Minimally Invasive Surgical Group Research Articles

Minimally Invasive vs Open First Ray Dorsiflexion Osteotomy: Radiographic Outcomes and Early Complications Report.

There is limited literature comparing open and minimally invasive surgical (MIS) techniques for first ray dorsiflexion osteotomy (DFO). This study is the first of its kind to report early healing and complication rates of patients undergoing MIS vs open first ray DFO. A retrospective cohort review of 28 patients who underwent a first ray DFO procedure at an academic medical center between 2015 and 2024 was conducted. Demographic factors and medical comorbidities were recorded. Radiologic parameters were measured along with healing. Postoperative healing and outcomes were identified through medical record review. Thirteen open and 15 MIS DFO procedures were performed. At follow-up, all osteotomies were healed with no wound or infection complications. There was no significant difference in hardware removal rates, 7.7% for open and 6.7% for MIS. The change in lateral Meary angle was 10.5 ± 3.9 and 9.7 ± 4.3 for the open and MIS groups, respectively (P = .61). The calculated dorsal closing wedge resection was 3.5 mm and 4.1 mm for open and MIS, respectively (P = .26). This study showed no significant differences in healing or complication rates in the short term between MIS and open surgery, with comparable magnitude of correction, suggesting similar ability for the MIS technique to correct first ray alignment. Further studies are needed to determine long-term outcomes.

Minimally invasive surgery of femoral periprosthetic fractures increases the rate of consolidation and decreases time to bone healing without a higher rate of complications

BackgroundKnee periprosthetic femoral fractures (KPPFF) are becoming more frequent due to the increasing number of arthroplasties and the aging population, for whom maintaining autonomy and function remains a challenge. The use of locking plates has improved functional results and promoted the development of “minimally invasive” surgical (MIS) approaches. Despite the availability of literature comparing between different types of osteosynthesis for KPPFF, there is a paucity of information available on the complications of osteosynthesis using locking plates, depending on the approach. We therefore carried out a retrospective multicenter study (nine centers: Dijon, Grenoble, Lille, Marseille, Nice, Paris, Saint-Étienne, Strasbourg, Colmar) as part of a Symposium of the French Society of Orthopedic Surgery and Traumatology (SOFCOT). Following osteosynthesis of KPPFF by locking plates carried out by a standard approach or by a minimally invasive approach (MIS), the objectives were: (1) to compare the complications, (2) to evaluate whether the radiological and clinical results (rate and time of consolidation, resumption of weight bearing, lack of reduction, postoperative autonomy) were comparable in the two groups. HypothesisThe hypothesis was that performing an MIS approach in these indications does not confer more complications than a standard approach, and rather, the MIS approach offers better functional and radiological results. Material and methodFive hundred and seventy-three patients presented with KPPFF over the periods studied (retrospective series from January 2012 to December 2016, then prospective series from January to December 2019). After applying the inclusion criteria (KPPFF by locking plate) and exclusion criteria (tumor context, infectious, intraoperative fractures, fractures on loose prostheses, other osteosynthesis methods, treatment by prosthetic revision, patients under the age of 18, follow-up less than 1-year, incomplete files), a global series of 306 patients was retained. Two groups were created according to the approach performed: a standard approach group (S, n=228) and a minimally invasive approach group (MIS, n=78). The demographic data of the population were recorded, as was the criteria for autonomy (Parker score, place of living). Postoperative complications were sought (infection, mechanical complication, surgical revision). Finally, the radiological and clinical results were evaluated (rate of, and time to consolidation, resumption of weight bearing, lack of reduction, postoperative autonomy). ResultsThe comparison of the two subgroups, S and MIS, found complication rates are comparable in the two groups in terms of infections [S group: n=18 (7.9%), MIS group: n=2 (2.6%)], mechanical complications [S: n=23 (10.1%), MIS: n=2 (2.6%)], and surgical revision [S: n=33 (14.5%), MIS: n=7 (8.9%)], and a lack of difference in postoperative autonomy [Parker; S group: 4.7±2.4 (0–9) vs. MIS group: 5±2, 7 (0–9)]. On the other hand, the time to return to weight bearing was shorter in the MIS group [4.3±3.5weeks (0–12) versus 10.1±10.1weeks (0–110), p<0.001]. The rate of nonunion was lower in the MIS group [n=1 vs. n=20, i.e. 1.7% vs. 11.1% (p=0.031)] and the time to consolidation was shorter [7.5±4.3weeks (6–30) versus 15.2±9.4weeks (5–78) (p<0.001)]. ConclusionPerforming an MIS approach in the management of KPPFF by locking plate osteosynthesis does not cause any more complications than a standard approach. In addition, higher consolidation rates can be obtained in shorter periods of time. This study suggests that it proposing osteosynthesis using the MIS approach as a primary surgery is a reasonable choice when treatment using locking plates is chosen for a KPPFF, subject to technical expertise. Level of evidenceIII; observational study.

