Mini-invasive Technique Research Articles

Assisted laparoscopic excision of huge abdominal cysts in newborns and infants using the umbilical laparoscopicport incision

Purpose The objective of this article was to present our experience in successfully managing a variety of abdominal cysts in newborns and infants using a mini-invasive technique performed in 8 cases using an umbilical laparoscopic port incision. Methods Assisted laparoscopic excision using an umbilical port incision was performed in 8 cases. Six were neonates (5 ovarian cysts and one hepatic cyst) and 2 were infants (6-months old with intestinal duplication and 11-months old with lymphatic malformation). Results The procedure was performed with ease and was successful in all 8 cases. Oral feeding was started early after the surgical intervention. Seven patients were discharged the next day. The last case was discharged on the fifth day after surgery because of intestinal resection. Conclusion This proposed mini-invasive technique using the umbilical port incision proved to be less invasive, easier, and less technically demanding than the classic laparoscopic approach and, hence, may be applied to different abdominal cystic pathologies in newborns and infants.

Biomedical Applications of Shape Memory Alloys

Shape memory alloys, and in particular NiTi alloys, are characterized by two unique behaviors, thermally or mechanically activated: the shape memory effect and pseudo-elastic effect. These behaviors, due to the peculiar crystallographic structure of the alloys, assure the recovery of the original shape even after large deformations and the maintenance of a constant applied force in correspondence of significant displacements. These properties, joined with good corrosion and bending resistance, biological and magnetic resonance compatibility, explain the large diffusion, in the last 20 years, of SMA in the production of biomedical devices, in particular for mini-invasive techniques. In this paper a detailed review of the main applications of NiTi alloys in dental, orthopedics, vascular, neurological, and surgical fields is presented. In particular for each device the main characteristics and the advantages of using SMA are discussed. Moreover, the paper underlines the opportunities and the room for new ideas able to enlarge the range of SMA applications. However, it is fundamental to remember that the complexity of the material and application requires a strict collaboration between clinicians, engineers, physicists and chemists for defining accurately the problem, finding the best solution in terms of device design and accordingly optimizing the NiTi alloy properties.

History and current status of mini-invasive thoracic surgery.

Mini-invasive thoracic technique mainly refers to a technique involving the significant reduction of the chest wall access-related trauma. Notably, thoracoscope is the chief representative. The development of thoracoscope technique is characterized by: developing from direct peep to artificial lighting, then combination with image and video technique in equipments; technically developing from diagnostic to therapeutic approaches; developing from simpleness to complexity in application scope; and usually developing together with other techniques. At present, the widely used mini-invasive thoracic surgery refers to the mini-open thoracic surgery performed mainly by using some instruments to control target tissues and organs based on the vision associated with multi-limb coordination, which may be hand-assisted if necessary. The mini-invasive thoracic surgery consists of three approaches including video-assisted thoracic surgery (VATS), video-assisted Hybrid and hand-assisted VATS. So far the mini-invasive thoracic technique has achieved great advances due to the development in instruments of mini-invasive thoracic surgery which has the following features: instruments of mini-invasive thoracic surgery appear to be safe and practical, and have successive improvement and diversification in function; the specific instruments of open surgeries has been successively developed into dedicated instruments of endoscopic surgery; the application of endoscopic mechanical suture device generates faster fragmentation and reconstruction of organ tissues; the specific delicated instruments of endoscopic surgery have rapid development and application; and the simple instruments structurally similar to the conventional instruments are designed according to the mini-incison. In addition, the mini-invasive thoracic technique is widely used in five aspects including diseases of pleura membrane and chest wall, lung diseases, esophageal diseases, mediastinal diseases and heart diseases. However, there remain many problems in specifications and trainings, economic cost, conservation and innovation. Therefore, particular attention should be paid to these problems. Nevertheless, the promotion of thoracic surgery appears promising in the future.

Mini-invasive technique for bone patellar tendon bone harvesting: its superiority in reducing anterior knee pain following ACL reconstruction

Arthroscopically-assisted ACL-reconstructions are currently reliable, reproducible. Residual anterior knee symptoms however, especially after patellar-BTB graft use, are not uncommon occurrences. Contributing factors are numerous and include injury to the saphenous nerve infrapatellar branches and/or histologic changes at the harvest site. The use of mini invasive harvesting technique decreases the risk of injury to the saphenous nerve infrapatellar branches while preserving the peritenon. The double-incision approach significantly reduces the mid-term incidence of anterior knee pain after ACL-reconstruction. Additionally, this technique markedly decreases the occurrence of sensory disorders and the extent of hypoesthesia. We thus advocate the use of a double-incision graft harvesting technique in ACL-reconstruction using a patellar-bone-tendon-bone transplant.

