Minimal Invasive Approach Research Articles

Donor site morbidity after computer assisted surgical reconstruction of the mandible using deep circumflex iliac artery grafts: a cross sectional study

BackgroundComputer Assisted Design and Computer Assisted Manufacturing (CAD/CAM) have revolutionized oncologic surgery of the head and neck. A multitude of benefits of this technique has been described, but there are only few reports of donor site comorbidity following CAD/CAM surgery.MethodsThis study investigated comorbidity of the hip following deep circumflex iliac artery (DCIA) graft raising using CAD/CAM techniques. A cross-sectional examination was performed to determine range of motion, muscle strength and nerve disturbances. Furthermore, correlations between graft volume and skin incision length with postoperative donor site morbidity were assessed using Spearman's rank correlation, linear regression and analysis of variance (ANOVA).ResultsFifteen patients with a mean graft volume of 21.2 ± 5.7 cm3 and a mean incision length of 228.0 ± 30.0 mm were included. Patients reported of noticeable physical limitations in daily life activities (12.3 ± 11.9 weeks) and athletic activities (38.4 ± 40.0 weeks in mean) following surgery. Graft volume significantly correlated with the duration of the use of walking aids (R = 0.57; p = 0.033) and impairment in daily life activities (R = 0.65; p = 0.012). The length of the scar of the donor-site showed a statistically significant association with postoperative iliohypogastric nerve deficits (F = 4.4, p = 0.037). Patients with anaesthaesia of a peripheral cutaneous nerve had a larger mean scar length (280 ± 30.0 mm) than subjects with hypaesthesia (245 ± 10.1 mm) or no complaints (216 ± 27.7 mm).ConclusionsDespite sophisticated planning options in modern CAD/CAM surgery, comorbidity of the donor site following iliac graft harvesting is still a problem. This study is the first to investigate comorbidity after DCIA graft raising in a patient group treated exclusively with CAD/CAM techniques. The results indicate that a minimal invasive approach in terms of small graft volumes and small skin incisions could help to reduce postoperative symptomatology.Trial registration Retrospectively registered at the German Clinical Trials Register (DRKS-ID: DRKS00029066); registration date: 23/05/2022

Case report: 'Photodynamics of Subependymal Giant Cell Astrocytoma with 5-Aminolevulinic acid'.

Subependymal Giant Cell Astrocytoma (SEGA) is a common diagnosis in patients with Tuberous Sclerosis. Although surgical treatment is often required, resection may entail a significant risk for cognitive function given the anatomical relation with critical structures such as the fornices and subgenual area. Therefore, target subtotal resections using minimal invasive approaches focused in the higher metabolic areas are valuable options to preserve quality of life while addressing specific problems caused by the tumor, such as hydrocephalus or progressive growth of a specific component of the tumor. In this report, the authors explore the potential role of 5-ALA in the identification of highly metabolic areas during SEGA resection in the context of minimal invasive approaches.

Neighborhood Socioeconomic Status Independently Predicts Outcomes After Mitral Valve Surgery

BackgroundSocioeconomic status has increasingly recognized influence on outcomes after cardiac surgery. However, singular metrics fail to fully capture the socioeconomic context within which patients live, which vary greatly between neighborhoods. We sought to explore the impact of neighborhood-level socioeconomic status on patients undergoing mitral valve surgery in the United States. MethodsAdults undergoing first-time, isolated mitral valve surgery were queried from The Society of Thoracic Surgeons Adult Cardiac Surgery Database between 2012 and 2018. Socioeconomic status was quantified using the Area Deprivation Index, a weighted composite including average housing prices, household incomes, education, and employment levels. The associations between regional deprivation, access to mitral surgery, valve repair rates, and outcomes were evaluated using logistic regression. ResultsAmong 137,100 patients included, patients with socioeconomic deprivation had fewer elective presentations, more comorbidity burden, and more urgent/emergent surgery. Patients from less disadvantaged areas received operations from higher volume surgeons and had higher repair rates (highest vs lowest quintile: 72% vs 51%, P < .001, more minimally-invasive approach (33% vs 20%, P < .001), lower composite complication rate (42% vs 50%, P < .001), and lower 30-day mortality (1.8% vs 3.9%, P < .001). After hierarchical multivariable adjustment, the Area Deprivation Index significantly predicted 30-day mortality and repair rate (P < .001). ConclusionsIn a risk-adjusted national analysis of mitral surgery, patients from more deprived areas were less likely to undergo mitral repair and more likely to have complications. Further work at targeting neighborhood-level disparity is important to improving mitral surgical outcomes in the United States.