Abstract B022: Conversion from minimally invasive surgical approaches to open surgery among endometrial cancer patients in a national cancer patients’ registry

Abstract Endometrial cancer (EC) ranks as the predominant gynecological malignancy in the US. While minimally invasive surgical (MIS) techniques have revolutionized EC management, conversion to laparotomy remains a concern, with reported rates varying widely. Factors influencing this conversion, including patient characteristics and tumor attributes, have not been fully understood. Addressing this gap, our study employs a national registry to analyze patient, tumor, and surgeon-related factors contributing to the transition from MIS to laparotomy in EC cases. Results: 0ur results showed, 3.4% (135/4028) experienced planned MIS-to-open conversion. Demographic disparities were absent between conversion and MIS groups. Conversion was more prevalent in obese (29%) and morbidly obese (37%) patients (P=0.04), linked to prior abdominal surgery (63% vs 52%; P=0.001). Endometrioid EC predominated (59%) in the converted group, with higher non-endometrioid rates (serous carcinoma 16%, clear cell carcinoma 4%, carcinosarcoma 5%, mixed histology 12%; all P&amp;lt;0.01). Advanced FIGO stages were more common in conversions (stage II: 5%, stage III: 25%, stage IV: 9%; all P&amp;lt;0.001). Type II (24%) and type III (5%) hysterectomies were more frequent in conversions (P&amp;lt;0.001). Logistic regression indicated BMI, prior surgery, FIGO stage, histology, and operation type affected conversion (p&amp;lt;0.001), explaining 12.3% of variance. Indications for conversion included uterine size, adhesions, and disease extent. Conclusion: the adoption of minimally invasive surgery (MIS) has become increasingly popular for managing endometrial cancer (EC), attributed to enhanced perioperative outcomes. However, prudent patient selection and surgical planning are imperative to mitigate the risk of unplanned transition to open surgery. Predictive factors for such conversion include uterine size, prior abdominal surgeries, surgical complexity, disease extent, and histologic types. Further prospective research is warranted to validate these findings and identify individuals at conversion risk. Ultimately, a personalized surgical approach, tailored to individual patient attributes, remains pivotal for optimizing outcomes in EC management. Citation Format: Abdelrahman Yousif, Julie Ngo, Deena Abdel-Gadir, Jenny Lachance, Benjamin Mize, Ilana Chefetz. Conversion from minimally invasive surgical approaches to open surgery among endometrial cancer patients in a national cancer patients’ registry [abstract]. In: Proceedings of the AACR Special Conference on Endometrial Cancer: Transforming Care through Science; 2023 Nov 16-18; Boston, Massachusetts. Philadelphia (PA): AACR; Clin Cancer Res 2024;30(5_Suppl):Abstract nr B022.

Minimally invasive small incision surgical technique for unicompartmental knee arthroplasty.

