Minimal Invasive Interventions Research Articles

Local Treatment of Neuroendocrine Liver Metastases: How Effective and Safe is Stereotactic Microwave Ablation?

Abstract Background The less invasiveness of local ablation techniques such as stereotactic microwave ablation (SMWA) for the treatment of malignant hepatic lesions has made it an attractive alternative to conventional surgical resection. Aims The aim of this retrospective study was to assess the successful ablation rate of neuroendocrine tumor liver metastases (NETLM) 3 months after SMWA, the recurrence-free survival time, as well as the rate of peri- and early post interventional complications. Methods Retrospective analysis including all patients treated with SMWA for NETLM in our institution between 03/2015 and 07/2022. SMWA was performed as per the decision of the interdisciplinary tumorboard. Patients were included independent of location of primary tumors, disease stage, prior treatments. Patients underwent follow-up imaging (FU) every 1-6 months. Results 41 metastases were ablated in 21 interventions in 17 patients with a mean age of 63.6±9.7 years. A median of two lesions (range 1-4) were ablated per intervention. Mean time until first FU was 2.8±1.5 months. 39 of 41 (95.1%) lesions were fully ablated at the first FU. The two incompletely ablated lesions were treated using re-ablation and systemic treatment, respectively. A local recurrence occurred in further two ablation zones (4.9%) after 3.6 years in a patient with a progressive disease. Remaining 37 (90.2%) patients had no tumor recurrence in the ablation zone at the latest available FU (mean 24.3±17.3 months). Postinterventional length of hospital stay was a median of 1 [IQR 1;1.5]. No complications higher than Clavien Dindo Grade II occurred. Conclusions SMWA is a good minimal invasive intervention for the treatment of NETLM with low morbidity and high local efficacy.

Cheek wrinkles revisited: Etiological classifications and nonsurgical treatment options.

Wrinkles are one of the key signs of an aging face. Cheek wrinkles have a prominent negative impact on facial aesthetic. Recognizing the pathology and types of different cheek wrinkles, and the possible minimal invasive interventions to treat them, are crucial for optimal aesthetic outcome. The classification of cheek wrinkles based on etiology, past literature, and wrinkle pattern, and the outlining of possible treatment options. Five different types of cheek wrinkles are described: Type 1-Atrophic cheek wrinkles, Type 2-dynamic expressional cheek wrinkles, Type 3-static expressional cheek wrinkles, Type 4-laxity cheek wrinkles, and Type 5-sleep cheek wrinkles. Treatment options and techniques for different types of cheek wrinkles are recommended accordingly.

Early versus Delayed Minimally Invasive Intervention for Acute Necrotizing Pancreatitis: An Updated Systematic Review and Meta-Analysis

Background: Nowadays, minimally invasive intervention (MII) has largely replaced delayed open surgery in acute necrotizing pancreatitis (ANP). However, the timing of MII remains unclear. The present study investigated the effect of early versus delayed MII on complications in ANP. Methods: Studies evaluating the impact of the timing of MII on complications in ANP patients were thoroughly searched on PubMed, Embase, Cochrane Library, and Web of Science from inception to June 2022. The primary outcome of interest was mortality. Secondary outcomes were the incidence of complications. Results: Nine studies reporting 870 patients undergoing MII for ANP were included. No significant difference was found in mortality between the early and delayed intervention groups. In addition, the timing of MII was not associated with the incidence of new-onset respiratory failure, new-onset cardiovascular failure, new-onset renal failure, new-onset multiple organ failure, gastrointestinal fistula or perforation, pancreatic fistula, stent migration, bleeding, venous thrombosis, and new-onset pancreatic endocrine insufficiency. Notably, in the subgroup analysis of biliary and Asian ANP patients, early intervention was associated with a significantly higher risk of new-onset renal failure than delayed intervention. Conclusions: Early intervention is safe and recommended only for patients with indications for intervention, such as infection.

