Minimally Invasive Surgical Techniques Research Articles

Coronal Suturectomy Through Minimal Incisions and Distraction Osteogenesis Are Enough Without Other Craniotomies for the Treatment of Plagiocephaly Due to Coronal Synostosis

In the last few years, many surgeons have tried to reduce the damage produced during surgical approaches by trying to apply the principles of minimal invasive surgical techniques in every type of surgery. Some endoscopic techniques, added to orthopedic mechanisms, allow us to reduce the size of the incisions needed for the craniosynostosis surgery. We present a conservative surgical option in the treatment of one frequent craniofacial malformation due to synostosis: plagiocephaly due to coronal synostosis. We have operated on 10 patients with unilateral coronal synostosis. In all cases, a unique craniotomy, just in the coronal suture, was made without other accessory craniotomies. Mobilization of the frontal bone was not done at time of surgery, but it was done slowly with a distractor device later. All the patients were younger than 14 months, and the minimum follow-up has been 1 year after the operative course, and in all the patients, the anthropometric results were satisfactory both for the families and the medical team.The treatment of coronal synostosis can be made with both a simple coronal suturectomy, using small incisions under endoscopic control, and the application of a unidirectional bone distraction system. An orthopedic helmet can help to gain better results for reshaping a patient's cranial vault, during the last part of the postoperative period.

Comparison of MIS vs. Non-MIS Total Knee Arthroplasty Using the Subvastus Approach

Minimally-invasive surgical (MIS) techniques are being used in total knee arthroplasty. MIS techniques incorporate shorter incisions, smaller instruments, and a quadriceps sparing approach. A number of studies have shown shorter hospital stays and increased range of motion compared to the medial parapatellar approach. However, concern has been raised about the introduction of a new technique that may compromise visualization and result in operative complications. The purpose of this study is to determine whether there is any benefit to the MIS technique over the standard technique if a quadriceps-sparing approach is used for both.

Minimally invasive surgical technique for egg collection from the Persian sturgeon, Acipenser persicus

A minimally invasive surgical technique (MIST) for the removal of ovulated eggs from Persian sturgeon Acipenser persicus was tested on broodstocks caught from the wild to determine whether it affected fecundity or hatching rates compared with the traditional stripping method of killing and removing the eggs (commonly used in hatchery). Morphological parameters of females, germinal vesicle (GV) position, weight of obtained egg, number of eggs/gram, fertilization rate, and percentage of hatching during incubation were not significantly different between the MIST and traditional stripping methods. Obtained ova were 4.8 ± 0.4 kg female−1 in the MIST and 4.6 ± 0.5 kg female−1 in traditional stripped groups, respectively; the fertilization rate was 83.4 ± 11.2% and 80.0 ± 7.2% in groups, respectively. The results of this study showed that the minimally invasive surgical technique approach is efficient, practical, and less stressful to Persian sturgeon broodstocks during artificial propagation than other reported egg collection procedures.

Minimal Surgery for Pilonidal Disease Using Trephines: Description of a New Technique and Long-Term Outcomes in 1,358 Patients

This study describes and reports the results of a new, minimally-invasive surgical technique for pilonidal disease. From March 1993 to January 2003, 1,358 patients (out of a total of 1,435 patients) with symptomatic pilonidal disease underwent treatment in a military surgical clinic dedicated for pilonidal disease. Patients were operated on under local anesthesia, utilizing trephines to excise pilonidal pits and to débride underlying cavities and tracts. One thousand three hundred fifty-eight symptomatic patients participated in the study and were mostly male (84.3 percent) and the mean age 20.9 +/- 3.6 years. Rates of postoperative infection, secondary bleeding, and early failure were 1.5, 0.2, and 4.4 percent, respectively. In patients with full postoperative clinical attendance, complete healing was observed within 3.4 +/- 1.9 weeks. Phone interview included 1,165 patients (85.8 percent) with a mean follow-up interval of 6.9 +/- 1.8 years. Recurrence rates after 1 year was 6.5 percent, 5 years was 13.2 percent, and 10 years was 16.2 percent. Mean time to recurrence was 2.7 +/- 2.6 years postoperatively. The disease-free probability estimate was 93.5 percent at one year and 86.5 percent at 5 years. Compared with frequently used pilonidal operations, the trephine technique is associated with a lower recurrence rate and a low postoperative morbidity rate.