An evaluation of the incidence of haemodynamic depression during carotid angioplasty and stenting and its relationship with specific risk factors

ENWEndNote BIBJabRef, Mendeley RISPapers, Reference Manager, RefWorks, Zotero AMA Gorący J, Widecka-Ostrowska K, Lewandowski M, Modrzejewski A, Kornacewicz-Jach Z. An evaluation of the incidence of haemodynamic depression during carotid angioplasty and stenting and its relationship with specific risk factors. Videosurgery and Other Miniinvasive Techniques. 2011;6(1):12-18. doi:10.5114/wiitm.2011.20987. APA Gorący, J., Widecka-Ostrowska, K., Lewandowski, M., Modrzejewski, A., & Kornacewicz-Jach, Z. (2011). An evaluation of the incidence of haemodynamic depression during carotid angioplasty and stenting and its relationship with specific risk factors. Videosurgery and Other Miniinvasive Techniques, 6(1), 12-18. https://doi.org/10.5114/wiitm.2011.20987 Chicago Gorący, Jarosław, Katarzyna Widecka-Ostrowska, Maciej Lewandowski, Andrzej Modrzejewski, and Zdzisława Kornacewicz-Jach. 2011. "An evaluation of the incidence of haemodynamic depression during carotid angioplasty and stenting and its relationship with specific risk factors". Videosurgery and Other Miniinvasive Techniques 6 (1): 12-18. doi:10.5114/wiitm.2011.20987. Harvard Gorący, J., Widecka-Ostrowska, K., Lewandowski, M., Modrzejewski, A., and Kornacewicz-Jach, Z. (2011). An evaluation of the incidence of haemodynamic depression during carotid angioplasty and stenting and its relationship with specific risk factors. Videosurgery and Other Miniinvasive Techniques, 6(1), pp.12-18. https://doi.org/10.5114/wiitm.2011.20987 MLA Gorący, Jarosław et al. "An evaluation of the incidence of haemodynamic depression during carotid angioplasty and stenting and its relationship with specific risk factors." Videosurgery and Other Miniinvasive Techniques, vol. 6, no. 1, 2011, pp. 12-18. doi:10.5114/wiitm.2011.20987. Vancouver Gorący J, Widecka-Ostrowska K, Lewandowski M, Modrzejewski A, Kornacewicz-Jach Z. An evaluation of the incidence of haemodynamic depression during carotid angioplasty and stenting and its relationship with specific risk factors. Videosurgery and Other Miniinvasive Techniques. 2011;6(1):12-18. doi:10.5114/wiitm.2011.20987.

Mini-invasive video-assisted surgery of the thyroid and parathyroid glands: A 2011 update

Thyroid surgery during the last century was characterized by a development of Kocher's concepts: through a relentless work of surgeons from all over the world thyroidectomy reached a standard of quality in terms of overall results which was unimaginable in the first half of the XX century. The flattering data collected in the literature until the 90's were all concordant in assuming that there would be little space for a real improvement in the quality standard of thyroid surgery. The introduction of laparoscopic surgery, though, changed very quickly the attitude of surgeons towards their operative behavior and countless new mini-invasive techniques were soon proposed for almost any field of surgery. In 1994, Gagner published the first series of laparoscopic adrenalectomies. Soon after, parathyroid adenomas seemed to offer an ideal field of application of these new surgical concepts. The first report of an endoscopic parathyroidectomy was in 1996. One year later other videoscopic procedures were described whose results seemed quite encouraging so as to push surgeons to try the same access and the same technique also for operations on thyroid. During the following decade several endoscopic or video-assisted approaches were proposed for the removal of thyroid gland. This paper aims to evaluate the results of minimally invasive thyroid and parathyroid surgery through an extensive review of the literature, in particular as far as minimally invasive video-assisted thyroidectomy is concerned.

