Mini-invasive Treatment Research Articles

From "gold standard" resection to reproducible "future standard" endoscopic enucleation of the prostate: what we know about anatomical enucleation.

Open prostatectomy (OP) and transurethral resection of the prostate (TURP) have traditionally been the most common surgical approaches for the treatment of benign prostatic hyperplasia causing bladder outlet obstruction and have certainly passed the test of time. In time, many endoscopic surgical procedures have been described as an alternative mini-invasive treatment. Holmium laser enucleation (HoLEP) guaranteed functional outcomes similar to OP and TURP with lower perioperative complication rates for any prostate size. With the development of different kinds of lasers (such as thulium, "green light" and diode) and bipolar energy, the feasibility of endoscopic enucleation using these energies has been explored. In this paper, recent techniques to perform true prostate enucleation have been reviewed through a search of PubMed and Web of Science, including articles published in the last 20 years in clinical journals. The review is based on a peer-review process of the authors after a structured data search. Search terms included "Thulium prostate enucleation, THULEP, TmLEP/Tm Yag enucleation" OR "Greenlight enucleation/prostate enucleation/vapo-enucleation/KTP prostate enucleation, PVP prostate enucleation, GreenLep/" OR "bipolar prostate enucleation" OR "HoLEP, Holmium prostate enucleation" OR "monopolar prostate enucleation" OR "Diode prostate enucleation" OR "DiLEP" OR "Eraser prostate enucleation" OR "ELEP". Following the example of HoLEP, many techniques have been described in the literature using a variety of energy sources and instruments either in a pure enucleative or a hybrid (mixed) fashion. However, the levels of evidence are too low and follow-up still too short to offer solid recommendations. HoLEP has become the conceptual and practical paradigm for the wide spread of enucleation thanks to the evidence provided by the literature and excellent outcomes. Higher level of evidence is required to assess efficacy of alternative enucleative techniques.

ALGORITHM OF DIAGNOSTICS AND TREATMENT OF ELDERLY AND SENILE PATIENTS WITH ACUTE CHOLECYSTITIS, CHOLEDOCHOLITHIASIS AND OBSTRUCTIVE JAUNDICE

We performed a retrospective analysis of treatment in 4,197 patients with acute cholecystitis. Destructive complicated cholecystitis was diagnosed in 658 (25.3%) patients . There were 431 (65.5%) patients of elderly and senile age. All patients had comorbidities. Cardiovascular insufficiency — 73.9%, respiratory diseases — 29.2%, diabetes — 26%. For urgent indications, 12 (2.8%) patients were operated, 2 (16.6%) of them died. In 419 (97.2%) patients, mini-invasive treatment was performed. Endoscopically, jaundice wasn’t managed in 86 (20.5%) cases. In 62 (14.8%) cases, percutaneous transhepatic microcholangiography was performed under ultrasound guidance. Laparoscopic cholecystectomy was performed in 183 (43.6 %) cases, traditional cholecystectomy was performed in 149 (35.6%) cases, and in 38 of them (23.9%) it was combined with Kerr’s drainage of choledoch. Mini-invasive cholecystectomy was performed in 87 (20.7%) cases. Postoperative complications were revealed in 21 (5.0%) patients, in 7 (2.9%) of elderly age and 14 (7.9%) of senile age. Postoperative mortality rate was 2.0%. The use of minimally invasive interventions in the complex treatment of this group of patients was the main goal and it was reasoned by the severity of the initial condition of elderly and senile patients.

Percutaneous Mechanical Thrombectomy Using Rotarex® S Device in Acute Limb Ischemia in Infrainguinal Occlusions.

