Invasive Drainage Research Articles

Modern possibilities of minimally invasive biliary drainage techniques for patients with malignant jaundice

Malignant biliary obstruction is a complex condition requiring a multimodal approach for both diagnosis and treatment. Most patients diagnosed with this disease are not candidates for radical surgery, as they come to us at advanced stages of the disease. Therefore, they need quality palliative care. Aim. Based on the data from scientific articles and literature, to highlight the possibilities of minimally invasive biliary drainage techniques in patients with malignant jaundice. The article analyzes the available sources of scientific literature and articles from the electronic resources PubMed, Google Scholar, UpToDate from 2019 to 2024. Minimally invasive methods of biliary drainage have demonstrated significant advantages over open surgeries, including a reduced risk of surgical complications, shorter rehabilitation period, and the ability to perform the procedure under local anesthesia. However, despite technological progress and accumulated clinical experience, a number of unresolved issues remain, in particular, related to choosing the optimal drainage method for a particular patient, and assessing the effectiveness and safety of a specific technique. Conclusions. The most controversial issue is the choice between endoscopic and percutaneous drainage methods. Some studies have shown that endoscopic drainage might be more effective in patients with tumors located in the distal bile ducts, while percutaneous drainage might be more appropriate in case of proximal obstructions. Therefore, the situation calls for additional studies to evaluate long-term results of different drainage techniques and the effectiveness of plastic, covered and uncovered metal stents in different clinical situations.

3D Technology-Assisted Minimally Invasive Surgery for the treatment of primary brainstem hemorrhage: A prospective cohort study

PurposeThe objective of this study was to assess the therapeutic efficacy of minimally invasive puncture and drainage (MIPD) facilitated by a three-dimensional (3D)-printed guide plate in the management of primary brainstem hemorrhage (PBH). MethodsThis single-center, prospective cohort study enrolled 30 PBH patients who underwent MIPD guided by 3D printing technology and 30 PBH patients who received conservative treatment, serving as the control cohort. The primary endpoint was the proportion of patients achieving modified Rankin Scale (mRS) scores of 1 and 2 at 30 days post-discharge. Secondary endpoints included hematoma volume at admission and post-treatment, incidence of hospital-acquired pneumonia (HAP) and/or rebleeding, in-hospital mortality rate, and length of hospital stay. ResultsThe treatment cohort demonstrated a significantly higher proportion of patients with mRS scores of 1 and 2 at 30 days post-discharge compared to the control cohort. Conversely, the treatment cohort exhibited significantly lower postoperative hematoma volumes, National Institutes of Health Stroke Scale (NIHSS) scores, HAP incidence, in-hospital mortality, and hospital stay duration than the control cohort. However, no significant difference in rebleeding incidence was observed between the two cohorts. ConclusionMIPD guided by 3D printing technology is more effective than conservative treatment in PBH cases without extensive hemorrhage. This approach can alleviate hematoma pressure earlier, mitigate neurological deficits, reduce HAP incidence, shorten hospital stay, and decrease mortality and disability rates associated with PBH.

Surgical Efficacy Analysis of Traumatic posterior fossa epidural Hematoma in Chidren

To investigate the treatment effect and prognosis of posterior fossa epidural hematoma in children by different surgical methods. The clinical data of 41 children with traumatic posterior fossa epidural hematoma treated by surgery in the Department of Neurosurgery from June 2015 to October 2023 were retrospectively analyzed. Among them, 32 cases underwent Minimally invasive skull trepanation and drainage and 9 cases underwent craniotomy and hematoma removal. The therapeutic effects and prognosis of the two surgical methods were analyzed. All the cases were successfully treated by operation. The operation time and intraoperative blood loss of the children who underwent Minimally invasive skull trepanation and drainage were significantly reduced compared with those who underwent craniocerebral hematoma removal (P<0.05), but there was no significant difference in the postoperative ventilator withdrawal time, hospitalization days and postoperative complications between the two groups (P>0.05). After 4 months to 2 years of follow-up, all the children recovered well, and no children died or became disabled after surgery. The effect of Minimally invasive skull trepanation and drainage in the treatment of posterior fossa epidural hematoma in children is similar to that of craniotomy hematoma removal, but the operation is simpler, less trauma, less intraoperative bleeding and short operation time, which is worthy of clinical application.

