Keyhole Technique Research Articles

Superior Capsular Reconstruction With the Mini-open Keyhole Technique Using Achilles Allograft Shows Favorable Outcomes for Patients With Preoperative Pseudoparalysis but Worse Outcomes and Strength With Longer Duration of Pseudoparalysis

PurposeThe purpose of this study was to analyze whether unique SCR with key-hole technique using Achilles allograft can improve pseudoparalysis in patients with irreparable rotator cuff tears and additionally to identify preoperative factors that influence clinical outcomes. MethodsBetween January 2018 and October 2021, patient data from SCR with our institution's unique key-hole technique using Achilles were retrospectively collected (minimum 2-years follow up). The patients were categorized into pseudoparalysis group (P group) and no pseudoparalysis group (NP group). Active range of motion (ROM) of shoulder, clinical scores (constant and pain visual analog scale scores) and muscle strength was assessed preoperatively and at 2-years postoperatively. And the correlation between preoperative and postoperative clinical data was analyzed through simple linear regression in the P group. Results69 patients who underwent SCR with key-hole technique using Achilles, were included in the study. Group P and NP had 24 and 45 cases, respectively. Preoperative ROM (FE, ER), constant score and muscle strength (FE, ER) were significantly lower in P group than NP group. At 2-year follow-up the active ROM (FE, p<0.001, ER, p<0.001), constant score, VAS, muscle strength (FE, p<0.001, ER, p<0.001) were improved in the P group. In P group, pseudoparalysis recovered in 21 out of 24 patients (87.5%) at 2-year after surgery. The minimum clinically important difference of patient reported outcomes (Constant Score / VAS) were 8.15/1.05 for the P group and 9.47/0.92 for the NP group. Among the 3 cases of recovery failed, 2 cases were due to graft failure, and 1 case had delayed recovery. Prolonged preoperative pseudoparalysis and weaker preoperative external rotation strength were associated with worse clinical outcomes. ConclusionsSuperior capsular reconstruction with mini open key-hole technique using Achilles allograft demonstrates favorable outcomes for patients with preoperative pseudoparalysis. However, for SCR with the pseudoparalyis patients the careful attention is needed because the longer pseudoparalysis duration and the weaker external rotation strength could have the tendency of worse postoperative outcomes.

PARASTOMAL HERNIA REPAIR IN BRICKER TYPE URINARY DIVERSION USING THE MODIFIED PAULI TECHNIQUE: A CASE REPORT

Abstract Introduction The incidence of parastomal hernia (PH) associated with Bricker ileal urinary diversion is approximately 20%. Surgery becomes necessary in the presence of symptoms or development of complications. Clinical case A 77-year-old woman with a Bricker urinary diversion following radical cystectomy presented to the emergency department with 72 hours of evolving obstructive symptoms, coupled with a large PH featuring incarcerated bowel. A CT scan confirmed complete intestinal obstruction. Urgent surgery was conducted, revealing ileum incarceration without perforations. Reduction of the intestinal content was performed, restoring viability. Transversus abdominis release (TAR) around the stoma was executed, followed by the placement of a retromuscular progrip mesh using the Pauli technique. The patient was discharged after 8 days without complications. Discussion The surgical treatment of PH remains controversial, lacking a consensus as the most effective technique. We opted for modified Pauli technique, involving retromuscular dissection, subsequent components separation via TAR and mesh repair according to the Keyhole technique. This combination leverages the advantages of each of procedures to reduce the recurrence risk: retromuscular mesh placement physiologically pushing the wall, utilization of wider prostheses reinforcing a larger surface area, complete mesh contact with the wall facilitating integration around the defect, and direct stoma exit without the need for repositioning. Conclusions The modified Pauli technique with Keyhole mesh placement, while demanding, can provide advantages in emergency surgery without causing significant postoperative complications.

Applying the Full Endoscopic Keyhole Technique to CPA Lesions: A Single-Center Study.