Purpose To evaluate the effectiveness of percutaneous mechanical thrombectomy using Rotarex S in the treatment of acute limb ischemia (ALI) in infrainguinal occlusions in a retrospective study of patients treated in our institution. Methods In this study, we identified a total of 147 ALI patients that underwent mechanical thrombectomy using Rotarex S at our institution. In 82% of the cases, percutaneous thrombectomy was used as first-line treatment, and for the remainder of the cases, it was used as bailout after ineffective aspiration or thrombolysis. Additional fibrinolysis and adjunctive aspirational thrombectomy were utilized for outflow occlusion when required. Procedural outcomes, amputation rate, and mortality at 30 days were evaluated. Results Of the 147 patients treated with mechanical thrombectomy, Rotarex S was used as first-line treatment in 120 cases and as second-line treatment in 27 cases. Overall, we achieved 90.5% procedural revascularization success rate when combining mechanical thrombectomy with limited thrombolysis for severe outflow obstruction, and 1 death and 3 amputations were observed. We achieved primary success in 68.7% of the patients with the mechanical thrombectomy only, and in 21.8% of the patients, we successfully used additional limited thrombolysis in the outflow. The overall mortality was 0.7% and amputation rate was 2% at 30 days. Conclusion Percutaneous mechanical thrombectomy as first-line mini-invasive treatment in infrainguinal ALI is safe, quick, and effective, and the performance outcomes can be superior to that of traditional surgical embolectomy.

Miniinvasive treatment of descending aorta visceral branches aneurysms

Miniinvasive treatment of descending aorta visceral branches aneurysms

Classification criteria of chronic pancreatitis

This is the analysis of the most widespread classification of chronical pancreatitis and the results of retrospective distribution of 120 patients. In our article the review of the main actual classifications of chronic pancreatitis is executed. Our own classification is presented. The authors suppose that the volume of the surgical intervention in most cases is determined by morphological alterations in the pancreas. The most important changes are affections of pancreas parenchyma (criterion “P”), large cavities (criterion “C”), and widening of Wirsung’s duct (criterion “H”). Such king of morphology is evidence for transferring a patient to a surgical department. Its assessment together with clinical signs determines expediency of operation. The method of surgical treatment depends on the localization and the combination of morphological changes. Existence of the positive criterion "Р" in combination with a constant or recidivous pain syndrome demands performance of a resection of a head of a pancreas. Existence of a large extrapancreatic cyst assumes preliminary mini-invasive treatment with the subsequent assessment of a condition of a parenchyma and expressiveness of clinic of pancreatitis. Expansion of the main pancreatic duct - the criterion of "H" refers to the need for wide opening duct during resection of the pancreas. So, the choice of surgical technique in a particular clinical situation depends on many factors, but in most cases, the amount of operation is determined by morphological changes in the pancreas. We created the classification considering morphological criteria. Efficiency of this scheme confirms the analysis of the remote results of surgical treatment of patients with chronic pancreatitis.

Curative effect of minimally invasive surgery for patients with medium volume of hypertensive criatocapsular hemorrhage

Objective To observe the mini-invasive treatment for patients with medium volume of hypertensive criatocapsular hemorrhage. Methods 59 patients with medium volume of hypertensive criatocapsular hemorrhage(20-30mL) were selected and randomly divided into mini-invsasive surgery group and conservative treatment group.Two groups were compared the average length of stay, hospital costs and clinical effect. Results The avergae hospital stay (14±3.26)days and avergae cost (1.1±0.33)ten thousand yuan of the mini-invsasive surgery group was lower than those of the conservative treatment group (25±6.58)days and (1.8±0.56)ten thousand yuan], the differences were statistically significant (t=7.999, 5.768, all P<0.01). After 3 months follow-up, the recovery of self-care ability after operation estimated by ADL scores in the mini-invsasive surgery group was significantly better than that in the conservative treatment group(12/31 vs.25/28, χ2=16.093, P<0.01). Conclusion For patients with medium volume of hypertensive criatocapsular hemorrhage(20-30mL), minimally invasive surgery can shorten hospital stay, reduce the financial burden of patients, and improve the prognosis significantly. Key words: Hypertensive, cerebral hemorrhage; Basal ganglia; Minimally invasive surgery; Clinic value

