Invasive Surgery In Patients Research Articles

Minimally invasive surgery in cervical cancer.

In recent years, minimally invasive surgery has replaced open surgery for almost all surgical indications in gynecological practice. Recently, the results of the laparoscopic approach to cervical cancer (LACC) trial questioned the role of minimally invasive surgery for patients affected by early-stage cervical cancer. In the present paper, we discussed the current evidence regarding the adoption of minimally invasive surgery for patients with cervical cancer. We evaluated the current evidence focusing on four interesting features: 1) the impact of tumor volume; 2) reasons explaining worse outcomes of patients undergoing minimally invasive surgery; 3) methods to reduce the risk of recurrence during minimally invasive surgery; and 4) the effect of minimally invasive surgery in patients with locally advanced cervical cancer. At the moment, in the light of current evidence, minimally invasive radical hysterectomy should be offered only in the context of clinical trials. Extensive counseling and appropriate patients' selection are needed. Further prospective evidence is warranted to identify the better approach for cervical cancer patients.

Minimally Invasive Surgery in Patients with Adolescent Idiopathic Scoliosis is Safer, Less Expensive with Better Restoration of Kyphosis

Minimally Invasive Surgery in Patients with Adolescent Idiopathic Scoliosis is Safer, Less Expensive with Better Restoration of Kyphosis

Assessment of Bleeding in Patients on Antiplatelets Undergoing Dental Implants.

Antiplatelet drugs are used for the secondary prevention of cardiac and cerebrovascular diseases. Clopidogrel and Aspirin are the most commonly prescribed drugs for these patients. Physicians and dentists have to weigh bleeding risks versus thrombotic risks in interrupting antiplatelet regimen. The balance of these risks for an individual patient is the primary consideration in management of dental patients who are taking antiplatelet drugs and require dental implants. The study was undertaken to assess the risk of bleeding in patients on single and dual antiplatelets undergoing dental implants. 65 patients were assessed for bleeding after placement of dental implants. They were divided into 2 groups: group I included 48 patients on single antiplatelets (Aspirin) and group II included 17 patients on dual antiplatelets (Aspirin and Clopidogrel) based upon the timing of coronary intervention. Bleeding was evaluated intra-operatively and post-operatively. Significant difference in bleeding was noted between group I and group II based on the Visual Analog Scale (VAS) for bleeding severity after implant placement both intra-operatively (P = 0.000) and post-operatively (P = 0.004) within 24h. However, post-operative complication after 24h was non-significant (P = 0.277). Dental implants can be safely placed in patients on single antiplatelet drugs without discontinuing them. In patients on dual antiplatelets, risk of bleeding is mild to moderate if the drugs are continued. Consultation with treating cardiologist is a must before any kind of dental invasive surgery in patients on antiplatelets.

Minimally invasive surgery in cervical cancer.

In recent years, minimally invasive surgery has replaced open surgery for almost all surgical indications in gynecological practice. Recently, the results of the Laparoscopic Approach to Cervical Cancer (LACC) trial questioned the role of minimally invasive surgery for patients affected by earlystage cervical cancer. In the present paper, we discussed the current evidence regarding the adoption of minimally invasive surgery for patients with cervical cancer. We evaluated the current evidence focusing on four interesting features: (i) the impact of tumor volume; (ii) reasons explaining worse outcomes of patients undergoing minimally invasive surgery; (iii) methods to reduce the risk of recurrence during minimally invasive surgery; and (iv) the effect of minimally invasive surgery in patients with locally advanced cervical cancer. At the moment, in the light of current evidence, minimally invasive radical hysterectomy should be offered only in the context of clinical trials. Extensive counseling and appropriate patients' selection are needed. Further prospective evidence is warranted to identify the better approach for cervical cancer patients.

