor oral surgery and its advantages and disadvantages, have been reviewed.

  1. Nitrousoxide as a conscious sedative in minor oral surgical procedure

    Directory of Open Access Journals (Sweden)

    Rakesh Mohan

    2015-01-01

    Full Text Available Nitrous oxide (N 2 O is the most commonly used inhalation anesthetic in dentistry and is commonly used in emergency centers and ambulatory surgery centers as well. When used alone, it is incapable of producing general anesthesia reliably. However, as a single agent, it has an impressive safety and is excellent for providing minimal and moderate sedation for apprehensive minor oral surgical procedure. In this article, action of N 2 O in overcoming the anxiety and pain of the patient during the minor oral surgery and its advantages and disadvantages, have been reviewed.

  2. Use of concentrated bone marrow aspirate and platelet rich plasma during minimally invasive decompression of the femoral head in the treatment of osteonecrosis.

    Science.gov (United States)

    Martin, John R; Houdek, Matthew T; Sierra, Rafael J

    2013-06-01

    The aim of this paper is to describe our surgical procedure for the treatment of osteonecrosis of the femoral head using a minimally invasive technique. We have limited the use of this procedure for patients with pre-collapse osteonecrosis of the femoral head (Ficat Stage I or II). To treat osteonecrosis of the femoral head at our institution we currently use a combination of outpatient, minimally invasive iliac crest bone marrow aspirations and blood draw combined with decompressions of the femoral head. Following the decompression of the femoral head, adult mesenchymal stem cells obtained from the iliac crest and platelet rich plasma are injected into the area of osteonecrosis. Patients are then discharged from the hospital using crutches to assist with ambulation. This novel technique was utilized on 77 hips. Sixteen hips (21%) progressed to further stages of osteonecrosis, ultimately requiring total hip replacement. Significant pain relief was reported in 86% of patients (n=60), while the rest of patients reported little or no pain relief. There were no significant complications in any patient. We found that the use of a minimally invasive decompression augmented with concentrated bone marrow and platelet rich plasma resulted in significant pain relief and halted the progression of disease in a majority of patients.

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

    Directory of Open Access Journals (Sweden)

    Kamen Kotsilkov

    2017-09-01

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

  4. Surgical techniques to minimize shoulder pain after laparoscopic cholecystectomy

    DEFF Research Database (Denmark)

    Donatsky, Anders Meller; Bjerrum, Flemming; Gögenür, Ismayil

    2013-01-01

    intraoperative surgical methods applied to minimize incidence or severity of SP after LC. Only papers published in English were included. Data extracted were year of publication, number of participants and allocation, nonsignificant or significant effect on incidence or severity of SP. RESULTS: A total of 31...... papers where included in the review. Seven, 8, and 12 papers investigated the effect of drains, abdominal wall lift (AWL), and low-pressure pneumoperitoneum respectively. Four papers investigated drain suction, active gas aspiration, low insufflation flow or N(2)O insufflation respectively...

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

    Science.gov (United States)

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

    2015-03-01

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

  6. Horizontal ridge reconstruction of the anterior maxilla using customized allogeneic bone blocks with a minimally invasive technique - a case series.

    Science.gov (United States)

    Venet, Laurent; Perriat, Michel; Mangano, Francesco Guido; Fortin, Thomas

    2017-12-08

    Different surgical procedures have been proposed to achieve horizontal ridge reconstruction of the anterior maxilla; all these procedures, however, require bone replacement materials to be adapted to the bone defect at the time of implantation, resulting in complex and time-consuming procedures. The purpose of this study was to describe how to use a 3D printed hardcopy model of the maxilla to prepare customized milled bone blocks, to be adapted on the bone defect areas using a minimally invasive subperiosteal tunneling technique. Cone beam computed tomography (CBCT) images of the atrophic maxilla of six patients were acquired and modified into 3D reconstruction models. Data were transferred to a 3D printer and solid models were fabricated using autoclavable nylon polyamide. Before the surgery, freeze-dried cortico-cancellous blocks were manually milled and adapted on the 3D printed hardcopy models of the maxillary bone, in order to obtain customized allogeneic bone blocks. In total, eleven onlay customized allogeneic bone grafts were prepared and implanted in 6 patients, using a minimally invasive subperiosteal tunneling technique. The scaffolds closely matched the shape of the defects: this reduced the operation time and contributed to good healing. The patients did not demonstrate adverse events such as inflammation, dehiscence or flap re-opening during the recovery period; however, one patient experienced scaffold resorption, which was likely caused by uncontrolled motion of the removable provisional prosthesis. Following a 6 month healing period, CBCT was used to assess graft integration, which was followed by insertion of implants into the augmented areas. Prosthetic restorations were placed 4 months later. These observations suggest that customized bone allografts can be successfully used for horizontal ridge reconstruction of the anterior maxilla: patients demonstrated reduced morbidity and decreased total surgery time. Further studies on a larger sample

  7. Minimal Invasive Circumferential Management of Thoracolumbar Spine Fractures

    Directory of Open Access Journals (Sweden)

    S. Pesenti

    2015-01-01

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

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

    Science.gov (United States)

    Ito, Toshiaki

    2016-03-01

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

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

    Science.gov (United States)

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

    2013-12-01

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

  10. Confocal fluorescence microscopy for minimal-invasive tumor diagnosis

    International Nuclear Information System (INIS)

    Zenzinger, M.; Bille, J.

    2000-01-01

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

  11. [A reduction in the invasiveness during surgical revascularization: the harvesting of the great saphenous vein by a video endoscopic technic].

    Science.gov (United States)

    Terrini, A; Graffigna, A; Martinelli, L

    2000-05-01

    The authors report their preliminary experience of endoscopic saphenous vein harvesting as part of a program devoted to reducing the invasivity of surgical myocardial revascularization. This method allows us to minimize the cutaneous incisions in the inferior limbs necessary to harvest the saphenous vein, thus reducing the incidence of complications. The study includes 41 patients who underwent endoscopic saphenous vein harvesting from October 1998 to September 1999 and, as a control group, 20 patients with similar characteristics operated on with the traditional technique during the same period. The variables considered were: the time necessary to harvest the saphenous vein, the incidence of complications, and the postoperative mobilization. All the endoscopically harvested grafts were adequate for the scheduled procedure. The only complication occurred in a patient operated on with the traditional technique. The time of harvesting and the day of mobilization were similar in the two groups. The reduction of surgical trauma allowed a fast deambulation recovery and better esthetic results. When complete arterial revascularization is not feasible, the endoscopic harvesting of the required saphenous vein segment allows for a significant reduction in the invasivity of the procedure.