Endourologic Diagnosis and Robotic Treatment of a Giant Fibroepithelial Polyp of the Ureter

Background: Fibroepithelial polyps (FEPs) are a rare cause of ureteropelvic junction (UPJ) obstruction. Radiologists and urologists are not always confident with this disease because of its rarity, complex diagnosis, and heterogeneity of the available treatment options.Case Presentation: We present the endourologic diagnosis and the robotic management of a ureteral polyp close to the left UPJ. A 16-year-old woman with a 12 years history of left lumbar pain was referred to our Center. A computed tomography scan detected a left hydronephrosis with no signs of obstructions at MAG-3 scintigraphy. The endourologic evaluation revealed a giant FEP of the left ureter, which was removed surgically with a videolaparoscopic robot-assisted approach.Conclusion: Considering that conventional radiologic imaging techniques can hardly detect a ureteral FEP, an endourologic study of the urinary tract is mandatory to directly observe the polyp. The mini-invasive treatment of ureteral FEPs is feasible and safe, and should be considered as first option in young patients.

Clinical evaluation of balloon dilation eustachian tuboplasty surgery in adult otitis media with effusion

Conclusion: BDET might be effective for the patients with OME, and proved to be an efficacious and mini-invasive treatment for OME. Objectives: To evaluate the therapeutic benefits of balloon dilation eustachian tuboplasty (BDET) in the treatment of adult patients with otitis media with effusion (OME) caused by eustachian tube dysfunction (ETD). Methods: After informed consent, eight adult patients with OME were included in this study. After investigated patients’ case history and oto-function, all patients underwent BDET treatment. Then four criteria including tympanic membrane, pure tone audiometry (PTA), tympanometry, and subjective symptoms were adopted to evaluate the therapeutic benefits of BDET. Results: None of the involved patients complained of problems or complications during the post-operative period, or with absence of pain and bleeding after the operation. Prominent post-operative improvement was observed in tympanic membrane and otoscopic appearance. In addition, cure rates after 3 months and 6 months post-operatively were gradually increased.

CORRECTION: Mini-invasive treatment for delayed or nonunion: the use of percutaneous autologous bone marrow injection

CORRECTION: Mini-invasive treatment for delayed or nonunion: the use of percutaneous autologous bone marrow injection

What's new in vertebral cementoplasty?

Vertebral cementoplasty is a well-known mini-invasive treatment to obtain pain relief in patients affected by vertebral porotic fractures, primary or secondary spine lesions and spine trauma through intrametameric cement injection. Two major categories of treatment are included within the term vertebral cementoplasty: the first is vertebroplasty in which a simple cement injection in the vertebral body is performed; the second is assisted technique in which a device is positioned inside the metamer before the cement injection to restore vertebral height and allow a better cement distribution, reducing the kyphotic deformity of the spine, trying to obtain an almost normal spine biomechanics. We will describe the most advanced techniques and indications of vertebral cementoplasty, having recently expanded the field of applications to not only patients with porotic fractures but also spine tumours and trauma.

Endoscopic treatment of intestinal malrotation in newborns and infants

To compare treatment of intestinal malrotation in newborns and infants using laparoscopy and laparotomy. For the period from January 2004 to December 2013 34 Ladd's procedures were performed. Children were divided into 2 groups by 17 patients: laparoscopic (group I) and open treatment (group II). Both groups had similar demographic and other preoperative parameters. There were significant differences in duration of operation between both groups (61 vs. 70 minutes). Nutrition was initiated earlier after mini-invasive treatment (1.5 days vs. 3 days) and the time need for full enteral nutrition was also less (4.2 days vs. 6.9 days). Hospital-stay was shorter in group I (7.7 vs. 10.2 days). Number of early postoperative complications was similar in groups. Incidence of remote complications was higher in laparotomy group but the differences were not significant. Our results showed that endoscopic correction of congenital anomalies of intestinal rotation provides better postoperative results than open surgery and can be widely used in young children.