Minimally Invasive Injectable Gel for Local Immunotherapy of Liver and Gastric Cancer.

Local immunotherapy represents a promising solution for preventing tumor recurrence and metastasis post tumor surgical resection by eliminating residue tumor cells as well as eliciting tumor-specific immune responses. Minimally invasive surgery has become a mainstream surgical method worldwide due to its advantages of aesthetics and rapid postoperative recovery. Unfortunately, the currently reported local immunotherapy strategies are mostly designed to be used after open laparotomy, which go against the current surgical philosophy of minimally invasive therapy and is not suitable for clinical translation. Aiming at this problem, a minimally invasive injectable gel (MIGel) is herein reported loaded with immunotherapeutic agents for gastric and liver cancer postoperative treatment. The MIGel is formed by crosslinking between oxidized dextran (ODEX) and 4-arm polyethylene glycol hydroxylamine (4-arm PEG-ONH2) through oxime bonds, which can be injected through a clinic-used minimally invasive drainage tube and adhered tightly to the tissue. The loaded oxaliplatin (OxP) and resiquimod (R848) can be released constantly over two weeks and resulted in over 75% cure rate in orthotopic mouse gastric and liver cancer model. Collectively, a concept of minimally invasive local immunotherapy is proposed and MIGel is designed for local intraperitoneal cancer immunotherapy through minimally invasive surgery, with good clinical translation potential.

A novel simple laser guidance puncture system for intracerebral hematoma

ObjectiveAccurate localization and real-time guidance technologies for cerebral hematomas are essential for minimally invasive procedures, including minimally invasive hematoma puncture and drainage, as well as neuroendoscopic-assisted hematoma removal. This study aims to evaluate the precision and safety of a self-developed laser-guided device in localizing and guiding hematoma punctures in minimally invasive surgery for intracerebral hemorrhage (ICH). MethodsWe present the components of the device and its operational procedures. Subsequently, surgeons with different titles conduct hematoma puncture experiments using the device on skull models, comparing it to freehand puncture methods and recording the offset distance from the puncture needle tip to the hematoma center. Additionally, we report the application of this device in 10 patients with ICH, assessing its accuracy and safety in comparison with a neuro-navigation system. ResultsIn simulated puncture experiments, the accuracy of the laser-guided group surpasses that of the freehand puncture group, with a significant statistical difference observed between the two groups (P < 0.05). In the laser-guided group, there is no statistically significant difference in puncture accuracy among the surgeons (P > 0.05). In clinical experiments, no relevant surgical complications were observed. The offset distance for the laser-guided group was 0.61 ± 0.18 cm, while the neuro-navigation group was 0.48 ± 0.13 cm. There was no statistically significant difference between the two groups in terms of offset distance (P > 0.05). However, there was a significant difference in surgical duration (P < 0.05), with the former being 35.0 ± 10.5 minutes and the latter being 63.8 ± 10.5 minutes. ConclusionThe current study describes satisfactory results from both simulated experiments and clinical applications, achieved through the use of a novel laser-guided hematoma puncture device. Furthermore, owing to its portability, affordability, and simplicity, it holds significant importance in advancing surgical interventions for ICH, especially in underdeveloped regions.

Partial pericardiectomy and minimally invasive pericardial drainage in pediatric surgery

Introducción. Una de las patologías más frecuentes del pericardio es la pericarditis, que puede presentarse como pericarditis aguda, subaguda o crónica, derrame pericárdico, taponamiento cardíaco o pericarditis constrictiva. Sin embargo, es una condición infrecuente en la población pediátrica. Métodos. Presentamos una serie de casos de pacientes con pericarditis que fueron llevados a pericardiotomía, drenaje pericárdico y pericardiectomía parcial anterior, entre julio de 2014 y junio de 2023. Se recolectaron las variables demográficas y clínicas, se evaluaron los aislamientos microbiológicos y el manejo recibido. Resultados. Un total de 12 pacientes fueron llevados a manejo quirúrgico mínimamente invasivo; de estos, 58 % pertenecían a comunidades indígenas y residían en zonas rurales. La mitad tenían neumonía asociada. En la mayoría de los casos no se obtuvo aislamiento microbiológico. Conclusión. La necesidad de manejo quirúrgico está determinada por la repercusión en las variables hemodinámicas relacionadas con el derrame y el compromiso pericárdico. La pericardiectomía parcial por toracoscopia es una alternativa en estos casos.

