Minimal Invasive Management Research Articles

Prevalence and management of ectopic and molar pregnancies in 17 countries in Africa and Latin America and the Caribbean: a secondary analysis of the WHO multi-country cross-sectional survey on abortion

IntroductionThere are limited global data on ectopic pregnancy (EP) and molar pregnancy (MP), making it important to understand their epidemiology and management across different regions. Our study aimed to describe...

Minimal invasive management of a large gingival fibroma: Report of a case

Minimal invasive management of a large gingival fibroma: Report of a case

6LBA LBA Mini Oral - Minimal vs. maximal invasive axillary management after neoadjuvant systemic therapy in node positive breast cancer: 5-year follow-up results of the Dutch MINIMAX registry study

6LBA LBA Mini Oral - Minimal vs. maximal invasive axillary management after neoadjuvant systemic therapy in node positive breast cancer: 5-year follow-up results of the Dutch MINIMAX registry study

Propensity Score-Matched Analysis of Minimal Invasive Surgery versus Open Surgery for Colorectal Cancer in Older Patients.

Introduction: Currently, surgeons deal with an older patient cohort, confronting new challenges brought by the raised life expectancy. This population is unrepresented in surgical trials; therefore, the optimal therapy is still a matter of debate. The efficacy of open versus minimal invasive management of colorectal cancer (CRC) in an elderly cohort is not clearly established. The current study assesses the minimal invasive approach in elderly patients undergoing colorectal surgery. Material and Methods: The General Surgery Department database was inquired between 2012 and 2015 using the following filters: age â?¥ 65 and rectal or colon adenocarcinoma. After applying the exclusion criteria, 975 cases were obtained: 842 underwent open surgery (OS) and 133 underwent minimal invasive surgery (MIS). A propensity score matching was performed to reduce patient selection bias. Results: After the propensity score matching, the MIS group had a shorter postoperative hospital stay than the OS group (p = 0.025). From the preoperative variables, the presence of chronic lung disease was significantly higher in the OS group (p = 0.039). The presence of chronic lung disease positively associates with the Clavien-Dindo classification (p 0.001) and with the number of days from surgery to discharge (p = 0.028). Conclusion: The chronological age alone should not be a limit to MIS granting that it showed no inferiority to the OS in terms of postoperative morbidity, correlating with lower postoperative stay in the elderly. Further prospective studies are needed to assess the outcome of MIS in elderly population.

Minipercutaneous Nephrolithotomy in the Management of Large and Complex Renal Calculi in Children: How Effective Is It?

Purpose: To evaluate the efficacy and safety of minipercutaneous nephrolithotomy (PCNL) in the management of large and complex calculi in children. Patients and Methods: From May 2017 to April 2021, a total of 41 pediatric cases were diagnosed with large/complex renal stones (partial-total staghorn) and following a detailed biochemical evaluation and thorough radiological examination (plain abdominal radiograph, urinary ultrasound, noncontrast and/or computed tomography), all cases underwent mini-PCNL procedure for the minimal invasive management of these calculi. Preoperative, intraoperative, and postoperative data were analyzed and reported in detail. Results: A total of 41 procedures were performed in 26 boys and 15 girls (male/female = 1.73). While the age of the kids ranged from 2.5 to 10 years (mean 6.74 ± 2.76), mean size of the stones was 16.28 ± 3.43 mm (range 11-24) with a mean stone density value of 816 HU (range 550-1350). Evaluation of the success rates in terms of complete stone clearance on postoperative day 1 revealed that while 73.2% (30/41), residual fragments have been noted in 11 cases (26.8%). Size of the residual fragments ranged from 2 to 7 mm (mean 4.3). Of those children, 10 cases required flexible ureteroscopy for stone removal, and in 1 case, placement of Double-J was adequate for spontaneous passage. During a 3-month follow-up, the stone-free rate (SFR) increased to 100% without any residual fragment left. Conclusions: Mini-PCNL with holmium laser lithotripsy is an effective and safe treatment alternative in the minimal invasive management of large/complex kidney stones in children with high SFRs.