Impact of previous abdominal surgery on robotic-assisted rectal surgery in patients with locally advanced rectal adenocarcinoma: a propensity score matching study

BackgroundThe application of minimally invasive surgery in patients with colorectal cancer (CRC) and a history of previous abdominal surgery (PAS) remains controversial. This retrospective study with propensity score matching (PSM) investigated the impact of PAS on robotic-assisted rectal surgery outcomes in patients with locally advanced rectal adenocarcinoma undergoing preoperative concurrent chemoradiotherapy (CCRT).MethodsIn total, 203 patients with locally advanced rectal adenocarcinoma who underwent preoperative CCRT and robotic-assisted rectal surgery between May 2013 and December 2019 were enrolled. Patients were categorized into PAS and non-PAS groups based on the PAS history. The PSM caliper matching method with 1-to-3 matches was used to match PAS patients with non-PAS.ResultsOf the 203 enrolled patients, 35 were PAS patients and 168 were non-PAS patients. After PSM, 32 PAS patients and 96 non-PAS patients were included for analysis. No significant between-group differences were noted in the perioperative outcomes, including median console time (165 min (PAS) vs. 175 min (non-PAS), P = 0.4542) and median operation time (275 min (PAS) vs. 290 min (non-PAS), P = 0.5943) after PSM. Postoperative recovery and overall complication rates were also similar (all P > 0.05). Moreover, the between-group differences in pathological or short-term oncological outcomes were also nonsignificant (all P > 0.05). No 30-day postoperative deaths were observed in either group.ConclusionThe current results indicate that robotic-assisted surgery is safe and feasible for PAS patients with locally advanced rectal adenocarcinoma undergoing preoperative CCRT. However, future prospective randomized clinical trials are required to verify these findings.

Optimal time window for minimally invasive surgery in treating spontaneous intracerebral hemorrhage in the basal ganglia region: a multicenter and retrospective study

Background The current treatment spontaneous intracerebral hemorrhage (sICH) is limited. Aim To determine the optimal time window for minimally invasive surgery in patients with sICH. Materials and methods sICH patients with a hematoma volume of 30–80 mL in the basal ganglia region were included in our study. A total of 357 patients were divided into groups according to different operative times from ICH onset (group 1: 0–6 h, group 2: 6–12 h, group 3: >12 h) and hematoma volumes (30–50 mL and >50 mL). All patients were followed-up for three months’ post-operation, and their clinical outcomes were compared. Results In the three groups of patients with hematoma volumes of 30–50 mL, the rebleeding and mortality rate were higher in group 1 than groups 2 and 3 (p < .05). The activities of daily living evaluated by Barthel Index (BI) three months’ post-operation was significantly lower in group 3 than other groups (p < .05) and group 2 had the highest proportion of good outcomes. Among the patients with the hematoma volumes of 50–80 mL, the rebleeding risk was higher in group 1 than groups 2 and 3 (p < .05). However, there were no significant differences in mortality rates among these three groups. Moreover, group 1 had significantly higher BI than groups 2 and 3 (p < .05). Conclusions Minimally invasive surgery is safe and effective in patients with sICH. 6–12 h after sICH onset is the optimal surgical window for patients with hematoma volumes of 30–50 mL, while ultra-early (≤6 h) may achieve better results in patients with hematoma volumes of >50 mL.

Value Of Radiotherapy After Minimally Invasive Surgery In Patients With Stage IA1-IIA1 Cervical Cancer

In this study, we aimed to estimate the value of adjuvant radiotherapy after receiving laparoscopic hysterectomy for stage IA1-IIA1 cervical cancer patients. Two hundred twenty-one women with cervical cancer of stage IA1-IIA1 were included in this retrospective analysis. Sixty-two of them were treated with laparoscopic hysterectomy and adjuvant radiotherapy (group A), 115 underwent open surgery (group B) and 44 performed laparoscopic hysterectomy alone (group C). The 3-year local recurrence-free survival (LRFS), distant metastasis-free survival (DMFS), and overall survival (OS) rates were assessed in three groups. The median follow-up time was 58.33 months (range, 56.91–59.76 months) for all the patients. Three groups were comparable in terms of age, histologic subtypes, tumor size and ECOG Performance Status. The 3-year LRFS rates were 98.4% in group A, 97.4% in group B, 86.4% in group C, respectively. The LRFS rate of group A and B patients surpassed those of group C patients (group A vs. B, p = 0.634; group A vs. C, p = 0.011; group B vs. C, p = 0.006). The 3-year overall survival (OS) and 3-year DMFS rates were 96.8% and 93.5% in group A, 97.4% and 98.3% in group B, 93.2% and 97.7% in group C, respectively. The 3-year OS and DMFS rates were comparable in three groups (p>0.05). Adjuvant radiotherapy after laparoscopic hysterectomy in patients with early stage cervical cancer can reduce the risk of recurrence, and bring local control and survival benefits.