Curative effect analysis of robot-assisted drainage surgery in treatment of spontaneous hypertensive brainstem hemorrhage.

Spontaneous hypertensive brainstem hemorrhage (HBSH) is characterized by sudden onset, rapid progression and poor prognosis. There has been a growing tendency of surgical treatment for HBSH. This study aimed to investigate outcomes and potential factors associated with the prognosis of robot-assisted drainage surgery for HBSH treatment. Patients with HBSH from July 2016 to March 2023 at a single neurosurgery center were included and divided into conservative group and surgical groups. Baseline and clinical data, radiographic characteristics, complications, and outcome evaluations were recorded and analyzed. A total of 125 patients, with 74 in the conservative group and 51 in the surgical group, were enrolled in the study. Mortality at 6 months was 59/74 (79.7%) in the conservative group and 9/51 (17.6%) in the surgical group. Twenty-four patients (47.1%) achieved favorable outcomes in the surgical group, whereas this rate in the conservative group was only 5.4% (4/74). There was a significant difference in NIHSS, GCS, and mRS at 6 months between surviving patients in the conservative and surgical groups. In prognostic analysis in the surgical subgroup, initial GCS score [5 (IQR 4-7) vs. 3 (IQR 3-4), p < 0.001], NIHSS [36 (IQR 32-38) vs. 40 (IQR 38-40), p < 0.001], smoking history [45.8% (11/24) vs. 74.1% (20/27), p = 0.039], hematoma volume [6.9 (IQR 6.2-7.6) vs. 9.6 (IQR 7.3-11.4), p = 0.001], and hemorrhage location (p = 0.001) were potential risk factors for poor 6-month prognosis after robot-assisted surgery for HBSH. Based on the results of this study, robot-assisted minimally invasive drainage of brain stem hematoma may significantly reduce mortality and improve prognosis. Surgery should be conducted for selected patients.

Resident dictation of operative notes: a reimbursement comparison and mixed-methods analysis

PurposeSurgical documentation is crucial to ensure quality patient care and accurate coding and billing. Operative dictation also serves as a valuable educational opportunity for surgical trainees. However, resident dictations may not fully capture procedural details and complexities, resulting in missed revenue opportunities. On July 1, 2021, our university-based surgery department implemented a policy requiring attendings to dictate all operative reports. The purpose of this mixed-method study was to investigate the financial impact of this policy and explore differences in resident and attending dictations.MethodsCore general surgery operations performed by the Department of Surgery between July 1, 2020 and June 30, 2022 were identified from billing data. The surgeon, current procedural terminology (CPT) and modifier codes, and relative value units (RVUs) for each case were acquired. Surgeons not present for the entire study period or cases requiring multiple surgeons were excluded. Descriptive statistics and Kolmogorov–Smirnov (KS) non-parametric tests compared pre- and post-policy RVU distributions on overall charges and 18 key general surgery operations. Targeted thematic analysis was performed on operative reports pre- and post-policy to explore resident and attending differences.ResultsA total of 42 attendings performed 16,233 cases, billing 28,560 CPT codes (50.3% pre- vs. 49.7% post-policy). There was a small but statistically significant increase in RVU distribution post-policy, mean 20.2 pre- vs. 20.3 RVUs post-, $4372 pre- vs. $4418 per case post-, KS = 0.02 (p = 0.009). Specifically, higher RVU distributions were seen among attending-dictated cases for melanoma (p = 0.009), minimally invasive ventral hernia repair (VHR, p = 0.008), parathyroidectomy (p < 0.001), anorectal incision and drainage (p = 0.003) and anorectal exam under anesthesia (p = 0.029). Higher RVU distributions were noted among resident-dictated, attending-edited cases for partial colectomy (p = 0.043), and open VHR (p = 0.004). No differences were noted among the remaining operations (p > 0.05). Three major themes were noted from focused sampling of 112 operative reports: billable items, clinical/surgical reasoning, and technical details. Differences in billable items and clinical and surgical reasoning were the most influential on modifying clinical implications of operative notes. Themes and differences were consistent regardless of surgeon or specialty.ConclusionAdopting an attending-only operative dictation policy yielded a small increase in billable RVUs, predominantly from select operations. Gaps in coding-directed language and depth of clinical reasoning were noted in resident dictations. These findings reveal an educational opportunity that concomitantly optimizes patient care, resident education, and procedural revenue.

