Mini-incision Surgery Research Articles

Mini-incision surgery for hyperparathyroidism: first experience of the endocrine surgery unit of a university center in Montevideo

Mini-incision surgery for hyperparathyroidism: first experience of the endocrine surgery unit of a university center in Montevideo

Early postoperative results analysis of standard and mini-incision posterolateral approach in total hip arthroplasty

Background/Aim. Total hip arthroplasty is the replacement of the hip joint with an artificial one. Standard surgical procedures involve a long skin incision and extensive dissection of healthy tissue. Mini-incision surgery is a modification of standard operative approaches. In addition to a significantly smaller skin incision, the main difference is based on much less damage to soft tissues, especially the muscles that move the hip. The aim of this study was to compare the early results of the mini-incision and a standard approach in total hip arthroplasty and to determine the advantages and disadvantages of the mini-incision surgical technique. Methods. A retrospective study analyzed data based on 63 patients who underwent total hip arthroplasty with a mini-incision and standard approach at the Institute of Orthopaedic Surgery ?Banjica?, Belgrade from 2004 to 2010. All the patients suffered from primary coxarthrosis. All operations were carried out by the same surgical team. All patients were clinically evaluated before and after the surgery using the Harris Hip Score (HHS). Results. The group of patients operated on with the mini-incision approach included 32 patients, while 31 patients made up the group of patients operated on with the standard approach. Comparing these groups did not reveal a statistically significant difference in age, body mass index, surgery duration, and HHS before the surgery. A statistically significant difference was determined by comparing intraoperative blood loss, the amount of drainage fluid after the surgery, and the HHS after the surgery. Conclusion. The mini-incision posterolateral approach, compared to the standard approach, apart from an esthetically more acceptable scar, achieves significantly less intraoperative blood loss and better hip function with almost the same risk of complications.

Comparison Study of Mini-Incision Versus Original Open Technique of the Half-Mini-Bunnell Achilles Tendon Repair

Mini-incision surgical procedures in our institution have been developed by decreasing the total skin incision length from the original mini half-Bunnell tendon repair technique. We hypothesized that the mini-incision, or minimum invasive Achilles tendon repair technique, would promote the tendon healing process leading to better outcomes and a reduced complication rate compared to the conventional open repair. The study sought to determine the more optimal method by comparing 44 mini-incision sutures to the 99 sutures in the original open Achilles tendon repairs. The mean skin incision length of the mini-incision surgery was 2.9 (range 2.5-3.0) cm and the original repair was 4.2 (range 3.5-7.0) cm. The mean surgery time was 60.0 minutes in the mini-incision repair and 68.1 minutes in the original one (p = .0003). The mean achievement time of bilateral heel-rise, starting jogging, single-legged heel-rise movement and the time to return-to-play was not significantly different between the 2 groups. Achilles Tendon Rupture Score was not significantly different from 3 to 9 months after surgery. Re-injury rate was 1/44 (2.3%) in mini-incision and 4/99 (4.0%) in conventional open repair (p = .36). No patients in either group developed any postoperative infections nor deep vein thrombosis complications. Although the mini-incision half-mini-Bunnell suture was showed equivalent clinical results to the original open repair, the technique is recommended in terms of curtailment of the surgery time without increase of complication ratio.

A COMPARATIVE CROSS- SECTIONAL STUDY BETWEEN THE USE OF VERTICAL AND HORIZONTAL SKIN INCISIONS DURING UMBILICAL AND PARAUMBILICAL HERNIA REPAIR IN A TERTIARY CARE HOSPITAL

One of the most underrated aspects of surgical procedure is the very placement of skin incisions. Several factors inuence the post-operative morbidity, outcome and satisfaction of a patient. One such being the very placement of a skin incision by the surgeon. Even though the trend nowadays is to opt for laparoscopic and mini-incision surgery, the rst and basic rule in surgery is to have an incision that will be comfortable for the surgeon and provide adequate access to the area of pathology. The purpose of this study is to compare vertical and horizontal skin incisions during umbilical and paraumbilical hernia repair that makes the surgical technique and post-operative outcome much more favorable. In this study, we compare the intraoperative difculty, post operative wound healing and morbidity between these two techniques.

