Mini-invasive Approach Research Articles

Complications of step-up mini invasive approach of surgical treatment of patients with acute necrotizing pancreatitis

Complications of step-up mini invasive approach of surgical treatment of patients with acute necrotizing pancreatitis

Robotic-assisted surgery for rectal cancer results of a non-randomized study.

The Czech Republic belongs to countries in which colorectal cancer significantly contributes to the overall oncological burden. Radical removal of tumor-affected tissues plays a key role in the multimodal therapy of rectal cancer. In the first decade of the third millennium the mini-invasive approach in rectal cancer surgery gradually expanded to include robotic-assisted surgeries. The aim of this paper is to present the results of a non-randomized study with prospectively collected data from robotically assisted rectal cancer surgeries. 204 patients with rectal cancer (.

A Modified Minimally Invasive Approach for the Treatment of Mandibular Condylar Fracture.

In this study, we introduced a small "V" shaped incision around the ear lobe modified from fact-lift approach to treat the mandibular condylar neck and subcondylar fractures to further minimize and hide the postsurgical scars. A total of 15 cases with mandibular condylar fractures from low levels of condylar neck to high levels of subcondylar region were treated by this approach. An incision was designed from the posterior rim of the tragus down to the anterior skin wrinkle to the ear lobe, surrounding it, continually up and backward for a little distance, forming a "V"-like shape. After cutting and elevation of the skin flap, the remaining steps were the same as those in trans-parotid mini-invasive approaches. The surgical scars introduced in this study were more hidden than those in other mini-invasive approaches and all patients were satisfied with their aesthetic appearances. We suggested that the modified "V" shaped mini-invasive approach has an advantage in achieving aesthetic results and could be an alternative incision in treating some types of mandibular condylar and subcondylar fractures.

Posterior Midline Approach for a C2 Schwannoma: 2-Dimensional Operative Video.

C2 schwannomas are rare lesions that may develop in the spinal canal, in the area of the C2 ganglion situated posterior to the C1C2 articulation, in the extraspinal area or in a combination of these 3 sectors.1,2 The surgical removal of these lesions is delicate because of the intimate relationships the schwannomas develop with the V3 segment of the vertebral artery. A variety of lateral, far-lateral, or extreme lateral approaches have been described in order to tackle these lesions. We use a posterior midline approach that takes advantage of the predominantly extradural development of C2 schwannomas. In this technique, the main step is the debulking of the posterior articular sector of the tumor, which is easily accessible through a midline posterior approach and necessitates minimal bone removal. In most cases, removal of the homolateral posterior arch of C1 is sufficient in order to create an adequate access. These maneuvers create the necessary space for dissecting both the intradural and extraspinal sectors of the schwannoma. We present this technique through a case with a minimal intradural component exerting mainly a lateral compression of the spinal cord. The tumor was operated through the midline mini-invasive posterior approach with a favorable result. We demonstrate the surgical technique in video and discuss the nuances.

Simultaneous laparoscopic liver resection or radiofrequency ablation by single-port approach during elective loop-ileostomy closure: A novel strategy in patients with colorectal metastases

BackgroundTo report on the feasibility, the morbidity and the mortality of a novel strategy for patients undergoing loop-ileostomy closure for colorectal cancer with synchronous treatment of colorectal cancer liver metastases (CRCLM). MethodsThe strategy consisted of laparoscopic liver resection (LLR) or radiofrequency ablation (LRFA) of CRCLM by a single-port approach and a simultaneous elective loop-ileostomy closure. All consecutive patients who underwent this strategy were included. Short-term and middle-term results and the patient’s perioperative satisfaction were recorded. ResultsBetween 2017 and 2019, five patients with CRCLM were treated according to this strategy. The feasibility was 100 %. The overall morbidity was 20 % (n=1, postoperative ileus) and the mortality was 0 %. The CRCLM were treated by wedge resection (n=3) or LRFA (n=3). The mean blood loss was 70±116.6mL [300-50]. The mean operating time was 168±52.3 [100–220] minutes. The mean LOS was 3.5±1.4 days [2–5]. The average EVAN G score was 83.3 % [70–95] showing a global satisfaction of the patients on the perioperative course. The rate of R0 resection was 80 % and the rate of local recurrence was 20 %. The 2-years overall survival rate was 84 % (n=4). At the end of follow-up, the rate of incisional hernia was 0 %. ConclusionsThis mini-invasive approach appears to be feasible, safe and useful for patients.