Minimally invasive surgical approaches for spontaneous intracranial hemorrhage in neonates aged 0–3 months

Objective The aim of this study is to assess the clinical efficacy of minimally invasive surgical interventions in addressing spontaneous intracranial hemorrhage among neonates aged 0–3 months. Methods A retrospective analysis was conducted on a cohort of 30 neonates diagnosed with spontaneous intracranial hemorrhage, who underwent minimally invasive cranial trepanation and drainage procedures at our department between 2011 and 2015. Results A comprehensive follow-up, spanning a duration of 1–5 years, was conducted for all 30 neonates, revealing a 100% survival rate among the pediatric cohort. Conclusion The findings suggest that minimally invasive cranial trepanation and drainage exhibit efficacy in neonates aged 0–3 months experiencing spontaneous intracranial hemorrhage, leading to a reduction in both mortality and disability rates. It is recommended that surgery be promptly performed upon definitive diagnosis and identification of operation indications to prevent severe brain damage resulting from prolonged intracranial hypertension and potential fatal outcomes in neonates. Furthermore, the surgical procedure is characterized by its simplicity, involving minimal trauma.

Prognostic factors in acute hypertensive intracerebral hemorrhage: impact of minimally invasive puncture and drainage.

To analyze the prognostic factors in patients with acute hypertensive intracerebral hemorrhage (HICH) undergoing minimally invasive puncture and drainage, providing scientific evidence to enhance clinical treatment strategies. A retrospective analysis was conducted on 350 patients with acute HICH treated at Gansu Provincial Hospital of Traditional Chinese Medicine and the First People's Hospital of Lanzhou City from March 2017 to January 2024. Patients were divided into two groups based on surgical method: the control group (n = 211) received traditional craniotomy, while the observation group (n = 139) underwent minimally invasive puncture and drainage. Functional scores, inflammatory markers, clinical efficacy, surgical time, first hematoma clearance rate, and hospitalization duration were compared between the groups. Patients were classified into poor prognosis (Glasgow Outcome Scale (GOS) score < 3) and improved prognosis (GOS score ≥ 3) groups. Logistic regression analysis identified independent risk factors for poor prognosis and examined their interaction with patient outcomes. Postoperative functional scores (National Institutes of Health Stroke Scale (NIHSS) score, GOS score, and Barthel Index) in the observation group were significantly better than those in the control group (all P < 0.001). Inflammatory markers (C-reactive protein (CRP), interleukin-6 (IL-6), and tumor necrosis factor-alpha (TNF-α)) were significantly lower post-treatment in the observation group compared to those in the control group (all P < 0.001). Multivariate logistic regression identified age (P = 0.003, OR = 0.573), time from onset to admission (P = 0.026, OR = 0.535), duration of hypertension (P = 0.006, OR = 1.766), and postoperative IL-6 levels (P = 0.048, OR = 1.870) as independent risk factors for poor prognosis. Prognosis was statistically associated with age (P = 0.040, OR = 0.978), time from onset to admission (P = 0.022, OR = 0.956), duration of hypertension (P = 0.022, OR = 1.085), and post-treatment IL-6 levels (P = 0.043, OR = 1.030). Minimally invasive puncture and drainage offer superior neurological recovery, reduced inflammatory response, and improved long-term prognosis compared to traditional craniotomy in the treatment of hypertensive intracerebral hemorrhage.

