Conventional Open Surgical Procedures Research Articles

Minimally Invasive Chevron Akin Osteotomy for Hallux Valgus Correction.

Minimally Invasive Chevron Akin Osteotomy for Hallux Valgus Correction.

Percutaneous Transforaminal Endoscopic Lumbar Interbody Fusion for Degenerative Lumbar Diseases: A Consecutive Case Series with Mean 2-Year Follow-Up

Conventional open surgical procedures may cause massive dissections of the spine, higher perioperative complications, prolonged hospitalization, protracted rehabilitation programs and recovery. Percutaneous endoscopic lumbar interbody fusion (PELIF) is an evolving treatment option. To present the detailed procedure and preliminary clinical and radiologic results of PELIF for degenerative lumbar diseases. A retrospective cohort study. A university affiliated tertiary hospital. The medical records of patients with degenerative lumbar diseases who underwent PELIF between January 2016 and December 2017 were retrospectively reviewed. Surgical level, surgical time, blood loss, hospital length of stay, and perioperative complications were discussed. Patients were also evaluated for pain by the Visual Analog Scale (VAS), and functional assessment by the Oswestry Disability Index (ODI) and the 36-Item Short Form Health Survey (SF-36), including Physical Component Summary (PCS) and Mental Component Summary (MCS) preoperatively, postoperatively, and during the follow-up period. Thirty-nine consecutive patients (25 men and 14 women) with a mean age of 59.0 years (range, 39-77 years) were enrolled. The average surgical time was 213.8 ± 31.7 minutes (range, 185-324 minutes). Mean estimated blood loss was 25.0 ± 12.6 mL (range, 15-50 mL). At the latest follow-up visit, the VAS scores for back pain, leg pain, ODI, and SF-36 (MCS/PCS) scores improved 89.5%, 95.0%, 71.2%, and 37.5%/58%, respectively. Reoperations were performed in one patient for residual disc mass and one for misplacement of pedicle screw. Fusion was achieved in all patients. The presented results are preliminary and should be interpreted taking the limitations into account, including nonrandomized design, relatively small sample size, and less intensive follow-up period. The presented PELIF technique seems to be a promising surgical alternative for the treatment of patients with specific degenerative lumbar diseases. Randomized studies with larger sample size and long-term follow-up duration are needed to validate the superiorities of this versatile surgery. Endoscopic, minimally invasive spine surgery, lumbar interbody fusion, disc herniation, spondylolisthesis.

A minimally invasive catheter-based ultrasound technology for therapeutic interventions in brain: initial preclinical studies.

OBJECTIVE Minimally invasive procedures may allow surgeons to avoid conventional open surgical procedures for certain neurological disorders. This paper describes the iterative process for development of a catheter-based ultrasound thermal therapy applicator. METHODS Using an ultrasound applicator with an array of longitudinally stacked and angularly sectored tubular transducers within a catheter, the authors conducted experimental studies in porcine liver, in vivo and ex vivo, in order to characterize the device performance and lesion patterns. In addition, they applied the technique in a rodent model of Parkinson's disease to investigate the feasibility of its application in brain. RESULTS Thermal lesions with multiple shapes and sizes were readily achieved in porcine liver. The feasibility of catheter-based focused ultrasound in the treatment of brain conditions was demonstrated in a rodent model of Parkinson's disease. CONCLUSIONS The authors show proof of principle of a catheter-based ultrasound system that can create lesions with concurrent thermode-based measurements.

Teach and Playback Training Device for Minimally Invasive Surgery.

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

Minimally invasive surgery in childhood

Similar to surgery in adults, minimally invasive techniques have also become established in pediatric surgery for a wide variety of indications and partially replaced the corresponding conventional open surgical procedures. This applies not only to laparoscopy for abdominal surgical interventions but also to thoracoscopic procedures. The therapy spectrum in pediatric surgery includes all congenital and acquired diseases of the growing organism, from neonates to adolescents and for this reason the indications that are suitable for minimally invasive surgical procedures are corresponding versatile. According to the literature almost every operation in pediatric surgery was performed via a minimally invasive access route. Of course, not every generally feasible minimally invasive technique can be considered as being suitable to replace proven and established open conventional procedures in pediatric surgery.

Early experience with laparoscopic surgical operations in Aminu Kano Teaching Hospital, Kano, Northwestern Nigeria

Background: New knowledge in health sciences, advances in technology, and a greater awareness of human rights add up to the need for higher standards in medical training and health services. Laparoscopic surgery is a major breakthrough in surgical practice that is now virtually integrated into all surgical fields. Its benefits have been recognized over many conventional open surgical procedures. However, its appropriateness and our readiness for the practice of laparoscopic surgery in Nigeria is yet to be determined. The objective of this study was to describe early experience, challenges, and prospect with laparoscopic surgical operations in Aminu Kano Teaching Hospital Kano, northwestern Nigeria. Materials and Methods: The case notes of patients admitted into the Surgical Wards of Mallam Aminu Kano Teaching Hospital in Kano, northwestern Nigeria that had laparoscopic surgical operations from October 2005 to October 2013 were retrieved and studied. The data collected from these was entered into Minitab Statistical Software. Relevant statistical indices were calculated. Results: A total of 42 patients were the subject of this review. Their mean age was 37 years, ranged 13-62 years. The male:female (M:F) was 1:1.2. The most common indication of laparoscopic operation was gallbladder disease in 38 (90.5%) patients. Laparoscopic cholecystectomy was the most common laparoscopic procedure performed. Two patients were converted to open surgery. The average duration of post-operative hospital stay was 4 days and the average operating time was 3 h. Conclusion: Experience with laparoscopic surgery is still early in our center, nevertheless the prospect is enormous. There is need for further skills acquisition and effective organization in order to maintain these services. Involvement of the National Health Insurance Scheme should assuredly bring about technological developments and subsidize the services to meet the socioeconomic challenges and changing disease pattern in our environment.