In recent years, endoscopy has become an increasingly common tool used during neurosurgical procedures. However, its application in treating cerebellopontine angle (CPA) lesions has not progressed as rapidly. In this study, the authors present their initial experience with surgically treating CPA lesions using a fully endoscopic keyhole retrosigmoid approach. They conducted a retrospective analysis of clinical data from patients who underwent endoscopic keyhole CPA surgery at their center between May 2017 and April 2022. They provide a comprehensive explanation of this method and an overview of the strategies that have been developed to achieve better clinical outcomes. The study included 107 patients, consisting of 10 cases of vestibular schwannoma, 21 cases of epidermoid cyst, 32 cases of trigeminal neuralgia, and 44 cases of hemifacial spasm. The authors analyzed the clinicodemographic details of the patients. Among the 31 tumor cases, gross total resection was achieved in 25 patients (80.6%), while near-total resection was performed in 6 patients (19.4%). In patients with trigeminal neuralgia, facial pain resolved in 31 out of 32 patients (96.9%). Similarly, facial convulsions disappeared or were relieved in all 44 patients (100%) with hemifacial spasms after the operation. Postoperative complications included facial nerve paresis (n=9, 8.4%), with improvement observed in 6 cases during follow-up, transient facial hypoesthesia (n=3, 2.8%), cerebrospinal fluid rhinorrhea (n=3, 2.8%), transient abducens paresis (n=1, 0.9%), and postoperative hemorrhage (n=1, 0.9%). Endoscopy provides improved deep illumination and, combined with close-up observation, enhances the visualization of structures within the CPA region. The fully endoscopic keyhole technique is a safe and effective method for managing CPA lesions.

Parastomal hernia repair, trying to optimize the impossible reconstruction

PurposeParastomal hernias are a common and challenging problem with high rates of wound complications and hernia recurrence after repair. We present our approach to optimizing parastomal hernia repair through preoperative preparation, surgical approach, and postoperative management.MethodsPatients are carefully evaluated and optimized prior to surgery. Our typical surgical approach involves a generous midline laparotomy and retrorectus dissection followed by a posterior component separation with transversus abdominis release. We typically utilize a Sugarbaker technique for retromuscular mesh placement but also use the retromuscular keyhole or cruciate technique if there is insufficient bowel length.ResultsPreviously published results from our institution include wound complication rates of up to 16% after open retromuscular parastomal hernia repair. Stoma-specific complications, such as mesh erosion in the bowel, may be attributed to the mesh placement techniques. Hernia recurrence rates range from 11 to 30% up to 2 years postoperatively.ConclusionWe prefer an open retromuscular approach with a Sugarbaker mesh configuration to treat complex parastomal hernias. However, wound morbidity and repair failure rates remain high, and additional research is needed to optimize surgical outcomes.

Fully Endoscopic Minimally Invasive Trans-Eyebrow Supraorbital Translaminar Approach to Third Ventricle Craniopharyngiomas: Technical Nuances and Stepwise Illustrative Description

BackgroundTraditional microsurgical approaches for addressing intraventricular craniopharyngioma pose limited access to the retrochiasmatic area and tumors with significant lateral or rostrocaudal extensions. Extended endoscopic endonasal approaches can effectively overcome many of limitations, yet they require a favorable angle between the optic chiasm and pituitary gland, as well as the involvement of the third ventricle floor by the tumor. MethodsHerein, the authors describe the surgical nuances of a keyhole technique for resecting third ventricle craniopharyngiomas via a fully endoscopic minimally-invasive trans-eyebrow supraorbital translaminar approach (ESOTLA). A case description detailing the approach’s application is provided, along with a series of cadaveric photographs to highlight the relevant anatomy and step-by-step dissection process. ResultsThe patient is a 44-year-old man who presented with polyuria, low urine specific gravity, hypogonadism, and hypopituitarism. Brain MRI revealed a solid-cystic heterogeneous-enhanced retrochiasmatic mass within the third ventricle, consistent with craniopharyngioma. A one-stage ESOTLA was indicated based on the narrow corridor between the pituitary gland and optic chiasm and the high functional status of the patient. Near-total resection was achieved, and no new postoperative neurologic or endocrine deficit was observed. Targeted therapy was implemented based on the histologic result, and the most recent surveillance MRI showed no evidence of the residual tumor. ConclusionsBy combining a keyhole approach with variable-angle endoscopic visualization through a smaller bony and soft tissue exposure, ESOTLA can provide enhanced illumination within the third ventricle, potentially addressing cosmetic concerns and limited exposure area and angle of freedom associated with its conventional microsurgical counterpart.

