Minimal Invasive Approach Research Articles

Diffusion of Minimally Invasive Approach for Lung Cancer Surgery in France: A Nationwide, Population-Based Retrospective Cohort Study

Background. The minimally invasive approach (MIA) has gained popularity thanks to its efficacy and safety. Our work consisted of evaluating the diffusion of the MIA in hospitals and the variability of this approach (within and between regions). Methods. All patients who underwent limited resection or lobectomy for lung cancer in France were included from the national hospital administrative database (2013–2020). We described between-hospital differences in the MIA rate over four periods (2013–2014, 2015–2016, 2017–2018, and 2019–2020). The potential influence of the hospital volume, hospital type, and period on the adjusted MIA rate was estimated by a multilevel linear regression. Results. From 2013 to 2020, 77,965 patients underwent a lobectomy or limited resection for lung cancer. The rate of the MIA increased significantly over the four periods (50% in 2019–2020). Variability decreased over time in 7/12 regions. The variables included in the multilevel model were significantly related to the adjusted rate of the MIA. Variability between regions was considerable since 18% of the variance was due to systematic differences between regions. Conclusions. We confirm that the MIA is part of the surgical techniques used on a daily basis for the treatment of lung cancer. However, this technology is mostly used by surgeons in high volume institutions.

Laparoscopic versus open-surgery in FIGO stage II endometrioid endometrium cancers: Is there a prognostic effect?

5605 Background: Based on two randomized trials (LACE and LAP2) minimal invasive surgery has turned into the surgical standard in early stage endometrial cancer including “high-risk” patients. However, these recommendations are predominately based on “low-risk” cancers, which are mainly represented in both trial collectives. We herein provide a retrospective study, which focuses on potential differences in clinical outcome in early stage endometrioid endometrial cancers with distinct risk constellations treated by laparoscopy or open surgery. Methods: 420 early stage endometrial cancers were retrospectively dichotomized according to the surgical approach and correlated to the recurrence rate and clinical outcome. In addition, subgroup analyses were performed according relevant clinical risk parameters, namely FIGO stage, grading and LVSI. Results: The analyzed collective consisted of 73.8% stage IA, 19.5% stage IB, and 6.7% stage II cases. Twenty-tree percent of patients exhibit G3 tumors and LVSI was detected in 12.4%. Minimal invasive surgery was performed in 54.5% of study patients. During a median follow-up of 5.0 years, recurrence or death were observed in 8.3% and 6.7%, respectively. Recurrences were predominately located in the vaginal cuff (n = 21; 60.0%), to a minor extent in loco-regional lymph nodes (n = 11; 31.4%), and in three patients (8.6%) in both sides. No distant metastases were detected at first recurrence. Also under consideration of the mentioned clinicopathologic parameters, the surgical approach in FIGO stage I did not influence the recurrence rate and patients’ survival. However, in a subgroup analysis of stage II disease, the laparoscopic approach was clearly associated with a significant higher recurrence rate (85.7% vs. 14.3%; p = 0.013). All of the recurrences were located in the vaginal cuff, and in one case, additional relapse was found in loco-regional lymph nodes. Moreover, laparoscopic surgery in stage II disease was associated with impaired progression-free and overall survival (HR 8.86 (1.008 – 20.85) and HR 6.36 (1.102 – 28.61), respectively). Conclusions: We herein demonstrate that a minimal invasive surgical approach in stage II endometrial cancer is associated with higher recurrence rates and impaired clinical outcome. These data could be interpreted to be in line with the results of the LACC trial in cervical cancer. Although, grounded on a retrospective analysis, these hypothesis-generating results warrants a confirmatory trial, which is ongoing in a much larger collective of stage II endometrial cancer patients.

Are new and young generations of surgeons more aware of transoral robotic surgery than older ones? An international survey.