Laparoscopic Partial Splenectomy: A Critical Appraisal of an Emerging Technique. A Review of the First 457 Published Cases.

Background: Laparoscopic partial splenectomy (LPS) may allow avoiding total splenectomy (TS) complications and maximizing the advantages of mini-invasive approach. The objective of this review is to assess feasibility and safety of LPS, to compare this approach with alternative options. Materials and Methods: A literature review of articles reporting LPS is performed. Several parameters, including age, indication, surgical technique, devices used for splenic section/hemostasis, adverse outcomes, including morbidity/mortality, conversions to open surgery, conversions to TS, operative time (OT), and hospital stay (HS), are analyzed. Articles comparing LPS' results with those of open partial splenectomy and laparoscopic TS are also analyzed. Results: Fifty-nine articles reporting 457 LPS were included. Patients' characteristics varied widely, concerning age and indications, including hematological disease (hereditary spherocytosis, drepanocytosis), splenic focal masses, and trauma. Several technical options are reported. Mean OT and HS are 128 ± 43.7 minutes and 4.9 ± 3.8 days, respectively. No mortality and 5.7% morbidity are reported. Conversion rates to open surgery and to TS are 3.9% and 3.7%, respectively. Conclusions: In conclusion LPS is feasible and safe, with no mortality, low morbidity, and low conversion rates to laparotomy and to TS. LPS may be accomplished by various techniques and tools. Major complications are sporadically reported, thus potential risks should not be underestimated.

Single centre 12 year experience with durable mechanical circulatory support: comparison with the EUROMACS registry.

Mechanical circulatory support is an established therapy in end-stage heart failure. The EUROMACS registry was created to promote research in these patients. The aim of this report was to present our 12 year experience with the durable mechanical circulatory support devices and compare it with the EUROMACS registry. Data from the entire EUROMACS registry from January 2011 to April 2019 were included (4704 implantations in 4410 patients). During the 12 years of our experience, until April 2019,125 mechanical support devices were implanted, in 122 patients. We compare patients´ characteristics, operative data and results with the EUROMACS registry and we report the major complications during the observational period. Primary end-point (death) occurred in 40 (32.8 %) patients in our cohort during the follow-up period, representing the survival rate 75 %, 68 %, and 58 % for 6, 12, 24 months respectively, which compares favourably with the data, reported by the EUROMACS registry, the survival 66 % and 53 % after 1 and 2 years respectively. Cerebrovascular accident occurred in 7 %, a bleeding event in 32 %, significant infection (driveline) in 78 % and a device malfunction in 13 % of the patients. Forty- three patients underwent a heart transplant with hospital and long-term mortality of 11.6 % and 14 % respectively. Mechanical circulatory support is a valuable therapeutic option with excellent survival rates, nevertheless it is associated with clinically significant complications rates. The direct comparison between our cohort and the EUROMACS registry showed that early implantation strategy and mini invasive approach may improve survival rates and decrease postoperative complications (Tab. 3, Fig. 3, Ref. 16).

Multicystic peritoneal mesothelioma treated with cytoreductive surgery followed or not by hyperthermic intraperitoneal chemotherapy: results from a large multicentric cohort