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

    Science.gov (United States)

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

    2012-08-01

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

  13. Management of obstructive urolithiasis in dairy calves with intact bladder and urethra by Fazili’s minimally invasive tube cystotomy technique

    Directory of Open Access Journals (Sweden)

    Mujeeb ur Rehman Fazili

    2012-09-01

    Full Text Available The present study was planned to evaluate minimally invasive tube cystotomy technique in calves suffering from obstructive urolithiasis having intact urinary bladder and urethra. Fifteen male non-castrated calves with age ranging from 1-10 months (mean 4.05 months, presented for treatment within one to three days (mean 2.2 days of complete urinary tract obstruction due to urethral calculi with intact bladder and urethra, were included in this study. Under light sedation and local infiltration anaesthesia, all the animals were subjected through left paralumbar fossa, to a minimally invasive surgical tube cystotomy in which catheter was placed in the bladder lumen through a metallic cannula and fixed to the skin with a stay suture (Fazili’s technique. All the animals were discharged the same day. Time taken for the procedure varied from 8 to 17 minutes (mean 11.0 minutes. Normal urination resumed in twelve (80.0% calves. Mean time taken for normal urination was 10.50 days. In two of the remaining calves, urine flow stopped through the catheter prematurely and they were then subjected to standard surgical tube cystotomy. One more calf did not urinate normally for 30 postoperative days and was lost to the follow up thereafter. Recurrence of the obstruction was not detected in ten and nine animals observed up to six and 12 months respectively. In conclusion, the outcome of this minimally invasive technique is similar to the standard tube cystectomy. Additionally, the procedure is cost effective, quick, simple and field applicable. It also minimizes exposure of abdominal cavity of metabolically compromised animals. However, the technique needs to be tried in larger number of such calves wherein better quality catheter of larger diameter be used before recommending its extensive use.

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

    Science.gov (United States)

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

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

  15. An analysis of postoperative thigh symptoms after minimally invasive transpsoas lumbar interbody fusion.

    Science.gov (United States)

    Cummock, Matthew D; Vanni, Steven; Levi, Allan D; Yu, Yong; Wang, Michael Y

    2011-07-01

    The minimally invasive transpsoas interbody fusion technique requires dissection through the psoas muscle, which contains the nerves of the lumbosacral plexus posteriorly and genitofemoral nerve anteriorly. Retraction of the psoas is becoming recognized as a cause of transient postoperative thigh pain, numbness, paresthesias, and weakness. However, few reports have described the nature of thigh symptoms after this procedure. The authors performed a review of patients who underwent the transpsoas technique for lumbar spondylotic disease, disc degeneration, and spondylolisthesis treated at a single academic medical center. A review of patient charts, including the use of detailed patient-driven pain diagrams performed at equal preoperative and follow-up intervals, investigated the survival of postoperative thigh pain, numbness, paresthesias, and weakness of the iliopsoas and quadriceps muscles in the follow-up period on the ipsilateral side of the surgical approach. Over a 3.2-year period, 59 patients underwent transpsoas interbody fusion surgery. Of these, 62.7% had thigh symptoms postoperatively. New thigh symptoms at first follow-up visit included the following: burning, aching, stabbing, or other pain (39.0%); numbness (42.4%); paresthesias (11.9%); and weakness (23.7%). At 3 months postoperatively, these percentages decreased to 15.5%, 24.1%, 5.6%, and 11.3%, respectively. Within the patient sample, 44% underwent a 1-level, 41% a 2-level, and 15% a 3-level transpsoas operation. While not statistically significant, thigh pain, numbness, and weakness were most prevalent after L4-5 transpsoas interbody fusion at the first postoperative follow-up. The number of lumbar levels that were surgically treated had no clear association with thigh symptoms but did correlate directly with surgical time, intraoperative blood loss, and length of hospital stay. Transpsoas interbody fusion is associated with high rates of immediate postoperative thigh symptoms. While larger

  16. Minimally Invasive Surgery (MIS) in Children and Adolescents with Pheochromocytomas and Retroperitoneal Paragangliomas: Experiences in 42 Patients.

    Science.gov (United States)

    Walz, Martin K; Iova, Laura D; Deimel, Judith; Neumann, Hartmut P H; Bausch, Birke; Zschiedrich, Stefan; Groeben, Harald; Alesina, Pier F

    2018-04-01

    Pheochromocytomas (PH) and paragangliomas (PGL) are rare tumours in children accounting for about 1% of the paediatric hypertension. While minimally invasive surgical techniques are well established in adult patients with PH, the experience in children is extremely limited. To the best of our knowledge, we herewith present the largest series of young patients operated on chromaffin tumours by minimally invasive access. In the setting of a prospective study (1/2001-12/2016), 42 consecutive children and adolescents (33 m, 9 f) were operated on. Thirty-seven patients (88%) suffered from inherited diseases. Twenty-six patients had PH, 11 presented retroperitoneal PGL, and five patients suffered from both. Altogether, 70 tumours (mean size 2.7 cm) were removed (45 PH, 25 PGL). All operations were performed by a minimally invasive access (retroperitoneoscopic, laparoscopic, extraperitoneal). Partial adrenalectomy was the preferred procedure for PH (31 out of 39 patients). Twenty patients received α-receptor blockade preoperatively. One patient died after induction of anaesthesia due to cardiac arrest. All other complications were minor. Conversion to open surgery was necessary in two cases with PGL. Median operating time for unilateral PH was 55 min, in bilateral cases 125, 143 min in PGs, and 180 min in combined cases. Median blood loss was 20 ml (range 0-1000). Blood transfusion was necessary in two cases. Intraoperative, systolic peak pressure was 170 ± 39 mmHg with α-receptor blockade and 191 ± 33 mmHg without α-receptor blockade (p = 0.41). The median post-operative hospital stay was 3 days. After a mean follow-up of 8.5 years, two patients presented ipsilateral recurrence (after partial adrenalectomy). All patients with bilateral PH (n = 13) are steroid independent post-operatively. PH and PGL in children and adolescents should preferably be removed by minimally invasive surgery. Partial adrenalectomy provides long-term steroid independence

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

    Science.gov (United States)

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

    2017-10-01

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

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

    Directory of Open Access Journals (Sweden)

    Murat Ulutaş

    2015-03-01

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

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

    Science.gov (United States)

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

    2004-01-01

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

  20. Systematic review of learning curves for minimally invasive abdominal surgery: a review of the methodology of data collection, depiction of outcomes, and statistical analysis.