Ultrasound combined with urokinase under key-shaped bone window enhances blood clot lysis in an in vitro model of spontaneous intracerebral hemorrhage.

Minimally invasive surgery for spontaneous intracerebral hemorrhage is impeded by inadequate lysis of the target blood clot. Ultrasound is thought to expedite intravascular thrombolysis, thereby facilitating vascular recanalization. However, the impact of ultrasound on intracerebral blood clot lysis remains uncertain. This study aimed to explore the feasibility of combining ultrasound with urokinase to enhance blood clot lysis in an in vitro model of spontaneous intracerebral hemorrhage. The blood clots were divided into four groups: control group, ultrasound group, urokinase group, and ultrasound + urokinase group. Using our experimental setup, which included a key-shaped bone window, we simulated a minimally invasive puncture and drainage procedure for spontaneous intracerebral hemorrhage. The blood clot was then irradiated using ultrasound. Blood clot lysis was assessed by weighing the blood clot before and after the experiment. Potential adverse effects were evaluated by measuring the temperature variation around the blood clot in the ultrasound + urokinase group. A total of 40 blood clots were observed, with 10 in each experimental group. The blood clot lysis rate in the ultrasound group, urokinase group, and ultrasound + urokinase group (24.83 ± 4.67%, 47.85 ± 7.09%, 61.13 ± 4.06%) was significantly higher than that in the control group (16.11 ± 3.42%) (p = 0.02, p < 0.001, p < 0.001). The blood clot lysis rate in the ultrasound + urokinase group (61.13 ± 4.06%) was significantly higher than that in the ultrasound group (24.83 ± 4.67%) (p < 0.001) or urokinase group (47.85 ± 7.09%) (p < 0.001). In the ultrasound + urokinase group, the mean increase in temperature around the blood clot was 0.26 ± 0.15°C, with a maximum increase of 0.38 ± 0.09°C. There was no significant difference in the increase in temperature regarding the main effect of time interval (F = 0.705, p = 0.620), the main effect of distance (F = 0.788, p = 0.563), or the multiplication interaction between time interval and distance (F = 1.100, p = 0.342). Our study provides evidence supporting the enhancement of blood clot lysis in an in vitro model of spontaneous intracerebral hemorrhage through the combined use of ultrasound and urokinase. Further animal experiments are necessary to validate the experimental methods and results.

PERSONALIZED APPROACH TO THE CHOICE OF BILIARY DRAINAGE TACTICS IN PATIENTS WITH TUMOR-INDUCED MECHANICAL JAUNDICE

Mechanical jaundice resulting from the tumor-induced obstruction of bile ducts is usually the first and quite severe complication of malignant neoplasms of the organs of the hepatopancreatoduodenal zone. Radical treatment for this condition, as reported by various sources, remains below 20-25%. Therefore, the imperative is to select the most effective minimally invasive biliary drainage method to alleviate biliary tract pressure and address the issue of mechanical jaundice. This approach serves both as a preparatory step for potential radical surgical intervention and as a definitive method for palliative treatment in this patient category.&#x0D; The aim of this work is to develop an optimal algorithm for diagnosis and treatment of patients with tumor-induced mechanical jaundice, which will increase the effectiveness of primary surgical intervention and reduce the number of complications and mortality for this category of patients.&#x0D; The investigation focused on examining the results of diagnostic and surgical interventions in 108 patients with tumor-induced mechanical jaundice. These patients underwent biliary drainage operations in surgical hospitals between 2017 and 2023. Analysis of the surgical outcomes revealed that endoscopic drainage and percutaneous transhepatic drainage exhibited similar effectiveness in I and II levels of biliary obstruction. However, endoscopic drainage demonstrated lower complication rates and improved quality of life for patients, establishing it as the preferred method. For level III blockages, percutaneous transhepatic drainage is recommended.&#x0D; The implementation of a diagnostic and treatment algorithm, which considers the level of biliary block, the severity of mechanical jaundice, and the tumor process stage, enables the selection of the most effective minimally invasive biliary drainage method. This approach contributes to a reduction in postoperative mortality.