Background Multicystic peritoneal mesothelioma (MCPM) is a rare, slowly growing, condition prone to recur after surgery. The role of hyperthermic intraperitoneal chemotherapy (HIPEC) added to complete cytoreductive surgery (CRS) remains controversial and difficult to assess. As patients are mostly reproductive age women, surgical approach, and fertility considerations are important aspects of the management. This observational retrospective review aimed to accurate treatment strategy reflections. Methods The RENAPE database (French expert centers network) was analyzed over a 1999–2019 period. MCPM patients treated with CRS were included. A special focus on HIPEC, mini-invasive approach, and fertility considerations was performed. Results Overall 60 patients (50 women) were included with a median PCI of 10 (4–14) allowing 97% of complete surgery, followed by HIPEC in 82% of patients. A quarter of patients had a laparoscopic approach. Twelve patients (20%) recurred with a 3-year recurrence free survival of 84.2% (95% confidence interval 74.7–95.0). The hazard of recurrence was numerically reduced among patients receiving HIPEC, however, not statistically significant (hazard ratio 0.41, 0.12–1.42, p = 0.200). A severe post-operative adverse event occurred in 22% of patients with five patients submitted to a subsequent reoperation. Among four patients with a childbearing desire, three were successful (two had a laparoscopic-CRS-HIPEC and one a conventional CRS without HIPEC). Conclusion MCPM patients treatment should aim at a complete CRS. The intraoperative treatment options as laparoscopic approach, fertility function sparing and HIPEC should be discussed in expert centers to propose the most appropriate strategy.

Role of mini-invasive bridge plate in the complex femoral fracture in school going children: A prospective clinical study of 30 cases.

Objective:Pediatric femoral fracture including supracondylar and subtrochanteric fracture constitutes 1.6% of all paediatric fracture. Elastic nails remain the standard treatment of choice in a midshaft transverse femoral fracture in children weighing less than 45 kg. But in subtrochanteric and spiral femoral fracture, the failure rate of elastic nails are quite high. Hence, in accordance with AAOS guidelines, we treated complex femoral fracture in children with submuscular mini-invasive bridge plate because of its advantage of minimal incision, early union with proper alignment and lower failure.Material and Methods:We retrospectively reviewed 30 complex femur fracture in children treated with Submuscular bridge plate by mini-invasive approach. Patients were analysed according to their age, type of fracture, time of union in weeks, complication and results were evaluated with modified Flynn's criteria.Result:Out of 30 patients 28 were boys and 2 were females, with an average age of 11.5 years in which Spiral fracture (n = 12), subtrochanteric fracture (n = 9), Complex Shaft fracture (n = 10). All fracture united well on an average of 11 weeks. And 29 patients has excellent results and in 1 patient there is Acceptable result. The single complication was 3 mm limb lengthening but it didn't change gait of the patient.Conclusion:Mini invasive bridge plating is an easy and soft tissue preserving procedure for managing complex femoral fracture in children. It has shown promising results in achieving union without any major complication. We strongly recommend the SBP in a complex femoral fracture in children.

Step-up mini invasive surgical treatment of patients with different morphological forms of acute necrotizing pancreatitis

Introduction: Despite significant progress in the treatment strategy of acute necrotizing pancreatitis (ANP), mortality in cases of its severe form remains high. There is no single point of view concerning the indications for the use of mini invasive interventions depending on the nature, extension and localization of the pathological foci of ANP. Material: We performed a prospective observational cohort study of efficacy of elaborated algorithmic mini invasive step-up approach of surgical treatment of 317 patients with different morphological forms of ANP. The following parameters were collected for each episode: length of hospital stay, mortality, occurrence of organ failure and local complications. Results: Transcutaneous punction/drainages were applied as the first step in 37 patients with acute necrotic collections (ANC). In the presence of walled-off pancreatic necrosis (WOPN) EUS procedures were preferred in case their close localization to the stomach or duodenum in 65 observations. Initial surgical treatment wasn't effective in 18.8% and video-assisted retroperitoneal debridement (VARD) in patients with ANC or necrosectomies under EUS control in cases of WOPN were applied. Necessary for laparotomic necrosectomies occurred in 14.5% of patients and was the final step of proposed algorithmic approach. During postoperative period complications occurred in 28.3% of patients. They included 7 new episodes of organ failure, 4 cases of arosive hemorrhage, and 5 observations of pancreatic and duodenal fistulas. Overall mortality rate was 3.3%, after interventional treatment - 6.5%. Conclusion: Surgical treatment in patients with ANP based on elaborated algorithmic step-up approach is followed by acceptable complication and mortality level.