    Science.gov (United States)

    Harrysson, Iliana J; Cook, Jonathan; Sirimanna, Pramudith; Feldman, Liane S; Darzi, Ara; Aggarwal, Rajesh

    2014-07-01

    To determine how minimally invasive surgical learning curves are assessed and define an ideal framework for this assessment. Learning curves have implications for training and adoption of new procedures and devices. In 2000, a review of the learning curve literature was done by Ramsay et al and it called for improved reporting and statistical evaluation of learning curves. Since then, a body of literature is emerging on learning curves but the presentation and analysis vary. A systematic search was performed of MEDLINE, EMBASE, ISI Web of Science, ERIC, and the Cochrane Library from 1985 to August 2012. The inclusion criteria are minimally invasive abdominal surgery formally analyzing the learning curve and English language. 592 (11.1%) of the identified studies met the selection criteria. Time is the most commonly used proxy for the learning curve (508, 86%). Intraoperative outcomes were used in 316 (53%) of the articles, postoperative outcomes in 306 (52%), technical skills in 102 (17%), and patient-oriented outcomes in 38 (6%) articles. Over time, there was evidence of an increase in the relative amount of laparoscopic and robotic studies (P statistical evidence of a change in the complexity of analysis (P = 0.121). Assessment of learning curves is needed to inform surgical training and evaluate new clinical procedures. An ideal analysis would account for the degree of complexity of individual cases and the inherent differences between surgeons. There is no single proxy that best represents the success of surgery, and hence multiple outcomes should be collected.

  1. Cost-benefit of minimally invasive staging of non-small cell lung cancer: a decision tree sensitivity analysis.

    Science.gov (United States)

    Steinfort, Daniel P; Liew, Danny; Conron, Matthew; Hutchinson, Anastasia F; Irving, Louis B

    2010-10-01

    Accurate staging of non-small cell lung cancer (NSCLC) is critical for optimal management. Minimally invasive pathologic assessment of mediastinal lymphadenopathy is increasingly being performed. The cost-benefit (minimization of health care costs) of such approaches, in comparison with traditional surgical methods, is yet to be established. Decision-tree analysis was applied to compare downstream costs of endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA), conventional TBNA, and surgical mediastinoscopy. Calculations were based on real costs derived from actual patient data at a major teaching hospital in Melbourne, Australia. One- and two-way sensitivity analyses were undertaken to account for potential variation in input parameter values. For the base-case analysis, initial evaluation with EBUS-TBNA (with negative results being surgically confirmed) was the most cost-beneficial approach (AU$2961) in comparison with EBUS-TBNA (negative results not surgically confirmed) ($3344), conventional TBNA ($3754), and mediastinoscopy ($8859). The sensitivity of EBUS-TBNA for detecting disease had the largest impact on cost, whereas the prevalence of mediastinal lymph node metastases determined whether surgical confirmation of negative EBUS-TBNA results remained cost-beneficial. Our study confirms that minimally invasive staging of NSCLC is cost-beneficial in comparison with traditional surgical techniques. EBUS-TBNA was the most cost-beneficial approach for mediastinal staging of patients with NSCLC across all studied parameters.

  2. Deformable three-dimensional model architecture for interactive augmented reality in minimally invasive surgery.

    Science.gov (United States)

    Vemuri, Anant S; Wu, Jungle Chi-Hsiang; Liu, Kai-Che; Wu, Hurng-Sheng

    2012-12-01

    Surgical procedures have undergone considerable advancement during the last few decades. More recently, the availability of some imaging methods intraoperatively has added a new dimension to minimally invasive techniques. Augmented reality in surgery has been a topic of intense interest and research. Augmented reality involves usage of computer vision algorithms on video from endoscopic cameras or cameras mounted in the operating room to provide the surgeon additional information that he or she otherwise would have to recognize intuitively. One of the techniques combines a virtual preoperative model of the patient with the endoscope camera using natural or artificial landmarks to provide an augmented reality view in the operating room. The authors' approach is to provide this with the least number of changes to the operating room. Software architecture is presented to provide interactive adjustment in the registration of a three-dimensional (3D) model and endoscope video. Augmented reality including adrenalectomy, ureteropelvic junction obstruction, and retrocaval ureter and pancreas was used to perform 12 surgeries. The general feedback from the surgeons has been very positive not only in terms of deciding the positions for inserting points but also in knowing the least change in anatomy. The approach involves providing a deformable 3D model architecture and its application to the operating room. A 3D model with a deformable structure is needed to show the shape change of soft tissue during the surgery. The software architecture to provide interactive adjustment in registration of the 3D model and endoscope video with adjustability of every 3D model is presented.