It is always a challenge for orthopaedic surgeons to minimise surgical incisions while ensuring excellent surgical results. We propose the minimally invasive small incision (MISI) technique and an extramedullary positioning technique in the unicompartmental knee arthroplasty (UKA) surgery. This study aimed to clarify the early postoperative clinical outcomes and component alignment between MISI and conventional minimally invasive surgical (MIS) techniques. We prospectively enrolled 60 patients who underwent MISI-UKA and 60 patients who underwent MIS-UKA as controls. Clinical parameters include the time of straight leg raising, postoperative walking time with walker assistance, hospital stay, Numerical Rating Scale (NRS) pain score and Knee Society Score (KSS). The postoperative components and lower extremity alignment were compared between the two groups with radiographic image measurement. The MISI group obtained a smaller incision during knee extension (P < 0.001) but a longer tourniquet usage time than the MIS group. The MISI group lost less blood (P < 0.001). The MISI group achieved straight leg raising and walking with aid earlier after surgery, with a shorter hospital stay than the MIS group (P < 0.001). Range of motion (ROM), NRS and KSS scores revealed no significant difference between the two groups in six months postoperative follow-up (P > 0.05). Radiographic measurement results between the two groups revealed no statistical difference (P > 0.05) CONCLUSION: The MISI-UKA could achieve faster earlier recovery after surgery and shorter hospital stays without compromising the principles of proper prosthesis position and limb alignment compared with the conventional MIS-UKA.

Association of transanal minimally invasive surgical approach with oncologic outcomes over conventional transanal excision for early-stage rectal cancer: An analysis of the US Rectal Cancer Consortium.

145 Background: For early-stage rectal cancer, minimally invasive surgical (MIS) approaches such as transanal endoscopic microsurgery (TEM) and transanal minimally invasive surgery (TAMIS) have not been widely adopted over conventional transanal excision (TAE). Direct comparisons are lacking. Our aim was to compare oncologic and perioperative outcomes between the two approaches. Methods: We identified patients with Tis or T1 tumors who underwent TAE or MIS (TEM or TAMIS) between 2007-2017 from the US Rectal Cancer Consortium database. Patients who received neoadjuvant therapy were excluded. Primary outcomes were rate of recurrence and recurrence-free survival (RFS). Results: Of 1881 patients, 89 met inclusion criteria: 44 TAE and 45 MIS (20 TEM, 25 TAMIS). Median age was similar between groups (63.5 years TAE vs 61 years MIS; p=0.582). Patients in each group had similar functional status and tumor size (1.86 cm TAE vs 1.79 cm MIS, p=0.837). The majority of patients had tumors ≤ 6 cm from the anal verge (75.7% TAE vs 65.5% MIS, p=0.544). The TAE group had a 10.3% margin positive rate versus 0% in the MIS group (p=0.049). There was a lower incidence of recurrence in the MIS group (4.5%) compared to TAE (26%, p=0.01); all recurred locally except for one in the TAE group. Median follow-up time was 23.7 months. On Kaplan-Meier analysis, MIS approach was associated with improved 5-year RFS (86.4%, p=0.005) and local RFS (86.4%, p=0.01), versus TAE (46.9% and 50.5%, respectively). On univariate cox regression analysis, lymphovascular invasion was associated with worse RFS (HR 4.23, p=0.033) and local RFS (HR 5.26, p=0.02), while MIS approach was associated with improved RFS (HR 0.15, p=0.015) and local RFS (HR 0.17, p=0.023). On multivariable cox regression, only MIS approach remained associated with improved RFS (HR 0.09, p=0.028) and local RFS (HR 0.11, p=0.045). Perioperative complication and readmission rates were equal between the two groups. Conclusions: In patients with Tis and T1 rectal cancers who undergo local excision, an MIS approach (TEM or TAMIS) is associated with a decreased rate of recurrence and improved RFS and local RFS compared to TAE, with no significant difference in perioperative complication rate. The MIS approach should be more frequently incorporated into standard practice. [Table: see text]

Spinal Intradural Extramedullary Tumors: A Retrospective Analysis on Ten-Years' Experience of Minimally Invasive Surgery and a Comparison with the Open Approach.