Single-centre review of the management of intra-thoracic oesophageal perforation in a tertiary oesophageal unit: paradigm shift, short- and long-term outcomes over 15 years

BackgroundOesophageal perforation is an uncommon surgical emergency associated with high morbidity and mortality. The timing and type of intervention is crucial and there has been a major paradigm shift towards minimal invasive management over the last 15 years. Herein, we review our management of spontaneous and iatrogenic oesophageal perforations and assess the short- and long-term outcomes.MethodsWe performed a retrospective review of consecutive patients presenting with intra-thoracic oesophageal perforation between January 2004 and Dec 2020 in a single tertiary hospital.ResultsSeventy-four patients were identified with oesophageal perforations: 58.1% were male; mean age of 68.28 ± 13.67 years. Aetiology was spontaneous in 42 (56.76%), iatrogenic in 29 (39.2%) and foreign body ingestion/related to trauma in 3 (4.1%). The diagnosis was delayed in 29 (39.2%) cases for longer than 24 h. There was change in the primary diagnostic modality over the period of this study with CT being used for diagnosis for 19 of 20 patients (95%). Initial management of the oesophageal perforation included a surgical intervention in 34 [45.9%; primary closure in 28 (37.8%), resection in 6 (8.1%)], endoscopic stenting in 18 (24.3%) and conservative management in 22 (29.7%) patients. On multivariate analysis, there was an effect of pathology (malignant vs. benign; p = 0.003) and surgical treatment as first line (p = 0.048) on 90-day mortality. However, at 1-year and overall follow-up, time to presentation (≤ 24 h vs. > 24 h) remained the only significant variable (p = 0.017 & p = 0.02, respectively).ConclusionOesophageal perforation remains a condition with high mortality. The paradigm shift in our tertiary unit suggests the more liberal use of CT to establish an earlier diagnosis and a higher rate of oesophageal stenting as a primary management option for iatrogenic perforations. Time to diagnosis and management continues to be the most critical variable in the overall outcome.

Laparo-endoscopic management of chole-choledocholithiasis: Rendezvous or intraoperative ERCP? A single tertiary care center experience

IntroductionThe management of chole-choledocholithiasis remains a matter of debate to preserve minimal invasive management and different options have been proposed, with single- or two-stage approaches. Two techniques of single-stage approach are intraoperative ERCP and laparoscopic rendezvous, which have the great advantage of reducing the length of hospital stay with increased patient compliance. This retrospective study aims to evaluate and compare the efficacy and safety of intraoperative ERCP and rendezvous technique for more than 15 years.Materials and methodsClinical records of 113 patients who underwent single-stage management for chole-choledocholithiasis between January 2003 and December 2020 were retrospectively reviewed using a prospectively maintained database. Patients were separated into two groups: those managed with intraoperative ERCP and those with rendezvous, and their intraoperative and postoperative parameters were compared. All patients were followed up for 6 months in an outpatient setting.ResultsA total of 68 (60%) patients were treated with intraoperative ERCP, while the remaining 45 (40%) were treated with rendezvous. There were no significant differences in terms of comorbidities. ERCP was performed with a median operative time of 145 min (104–168) and an endoscopic time of 27 min (15–36). Meanwhile, rendezvous was performed with a significantly lower operative [120 min (94–147)] and endoscopic time [15 min (12–22)]. No intraoperative complications were recorded. Patients treated with rendezvous had a significantly shorter median hospitality stay [4 (3–5) vs. 3 (2–4) days, p < 0.05]. No hospital readmissions or mortalities were observed in either group after 30 days. Ten mild pancreatitis cases were observed, mainly in the intraoperative ERCP group (9 vs. 1, p < 0.05), and all were treated conservatively. Only two patients treated with intraoperative ERCP developed biliary complications later on.ConclusionLaparoscopic rendezvous should be considered a preferable alternative to intraoperative ERCP for the treatment of patients with concomitant CBD stones and gallstones.