Percutaneous resection of calcaneo-navicular coalition with interposition of synthetic graft

Background Surgical resection of calcaneo-navicular coalition (CNC) with interposition of fat or muscle graft is indicated when there is failure of conservative treatment. Objectives to evaluate the clinical and functional of outcome of a new mini-invasive technique for resection of CNC and interposition of synthetic graft. Methods This is a prospective case series study on 9 patients (12 feet) with symptomatic CNC. Percutaneous resection of the CNC was done using a motorized bone burr through a small incision in the sinus tarsi under image intensifier control. After complete resection a synthetic graft of Teflon or Dacron measuring 15 mm × 30 mm was interposed to prevent re-union of the bone bar. Results The mean follow up period was 26.44 months (±1.5 SD). There was statistically significant improvement in the mean total AOFAS score from 47.89 (±8.49 SD) preoperatively to 90.22 (± 5.26 SD) at two years follow up ( P < 0.05). The mean time to return to full daily activity was 7.44 weeks (±0.88 SD) Conclusion Percutaneous resection of calcaneo-navicular bar with interposition of synthetic graft is an effective mini-invasive method for treatment of calcaneo-navicular coalition with good results in 44.4% of patients and excellent results in 55.6% of patients.

Bone Integration of New “Stemless” Hip Implants (Proxima Vs. Nanos). A DXA Study: Preliminary Results

The development of short femoral prostheses has the advantage to preserve bone and soft tissues, restore hip geometry, permit mini-invasive techniques and allow quickly return to an active life, but very few studies described bone reaction to these new designed prostheses. The aim of the present study was to evaluate the osseointegration of two different partial neck retained stemless hip prosthesis at one year after surgery, measured by the changes of periprosthetic bone mineral density (BMD) in 5 regions of interest (ROIs) using a dual-energy X ray absorptiometry (DXA) device. The signs of stress-shielding were evaluated by standard radiographs. Thirty-two uncemented primary total hip arthroplasty (THA) patients allocated into 2 groups were evaluated. In the first group (n=19) a Proxima (De-Puy-J&J) hip stem was implanted. In the second group (n=12) a Nanos (Smith & Nephew) hip stem was used. We found that both the implants preserve metaphyseal bone stock and increase periprosthetic BMD. In Nanos prostheses a significant higher BMD values were observed in region of interest (ROI) 3 and 4 (p<0.05). No differences were found in ROIs 1, 2, and 5. Proxima stem seem to produce a physiological strain distribution in the femur. No signs of stress-shielding were present in both the implants. In conclusion, this preliminary DXA analysis showed a physiological integration of both the stems that reproduces the biomechanical stress of proximal femur. New designed short stem implants showed optimal osseointegration after one year, and therefore appears an excellent alternative to traditional long stem hip prostheses.

Navigated intra-articular ACL reconstruction with additional extra-articular tenodesis using the same hamstring graft

In some complex cases, standard anterior cruciate ligament reconstruction is not enough and could lead to a new failure. Lateral extra-articular reconstruction should be added. We describe a new mini-invasive technique using the same hamstring graft for intra-articular reconstruction and lateral tenodesis, optimized with navigation. This arthroscopic technique is precisely described, different graft setting are possible, four strands graft inside the joint and two strands for the tenodesis or two strands graft for all the whole graft. As the lateral tenodesis is not anatomic, tunnel placement could be tricky. The use of navigation system is a real advantage for this technique with optimal tunnels placement. No results are given. This technique is comparable to others reported previously, showing a clinical advantage and no increasing of osteoarthritis. The use of the same graft avoids collateral damages, and navigation improves the graft placement.

The Antiarrhythmic Properties of Quifenadine, H1-Histamine Receptor Blocker in Children with Premature Beats: A Randomized Controlled Pilot Trial