  3. Minimally Invasive and Open Distal Chevron Osteotomy for Mild to Moderate Hallux Valgus.

    Science.gov (United States)

    Brogan, Kit; Lindisfarne, Edward; Akehurst, Harold; Farook, Usama; Shrier, Will; Palmer, Simon

    2016-11-01

    Minimally invasive surgical (MIS) techniques are increasingly being used in foot and ankle surgery but it is important that they are adopted only once they have been shown to be equivalent or superior to open techniques. We believe that the main advantages of MIS are found in the early postoperative period, but in order to adopt it as a technique longer-term studies are required. The aim of this study was to compare the 2-year outcomes of a third-generation MIS distal chevron osteotomy with a comparable traditional open distal chevron osteotomy for mild-moderate hallux valgus. Our null hypothesis was that the 2 techniques would yield equivalent clinical and radiographic results at 2 years. This was a retrospective cohort study. Eighty-one consecutive feet (49 MIS and 32 open distal chevron osteotomies) were followed up for a minimum 24 months (range 24-58). All patients were clinically assessed using the Manchester-Oxford Foot Questionnaire. Radiographic measures included hallux valgus angle, the intermetatarsal angle, hallux interphalangeal angle, metatarsal phalangeal joint angle, distal metatarsal articular angle, tibial sesamoid position, shape of the first metatarsal head, and plantar offset. Statistical analysis was done using Student t test or Wilcoxon rank-sum test for continuous data and Pearson chi-square test for categorical data. Clinical and radiologic postoperative scores in all domains were substantially improved in both groups (P .05). There were no significant differences in complications between the 2 groups ( > .5). The midterm results of this third-generation technique show that it was a safe procedure with good clinical outcomes and comparable to traditional open techniques for symptomatic mild-moderate hallux valgus. Level III, retrospective comparative study. © The Author(s) 2016.

  4. Successful treatment of rare-earth magnet ingestion via minimally invasive techniques: a case series.

    Science.gov (United States)

    Kosut, Jessica S; Johnson, Sidney M; King, Jeremy L; Garnett, Gwendolyn; Woo, Russell K

    2013-04-01

    Cases of rare-earth magnet ingestions have been increasingly reported in the literature. However, these descriptions have focused on the severity of the injuries, rather than the clinical presentation and/or therapeutic approach. We report a series of eight children, ranging in age from 2 to 10 years, who ingested powerful rare-earth magnets. The rare-earth magnets were marketed in 2009 under the trade name Buckyballs(®) (Maxfield & Oberton, New York, NY). They are about 5 mm in size, spherical, and brightly colored, making them appealing for young children to play with and place in their mouths. Three children presented within hours of ingestion, and the magnets were successfully removed via endoscopy in two, whereas the third child required laparoscopy. No fistulas were found in these children. A fourth child presented 2 days after ingestion with evidence of bowel wall erosion, but without fistula formation; the magnets were removed via laparoscopy. A fifth child ingested nine magnets in a ring formation, which were removed via colonoscopy without evidence of injury or fistula formation. The three remaining children presented late (5-8 days after ingestion) and were found to have associated fistulas. They were treated successfully with a combination of endoscopy and laparoscopy with fluoroscopy. None of the children in our series required an open surgical procedure. All children were discharged home without complications. This case series highlights the potential dangers of rare-earth magnet ingestion in children. Our experience suggests that prompt intervention using minimally invasive approaches can lead to successful outcomes.

  5. Assessing outcomes, costs, and benefits of emerging technology for minimally invasive saphenous vein in situ distal arterial bypasses.

    Science.gov (United States)

    Piano, G; Schwartz, L B; Foster, L; Bassiouny, H S; McKinsey, J F; Rosenthal, D; Gewertz, B L

    1998-06-01

    Instrumentation for a minimally invasive angioscopic in situ peripheral arterial bypass (MIAB) with catheter-directed side-branch occlusion has recently been approved for use. Despite the attractiveness of this approach (2 short incisions), benefits such as lower morbidity and shorter hospitalizations remain undocumented. To justify wide acceptance, minimally invasive surgical techniques must match conventional procedures in durability and cost while enhancing patient comfort. Often such comparisons are difficult during the implementation phase of a new procedure. To compare the outcomes of the MIAB procedures with a concurrent group of patients undergoing conventional in situ bypass procedures. Retrospective review. University medical center. The first 20 consecutive MIAB procedures in 19 patients performed between August 1, 1995, and July 31, 1997, were compared with 19 contemporaneous consecutive conventional in situ bypass procedures performed at the same institution. Operative time, postoperative length of stay, hospital costs, complications, primary assisted and secondary patency, limb salvage, and survival. The patient groups were comparable with respect to age, sex, incidence of smoking, coronary artery disease, hypertension, diabetes, renal failure, cerebrovascular disease, indication, and distal anastomosis level. The median operative time was significantly greater for the MIAB group (6.6 hours vs 5.7 hours; P=.009), and intraoperative completion arteriography more frequently showed retained arteriovenous fistulas in the MIAB group (55% vs 21%; P=.05). The median postoperative length of stay and total cost were 6.5 days and $18,000 for the MIAB group and 8 days and $27,800 for the conventional group (P > or = .05). There were no significant differences in major complications (10% in the MIAB group vs 11% in the conventional group), wound complications (10% vs 11%, respectively), primary assisted patency at 1 year (68%+/-11% vs 78%+/-10%, respectively

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

    LENUS (Irish Health Repository)

    Bahari, Syah

    2007-10-01

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

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

    Science.gov (United States)

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

    2012-04-01

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

  8. Interventional MRI of the breast: minimally invasive therapy

    Energy Technology Data Exchange (ETDEWEB)

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

    2000-01-01

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

  9. Interventional MRI of the breast: minimally invasive therapy

    International Nuclear Information System (INIS)

    Hall-Craggs, M.A.

    2000-01-01

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

  10. Impact of body image on patients' attitude towards conventional, minimal invasive, and natural orifice surgery.

    Science.gov (United States)

    Lamadé, Wolfram; Friedrich, Colin; Ulmer, Christoph; Basar, Tarkan; Weiss, Heinz; Thon, Klaus-Peter