Percutaneous and Minimally Invasive Surgical Technique for Achilles Tendon Repair

Category:Ankle; Sports; TraumaIntroduction/Purpose:Achilles tendon rupture is a traumatic injury that can cause considerable morbidity and reduced function. The optimal treatment method for this injury remains controversial. Non-operative intervention puts patients at higher risk of re-rupture whereas surgical intervention has risks of infection and iatrogenic nerve injury. Recently, surgeons have established a less invasive surgical approach to repairing the achilles tendon. The ‘Percutaneous or Mini-Invasive’ technique was adopted in order to reduce infection rates and wound breakdown. However, due to the scarce amount of literature reported, the efficacy of this procedure still remains under scrutiny. The goal of this study was to examine the functional outcomes of patients treated at our facility for a ruptured achilles tendon using the percutaneous and minimally invasive surgical technique.Methods:From 2014 to 2020 eighty-one patients underwent a percutaneous or mini invasive surgery at our facility for the treatment of a ruptured achilles tendon. Functional outcome scores were assessed using the American Orthopaedic Foot & Ankle scoring system (AOFAS) and the Achilles Tendon Rupture Score (ATRS). Outcomes, complications, and any reoperations were recorded through retrospective chart review, direct patient examination, and phone calls to patients and their families. A statistical analysis was performed using Fischer’s Exact Test. Results were deemed statistically significant if the calculated p-value was less than 0.05.Results:The mean follow up for our patient cohort was 36.40 months (range, 6 to 71). The average age was 41.46 years (range, 17- 65). Mean pre-op AOFAS and ATRS were 45.60 and 47.18 respectively, compared to 90.29 and 87.97 after surgery (p-value <0.05). There were two significant complications reported post-operatively. One patient re-ruptured their Achilles tendon four months post-operatively. This patient was successfully treated with a mini invasive approach and reconstruction of the tendon. A second patient developed a superficial infection ten months post-operatively. This patient successfully underwent irrigation and debridement of the wound.Conclusion:The pre-op and post-op AOFAS and ATRS scores were deemed statistically significant. A percutaneous and mini invasive approach to repair a ruptured achilles tendon, although new, offers promising functional outcome results and remains a viable treatment option to decrease the incidence rate of post-operative infection and iatrogenic nerve injury. However, a prospective randomized controlled trial comparing the efficacy of this procedure to other surgical methods would be necessary to further evaluate and validate our findings.

Is the lower pole crossing vessels transposition a valid option for the treatment of extrinsic ureteropelvic obstruction in children? Considerations from a single-centre experience

To assess the efficacy of the vascular hitch procedure in extrinsic ureteropelvic junction obstruction (UPJO) by crossing vessels in children, both by open and mini-invasive approach. Retrospective analysis on patients treated by open or mini-invasive vascular hitch during the period 2006–2020. Preoperative imaging included renal ultrasound (US) and functional studies by magnetic resonance or renogram. Crossing vessels obstruction and UPJ anatomy were evaluated at surgery. Success was defined as the resolution of symptoms and improvement of hydronephrosis at US or functional studies. Forty-eight patients were included with mean age at surgery of 7.6 years and 25% had an antenatal diagnosis. Aberrant vessels were suspected preoperatively in 72.9%; mean hydronephrosis and renal function were 30.9 mm and 38% respectively. Seven cases were treated by open approach, 37 by laparoscopy and 4 were robotassisted. Mean operative time was 58.3 min and mean hospital stay was 2 days. Mean follow-up was 16.9 months; success rate was 91.6% and 5 patients required secondary surgery. Vascular hitch shows to be a safe, feasible and effective alternative to pyeloplasty. Careful pre and intra-operative patients’ selection is essential to exclude any intrinsic cause of UPJO. Mini-invasive surgery could be helpful for better evaluation of UPJ anatomy and its relationships with crossing vessels. Complications and secondary surgeries could be related to incorrect patients’ selection.