Nursing analysis of minimally invasive intracranial hematoma drainage for hypertensive cerebral hemorrhage.

Nursing analysis of minimally invasive intracranial hematoma drainage for hypertensive cerebral hemorrhage.

Comparative assessment of clinical and diagnostic aspects of computed tomographic indices of severity of acute necrotising pancreatitis

Objective. To compare the clinical and diagnostic informativeness of computed tomographic indices Balthazar and Mortele (modified) in acute necrotising pancreatitis based on a retrospective assessment of their correlation with the main clinical parameters.&#x0D; Materials and methods. The clinical course of acute necrotising pancreatitis and the informativeness of computed tomographic indices were retrospectively compared in 30 patients.&#x0D; Results. Moderately severe acute pancreatitis according to the Balthazar index was present in 11 (36.7%) and severe in 19 (63.3%) patients, but according to the Mortele index, moderate severe disease was confirmed in 5 (16.7%) and severe in 25 (83.3%), i.e. in 6 (54.5%) patients, or more than half, the moderate form was retrospectively reclassified as not severe acute pancreatitis. In general, the mean score of the modified index was slightly higher than that of the Balthazar index: 8.4 ± 1.61 and 7.4 ± 1.73, respectively (p&lt;0.05). This is due to the consideration of isolated and combined extrapancreatic lesions in 24 (80%) patients: exudative pleurisy (24), portal vein thrombosis (1). The Mortele index recategorisation of moderate acute pancreatitis according to the Balthazar index led to a decrease in the proportion of patients who underwent ultrasound–guided percutaneous drainage or surgery from 63.6 to 40% (p&gt;0.05). No differences were found in the frequency of surgical treatment of severe acute pancreatitis according to the Balthazar index and the Mortele index – 78.9 and 80%, respectively, and similarly, minimally invasive drainage was ineffective in 44.4 and 36.4% of patients, respectively.&#x0D; Conclusions. Both computed tomography indices correlated equally well with the clinical course of severe acute necrotising pancreatitis and the frequency of various surgical treatments.

Perihematomal edema after minimally invasive surgery: a matter of concern to neurosurgeons.

The purpose of this study is to explore the evolution of brain edema after minimally invasive surgery in deep spontaneous cerebral hemorrhage (DSICH) treatment and to analyze the differences in edema after different surgical methods. The clinical data of 105 patients with DSICH treated at Renmin Hospital of Wuhan University from January 2020 to June 2022 were analyzed retrospectively. Among them, 54 patients were treated with minimally invasive puncture and drainage surgery (MIPDS group), and 51 were treated with neuroendoscopic surgery (NES group). Continuous computed tomography images of patients in the hospital and 3D Slicer software were used to quantitatively calculate the edematous area to explore the changes in perihematomal edema volume in the two groups after the operation. The peak volume of postoperative edema (37.36±10.51 mL) in the MIPDS group was more extensive than that in the NES group, and its net increase in edema volume was 16.86±10.01 mL more than that in the NES group. The relative edema index (0.86±0.26) was lower in the NES group than in the MIPDS group (P < 0.05). The peak of postoperative edema in the MIPDS group was at 6-8 days after the operation, and that in the NES group was most often at 3-5 days after the operation. There are differences in perihematomal edema of DSICH treated by different minimally invasive methods. Compared with the MIPDS group, the NES group showed earlier peak of cerebral edema and lower degree of cerebral edema. The absolute regression volume of edema in the MIDPs group was greater than that in the NEs group, but there was no difference in the regression rate of edema between the two groups.

Clinical application of 3DSlicer and Sina in minimally invasive puncture drainage of elderly patients with spontaneous intracerebral hemorrhage under local anesthesia