    2011-03-01

    A series of investigations proposed that patients' preference on minimal invasive and scarless surgery may be influenced by age, sex, and surgical as well as endoscopic history of the individual patient. However, it is unknown which psychological criteria lead to the acceptance of increased personal surgical risk or increased personal expenses in patients demanding scarless operations. We investigated whether individual body image contributes to the patient's readiness to assume higher risk in favor of potentially increased cosmesis. We conducted a nonrandomized survey among 63 consecutive surgical patients after receiving surgery. Individual body image perception was assessed postoperatively applying the FKB-20 questionnaire extended by four additional items. The FKB-20 questionnaire is a validated tool for measuring body image disturbances resulting in a two-dimensional score with negative body image (NBI) and vital body dynamics (VBD) being the two resulting scores. A subgroup analysis was performed according to the conducted operations: conventional open surgery = group 1, traditional laparoscopic surgery = group 2, and no scar surgery = group 3. There was a significant correlation between a negative body image and the preference for scar sparing and scarless surgery indicated by a significantly increased acceptance of surgical risks and the willingness to spend additional money for receiving scarless surgery (r = 0.333; p = 0.0227). Allocated to operation subgroups, 17 of 63 patients belonged to group 1 (OS), 29 to group 2 (minimally invasive surgery), and 17 patients to group 3 (no scar). Although age and sex were unequally distributed, the groups were homogenous regarding body mass index and body image (NBI). Subgroup analysis revealed that postoperative desire for scar sparing approaches was most frequently expressed by patients who received no scar operations. Patients with an NBI tend towards scarless surgery and are willing to accept increased

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

    Directory of Open Access Journals (Sweden)

    Benjamin Ritsma

    2014-01-01

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

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

    Science.gov (United States)

    Savoia, Antonella; Landi, Simone; Baldi, Alfonso

    2013-06-01

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

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

    Science.gov (United States)

    Wang, Kai; Fan, Ying

    2017-02-01

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

  14. Minimally invasive surgery in the treatment of esophageal cancer

    International Nuclear Information System (INIS)

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

    2016-01-01

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

  15. Minimally invasive treatment of hepatic adenoma in special cases

    Energy Technology Data Exchange (ETDEWEB)

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

    2013-07-01

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

  16. Minimally invasive treatment of hepatic adenoma in special cases

    International Nuclear Information System (INIS)

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

    2013-01-01

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

  17. Combined PCI and minimally invasive heart valve surgery for high-risk patients.

    Science.gov (United States)

    Umakanthan, Ramanan; Leacche, Marzia; Petracek, Michael R; Zhao, David X; Byrne, John G

    2009-12-01

    Combined coronary artery valvular heart disease is a major cause of morbidity and mortality in the adult patient population. The standard treatment for such disease has been open heart surgery in which coronary artery bypass grafting (CABG) is performed concurrently with valve surgery using a median sternotomy and cardiopulmonary bypass. With the increasing complexity of patients referred to surgery, some patients may prove to be poor surgical candidates for combined valve and CABG surgery. In certain selected patients who fall into this category, valve surgery and percutaneous coronary intervention (PCI) have been considered a feasible alternative. Conventionally, valve surgery is performed in the cardiac surgical operating room, whereas PCI is carried out in the cardiac catheterization laboratory. Separation of these two procedural suites has presented a logistic limitation because it impedes the concomitant performance of both procedures in one setting. Hence, PCI and valve surgery usually have been performed as a "two-stage" procedure in two different operative suites, with the procedures being separated by hours, days, or weeks. Technologic advancements have made possible the construction of a "hybrid" procedural suite that combines the facilities of a cardiac surgical operating room with those of a cardiac catheterization laboratory. This design has enabled the concept of "one-stage" or "one-stop" PCI and valve surgery, allowing both procedures to be performed in a hybrid suite in one setting, separated by minutes. The advantages of such a method could prove to be multifold by enabling a less invasive surgical approach and improving logistics, patient satisfaction, and outcomes in selected patients.

  18. A novel minimally invasive dual-modality fiber optic probe for prostate cancer detection

    Science.gov (United States)

    Sharma, Vikrant

    Prostate cancer is the most common form of cancer in males, and is the second leading cause of cancer related deaths in United States. In prostate cancer diagnostics and therapy, there is a critical need for a minimally invasive tool for in vivo evaluation of prostate tissue. Such a tool finds its niche in improving TRUS (trans-rectal ultrasound) guided biopsy procedure, surgical margin assessment during radical prostatectomy, and active surveillance of patients with a certain risk levels. This work is focused on development of a fiber-based dual-modality optical device (dMOD), to differentiate prostate cancer from benign tissue, in vivo. dMOD utilizes two independent optical techniques, LRS (light reflectance spectroscopy) and AFLS (auto-fluorescence lifetime spectroscopy). LRS quantifies scattering coefficient of the tissue, as well as concentrations of major tissue chromophores like hemoglobin derivatives, β-carotene and melanin. AFLS was designed to target lifetime signatures of multiple endogenous fluorophores like flavins, porphyrins and lipo-pigments. Each of these methods was independently developed, and the two modalities were integrated using a thin (1-mm outer diameter) fiber-optic probe. Resulting dMOD probe was implemented and evaluated on animal models of prostate cancer, as well as on human prostate tissue. Application of dMOD to human breast cancer (invasive ductal carcinoma) identification was also evaluated. The results obtained reveal that both LRS and AFLS are excellent techniques to discriminate prostate cancer tissue from surrounding benign tissue in animal models. Each technique independently is capable of providing near absolute (100%) accuracy for cancer detection, indicating that either of them could be used independently without the need of implementing them together. Also, in case of human breast cancer, LRS and AFLS provided comparable accuracies to dMOD, LRS accuracy (96%) being the highest for the studied population. However, the

  19. [Clinical application of Da Vinci surgical system in China].

    Science.gov (United States)

    Jin, Zhenyu

    2014-01-01

    Da Vinci robotic surgical system leads the development of minimally invasive surgical techniques. By using Da Vinci surgical robot for minimally invasive surgery, it brings a lot of advantages to the surgeons. Since 2008, Da Vinci surgeries have been performed in 14 hospitals in domestic cities such as Beijing and Shanghai. Until the end of 2012, 3 551 cases of Da Vinci robotic surgery have been performed, covering various procedures of various surgical departments including the department of general surgery, urology, cardiovascular surgery, thoracic surgery, gynecology, and etc. Robotic surgical technique has made remarkable achievements.

  20. Application of a real-time three-dimensional navigation system to various oral and maxillofacial surgical procedures.