Laparoscopic parastomal hernia repair: keyhole, Sugarbaker, sandwich, or hybrid technique with 3D mesh? An updated systematic review and meta-analysis

PurposeParastomal hernia is the most common complication after stoma formation with an incidence that approaches 50% at 2 years postoperatively. In the last decade, different approaches of minimally invasive procedures have been proposed for the treatment of parastomal hernia. Nevertheless, the superiority of one technique over the others remains still unclear. Our objective was to update and systematically analyze current state of research concerning the postoperative outcomes of the four most prevalent minimally invasive techniques.MethodsA systematic literature search of three databases (Medline, Scopus, Google Scholar) was undertaken for articles published from January 2015 to November 2022. Fifteen studies from a previous meta-analysis on the topic were included.ResultsThirty-three studies incorporating 1289 total patients were deemed eligible for inclusion in the final analysis. The keyhole technique was associated with the highest incidence of postoperative complications and recurrences (31.3% and 24.1%, respectively), followed by the Sugarbaker technique (27.6% and 9%, respectively). Operative time was among the lowest in patients operated with the 3D mesh technique, while patients undergoing the keyhole technique experienced the shortest cumulative length of hospital stay (6 days).ConclusionEach technique demonstrates a unique profile of effectiveness offset by the propensity towards developing postoperative complications. While no conclusive evidence on the optimal technique exist to date, newer minimally invasive techniques show promising results, albeit based on limited data. The future of parastomal hernia repair seems to rely on a highly individualized approach, tailored to the distinctive characteristics of both the hernia and the patient.

The clinical efficacy of posterior cervical open-door expansive laminoplasty combined with Key-hole technique for the treatment of mixed cervical spondylosis

Objective: To investigate the clinical efficacy of posterior cervical open-door expansive laminoplasty combined with Key-hole technique in treating mixed cervical spondylosis. Methods: A retrospective cohort study. A retrospective analysis was made of 128 cases of mixed cervical spondylosis with symptoms of spinal cord and nerve root compression and complete follow-up data admitted to the Department of Spinal Surgery, Affiliated Hospital of Jining Medical University from January 2016 to June 2022. Of the patients, there were 90 males and 38 females with a mean age of (58.5±9.8) years. Before February 2018, 72 cases were treated with posterior cervical open-door expansive laminoplasty (single-door group), and after February 2018, 56 cases were treated with posterior cervical open-door expansive laminoplasty combined with Key-hole technique (combined group). There was no significant difference between the two groups in age, Japanese Orthopaedic Association (JOA) score, visual analogue scale (VAS) score of pain and Cobb angle of imaging before operation. The operation time, intraoperative blood loss, postoperative JOA score, VAS score and Cobb angle of imaging were compared between the two groups. Results: Both groups of patients successfully completed the operation. Operation time [M(Q1, Q3)]: 89.0 (68.5, 104.5) min in the single-door group and 90.0 (72.8, 108.8) min in the combined group, there was no statistical difference between the two groups (P=0.640). The intraoperative blood loss in the single-door group was 100 (100, 200) ml, and it was 100(100, 200) ml in the combined group, there was no significant difference between the two groups (P=0.680). Postoperative JOA scores increased significantly, while VAS scores decreased significantly in both groups. At the last follow-up, the JOA and VAS scores of the combined group were better than those of the single-door group (both P<0.05). Conclusion: The posterior cervical open-door expansive laminoplasty combined with Key-hole technique for the treatment of mixed cervical spondylosis can effectively remove the compression on the cervical spine without causing cervical instability.