Recrudescent pouch calculi in cutaneous continent diversion

Reservoir pouch calculi are the most common complication following continent urinary diversion. The presence of calculi in the neobladder can be silent or provoke flank pain, hematuria, and urinary tract infections. Minimal invasive interventions like endoscopic or percutaneous retrieval in smaller calculi to open surgical approaches in large calculi is some of the treatment modalities. Here we present a 34-year-old patient who is a known case of exstrophy-epispadias complex, underwent bladder closure at one year of age and continent cutaneous urinary diversion (Modified Indiana pouch) 26 years ago. Plain and contrast computerized tomography showed multiple large calculi six in number, inside the pouch. In this case, the calculi were successfully managed through an open surgical approach.

Development of a sterile Interaction Device during Image guided minimal-invasive Interventions.

For correct setting and control of imaging during image-guided Magnetic Resonance (MR) procedures (e.g. changing the slice orientation), the radiologist currently depends heavily on the assistants in the control room. The communication between the surgeon and the assistant is difficult due to acoustic noise generated by the MR gradients. The development for a dedicated interventional interaction device is addressed in this work, which includes the development and evaluation of a sterile, MR-compatible capacitive gesture controller. The gesture controller consists of a surgical drape with four capacitive sensors, that are made of conductive fabric. These sensors are based on the principle of electrical capacitance between isolated conductive structures. Measurements of these capacitances are exploited to calculate the distance of a hand to one of the sensors. By comparing the distances of the hand to each sensor, simple swipe gestures can be detected. The sensor unit is connected to a micro-controller, which allows direct and fast processing of the incoming data. To evaluate the prototype, a user study with 25 participants took place. Each user had to perform the four swiping gestures and the hold gesture in a specific order. The gesture controller is capable of registering five different gestures (left-right, right-left, up-down, down-up, hold). A survey of the second prototype showed, that in 92,4% of cases, the correct gesture was registered. Clinical relevance This interaction device allows the practicing physician to manipulate the imaging independently and in a sterile manner, thus enabling a significant improvement in work-flow.

The outcome of conventional open reduction approach vs endoscopic approach for orbital floor repair

IntroductionBlunt trauma to the orbital rim is a frequent cause of both orbital fractures and damage to the surrounding facial bones and soft tissues. The inception of endoscopy and minimal invasive intervention has revolutionized the surgical treatment of blow out fracture of orbital walls. Thus, the present study was conducted to compare the outcome of conventional open reduction approach with endoscopic approach for orbital floor repair. Materials and methodThe study included 10 patients with clinical and radiographic evidence of orbital floor fracture, divided randomly into two groups: Group I-operated using endoscopic approach; and Group II- operated using conventional external approach. All the patients were evaluated clinically preoperatively, immediate post-operative and after 1 month for Diplopia, Extrinsic ocular motility, Enophthalmos and Hypoglobus. ResultsThe study consisted of 40% females and 60% males, with mean age of Endoscopic and Conventional group being 27.20 ± 6.14 years and 27.60 ± 7.23 years respectively. In relation to diplopia, an insignificant difference was observed statistically. The mean change in enophthalmos and hypoglobus in endoscopic and conventional group showed a significant difference statistically (p < 0.001). Unrestricted ocular motility was present only in one case of each group and significantly increased to 5 cases in both the groups (p = 0.048). The mean duration of surgery in endoscopic and conventional group showed a significant difference statistically. ConclusionDiplopia, hypoglobus and Enophthalmos correction was better achieved in endoscopic group as compared to conventional group. But duration of surgery was more in endoscopic group as compared to conventional group.