Effectiveness and safety of the improved mini-incision surgery for osmidrosis treatment.

As the mainstream treatment of axillary osmidrosis, surgical treatment is still limited by various complications, such as paresthesia, scars, local infection, hematoma, flap necrosis, and long recovery time. In this study, we tried to adopt the improved mini-incision surgery for osmidrosis treatment. The paper aims to evaluate the clinical effectiveness and safety of the improved mini-incision surgery for axillary osmidrosis treatment. Clinical series of patients underwent improved mini-incision surgery were retrospectively reviewed. Dates of complications, including paresthesia, scars, infection, hematoma, skin necrosis, and recurrence were analyzed. Among 61 cases, 58 cases had a preoperative osmidrosis score of 3 and 3 cases had a preoperative score of 2; while 13 cases had a postoperative osmidrosis score of 0, 43 cases had a postoperative score of 1 and 5 cases had a postoperative score of 2, significantly lower than that before (p<0.001). A total of 12 axillae complications occurred, 2 axillae (1.6%) had paresthesia; 5 axillae (4.1%) had hematoma; 2 axillae (1.6%) had local flap necrosis due to hematoma; and 3 axillae (2.4%) had hypertrophic scars. The results showed that the improved mini-incision surgery was safe and effective for osmidrosis treatment.

Minimally Invasive Cardiac Surgery in China: Multi-Center Experience.

BackgroundTo the best of our knowledge, there is no nationwide data available on the development of minimally invasive cardiac surgery (MICS) in China. The purpose of this study was to report the results of MICS in 6 experienced centers in China.Material/MethodsFrom September 2014 to July 2016, 1241 patients with cardiac conditions who underwent MICS procedures were randomly enrolled in 6 centers in China, and those patients were randomly selected for inclusion in this study. The MICS procedures were defined as any cardiac surgery performed through a less invasive incision, rather than a complete median sternotomy, mainly including mini-incision surgery (400, 32.2%), video-assisted approach (265, 21.3%), completely thoracoscopic approach without robotic assistance (504, 40.6%), and robotic procedure (55, 4.4%).ResultsThe 5 most common in-hospital complications were respiratory failure (28, 2.3%), reoperation for all reasons (19, 1.5%), renal failure (11, 0.9%), heart failure (9, 0.7%), and stroke (6, 0.5%). The multivariate logistic regression analysis results showed that cardiopulmonary bypass (CPB) time (P=0.033), aortic cross-clamp time (P=0.003), cannulation approach (P=0.010), and left ventricular ejection fraction (LVEF) (P=0.003) at baseline were all significant risk factors of any in-hospital complication of MICS procedures.ConclusionsFrom our experience, minimally invasive cardiac approaches are safe and reproducible, with acceptable CPB and aortic cross-clamp time duration and low mortality.

Modified mini-incision surgery for carpal tunnel syndrome: Results of 131 interventions

Modified mini-incision surgery for carpal tunnel syndrome: Results of 131 interventions

THE COMPARATIVE ANALYSIS OF LIFE QUALITY OF PATIENTS WITH PRIMARY HYPERPARATHYROIDISM IN THE LATE POSTOPERATIONAL PERIOD

The aim of the study was to analyze life quality of patients with primary hyperparathyroidism in the pre- and postoperational periods. 90 patients were examined and they were divided into 3 groups depending on the type of parathyroidectomy. The survey was done by means of the short questionnaire of life quality (SF-36) before the surgery and in the late postoperational period. The received data indicate that the parameters of life quality in the postoperational period increase in all the groups of the patients. However, the highest values were found in the patients who had underwent the mini-incision surgery.

Creating Natural Double Eyelids With Continuous Buried Suture and Mini-incision Technique Using Subcutaneous Absorbable Suture for Patients With Puffy Eyelids