Despite evolving success of mini-invasive techniques in treating cardiac arrhythmias in children, pharmaceuticals remain the cornerstone therapeutic option. Beyond conventional antiarrhythmic agents such as amiodarone, local anesthetics, tranquilizers, anticonvulsants, and neuroleptics exhibit antiarrhythmic properties. H(1)-histamine receptor blockers are widely used in treating allergies in children. Observational studies suggest efficacy of these agents for treating or preventing tachyarrhythmias, although prolongation of QT interval, and ventricular arrhythmias occur. We determined safety and efficacy of antihistamine, quifenadine, versus conventional amiodarone on cardiac rhythm in children with frequent premature beats (PB). One hundred and four patients (mean age 10.8 +/- 3.2 years) with ventricular (n = 65), supraventricular (n = 39) PB were randomized 1:1 to quifenadine (2 mg kg(-1) day(-1); n = 54), or amiodarone (9 mg kg(-1) day(-1), n = 50) arms. Both groups were treated for 2 weeks. All patients underwent 24-hour Holter monitoring 3 times: before at 14-28 days after randomization, and during the follow up at 2-3 months. The mean frequency of PB in quifenadine group was 562 +/- 61 per hour and 597 +/- 78 per hour in the amiodarone-treated children. Full antiarrhythmic efficacy (PB < 75% from baseline) has been achieved in 23/54 (43%) of quifenadine-treated patients, which was less than after amiodarone treatment (37/50, 74%, P = 0.02). Quifenadine was mostly beneficial in children with supraventricular PB and/or bradycardia than in those with ventricular PB; it was associated with a trend toward increased heart rate during day (88.5 +/- 8.4 beats/min) and night (67.3 +/- 6.2) compared with amiodarone (79.6 +/- 7.8 and 56.1 +/- 5.7 beats/min, respectively; P = 0.04). The incidence of side effects in quifenadine group (drowsiness and headache) was low (2%) in contrast to the alarming 40% risk associated with amiodarone therapy. Quifanidine exhibits antiarrhythmic activity in children with frequent PB, without significant QT prolongation, or sinus node depression. Although, H(1)-histamine receptor blocker is less potent than amiodarone, much better safety profile of quifenadine is advantageous, especially in children. Future large trials with proving novel antihistamines pleiotropy are warranted.

Endosopic Achilles tendon augmentation with a graft loop anatomic and radiologic study

Mini-invasive techniques are commonly used for repair of tendon Achilles (TA) rupture. However, the use of these techniques is limited when graft augmentation is needed. A radiological study was conducted on 18 normal ankles using multi-slice CT scan with soft tissue reconstruction to determine the endoscopic landmarks for Achilles tendon insertion. The surgical procedure was performed on six whole lower limb formaldehyde preserved specimens. Endoscopic-assisted TA augmentation with a graft loop was done for all specimens. Postoperative assessment of the tunnel was done using multi-slice CT scan. Anatomic dissection showed that the sural nerve and neurovascular bundle were intact in all specimens. With the technique described a graft loop can be delivered endoscopically for Achilles tendon augmentation. The technique was found to be safe for the sural nerve and medial neurovascular structures.

Study of clinic application of percutaneous Cool-tip Radiofrequency Ablation of advanced lung cancer

Objective To investigate the efficacy and safety of percutaneous Cool-tip Radiofrequency ablation guided by computerized tomography (CT) for the treatment of advanced lung cancer. Methods 32 patients of advanced lung cancer with 102 different pathological types were treated with MERP technique. The patients' blood pressure,pulse rate and oxygen saturation were monitored during the procedure. The hepatic, pulmonary and renal functions were examined before and after the procedure. The tumor bulk was compared with CT before and after the treatment. Results There were no any changes in the blood pressure, pulse rate and oxygen saturation in the whole series before, immediately after the term ination and one month after the procedure, nor did the hepatic,pulmonary and renal function as well. The bulk of the tumor in this group as a whole enlarged by the end of the first month after the therapy. The CT scanning of the tumor at the end of the third month revealed that there had 23 CR, 53 PRa, 24 PRb, and 2 NR among 102 tumors. Conclusion The Cool-tip Radiofrequency ablation is a promising mini-invasive technique for the treatment of advanced lung cancer with the satisfactory efficacy and safety. Key words: Lung neoplasms; Radiofrequency ablaton; Percutaneous; Cool-tip; Treatment

Choice of route for hysterectomy &amp;#8211; evaluation of procedures performed in the gynaecological department of the Tuchola District Hospital, from 2005 to 2008