Outcomes After Superior Capsular Reconstruction With an Achilles Tendon–Bone Allograft Using the Modified Keyhole Technique: A 2-Year Follow-up of a Novel Technique for Irreparable Rotator Cuff Tears

Background: Despite improved outcomes, failure or nonhealing of graft materials has been reported after superior capsular reconstruction (SCR) for massive irreparable rotator cuff tears. Purpose: To evaluate the short-term clinical and radiological outcomes of a novel technique for SCR using an Achilles tendon–bone allograft. Study Design: Case series; Level of evidence, 4. Methods: We performed a retrospective review of patients who underwent SCR using an Achilles tendon–bone allograft with the modified keyhole technique and who had a minimum follow-up of 2 years. The visual analog scale score for pain, American Shoulder and Elbow Surgeons score, and Constant score were evaluated as subjective outcomes, while range of motion of the shoulder joint and isokinetic strength were evaluated as objective outcomes. The acromiohumeral interval (AHI), bone-to-bone healing of the allograft and humeral head on computed tomography, and graft integrity on magnetic resonance imaging were evaluated as radiological outcomes. Results: This study included 32 patients with a mean age of 56.8 ± 4.2 years and a mean follow-up of 28.4 ± 6.2 months. A significant improvement from preoperatively to the last follow-up was seen in the mean visual analog scale score for pain (from 6.7 to 1.8), American Shoulder and Elbow Surgeons score (from 42.7 to 83.8), Constant score (from 47.2 to 78.5), and AHI (from 4.8 to 8.2 mm) ( P &lt; .001 for all) as well as range of motion in forward elevation and internal rotation ( P &lt; .001 for both). Medial-to-lateral graft integrity was good in all patients. Nonunion at the fitting zone of the keyhole on the greater tuberosity was diagnosed in 1 case (3.1%), and failure of incorporation between the allograft and remnant tendon at the site of posterior margin convergence was observed in 4 cases (12.5%). Conclusion: The outcomes after SCR using an Achilles tendon–bone allograft and the keyhole technique improved, with an increased AHI and excellent integrity in the medial and lateral directions compared with preoperatively. This technique is a reasonable option for the surgical treatment of irreparable rotator cuff tears.

Comparative study of laparoscopic Keyhole and Sugarbaker technique in the treatment of terminal paracolostomy hernia

Objective: To compare laparoscopic Keyhole repair with Sugarbaker repair in consecutive patients with parastomal hernia. Methods: From January 2015 to December 2021, 117 patients with parastomal hernia were treated with Keyhole or Sugarbaker laparoscopy repairs in the Department of Hernia and Bariatrci Surgery, the First Affiliated Hospital of University of Science and Technology of China, and the clinical data were retrospectively analyzed. There were 45 males and 72 females, aged (68.6±8.6) years (range: 44 to 84 years). Laparoscopic Sugarbaker repair was performed in 89 cases, and Keyhole repair was performed in 28 cases. The t-test, Mann-Whitney U test, χ2 test and Fisher exact test were used to compare the observation indicators between the two groups, such as operation time, incidence of operation-related complications, and postoperative recurrence rate. Results: The follow-up period was (M(IQR)) 33 (36) months (range: 12 to 84 months). Compared to the Sugarbaker group, the hernia ring area of the Keyhole group was bigger (35 (26) cm2 vs. 25 (16) cm2, Z=1.974, P=0.048), length of stay was longer ((22.0±8.0) d vs. (14.1±6.2) d, t=5.485, P<0.01), and the postoperative rate of recurrence was higher (28.6% (8/28) vs. 6.7% (6/89), χ2=7.675, P=0.006). There was no difference in operation time and postoperative complications between the two groups. Conclusions: Laparoscopic Sugarbaker repair is superior to Keyhole repair in the recurrence rate of parastomal hernia treated with compsite mesh (not funnel-shaped mesh). There are no differences in operation time and postoperative complications between the two groups.