Mini-invasive Approach for Complex Arch and Thoracic Aortic Diseases Using the New Last-Generation Low-Profile Stent Grafts

Conformability, navigability, and considerable diameters are limiting factors in the treatment of complex diseases of the arch and descending aorta that can be overcome with low-profile endografts. Conscious sedation (CS) and local anesthesia (LA) offer the advantage of optimal neuromonitoring without cardiovascular and respiratory depression, especially in high-risk patients (American Society of Anesthesiologists class 3 and class 4). Finally, rapid artificial cardiac pacing (RACP) allows a quick and more precise graft positioning.

Laparoscopic inguinal hernia repair in children via PIRS (percutaneous internal ring suturing).

The miniinvasive approach is atrend in pediatric surgery nowadays. The new surgical technique called percutaneous internal ring suturing (PIRS) is apromising method bringing all the benefits of miniinvasive surgery. Prospective study of patients operated on using the PIRS technique from 01 January 2018 to 01 January 2020 at the Department of Pediatric Surgery, 2nd Faculty of Medicine, Charles University, University Hospital Motol. 73 patients (25 boys and 48 girls) were operated on using PIRS. The median age was 68 months. 90% of operations were performed by the same team of surgeons. During the procedure there were found 53 right-sided and 38 left-sided inguinal hernias. In 18 cases the hernia was bilateral, but only in 13 cases was this diagnosis made before the operation. Anon-absorbable stitch was used in 57 cases to close the internal ring of the inguinal canal, and anon-absorbable monofilament in 16. The median operating time was 34 minutes. There were 3 recurrences (3.3%) in our study. Conclusion: In our initial study, the PIRS technique proved to be asafe alternative method to the open inguinal hernia surgery. This method provides the benefit of allowing to revise the contralateral inguinal canal as aprevention of ametachronous inguinal hernia. The cosmetic results were excellent.

Minimal invasive management of early revision after minimal invasive posterior lumbar fusion

BackgroundMinimally invasive spine (MIS) fusion is an increasingly common procedure, with advantages over open approach in the form of minimal dissection and superior early clinical outcome. The frequency of complications is known, but the most appropriate surgical revision for this technique remains unclear. HypothesisThe main hypothesis was that early revision surgery, for acute complications after MIS, was possible through mini-invasive approach. MethodsA retrospective study of patients undergoing MIS has been performed, with or without transforaminal interbody fusion (TLIF) using specific navigation and ancillary. All surgical revisions were done by minimally invasive approach. Preoperative and surgical data, as well as postoperative complications have been analyzed. The primary endpoint was clinical outcome obtained after surgical revision. ResultsData of 187 patients undergoing MIS procedure at 1–4 levels was analyzed. The rate of early revision (within one month) was 5.3%: 0.5% for infection, 1.6% for compressive hematoma, and 2.1% for misplaced screw. The use of intraoperative navigation decreased the frequency of screw misplacement from 4.5% to 1.4%. The rate of surgical revision was 7.8% for surgeons in their learning curve and 3.6% for experienced surgeons. DiscussionOn these large series, MIS early revision rates were lower than previously reported for conventional fusions. Surgeon's experience in MIS procedures seems to be crucial to decrease revision and complications rates. Hemorrhagic complications led to multidisciplinary discussions and the establishment of a management protocol. Surgical revisions can be performed by minimally invasive techniques, regardless of the indication. Level of evidenceIV, retrospective study.

Should obesity be considered a contraindication to mini-invasive pancreaticoduodenectomy?

Obesity is expanding worldwide. In parallel, surgery keeps evolving and improving while mini- invasive surgery is now concerning many different fields if not all. While obese patients may be more challenging to operate on, surgeons should not deny the mini-invasive approach in spite of the potential difficulties linked to increased adiposity, especially in case of complex procedures. We discuss here the challenges of laparoscopic pancreaticoduodenectomy (LPD) in such patients, with the advantages it can offer as well as the inconveniences it can struggle on.

Subtotal ureteral substitution with ileum for patients with multiple ureteral stenosis.