The objective of this study is to investigate adoption, perception, and awareness of otolaryngologist-head neck surgeons (OTO-HNS) toward transoral robotic surgery (TORS) according to the surgeon experience. A total of 1,383 OTO-HNS of YO-IFOS and IFOS received an online survey dedicated to the adoption, perception, and awareness toward TORS. The following outcomes were compared between residents and fellows, young/middle-aged and older OTO-HNS: awareness/perception; indications; advantages; barriers and expected improvements of TORS practice. From the 357 responders (26%), 147 participants were residents and fellows; while 105 and 105 OTO-HNS reported 10 to 19, and more than 20years of practice. The main barriers of using TORS included the cost and the availability of robot, and the lack of training opportunity. The better view of the operative field and the shorter patient hospital stay were considered as the main advantages. Older surgeons trust more likely in TORS benefits (p = 0.001) and surgical field view advantages (p = 0.037) compared to younger participants. TORS is an important surgical minimal invasive approach for the future for 46% of residents and fellows versus 61% of older OTO-HNS (p = 0.001). Compared to older OTO-HNS, residents and fellows reported more frequently that the lack of training opportunity is the main barrier of TORS (52% versus 12%; p = 0.001). Residents and fellows did not share the same expectations of robot improvement for the future than older OTO-HNS. Experienced OTO-HNS had better perception and trust toward TORS than residents and fellows. Residents and fellows identified the lack of training opportunity as the main barrier to the use of TORS. TORS access and training programs need to be improved in academic hospitals for residents and fellows.

Long-term outcomes after minimal right lateral thoracotomy for the resection of cardiac tumors

ObjectivesCardiac tumors are a rare and heterogeneous entity, with a cumulative incidence of up to 0.02%. This study aimed to investigate one of the largest patient cohorts for long-term outcomes after minimally-invasive cardiac surgery using right-anterior thoracotomy and femoral cardiopulmonary bypass (CPB) cannulation. MethodsBetween 2009 and 2021, patients who underwent minimally-invasive cardiac tumor removal at our department were included. The diagnosis was confirmed postoperatively by (immune-) histopathological analysis. Preoperative baseline characteristics, intraoperative data, and long-term survival were analyzed. ResultsBetween 2009 and 2021, 183 consecutive patients underwent surgery for a cardiac tumor at our department. Of these, n = 74 (40%) were operated on using a minimally-invasive approach. The majority, n = 73 (98.6%), had a benign cardiac tumor, and 1 (1.4%) had a malignant cardiac tumor. The mean age was 60 ± 14 years, and n = 45 (61%) of patients were female. The largest group of tumors was myxoma (n = 62; 84%). Tumors were predominantly located in the left atrium in 89% (n = 66). CPB-time was 97 ± 36min and aortic cross-clamp time 43 ± 24 min s. The mean hospital stay was 9.7 ± 4.5 days. The perioperative mortality was 0%, and all-cause mortality after ten years was 4.1%. ConclusionMinimally-invasive tumor excision is feasible and safe, predominantly in benign cardiac tumors, even in combination with concurrent procedures. Patients who require cardiac tumor removal should be evaluated for minimally-invasive cardiac surgery at a specialized center, as it is highly effective and associated with good long-term survival.

Comparison between two minimally invasive techniques for Hirschsprung disease: transanal endorectal pull-through (TERPT) versus laparoscopic-TERPT.

Surgical treatment for Hirschsprung disease (HD) has recently evolved into different minimally invasive techniques. The aim of the present study is to compare results from two different minimal invasive approaches, transanal endorectal pull-through (TERPT) and laparoscopic-assisted endorectal pull-through (LA-TERPT). Patients have been divided into two groups according to surgical technique. Data of HD patients treated by TERPT and those treated by LA-TERPT, respectively, performed at two different centers from January 2007 to December 2017, were retrospectively collected. Patients with aganglionosis confined to the recto-sigmoid colon with a minimum follow-up period of 4years have been included. Demographic, clinical, surgical and functional outcome data were reviewed for each group using Chi-square and Fisher tests (statistical differences were considered for p < 0.05). Among patients treated for HD in the two centers during the study period, 65 met the inclusion criteria (37 TERPT group and 28 LA-TERPT group). No differences regarding demographic and clinical data were observed between the two groups. Operative time was longer in the LA-TERPT group (p < 0.001). Time to start oral feeding was faster in the TERPT group while hospital stay was similar between the two groups. Three patients of the TERPT group required an additional abdominal approach. The rate of early complications was higher in the TERPT group. Long-term bowel function was assessed in 31 patients for the TERPT group and 24 patients for the LA-TERPT group. Outcomes showed that the bowel functional outcome was good (BFS ≥ 17) in 55% (n = 17) of TERPT group and 54% of LA-TERPT group (p = 0.97), moderate (BFS 12 to 16) in 16% (n = 5) and 33% (n = 8), respectively (p = 0.24), and poor in 29% (n = 9) and 13% (n = 3), respectively (p = 0.23). Both TERPT and LA-TERPT techniques should be considered safe and feasible for the treatment of HD patients. TERPT patients present faster time to return to normal bowel function while LA-TERPT patients have slightly lower incidence of postoperative complications. Long-term functional outcomes are similar between the two groups. III.