Atmospheric Plasma Lingual Frenectomy Followed by Post Operative Tongue Exercises: A Case Series.

The lingual frenulum is a submucosal component significantly involved in the mobility of the tongue. In the case of short lingual frenulum, different surgical approaches have been proposed. Atmospheric plasma is a thermal technique of vaporization or sublimation of the superficial tissues, without going deep, and the resulting fine carbonized layer avoids bleeding. The aim of the present investigation was to evaluate the effectiveness of atmospheric plasma (voltaic arc dermabrasion) for the frenectomy of a short lingual frenulum. A total of 30 patients with an age range between 6-11 years old and a class III/IV Kotlow's ankyloglossia classification were included in the study. The Kotlow's free-tongue, maximal interincisal mouth opening (MIO, mm) and interincisal mouth opening with tongue tip to maxillary incisive papillae at roof of mouth (MOTTIP, mm) were calculated at the baseline, immediately postoperatively (T0), at one week (T1), one month (T2) and two months (T3). A significant increase of Kotlow's measurements, MOTTIP and MIO were detected when comparing the baseline and the T0 (p &lt; 0.05). No significant difference was detected between the T0, T1 and T2 (p &gt; 0.05). The atmospheric plasma demonstrated a very minimal invasive approach for frenectomy, without important or fibrotic complications and with very low recurrence rates.

Middle column Stent-screw Assisted Internal Fixation (SAIF): a modified minimally-invasive approach to rescue vertebral middle column re-fractures

BackgroundThere is limited literature regarding the re-fracture of a previously augmented vertebral compression fracture (VCF). These re-fractures may present as an asymptomatic remodeling of the vertebral body around the cement...

Laparoscopic and robotic approaches for treatment of choledochal cysts in adults

Background: While well-described for hepatic and pancreatic resection, the minimally invasive (MIS) approach in the treatment of choledochal cysts (CC) has been under-reported. Due to the technical complexity and steeper learning curve of minimally invasive biliary reconstruction, the MIS approach has not been as widely adopted in biliary surgery. We herein review the use of laparoscopic and robotic-assisted surgery in the treatment of CC. Methods: A comprehensive review of the literature was performed on the use of laparoscopic and robotic-assisted surgery in the treatment of CC. Results: Similar morbidity and mortality rates were noted among patients undergoing laparoscopic choledochal cyst resection (LCCR) compared with previous data from patients in the literature who had undergone an open approach (OCCR, open choledochal cyst resection); however, LCCR was associated with longer operative times and high conversion rates, largely attributable to the learning curve given the technically challenging nature of the procedure. The robotic platform (RCCR, robotic choledochal cyst resection) has been shown to offer an advantage in the hepaticojejunostomy anastomosis portion of CC resection vs. laparoscopy while providing comparable short-term outcomes compared with the LCCR approach. Conclusion: A minimally invasive approach to CC likely has improved perioperative outcomes with shorter LOS, return to baseline function, as well as improved cosmesis vs. OCCR. Longer operative times with minimally invasive approaches to CC have been attributed to steep learning curves, which have improved over time as surgeons become more facile with this technique. Both LCCR and RCCR have demonstrated similar rates of long-term postoperative complications and overall survival when compared to OCCR.

Early bile duct injury repair. all in one minimal invasive approach

Background: 50 years old male patient. No relevant clinical history

Use of needle cover as a trocar for removal of an infected implant: a novel minimal invasive approach

Use of needle cover as a trocar for removal of an infected implant: a novel minimal invasive approach

Guided Endodontic Access Cavity of Maxillary Obliterated Pulp Canal Lateral Incisor