Spinal intradural extramedullary (ID-EM) tumors are pathologies widely treated through a classical open approach. However, minimally invasive surgery is gaining traction as a comparable treatment option because it carries less morbidity and may reduce healthcare costs.This study aimed to compare the clinical and functional outcomes of open versus minimally invasive approaches for patients with ID-EM tumors. We performed a retrospective analysis on prospectively collected data from patients with ID-EM tumors submitted to surgery. Baseline features and operative variables were compared, including surgery duration and estimated blood loss (EBL). Postoperative data covered tumor histology, length of stay (LOS), complication(s), and neurological status (Medical Research Council (MRC) scale) at the last follow-up.In total, 46 patients were included: 30 (65.2%) operated through an open approach and 16 (34.8%) through a minimally invasive surgical (MIS) approach. The predominant histology type was schwannomas (43.5%). Lesions more frequently affected the lumbar spine (34.8%). The tumor dimensions were similar in both cohorts. The minimally invasive approach was on average 76.7 min faster and correlated positively with less EBL (140 mL less than that of the open approach). Patients in the MIS group had shorter LOSs (5.63 days vs. 17.27 days) and had fewer postoperative complications. No significant difference in functional outcome was found.MIS is as effective as the traditional approach in achieving comparable functional outcomes, with advantages such as shorter surgery durations, less blood loss, and shorter hospital LOSs.

Soft tissue complications following extensile lateral compared with minimally invasive surgical approaches in the operative treatment of calcaneus fractures.

Extensile lateral (ELA) and minimally invasive surgical (MIS) approaches are commonly used in the operative fixation of calcaneus fractures. The ELA has been the standard of care, but is associated with a high risk of wound complications. Minimally invasive surgical approaches have been developed to reduce these complications. We completed a retrospective chart review of 201 patients with calcaneus fractures repaired by either ELA or MIS approaches between 2011 and 2018. We compared the incidence of soft tissue complications, including wound infections (requiring no surgical treatment) and deep infections (requiring surgical intervention), and performed multivariate regression analysis to determine independent risk factors associated with soft tissue complications and reoperation. The overall incidence of soft tissue complications was 8.1% in the MIS group compared with 28.8% in the ELA group (p = 0.0004). The incidence of patients with a deep infection requiring reoperation was 4.7% in the MIS group compared with 19.2% in the ELA group (p = 0.003). Risk factors of soft tissue complications included the presence of an open fracture (odds ratio [OR] 11.59, 95% confidence intervals [CI] 3.25-44.25) and use of ELA (OR 4.22, 95% CI 1.67-10.90). Risk factors for a deep infection requiring reoperation included the use of ELA (OR 4.43, 95% CI 1.51-13.64) and the presence of an open fracture (OR 4.00, 95% CI 0.91-15.3). The ELA is associated with an increased incidence of soft tissue complications and reoperation when compared with the MIS approach. The ELA and open fractures were found to be independent risk factors of soft tissue complications and reoperation. Surgeons treating calcaneus fractures should consider using a MIS technique, provided they are able to achieve the goals of surgical management without the ELA.