V-002 Robotic suprapubic eTEP retrorectus repair for incisional hernia

Abstract Aim A retrorectus mesh position is often considered the most suitable for the repair of a midline incisional hernia. The minimal invasive extraperitoneal approach is gaining popularity. Material &amp; Methods A 56-year-old female patient, who had a laparoscopic deroofing of a bile cyst in her history, presented with an incisional midline hernia (EHS M2-M3, width 6.6 cm). Preoperative optimization via dietary instructions reduced her BMI from 40 kg/m2 to a BMI of 35 kg/m2. Results A robotic extraperitoneal approach via suprapubic docking was performed. The patient is positioned supine and flexed for 15° at the level of the spina iliaca. An intraperitoneal trocar is placed to explore the abdomen for adhesions. Three trocars are placed in the suprapubic position in the extraperitoneal plane whereafter the robot is docked. A dissection in the cranial direction is performed in the retrorectus plane by incising both posterior rectus fascia in a symmetric way. A preperitoneal plane behind the linea alba is created. At the level of the hernia defect the hernia sac is opened, and adhesions are freed. Once the retrorectus space is dissected up to the xyphoid, the linea alba is reconstructed with a barbed suture size 0. A self-fixating mesh is placed in the retrorectus position. The posterior layer of the peritoneum is closed. The postoperative course was uneventful. Conclusions We present an extraperitoneal minimal invasive approach to the retrorectus plane allowing for an adequate retrorectus dissection and mesh placement like in a classical Rives-Stoppa repair.

Occipital site deactivation for the treatment of chronic migraine: a minimally invasive approach.

In this paper, we describe our experience in treating migraine headache localized in the occipital area. Using our minimally-invasive approach, from June 2011 till January 2022, we have performed MH decompression surgery over 232 patients with occipital migraine trigger site. After a mean follow-up of 20 months (range, 3-62 months), patients complaining for occipital MH had 94% positive surgical outcome (86% complete MH elimination). Only rare minor complications were reported (e.g., oedema, paresthesia, ecchymosis, and numbness). Presented, in part, at the XXIV Annual Meeting European Society of Surgery (Genoa, Italy, May 28-29, 2022), at the Celtic Meeting of the British Association of Plastic, Reconstructive and Aesthetic Surgeons (BAPRAS), (Dunblane, Scotland, September 8-9, 2022), at the Fourteenth Quadrennial European Society of Plastic, Reconstructive and Aesthetic Surgery Conference, (Porto, Portugal, October 5-7, 2022), at the 91st Annual Meeting of the American Society of Plastic Surgery, (Boston, USA, October 27-30, 2022), and at the 76 BAPRAS (British Association of Plastic, Reconstructive and Aesthetic Surgery) Scientific Meeting, (London, UK, November 30 - December 2, 2022).

Microinvasive mitral valve surgery: Current status and status quo.

Surgical mitral valve repair, performed either through median sternotomy or minimal invasive approach, presents the gold standard treatment for degenerative mitral valve disease. In dedicated centres, high repair and low complication rates have been established with excellent valve repair durability. Recently, new techniques have been introduced, that allow mitral valve repair to be performed through small surgical incisions and while avoiding cardio-pulmonary bypass. These new techniques, however, conceptually differ significantly when compared to surgical repair and it remains questionable whether they are capable of reproducing the results of surgical treatment.