Background: Managing severe calcified teeth in endodontics seems to be challenging for clinical, so static and dynamic guided endodontics ware developed to reduce the professional stress, increasing the patient\&amp;apos;s comfort, gives shorter clinical or procedural sessions with minimal invasive approach, and predictable canal location to avoid iatrogenic mishaps to be happened. Case Presentation: Preoperative investigations were conducted, tooth #12 had calcified chamber. Cone beam computed tomography (CBCT) was taken (Sirona GALILEOS Comfort CBCT scanner) showed that the coronal third of root canal is obliterated. For Guide planning, maxillary alginate impression was taken and scanned by digital scanner (smart optics - Vinyl High Resolution). Digital planning was done by 3Shape Implant Studio Software using sleeve size 3.5 mm (external diameter). Guided was printed by Digital Light Processing (DLP) 3d printing machine (NextDent 5100 3D printer). Enamel drilling by diamond round bur, guide was adapted to mouth and drill through until reach to 10 mm, periapical radiograph was taken to confirm the drilling depth. Conclusion: Guided treatment modality is not only used for anterior teeth or initial endodontic treatment, for posterior teeth and re-treatment endodontic cases as well. Finally, guided endodontic should be considered as mandatory treatment modality for pulp canal obliteration.

TRENDS IN SURGICAL MANAGEMENT OF RENAL NEOPLASMS: SINGLE CENTER RESULTS IN THE LAST DECADE.

The majority of renal neoplasms can be treated surgically using open or minimally-invasive approach. Nephron-sparing surgery should be used when possible, regardless to the operative approach. In this retrospective study, we analyzed surgical trends of operative treatment of renal neoplasms in the period from February 2011 until December 2020. There were a total of 1031 procedures, 703 (68.2%) radical nephrectomies (RN) and 328 (31.8%) partial nephrectomies (PN). Laparoscopic approach was used in 211 (20.5%) (111 PN and 100 RN), while open approach was used in 820 (79.5%) (328 PN and 703 RN) cases. There were 12 procedures performed with the use of cardiopulmonary bypass and hypothermic arrest. The median operative time was 161 minutes for open RN and 158 for open PN, 160 for laparoscopic RN, and 162 for laparoscopic PN. The most common pathology was clear cell carcinoma in 693 (67.3%), papillary carcinoma in 115 (11.2%), chromophobe carcinoma in 67 (6.5%), oncocytoma in 46 (4.5%), and angiomyolipoma in 33 (3.2%) patients. Pathologically, pT1 stage was diagnosed in 56.9%, pT2 in 5.8%, pT3 in 22.4% and pT4 in 1.2% of patients. Regional lymphadenectomy was performed in 354 (34.3%) patients, among which lymph nodes were positive in 40 (11.3%) cases. Surgical margins were positive in 27 cases when PN was performed (8.2%). In conclusion, there was an ongoing raising trend in the number of procedures in general, and also in minimally invasive and nephron-sparing surgery in our study.

Minimal Invasive Treatment Approaches in Pediatric Dentistry

Minimal Invasive Treatment Approaches in Pediatric Dentistry

Successful Management of Large Dentigerous Cyst with Spontaneous Eruption of Affected Teeth by Minimal Invasive Surgical Approach: A Case Report

Successful Management of Large Dentigerous Cyst with Spontaneous Eruption of Affected Teeth by Minimal Invasive Surgical Approach: A Case Report

Intraperitoneal onlay mesh laparoscopic repair of an incarcerated Spigelian hernia - case report and literature review

Introduction. Spigelian hernia is a type of lateral ventral hernia, localized between the rectus abdominis muscle and the semilunar line. Current literary data indicate that the prevalence of Spigelian hernia is 1?2% of all hernias of the abdominal wall. Patients are most commonly asymptomatic. Case outline. We present a 63-year-old male patient admitted to our hospital as an emergency case due to lower abdominal pain. Upon hospital admission, radiological diagnostics, and a physical examination, the presence of a Spigelian hernia was verified, which, at the moment of the examination, was incarcerated. It was established that surgical treatment was indicated. We performed laparoscopic intraperitoneal onlay mesh plastic in the standard way. The patient was discharged from hospital on the following day with normal values of vital and laboratory parameters. Conclusion. The Spigelian hernia, although first described many years ago, remains a diagnostic challenge, which is why its occurrence requires a multidisciplinary approach for the purpose of establishing a timely and accurate diagnosis. Within the surgical treatment of this state, there are several surgical techniques, and special focus is placed on the minimally invasive surgical approach. Also, within the minimally invasive surgical approach, there are several operating techniques.