BackgroundDecreased organ function and poor physical compensatory capacity in elderly patients diagnosed with spontaneous intracerebral hemorrhage (ICH) can make surgical treatment procedures challenging and risky. Minimally invasive puncture drainage (MIPD) combined with urokinase infusion therapy is a safe and feasible method of treating ICH. This study aimed to compare the treatment efficacy of MIPD conducted under local anesthesia using either 3DSlicer + Sina application or computer tomography (CT)–guided stereotactic localization of hematomas in elderly patients diagnosed with ICH. MethodsThe study sample included 78 elderly patients (≥ 65 years of age) diagnosed with ICH for the first time. All patients exhibited stable vital signs and underwent surgical treatment. The study sample was randomly divided into two groups, either receiving 3DSlicer+Sina or CT-guided stereotactic assistance. The preoperative preparation time; hematoma localization accuracy rate; satisfactory hematoma puncture rate; hematoma clearance rate; postoperative rebleeding rate; Glasgow Coma Scale (GCS) score after 7 days; and modified Rankin scale (mRS) score 6 months after surgery were compared between the two groups. ResultsNo significant differences in gender, age, preoperative GCS score, preoperative hematoma volume (HV), and surgical duration were observed between the two groups (all p-values > 0.05). However, the preoperative preparation time was shorter in the group receiving 3DSlicer + Sina assistance compared to that receiving CT-guided stereotactic assistance (p-value < 0.001). Both groups exhibited significant improvement in GCS scores and reduction in HV after surgery (all p-values < 0.001). The accuracy of hematoma localization and puncture was 100% in both groups. There were no significant differences in surgical duration, postoperative hematoma clearance rate, rebleeding rate, postoperative GCS and mRS scores between the two groups (all p-values > 0.05). ConclusionsA combination of 3DSlicer and Sina is effective in accurately identifying hematomas in elderly patients with ICH exhibiting stable vital signs, thus simplifying MIPD surgeries conducted under local anesthesia. This procedure may also be preferred over CT-guided stereotactic localization in clinical practice due to its ease of use and accuracy in hematoma localization.

Laser navigation combined with XperCT technology–assisted puncture of basal ganglia intracerebral hemorrhage

Basal ganglia hemorrhage, which is characterized by excessive incapacity charge and high mortality rates, is surgically treated by minimally invasive hematoma puncture and drainage. We aimed at determining the efficacy of laser-guided minimally invasive hematoma puncture and drainage for treatment of basal ganglia hemorrhage. A total of 61 patients with hypertensive basal ganglia hemorrhage were recruited at the Binzhou Medical University Hospital, between October 2019 and January 2021, and their clinical information retrospectively analyzed. Based on the surgical approach used, patients were assigned into either laser navigation or small bone window groups depending on the surgical approach. Then, we compared the operation times, intraoperative blood loss, clinic stay, Glasgow Outcome Score (GOS) rating at 30 days, Barthel index (BI) rating at 6 months, postoperative pneumonia incidences, and intracranial contamination complications between groups. Intraoperative blood loss, operation time, and sanatorium were significantly low in laser navigation group, relative to the small bone window group. At the same time, there were no significant differences between the groups with regard to postoperative hematoma volume, lung contamination, cerebrospinal fluid (CSF) leak, and intracranial contamination, as well as the 6-month BI and 30-day GOS rating. There were no deaths in either group. Compared with the traditional small bone window surgery, laser-guided puncture and drainage is a low-cost, accurate, and safe method for the treatment of basal ganglia hemorrhage, which is suitable for promotion in developing countries and economically underdeveloped areas.

Evaluation of the factors influencing the choice of laparoscopic echinococcectomy in liver echinococcosis (LE) and its impact on postoperative outcomes.

