Mini-invasive Procedure Research Articles

Imaging of Spondylodiscitis: A Comprehensive Updated Review-Multimodality Imaging Findings, Differential Diagnosis, and Specific Microorganisms Detection.

Spondylodiscitis is defined by infectious conditions involving the vertebral column. The incidence of the disease has constantly increased over the last decades. Imaging plays a key role in each phase of the disease. Indeed, radiological tools are fundamental in (i) the initial diagnostic recognition of spondylodiscitis, (ii) the differentiation against inflammatory, degenerative, or calcific etiologies, (iii) the disease staging, as well as (iv) to provide clues to orient towards the microorganisms involved. This latter aim can be achieved with a mini-invasive procedure (e.g., CT-guided biopsy) or can be non-invasively supposed by the analysis of the CT, positron emission tomography (PET) CT, or MRI features displayed. Hence, this comprehensive review aims to summarize all the multimodality imaging features of spondylodiscitis. This, with the goal of serving as a reference for Physicians (infectious disease specialists, spine surgeons, radiologists) involved in the care of these patients. Nonetheless, this review article may offer starting points for future research articles.

Conversion rate to open surgery during transanal total mesorectal excision (TaTME) for rectal cancer: a single-center experience

Minimally invasive techniques for rectal cancer have demonstrated considerable advantages in terms of faster recovery and less post-operative complications. However, due to the complex anatomy and a limited surgical field, conversion to open surgery is still sometimes required, with a negative impact on the short-and long-term outcomes. The purpose of this study was to analyse the conversion rate to open abdominal surgery during laparoscopic transanal total mesorectal excision (TaTME) procedures performed at a high-volume Italian referral center. All consecutive TaTME performed for mid-to-low rectal cancer between 2015 and 2023 were reviewed, independently if treated with a primary anastomosis (with/without a diverting ostomy) or an end stoma. All procedures were performed using a standardized approach by the same surgical team. Patients with benign diagnosis that underwent different-from rectal resection procedures and cases pre-operatively scheduled for open surgery were excluded. The primary outcome of interest was the rate of conversion, defined as an un-planned intraoperative switch to open surgery using a midline laparotomy. Secondary aims included the comparison of patients who had a longer vs shorter operative time. Out of 220 patients, 210 were selected. In 187 cases, a primary anastomosis was performed, while 23 patients received a terminal colostomy (1 in the converted group; 22 in the full MIS- TaTME group, 10.6%). A surgical approach modification occurred in two cases, with a conversion rate of 0.95%. Median operative time was 281 min. Reasons for conversions included intra-operative difficulties impairing the mini-invasive procedure without intra-operative complications in one case, and difficulties in the laparoscopic control of an intraoperative bleeding due to a splenic lesion in another patient. Male sex and a higher BMI were found to be statistically significantly associated to longer operative time (respectively: p = 0.001 and p = 0.0025). In a high-volume center, a standardized TaTME is associated to a low conversion rate to open abdominal surgery.

Can surgical computer vision benefit from large-scale visual foundation models?

We investigate whether foundation models pretrained on diverse visual data could be beneficial to surgical computer vision. We use instrument and uterus segmentation in mini-invasive procedures as benchmarks. We propose multiple supervised, unsupervised and few-shot supervised adaptations of foundation models, including two novel adaptation methods. We use DINOv1, DINOv2, DINOv2 with registers, and SAM backbones, with the ART-Net surgical instrument and the SurgAI3.8K uterus segmentation datasets. We investigate five approaches: DINO unsupervised, few-shot learning with a linear decoder, supervised learning with the proposed DINO-UNet adaptation, DPT with DINO encoder, and unsupervised learning with the proposed SAM adaptation. We evaluate 17 models for instrument segmentation and 7 models for uterus segmentation and compare to existing ad hoc models for the tasks at hand. We show that the linear decoder can be learned with few shots. The unsupervised and linear decoder methods obtain slightly subpar results but could be considered useful in data scarcity settings. The unsupervised SAM model produces finer edges but has inconsistent outputs. However, DPT and DINO-UNet obtain strikingly good results, defining a new state of the art by outperforming the previous-best by 5.6 and 4.1 pp for instrument and 4.4 and 1.5 pp for uterus segmentation. Both methods obtain semantic and spatial precision, accurately segmenting intricate details. Our results show the huge potential of using DINO and SAM for surgical computer vision, indicating a promising role for visual foundation models in medical image analysis, particularly in scenarios with limited or complex data.