New generation of abdominal surgery: the Natural Orifice Transluminal Endoscopic Surgery

Minimal invasive surgical techniques, namely laparoscopic procedures to the abdominal surgery have been introduced more than 20 years ago. In view of clinical results, the majority of these are considered as routinely performed procedure today. Natural Orifice Transluminal Endoscopic Surgery can be considered as a new generation of abdominal surgery. It means a method directed through natural orifices, and abdominal surgery operated by transluminal endoscopic techniques (transgastric, transcolonic, transvaginal) to reach diagnostic and therapeutic goals. Theoretically, this method allows the possibility to decrease invasiveness and postoperative pain, to prevent postoperative hernias and to improve cosmetic results. At present numerous researchers work worldwide to receive scientifically based answers to arising questions (surgical technique, indication, contraindication, complications, monitoring) and concerns in this area. The present paper gives an overview of the national and international literature on experimental results and clinical approaches in the field of this new surgical technique.

Enabling superior m-health project success: a tricountry validation

The healthcare industry is facing increasing pressures to embrace new technologies that support greater patient access to, and higher quality of (but at the same time offer cost-effective), healthcare delivery. This pressure has spawned a plethora of initiatives to embrace the possibilities and potentials of technologies to develop and then diffuse new devices, new pharmaceutical products and support minimal invasive surgical techniques that will facilitate superior healthcare delivery. Pursuing such initiatives from idea generation to commercialisation and adoption, however, also necessitates new alliances between academe and industry to ensure rigorous research followed by rapid diffusion to support the realisation of these initiatives so that the patient becomes the ultimate beneficiary. This in turn requires new research methodologies for such applied research scenarios. The Accelerated Mapping-to-Realisation (AMR) methodology is used as an appropriate knowledge-based methodology to ensure academic rigour and validation and also facilitate rapid diffusion and commercialisation of m-health initiatives.

Minimally invasive surgical technique and enamel matrix derivative in intra‐bony defects. I: clinical outcomes and morbidity

This case cohort study was designed to evaluate the clinical performance and the intra-operative and post-operative morbidity of the minimally invasive surgical technique (MIST) associated with the application of an enamel matrix derivative (EMD) in the treatment of isolated deep intra-bony defects. Forty deep isolated intra-bony defects in 40 patients were surgically accessed with the MIST. This technique was designed to limit the mesio-distal flap extension and the corono-apical flap reflection in order to reduce the surgical trauma and increase flap stability. The incision of the defect-associated papilla was performed according to the principles of the papilla preservation techniques. EMD was applied on the debrided and dried root surfaces. Stable primary closure of the flaps was obtained with modified internal mattress sutures. Surgery was performed with the aid of an operating microscope and microsurgical instruments. Clinical outcomes were collected at baseline and at 1 year. Intra-operative and post-operative morbidity was evaluated with questionnaires. The 1-year clinical attachment gain was 4.9+/-1.7 mm (p<0.0001 compared with baseline). This corresponded to a 77.6+/-21.9% resolution of the defect. Residual probing pocket depths were 3+/-0.6 mm. A minimal increase of 0.4+/-0.7 mm in gingival recession between baseline and 1 year was recorded. No patients experienced intra-operative pain, while only 14 reported a very moderate perception of the hardship of the surgical procedure [7+/-12 visual-analogue scale (VAS) units, on average]. Primary closure was obtained in all treated sites. At the 1-week follow-up visit, 38 sites (95%) were still closed. Only 12 subjects reported moderate post-operative pain (VAS 19+/-10) that lasted for 26+/-17 h. These data indicate that the minimally invasive surgical technique, in combination with EMD, can be successfully applied in the treatment of isolated deep intra-bony defects, resulting in excellent clinical outcomes with very limited intra- and post-operative morbidity.

Mini-Subvastus Approach for Total Knee Arthroplasty

The mini-subvastus surgical technique avoids both quadriceps arthrotomy and patella eversion. Since March 2003, this quad-sparing minimally invasive surgical (MIS) technique has been applied to more than 98% of our primary total knee arthroplasty (TKA) patients. This study compares our first 150 MIS TKA patients to our previous 150 traditional TKA patients. Quadriceps recovery was rapid in the MIS group with 83% able to do a straight leg raise the day after surgery. Hospital length of stay was decreased in the MIS group, 3.4 days, vs the traditional group, 4.1 days (P = .00013). Fewer MIS patients required skilled nursing or rehabilitation center admission. Increased knee flexion was seen for the MIS patients throughout the first 2 years of follow-up. Mean knee flexion at 1 year was 127° for the MIS patients vs 114° in the traditional TKA patients (P < .0001). Comparison between the MIS and traditional techniques demonstrated no increase in the number or severity of complications and no difference in operating room time.