Predictive Variables for Postoperative Opioid Requirements Following Hysterectomy

Study Objective To identify predictive factors for opioid consumption following hysterectomy by determining the relationship between perioperative opioid requirements, preoperative pelvic pain scores and patient variables. Design A prospective cohort study. Setting Canadian tertiary care academic center. Patients or Participants The study included 191 women undergoing hysterectomy. Interventions Preoperatively, all patients completed the Pain Sensitivity Questionnaire (PSQ), Pain Catastrophizing Scale and the Numeric Rating Scale (NRS). Cumulative opioid consumption (COC), calculated in oral morphine equivalents (OME), was the sum of opioid consumption recorded during three time periods; (i) intraoperatively, (ii) recovery room, and (iii) first 24 hours postoperatively. Measurements and Main Results 191 women underwent hysterectomy, 68 vaginal (36%), 91 laparoscopic assisted (48%), and 32 open (17%). The mean age and body mass index were 50 (27–77) and 27 (17-64) kg/m2, respectively. Most hysterectomies (138, 73%) were performed in premenopausal women. The majority of all hysterectomies were for benign indications (166, 87%), and 40 (21%) were pain-related. Median COC for all hysterectomies was 75 mg OME, and median 24h postoperative COC was 16 mg OME. In multivariate analysis, preoperative NRS scores, PSQ minor scores, preoperative use of pain medication and an open approach were found to be significant predictors of increased COC. Each additional point on the PSQ minor mean score and preoperative NRS score was found to be associated with an increase of 4 and 2.5 mg OME, respectively. Patients with open hysterectomy consumed 59.75 mg OME more than minimally invasive surgery patients, when all other factors were equal. Each additional preoperative pain medication was associated with a 9 mg OME increase. Conclusion Predictors of cumulative postoperative opioid requirements for hysterectomy include preoperative NRS scores, PSQ minor scores, number of preoperative pain medications, and surgical approach. This information can be used to create a predictive calculator to individualize perioperative interventions, optimize postoperative pain management, and tailor opioid use.

Long-term survival results of minimally invasive surgery in patients with uterine serous carcinoma

Long-term survival results of minimally invasive surgery in patients with uterine serous carcinoma

Impact of uterine manipulator on oncological outcome in endometrial cancer surgery

There are limited data available to indicate whether oncological outcomes might be influenced by the uterine manipulator, which is used at the time of hysterectomy for minimally invasive surgery in patients with endometrial cancer. The current evidence derives from retrospective studies with limited sample sizes. Without substantial evidence to support its use, surgeons are required to make decisions about its use based only on their personal choice and surgical experience. To evaluate the use of the uterine manipulator on oncological outcomes after minimally invasive surgery, for apparent early-stage endometrial cancer. We performed a retrospective multicentric study to assess the oncological safety of uterine manipulator use in patients with apparent early-stage endometrial cancer, treated with minimally invasive surgery. The type of manipulator, surgical staging, histology, lymphovascular space invasion, International Federation of Gynecology and Obstetrics stage, adjuvant treatment, recurrence, and pattern of recurrence were evaluated. The primary objective was to determine the relapse rate. The secondary objective was to determine recurrence-free survival, overall survival, and the pattern of recurrence. A total of 2661 women from 15 centers were included; 1756 patients underwent hysterectomy with a uterine manipulator and 905 without it. Both groups were balanced with respect to histology, tumor grade, myometrial invasion, International Federation of Gynecology and Obstetrics stage, and adjuvant therapy. The rate of recurrence was 11.69% in the uterine manipulator group and 7.4% in the no-manipulator group (P<.001). The use of the uterine manipulator was associated with a higher risk of recurrence (hazard ratio, 2.31; 95% confidence interval, 1.27-4.20; P=.006). The use of uterine manipulator in uterus-confined endometrial cancer (International Federation of Gynecology and Obstetrics [FIGO] I-II) was associated with lower disease-free survival (hazard ratio, 1.74; 95% confidence interval, 0.57-0.97; P=.027) and higher risk of death (hazard ratio, 1.74; 95% confidence interval, 1.07-2.83; P=.026). No differences were found regarding the pattern of recurrence between both groups (chi-square statistic, 1.74; P=.63). In this study, the use of a uterine manipulator was associated with a worse oncological outcome in patients with uterus-confined endometrial cancer (International Federation of Gynecology and Obstetrics I-II) who underwent minimally invasive surgery. Prospective trials are essential to confirm these results.