LIVE Procedure - A Bespoke Technique for Ischemic Heart Failure

<h3>Purpose</h3> Ischemic cardiomyopathy is the most common cause of heart failure (HF). In patients with left ventricular (LV) dilatation, low ejection fraction (EF) and transmural scar, Less Invasive Ventricular Enhancement (LIVE procedure) is a therapeutic option. LIVE is a unique minimal invasive intervention to exclude scarred myocardium, reduce volumes and reshape the LV, while improving HF symptoms. The procedure can be tailored to the unique characteristics of individual scar morphology. <h3>Methods</h3> We herein report 2 cases that highlight this therapy's scope of applicability. <h3>Results</h3> First patient is a 69 year-old male with a mid anterior wall and apical myocardial infarct (MI), which resulted in a dyskinetic scar. Despite guideline-directed medial therapy (GDMT), he was in NYHA class III. Cardiac CT showed a dilated heart with a LV end-systolic volume index (LVESVI) of 82 mL/m² and an EF of 24%. Due to recurrent ventricular tachycardia (VT), he underwent endocardial ablation. However, persistent slow VT's were shown during follow-up. As such, he underwent successful LIVE procedure using 3 Revivent TC™ (BioVentrix™) surgically applied anchors combined with epicardial cryoablation using the Atricure™ CryoICE™, improving his LVESVI to 52 mL/m² (-37%) and EF to 33% (+38%). Post-operative (PO) course was uneventful and follow-up defibrillator interrogation showed no sign of VT's. NYHA class improved to class I. Second patient is a 62 year-old male who suffered a previous osteal left anterior descending artery MI. This has resulted in extreme LV remodeling, with a LVESVI of 162 mL/m2 and EF of 18% by CT, due to a large highly transmural scar. Despite GDMT, he was in NYHA III. As there was an important septal scar component, he underwent hybrid LIVE procedure with Revivent TC™ system (RV-LV). 5 anchor pairs were used, including 1 internal anchor, 1 Antonius stitch (external RV-LV) and 3 LV-LV anchor pairs. PO course was straightforward and he was discharged on PO day #6. Follow-up CT showed a LVESVI of 60 mL/m2 (-63%), an EF of 44% (+151%) and full scar exclusion. <h3>Conclusion</h3> Hybrid LV reshaping and volume reduction is a safe and effective option in patients with symptomatic HF after MI. The procedure is highly customizable and adaptable to each patient's scar morphology. Additionally, concomitant procedures are possible, as described above, making of this therapy a valuable tool in the HF therapeutic armamentarium.

Minimally invasive magnetic resonance image-guided prostate interventions.

Whole gland prostate cancer treatment, i.e. radical prostatectomy or radiation therapy, is highly effective but also comes with a significant impact on quality of life and possible overtreatment in males with low to intermediate risk disease. Minimal-invasive treatment strategies are emerging techniques. Different sources of energy are used to aim for targeted treatment in order to reduce treatment-related complications and morbidity. Imaging plays an important role in targeting and monitoring of treatment approaches preserving parts of the prostatic tissue. Multiparametric magnetic resonance imaging (mpMRI) is widely used during image-guided interventions due to the multiplanar and real-time anatomical imaging while providing an improved treatment accuracy. This review evaluates the available image-guided prostate cancer treatment options using MRI or magnetic resonance imaging/transrectal ultrasound (MRI/TRUS)-fusion guided imaging. The discussed minimal invasive image-guided prostate interventions may be considered as safe and feasible partial gland ablation in patients with (recurrent) prostate cancer. However, most studies focusing on minimally invasive prostate cancer treatments only report early stages of research and subsequent high-level evidence is still needed. Ensuring a safe and appropriate utilization in patients that will benefit the most, and applied by physicians with relevant training, has become the main challenge in minimally invasive prostate cancer treatments.

An anthropomorphic pelvis phantom for MR-guided prostate interventions.

To design and manufacture a pelvis phantom for magnetic resonance (MR)-guided prostate interventions, such as MRGB (MR-guided biopsy) or brachytherapy seed placement. The phantom was designed to mimic the human pelvis incorporating bones, bladder, prostate with four lesions, urethra, arteries, veins, and six lymph nodes embedded in ballistic gelatin. A hollow rectum enables transrectal access to the prostate. To demonstrate the feasibility of the phantom for minimal invasive MRI-guided interventions, a targeted inbore MRGB was performed. The needle probe was rectally inserted and guided using an MRI-compatible remote controlled manipulator (RCM). The presented pelvis phantom has realistic imaging properties for MR imaging (MRI), computed tomography (CT) and ultrasound (US). In the targeted inbore MRGB, a prostate lesion was successfully hit with an accuracy of 3.5mm. The experiment demonstrates that the limited size of the rectum represents a realistic impairment for needle placements. The phantom provides a valuable platform for evaluating the performance of MRGB systems. Interventionalists can use the phantom to learn how to deal with challenging situations, without risking harm to patients.