Incidence of minimally invasive colorectal cancer (CRC) surgery in patients treated at NCCN institutions

6575 Background: In May 2004 the Clinical Outcomes of Surgical Therapy Study Group published the results of the North American randomized trial demonstrating that oncologic outcome is similar for laparoscopic assisted and open surgery for CRC. This and other studies have shown quicker recovery with laparoscopic CRC surgery including earlier resolution of postoperative ileus, less discomfort, and earlier discharge from the hospital. The extent to which surgeons have adopted the minimally invasive surgical (MIS) approach in CRC is unknown. Methods: Using the NCCN Colon/Rectal Cancer Outcomes Project Database, 715 patients were identified who underwent CRC resection in 2005–6. The distribution of lesions included right colon (39%), left colon (31%), and rectum (30%). The incidence of MIS for CRC and clinicopathologic features associated with this approach were analyzed by logistic regression; results are reported as odd ratio (OR) with 95% confidence intervals (CI), and significance defined at p&lt;0.05 level. Results: A total of 167 (23%) patients underwent MIS colorectal surgery (laparoscopy in 98% and robotic in 2%). Conversion to open surgery was noted in 33 cases (20%). Surgery was performed in outside institutions in 21% of cases prior to patients presenting to NCCN institutions for further treatment. The MIS approach was more common in colon than rectal cancer (30% vs.12%, OR 2.96, CI 1.94–4.51, p&lt;0.0001). Within the colon cancer cohort, right sided lesions were more likely to be approached with MIS techniques rather than left sided lesions (32% vs. 25%; OR 1.42, CI 1.96–2.21, p&lt;0.0001). Stage I tumors were also more likely to be managed with the less invasive approach: Stage I-41%; II-20%; III-21%; IV-19% (Stage I vs. IV, OR=3.00, CI 1.74–5.16 p&lt;0.0001). No differences in surgical approach were noted based on age, gender, race, Charlson comorbidity score, insurance type, or location of surgery (NCCN vs outside facility). Conclusion: The majority of CRC surgery for patients presenting to NCCN institutions is performed by open techniques. Right sided and early stage CRCs were more likely treated with MIS, possibly related to the less demanding nature of the procedure. The adoption of MIS is expected to rise as surgeons become trained in MIS techniques for CRC. No significant financial relationships to disclose.

Fostering knowledge assets in healthcare with the KMI model

Facing relentless pressure to provide cost effective high quality healthcare, greater emphasis is being placed on minimal invasive surgical and diagnostic techniques. Such techniques necessitate the confluence of advances in technology with highly skilled expertise of multidisciplinary teams of healthcare providers. At the micro level these interventions appear to be successful in the short term, however it is likely that their full potential is not being realised. This is because of the lack of systematic knowledge capture throughout various stages of the process. This paper discusses the benefits of adopting knowledge management infrastructure model as a way of making explicit critical knowledge assets. Case data from a spine unit is provided to illustrate the power of such an approach.

Total hip arthroplasty in Jesenice General hospital 1985–2006 – what has been done and look forward

Background: Total arthroplasty is one of the most interesting and fast developing fields in orthopaedic surgery. Practically every joint in the human body is involved, total hip arthroplasties (THA) being most frequent and with the longest history. Information on long-term results and survival of different types of prosthesis is invaluable for both patients and surgeons. Patients and methods: Between 1985 and 2006 there were 1563 THAs performed in Jesenice General Hospital. Average age at the time of operation was 67 years, almost two thirds of patients were women. The reason for operation was in 72 % idiopathic arthrosis and in 14 % sequaele of dysplasia. Results: There were 1370 primary procedures and 193 revisions (12.6 %). Aseptic loosening of the implant was the most frequent reason for revision (74 %) and infection was observed in 1.5 %. In the first ten years of this research hybrid type of prosthesis was most frequently used, but nowadays, non-cemented prosthesis is used in majority of cases. Conclusions: Total hip arthroplasty is well established procedure at the Jesenice General Hospital. It considerably improves quality of life of the patient, for both, short- and long term, results are very good. New minimal invasive surgical techniques make postoperative rehabilitation faster and easier. The Register of prosthesis enables us to regularly analyze the results and provides treatment outcome information concerning the choice of prosthesis and the optimal surgical technique. Jesenice General Hospital is well recognized as one of the centers for arthroplasties in our country.