    Science.gov (United States)

    Ohba, Seigo; Yoshimura, Hitoshi; Ishimaru, Kyoko; Awara, Kousuke; Sano, Kazuo

    2015-09-01

    The aim of this study was to confirm the effectiveness of a real-time three-dimensional navigation system for use during various oral and maxillofacial surgeries. Five surgeries were performed with this real-time three-dimensional navigation system. For mandibular surgery, patients wore acrylic surgical splints when they underwent computed tomography examinations and the operation to maintain the mandibular position. The incidence of complications during and after surgery was assessed. No connection with the nasal cavity or maxillary sinus was observed at the maxilla during the operation. The inferior alveolar nerve was not injured directly, and any paresthesia around the lower lip and mental region had disappeared within several days after the surgery. In both maxillary and mandibular cases, there was no abnormal hemorrhage during or after the operation. Real-time three-dimensional computer-navigated surgery allows minimally invasive, safe procedures to be performed with precision. It results in minimal complications and early recovery.

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

    Science.gov (United States)

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

    2014-06-01

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

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

    Science.gov (United States)

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

    2017-07-01

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

  3. Minimally Invasive Direct Repair of Bilateral Lumbar Spine Pars Defects in Athletes

    Directory of Open Access Journals (Sweden)

    Gabriel A. Widi

    2013-01-01

    Full Text Available Spondylolysis of the lumbar spine has traditionally been treated using a variety of techniques ranging from conservative care to fusion. Direct repair of the defect may be utilized in young adult patients without significant disc degeneration and lumbar instability. We used minimally invasive techniques to place pars interarticularis screws with the use of an intraoperative CT scanner in three young adults, including two athletes. This technique is a modification of the original procedure in 1970 by Buck, and it offers the advantage of minimal muscle dissection and optimal screw trajectory. There were no intra- or postoperative complications. The detailed operative procedure and the postoperative course along with a brief review of pars interarticularis defect treatment are discussed.

  4. Reasons for conversion and adverse intraoperative events in Endoscopic Port Access™ atrioventricular valve surgery and minimally invasive aortic valve surgery.

    Science.gov (United States)

    van der Merwe, Johan; Van Praet, Frank; Stockman, Bernard; Degrieck, Ivan; Vermeulen, Yvette; Casselman, Filip

    2018-02-14

    This study reports the factors that contribute to sternotomy conversions (SCs) and adverse intraoperative events in minimally invasive aortic valve surgery (MI-AVS) and minimally invasive Endoscopic Port Access™ atrioventricular valve surgery (MI-PAS). In total, 3780 consecutive patients with either aortic valve disease or atrioventricular valve disease underwent minimally invasive valve surgery (MIVS) at our institution between 1 February 1997 and 31 March 2016. MI-AVS was performed in 908 patients (mean age 69.2 ± 11.3 years, 45.2% women, 6.2% redo cardiac surgery) and MI-PAS in 2872 patients (mean age 64.1 ± 13.3 years, 46.7% women, 12.2% redo cardiac surgery). A cumulative total of 4415 MIVS procedures (MI-AVS = 908, MI-PAS = 3507) included 1537 valve replacements (MI-AVS = 896, MI-PAS = 641) and 2878 isolated or combined valve repairs (MI-AVS = 12, MI-PAS = 2866). SC was required in 3.0% (n = 114 of 3780) of MIVS patients, which occurred in 3.1% (n = 28 of 908) of MI-AVS patients and 3.0% (n = 86 of 2872) of MI-PAS patients, respectively. Reasons for SC in MI-AVS included inadequate visualization (n = 4, 0.4%) and arterial cannulation difficulty (n = 7, 0.8%). For MI-PAS, SC was required in 54 (2.5%) isolated mitral valve procedures (n = 2183). Factors that contributed to SC in MI-PAS included lung adhesions (n = 35, 1.2%), inadequate visualization (n = 2, 0.1%), ventricular bleeding (n = 3, 0.1%) and atrioventricular dehiscence (n = 5, 0.2%). Neurological deficit occurred in 1 (0.1%) and 3 (3.5%) MI-AVS and MI-PAS conversions, respectively. No operative or 30-day mortalities were observed in MI-AVS conversions (n = 28). The 30-day mortality associated with SC in MI-PAS (n = 86) was 10.5% (n = 9). MIVS is increasingly being recognized as the 'gold-standard' for surgical valve interventions in the context of rapidly expanding catheter-based technology and increasing

  5. Minimally Invasive Spine Metastatic Tumor Resection and Stabilization: New Technology Yield Improved Outcome

    Directory of Open Access Journals (Sweden)

    Ran Harel

    2015-01-01

    Full Text Available Spinal metastases compressing the spinal cord are a medical emergency and should be operated on if possible; however, patients’ medical condition is often poor and surgical complications are common. Minimizing surgical extant, operative time, and blood loss can potentially reduce postoperative complications. This is a retrospective study describing the patients operated on in our department utilizing a minimally invasive surgery (MIS approach to decompress and instrument the spine from November 2013 to November 2014. Five patients were operated on for thoracic or lumbar metastases. In all cases a unilateral decompression with expandable tubular retractor was followed by instrumentation of one level above and below the index level and additional screw at the index level contralateral to the decompression side. Cannulated fenestrated screws were used (Longitude FNS and cement was injected to increase pullout resistance. Mean operative time was 134 minutes and estimated blood loss was minimal in all cases. Improvement was noticeable in neurological status, function, and pain scores. No complications were observed. Technological improvements in spinal instruments facilitate shorter and safer surgeries in oncologic patient population and thus reduce the complication rate. These technologies improve patients’ quality of life and enable the treatment of patients with comorbidities.

  6. 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.

  7. Minimally Invasive Posterior Stabilization Improved Ambulation and Pain Scores in Patients with Plasmacytomas and/or Metastases of the Spine

    Directory of Open Access Journals (Sweden)

    Joseph H. Schwab

    2011-01-01

    Full Text Available Background. The incidence of spine metastasis is expected to increase as the population ages, and so is the number of palliative spinal procedures. Minimally invasive procedures are attractive options in that they offer the theoretical advantage of less morbidity. Purpose. The purpose of our study was to evaluate whether minimally invasive posterior spinal instrumentation provided significant pain relief and improved function. Study Design. We compared pre- and postoperative pain scores as well as ambulatory status in a population of patients suffering from oncologic conditions in the spine. Patient Sample. A consecutive series of patients with spine tumors treated minimally invasively with stabilization were reviewed. Outcome Measures. Visual analog pain scale as well as pre- and postoperative ambulatory status were used as outcome measures. Methods. Twenty-four patients who underwent minimally invasive posterior spinal instrumentation for metastasis were retrospectively reviewed. Results. Seven (29% patients were unable to ambulate secondary to pain and instability prior to surgery. All patients were ambulating within 2 to 3 days after having surgery (=0.01. The mean visual analog scale value for the preoperative patients was 2.8, and the mean postoperative value was 1.0 (=0.001. Conclusion. Minimally invasive posterior spinal instrumentation significantly improved pain and ambulatory status in this series.