Perspectives of prevention and treatment of parastomal hernia-what do we really know and where should we go?

Parastomal hernia is a frequent complication after ostomy formation, causing a significant reduction of the quality of life of patients. In contrast to surgical dogmas dealing with the surgical technique of ostomy formation, mesh-based prophylaxis of parastomal hernia seemed to be effective, leading to the strong recommendation in the European Hernia Society(EHS) guidelines. More recent studies do not favor prophylaxis of parastomal hernia anymore, mainly due to the lack of clearly differentiating the techniques. The mostly used keyhole technique (flat mesh) cannot be equated with the “chimney technique” (3-dimensional mesh) that can be easily performed laparoscopically. Very recent results of the Finnish Randomized Study showed a dramatic reduction of parastomal hernia using the chimney technique. Concerning therapy of parastomal hernia, the chimney technique was also revealed to be effective. The laparoscopic “sandwich technique” should also be used therapeutically with very promising mid- and long-term results and seems to be superior to any other approaches. In a conclusion, investigating the prevention of parastomal hernia should clearly differentiate between the keyhole and chimney techniques and adopt strict technical standardization. Therapy of parastomal hernia should be based on the most effective sandwich or the chimney technique in specialized centers, according to recent registry results. Both techniques are based on the intraperitoneal placement of meshes requiring 3-dimensionality or the possibility of overlapping two meshes. Up to now, these requirements are only fulfilled by meshes made by polyvinylidene fluoride.

Robotic assisted cyst gastrostomy "key-hole" technique

Background: Pancreatic pseudocysts are complications of pancreatitis. Most resolve spontaneously. Indications for intervention include the presence of symptoms (pain) or complications (such as gastric outlet obstruction, hemorrhage, or infection). Endoscopic drainage/debridement is our preferred approach when feasible. Other techniques include percutaneous drainage and surgical (open vs minimally invasive approach). We reserve surgical intervention for cases of failed endoscopic debridement, patients with anatomy not conducive to an endoscopic approach, or those with extensive necrosis requiring multiple endoscopic debridements. Here we describe our technique of robotic-assisted cyst gastrostomy “keyhole technique”

Does the endoscopic keyhole technique have advantages over the microscopic keyhole technique for treating cervical radiculopathy?

Does the endoscopic keyhole technique have advantages over the microscopic keyhole technique for treating cervical radiculopathy?

Laparoscopic two-stage parastomal hernia repair using a sugarbaker approach overlapping the previous keyhole technique: a case report with video

article: Laparoscopic two-stage parastomal hernia repair using a sugarbaker approach overlapping the previous keyhole technique: a case report with video - Chirurgia 2022 December;35(6):387-9 - Minerva Medica - Journals

Assessment of Anatomic Restoration and Clinical Outcomes Between Medial and Lateral Meniscal Allograft Transplantation.