Low success rate of stoma stapling to treat stoma prolapse and retraction

BackgroundStoma prolapse and retraction are common stoma complications, and there are many available techniques for correction. Results of stoma stapling to treat prolapse/-retraction in children has not yet been reported. The aim of this study was, therefore, to present results with this technique. MethodsRetrospective study with review of medical records of patients treated with stoma stapling during 2001–2022. Results19 patients were identified; 12 boys (63 %). Most common underlying diagnoses were Hirschsprung's disease and anorectal malformation. There were ten colostomies and nine ileostomies. Stapling was performed under general anesthesia. The enterostomy was stapled longitudinally along the whole length of the extra-abdominal part of the stoma at three places, usually with 120° between each stapler row. A knifeless GIA stapler was used. A total of 32 stapling procedures were performed, median 1 (1–5) per patient. Median operating time was 16 (4–51) minutes, 22 % of patients needed opiates the first 24 h postoperatively, and median postoperative stay was 1 (1–4) day. There were no complications related to the stapling procedures. Success was defined as no prolapse or retraction after maximum two stapling procedures. Five (26 %) patients had successful outcome. Underlying diagnosis, type of stoma (colostomy/ileostomy) or age at stoma formation did not influence the success rate. ConclusionsStoma stapling to treat stoma prolapse/retraction was only successful in 1/4 of patients. Although the success rate was rather low, we suggest that stoma stapling may be attempted once because it is a mini-invasive procedure. Level of evidenceIV.

TCT-298 Bariatric Arterial Embolization: A Mini-Invasive Procedure for Treating Obesity

TCT-298 Bariatric Arterial Embolization: A Mini-Invasive Procedure for Treating Obesity

Complications after partial nephrectomy: robotics overcomes open surgery and laparoscopy: the PMSI French national database

PurposeTo evaluate three partial nephrectomies (PN) procedures: open (OPN), standard laparoscopy (LPN), and robot-assisted laparoscopy (RAPN), for the risk of initial complications and rehospitalization for two years after the surgery.Materials and methodsFrom the French national hospital database (PMSI-MCO), every hospitalization in French hospitals for renal tumor PN in 2016–2017 were extracted. Complications were documented from the initial hospitalization and any rehospitalization over two years. Chi-square and ANOVA tests compared the frequency of complications and length of initial hospitalization between the three surgical procedures. Relative risks (RR) and 95% confidence intervals were computed.ResultsThe 9119 initial hospitalizations included 4035 OPN, 1709 LPN, and 1900 RAPN; 1475 were excluded as the laparoscopic procedure performed was not determined. The average length of hospitalization was 8.1, 6.2, and 4.5 days for OPN, LPN, and RAPN, respectively. Compared to OPN, there were fewer complications at the time of initial hospitalization for the mini-invasive procedures: 29% for OPN vs. 20% for LPN (0.70 [0.63;0.78]) and 12% for RAPN (RR=0.43, 95%CI [0.38;0.49]). For RAPN compared to LPN, there were fewer haemorrhages (RR=0.55 [0.43;0.72]), anemia (0.69 {0.48;0.98]), and sepsis (0.51 [0.36;0.71]); during follow up, there were fewer urinary tract infections (0.64 [0.45;0.91]) but more infectious lung diseases (1.69 [1.03;2.76]). Over the two-year postoperative period, RAPN was associated with fewer acute renal failures (RR=0.73 [0.55;0.98]), renal abscesses (0.41 [0.23;0.74]), parietal complications (0.69 [0.52;0.92]) and urinary tract infections (0.54 [0.40;0.73]) than for OPN.ConclusionsConservative renal surgery is associated with postoperative morbidity related to the surgical procedure fashion. Mini-invasive procedures, especially robot-assisted surgery, had fewer complications and shorter hospital lengths of stay

If a patient has cirrhosis, should I correct coagulation abnormalities before a minor invasive procedure?

If a patient has cirrhosis, should I correct coagulation abnormalities before a minor invasive procedure?

Patient-Reported Outcomes of Endovascular Treatment of Post-Thrombotic Syndrome: Ancillary Study of a French Cohort.