The aim of this article is to evaluate the factors influencing the choice of laparoscopic echinococcectomy (LapEE) in liver echinococcosis (LE) and its impact on postoperative outcomes. The article presents a retrospective analysis of the effectiveness of LapEE depending on gender, age, cyst location, size and stage of echinococcal cysts (EC) development, also taking into account the performance of drainage or abdominal interventions in relation to the residual cavity (RC). The study included patients with the primary form of LE - 46 patients who underwent LapEE at the State Institution "Republican Specialized Scientific and Practical Medical Center for Surgery, named after the academician V. Vakhidov", between 2019 and 2020. Taking into account the stage of cyst development, various difficulties with aspiration or removal of the cyst contents occurred in only 14 (30.4%) cases, more often with type II-IV cystic echinococcosis (CE). Another problem was the difficulty with adequate revision and treatment of RC (in 6 (13.0%) patients) with predominantly intraparenchymal localization. Difficulties with performing percytectomy with sufficient excision of the fibrous capsule were noted in 9 (19.6%) cases. In the period up to a week after the operation, the drainage was removed for cysts up to 8cm in 11 (36.7%) cases, with more than 8cm - in 5 (31.3%). By 3 weeks of observation, the drains were removed in all cases with cysts up to 8cm, while with large sizes in 12.5% (2 patients) cases, the drainage was removed on days 21-28 and in 1 (6.3%) patient at a later period. In general, in the group, complications from the RC on days 9-27 after LapEE were noted in 10 (21.7%) of 46 patients, fluid accumulation in 8 (17.4%) and suppuration in 2 (4.3%). Most complications were resolved conservatively - 13.0% (in 6 patients), a minimal invasive drainage of the RC was performed in 6.5% (3 patients), 1 (2.2%) patient was operated on with a RC abscess. Among the main factors that technically complicate LapEE, in addition to localization, difficulties with aspiration or removal of cyst contents in CE II, III, and IV are highlighted due to the presence of many daughter cysts that completely fill the maternal membrane (CE II, III) or thick viscous discharge (CE IV), as well as difficulties in performing a pericystectomy for adequate elimination of the RC when the hydatid is located 3/4 or more in the liver parenchyma.

Optimizing The Timing of Stereotactic Minimally Invasive Drainage for Hypertensive Intracerebral Hemorrhage

Intracerebral hemorrhage is a high-risk pathological event that is associated with formidable morality rates. Here, our objective was to perform a retrospective study to determine the best timing for drainage using physiological data on patients who received drainage at different timings. In this retrospective study, we reviewed 198 patients with hypertensive cerebral hemorrhage who underwent stereotactic drainage at the conventional timing (surgery within 12h of admission; control group) and 216 patients who underwent stereotactic drainage at a customized surgical timing (elective group). Follow-ups were performed at 3 and 6 months after surgery. The clinical indicators, including prognosis, hematoma clearance, recurrent hemorrhage, intracerebral infection, pulmonary infection, deep venous thrombosis, gastrointestinal hemorrhage, National Institutes of Health Stroke Scale scores, and matrix metallopeptidase 2 and 9 levels, were compared between the control and elective groups. Our data indicated that the elective group had significantly better prognosis compared to the control group (p = 0.021), with a higher rate of hematoma clearance (p = 0.004) and a lower rate of recurrent hemorrhage (p = 0.018). The total occurrence rate of post-surgery complications was also lower for the elective group (p = 0.026). NIHSS scores and serum MMP2/9 levels of the elective group were lower than those of the control group. Customized timing of stereotactic drainage may be superior to conventional fixed timing (within 12h post-hemorrhage) in reducing post-surgery complications and promoting recovery, which supports the potential use of customized timing of stereotactic minimally invasive drainage as a new convention in clinics.

Readiness for hospital discharge post-initial invasive percutaneous transhepatic biliary drainage: A mixed-methods study

This study explores perceptions regarding hospital discharge readiness among patients with post-first invasive percutaneous transhepatic biliary drainage (PTBD), family caregivers, and healthcare providers who are involved during the discharge period. A convergent mixed-method design was applied. A purposive sample of 30 patients completed a scale measuring readiness for hospital discharge, and 30 participants, including patients, family caregivers, and healthcare providers, participated in in-depth interviews. Descriptive analyses were combined with quantitative data, thematic analyses with qualitative data, and joint displays with mixed analyses. Findings indicate that readiness for hospital discharge was high, the expected support subscale was at the highest possible level, and the personal status subscale was at the lowest level. Three main themes emerged from an analysis of the interview transcripts: improved health conditions, self-care knowledge, and homecare preparedness. Self care knowledge had three sub-themes: taking care of biliary drainage, consuming a suitable diet, and observation of abnormal symptoms. Being ready for hospital discharge contributes to a safer transition from hospital to home. Healthcare providers need to reconsider the criteria for discharge and clarify patients’ individual needs. Patients, family caregivers, and healthcare providers need to be prepared for hospital discharge.