And then there was one … incision. First single-port pediatric robotic case series

In the past two decades, technology has advanced to augment an already minimally-invasive approach in laparoscopic surgery. Robotic-assisted laparoscopic platforms have now evolved to its 4th-generation product: a single-port system, first cleared through the FDA for urologic procedures last year. A single, 2.5cm incision allows for placement of a port that admits a fully-wristed camera as well as three fully-wristed instruments, all controlled by the surgeon at the console. We sought to document the feasibility of the single-port (SP) robotic platform in the first clinical series of pediatric patients, reporting use of this system for dismembered pyeloplasty and Mitrofanoff. Secondary aims were to report intraoperative details and perioperative outcomes. Seven patients underwent surgery using the da Vinci SP Surgical System (Intuitive Surgical, Sunnyvale, CA). Six patients, two girls and 4 boys, were diagnosed with ureteropelvic junction obstruction and underwent SP robotic-assisted dismembered pyeloplasty while one male patient with neurogenic bladder underwent SP robotic-assisted Mitrofanoff procedure. Patient's ages ranged from 22 months to 14 years. A 2.5-cm incision was made within the Pfannenstiel line in HIdES fashion for the pyeloplasties, while the previous gastrostomy tube site was used for the Mitrofanoff. Through this incision a 25-mm multichannel port was placed. The 12×10-mm articulating robotic camera and two 6-mm articulating robotic instruments were utilized. All surgeries were completed successfully through the single port without intraoperative complications, need for separate ports, or conversion. Median operative time was 120min, and all patients were dismissed in less than 24h, taking only acetaminophen and ibuprofen for pain control. There was no issue with instrumentation in older patients; however, shorter working distance in the 22-month-old pyeloplasty limited wristing of the instruments. We report the first cases utilizing the SP robotic platform in children. Despite their smaller size and limited workspace, we had no issues with instrument clashing or triangulation in older patients, completing the procedures in a similar timeframe as multiport robotic platforms. Use of the SP platform is not recommended if working distance will be<10cm from the end of the port as instrument movement is prohibitive. The HIdES approach of placing the port in the Pfannenstiel line gave additional working distance and kept the incision below the swimsuit line for excellent cosmesis (Figure1). Further study with additional cases will compare this approach with standard multiport robotics to analyze and compare operative data and outcomes.

Abstract 2316: Automating ctDNA liquid biopsy workflow for mutation testing: From sample extraction to dPCR analysis utilizing the Maxprep™ Liquid Handler, Maxwell® extraction system, and high-plex detection assays

Abstract Liquid biopsies are a minimally-invasive sampling approach to overcome the heterogeneity of tumors and represent a valuable source of circulating tumor DNA (ctDNA) for oncological biomarker analysis. The use of ctDNA as a surrogate for tissue DNA is increasingly popular, and advances in the detection and characterization of ctDNA has enabled liquid biopsy assay integration into clinical utilization. However, an innate challenge with measurement of ctDNA is the requirement for highly sensitive quantitation to reliably detect rare genetic aberrations. Digital PCR has emerged as a powerful technology addressing the needs for next-generation analysis of liquid biopsies samples. Having reliable assays for analysis of key oncology targets help drive adoption of this technology into real-world applications. The exquisite sensitivity of digital PCR requires sample preparation methods that reduce variation, making automation of any manual steps highly desirable. Automation also provides flexibility to scale up as testing volumes increase while simultaneously decreasing overall complexity for the operator. Here we present an automated workflow for ctDNA extraction and analysis using the Maxprep™ Liquid Handler, Maxwell® extraction system (Promega Corporation), and a new, high-throughput digital PCR consumable, the Ruby Chip (Stilla Technologies). This ultra-sensitive detection for liquid biopsy samples was performed using a high-plex dPCR assay. Citation Format: Michael Granitsiotis, Kimberly Gutierrez, Doug Horejsh, Monica Yue. Automating ctDNA liquid biopsy workflow for mutation testing: From sample extraction to dPCR analysis utilizing the Maxprep™ Liquid Handler, Maxwell® extraction system, and high-plex detection assays [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2023; Part 1 (Regular and Invited Abstracts); 2023 Apr 14-19; Orlando, FL. Philadelphia (PA): AACR; Cancer Res 2023;83(7_Suppl):Abstract nr 2316.