Antegrade Versus Retrograde Cerebral Perfusion in Aortic Surgery: Systematic Review and Meta-Analysis of 19365 Patients

Background Since the risk of neurological injury and mortality can be mitigated with the appropriate choice of established brain protection strategies, we performed a meta-analysis of studies reporting cerebral perfusion strategy outcomes. Our focus was on surgeries that can be performed through a minimally-invasive approach, to support the decision-making process of adopting surgeons. Methods We searched the Excerpta Medica dataBASE (EMBASE), Medical literature analysis and retrieval system online (MEDLINE), and Cochrane databases, as well as ClinicalTrials.gov, Google Scholar, and the reference lists of relevant articles for studies reporting early mortality and/or stroke outcomes of both retrograde cerebral perfusion (RCP) and antegrade cerebral perfusion (ACP) strategies. The principal summary measures were odds ratio (OR) with 95% confidence interval (CI) and p values (statistically significant when &lt;0.05). The pooled ORs were combined across studies that met the eligibility criteria. Results We identified and included seventeen eligible studies with a total of 19,365 patients undergoing ascending aorta and arch surgery from 2008-2019 by means of ACP (a total of 10,473 patients) or RCP (a total of 8,892 patients). Random effect model analyses found no increase in mortality (OR=1.03, 95%CI:0.80-1.32) or stroke (OR=1.04, 95%CI:0.81-1.32) associated RCP when compared to ACP (p&gt;0.05). Conclusion In ascending aorta and arch surgery, requiring cerebral protection, ACP and RCP have similar rates of early mortality and stroke. While optimal application of cerebral protection strategies is both patient and surgeon specific, surgeons can comfortably adopt RCP in minimally invasive cases after accounting for factors that determine the outcomes of aortic surgery adequately.

Addressing local bone loss in the proximal femurs of women at high risk of fracture

Proximal femoral fractures in older women are a worldwide leading cause of morbidity and mortality and a public health problem. Although pharmacological therapies can improve bone mineral density (BMD) and reduce fracture risk, current efforts are focused on researching a procedure that guarantees both immediate and long-lasting effectiveness over time. The AGN1 local osteo-enhancement procedure is a recently developed bone augmentation procedure. This minimally-invasive surgical approach is used to prepare an enhancement site, the area where new bone is desired within a local bony region weakened by osteoporotic bone loss, and fill it with a triphasic, resorbable, calcium-based implant material. This procedure results in a notable, statistically significant and sustained long-term increase in proximal femur BMD and femoral strength, improving femoral neck resistance to compression and distraction forces acting on it and thereby preventing fall-related fractures.

Risk Assessment Model for Complications in Minimally Invasive Hysterectomy: A Pilot Study.

To estimate the rate of intra-operative and postoperative complications, and to define the risk of 30-day major postoperative complications (Clavien-Dindo &gt; 2) according to the presence of one of 10 different variables of minimally invasive (MI) hysterectomy; and then to create a risk assessment model easily applicable in clinical practice. A single center single arm retrolective study. Data of consecutive patients who have undergone MI hysterectomy for gynaecologic disorders between May 2018 and April 2021 were analyzed. Perioperative surgical outcomes, occurrence of intra- and postoperative complications, and readmissions within 30 days from surgery were registered. Univariate and multivariable analyses were performed to determine the factors associated with major postoperative complications. Over the study period, 445 patients were included in the study. The majority of patients developed a minor event, while major complications (grade III) were required in 14 patients. None of the patients showed a grade IV or V complication. Univariate analysis was performed on patients who had developed intra- or postoperative complications from those who did not experience complications. Body mass index (BMI) (p-value 0.045) and surgeon's experience (p-value 0.015) were found to be associated with a different surgery time. Regarding major postoperative complications, a statistically significant association was found for the variables: BMI (p-value 0.006), previous abdominal surgery (p-value 0.015), and surgeon's experience (p-value 0.035) in the univariate analysis. Also in the multivariate analysis, the risk of major postoperative complications was higher in these three different variables. BMI, previous surgery, and surgeon's experience were inserted in a reproducible risk assessment model in order to stratify the risk of major postoperative complications. We proposed a risk assessment model including factors not previously considered in the literature: the standardization of the surgical technique, the surgeon's experience, the best MI approach (laparoscopy or robot-assisted), and previous abdominal surgery are crucial tools to consider. Further prospective studies with a larger population sample are needed to validate these preliminary evaluations for patients undergoing MI hysterectomy.

The impact of robotic-assisted transperineal biopsy of the prostate on erectile function.