Is urgent surgical management necessary for priapism in pediatric patients with hematologic conditions?

Acute priapism is usually considered a medical emergency that warrants prompt urologic evaluation and treatment. Efforts have been made to determine the optimal management strategy for pediatric priapism. The aim of this study is to assess differences in conservative, minimally-invasive, and operative management of acute priapism in the pediatric population. A retrospective study of pediatric patients with acute priapism from 2015 to 2021at a single tertiary care children's hospital was conducted. Conservative, minimally-invasive, and operative approaches for the priapism episodes during these hospital encounters were analyzed. Thirty-nine patients were identified with a total of 61 cases of acute pediatric priapism were evaluated in the study period. Eight-three percent of patients were African-Americans, and 72% of patients had a history of sickle cell disease. Oxygen therapy (P=0.001) and hydration with intravenous fluids (P=0.00318) were more commonly utilized for hematologic-associated cases compared to other etiologies. For priapism episodes of hematologic etiology, 18 (40.0%) and 18 (40.0%) patients received phenylephrine injection and aspiration/irrigation (e.g., minimally-invasive therapy), respectively, while for the other causes of priapism, three (18.8%) and four (25.0%) received phenylephrine injection and aspiration/irrigation (e.g., minimally-invasive), respectively. Conservative and minimally-invasive treatment resulted in complete resolution of priapism in 27 (60%) and 16 (35.5%) patients with hematologic-associated priapism while 12 (75%) and 1 (6.3%) patients with other etiologies had resolution of priapism with conservative and minimally-invasive treatment, respectively. One patient received shunting in the hematologic group while two patients received shunting in the non-hematologic group (P=0.1031). Hematologic disorders are the most common causes of priapism in children and adolescents. An overwhelming majority of priapism events in the pediatric population can be managed with conservative therapies including oxygenation and intravenous hydration as well as minimally-invasive procedures such as corporal aspiration, irrigation and/or injections. The utilization of corporal shunting, anesthesia, and hospital resources is infrequently necessary for pediatric priapism episodes. While urgent surgical management is often performed in the adult population, a minimally-invasive management strategy can be implemented in the pediatric population where an extended period of conservative management that avoids operative management and general anesthesia is effective.

Minimal invasive management of proximal small bowel bleeding: A case report and reviewing the evidences

Objective: Gastrointestinal bleeding is one of the surgical emergencies that is routinely visited in emergency departments. Although most of these patients are managed with endoscopic modalities, some of them are managed with surgical interventions. Most of emergency surgical interventions are done via laparotomy. With evolution in minimal invasive surgery, the role of laparoscopic surgeries in emergency settings is on a rise. Case Presentation: In this report we describe a case of lower gastrointestinal bleeding that was presented with melena and during workups no bleeding lesion was detected in colon, stomach or duodenum. Further investigations revealed bleeding of proximal jejunum mass that was resected with the laparoscopic approach which is rarely used in the emergency management of patients with gastrointestinal bleedings. Also, resection and anastomosis of proximal jejunal loop was challenging in this case. Conclusion: This report is intended to describe the feasibility of laparoscopy in proximal small bowel lesion resection in emergency settings as well as the role of computed tomography (CT) angiography in detecting the source of obscure gastrointestinal bleeding.

Efficacy of Minimal Invasive Methods in Management of Traumatic Pancreatic Injury

Introduction Isolated pancreatic injury is relatively uncommon due to its mostly retroperitoneal location. However, if present, it is associated with other visceral injuries and causes serious complications if expected management is delayed. Cases In this report we have discussed about the different minimal invasive management approaches in two cases of pancreatic injury. The first case had American Association for the Surgery of Trauma Organ Injury Scale (AAST-OIS) grade IV pancreatic injury with late presentation who underwent ultrasound-guided percutaneous drainage of pseudocyst with video assisted lavage of cavity, followed by endoscopic retrograde cholangiopancreatography (ERCP) guided pancreatic duct stenting. Second case had AAST-OIS grade II pancreatic injury which was managed with serial percutaneous drainage. Conclusion Management of pancreatic injury is complex. Evolving trend of minimal invasive techniques of management for selected patients with higher grade pancreatic injury is associated with better outcomes.