μRIGS – Ultra-light Micropositioning Robotics for Universal MRI Guided Interventions

Abstract Performing minimal invasive interventions under real-time image guidance proves problematic in a closed-bore magnetic resonance imaging scanner. To enable better usability in MRI guided interventions, robotic systems could be used for additional assistance. However, the integration of such devices into the clinical workflow relates to many technical challenges in order to increase precision of the procedure while ensuring the overall safety. In this work, an MR compatible, compact, ultra-light and remotely controllable micropositioning system called μRIGS is presented. The instrument positioning unit can be operated in a 5-DoF range within a working volume of 2100 cm3with an instrument feed of 120 mm. The kinematics are actuated with a combination of non-metallic Bowden cables and electric stepper motors from a safe distance inside the scanner room, while their control is initiated from the control room via a custom-fitted GUI. Thereby, the precision of the positioning reproducibility of the respective DoF can be achieved with a mean deviation of 0.12 °. Furthermore, a feed force of 14 N can be provided to puncture various soft tissue.

The reasons of unsatisfactory results of extracorporeal shock wave lithotripsy in patients with ureterolithiasis

The article dedicate to the problem of failure of extracorporeal shockwave lithotripsy in patients with ureterolithiasis and reveal the changes which appear in the ureter in the location of the stone.The aim. Analysis of the results of treatment in patients, suffering ureteric stones, using the ureterolithotripsy procedure after failure extracorporeal shockwave lithotripsy.&#x0D; Materials and methods. In 137 patients with ureteric stones, whom ureterolithotripsy procedure after failure extracorporeal shockwave lithotripsy was conducted, the symptoms of the disease, the diagnostic methods value, efficacy of surgical treatment and reasons of the failure of previous method of treatment were analyzed.&#x0D; Results. In 135 patients endoscopic removal of stones has been succeeded, in 2 patients because of total obliteration of the ureter, uretero-ureteral anastomosis has been performed. If the symptoms, with are characteristic of ureterolithiasis, persists up to one week stones don’t cause significant macroscopic changes to the ureter wall. If the stone persists in the ureter longer than a week we identified local appearing of oedema. Long–term (more than two months) ureteric stone persistence increase the risk of intramucosal “ingrowth” of the calculi greatly.&#x0D; Conclusion. The URS and ESWL are high effective and minimal invasive methods of surgical intervention for patients with ureterolithiasis, guaranteeing high level of postoperative “stone free rate”. Prolongation of the stone insertion time in the ureter causes the ureteric wall changes, complicating performance of minimal invasive interventions (ureterolithotripsy and extracorporeal shock–wave lithotripsy) and reduce its efficacy.

Effectiveness of virtual reality immersion on procedure-related pain and anxiety in outpatient pain clinic: an exploratory randomized controlled trial.

BackgroundThe study investigated virtual reality (VR) immersion in alleviating procedure-related pain in patients with chronic pain undergoing fluoroscopy-guided minimally-invasive intervention in a prone position at an outpatient clinic.MethodsIn this prospective randomized controlled study, 38 patients undergoing lumbar sympathetic ganglion block were randomized into either the VR or the control group. In the VR group, procedure-related pain was controlled via infiltration of local anesthetics while watching a 30-minute VR hypnotic program. In the control group, the skin infiltration alone was used, with the VR device switched off. The primary endpoint was an 11-point score on the numerical rating scale, indicating procedure-related pain. Patients’ satisfaction with pain control, anxiety levels, the need for additional local anesthetics during the procedure, hemodynamic stability, and any adverse events were assessed.ResultsProcedure-related pain was significantly lower in the VR group (3.7 ± 1.4) than in the control group (5.5 ± 1.7; P = 0.002). Post-procedural anxiety was lower in the VR group than in the control group (P = 0.025), with a significant reduction from pre-procedural anxiety (P < 0.001). Although patients’ satisfaction did not differ significantly (P = 0.158) between the groups, a higher number of patients required additional local anesthetics in the control group (n = 13) than in the VR group (n = 4; P = 0.001). No severe adverse events occurred in either group during the study.ConclusionsVR immersion can be safely used as a novel adjunct to reduce procedural pain and anxiety during fluoroscopic pain intervention.

The Trends of Urolithiasis Therapeutic Interventions over the Last 20 Years: A Bibliographic Study.