666 Comparison of Minimally Invasive and Open Surgical Approaches for Intradural-Extramedullary Spine Tumors: A Systematic Review and Meta-Analysis

INTRODUCTION: Traditionally spinal intradural-extramedullary (ID-EM) tumors have been accessed via open surgery. Removal of these tumors involves significant tissue damage, prolonged recovery, and risk of infection. More recent minimally invasive surgery (MIS) techniques aim to reduce these risks and complications while achieving similar goals of surgery as traditional approaches. METHODS: A systematic literature search was employed (PROSPERO#CRD42022302574) with searches through PubMed (MEDLINE), EBSCO, and Wiley Cochrane Library databases from conception till 9th January 2022. Cohort and case series studies with comparisons of minimally-invasive and open surgery for ID-EM spinal tumors were included; pooled sampled data were included in the random-effects (Mantel-Haenszel method) model for meta-analysis. RESULTS: Our search strategy yielded 403 total articles across these databases – after systematic review and exclusion, 13 studies were included for qualitative and quantitative analysis. On meta-analysis, minimally-invasive approaches were non-inferior to open surgery for achieving gross total resection (RR = 1.01, 95% CI 0.94 – 1.09, p = 0.78, I2 = 0%). Intraoperative blood loss (MD = -119.18, 95% CI -157.83 - -80.52, p &lt; 0.0001, I2 = 89%), operative time (MD = -25.94, 95% CI -50.28 – -1.60, p = 0.04, I2 = 91%), and length of stay (MD=-2.50, 95% CI -3.89 – -1.10, p = 0.0004, I2 = 95%) were significantly lower within cohorts undergoing MIS surgery for ID-EM spinal tumor. CONCLUSIONS: Data within the reviewed studies suggest similar rates of gross total resection within MIS and open surgery cohorts for ID-EM spinal tumors. Moreover, MIS affords shorter hospital stays, decreased blood loss, and operative time for patients. For certain patient groups, MIS spinal tumor resection can be preferred over standard surgical approaches, with preservation of function and decreasing overall surgical complications.

V01-11 ROBOT-ASSISTED BILATERAL URETERAL RE-IMPLANTATION AFTER CYSTECTOMY AND ORTHOTOPIC NEOBLADDER FOR DISTAL URETERAL FIBROSIS

You have accessJournal of UrologyCME1 Apr 2023V01-11 ROBOT-ASSISTED BILATERAL URETERAL RE-IMPLANTATION AFTER CYSTECTOMY AND ORTHOTOPIC NEOBLADDER FOR DISTAL URETERAL FIBROSIS Gabriel Frölicher, Christoph Schregel, Yasmin Trachsel, Tutal Mustafa, and Hubert John Gabriel FrölicherGabriel Frölicher More articles by this author , Christoph SchregelChristoph Schregel More articles by this author , Yasmin TrachselYasmin Trachsel More articles by this author , Tutal MustafaTutal Mustafa More articles by this author , and Hubert JohnHubert John More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003221.11AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: This video presents the surgical technique of robot-assisted ureteral re-implantation for distal ureteral fibrosis after open cystectomy and reconstruction with Studer orthotopic neobladder. A 59-year-old patient underwent open radical cystectomy and orthotopic urinary diversion for muscle-invasive bladder cancer. Postoperatively, left hydronephrosis and pyelonephritis occurred. Antegrade attempts to place an ureteral stent were unsuccessful. A nephrostomy drain was placed in the left side. The patient was then referred for laparoscopic robotic reconstruction. METHODS: The ports were placed in analogy to robot-assisted cystectomy. First an extended adhesiolysis was necessary. The intestinal loops were dissected guided by concomitant cystoscopy which revealed the borders between intestine and bladder wall. Finally, right ureter was identified in the proximity of the afferent loop of the Studer neobladder. After preparing and freeing, the right ureter was intubated with a Ch.8 mono-J catheter. The search for the left ureter continued. The left ureter was localised using Methylene blue applied antegrade by the nephrostomy tube. Several attempts to intubate the left ureter Ch.8 mono-J were frustrane due to the considerable long stricture. Further dissection into the retroperitoneal space was necessary. The ureter seemed totally fibrotic over several centimetres. Finally antegrade left ureteral catheterization and retrograde insertion of a Ch.8 mono-J catheter was successful. Accidental lesions of the afferent loop were closed with a 4-0 PDS suture. The ureters were re-implanted end-to-side with 4-0 Stratafix® running sutures. RESULTS: The patient was discharged on the 7th postoperative day after testing the uretero-neobladder anastomosis through a pouchography and a retrograde ureteropyelography and after removal of both mono-J stents. No perioperative complications were observed. Furthermore, the left renal function showed an increasing function 1 year postoperatively in the renal scintigraphy. CONCLUSIONS: This demanding robotic reconstructive ureteral re-implantation so far shows the feasibility and the clinical value of robotic minimal invasive approaches even in complex reconstructive surgeries after open urinary diversion. Source of Funding: none © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e83 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Gabriel Frölicher More articles by this author Christoph Schregel More articles by this author Yasmin Trachsel More articles by this author Tutal Mustafa More articles by this author Hubert John More articles by this author Expand All Advertisement PDF downloadLoading ...