“Polarsystem” dual mobility hip prosthesis and “minimally invasive surgery” (MIS)

The authors describe the surgical technique for minimal invasive surgery using a dual mobility total hip prosthesis by posterior external approach and cutaneous incision of 5 to 10 cm length. Six hundred total hip prosthesis were implanted between 2002 and 2005, 450 due to osteoarthrisis and 150 to neck fractures. The results show a duration of hospital stay reduced to 5 to 8 days, a reduction of blood loss with a transfusion in 15 to 35% of the cases, and a dislocation rate of 0.7%, with one dislocation for osteoarthrisis (0.22%) and three for fractures (2%). We report two revision surgeries due to femoral fractures at the beginning of our experience, and two deep infections. The compatibility between the minimal invasive surgical technique and the dual mobility which is known to rarely induce dislocation, have been discussed.

O.409 Endoscopic-assisted intra-oral osteosynthesis of condyle fractures of mandible

To assess a combined external lithotripsy-sialoendoscopy method developed for advanced salivary gland sialolithiasis.A total of 94 patients (43 males and 51 females) underwent these treatment methods. Of these 94 patients, 60 had pathologic features in the submandibular gland and 34 in the parotid gland. A miniature external lithotripter was used, combined with multifunctional sialoendoscopes and endoscopic-assisted techniques, to achieve effective removal/elimination of the stones in these difficult cases.Total elimination of the stone using lithotripsy alone was achieved in 32% of the cases; in 29%, intraductal endoscopic assistance was needed. In the remaining 39%, the removal of a stone was achieved with the help of an endoscopy-assisted extraductal approach (37 cases). At 6 months of follow-up, all patients who had undergone lithotripsy or lithotripsy plus intraductal endoscopy had an absence of symptoms. Of the 37 patients who had undergone an endoscopy-assisted extraductal approach, 35 (95%) remained asymptomatic.Lithotripsy plus intraductal or extraductal endoscopic treatment of sialolithiasis is a highly effective surgical method of eliminating/removing salivary stones, especially those attached to the surrounding tissue and in the secondary ducts. This method helps to avoid resection of the salivary glands and represents an additional development of minimal invasive surgical techniques.

Convalescence after colonic surgery with fast‐track vs conventional care

To compare convalescence after colonic surgery with a fast-track rehabilitation programme vs conventional care. Introduction of a multimodal rehabilitation programme (fast-track) with focus on epidural anaesthesia, minimal invasive surgical techniques, optimal pain control, and early nutrition and mobilization together with detailed patient information have led to a shorter hospital stay after colonic surgery. There are not much data on convalescence after discharge. A prospective, controlled, non-randomized interview-based assessment in 160 patients undergoing an elective, uncomplicated, open colonic resection or the Hartmann reversal procedure with a fast-track or a conventional care programme in two university hospitals. A structured interview-based assessment was performed preoperatively, and day 14 and 30 postoperatively. Patients undergoing colonic surgery with a fast-track programme regained functional capabilities earlier with less fatigue and need for sleep compared with patients having conventional care. Despite early discharge of the fast-track patients (mean 3.4 days vs 7.5 days), no differences were found according to the need for home care, social care and visit to general practitioners, although the fast-track group had an increased number of visits at the outpatient clinic for wound care. More patients in the fast-track group were re-admitted, but the overall mean total hospital stay was 4.2 days vs 8.3 days in the conventional group. A fast-track rehabillitation programme led to a shorter hospital stay, less fatigue and earlier resumption of normal activities, without the increased need for support after discharge compared with conventionally treated patients after uncomplicated colonic resection.

Use of Minimally Invasive Surgical Techniques in the Management of Thoracolumbar Trauma

Literature review and expert opinion. To provide an overview of the current concepts of minimally invasive surgical (MIS) techniques for the management of thoracolumbar (TL) spinal trauma. Current surgical treatment of thoracolumbar trauma typically involves open placement of spinal instrumentation with fusion. Conventional open spinal exposures can be associated with significant muscle morbidity that can lead to subsequent paraspinal muscular atrophy, scarring, decreased extensor strength and endurance, as well as pain. This approach-related morbidity is the main impetus for application MIS techniques to spinal procedures including trauma. A review of the relevant English literature was performed. The current rationale, clinical applications, outcomes, and limitation of MIS management of TL injuries are summarized. The application of MIS techniques to spinal trauma is theoretically sound. However, the indications and technology are currently in evolution. Although very limited information is available, the results of current MIS techniques for the management of TL trauma are encouraging.