IMPORTANCE Incision and buried suture are 2 primary techniques for creating double eyelids. The incision method is suitable for all kinds of eyelids, but operational trauma and prolonged recovery time limit its application. The non-incision approach can shape a natural and vivid crease with a relatively short recovery time. However, it is not suitable for patients with puffy eyelids, and in those patients the duration of the supratarsal crease is not long.We propose a method of combining the techniques of continuous buried suture and mini-incision. OBJECTIVE To explore a new kind of double eyelid plasty, a corrective surgical procedure for patients with puffy eyelids. DESIGN, SETTING, AND PARTICIPANTS Observational study of 221 patients with puffy single eyelids who underwent this new blepharoplasty from May 2007 to and March 2012. INTERVENTIONS Combined continuous buried-suture and mini-incision surgery using subcutaneous absorbable suture to create natural double eyelids under local anesthesia. All procedures were performed by the same surgeon. MAIN OUTCOMES AND MEASURES All patients were observed after surgery for a period ranging from 1 to 28 months (mean follow-up, 16 months). Data collection included operative time, postoperative recovery and complications. RESULTS All double eyelids appeared natural after short operative time and rapid postoperative recovery, leaving an invisible scar and long-lasting supratarsal crease. No corneal damage or infection occurred.CONCLUSIONS AND RELEVANCE Combined continuous buried-suture and mini-incision surgery using subcutaneous absorbable suture to create natural double eyelids is a reliable,durable, and less-invasive technique for patients with puffy eyelids.

Single Mini-Incision Total Hip Replacement for the Management of Arthritic Disease of the Hip

Mini-incision total hip replacement continues the current trend in orthopaedics and other specialties toward smaller-incision surgery. The purpose of this systematic review was to assess the effectiveness and safety of single mini-incision compared with standard-incision total hip replacement for treatment of arthritis of the hip. We conducted an electronic literature search for relevant studies published in any language up to March 2010. Key conference proceedings and national orthopaedic registries were searched, professional organizations and implant manufacturers were approached, and reference lists from included studies were screened. We included randomized and quasi-randomized controlled trials assessing single mini-incision surgery, defined as an incision of ≤ 10 cm, compared with standard primary total hip replacement. Two reviewers independently assessed studies for inclusion and extracted data. Fifteen randomized and five quasi-randomized controlled trials, involving 1857 participants, were eligible. Included trials were of mixed methodological quality, with the sample size ranging from twenty to 219. Mean follow-up periods were short, ranging from six weeks to three years. Compared with standard total hip replacement, mini-incision procedures may have small perioperative advantages in terms of less blood loss, shorter operative time, and shorter inpatient stay, but the differences were not clinically important. Few complications were reported, and the complication rate did not differ significantly between groups. There was insufficient evidence to suggest any major difference in the short-term revision rate, and confidence intervals for surrogate measures for long-term outcome were broad enough to include clinically important differences in favor of either approach. Although there were marginal short-term advantages and disadvantages for each of the surgical techniques, there was no strong evidence either for or against mini-incision compared with standard-incision total hip replacement. Importantly, evidence on longer-term performance, especially the risk of revision arthroplasty, for mini-incision hip arthroplasty is very limited.

Flapless Implant Surgery Using a Mini‐Incision

Traditional flapless implant surgery using a soft tissue punch device requires a circumferential excision of keratinized tissue at the implant site. A new flapless implant technique that can submerge implant fixtures is needed. This article describes a flapless implant surgery method using a mini-incision and compares the effects of soft tissue punch and mini-incision surgery on both the amount of osseointegration and the bone height around the implants using a canine mandible model. Bilateral, edentulated, flat alveolar ridges were created in the mandibles of six mongrel dogs. After a 3-month healing period, two implants were placed on each side of the mandible using either soft tissue punch or mini-incision procedures. After an additional 3-month healing period, a second stage surgery and transmucosal abutment attachment was performed for mini-incision implant cases. Following a 2-month healing period, the dogs were sacrificed to evaluate the osseointegration and bone height around the implants. Average bone height was 9.6 ± 0.4 mm in the soft tissue punch group and 9.8 ± 0.3 mm in the mini-incision group (p > .05). Average osseointegration was 70.4 ± 6.3% in the soft tissue punch group and 71.2 ± 7.1% in the mini-incision group (p > .05). No significant differences were noted between the two groups in vertical alveolar ridge height or bone/implant contact. Our findings support the clinical use of mini-incision implant surgery at sites where implants need to be protected below the soft tissue during the early phase of healing, particularly for patients with poor bone quality and/or low primary implant stability.