Endobiliary Interventions via Transgallbladder Access in Staged Mini-invasive Treatment of Complicated Cholelithiasis

Aim. To improve the results of minimally invasive treatment of choledocholithiasis by antegrade endobiliary transvesical interventions. Material and Methods. Minimally invasive access into bile ducts through the cystic duct was successfully implemented in 36 (70.6%) patients after prior contact lithotripsy and antegrade lithoextraction for relief of acute obstructive cholecystitis in high risk patients. Different manipulative angiographic catheters (5 Fr) and hydrophilic guidewires (0.018'', 0.025'', 0.035'') were used for cystic duct catheterization. Was considered that cystic duct intubation with proportionate introducer with radiopaque marker is optimal for subsequent manipulations on common bile duct. Results. In 12 cases externally-internal drainage or guidewire for endoscopic papillotomy were deployed after transvesical catheterization of common bile duct. In 24 cases papillodilatation by antegrade balloon catheter, dislocation of stones fragments and biliary sludge into duodenum and antegrade balloon examination of distal common bile duct were performed. There were no complications after the procedure. Conclusion. Transvesical X-ray surgical access into common bile duct can be successfully used as an element of “rendezvous” technology for antegrade transpapillary navigation of guidewire followed by conventional endoscopic procedure. The method provides balloon dilatation of major duodenal papilla, externally-internal drainage of common bile duct and also dislocation of stones from common bile duct into duodenum in clinically difficult cases

Mini-invasive treatment for delayed or nonunion: the use of percutaneous autologous bone marrow injection

Delayed union or nonunion of bone fracture is becoming less frequent, but still remains a challenging clinical problem. Autologous cancellous bone grafting that is the gold standard method, often involves donor site morbidities and complications. Once these fractures have been mechanically stabilized, other local factors should be investigated to promote delayed healing. The purpose of this study was to evaluate the initial outcome of the percutaneous injection of autologous bone marrow after concentration for the treatment of delayed or nonunion. Our subjects included 10 patients of delayed or nonunion fracture (3 female, 7 male) with an average age of 28 years. All fractures were mechanically stabilized after accident. Delayed or nonunion affected the femur in 2 patients, the tibia in 5 patients, the humerus in 2 patients, and the ulna in 1 patient. Bone marrow aspirates were obtained from both the posterior superior iliac crest. Bone marrow aspiration concentrate was produced via density gradient centrifugation. Trocars were inserted in the delayed or nonunion gap under fluoroscopic guidance. The bone marrow aspiration concentrate was injected slowly. As results, all of 10 delayed or nonunion healed after treatment with percutaneous injection of autologous bone marrow. The mean time for new bone formation was 3.3 months, for clinical union was 5.2 months, and for radiological union was 11.8 months. The current study is encouraging in the initial outcome and percutaneous bone marrow implantation could be an effective and safe treatment for delayed or nonunion.

Simulation and Visualization of Liver Cancer Ablation Focus in Optical Surgical Navigation

Radiofrequency ablation therapy of liver cancer is a local mini-invasive treatment technology with several advantages, such as low trauma, safety, effectiveness, and quick postoperative recovery. The application of the optical surgical navigation system in radiofrequency ablation therapy can realize the real-time positioning of surgical instruments and focus. The positioning results can be displayed on the computer, thereby guiding doctors to accurately insert the radiofrequency electrode into the focus and improving surgical efficiency. Meanwhile, the accurate evaluation of the form and size of the ablation focus by the navigation system is the key to realizing the complete ablation of liver cancer. Therefore, based on the heat conduction equation, this paper simplifies the simulation process of the ablation focus, calculates the volume of the ablation focus by distinguishing boundary points and internal points, achieves the effective simulation of the ablation results in the surgery, and reconstructs the ablation focus by using ray casting algorithm and mobile cube algorithm for 3D visualization processing, thereby providing doctors the convenience of being able to simulate the radiofrequency ablation surgery before the actual surgery.