Frailty Predicts Severe Postoperative Complications After Elective Minimally Invasive Surgery in Patients with Colorectal Cancer

To examine whether frailty is associated with postoperative complications in patients undergoing laparoscopic colorectal surgery. Patients over 65 years of age undergoing laparoscopic colorectal surgery from 2011 to 2016 at Saiseikai Kumamoto Hospital were enrolled. Frailty was defined by the Clinical Frailty Scale (CFS). Sarcopenia was defined as the total muscle area at the level of the third lumbar vertebra (L3) measured on computed tomography (CT). Relevance of the CFS score and sarcopenia to severe postoperative complications was assessed. Among 193 patients analyzed, 45 (23%) were frail and 122 (63%) had sarcopenia. Frailty was associated with older age (P < 0.0001), surgical site infection (P = 0.011), anastomotic leakage (P = 0.033), severe postoperative complications (Clavien–Dindo ≥ 3) (P = 0.0009), and postoperative in-hospital stay (P < 0.0001). In contrast, sarcopenia was not associated with postoperative outcomes. Low anterior resection and frailty were independent predictors of severe postoperative complications (risk ratios of 4.1 [P = 0.016 ] and 5.9 [P = 0.0005], respectively). With regard to severe postoperative complications, the occurrence of superficial surgical site infection and anastomotic leakage was significantly higher in the frailty group than that in the non-frailty group (P = 0.043 and 0.035, respectively). Frailty, but not sarcopenia, is a robust predictor of severe postoperative complications in patients undergoing endoscopic colorectal surgery.

Minimally Invasive Surgery for Patients with Spontaneous Intracerebral Hemorrhage: a Book Reopened

In contrast to remarkable recent gains made in the outcomes of patients with ischemic stroke, outcomes for patients with hemorrhagic stroke (spontaneous intracerebral hemorrhage [ICH]) remain poor. The results of past surgical trials for ICH—motivated by the hypothesis that patients would benefit from interventions to reduce intracranial hypertension associated with clot burden and prevent secondary injury induced by blood in the brain parenchyma—have to date been disappointing. Here, we review the results of the recently completed Minimally Invasive Surgery Plus Alteplase for Intracerebral Hemorrhage Evacuation III trial, which suggest that minimally invasive ICH evacuation may be clinically beneficial, but only when significant hematoma evacuation is achieved, and discuss ongoing minimally invasive surgical evacuation trials for ICH.

Outcomes of minimally invasive surgery for patients with endometrial carcinoma involving the cervix

ObjectiveMost studies evaluating the oncologic safety of minimally invasive surgery for endometrial cancer focus on patients with stage I disease. The aim of this study was to investigate the outcomes...

Locoregional anesthesia in endoscopic surgery of intracerebral hypertensive hemangiomas

Currently, minimally invasive methods of surgical treatment of hypertensive intracerebral hematomas (ICHs) are actively used. However, anesthetic management of these surgeries are unclear. Moreover, advisability of locoregional anesthesia (LRA) for endoscopic aspiration of hypertensive ICHs has not been studied. To analyze application of regional anesthesia in minimally invasive surgery of hypertensive intracerebral hematomas. Patients were divided into 2 groups. Group 1 included 45 patients who underwent surgery under total intravenous anesthesia with mechanical ventilation (TIVA + mechanical ventilation), group 2 (n=43) - surgery under LRA. The incidence of pneumonia and postoperative outcomes in accordance with the GOS grading system were analyzed depending on the method of anesthesia. Pneumonia was 3 times more common in the first group (33%) that required prolonged ventilation and tracheostomy. Thus, there were 9 tracheostomies (20%) in the first group. In the second group, one patient required mechanical ventilation on the second postoperative day due to severe chronic obstructive pulmonary disease followed by deterioration of respiratory failure. Tracheostomy was also performed in this case. According to analysis of GOS outcomes, the LRA group was characterized by 4 times lower mortality and 1.5 times greater number of patients with good recovery and moderate disabilities compared with the first group. LRA is a feasible and effective method for the anesthetic management of minimally invasive surgery in patients with hypertensive ICHs. This approach ensures decrease of mortality rate, increase of good neurological outcomes and reduce pulmonary infectious complications.