Prostate biopsy represents one of the most frequently performed urologic procedures worldwide and therefore presupposes knowledge on potential effects like on the erectile function, especially in extensive or repeated biopsies. The robotic-assisted biopsy system (Mona Lisa) offers a minimal invasive approach via only two incision points ensuring maximal accuracy combined with protection of the neurovascular bundle of the prostate. Our purpose was to analyse the impact of robotic-assisted transperineal biopsy of the prostate on the erectile function. Our prospective study analyses the outcomes of 210 patients, who had undergone minimal-invasive, transperineal robotic-assisted biopsy of the prostate at the University Hospital Basel from January 2020 to March 2022 and provided sufficient data. Of these, 157 (74.8%) were included in final analysis. Mean (range) age, prostate volume, PSA and IIEF-5 score at baseline were 63.8 years (46.1-83.6), 46.4 ml (9-310), 13.2 ng/ml (0.2-561), and 18.8 points (6-25), respectively. EF before and 1 month after intervention was assessed with the IIEF-5 questionnaire for the whole cohort. No significant change of IIEF-5 was observed for the whole cohort with a mean (± SD) decrease of 0.4 (± 3.1) points. Except for patients > 69 years, subgroup analysis revealed no change of IIEF-5 in statistically significant manner for all subgroups. Number of biopsy cores (< 20 and ≥ 20), previous biopsies and active surveillance showed no significant influence. Our results suggest that the minimally invasive and highly precise robotic technique can spare the erectile function without limiting the extent of biopsy and without compromising diagnostic accuracy.

Safety profile of robotic-assisted transperineal MRI-US-fusion guided biopsy of the prostate.

Robotic-assisted transperineal MRI-US-fusion guided biopsy of the prostate is a novel and highly accurate procedure. The aim of this study was to evaluate the MonaLisa prostate biopsy system in terms of safety, tolerability, and patient-related outcomes. This prospective study included 228 patients, who had undergone Robotic-assisted transperineal MRI-US-fusion guided biopsy of the prostate at the University Hospital Basel between January 2020 and June 2022. Peri-operative side effects, functional outcomes and patient satisfaction were assessed. Mean pain score on the day of biopsy was 1.3 points on VAS, which remained constant on the day after biopsy. Overall, 32 of 228 patients (14%) developed grade I complications according to Clavien-Dindo classification. No higher-grade complications occurred. Gross haematuria, hematospermia and acute urinary retention occurred in 145/228 (63.6%), 98/228 (43%) and 32/228 (14%) patients, respectively. One patient (0.4%) developed urinary tract infection. Robotic-assisted transperineal MRI-US-fusion guided biopsy of the prostate performed under general anesthesia is a safe and well tolerated procedure. This technique allows to omit perioperative prophylaxis and at the same time minimizes the risk of infectious complications. We attribute the favorable risk profile and tolerability to the minimal invasive approach via two entry points.

Short Term Outcomes of Open and Minimally Invasive Approaches to Segmental Colectomy for Benign Colovesical Fistula.

We speculated that a minimally invasive (MIS) colectomy for colovesical fistula is associated with less morbidity compared to an open colectomy. Multivariate analysis using logistic regression was used to investigate the outcomes of patients who underwent colectomy for benign colovesical fistula during 2012-2017 by surgical approach using the NSQIP database. We identified 748 patients underwent partial colectomy for benign colovesical fistula during 2012-2017. Surgeons used the MIS approach in 72.7% of operations, with a conversion rate of 13.1%. The MIS approach was associated with lower morbidity (27.4% vs. 43.1%, AOR: 0.46, P=0.02) compared to the open approach. The mean operation duration was longer in MIS operations compared to open (225 min vs. 201 min, P < 0.01). The robotic approach to colectomy showed no significant difference in morbidity (28.4% vs. 27.2%, P=0.77) but a decrease in conversion rate (8.1% vs. 13.8%, P < 0.01) and an increase in operation length (249 min vs. 222 min, mean difference: 27 min, P < 0.01) compared to a laparoscopic approach. There was no significant difference in the anastomotic leak rate between MIS and open approaches (3.7% vs. 5.4%, P=0.14) and between laparoscopic and robotic approaches (2.8% vs. 3.8%, P=0.99). We found a 72.7% utilization rate of MIS approach to colectomy for benign colovesical fistula in the NSQIP hospitals with a 13.6% conversion rate. Patients with MIS approach had significantly lower morbidity compared to open. A robotic approach to partial colectomy has the same morbidity risk with a decreased conversion rate compared to laparoscopic approach.