  8. 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.

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

    Science.gov (United States)

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

    2014-07-01

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

  10. [Abdominothoracic esophageal resection according to Ivor Lewis with intrathoracic anastomosis : standardized totally minimally invasive technique].

    Science.gov (United States)

    Runkel, N; Walz, M; Ketelhut, M

    2015-05-01

    The clinical and scientific interest in minimally invasive techniques for esophagectomy (MIE) are increasing; however, the intrathoracic esophagogastric anastomosis remains a surgical challenge and lacks standardization. Surgeons either transpose the anastomosis to the cervical region or perform hybrid thoracotomy for stapler access. This article reports technical details and early experiences with a completely laparoscopic-thoracoscopic approach for Ivor Lewis esophagectomy without additional thoracotomy. The extent of radical dissection follows clinical guidelines. Laparoscopy is performed with the patient in a beach chair position and thoracoscopy in a left lateral decubitus position using single lung ventilation. The anvil of the circular stapler is placed transorally into the esophageal stump. The specimen and gastric conduit are exteriorized through a subcostal rectus muscle split incision. The stapler body is placed into the gastric conduit and both are advanced through the abdominal mini-incision transhiatally into the right thoracic cavity, where the anastomosis is constructed. Data were collected prospectively and analyzed retrospectively. A total of 23 non-selected consecutive patients (mean age 69 years, range 46-80 years) with adenocarcinoma (n = 19) or squamous cell carcinoma (n = 4) were surgically treated between June 2010 and July 2013. Neoadjuvant therapy was performed in 15 patients resulting in 10 partial and 4 complete remissions. There were no technical complications and no conversions. Mean operative time was 305 min (range 220-441 min). The median lymph node count was 16 (range 4-42). An R0 resection was achieved in 91 % of patients and 3 anastomotic leaks occurred which were successfully managed endoscopically. There were no postoperative deaths. The intrathoracic esophagogastric anastomosis during minimally invasive Ivor Lewis esophagectomy can be constructed in a standardized fashion without an additional thoracotomy

  11. Comparison of standard laparoscopic distal pancreatectomy with minimally invasive distal pancreatectomy using the da Vinci S system.

    Science.gov (United States)

    Ito, Masahiro; Asano, Yukio; Shimizu, Tomohiro; Uyama, Ichiro; Horiguchi, Akihiko

    2014-01-01

    Minimally invasive procedures for pancreatic pathologies are increasingly being used, including distal pancreatectomy. This study aimed to assess the indications for and outcomes of the da Vinci distal pancreatectomy procedure. We reviewed the medical records of patients who underwent pancreatic head resection from April 2009 to September 2013. Four patients (mean age, 52.7 years) underwent da Vinci distal pancreatectomy and 10 (mean age, 68.0 +/- 12.1 years) underwent laparoscopic distal pancreatectomy. The mean surgical duration was 292 +/- 153 min and 306 +/- 29 min, the mean blood loss was 153 +/- 71 mL and 61.7 +/- 72 mL, and the mean postoperative length of stay was 24 +/- 11 days and 14 +/- 3 days in the da Vinci distal pancreatectomy and laparoscopic distal pancreatectomy groups, respectively. One patient who underwent da Vinci distal pancreatectomy developed a pancreatic fistula, while 2 patients in the laparoscopic distal pancreatectomy group developed splenic ischemia and gastric torsion, respectively. Laparoscopic and robotic pancreatic resection were both safe and feasible in selected patients with distal pancreatic pathologies. Further studies are necessary to clarify the role of robotic surgery in the advanced laparoscopic era.

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

    Directory of Open Access Journals (Sweden)

    Arvind G Kulkarni

    2016-01-01

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

  13. Miniature fibre optic probe for minimally invasive photoacoustic sensing

    Science.gov (United States)

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

    2016-03-01

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

  14. 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.

  15. Evaluation of the radiation levels in different surgical procedures

    International Nuclear Information System (INIS)

    Silva Santos, M.C.P. da; Almeida, A. de; Belluci, A.D.; Ghilardi Neto, T.

    1989-01-01

    The exposure of a medical team to radiation during surgical procedures evidently depends on the duration and difficulties of the particular procedure. We have made a dosimetric study of the average equivalent doses received by the surgical teams during 10 different surgical procedures over a period of one month. Our results demonstrate that the levels of ionizing radiation that the members of the teams receive typically do not surpass the limits stipulated for the following surgical procedures: nefrolithotomy, percutaneous ureterolithomy, ureteroscoy connected with removal of stones in the inferior third of the ureter, osteosynthesis of the tibial plateau together with a articular toalet and minireconstruction of the knee. For compound surgical procedures, for example, osteosynthesis of a femur fracture together with biopsy of an exposed femur or percutaneous nefrolithotomy (complex cases), the dose limits have been surpassed owing to the additional fluoroscopy needed in those p rocedures. (author) [pt

  16. [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

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

    Science.gov (United States)

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

    2018-03-01

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

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

    NARCIS (Netherlands)

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

    2016-01-01

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

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

    Science.gov (United States)

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

    2014-05-01

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

  20. Surgical and procedural skills training at medical school - a national review.

    Science.gov (United States)

    Davis, Christopher R; Toll, Edward C; Bates, Anthony S; Cole, Matthew D; Smith, Frank C T