Non-intubated Thoracic Surgery: Wedge Resections for Peripheral Pulmonary Nodules.

The feasibility of performing pulmonary resections of peripheral lung nodules has been one of the main objectives of non-intubated thoracic surgery. The aim was to obtain histological characterization and extend a radical intended treatment to oncological patients unfit for general anesthesia or anatomic pulmonary resections. There is mounting evidence for the role of wedge resection in early-stage lung cancer treatment, especially for frail patients unfit for general anesthesia and anatomic resections with nodules, demonstrating a non-aggressive biological behavior. General anesthesia with single lung ventilation has been associated with a higher risk of ventilator-induced barotrauma and volotrauma as well as atelectasis in both the dependent and non-dependent lungs. Nonetheless, general anesthesia has been shown to impair the host immune system, eventually favoring both tumoral relapses and post-operative complications. Thus, non-intubated wedge resection seems to definitely balance tolerability with oncological radicality in highly selected patients. Nonetheless, differently from other non-surgical techniques, non-intubated wedge resection allows for histological characterization and possible oncological targeted treatment. For these reasons, non-intubated wedge resection is a fundamental skill in the core training of a thoracic surgeon. Main indications, surgical tips, and post-operative management strategies are hereafter presented. Non-intubated wedge resection is one of the new frontiers in minimal invasive management of patients with lung cancer and may become a standard in the armamentarium of a thoracic surgeon. Appropriate patient selection and VATS expertise are crucial to obtaining good results.

Comparative Study between the Use of Pigtail Catheters and Traditional Chest Tube Drain in Cases with Pneumothorax

Background Pneumothorax is a condition in which air or other gas is present in the pleural cavity. Mainstay of management of pneumothorax is to remove the air from the pleural space usually done by chest tube insertion. There is still uncertainty whether minimal invasive management with pigtail catheter is sufficient for the management of pneumothorax.&#x0D; Objective To find the effectiveness, safety, tolerability, efficacy of pigtail catheters and large bore chest tubes.&#x0D; Method Prospective comparative study was done in Dhulikhel Hospital between August 2019 till August 2021. Chest tube insertion used to be the only available treatment modality till December 2020 (15 months). Following January 2021 after obtaining ethical clearance for use of pigtail insertion for pneumothorax, this treatment modality was done (8 months).&#x0D; Result Among 76 patients, 52(68.4%) underwent a large bore chest tube and 24 (34.6%) pigtail catheter patients. Mean age of the patients was 48 years (SD 18.01). Duration of hospital stay and length of hospital stay was more in large bore catheters and less in pigtail catheters. Eight hours post tube placement of the expansion of the lungs was present in pigtail and was statistically significant. Pain killer used in pigtail catheters was limited to Non-steroidal anti-inflammatory drugs, for large bore catheter opioids were added and were statistically significant.&#x0D; Conclusion Pigtail catheter is nearly effective as compared to traditional wide bore catheters.

Minimal invasive management of complete renoureteral duplication with upper pole megaureter in children

Renal malformations represent a large part of the pathology referred to the pediatric surgeon. Most of them are diagnosed during pregnancy. We present one case of complete ureteral duplex with upper pole obstructive megaureter managed in a private hospital using minimally invasive methods for both diagnosis and treatment due to good teamwork. We do not want to demonstrate that other investigations are not leading to the same diagnose, we want to highlight an alternative to the classic approach. We hope that our experience is a starting point for further research and that in future radiation and general anesthesia in children will be avoided as much as possible for renal investigations.