A Minimally Invasive Approach for Cardiac Electrophysiology Studies in Mice

Review A Minimally Invasive Approach for Cardiac Electrophysiology Studies in Mice Min Zi , * , Sabu Abraham , Alicia D'souza , David Hutchings , Sukhpal Prehar , Xin Wang , and Elizabeth J Cartwright Division of Cardiovascular Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester M13 9PL, United Kingdom * Correspondence: min.zi@manchester.ac.uk Received: 6 January 2023 Accepted: 9 February 2023 Published: 25 March 2023 Abstract: Atrial fibrillation and ventricular tachycardia are commonly seen in clinic. Different approaches have been developed to investigate underlying mechanisms. Transvenous approach (TA) is widely used for studies but has several drawbacks. We therefore developed a novel minimally invasive approach (MIA) for mechanistic studies. Study included 27 male C57BL/6J mice, 19 for MIA and 8 for TA. Under general anaesthesia, ECG was recorded. A key hole was made on the right first intercostal space by separating the intercostal muscles, followed by the exposure of the superior vena cava and the top of the atrium. An EPR-800 catheter was inserted vertically, perpendicular to the chest, for atrial pacing and flatly over the ventricles for ventricular pacing. Burst S1–S1 and decremental S1–S2 pacing protocols were performed to evaluate SA recovery time (SNRT), the atrioventricular node effective refractory period (AVN-ERP), Wenckebach period, ventricular ERP, and arrhythmia susceptibility. MIA was successfully performed in all 19 mice without any complications. One mouse died during TA due to venous rupture. Compared MIA with TA, surgical time were significantly shorter (P&lt;0.0001). Wenckebach period was shorter as well (P&lt;0.05). No difference was found in baseline sinus cycle length, SNRT, correct SNRT, AVN-ERP, ventricular ERP, and arrhythmia susceptibility (all P&gt;0.05). The novel MIA outplays TA by providing similar outcomes of PES but consuming less time, demanding less surgical expertise, and reducing the potential of surgical complications. Given the minimal tissue injury, it also provides great potential as a recovery procedure for longitudinal study.

Reoperation Rates Due to ASD following Primary 1-2 level MIS vs. Open TLIF.