Video-assisted thoracoscopic lung biopsy in children

Minimal invasive surgical techniques have gained high acceptance in thoracic surgery during the last 10 years. Video-assisted thoracoscopy (VATS) is less invasive than open thoracotomy and its development is associated with expansion of indication for lung biopsies. Lung biopsy remains an important investigation in the diagnosis of few of the lung disorders despite improved diagnostic yield of high resolution computed tomography scanning. Thoracoscopic lung biopsy is becoming the procedure of first choice for the diagnosis of many localized and diffuse lung diseases. We report a small series of eight patients who underwent VATS lung biopsy to demonstrate the safety and efficacy of this procedure.

Transanal endoscopic microsurgical repair of iatrogenic recto-urethral fistula

Recto-urethral fistula formation following radical prostatectomy is an uncommon but potentially devastating event. Traditional surgery for such fistulae is technically demanding, jeopardizes continence and usually necessitates a diverting colostomy. We present the case of an iatrogenic fistula treated by a transanal endoscopic microsurgical approach, without recourse to a stoma. A 71-year-old man had recently undergone a radical prostatectomy, complicated by significant intra-operative haemorrhage. He subsequently developed a recto-urethral fistula, confirmed clinically and endoscopically. Due to his bleeding diathesis, he was considered for, and underwent, a transanal endoscopic microsurgical (TEMS) repair. TEMS is a safe and reliable minimally-invasive surgical technique for the treatment of this difficult condition.

Arthroscopic treatment of synovial chondromatosis of the ankle

A 34-year-old male soccer player with chronic right ankle dysfunction and a history of repeated ankle joint injuries is presented. Imaging studies revealed synovial chondromatosis of the ankle joint. Arthroscopic partial synovectomy was performed and more than 20 loose bodies were excised. Four months postoperatively the patient was asymptomatic and has returned to his previous level of sport activities. At the latest follow-up, 2 years after the initial diagnosis there is no local recurrence of the disease. Arthroscopy is a minimal invasive surgical technique, with satisfactory results in the treatment of synovial chondromatosis of the ankle joint.

Trigger Activity More Than Three Years After Left Atrial Linear Ablation Without Pulmonary Vein Isolation in Patients With Atrial Fibrillation

The aim of this study was to analyze trigger activity in the long-term follow-up after left atrial (LA) linear ablation. Interventional strategies for curative treatment of atrial fibrillation (AF) are targeted at the triggers and/or the maintaining substrate. After substrate modification using nonisolating linear lesions, the activity of triggers is unknown. With the LA linear lesion concept, 129 patients were treated using intraoperative ablation with minimal invasive surgical techniques. Contiguous radiofrequency energy-induced lesion lines involving the mitral annulus and the orifices of the pulmonary veins without isolation were placed under direct vision. After a mean follow-up of 3.6 +/- 0.4 years, atrial ectopy, atrial runs, and reoccurrence of AF episodes were analyzed by digital 7-day electrocardiograms in 30 patients. Atrial ectopy was present in all patients. Atrial runs were present in 25 of 30 patients (83%), with a median number of 9 runs per patient/week (range 1 to 321) and a median duration of 1.2 s/run (range 0.7 to 25), without a significant difference in atrial ectopy and atrial runs between patients with former paroxysmal (n = 17) or persistent AF (n = 13). Overall, 87% of all patients were completely free from AF without antiarrhythmic drugs. A detailed rhythm analysis late after specific LA linear lesion ablation shows that trigger activity remains relatively frequent but short and does not induce AF episodes in most patients. The long-term success rate of this concept is high in patients with paroxysmal or persistent AF.

Isolated rectal diverticulum complicating with rectal prolapse and outlet obstruction: Case report

The occurrence of rectal diverticula is very rare, with only sporadic reports in the literature since 1911. Symptomatic rectal diverticula are encountered even less frequently. Treatments of these complicated events range from conservative treatments to major surgical interventions. We present a hitherto unreported occurrence of isolated rectal diverticulum complicated with rectal prolapse and outlet obstruction. Delorme's procedure resulted in subsidence of symptoms and resolution of the diverticulum. It provides a minimal invasive surgical technique to successfully address the reported malady.