HIGH POWER TRANSURETHRAL THULIUM:YAG LASER VAPOENUCLEATION OF PROSTATE – A NEW STANDARD IN BENIGN PROSTATE HYPERPLASIA SURGERY

According to current reccomandations, open adenomectomy is considered the most efficient surgical option for patients with large benign prostatic hyperplasia. In order to reduce surgical trauma and to improuve postoperative recovery, there have been proposed several minimally invasive techniques for the treatment of large benign prostatic hyperplasia, the most innovative being laser surgery. High power Thulium:YAG laser vapoenucleation of prostate is becoming popular for minimal invasive surgical management of benign prostate hyperplasia.

Clinical Profile Management of Liver Abscess with Percutaneous Pigtail Cathater

Background: Management of liver abscess has advanced in this era with many patients wanting its nonsurgical treatment. Percutaneous drainage with Ultrasound guidance is one such minimal invasive procedurefor management of abscess with its own limitation and advantages. We have undertaken this study at ourinstitute to study clinical profile and management of liver abscess.Methodology: All the patient enrolled after taking detailed history and Ultrasound was done. After givingconsent an ultrasound guided pigtail catheter was insertion was done under local anesthesia. Post procedureall the parameters were observed and antibiotics was given and depending upon drainage of pus patientswere followed.Results: Total 30 patient of liquefied and partially liquefied liver abscess were enrolled in this study. Underlocal anesthesia ultrasound guided pigtail catheters of various sizes (14 F) were introduced in these patientsusing the Seldinger technique. There were 25 male and 5 female patients in this study.Most commonaffected age group was 31-40. Abdominal pain with fever was common presenting features. All the patientsrecovered in this study.Conclusion: Ultrasound guided percutaneouspigtail catheter drainage ofliver abscesses is cost effective andminimal invasive procedure for liquefied and partially liquefied abscesses.

Neonatal minimal invasive management of a prenatal gunshot trauma: case report

BackgroundPrenatal penetrating gunshot trauma represents a challenging scenario for healthcare providers. Trauma is the leading non-obstetric cause of morbidity and mortality during pregnancy, and even though rare, firearm injuries have the most fatal outcomes and higher fetus mortality rates. Understanding the mechanism of injury in order to identify the possible injuries and adequate management is essential. In this paper, we discuss the case of a newborn with prenatal gunshot trauma, the treatment used, and the outcome of conservative and minimally invasive management.Case presentationWe present the case of a male newborn, 37 weeks of gestational age and weighing 3050 g, delivered through an emergency cesarean section with prenatal gunshot trauma. Two skin wounds were found, one in the arm and another in the left thoracic region. The patient presented with respiratory distress, bilateral pneumothorax, and pneumoperitoneum, requiring high-frequency mechanical ventilation and the placement of bilateral thoracic drains. The pneumoperitoneum was attributed to pulmonary barotrauma, with no suspicion of abdominal hollow viscera lesion. A right thoracoscopy was performed after 24 h of conservative management for the removal of the foreign body. Both the mother and the baby had a positive outcome, with no further treatment needed.ConclusionsFor the improvement in the result of trauma events, an adequate intervention and coordinated efforts from multidisciplinary clinical and surgical teams are required. For gunshot wounds, entry, trajectory, the final position of the bullet, and pathological findings in images need to be analyzed before taking the patient to the operative room. Chosen with strict selection criteria, some patients could benefit from conservative management.

Uterine Artery Embolization for Primary Postpartum Hemorrhage

Postpartum hemorrhage (PPH) is a common source of morbidity and mortality for delivering mothers worldwide, resulting in greater than 100,000 deaths per annum. Pathologic postpartum hemorrhage is defined as blood loss greater than 500 mL for vaginal deliveries and 1,000 mL for caesarean births, which occurs in up to 10% of deliveries. Severe postpartum hemorrhage can progress to shock, disseminated intravascular coagulation (DIC) and death. PPH is further characterized by time of onset; primary PPH occurs within 24 hours of parturition, and secondary PPH beyond that. Secondary hemorrhage is discussed in a separate article in this issue, this article will exclusively explore primary postpartum hemorrhage. PPH arises from a number of etiologies, including uterine atony, birth canal/perineal lacerations and intrapelvic arterial injuries. PPH is primarily managed by standard medical obstetric maneuvers including uterotonics, fundal massage, intrauterine (Bakri) balloon tamponade and direct control of hemorrhage where applicable. Definitive control with hysterectomy is preserved for hemorrhage refractory to conservative and minimally-invasive management. First described in 1979, angiography and trans-catheter embolization represent valuable tools in the control of postpartum hemorrhage of most etiologies. Embolization is an acceptable, effective alternative to hysterectomy, particularly in patients who desire future fertility. It has high clinical success rates and a body of literature supporting preserved post-embolization fertility.