ENWEndNote BIBJabRef, Mendeley RISPapers, Reference Manager, RefWorks, Zotero AMA Klimczak K, Malinowski A, Dejewski C. Choice of route for hysterectomy – evaluation of procedures performed in the gynaecological department of the Tuchola District Hospital, from 2005 to 2008. Videosurgery and Other Miniinvasive Techniques. 2010;5(1):14-18. doi:10.5114/wiitm.2010.13601. APA Klimczak, K., Malinowski, A., & Dejewski, C. (2010). Choice of route for hysterectomy – evaluation of procedures performed in the gynaecological department of the Tuchola District Hospital, from 2005 to 2008. Videosurgery and Other Miniinvasive Techniques, 5(1), 14-18. https://doi.org/10.5114/wiitm.2010.13601 Chicago Klimczak, Krzysztof, Andrzej Malinowski, and Cezary Dejewski. 2010. "Choice of route for hysterectomy – evaluation of procedures performed in the gynaecological department of the Tuchola District Hospital, from 2005 to 2008". Videosurgery and Other Miniinvasive Techniques 5 (1): 14-18. doi:10.5114/wiitm.2010.13601. Harvard Klimczak, K., Malinowski, A., and Dejewski, C. (2010). Choice of route for hysterectomy – evaluation of procedures performed in the gynaecological department of the Tuchola District Hospital, from 2005 to 2008. Videosurgery and Other Miniinvasive Techniques, 5(1), pp.14-18. https://doi.org/10.5114/wiitm.2010.13601 MLA Klimczak, Krzysztof et al. "Choice of route for hysterectomy – evaluation of procedures performed in the gynaecological department of the Tuchola District Hospital, from 2005 to 2008." Videosurgery and Other Miniinvasive Techniques, vol. 5, no. 1, 2010, pp. 14-18. doi:10.5114/wiitm.2010.13601. Vancouver Klimczak K, Malinowski A, Dejewski C. Choice of route for hysterectomy – evaluation of procedures performed in the gynaecological department of the Tuchola District Hospital, from 2005 to 2008. Videosurgery and Other Miniinvasive Techniques. 2010;5(1):14-18. doi:10.5114/wiitm.2010.13601.

Comparative Functional Analysis of Two Different Achilles Tendon Surgical Repairs

A number of different surgical procedures have been developed to treat Achilles tendon injuries including open and mini-invasive type. The aim of the present work was to compare the functional outcome of two different techniques, applying a clinical and instrumented protocol. Fifty-one subjects were enrolled in the study. The experimental group consisted of 34 patients with a ruptured Achilles tendon, 19 operated by open surgical reconstruction without reinforcement (Open Group), while 15 underwent a mini-invasive procedure (Mini-invasive Group); the Control Group consisted of 17 healthy subjects. The assessment was based on the standing vertical jump, in both 'countermovement jump' and 'squat jump' mode, studying the relative flight times and the coordination of movement of each limb. An accelerometer was fastened to each ankle to obtain an independent assessment of the movement of each limb. The surgically treated patients showed a comparable functional performance to that of the Control Group but despite this full recovery they showed a tendency to ''favor'' the affected limb. This finding was more marked in the Mini-invasive Group. The Control Group invariably showed better coordination of the movement of the two limbs than the two experimental groups. This was particularly apparent in the take-off phase, indicated by asymmetrical push-off of the two limbs. The jumping evaluation used in this study resulted in similar results between the open and the mini-invasive techniques.

Medical Therapy and Multilevel Vertebroplasty in Osteoporosis: When and Why

Vertebroplasty (VP) is a mini-invasive percutaneous technique for the treatment of symptomatic, vertebral body fracture (VBF) caused by porotic or other diseases and its outcome has now been demonstrated by many trials. Beyond the results of these trials on the efficacy and safety of VP, the real problem for patients with osteoporotic and non-osteoporotic vertebral fractures is the risk of new fractures to adjacent or distant vertebra following VP that is reported to range from 10% to 30%. It is still unclear whether this is related to the natural history of the underlying disease (osteoporotic and non-osteoporotic diseases) or to the treatment, especially when a single vertebral fracture in an osteoporotic patient is highly predictive of future fractures. To prevent new fractures to adjacent or distant vertebra following VP in porotic patients multiple non-pharmacologic interventions are recommended (diet with vitamin D or calcium supplements, smoking cessation, exercise) in addition to a specific medical therapy to block the activation of osteoclast cells responsible for bone resorption, and to re-establish correct bone remodeling. These drugs include anti-catabolic drugs: bisphosphonate, oestrogen hormone, and anabolic drugs: PTH analogues and strontium ranelate. Bisphosphonate are the most commonly used compounds to treat postmenopausal osteoporosis. However, medical treatment appears to be too slow to prevent the natural history of patients with VBF. One session multilevel VP could be performed to prevent vertebral refracture risk in porotic or non-porotic patients with recurrent VBFs also after the first VP even if there is not a true vertebral collapse. Even if there are no limits to how many body levels can be treated in one session, European and American guidelines suggest doing no more than three body levels in the same session to reduce patient discomfort, and to prevent peri-procedural anesthesiologic problems, like uncontrolled fat-embolism, cement leakage, and pulmonary embolism, that could be increased. How many vertebrae could be treated in same session could be analyzed beforehand based on MDCT vertebral morphology and trabecular structure, or on MRI-signal changes. Added to medical therapy, multilevel VP can be performed in selected cases to treat VBF related to osteoporosis, preventing fractures or refracture without any further thrombo-embolic or fat uncontrolled embolism peri or post-procedural complications.