Introduction: The clinical and economic burden of kidney stones is a challenge for the healthcare system. There is a limited bibliometric project exploring the literature trends on 'urolithiasis' and its related management. Methods: A systematic review was conducted to discover the related abstracts regarding each specific issue, investigated year by year from May 2000 to May 2020 (20 years). To make an effective comparison, the statistics resulting from every single study were allocated to two 10-year periods: period 1 (2000 to 2010) and period 2 (2010 to 2020). In this study, we included all English language articles, all non-English articles with English abstracts, and studies in which interventions were used for stone removal, including laser technology. Also, we excluded the studies without a published abstract, an intervention or a laser, animal and in vitro studies, and case reports. Results: These articles are about ureteroscopy (URS) (n=10360, 33.45%), percutaneous nephrolithotomy (PCN) (n =10790, 34.84%) and extra-corporeal shockwave lithotripsy (ESWL) (n=9846, 31.76%). When evaluating the two time periods, there were 9912 studies available in period one, which increased by ×2.12 times (112.71% rise) to 21084 studies in period two (P = 0.001). The increase was 133%, 103.51%, and 70.4% for URS, PCN, and SWL respectively. A total of 855 studies on Laser application via URS were published on PubMed over a 20-year period. There was an increasing trend toward using laser application via URS over the study period. Also, there were 230 articles published in period one, which increased by nearly 2.71 times (rise of 171.73%) to 625 papers in period two (P < 0.001). There was an increasing trend toward using laser application via PCN; 126 papers were published in period one, which increased by nearly 3.05 times (rise of 205.5%) to 385 papers in period two (P = 0.002). Conclusion: The minimal invasive interventions for stone removal, including URS and PCN, increased dramatically in the last decade, and the use of lasers in stone treatment increased significantly in the last decade.

Personalized Image-Guided Therapies for Local Malignencies: Interdisciplinary Options for Interventional Radiology and Interventional Radiotherapy.

Minimal-invasive interventions considerably extend the therapeutic spectrum in oncology and open new dimensions in terms of survival, tolerability and patient-friendliness. Through the influence of image-guided interventions, many interdisciplinary therapy concepts have significantly evolved, and this process is by far not yet over. The rapid progression of minimal-invasive technologies offers hope for new therapeutic concepts in the short, medium and long term. Image-guided hybrid-technologies complement and even replace in selected cases classic surgery. In this newly begun era of immune-oncology, interdisciplinary collaboration and the focus on individualized and patient-friendly therapies are crucial.

Tongue function characteristics in infants experiencing breastfeeding difficulties and changes in breastfeeding after frenotomy procedures

The aims of the study were to describe tongue function in infants experiencing breastfeeding difficulties and to examine changes in breastfeeding after frenotomy procedures. Mothers, and their infants, facing difficulties in breastfeeding were referred to the Vilnius University hospital Žalgirio clinic after assessment of breastfeeding quality by a lactation specialist. Anatomy evaluations included the type of ankyloglossia, tongue function, and the need for a frenotomy. All mothers completed the breastfeeding questionnaire twice, once during the referral consultation and 1month later. The total breastfeeding hindrance score was calculated before and after the frenotomy. Fifty infants were included in the study and their mean age was 29.6days (min age 1day and max 78days). The male to female ratio was 1.8:1.0. Of all infants, 70% had severe lingual function alterations and their mothers were facing issues in breastfeeding. After the frenotomy, there was a significant reduction in breastfeeding hindrance in infants who had disturbed function and aberrant anatomic characteristics. It was found that for type II ankyloglossia, the frenotomy procedure was significant more (p = 0.002) beneficial, than for type I ankyloglossia. After the frenotomy, there was a significant improvement in nine out of 14 criteria of breastfeeding (p = 0.001). Frenotomy procedures had a positive effect on improving breastfeeding. Current study analyses issues with breastfeeding. Dental practitioners and pediatricians should be familiar with this topic, as early and timely minimal invasive surgical intervention has a significant impact for better comfort of the mothers and continuation of breastfeeding.