Laparoscopic and Laparoscopy-Assisted Resection of Enteric Duplication Cysts in Children.

Enteric duplication (ED) cysts are rare. The commonness of ultrasonographic investigation contributes to an earlier diagnosis of such a pathology before the onset of the first clinical symptoms. A planned mini-invasive surgical treatment during the infancy is proposed. This study presents the possibility and safety of elective laparoscopic or laparoscopy-assisted mini-invasive resection of ileal (IL) and ileocecal (IC) duplications, thus avoiding bowel resection. A retrospective review was conducted of medical records of 6 patients at the age from 3 to 22 months with the diagnosis of ED, treated in the Department of Pediatric Surgery, Jagiellonian University Medical College, Krakow, Poland, within the period from January 2012 to September 2014. Excision of cysts without bowel resection was performed in five children with IC and IL duplications. Laparoscopic excision was performed in two children with IC duplication; in the other three children (1 IC and 2 IL duplication), laparoscopy confirmed the diagnosis with consecutive cyst excision without bowel resection after external evacuation of the cyst. The external resection of the cecum and Bauhin's valve was necessary in 1 patient with large IC duplication and malrotation. The postoperative course was satisfactory in all the cases. The laparoscopic approach allows for confirming the diagnosis and accurately defining the exact site of duplication, as well as for effective and safe mini-invasive treatment. Laparoscopic or laparoscopy-assisted excision of ED without bowel resection is a safe option in a significant number of IL and IC duplications.

Effectiveness of Magnetic Resonance-guided Focused Ultrasound Surgery (MRgFUS) in the uterine adenomyosis treatment: technical approach and MRI evaluation.

To evaluate the treatment efficacy of uterine adenomyosis using MRgFUS as a mini-invasive therapy. Twenty-three patients affected by symptomatic uterine adenomyosis (11 focal and 7 diffuse forms), diagnosed using MRI, were included in this study. Eighteen out of 23 were submitted to MRgFUS. All junctional zone more than 12 mm in width were considered to be adenomyosis. Study evaluates the pre-treatment target volume measured prior to the treatment on the CE T1-weighted sequence and the MRgFUS-treated volume (MRgFUS-TV), represented by the volume of the lesion ablated, measured directly by means of the MRgFUS. The treated volume on the CE T1-weighted sequence (CE MRI-TV) was measured immediately after treatment. After 1 year, the junctional zone thickness was measured in order to compare pre- and post-treatment values. The therapeutic plan consisted of a high-energy-grid sonication. Symptomatology was assessed through the UFS-QOL. The pre-treatment target volume mean value was of 59.7 cc; the MRgFUS-TV had a mean value of 44.9 cc, and the mean value of CE MRI-TV, measured immediately after treatment, was of 52.8 cc, with an increase of 13.7%. The 86.5% of the lesion was treated. After 1 year from the treatment, 15/18 (83%) patients showed thickness of the junctional zone <12 mm; 3/18 (17%) had a junctional zone >12 mm. MRgFUS is an encouraging mini-invasive treatment for adenomyosis that permits to maintain the integrity of the uterus in a pathology with limited therapeutic possibility.

Miniinvasive treatment of nodular colloid goiter: debate continues

The review reflects the discussion questions on the issue of nodular goiter miniinvasive treatment, the reasons for endocrinologists and surgeons differences approaches, a vector search for consensus is provided.