Single-Cell Multi-Omics of Peripheral Blood Reveals Tiding and Evolution of Responsive and Resistant Clones upon Daratumumab-Based Treatments in Multiple Myeloma and Plasma Cell Leukemia

Background: Treatment with anti-CD38 antibodies is a standard of care in newly diagnosed and relapsed/refractory multiple myeloma (MM). Clonal tiding and evolution as well as genomic heterogeneity are major drivers towards drug-resistant disease. However, modes of resistance to anti-CD38 directed therapies are currently unknown and might include loss of antigen expression and/or exhaustion of the immune system. We performed longitudinal single-cell multi-omic analyses of circulating tumor cells (CTC) and non-malignant cells to decipher clonal heterogeneity and tiding upon response and resistance to daratumumab (Dara)-based therapies in MM and plasma cell leukemia (PCL). Methods: Peripheral blood mononuclear cells (MNCs) were isolated from 7 patients (PCL n=5, MM n=2) before and after exposure to Dara. Samples were collected at four different time points: 1. before administration of Dara (CD38-naïve). 2. Four days after first application of Dara (CD38-exposed). 3. After relapse from Dara (CD38-refractory). 4. After an additional line of non-CD38 targeted therapy following relapse from Dara. In total, we analyzed 17 PB samples. To demonstrate that results from PB are comparable to bone marrow (BM), four paired PB and BM samples were included (21 samples in total). MNCs were subjected to single cell RNA (scRNAseq), B-cell (scBCRseq), and T-cell receptor sequencing (scTCRseq). Surface protein expression was measured using a custom panel of 57 DNA-barcoded antibodies. Sequencing files were processed with CellRanger (10x Genomics) and data were analyzed with the Seurat toolkit for single cell sequencing. Cell types were annotated with SingleR based on the Human Primary Cell Atlas built-in references. ScRepertoire was used for longitudinal scTCRseq and scBCRseq data. Copy number variations (CNVs) in CTCs were detected with inferCNV, and cellular interactions were investigated with CellPhoneDB. Results: In total, we sequenced 130.038 MNCs (PB: 108.236, range 414-8700/patient; BM: 21802, range 3375-8516/patient, Figure 1A). Malignant plasma cells were identified using scBCRseq and restricted light chain expression from scRNAseq. Even in MM patients without morphological evidence for CTC, we could identify and characterize single malignant plasma cells in PB. By inferring genome-wide CNVs from scRNAseq, we were able to characterize intra-patient genomic heterogeneity. Longitudinal tracking of CTC revealed tiding of clones characterized by distinct CNV profiles and transcriptomes upon Dara-exposure and resistance. Early transcriptional changes in CTCs upon Dara-exposure included inflammatory signaling (e.g. upregulation of IFI6, IFI35, IFIT1, IFITM1). Analysis of CD38 protein surface expression using DNA-barcoded antibodies showed significantly decreased levels after Dara exposure. To rule out that this might have resulted from competitive binding of the diagnostic antibody and Dara, we repeated analyses after discontinuing Dara and after application of a further line of therapy. In contrast to CD38 RNA expression, surface protein expression decreased significantly upon exposure and relapse, but recovered after an additional line of therapy. Expression of other druggable antigens (BCMA, SLAMF7, GPRCD5, FcRL5, Figure 1B) was not affected by treatment with Dara. Next, we investigated co-evolution of non-malignant cells. Longitudinal scTCRseq showed concomitant expansion and stagnation of TCRs. Receptor-ligand interaction analyses demonstrated that exposure to Dara resulted in significant differences in CD38-PECAM1-mediated interactions between CTCs with non-malignant B-cells and CD8+ T-cells. We detected recurrently increased immunosuppressive receptor-ligand interactions between malignant plasma cells and CD4+, CD8+, and regulatory T-cells via CD86-CTLA4 and NECTIN3-TIGIT axis upon Dara exposure. Conclusion: We demonstrate that single-cell multi-omic analyses of PB provide a minimal invasive approach to study genomic heterogeneity and evolution of malignant plasma cells and non-malignant cells of the immune system. Longitudinal analyses reveal different patterns of response and resistance to targeted myeloma therapies and might affect future therapeutic decision-making. Figure 1View largeDownload PPTFigure 1View largeDownload PPT Close modal