Excellent outcomes of angioplasty/stenting for the post-thrombotic syndrome (PTS) have been reported, notably regarding objective criteria in the vast French SFICV cohort. Differences may exist between patient-reported and objective outcomes. We investigated this possibility by using validated scales because significative correlations are discordant in the literature between patency and patient-reported characteristics. Patient-reported outcomes seem to be a more consistent tool than radiologic patency for the diagnosis and follow-up of patients displaying PTS. We retrospectively reviewed the Villalta scale and 20-item ChronIc Venous dIsease quality-of-life Questionnaire (CIVIQ-20) scores recorded after endovascular stenting for PTS at 14 centres in France in 2009-2019. We also collected patency rates, pre-operative post-thrombotic lesion severity, and the extent of stenting. We performed multivariate analyses to identify factors independently associated with improvements in each of the two scores. The 539 patients, including 324 women and 235 men, had a mean age of 44.7 years. The mean Villalta scale improvement was 7.0 ± 4.7 (p < 0.0001) and correlated with the thrombosis sequelae grade and time from thrombosis to stenting. The CIVIQ-20 score was available for 298 patients; the mean improvement was 19.2 ± 14.8 (p < 0.0001) and correlated with bilateral stenting, single thrombosis recurrence, and single stented segment. The objective gains demonstrated in earlier work after stenting were accompanied by patient-reported improvements. The factors associated with these improvements differed between the Villalta scale and the CIVIQ-20 score. These results proved that clinical follow-up with validated scores is gainful in patients treated for PTS thanks to a mini-invasive procedure.

29 - Rezum and Urolift mini-invasive procedures: The nurses setting up of endoscopic room

29 - Rezum and Urolift mini-invasive procedures: The nurses setting up of endoscopic room

Complications in repairing acute closed Achilles tendon rupture with micro-incision percutaneous Achilles tendon suture system

To analyze the causes, management and prevention of complications after micro-incision percutaneous repair of acute Achilles tendon rupture. A retrospective study indentyfied 279 patients with acute Achilles tendon rupture who underwent a mini-invasive procedure using the micro-incision percutaneous Achilles tendon suture system(MIPAS) from August 2008 to November 2019, including 269 males and 10 female;96 cases on the right side and 183 cases on the left side;aged from 18 to 64 years old with an average of (36.9±11.4 )years old. Surgery was performed 0.5 to 7 days with an average of(2.7±0.9 )days after injury. The incision-related complications, re-rupture, sural nerve injury, deep vein thrombosis, Achilles tendon adhesion, local pain, and ankle stiffness within 18 months after surgery were recorded, as well as the corresponding management and outcome, the causes and prevention measures were analyzed. No superficial or deep infection was found in all patients, symptomatic Achilles tendon adhesion and ankle stiffness were not observed, delayed suture foreign-body reactions occurred in 2 cases (0.7%), re-rupture in 5 cases (1.8%), sural nerve injury in 3 cases (1.1%), 21 cases(7.5%) with skin invagination at puncture site, 2 cases (0.7%) with symptomatic vein thrombosis, and 45 cases (16.1%) of transient posterior medial malleolus pain. After individualized treatment, the function was good. American Orthopeadic Foot & Ankle Sciety(AOFAS) score was 93 to 100 with an average of(98.9±5.4) scores. Despite the occurrence of unique complications with MIPAS, it shows low functionally-related complications rates, such as incision-related complications, re-rupture, sural nerve injury, deep vein thrombosis and ankle stiffness.

Urinary tract infection in the context of mini-invasive procedures after kidney transplantation.

The use of antibiotic prophylaxis in invasive procedures is generally accepted and highly recommended. The question is the need to apply antibiotic prophylaxis even in the case of mini-invasive procedures in the post-transplantation period. The aim of the study was to dermine the occurrence of infectious complications during mini-invasive procedures (pig-tail extraction, protocol biopsy) withou the use of antibiotic (ATB) prophylaxis. The secondary aim was to identify risk factors for a positive urine culture finding at the time of mini-invasive procedures. This is aprospective monocentric study in which pacients after kidney transplantation at Transplantation centrum in Martin were included (n = 68). We investigated the incidence of positive urine findings at the time of pig-tail extraction (6 weeks after transplantation) and at the time of protocol biopsy (3 months after transplantation) with comparison within the group with and without ATB prophylaxis. Patients in group without ATB prophylaxis had a significantly higher tacrolimus value at the time of pig-tail extraction (p = 0.0274) and a significantly higher dose of mycophenolic acid at the time of protocol biopsy (p = 0.0429). We did not confirm significant difference in occcurence of positive urine findings at the time of pig-tail extraction or at the time of protocol biopsy. We completed aunivariate logistic regression in order to identify a potential risk predictor for positive urine findings at the time of pig-tail extraction and protocol biopsy. None of the monitored parameters, including ATB prophylaxis, was confirmed as risk or protective factor. The use of antibiotic prophylaxis during mini-invasive procedures (pig-tail extraction, protocol biopsy) in the posttransplantation period had no effect on positive culture findings at our department. Based on our analysis, we therefore do not use antibiotic prophylaxis in the case of these procedures at our centre (Tab. 3, Fig. 6, Ref. 23).