    2014-01-01

    This national study quantifies procedural and surgical skills training at medical schools in the United Kingdom (UK), a stipulated requirement of all graduates by the General Medical Council (GMC). A questionnaire recorded basic procedural and surgical skills training provided by medical schools and surgical societies in the UK. Skills were extracted from (1) GMC Tomorrows Doctors and (2) The Royal College of Surgeons Intercollegiate Basic Surgical Skills (BSS) course. Data from medical school curricula and extra-curricular student surgical societies were compared against the national GMC guidelines and BSS course content. Data were analysed using Mann-Whitney U tests. Representatives from 23 medical schools completed the survey (71.9% response). Thirty one skills extracted from the BSS course were split into 5 categories, with skills content cross referenced against GMC documentation. Training of surgical skills by medical schools was as follows: Gowning and gloving (72.8%), handling instruments (29.4%), knot tying (17.4%), suturing (24.7%), other surgical techniques (4.3%). Surgical societies provided significantly more training of knot tying (64.4%, P = 0.0013) and suturing (64.5%, P = 0.0325) than medical schools. Medical schools provide minimal basic surgical skills training, partially supplemented by extracurricular student surgical societies. Our findings suggest senior medical students do not possess simple surgical and procedural skills. Newly qualified doctors are at risk of being unable to safely perform practical procedures, contradicting GMC Guidelines. We propose a National Undergraduate Curriculum in Surgery and Surgical Skills to equip newly qualified doctors with basic procedural skills to maximise patient safety. Copyright © 2014 Surgical Associates Ltd. Published by Elsevier Ltd. All rights reserved.

  1. Automatic classification of minimally invasive instruments based on endoscopic image sequences

    Science.gov (United States)

    Speidel, Stefanie; Benzko, Julia; Krappe, Sebastian; Sudra, Gunther; Azad, Pedram; Müller-Stich, Beat Peter; Gutt, Carsten; Dillmann, Rüdiger

    2009-02-01

    Minimally invasive surgery is nowadays a frequently applied technique and can be regarded as a major breakthrough in surgery. The surgeon has to adopt special operation-techniques and deal with difficulties like the complex hand-eye coordination and restricted mobility. To alleviate these constraints we propose to enhance the surgeon's capabilities by providing a context-aware assistance using augmented reality techniques. To analyze the current situation for context-aware assistance, we need intraoperatively gained sensor data and a model of the intervention. A situation consists of information about the performed activity, the used instruments, the surgical objects, the anatomical structures and defines the state of an intervention for a given moment in time. The endoscopic images provide a rich source of information which can be used for an image-based analysis. Different visual cues are observed in order to perform an image-based analysis with the objective to gain as much information as possible about the current situation. An important visual cue is the automatic recognition of the instruments which appear in the scene. In this paper we present the classification of minimally invasive instruments using the endoscopic images. The instruments are not modified by markers. The system segments the instruments in the current image and recognizes the instrument type based on three-dimensional instrument models.

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

    International Nuclear Information System (INIS)

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

    2013-01-01

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

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

    Energy Technology Data Exchange (ETDEWEB)

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

    2013-01-01

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

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

    Science.gov (United States)

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

    2014-06-01

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

  5. 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

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

    Directory of Open Access Journals (Sweden)

    Nitin Garg

    2014-01-01

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

  7. Highly dexterous 2-module soft robot for intra-organ navigation in minimally invasive surgery.

    Science.gov (United States)

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

    2018-02-01

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

  8. Transtemporal amygdalohippocampectomy: a novel minimally-invasive technique with optimal clinical results and low cost

    Directory of Open Access Journals (Sweden)

    Juan Antonio Castro Flores

    Full Text Available ABSTRACT Mesial temporal sclerosis creates a focal epileptic syndrome that usually requires surgical resection of mesial temporal structures. Objective: To describe a novel operative technique for treatment of temporal lobe epilepsy and its clinical results. Methods: Prospective case-series at a single institution, performed by a single surgeon, from 2006 to 2012. A total of 120 patients were submitted to minimally-invasive keyhole transtemporal amygdalohippocampectomy. Results: Of the patients, 55% were male, and 85% had a right-sided disease. The first 70 surgeries had a mean surgical time of 2.51 hours, and the last 50 surgeries had a mean surgical time of 1.62 hours. There was 3.3% morbidity, and 5% mild temporal muscle atrophy. There was no visual field impairment. On the Engel Outcome Scale at the two-year follow-up, 71% of the patients were Class I, 21% were Class II, and 6% were Class III. Conclusion: This novel technique is feasible and reproducible, with optimal clinical results.

  9. New minimally invasive option for the treatment of gluteal muscle contracture.

    Science.gov (United States)

    Ye, Bin; Zhou, Panyu; Xia, Yan; Chen, Youyan; Yu, Jun; Xu, Shuogui

    2012-12-01

    Gluteal muscle contracture is a clinical syndrome that involves contracture and distortion of the gluteal muscles and fascia fibers due to multiple causes. Physical examination demonstrates a characteristic gait due to hip adduction and internal thigh rotation. This study introduces a new minimally invasive method for surgical release of gluteal muscle contracture. Patients with gluteal muscle contracture were assigned to 4 categories: type A, contracture occurred mainly in the iliotibial tract; type B, contracture occurred in the Iliotibial tract and gluteus maximus; type C1, movement of the contraction band was palpable and a snapping sound was audible during squatting; and type C2, movement of the contraction band was not palpable or almost absent and a snapping sound was audible during squatting. This classification method allowed prediction of the anatomic location of these pathological contractures and determination of the type of surgery required. Four critical points were used to define the operative field and served as points to mark a surgical incision smaller than 4 mm. The contracture was easily released in this carefully marked operative field without causing significant neurovascular damage. Over a period of 5 years, between March 2003 and June 2008, the authors treated 1059 patients with this method and achieved excellent outcomes. Most patients were fully active within 12 weeks, with the assistance of an early postoperative rehabilitation program. The most significant complication was a postoperative periarticular hematoma, which occurred in 3 patients within 10 days postoperatively and required surgical ligation of the bleeding vessel. Copyright 2012, SLACK Incorporated.

  10. 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.

  11. 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.

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

    Science.gov (United States)

    Wang, Yezhong; Lei, Ting; Wang, Zhi

    2009-06-01

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

  13. 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