Comparison of Mini Percutaneous Nephrolithotomy (Mini PCNL) and Retrograde Intrarenal Surgery (RIRS) for the Minimal Invasive Management of Lower Caliceal Stones.

To evaluate the stone-free rates, quality of life, complications, use of fluoroscopy, analgesic requirements, a hospital stay following the management of lower calyceal with two different techniques (Mini Percutaneous Nephrolithotomy and Retrograde Intrarenal Surgery) in a prospective manner. 50 patients with a diagnosis lower pole 1-2 cm stone were included into the study and were randomized into two groups.(Mini PCNL n: 25) ( RIRS n: 25). Safety and efficacy of both methods along with some other certain related factors were comparatively evaluated in both groups. There was no significant difference between preoperative stone size, stone to skin distance, hemogram and creatinine values, need for analgesic drug, patients' replies to visual analog scale (VAS). The duration of both the hospital stay and the exposure to fluoroscopy, hematocrit decrease due to hemorrhage, complication rates were significantly higher in cases undergoing mini PCNL when compared to RIRS. Additionally, any significant difference was not observed with respect to the stone-free rates. Despite an increase in quality of life following the both type operations was noted; there was no significant difference in the quality of life between the patients in both groups. Our findings demonstrated that both surgical techniques are the feasible alternatives in the minimal invasive treatment of lower pole stones. Although there was no meaningful difference in stone-free rates between two groups; complications, use of fluoroscopy, bleeding and duration of hospital stay were noted to be significantly higher in cases treated with mini PCNL.

A minimal invasive management of retention mucocele of lower lip by Kshara karma - A case report.

Oral mucocele of the lips is a common ailment in patients who are habituated to lip biting or by trauma to lip mucosa. Lower lip is said to be the more prone site in oral cavity. The treatment of choice is excision or marsupialization under local anaesthesia. But these interventions come with complications like injury to adjacent salivary ducts, which further develops new lesions. Thus, this case study was undertaken to evaluate the effectiveness of Kshara karma in oral mucocele as a minimal invasive procedure. A 42 years old health seeker with no significant medical history, reported with the chief complaints of a painless swelling, over the inner aspect of lower lip for 8 months. The lesion was diagnosed as a retention mucocele of the lower lip based on the history and clinical findings. It was treated with Kshara karma under topical anaesthesia. Patient was observed post operatively for 7 days. The lesion had regressed in size gradually without any post-operative discomfort or complication. A follow up after 6 months shows no recurrence, no visible scar/ fibrosis at the site of lesion. As the chances of recurrence in oral mucocele is high, the management with conventional surgical techniques is challenging. Kshara karma being a minimal invasive procedure is seen to have better outcome. Further prospective studies are needed to evaluate the reproducibility, pros and cons of this procedure.

Uretero-duodenal Fistula as a Result from Ureteropelvic Junction Obstruction Correction: Case Report

Uretero-duodenal fistula is an uncommon complication in urology. The cause of fistula have been reported as ureteral calculi, iatrogenic injury, trauma and malignancy. The gold standard treatment of uretero-duodenal fistula remains controversial. The most common management is nephrectomy and primary closure of fistula. We report a case of 67 yearold man with uretero-duodenal fistula after laparoscopic correction of ureteropelvic junction obstruction. In the era of minimal invasive management, we decided to use endoscopic and conservative treatment. The definitive treatment will be reconsidered if conservative treatment fails. We will discuss the steps of management and follow-up for this patient.