Zrýchlené formy rehabilitácie po mini-invazívnych zákrokoch v neurochirurgii

The development of spinal surgery makes it possible to perform minimally invasive interventions in the treatment of LDD (lumbar disc degeneration). The lumbar spine is most often indicated for surgery. At present, several types of operations (decompression, fusion, dynamic stabilization) are performed in the surgical solution of vertebrogenic problems in the lumbar spine. What type of operation and operative technique the operator chooses depends on the graphic documentation of the affected section of the spine and the clinical picture. At present, the minimally invasive surgical technique called minimally invasive spinal surgery (MISS). The procedure allows less tissue damage, less blood loss, earlier verticalization and a shorter hospitalization period. this fact points to the necessity of accelerated forms of rehabilitation in spinal surgery. We followed 250 patients whose average length of hospitalization after mini-invasive procedures at NCHK in Ružomberok in 2022 was 4.84±0.81 days. We appeal to the need for preoperative preparation, which will speed up postoperative rehabilitation.

Bibliographic Study and Meta-Analysis of Clinical Outcomes of Full-Endoscopic Spine Surgery for Painful Lumbar Spine Conditions

Full-endoscopic spine surgery (FESS) indications already cover degenerative, infectious, and neoplastic diseases. This study aimed to use a bibliometric search and meta-analysis of the highest-quality studies in the last 20 years to determine the quantity and quality of FESS research, geographic distribution, and the outcomes for lumbar conditions. Articles on FESS published from 2000 to 2022 were screened and assessed through Web of Science, PubMed, and Scopus. Also, databases were searched for longitudinal studies to pool in a meta-analysis of patients undergoing FESS for lumbar conditions. After stratifying the risk of bias and having collected the studies of the highest quality, we included the proportion of patients with a satisfactory outcome and intraoperative and postoperative adverse events after the analysis of lumbar spine conditions. A total of 728 articles were identified by the bibliographic search. Between 2000 and 2021, the published articles increased 21-fold. Most were from China (70.15%), followed by South Korea (19.5%). Most were retrospective (68.3%) and regarding treatment of lumbar disease (86.4%). Fifty studies, including 34,828 patients, were pooled in the meta-analysis. More than 85% of patientsexperienced satisfactory improvement in each of different lumbar conditions. Major adverse events were <2%; recurrence and postoperative dysesthesia rates were within those reported for open or mini-invasive procedures. This study may fill research gaps on FESS and lead to adequately designed studies. Our meta-analysis showed that FESS for lumbar diseases is a procedure with satisfactory outcomes and low rates of adverse events.

Robotic-assisted colorectal surgery - initial results.

The mini invasive procedure in colorectal surgery is gaining ground as an alternative to conventional surgery. Colorectal surgery has significantly evolved since the advent of the automatic stapler devices and subsequently with the minimally invasive approach. The next logical step - the robotic assisted surgery was developed to satisfy surgeons' needs to the area of colorectal surgery and to offer a new and safer method to patients. The evidence for benefits of its use in this area appears to be promising.

Minimally Invasive Interventional Procedures for Metastatic Bone Disease: A Comprehensive Review.

Metastases are the main type of malignancy involving bone, which is the third most frequent site of metastatic carcinoma, after lung and liver. Skeletal-related events such as intractable pain, spinal cord compression, and pathologic fractures pose a serious burden on patients’ quality of life. For this reason, mini-invasive treatments for the management of bone metastases were developed with the goal of pain relief and functional status improvement. These techniques include embolization, thermal ablation, electrochemotherapy, cementoplasty, and MRI-guided high-intensity focused ultrasound. In order to achieve durable pain palliation and disease control, mini-invasive procedures are combined with chemotherapy, radiation therapy, surgery, or analgesics. The purpose of this review is to summarize the recently published literature regarding interventional radiology procedures in the treatment of cancer patients with bone metastases, focusing on the efficacy, complications, local disease control and recurrence rate.