Current progress in etiology and clinical management of dental caries

Dental caries is a chronic infectious disease that occurs in the tooth hard tissues. Increasing evidence has also indicated a close involvement of dental caries in the onset and development of systemic diseases. In recent years along with the advances in high throughput-omics technologies, disease animal models, multicenter clinical studies, as well as the research and development in novel dental materials, digital and minimal invasive clinical techniques, robust progress have been made in the field of etiology, pathogenesis, diagnosis, prevention and treatment of dental caries. More importantly, the strategy of whole life cycle management of caries has promoted the combinatory management of dental caries and other systemic chronic diseases, and it has also shed light on the age-based management and risk-control-oriented personalized treatment of caries. In the future, more efforts should be warranted to further the basic research and accelerate its clinical application, so as to advance the early diagnosis, comprehensive prevention and functional-aesthetic treatment with minimal invasive intervention of carious teeth, and ultimately to promote the population-based whole lifecycle management of caries.

EVALUATION OF PUNCTURE DRAINING INTERVENTIONS EFFICACY IN PATIENTS WITH PANCREATIC FLUID COLLECTIONS

The aim of the research is to evaluate the effectiveness of ultrasound guided punctures and drainage for FCs in AP. The results of the examination and treatment of 72 patients with FCs in AP who have been treated using step up approach in the period from 2010 till 2018 are analyzed. Patients were divided on two groups: The first group included 40 patients, who underwent draining of FCs under ultrasound guidance as a first stage of treatment. The second group included 32 patients, who underwent puncture of FCs under ultrasound guidance as the first stage of treatment. In the majority of patients in Group I (65.0%) we observed acute post-necrotic FCs. In 30 (75.0%) patients draining under ultrasound guidance was final in treatment. 10 (25.0%) patients with infected acute postnecrotic FCs, after drainage and aspiration underwent necrectomy. In most of patients of group II (62.5%) were noted acute postnecrotic FCs too. 17 patients underwent ultrasound guided puncture and aspiration of FCs. 15 patients of group II underwent drainage of acute post-necrotic FCs under the ultrasound guidance. In 11 (73.3%) of them the drainage of FCs was definitive in treatment, 4 (26.7%) - required the necrosectomy. In group II, in 81.2% patients minimal invasive surgical interventions were effective. SIRS was noted as in patients with aseptic FCs so in patients with infected FCs. In patients with acute pancreatitis, the duration of the disease up to 4 weeks, as well as the presence of SIRS, is not a specific sign of infection only. Ultrasound-guided diagnostic puncture of FCs is a safe method that facilitates early diagnosis of infected FCs. Ultrasound guided puncture with aspiration can reduce the incidence of purulent-septic complications and be definitive in treatment for aseptic acute parapancreatic FCs and aseptic acute post-necrotic FCs. Infected FCs without suppuration do not require routine drainage. Drainage is absolutely indicated in case of purulent content and persistent SIRS in patients after primary puncture of infected FCs.

“Functional outcome in pediatric grade IV renal injuries following blunt abdominal trauma salvaged with minimally invasive interventions”

Non-operative management of higher-grade renal injuries has gradually become accepted in pediatric circles following multiple studies over the past decade which showed good renal salvage rates. However, some children do fail this conservative approach and need interventions which are mostly minimally invasive. There is still paucity of studies on the functional outcomes in this unique subgroup of patients. In this study, we review our management and functional outcome of children with grade IV renal injury due to blunt trauma of abdomen managed with minimally invasive interventions (MII) in a tertiary referral center. The present study seeks to summarize contemporary management of pediatric grade IV renal injury due to blunt trauma at our tertiary care center and to assess the functional outcomes in the subgroup who needed MII. A retrospective review was performed on children≤18 years with abdominal blunt trauma managed at our tertiary care facility over the past 10 years (January 2008-January 2018) to identify those with grade IV renal injuries. Data collected included demographic data like age, sex, mechanism of injury, incidence of hematuria, incidence of pre-existing urologic conditions, associated non-renal injuries, transfusion requirements, imaging findings, type of interventions, length of hospital stay, complications and outcomes on follow up. Review of our institutional database identified 10 children with grade IV renal injury. Mean age was 11.7±3.6 years (range, 6-18) and majority (6/10) were male. Motor vehicle collision and fall from heights were the commonest mechanisms of injury. While one patient responded to non-operative management, one girl needed emergency renal exploration and later nephrectomy. Eight needed minimally invasive interventions following initial non-operative management. One patient needed nephrectomy due to delayed hemorrhage while three patients needed delayed open reconstruction. The salvage rate in the group which needed interventions was 87.5% (7 of 8) however, the functional outcome was good only in 50% (4 of 8) of patients. The outcomes were better in those who were managed with MII earlier (3/4) compared to those who underwent delayed intervention (1/4). The median hospital stay was 11.5 days (range 7-34 days). Pediatric patients with non-exsanguinating grade IV renal injuries due to blunt trauma who fail non-operative management and need minimal invasive interventions have good renal salvage rates however, the functional outcomes are poorer. Judicious and early use of these minimally invasive interventions, instead of persisting with non-operative management can possibly improve these functional outcomes.