Surgical management of organ-contained unilateral pheochromocytoma: comparative outcomes of laparoscopic and conventional open surgical procedures in a large single-institution series

Laparoscopic excision is preferred for small non-invasive pheochromocytoma over open approach. Applicability of laparoscopic procedures for large organ-contained pheochromocytoma is unclear. A database of 137 pheochromocytoma patients managed during 1990-2010 was reviewed to compare outcomes of open and laparoscopic procedures for 101 unilateral organ-contained pheochromocytoma patients in this retrospective non-randomized study. Forty-nine patients underwent open procedures, and 52 underwent laparoscopic procedures. Laparoscopic procedure was converted to open in 19 due to bleeding (n = 12), concern for malignancy (n = 5), hypertensive crisis (n = 1), and equipment failure (n = 1). Outcome measures were compared between open, laparoscopic, and conversion patient groups. Patient groups were well matched for age, gender, BMI, and clinical and pathological characteristics. Mean tumor size was insignificantly larger in the open (7.6 ± 2.7 cm) than the laparoscopic group (6.6 ± 2 cm, p = 0.06). There were no significant differences in periop hemodynamic events. Mean blood loss, blood transfusion and analgesic requirements, and postop ICU and hospital stay were significantly lesser in laparoscopic than open and conversion groups (p < 0.05). There was no periop mortality. Morbidity occurred more frequently in the open (n = 12) than in the laparoscopic group (n = 3). At follow-up (mean, 44 ± 33.7; range, 6-160 months), no patient had recurrent pheochromocytoma. Outcomes in terms of cure of pheochromocytoma and hypertension were not different between the three groups. Laparoscopic procedures are feasible and as safe and effective as open procedures for patients with organ-contained pheochromocytoma. In a patient cohort where majority of the patients had large (>6 cm) pheochromocytoma, laparoscopic procedures resulted in lesser morbidity and shorter convalescence and provided equal chance for cure of pheochromocytoma and hypertension as conventional open surgical procedures.

Management of complications of minimally invasive thoracic surgery

Minimally invasive thoracic surgery (MITS) has become part of the modern thoracic surgeon's armamentarium. Its applications include diagnostic and therapeutic procedures, and over the past one and a half decades, the scope of MITS has undergone rapid evolution. The role of MITS is well established in the management of pleural and mediastinal conditions, and it is beginning to move beyond diagnostic procedures for lung parenchyma conditions, to gain acceptance as a viable option for primary lung cancer treatment. However MITS poses technical challenges that are quite different from the conventional open surgical procedures. After a brief review of the history of MITS, an overview of the scope of MITS is given. Important examples of diagnostic and therapeutic indications are then discussed, with special emphasis on the potential complications specific to MITS, and their prevention and management.

Transoral robotic surgery

Surgical robotics is a rapidly developing field. The application of robotic technology to head and neck procedures potentially offers patients alternatives to conventional open surgical procedures with decreased morbidity. Additionally, transoral robotic surgery (TORS) may extend minimally invasive head and neck surgery beyond transoral laser microsurgery with the ability to work around corners while avoiding certain line-of-site limitations. This article describes the history of TORS including original laboratory data, early clinical data, and a description of technical aspects of the procedures.

Systemic thrombolysis for prosthetic valve thrombosis in the immediate postoperative period of major abdominal surgery

define; LeMaire, Carter, and Coselli have advocated a 6-week recovery period whereas Safi and colleagues recommend performing the second-stage repair 4 weeks after the first stage. In patients who have had elephant trunk repair of the arch, a secondstage surgical approach via a left thoracotomy for the replacement of the DTA is usually performed. On the other hand, several groups have reported using endografts to complete the second stage of the procedure. We chose endoluminal repair of the DTA aneurysm because we believed that it reduced procedural time, blood loss, length of intensive care unit stay, and hospital stay and that it is associated with lower rates of morbidity and mortality if compared with conventional open surgical procedures. In our patient, the presence of an aneurysmal dilatation of ARSA origin made management of this already complex pathologic condition even more complicated. Most patients with ARSA are asymptomatic, but aneurysms in this location require surgical treatment since they can cause serious complications: distal embolization, rupture, and compression of neighboring structures. Because of the rareness of the ARSA aneurysms, surgical strategies are still unclear. We have performed a bilateral subclaviancarotid bypass after ETT to prepare the patient for the last step of the procedure: stent grafting of the DTA. We have modified the conventional 2-step repair of thoracic complex aneurysms adding a third stage to suit the peculiar features of our patient. The 3-stage approach has been effective and we believe that it can be safely performed in patients with diffuse aneurysms of the thoracic aorta involving an ARSA. Long-term evaluation in larger numbers of patients is necessary to verify the efficacy of this technique.

Diagnostic and operative arthroscopy of the temporomandibular joint

Introduction: In the past, most efforts aimed at treating internal derangement of the temporomandibular joint (TMJ) have involved nonsurgical modalities and/or conventional open surgical procedures (i.e. arthrotomy). Common non­surgical methods include physical therapy, bite splint appliances, anti-inflammatory medications and patient education regarding potentially destructive habits such as clenching and bruxing. If these methods failed to yield symptomatic and functional improvement, open ar­throtomy of the joint was often proposed. These procedures consist of disk repositioning, arthroplasty, meniscectomy with and without implants and other treatments (AAOMS, 1984). The purpose of this article is to describe TMJ arthroscopy: a useful alternative to open surgery for the diagnosis and treatment of intracapsular TMJ pathology.