A Refined Minimally Invasive Distal First Metatarsal Osteotomy for Moderate Hallux Valgus Treatment: The BC Procedure

During the last 2 decades, there was an increasing interest in mini-invasive procedures for hallux valgus correction. In this scenario the Bösch technique appears to be a reproducible distal metatarsal osteotomy (DMO) to achieve a proper correction. Our DMO variant, called BC, was planned to combine the stability and predictability of the chevron osteotomy, with the power of correction, low surgical time and mini-invasive approach of the Bösch-SERI technique. The purpose of this investigation is to describe the surgical technique and report the results of this modified procedure at a minimum 2-year follow-up. Sixty-three patients who underwent the BC technique for mild and moderate hallux valgus were prospectively evaluated. Mean follow-up was 36.5 (range 23.4-59.8) months, the mean American Orthopedic Foot and Ankle Society score improved from a median of 47.4 points preoperatively to a median of 88 points postoperatively (p < .05). First MTPJ ROM did not change from preoperative period (mean 32.5°) to the postoperative period (mean 31.8°) (p > .65). All osteotomies went on to bony healing in the 6-week follow-up visit. Fifty-two (82%) of patients were either very satisfied or satisfied with the procedure (p < .05). With our numbers, BC osteotomy is shown to be a technique that can treat both mild and moderate deformities, achieving correction that is maintained over the follow-up evaluated, with a 24 relatively simple procedure and short operative time.

Endoscopic management of gastrointestinal motility disorders.

Gastrointestinal motility disorders include several heterogeneous units affecting the esophagus, stomach, small or large intestine and the rectum. These are namely Zenkers diverticulum, esophageal achalasia, gastroesophageal reflux disease, gastroparesis, constipation, Ogilvies syndrome and post-fundoplication dysphagia. Given the progressive development of endoscopic techniques, patients with most of the above mentioned diseases can be offered a solution consisting of a mini-invasive endoscopic procedure which has already become a first-choice treatment for some of the disorders. This article summarizes the current role of endoscopy in the treatment of the most important gastrointestinal motility disorders.

Feasibility Study of a Variant Procedure of Radical Breast Ductectomy (Dolichectomy) with a Perinipple Incision.

Papillomatosis and recurrent duct ectasia could be treated with terminal lactiferous ducts excision. In this study we describe a modified miniinvasive procedure of terminal lactiferous ducts excision with a perinipple approach to the lower or upper half of the nipple. This technique avoids the much more extensive periareolar incision and has excellent aesthetic results.

Effectiveness of Kinetic Oscillation Stimulation Treatment in Patients with Non-Allergic Rhinitis Refractory to Conventional Medical Therapies

1.1. Introduction: Kinetic Oscillation Stimulation (KOS) is a new treatment for symptoms of non-allergic rhinitis (NAR). The aim of the study was to investigate effectiveness of KOS treatment in patients affected by NAR. 1.2. Methods: From December 2018 to July 2020, 39 patients, already refractory to conventional medical therapy, were treated with KOS. As control group, we considered a group of 41 patients treated with topical mometasone furoate, observed in the same period and number of days. During the ENT visit, objective examinations were performed to assess respiratory function. In addition, all the subjects filled out quality of life (QoL) questionnaires. All patients were reevaluated after 45 days. 1.3. Results: All the instrumental assessments and QoL questionnaires showed a significant improvement 45 days after KOS treatment. Sixteen patients (43%) reported an improvement across all tests. Active anterior rhinomanometry improved for Inspiratory Resistance in 26 patients (70%) and for Expiratory Resistance for 27 patients (73%). Moreover, we found that KOS group presented a better improvement statistically significant for the QoL questionnaries, respect the control group. 1.4. Conclusion: KOS treatment is a safe and mini-invasive procedure for the treatment of NAR symptoms, well accepted from patients and with a promising improvement of QoL, better than conventional medical therapies.

Laparoscopic Resection of Retroperitoneal Schwannoma: Report of 3 cases

Background: Schwannoma is a neoplasm that arises from Schwann cells in the peripheral nerve sheath. They are mainly benign tumors, Ohigashi T et al. reported that only 0.7% is located in the retroperitoneum and these are associated with a higher rate of malignancy. The preoperative diagnosis is a challenge due to its low frequency and the low specificity of imaging studies. Treatment consists of its complete surgical resection, avoiding its rupture since it is associated with local recurrences. The laparoscopic approach presents technical limitations due to the usually large size of these tumors, and few cases of laparoscopic excision have been reported in the world literature to date. Methods: the results of 3 retroperitoneal schwannomas of different location, size and complexity are presented, all resolved laparoscopically by a highly complex laparoscopic surgery team. Results: all surgeries were performed completely laparoscopically, there were no complications associated with the mini-invasive procedure and all the benefits of it were obtained. The anatomopathological and immunohistochemical examination was compatible with schwannomas in all 3 cases. To date, the patients do not present recurrences. Conclusions: although the location, size and relationship with other anatomical structures make the laparoscopic surgical approach difficult, with a well-trained team in laparoscopic surgery, these procedures can be performed safely, without increased morbidity and with all the benefits that mini-invasive procedures provide