The mid-term outcomes of minimally invasive plasty for severe tricuspid regurgitation after cardiac surgery

Objectives: To evaluate the efficacy of minimally invasive surgery in patients with late severe tricuspid regurgitation after cardiac surgery, and to evaluate the role of leaflets augmentation technique in tricuspid valvuloplasty. Methods: From January 2015 to June 2019, 85 patients undergoing tricuspid valve repair procedure with minimally invasive approach at Department of Cardiovascular Surgery, Guangdong provincial People's Hospital were enrolled. There were 22 males and 63 females, aging of (53.6±12.4) years (range: 15 to 75 years). The interval between the prior and current operations was (16.0±7.3) years (range: 0.2 to 35.0 years). The diameter of right atrium and right ventricle was (77.3±17.2) mm and (61.0±8.4) mm, respectively. Tricuspid regurgitation was severe or extremely severe, the tricuspid regurgitation area was (19.0±10.3) cm(2). All patients underwent minimally invasive tricuspid valvuloplasty or tricuspid valve replacement on beating-heart with totally endoscopic technique and port-access approach through right chest wall. The operations included tricuspid valve replacement and tricuspid valvuloplasty, the technique of tricuspid valvuloplasty including leaflets augmentation with patch, ring implantation, chordae tendineaes reconstruction, release of papillary muscle, edge to edge method, etc. Postoperative hospitalization days, the time of ICU stay, blood transfusion rate, ventilator time and the results of echocardiography were recorded. Follow-up was completed regularly by WeChat, telephone and outpatient visit. Results: Sixty-five patients underwent tricuspid valve repair, and 20 patients underwent tricuspid valve replacement because of prosthetic failure and plasty failure. Five patients died during hospitalization, with mortality rate 5.9%. One patient was transferred to local hospital for anti-infection treatment, the other 79 patients were discharged from hospital in well condition and followed-up. The postoperative hospitalization time was 7.0 (5.5) days (M(Q(R))) days, the mean ventilator time was 18.0 (16.2) hours, and the mean ICU stay time was 68.0 (75.5) hours. There were 35 patients without blood conduction transfusion, the transfusion rate was only 58.9% (50/85). Four cases of severe, 9 cases of moderate and 67 cases of mild to zero tricuspid regurgitation were examined before being discharged, with tricuspid regurgitation area of (2.8±3.5) cm(2) (range: 0 to 19.1 cm(2)). The follow-up time was 1 to 38 months. Two patients died during follow-up, one patient died from infective endocarditis and mitral perivalvular leakage, the other one died of intractable right heart failure. One patient was implanted with permanent pacemaker due to Ⅲ atrioventricular block. Valvular re-replacement was performed in 2 patients who were re-admitted for the artificial valve infection and mechanical valve obstruction. No re-operation of tricuspid valve. Conclusions: Totally endoscopic minimally invasive technique provided satisfactory surgical outcomes for critically sick patients with severe tricuspid regurgitation following cardiac surgery. The application of leaflets augmentation technique achieved ideal repair effect for previously unrepairable lesions.

Handling of endoscopic equipment after use in the case of a patient with suspected prion disease

Prion diseases are slow-acting, neurodegenerative diseases found in humans and many species of animals. Although they occur very rarely in humans, currently, an increase in this type of disease is being observed, probably as a result of exposure to infectious prions causing BSE disease in cows. The aim of the procedures described in the article is to minimize the risk of human-to-human transfer of all forms of transmissible spongiform encephalopathy, including variant CJD (vCJD) by contaminated medical equipment. All diseases caused by prions, referred to as transmissible spongiform encephalopathies, are fatal. They are characterized by a long development period (up to several decades). Enormous problems are connected with the risk of transferring prions from patient to patient on the surface of instruments used in medical procedures. Laboratory tests indicate that standard disinfection and sterilization procedures may be insufficient to completely remove infectious proteins from contaminated instruments. One of the methods of infection prevention involves taking equipment used for surgery within the brain, tonsils or appendix, into quarantine until biopsy results of these organs have been received that exclude, as far as possible, asymptomatic carriage of prions. Whenever possible and justified, disposable-use instruments should be used for invasive surgery in patients with definite, clinically probable cases of CJD (vCJD). After use, these instruments should be incinerated.