Holmium laser enucleation of the prostate for the treatment of size-independent BPH: A single-center experience of 600 cases.

Holmium laser enucleation of the prostate (HoLEP) is an endourologic minimal invasive intervention of benign prostate hyperplasia (BPH). The interest on HoLEP is increasing in the literature. The aim of the present study was to evaluate the learning curve and our preliminary results. A retrospective analysis on 600 patients with BPH who underwent HoLEP between July 2015 and April 2019 was performed. Perioperative measures including enucleation efficiency (EE), morcellation efficiency (ME), and percentage of resected tissue weight (PRW) were recorded. Hospitalization time (HT) and catheterization time (CT) were measured. Functional outcomes, Clavien-Dindo classification complications, and continence status were assessed at 1-, 3-, and 6-month follow-up. The mean age, prostate size, and prostate-specific antigen levels of the patients were 64.54 years, 91 g, and 4.54 ng/mL, respectively. There were 38.3% of patients with ≥100 g prostate size. The measured EE, ME, and PRW were 1.12 g/min, 4 g/min, and 72%, respectively. The mean HT and CT were 24.53 h and 21.50 h, respectively. Functional outcomes showed significant improvement at 1-, 3-, and 6-month follow-up. Intraoperative and postoperative complications were comparable with the literature. The most common perioperative complication was superficial bladder mucosal injury (n=8, 1.33%). Only one patient had persistent stress urinary incontinence at 6-month follow-up. As mentioned in the literature, HoLEP indications are independent from prostate size. Our results showed similarity with the literature on functional outcomes, complication rates, and continence status. With its superior results, our HoLEP series from Turkey supports that HoLEP will replace transurethral resection of the prostate as the known current gold standard.

Effect of Celiac Plexus Neurolysis for Pain Relief in Patients with Upper Abdominal Malignancy: A Retrospective Observational Study and Review of Literature.

Background:Abdominal pain from primary cancer or metastatic disease is a significant cause of pain for patients undergoing treatment for the disease. Patient's pain may be resistant or non-responsive to the pharmacological management, hence minimal invasive pain intervention like celiac plexus neurolysis or splanchnic nerve rhizolysis may be required to relieve pain of such patients.Objective:The aim of this retrospective study is to assess the effect of celiac plexus neurolysis for pain relief in patients with upper gastro-intestinal malignancies.Study Design:This is a retrospective, observational study with short review.Methods:This retrospective observational study was done in the Pain Medicine unit from 2016 and November 2018. Ninety-four patients with upper abdominal malignancy and unrelenting pain, non-responsive or poorly responsive to pharmacological treatment as per WHO ladder of analgesics, received fluoroscopy-guided celiac plexus neurolysis (CPN). All the patients underwent celiac plexus neurolysis through Trans-Aortic approach and the primary outcome measure was pain as assessed with Visual Analogue Scale (VAS) ranging from 0 to 10; the secondary outcome measures were morphine consumption per day (M), quality of life (QOL) as assessed by comparing the percent of positive responses and complications, if any. These were noted and analyzed prior to intervention and then on day 1, and months 1, 2, 3, 4, 5, 6 following CPN.Results:Follow up was completed 6 months after the procedure. VAS score, daily morphine consumption, and the quality of life showed improvement for the duration of the study. There was some relapse in pain and deterioration in QOL during the fourth to sixth month of pain intervention due to disease progression. Some transient known side effects also occurred.Conclusion:Trans-Aortic celiac plexus neurolysis with low volume of alcohol is a safe procedure providing up to 6 months of pain relief and is an effective, well established, minimally invasive procedure for abdominal pain due to primary malignancy or metastatic spread.