Background:Proper anatomic restoration is an important consideration for meniscal allograft transplantation (MAT), even with the different anatomica characteristics between the medial meniscus and lateral meniscus.Purpose/Hypothesis:The purpose of this study was to assess the accuracy of anatomic restoration in medial and lateral MAT (MMAT and LMAT) procedures and to compare their outcomes. We hypothesized that (1) the anatomic differences between the medial and lateral menisci will mean a less accurate anatomic restoration for MMAT and (2) clinical outcomes after MMAT will be inferior compared with LMAT.Study Design:Cohort study; Level of evidence, 3.Methods:We retrospectively evaluated 20 patients who underwent MMAT using the bone plug technique and 21 patients who underwent LMAT using the keyhole technique at a single institution from July 2014 to June 2019. Demographic data, previous surgeries, and concomitant procedures were recorded, as were lower limb alignment and osteoarthritis grade on radiographs. Using preoperative and follow-up magnetic resonance imaging, the meniscal position, rotation, extrusion, and intrameniscal signal intensity were evaluated. Clinical outcomes were evaluated using the International Knee Documentation Committee and Lysholm scores.Results:The mean follow-up was 41.15 ± 18.86 and 45.43 ± 21.32 months for the MMAT and LMAT patients, respectively. Concomitant procedures were performed in 90% of MMATs and 15% of LMATs. There was no significant difference between the native and postoperative root positions after LMAT; however, for MMAT, the position of the anterior root was located significantly posteriorly (P = .002) and medially (P = .007) compared with preoperatively. In addition, the allograft medial meniscus was restored in a more internally rotated position (P = .029). MMATs also exhibited significantly increased meniscal extrusion compared with LMATs (posterior horn, P < .001; midbody, P = .027; anterior horn, P = .006). However, there was no significant difference between the 2 groups at final follow-up in intrameniscal signal intensity or clinical scores.Conclusion:LMAT showed higher accuracy than MMAT in restoring meniscal position and rotation, and there was less meniscal extrusion. However, clinical scores improved after both LMAT and MMAT compared with preoperative values, and midterm clinical outcomes were similar. The small anatomical errors seen in the MMAT technique were not clinically relevant at midterm follow-up.

Modified lateral orbitotomy approach for resection of anterior temporal cavernous malformation

Background: The lateral orbitotomy approach (LOA) provides a direct and minimally invasive corridor to orbital apex, cavernous sinus, and middle cranial fossa (MCF) lesions. Removal of the lateral orbital wall and retraction of the orbital contents, as performed with a traditional LOA, can cause diplopia and enophthalmos and affect visual acuity. The modified LOA (mLOA) preserves the lateral orbital wall to limit this morbidity.Case Description: A 58-year-old man experienced new-onset headaches and anxiety attacks that improved with anti-seizure medication. He was neurologically intact on examination. Magnetic resonance imaging demonstrated a 2-cm right anterior temporal cavernous malformation with an associated hemosiderin ring. Electroencephalogram revealed right temporal intermittent rhythmic delta activity suspicious for anterior temporal lobe epilepsy. He underwent an endoscopic-assisted keyhole mLOA for resection of the cavernoma and hemosiderin-stained brain. Key steps included a Y-shaped incision in the upper eyelid/lateral canthus, removal of a 1.5-cm segment of the lateral orbital rim, drilling of the lateral orbital wall with preservation of the medial cortex, drilling the lateral sphenoid ridge to access the anterior temporal lobe, resecting the cavernoma with endoscopic assistance for removal of all potentially epileptogenic abnormal brain, and plating the orbital rim as part of a layered closure. Postoperatively, he remained neurologically intact. He was discharged on postoperative day 4 after resolution of a cerebrospinal fluid leak with lumbar drainage. On follow-up, his anxiety attacks had completely resolved, and his incision was well-healed.Conclusion: The mLOA is an ideal keyhole technique for selected lesions of the MCF.

Endoscopic Assisted Supraorbital Approach for Tumors of Anterior and Middle Skull Base

Background Data: The supraorbital eyebrow approach is a minimally invasive keyhole technique that offers wide access to the anterior skull base and parasellar region using the subfrontal corridor, with assistances of neuroendoscopy The approach through the eyebrow permits access to a number of lesions in the subfrontal corridor with minimal brain retraction and a much smaller area of potential injury of main structures.&#x0D; Study Design: This study is a follow up study.&#x0D; Objective: To evaluate the role of supraorbital endoscopic approach for tumors of anterior and middle skull base.&#x0D; Patients and Methods: All the operations were performed at Suez Canal University hospitals, in about 24 months, the first 30 patients having tumors of anterior and middle skull base fulfilling the inclusion criteria were included in this prospective study.&#x0D; Results: Endoscopy can play an important role in improving visualization through the keyhole corridor. With the use of neuroendoscopy, the reach of this approach may be extended even further to include the pituitary fossa, the top third of the clivus, the interpeduncular cistern, the anterior third ventricle, and the medial and anterior temporal lobe and middle fossa.The major advantage of the supraorbital over the endonasal route is a simplified skull base closure and reduced risk of postoperative CSF leak. It is a valuable approach for selected patients. Neuromonitoring may further increase surgical safety.&#x0D; Conclusion: The approach through the eyebrow permits access to a number of lesions in the subfrontal corridor With the use of the assisstence of neuroendoscopy, with minimal brain retraction and a much smaller area of potential injury of anatomical structures.