Effect of minimally invasive surgery on upper urinary calculi with renal empyema and its effect on renal function

Objective To investigate the clinical effect of minimally invasive surgery in patients with upper urinary calculi and renal empyema and its effect on renal function. Methods Eighty-four patients with upper urinary calculi and renal empyema admitted from April 2016 to March 1818 were enrolled. The random number table was divided into control group and observation group, 42 cases in each group. The control group was treated with ureteroscopic lithotripsy. The observation group was treated with microchannel percutaneous nephrolithotomy. The effect of the patients was evaluated 3 days after surgery. The 7600 automatic biochemical analyzer was used to measure the levels of urea nitrogen, serum creatinine (Scr) and 24 h urine protein (24 h UP) before and after treatment. The enzyme-linked immunosorbent assay was used to measure the two groups before and after surgery. Hypersensitive C-reactive protein, tumor necrosis factor-a (TNF-a), interleukin-6 (IL-6) levels, and endothelin (ET-1) levels, serum of patient was completed by enzyme-linked immunosorbent assay (ELISA) Cortisol (CORT), catecholamine (CA), plasma glutamate (GLU) levels, statistics and re-corded the incidence of stone clearance, septic shock, perirenal abscess, major bleeding and sepsis in the two groups. Effects and effects on renal function in patients. Results The levels of BUN, Scr and 24 h UP in the observation group were lower than those in the control group 3 days after surgery (P 0.05). The incidence of septic shock, perirenal abscess, massive hemorrhage and sepsis after operation was lower in the observation group than in the control group (P<0.05). Conclusions Microchannel percutaneous nephrolithotomy for upper urinary calculi with renal empyema can improve the renal function of patients, reduce inflammatory factors and stress response, and the incidence of postoperative complications is low. It is worthy of popularization and application. Key words: Urinary Calculi; Pyonephrosis; Minimally Invasive Surgical Procedures

Arthroscopic minimally invasive surgery for knee joint gouty arthritis

Objective: To analyse the efficacy of arthroscopic minimally invasive surgery in patients with knee joint gouty arthritis. Methods: A retrospective analysis method was carried out on randomly selected 56 patients with knee gouty arthritis from early July 2018 to the end of June 2019. All patients underwent arthroscopic minimally invasive surgery. Results: In this study, the patients were followed for 10 months. The Lysholm score of knee function was found to be significantly higher after treatment compared to the scores before treatment (P&lt;0.05). Conclusion: Arthroscopic minimally invasive surgery is a promising method to treat for knee joint gouty arthritis.

Advances in laparoscopic surgery for cervical cancer

In the recent years, minimally invasive surgery has emerged as the gold standard for the treatment of both benign and malignant gynecological conditions. Growing evidence suggest that laparoscopic and robotic-assisted treatments allow to archived the same long-term outcomes than conventional open abdominal treatments, minimizing peri-operative morbidity. In the present review we analyzed the advances in the treatment of cervical cancer patients, reporting the advances in both the evolution of concept of radical hysterectomy and of the adoption of minimally invasive surgery. We discussed the advantages related to the introduction of minimally invasive treatment for cervical cancer patients; innovation of conventional laparoscopic surgery as discussed as well. Recent evidence suggested a potential detrimental effect on long-term survival outcomes related to the use of minimally invasive surgery in patients affected by cervical cancer. However, reasons why minimally invasive surgery might have a detrimental effect are still unclear. Further evidence is needed in order to improve quality of treatment for cervical cancer patients.

Minimally invasive interval debulking surgery in ovarian cancer (MIID-SOC): A prospective pilot study

Objective: Neoadjuvant chemotherapy (NACT) and interval debulking surgery (IDS) have been shown to have similar survival rates compared to primary surgery. The objective of this study is to implement, evaluate, and further investigate the role of minimally invasive surgery in patients undergoing interval debulking following neoadjuvant chemotherapy in patients with advanced ovarian cancer (AOC).