Clinical results after anterior mini-open approach for femoroacetabular impingement in early degenerative stage

We describe our modified anterior mini-invasive technique and results obtained in our first consecutive 117 cases in 105 patients. To assess the influence of preoperative Tönnis degenerative stage, cases were divided into group A (Tönnis 0, 32 hips), B (Tönnis 1, 61 hips), and C (Tönnis 2, 24 hips). The clinical score Dexeus combined score (DCS) was used preoperatively, 3 months, 6 months, and every year after operation. At 3-month follow-up, impingement test results improved significantly in 30 hips of group A (94%; p<0.001) and in 58 of group B (95%; p<0.001), whereas in group C, improvement was observed in only 14 cases (58%; p>0.05). No statistical difference was observed at 3-year visit in all groups. Merle d'Aubigné-Postel and WOMAC scores improved significantly in group A (p<0.001) and B (p<0.001) after 1 year and remained unchanged at subsequent yearly follow-ups. For group C, clinical outcomes scores did not show any significant improvement overall (p>0.05). We concluded that anterior mini-invasive technique is an effective method to treat femoroacetabular impingement, and results are highly influenced by preoperative degenerative state, especially in stage Tönnis 2. Therefore, it seems to be a reasonable early surgical treatment in symptomatic patients.

Clinical results after anterior mini-open approach for femoroacetabular impingement in early degenerative stage

We describe our modified anterior mini-invasive technique and results obtained in our first consecutive 117 cases in 105 patients. To assess the influence of preoperative Tönnis degenerative stage, cases were divided into group A (Tönnis 0, 32 hips), B (Tönnis 1, 61 hips), and C (Tönnis 2, 24 hips). The clinical score Dexeus combined score (DCS) was used preoperatively, 3 months, 6 months, and every year after operation. At 3-month follow-up, impingement test results improved significantly in 30 hips of group A (94%; p<0.001) and in 58 of group B (95%; p<0.001), whereas in group C, improvement was observed in only 14 cases (58%; p>0.05). No statistical difference was observed at 3-year visit in all groups. Merle d'Aubigné-Postel and WOMAC scores improved significantly in group A (p<0.001) and B (p<0.001) after 1 year and remained unchanged at subsequent yearly follow-ups. For group C, clinical outcomes scores did not show any significant improvement overall (p>0.05). We concluded that anterior mini-invasive technique is an effective method to treat femoroacetabular impingement, and results are highly influenced by preoperative degenerative state, especially in stage Tönnis 2. Therefore, it seems to be a reasonable early surgical treatment in symptomatic patients.

Anatomical and Surgical Considerations on Lumbar Hernias

Lumbar hernias, which are rare hernias of the posterolateral abdominal wall, can be divided into two groups: primary lumbar hernias, often the expression of a congenital defect, which typically arise in two areas of weakness, the superior triangle and inferior triangle and acquired (or diffuse) lumbar hernias which are usually due to previous lumbar trauma or surgery. Clinical examination may be adjuvated by ultrasound or CT scan, which can reveal the abdominal wall defect with the hernia content (viscera or extraperitoneal tissue). Surgical repair of lumbar hernias, both primary and acquired, has rapidly developed through recent years, similarly to the treatment of more frequent kinds of hernia (groin, epigastric), evolving from direct repair to mini-invasive techniques, even if, since the rarity of these hernias, precise knowledge of this complex anatomic region is required. Nowadays there are two valid alternatives: open tension-free repair (with use of mesh), and mini-invasive repair. Both are safe and effective, even if smaller hernias can be treated by open approach, with loco-regional anesthesia and good cosmetic effect. Larger hernias, or hernias with suspected viscera involvement, should require larger incisions and viscera exploration. For this reason laparoscopic access would be preferable.