Retrospective analysis of prospectively collected data. To investigate the effect of the approach of the TLIF (open vs. MIS) on reoperation rates due to ASD at 2 - 4 year follow up. Adjacent segment degeneration (ASDeg) is a complication of lumbar fusion surgery which may progress to adjacent segment disease (ASD) and cause debilitating postoperative pain potentially requiring additional operative management for relief. Minimally invasive (MIS) transforaminal lumbar interbody fusion surgery (TLIF) has been introduced to minimize this complication but the impact on ASD incidence is unclear. For a cohort of patients undergoing 1- or 2-level primary TLIF between 2013 and 2019, patient demographics and follow-up outcomes were collected and compared between patients who underwent open versus MIS TLIF using Mann Whitney U test, Fischer's exact test, and binary logistic regression. 238 patients met inclusion criteria. There was a significant difference in revision rates due to ASD between MIS and open TLIFs at 2 (5.8% vs. 15.4%, P=0.021) and 3 (8% vs. 23.2%, P=0.03) year follow up, with open TLIFs demonstrating significantly higher revision rates. Surgical approach was the only independent predictor of reoperation rates at both 2 and 3 year follow ups (2-year P=0.009; 3-year P=0.011). Open TLIF was found to have a significantly higher rate of reoperation due to ASD compared to the MIS approach. Additionally, surgical approach (MIS vs. Open) appears to be an independent predictor of reoperation rates.

Using Femtosecond Laser Light-Activated Materials: The Biomimetic Dentin Remineralization Was Monitored by Laser-Induced Breakdown Spectroscopy.

Introduction: The purpose of this study is to investigate and compare the effects of the antimicrobial agents Moringa oleifera and bioactive glass nanoparticles activated by femtosecond laser light on the biomimetic dentin remineralization using teeth having carious dentin ICDAS code 3. Methods and Materials: A total of 27 dentin surface samples were divided into three groups: the first group was treated with a Moringa oleifera extract, while the second group was treated with bioactive glass nanoparticles, and as for the control group, the third group received no additional agent. All groups were subjected to femtosecond laser light at three different wavelengths: 390 nm, 445 nm, and 780 nm. The photoactivation of each sample was achieved using the femtosecond laser light for 5 min with an average power rating of 300 mW, a pulse duration of 100 fs, and a pulse repetition rate of 80 Hz. The mineral content of the samples was obtained and analyzed using the laser-induced breakdown spectroscopy (LIBS). The LIBS analysis was conducted with the following laser light parameters: average power of ~215 mW, wavelength of 532 nm, pulse duration of 10 ns, and a pulse repetition rate of 10 Hz. Results: Most studied samples exhibited a relative increase in the mineral content that may enhance biomimetic remineralization. Moringa oleifera photoactivated by femtosecond laser light at 445 nm achieved a significant increase in mineral content. Conclusion: Using the femtosecond laser light to activate the relatively cheap and commercially available antimicrobial agent Moringa oleifera supports the strategy of minimal invasive approaches for the treatment and biomimetic remineralization of carious dentin ICDAS code 3.

Standardization of Strategies to Perform a Parafascicular Tubular Approach for the Resection of Brain Tumors in Eloquent Areas.

The aim of this work is to define a methodological strategy for the minimally invasive tubular retractor (MITR) parafascicular transulcal approach (PTA) for the management of brain tumors sited in eloquent areas. An observational prospective study was designed to evaluate the benefits of PTA associated with MITRs, tractography and intraoperative cortical stimulation. They study was conducted from June 2018 to June 2021. Information regarding white matter tracts was processed, preventing a potential damage during the approach and/or resection. All patients older than 18 years who had a single brain tumor lesion were included in the study. Patients with a preoperative Karnofsky Performance Scale (KPS) score greater than 70% and a Glasgow Coma Scale (GCS) score > 14 points were included. 72 patients were included in the study, the mean age was 49.6, the most affected gender was male, 12.5% presented aphasia, 11.1% presented paraphasia, 41.6% had motor deficit, 9.7% had an affection in the optic pathway, the most frequently affected region was the frontal lobe (26.3%), the most frequent lesions were high-grade gliomas (34.7%) and the measurement of the incisions was on average 5.58 cm. Of the patients, 94.4% underwent a total macroscopic resection and 90.2% did not present new postoperative neurological deficits. In all cases, a PTA was used. Tubular minimally invasive approaches (MIAs) allow one to perform maximal safe resection of brain tumors in eloquent areas, through small surgical corridors. Future comparative studies between traditional and minimally invasive techniques are required to further investigate the potential of these surgical nuances.