Recurrence and Survival Rates of Patients Who Undergo Minimally Invasive Surgery for Endometrial Carcinoma with Different Prognostic Risk Groups

Objective To compare the recurrence rate and prognosis between minimally invasive surgical (MIS) approach and open surgical approach of endometrial carcinoma (EC) patients with different prognostic risk groups. Methods A retrospective analysis of all cases undergoing EC surgery between January 2011 and March 2018 was performed. The patients were grouped according to the management guidelines of EC patients jointly formulated by the ESGO/ESTRO/ESP 2020. Different surgical approaches were compared with regard to tumor characteristics, recurrence rate, disease-free survival (DFS), and overall survival (OS). Results A total of 665 patients met the inclusion criteria of which 196 patients underwent MIS (29.5%), and 469 patients underwent open surgery (70.5%). In the MIS group, there was a significant higher rate of recurrence (17.3% vs 6.6%, P = 0.000) compared to the open surgery group. The recurrence rate of MIS was 7.7% (P = 0.000) in the medium-high risk group and 8.2% (P = 0.014) in the high-risk group. Multivariate logistic regression analysis showed that the independent factors influencing recurrence included prognostic risk grouping, surgical approach and lymph vascular space invasion (LVSI) positivity (P < 0.05). K-M survival analysis revealed that in the intermediate and high-risk group of EC, MIS patients had a significantly lower DFS than those undergoing open surgery (P < 0.05), but no significant difference was found in OS. Conclusions For patients with EC at moderate and high prognostic risk, MIS is associated with poorer DFS compared to open surgery, but OS was similar across prognostic risk groups. The application of MIS in patients with moderate and high-risk EC needs further research and analysis.

Survival after minimally invasive hysterectomy for type 2 uterine cancer

Objectives: Minimally invasive surgical (MIS) staging has become the standard of care for low-grade clinical stage I endometrioid uterine cancer based on randomized studies demonstrating survival outcomes comparable to laparotomy. However, there is limited data on the use of MIS for high-grade uterine cancers at much higher risk for local disease extension and metastasis. The LACC trial showed inferior survival among early-stage cervical cancer patients undergoing MIS compared to laparotomy. The aim of this study was to test the hypothesis that MIS staging of type 2 uterine cancers would be associated with inferior survival. Methods: The National Cancer Database was used to identify women with type 2 uterine cancer (serous, carcinosarcoma, high-grade endometrioid, clear cell) diagnosed from 2010-2015 who underwent primary surgical management. Patients with low grade endometrioid uterine cancer were excluded. MIS included both laparoscopic and robotic approaches. Inverse probability of treatment weighting (IPTW) was used to balance confounders between the MIS and laparotomy groups. Variables in the propensity score model included age, race, median neighborhood education and income, insurance status, year of diagnosis, tumor stage, size, and grade, medical co-morbidities, facility type, and location. Kaplan-Meier curves and Cox regression were used to compare survival. Results: A total of 54,027 women (mean age 65.0±10.1 years) were included in the analysis. 33,763 (62.5%) underwent MIS approach. Compared to those in the laparotomy group, patients treated with MIS were noted to have tumors that were smaller, had earlier stage disease, and were less likely to be graded as poorly differentiated. Following weighting, the 5 year survival rates were 63.4% for laparotomy and 66.5% for MIS. (Figure 1). Patients treated with an MIS approach demonstrated significantly improved survival compared to an open approach (HR=0.87; 95% CI [0.84, 0.91], p Download : Download high-res image (103KB) Download : Download full-size image Conclusions: MIS staging was performed in two-thirds of patients with type 2 uterine cancer yet with significant baseline differences compared to the laparotomy group. Propensity score weighted matching was used in an attempt to create equivalent cohorts from this large retrospective sample. Our findings support the null hypothesis that MIS staging is not inferior to laparotomy, which are consistent with prior literature on type 1 uterine cancer and reinforce that MIS is the preferred approach for surgical staging of all types of uterine cancer.

Comparison of a minimally invasive surgical technique with open surgery for transverse patella fractures.