Mini-Invasive Treatment of Monolevel Dorsolumbar Metastatic Lesions by Radio Frequency Ablation and Augmentation: Preliminary Experience in a Series of 10 Cases

Introduction Technological advances have allowed the development of several “minimally invasive” surgical techniques in the treatment of metastatic spinal tumors. The authors analyzed the effectiveness and impact on quality of life in the short and medium term using radiofrequency ablation and injection of PMMA in the treatment of chronic low back pain in a series of 10 patients suffering from a monolevel metastatic lesion of the dorsolumbar spine. Patients and Methods In 2013, at our Department, 10 patients affected by dorsolumbar monolevel metastatic lesion, in advanced disease, were selected to undergo treatment of transpedicle radio frequency ablation and injection of PMMA. Overall, nine patients were treated by percutaneous technique as they had an already known and suitably treated primary lesion, good performance status, chronic low back pain (mean low back VAS: 8.5), no neurological deficit. Only one patient came to our observation for the presence of low back pain and progressive weakness in the lower limbs, in the absence of already known primitive tumor. In this case, an open surgery with decompression, posterior fusion, and then ablation with augmentation was performed. Results Patients treated percutaneously showed an improvement in pain symptoms with a significant reduction in the VAS (post-op VAS: 3.5) in the absence of new-onset neurological deficit. The patient treated in “open surgery” had a reduction in pain with improvement of neurological function of the lower limbs making it possible walking. All the patients were sent to the oncologist for medical care. Conclusions The radiofrequency thermocoagulation with injection of PMMA seems a good strategy, as palliative treatment, in patients with metastatic advanced disease, with low back pain in the absence of significant neurological deficit when suffering from single level metastatic somatic lesion, ensuring both the effectiveness because of the neoplastic tissue ablation and the augmentation. This allows a gain of QOL in critically ill patients in terms of reduction of pain symptoms.

The role of crossing screws as a mini-invasive treatment for isolated non-comminuted olecranon fractures

Background Several options continue to evolve for treating the common olecranon fractures. The reported high percentage of skin and implant-related complications for these subcutaneous fractures raised the question about the need for a mini-invasive line of treatment that improves the results and minimizes the complications.

Evaluation of the therapeutic efficacy of sequential therapy involving percutaneous microwave ablation in combination with 131I-hypericin using the VX2 rabbit breast solid tumor model.

PurposeCombination of percutaneous microwave ablation (PMWA) and intravenous injection of 131I-hypericin(IIIH) may bear potential as a mini-invasive treatment for tumor. The objective of this study was to assess the effect of PMWA and IIIH in breast tumor growth.MethodsTen New Zealand White rabbits bearing VX2 breast carcinomas were randomly divided into two groups (each 5 examples) and processed using PMWA followed by IIIH and IIIH alone. The IIIH activity was evaluated using planar scintigraphy, autoradiography and biodistribution analysis. The maximum effective safe dose of IIIH was found through 48 rabbits with VX2 breast tumor, which were randomized into six groups (n=8 per group). Subsequently, a further 75 rabbits bearing VX2 breast solid tumors were randomly divided into five groups (each 15 examples) and treated as follows: A, no treatment group; B, PMWA alone; C, IIIH alone; D, PMWA+IIIH×1 (at 8 h post-PMWA); and E, PMWA+IIIH×2 (at 8 h and at 8 days post-PMWA). The therapeutic effect was assessed by measurement of tumor size and performation of positron emission tomography/computed tomograph (PET/CT) scans, liver and renal function tests and Kaplan-Meier survival analysis.ResultsThe planar scintigraphy findings suggested a significant uptake of 131I in necrotic tumor tissue. The autoradiography gray scales indicated higher selective uptake of IIIH by necrotic tissue, with significant differences between the groups with and those without necrotic tumor tissue (P<0.05). The maximum effective safe dose of IIIH was 1mCi/kg. The PET/CT scans and tumor size measurement suggested improvements in treatment groups at all time points (P<0.01). Significant differences were detected among Groups A, B, D and E (P<0.05). Lower levels of lung metastasis were detected in Groups D and E (P<0.05). There were no abnormalities in liver and renal functions tests or other reported side effects.ConclusionIIIH exhibited selective uptake by necrotic tumor tissue. Sequential therapy involving PMWA+IIIH was successfully inhibiting tumor growth and prolonging survival.