CHARACTERISTICS AND PREDICTORS OF PATIENTS WITH SEPSIS WHO ARE CANDIDATES FOR MINIMALLY INVASIVE APPROACH OUTSIDE OF INTENSIVE CARE UNIT.

Objective: To identify and describe characteristics of patients with sepsis who could be treated with minimally invasive sepsis (MIS) approach without intensive care unit (ICU) admission and to develop a prediction model to select candidates for MIS approach. Methods: A secondary analysis of the electronic database of patients with sepsis at Mayo Clinic, Rochester, MN. Candidates for the MIS approach were adults with septic shock and less than 48 hours of ICU stay, who did not require advanced respiratory support and were alive at hospital discharge. Comparison group consisted of septic shock patients with an ICU stay of more than 48 hours without advanced respiratory support at the time of ICU admission. Results: Of 1795 medical ICU admissions, 106 patients (6%) met MIS approach criteria. Predictive variables (age >65 years, oxygen flow >4 L/min, temperature <37°C, creatinine >1.6 mg/dL, lactate >3 mmol/L, white blood cells >15 × 10 9 /L, heart rate >100 beats/min, and respiration rate >25 breaths/min) selected through logistic regression were translated into an 8-point score. Model discrimination yielded the area under the receiver operating characteristic curve of 79% and was well fitted (Hosmer-Lemeshow P = 0.94) and calibrated. The MIS score cutoff of 3 resulted in a model odds ratio of 0.15 (95% confidence interval, 0.08-0.28) and a negative predictive value of 91% (95% confidence interval, 88.69-92.92). Conclusions: This study identifies a subset of low-risk septic shock patients who can potentially be managed outside the ICU. Once validated in an independent, prospective sample our prediction model can be used to identify candidates for MIS approach.

The Role of Prolonged Bed Rest in Postoperative Cerebrospinal Fluid Leakage After Surgery of Intradural Pathology-A Retrospective Cohort Study.

Postoperative cerebrospinal fluid leakage (CSFL) is a feared complication after surgery on intradural pathologies and may cause postoperative complications and subsequently higher treatment costs. To assess whether prolonged bed rest may lower the risk of CSFL. We performed a retrospective cohort study including patients with intradural pathologies who underwent surgery at our department between 2013 and 2021. Cohorts included patients who completed 3 days of postoperative bed rest and patients who were mobilized earlier. The primary end point was the occurrence of clinically proven CSFL. Four hundred and thirty-three patients were included (female [51.7%], male [48.3%]) with a mean age of 48 years (SD ±20). Bed rest was ordered in 315 cases (72.7%). In 7 cases (N = 7/433, 1.6%), we identified a postoperative CSFL. Four of them (N = 4/118) did not preserve bed rest, showing no significant difference to the bed rest cohort (N = 3/315; P = .091). In univariate analysis, laminectomy (N = 4/61; odds ratio [OR] 8.632, 95% CI 1.883-39.573), expansion duraplasty (N = 6/70; OR 33.938, 95% CI 4.019-286.615), and recurrent surgery (N = 5/66; OR 14.959, 95% CI 2.838-78.838) were significant risk factors for developing CSFL. In multivariate analysis, expansion duraplasty was confirmed as independent risk factor (OR 33.937, 95% CI 4.018-286.615, P = .001). In addition, patients with CSFL had significant higher risk for meningitis (N = 3/7; 42.8%, P = .001). Prolonged bed rest did not protect patients from developing CSFL after surgery on intradural pathologies. Avoiding laminectomy, large voids, and minimal invasive approaches may play a role in preventing CSFL. Furthermore, special caution is indicated if expansion duraplasty was done.

Racial and ethnic disparities in open versus minimally-invasive approach for sacrocolpopexy

Racial and ethnic disparities in open versus minimally-invasive approach for sacrocolpopexy

The results of salvage esophagectomy by minimal invasive approach after failed definitive chemoradiotherapy for carcinoma esophagus at a tertiary cancer care centre from India

The results of salvage esophagectomy by minimal invasive approach after failed definitive chemoradiotherapy for carcinoma esophagus at a tertiary cancer care centre from India