Abdominal incisions in General Surgery: a review

There is this wrong notion that the only standard abdominal incision is the midline incision. Cases have been seen in which an abdominal incision extends from the xyphoid process to the symphysis pubis just to remove a perforated appendix! It is also not unusual to see a groin incision together with a lower abdominal incision for an obstructed inguinal hernia repair that "slipped" back into the abdominal cavity during preparation for surgery. Even though the trend nowadays in surgery is to opt for laparoscopic and mini-incision surgery, the basic rule in surgery is to have an incision that will be comfortable for the surgeon and provide adequate access to the area of pathology.

The clinical analysis of Posterior mini-incision surgery for the single segment of the lumbar disc herniation

Objective To explore the treatment and clinical characteristic of posterior mini-incision surgery for the single segment of the lumbar disc herniation.Methods Clinical data of 260 cases with single segment lumbar disc herniation were analyzed retrospectively.Results Follow-up for 6 months to 5 years,with an average of 24 months.According to Nakai effect criteria,109 cases of excellent,good in 132 cases,17 cases of fair,two cases of poor,12 cases of cerebrospinal fluid leakage,2 cases of wound hematoma,one case of vertebral space infection,resulting in 92.7%.Conclusion Advantages of posterior mini-incision surgery for the single segment of the lumbar disc herniation are small incision,less trauma,shorter operative time,less bleeding,quick recovery and low costs.Stressed the need to accuratel position preoperation. Key words: lumbar vertebrae; Surgical procedures; oper ative

A randomised clinical trial comparing minimally invasive surgery to conventional approach for endoprosthesis in elderly patients with hip fractures

Background In recent years, the concept of minimally invasive surgery has invaded the orthopaedic field and literature on the subject is spawning. Mini-incision surgery for total hip arthroplasty has been studied without a clear consensus on the efficacy, safety and advantage of that technique. To our knowledge, the efficacy and safety of mini-incisions in hip fracture surgery has not been studied in a randomised fashion. Methods This study is a prospective clinically randomised trial whose primary objective was to demonstrate the safety and efficacy of a single posterior mini-incision approach compared to a standard posterior approach for endoprosthesis in acute femoral neck fractures. The mini-incision was defined as less than 8 cm. 25 patients in the mini-incision surgery (MIS) group and 31 patients in the standard incision group (STD) were available for analysis. The following validated disease-specific outcome instruments were used: the Lower Extremity Measurement (LEM) and the Time Up and Go (TUG). Secondary endpoints of pain, function, and quality of life were assessed by the components of the Harris Hip Score (HHS) and SF-36. Radiographic outcomes were also evaluated as well as the rates of all reported complications and adverse events during the 2 years follow-up. Results There was no significant difference for operative time, blood losses, 72 h postoperative haemoglobin as well as the need for transfusion therapy between the two groups. Also, there was no difference between the groups for postoperative morphine use and pain evaluation with the Visual Analog Scale. The functional assessment using LEM and TUG did not demonstrate any statistically significant difference between mini- and standard incision. However, the HHS and the physical function component of the SF-36 were statistically better at 2 years in favour of the standard incision group. Conclusion Based on the results of the present study, we cannot recommend the use of a minimally invasive approach over a standard approach in the implantation of a cemented endoprosthesis.

Minimally invasive surgery for total hip arthroplasty

We review recent publications (primarily January, 2007 through July, 2008) and describe the development of minimally invasive techniques and protocols for total hip arthroplasty. The main themes are the short-term outcome differences between standard and minimally invasive surgical approaches and between two types of minimally invasive surgical approaches: the mini-posterior and two-incision approach. Some investigators contend that outcome depends on choice of surgical approach alone; others have found that outcome is more attributable to perioperative protocols. The distinction between minimally invasive and mini-incision surgery continues to be clarified. The literature indicates that (1) patient expectations, anesthetic modality and rapid rehabilitation protocols may affect recovery time more than the type of surgical approach or length of skin incision; (2) deep dissection plays more of a role in recovery than the length of skin incision; and (3) the differences in outcomes related to the type of minimally invasive surgical approach remain undistinguished. However, patients and surgeons continue to believe that smaller incisions lead to better outcomes. Additional investigation is needed to identify the best approach and to delineate the specific roles of expectations, pain control and rapid rehabilitation.