Mini-invasive nail versus DHS to fix pertrochanteric fractures: A case-control study

Fixation devices to treat trochanteric fractures belong to two general categories: dynamic hip screw (DHS) type and intramedullary type implants. In spite of possible pitfalls, both are considered valid options. Comparing a sliding screw-plate system (DHS) along a mini-invasive nailing device (BCM nail) with primary insertion of the cephalic screw, sheds light on the debated management of trochanteric fractures.Due to its design, the BCM nailing system allows a stable internal fixation and promotes enhanced postoperative functional recovery.To test this hypothesis in a comparative prospective case-control study using the DHS screw-plate as a reference.Two groups of 30 patients, older than 60 years old, with trochanteric fractures were included in this study. The screw-plates were placed according to the standard method. Regarding the nailing system, the cephalic screw was positioned first, then the nail was inserted through the screw via a mini-invasive approach and locked distally using a bicortical screw. Comparison between the two groups was based on (1) operative data: operating time, intra- and postoperative blood loss; (2) immediate postoperative course: complications, length of hospital stay, delay to sitting in a wheelchair; (3) the postdischarge evolution: weightbearing, readmission to hospital; (4) functional outcomes: recovery and mobility; (5) anatomical outcomes: restitution and bone healing.The operating time (54+/-8.8 min vs 59+/-13.8 min) and intraoperative (1.37+/-0.98 vs 1.90+/-1.43) and at Day 3 (1.25+/-1.05 vs 1.82+/-1.5) blood loss (haemoglobin loss), were favourable to the screw-plate subgroup (p<0.05). The delay to sitting in a wheelchair (4.76+/-1.53 d vs 4+/-1.44 d) was favourable to the nail subgroup (p<0.05). There was a higher incidence of secondary displacements in the screw-plate subgroup (3/26 [11.5%] vs 0/25 [0%]) (p<0.05). The screw-plate subgroup demonstrated a poorer healing rate at 3 months (88% vs 100%) (p<0.05). Regarding functional recovery, a lesser decrease in the Parker score was observed in the nail subgroup at 3 postoperative months (2.42+/-2.3 vs 1.52+/-1.44) (p<0.05).This study has shown the benefits of the BCM nail in terms of stability. But the potential advantages of this mini-invasive technique were limited by ancillary-related difficulties which need to be rectified. These preliminary results are in favour of a further development of this innovating device.

Résultats de l’aspiration cytologique à l’aiguille fine dans le diagnostic des tumeurs solides du rein de nature indéterminée

To evaluate the accuracy of fine-needle aspiration cytology for the diagnosis of imaging indeterminate solid renal tumours.From February 2003 to February 2009, 60 cytoaspirations have been performed to 20 female and 40 male patients (average age: 62.0+/-14.2 years) with an indeterminate solid renal mass by imaging. The average tumour size was 3.4+/-2.8 cm. The cytoaspiration was performed through a 22 Gauge needle under CT (n=39) or US (n=21) guidance. Papanicolaou staining was used. All slides were examined by one experienced cytologist without any clinicoradiological information. The results were given as malignant, benign, suspect or non significant. A classification of subtypes of renal cancer might be added by the cytologist.Twenty-one cytoaspirations (35%) were non significant while 39 (65%) showed cells of interest. Among these 39 cellular cytoaspirations, the specificity for malignancy or benignity was 89.7%. The proportion of non-significant samples was the same in tumors lesser than 2 cm (38.4%) as in tumors 2-4 cm (38.8%) (p=1.000, Fisher's exact test). Subtype identification was only reliable for clear cell carcinomas. No complication was observed.The fine-needle aspiration cytology is an auxiliary technique for the diagnosis of indeterminate solid renal tumours. This simple and mini-invasive technique had a high specificity but a low sensitivity in our experience. Fine-needle aspiration is complementary to core biopsy which remains the gold standard of percutaneous sampling.