The use of small bowel for ureteral substitution in patients with ureteral stenosis can, nowadays, be safely performed with a laparoscopic or robotic mini-invasive approach. To date, this technique required a complete substitution of the ureter with ileum. In this work we present our robotic intracorporeal sub-total ureteral substitution preserving the distal part of the ureter with the aim to reduce the risk of vescico-ureteral reflux. We report the case of a 65-years old male with a “functional” right single kidney and multiple recurrent stenosis. Our technique seems to be feasible and safe, no intra or postoperative complication were recorded. At 3 months of follow-up the trans-nephrostomic enhanced CT showed a completely opacification of ileal ureter, thus the nephrostomic tube was removed. At 6 and 12 months the patient was asymptomatic and with a level of serum creatinine 1.9 and 1.6 mg/dL, respectively. In conclusion the sub-total ureteral substitution with ileum can be a safety and effective procedure for patients who require a mandatory preservation of homolateral renal function.

Laparoscopic liver resections - state of art.

Progress had been made in the miniinvasive surgery in the past 30 years. Laparoscopic liver procedures were expanded from limited resections to major resection and complicated procedures. Miniinvasive approach offered better short-time results and similar oncological outcomes compared with open liver surgery. However, it is still challenging to perform some difficult procedures laparoscopically which requires alearning curve and accumulation of experiences in specialized centers.

Short- and mid-term results of limited approach septoplasty

Limited approach septoplasty (LAS) follows the principle of respecting nasal structures and aims to minimize complications while ensuring proper nasal respiratory function. LAS is only applicable to selected cases of septal deviation. The present study aimed to: (1) compare short- and mid-term complications in two consecutive series of patients with the same type of septal deviation treated with LAS or classical septoplasty; and (2) examine postoperative respiratory function with active anterior rhinomanometry in the two series, and in a group of healthy, non-surgical volunteers. The study concerned two groups of 20 consecutive patients who underwent LAS or classical septoplasty for deviation in Cottle's areas 4/5, and a control group of 11 healthy adult volunteers with no sinonasal disorders. The mean operating time did not differ significantly between the two groups. Three patients in each group developed minor complications. In a sitting position, the mean total nasal inspiratory resistance was 0.018 and 0.019Paml/s (p = 0.46) in the LAS and classical septoplasty groups, respectively, and the total expiratory resistance was 0.019 and 0.018Paml/s (p = 0.30). In a supine position, the mean total nasal inspiratory resistance was 0.017 and 0.021Paml/s (p = 0.05), and the total expiratory resistance was 0.017 and 0.019Paml/s (p = 0.14) in the LAS and classical septoplasty groups, respectively. In selected cases, LAS achieved much the same short- and mid-term results as classical septoplasty. The mini-invasive approach is certainly more respectful of the nasal mucosa, requiring a less extensive detachment, with consequent faster healing times and less tissue damage.

Contemporary balloon aortic valvuloplasty: Changing indications and refined technique.

Even if un to improve long-term prognosis, balloon aortic valvuloplasty (BAV) may be useful in selected patients with symptomatic severe aortic stenosis either as a bridge to surgical or transcatheter valve replacement (aortic valve replacement [AVR] or transcatheter aortic valve implantation [TAVI]) or as a triage strategy for patients with uncertain indications. International guidelines recommend BAV as: a "bridge" to AVR/TAVI, a "trial" in patients with undetermined symptoms, or a "bridge-to-decision" in case of comorbidities. However, in clinical practice, BAV is also used as a palliative measure to improve hemodynamics and quality of life in many patients who are excluded from AVR/TAVI. Finally, BAV is often performed during TAVI to facilitate prosthesis delivery, optimize frame expansion, or for bioprosthetic valve fracture in selected valve-in-valve procedures. Technical innovations, which allow for a mini-invasive approach via transradial access and pacing delivered through the wire, have led to a decrease in complications over time. This review focuses on contemporary BAV with a specific emphasis on new indications, innovative techniques, and specific complex patient subgroups.