Comparison of navigation accuracy in THA between the mini‐anterior and ‐posterior approaches

The accuracy of a CT-based hip navigation might depend on surgical approaches, resulting in varying accuracy of implant alignment. We performed primary cementless total hip arthroplasty (THA) with mini-incision surgery (MIS) to 40 well-matched patients (anterior or posterior approaches, 20 hips each), using navigation with surface registration. We investigated cup alignment using postoperative computed tomography (CT) and compared the navigation accuracy between the two approaches, i.e. the difference between intra-operative and postoperative alignments of the cup. There was no significant difference between the two approaches. The mean navigation accuracies in abduction and anteversion were 2.0 degrees (SD 1.4 degrees) and 2.7 degrees (SD 1.9 degrees), respectively, in the anterior approach, and 2.4 degrees (SD 2.0 degrees) and 2.0 degrees (SD 1.4 degrees), respectively, in the posterior approach. All cup alignments were within 10 degrees of the target orientation. This CT-based navigation for MIS-THA provides navigation accuracy without significant differences between the two approaches and with favourable alignment of the cup.

Comparison of Skin Blood Flow Between Mini- and Standard-Incision Approaches During Total Hip Arthroplasty

Twenty patients who underwent total hip arthroplasty were randomly allocated to have surgery through a mini incision of ≤8 cm (mini-incision surgery [MIS] group, n = 10) or a standard incision of 14 cm (standard group, n = 10). A laser Doppler flowmeter was used to measure the intraoperative blood flow of the skin. The measurements were performed at 2 regions, specifically, anterior and posterior regions across the middle points of skin incision. The measurements were taken before making the incision and after implantation. As a control, the skin blood flow over the anterior superior iliac spine was measured. After implantation, mean skin blood flows at both regions in the MIS group were significantly decreased by 32% and 33%. However, the corresponding flows in standard group and control regions were constant during operation.

Surgical Treatment for Osteoid Osteoma — Experience in Both Conventional Open Excision and CT-guided Mini-incision Surgery

Conventional open excision, or en bloc excision, was the standard treatment for osteoid osteoma until the development of percutaneous treatment for this tumor in the early 1990s. Most percutaneous treatments were performed under the guidance of computed tomography (CT), which could clearly demonstrate the exact location of the tumor and minimize bone destruction or resection. In order to minimize bone resection without adding to the costs of these new percutaneous instruments, we modified the percutaneous technique into a CT-guided mini-incision surgery. The patients treated with this technique were compared with those treated by conventional open excision. We retrospectively reviewed the medical charts of patients with osteoid osteoma treated between 1990 and 2004. The patients diagnosed before 2000 were all treated with conventional open excision. After 2000, some of them were treated with CT-guided mini-incision surgery. Follow-up was done either by phone or on an outpatient basis. There were 23 patients with osteoid osteoma who were treated surgically between 1990 and 2004, of whom 20 were treated with conventional open excision. Six patients were treated with CT-guided mini-incision surgery, including 3 primary cases and 3 patients who had previously been treated with conventional open excision (2 recurrent cases and 1 with incomplete excision). The patients treated with CT-guided mini-incision surgery had smaller bone defects, shorter surgical time, and shorter hospital stay. The rate of recurrence or incomplete excision was 23% for conventional surgery and 0% for mini-incision surgery. CT-guided mini-incision surgery is effective in treating primary as well as recurrent osteoid osteoma.

The Emotional State of the Patient after Total Hip and Knee Arthroplasty

The new processes of total hip and knee arthroplasty partly engendered by mini-incision surgery have helped patients achieve all three goals of their operation: pain relief, improvement in function, and satisfaction. Satisfaction means the patient is no longer self-conscious about their disability and has regained the ability to live in their world in their usual way. The emotional state of the patient preoperatively, in the hospital, and during recovery will affect their feeling of satisfaction. Proper preoperative education makes patients more optimistic, and they anticipate fewer problems. In the hospital, a multimodal pain management program limits the use of parenteral narcotics and avoids the side effects of nausea and vomiting, which is the most important factor for in-hospital satisfaction. Recovery with an active physical therapy program individualized for the abilities and goals of the patient improves function and satisfaction. Surgeons must understand the expectations of the patient, direct them to realistic goals, and use the new processes of patient care to allow patients to exceed their expectations.