MP40-12 THE KEYHOLE TECHNIQUE FOR RESECTION OF THE DISTAL URETER AND BLADDER CUFF DURING ROBOTIC RADICAL NEPHROURETERECTOMY

You have accessJournal of UrologyCME1 May 2022MP40-12 THE KEYHOLE TECHNIQUE FOR RESECTION OF THE DISTAL URETER AND BLADDER CUFF DURING ROBOTIC RADICAL NEPHROURETERECTOMY Luis G. Medina, Muhannad Alsyouf, Alireza Ghoreifi, Aref S. Sayegh, Kailyn Koh, Wenhao Yu, Sina Sobhani, Antoin Douglawi, and Hooman Djaladat Luis G. MedinaLuis G. Medina More articles by this author , Muhannad AlsyoufMuhannad Alsyouf More articles by this author , Alireza GhoreifiAlireza Ghoreifi More articles by this author , Aref S. SayeghAref S. Sayegh More articles by this author , Kailyn KohKailyn Koh More articles by this author , Wenhao YuWenhao Yu More articles by this author , Sina SobhaniSina Sobhani More articles by this author , Antoin DouglawiAntoin Douglawi More articles by this author , and Hooman DjaladatHooman Djaladat More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002600.12AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Radical nephroureterectomy (RNU) is the standard treatment for high grade upper tract urothelial carcinoma (UTUC). Robotics have shown comparable oncological outcomes with potential advantages in terms of perioperative morbidity compared to standard open approaches. En-bloc removal of the distal ureter and the bladder cuff excision is critical to achieve adequate oncologic control and minimize local recurrences. The “Keyhole” technique allows for an en-bloc extraction by providing direct visualization of the edges of bladder resection and ureteric orifices. We describe our initial experience with this technique for the distal ureter and bladder cuff excision during robotic RNU. METHODS: Between 2015 and 2020, eighteen patients who underwent robotic RNU with bladder cuff resection using the keyhole technique were retrospectively reviewed. Baseline characteristics, surgical and pathological outcomes were collected. Complications were reported using the modified Clavien-Dindo classification system.Continuous variables were depicted as median and quartiles, whereas categorical variables as frequencies and percentages. RESULTS: Eighteen patients with median follow-up of 26 months were included in this study. Table 1 shows clinico-pathologic and perioperative outcome of these patients. Keyhole technique was feasible in all cases with no intraoperative complications. One urine leak (grade II) was recorded and managed conservatively with a catheter. Bladder recurrence was reported in six (33%) cases with a median time of 11 months (5-30). CONCLUSIONS: The Keyhole technique for the management of distal ureter and bladder cuff during robotic RNU is a feasible approach with minimal 90-day complications. Source of Funding: None © 2022 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 207Issue Supplement 5May 2022Page: e678 Advertisement Copyright & Permissions© 2022 by American Urological Association Education and Research, Inc.MetricsAuthor Information Luis G. Medina More articles by this author Muhannad Alsyouf More articles by this author Alireza Ghoreifi More articles by this author Aref S. Sayegh More articles by this author Kailyn Koh More articles by this author Wenhao Yu More articles by this author Sina Sobhani More articles by this author Antoin Douglawi More articles by this author Hooman Djaladat More articles by this author Expand All Advertisement PDF DownloadLoading ...

Added value of ultrafast sequence in abbreviated breast MRI surveillance in women with a personal history of breast cancer: A multireader study

PurposeTo evaluate the added value of ultrafast MRI in abbreviated breast MRI (AB-MRI) surveillance in women with a personal history of breast cancer (PHBC). MethodBetween September 2017 and November 2019, consecutive postoperative surveillance AB-MRIs with ultrafast MRIs (20 images with a 4.0-second temporal resolution using 4D time-resolved angiography with keyhole technique) were retrospectively collected. Four blinded radiologists independently classified the Breast Imaging Reporting and Data System (BI-RADS) category for AB-MRI alone versus the combined protocol (AB-MRI + ultrafast MRI). Readers were recommended to change BI-RADS category according to the time to enhancement cut-off of 12 s in ultrafast MRI. McNemar test and generalized estimation equation model were used to compare the diagnostic performances. ResultsA total of 867 MRI examinations in 867 women (mean age ± standard deviation, 51 years ± 8) were evaluated. The sensitivity of both protocols among all readers was the same, at 90% (9/10). Addition of ultrafast MRI improved the specificity (a mean of 95.3% vs. 88.6 %, p < 0.001 for all readers) and positive predictive value 1 (PPV1) (a mean of 21% vs. 10%, p < 0.001 for all readers) compared to AB-MRI alone. Downgrading BI-RADS category 3 to 2 in four readers in a mean of 6.7% (57 of 857) of negative or benign findings was the main reason for the improved specificity and PPV1. ConclusionAddition of ultrafast MRI to AB-MRI improved the specificity and PPV1 by reducing unnecessary short-term follow-ups without compromising sensitivity in postoperative surveillance.

Comparing Sugarbaker versus keyhole mesh technique for open retromuscular parastomal hernia repair: study protocol for a registry-based randomized controlled trial

BackgroundParastomal hernia, common after stoma creation, negatively impacts patient quality of life. For patients with a permanent stoma, durable parastomal hernia repair remains a challenge, with few high-quality studies for guidance. An alternative to open retromuscular parastomal hernia repair with retromuscular “keyhole” mesh is the recent Sugarbaker modification. We aim to compare these two techniques in a head-to-head prospective study.MethodsThis is a registry-based randomized controlled trial designed to investigate whether the retromuscular Sugarbaker technique is superior to the retromuscular keyhole technique for parastomal hernia repair. The primary study endpoint is parastomal hernia recurrence at 2 years. Secondary endpoints include hospital length-of-stay, readmission, wound morbidity, mesh-related complications, re-operation, all 30-day morbidity, and patient-reported outcomes, including hernia-related quality of life, stoma-specific quality of life, pain, and decision regret.DiscussionBased on the post hoc analysis of a recent randomized controlled trial, we hypothesize that the retromuscular Sugarbaker technique will reduce parastomal hernia recurrence by 20% at 2 years compared to the retromuscular keyhole mesh technique. The results of this study may provide evidence-based guidance for surgeons repairing parastomal hernias.Trial registrationClinicalTrials.gov NCT03972553. Registered on 3 June 2019

Plasma Welding of Thermo-Mechanically Processed Steel

The article presents the course and results of tests involving the technological plasma welding of 3 mm thick butt joints made of steel S700MC using the melt-in welding technique and the key-hole welding technique. The technological tests made it possible to determine parameters enabling the obtainment of joints representing quality level B in accordance with the PN-EN ISO 5817:2014 standard. The tests discussed in the article included tensile tests, bend tests, hardness tests as well as macro and microscopic metallographic tests involving the use of light microscopy. The test results were subjected to detailed analysis performed to identify the effect of high arc energy used in plasma welding on the structure and properties of the test joints. The test results revealed that the melt-in welding technique (characteristic of the TIG method) did not ensure the obtainment of minimum tensile strength.