The current study aimed to compare a minimally invasive surgical technique with open surgery for the treatment of transverse patella fractures. A total of 38 patients with displaced transverse fractures of the patella were included in the current prospective study. A total 21 of them were treated with a minimally invasive surgical (MIS) technique and the other 17 patients had open surgery (OS) when using the Cable Pin System. Postoperative comparisons were based on radiographs, the visual analog scale (VAS) of pain, their ranges of motion and the Bostman grading scale. Compared with the OS group, the VAS score for pain was significantly lower and the angle of active flexion was better in the MIS group at 4 and 8 weeks. The angle of active extension at 4 weeks and the Bostman score at 8 weeks after surgery were better in the MIS group, although the differences became non-significant at 8 weeks and 12 months. In conclusion, the MIS technique for transverse patella fractures provided better clinical results and the knees functioned with less pain when compared with the OS group in the early period following surgery. MIS could be an adequate alternative in the treatment of transverse patella fractures.

Wednesday, September 26, 2018 1:00 PM – 2:00 PM What's New in MIS: 41. Complication risk in primary and revision minimally invasive lumbar interbody fusion: a comparable alternative to conventional open techniques?

BACKGROUND CONTEXT Recent studies show similar clinical outcomes between primary and revision lumbar interbody fusion procedures performed using conventional open techniques. As an increasing number of lumbar fusions are performed using minimally invasive surgical (MIS) techniques, it is important to assess the corresponding complication risks between primary and revision lumbar interbody fusion procedures. PURPOSE Assess differences in perioperative outcomes between primary and revision MIS lumbar interbody fusion patients, and compare to those of patients undergoing corresponding procedures utilizing an open technique. STUDY DESIGN/SETTING Retrospective chart review at single academic institution. PATIENT SAMPLE A total of 154 lumbar interbody fusion patients (77 primary, 77 revision; 44 MIS, 110 open). OUTCOME MEASURES Perioperative complications, length of stay (LOS), estimated blood loss (EBL) METHODS Patients >18 years undergoing primary and revision lumbar interbody fusion were propensity score matched (PSM) for comorbidities and levels fused. Cases were grouped by surgical technique: MIS or open. demographics, charlson comorbidity index (CCI) scores, surgical factors, and perioperative complications incidences were compared between primary and revision cases using means comparison tests, as appropriate. Significance was set to p RESULTS Included: 154 lumbar interbody fusion patients (62±12 year, 62%F, 29±6 kg/m2). Fourty-four (29%) cases were MIS, and 110 (71%) were open. Proportion of revision cases within the MIS and open groups were 40.9% and 53.6%, respectively. Within both MIS and open groups, there were no differences between primary and revision cases in age, sex, BMI, CCI, or levels fused (all p>.05). For both MIS and open patients, there were no differences between primary and revision cases in surgical approach, rates of laminectomy, or number of interbodies (all p>.05). For both MIS and open techniques, primary and revision patients did not differ in EBL, op time, LOS, or ICU LOS (all p>.05). Similarly, within both MIS and open groups, there were no differences between primary and revision surgeries in overall rates of postop complications, including cardiac, pulmonary, urinary, infection, and anemia complications (all p>.05). Primary MIS cases had higher rates of intraoperative complications as compared to revision cases (19% vs. 0.0%, p=.048), unlike open procedures, in which primary cases had lower intraoperative complication rates (0% vs. 7%, p=.058). Whereas MIS and open groups did not differ in operative time of primary surgery (279 minutes vs. 280, p=.976), MIS revision procedures were shorter than open (244 minutes vs. 296, p=.024). For both primary and revision procedures, there were no differences between MIS and open groups in overall rates of postoperative complications(all p>.05); however, primary MIS cases had higher intraoperative complication rates than primary open cases (19% vs. 0%, p=.001). CONCLUSIONS Clinical outcomes of revision MIS lumbar interbody fusion were similar to those of primary surgery, with no differences in operative time, inpatient length of stay, blood loss, or rates of postoperative complications. Despite higher intraoperative complication rates for primary MIS fusions, postoperative clinical outcomes were similar between MIS and open groups for both primary and revision procedures. These results point to revision MIS lumbar interbody fusion as a comparable alternative to similar fusions preformed using conventional open techniques. FDA DEVICE/DRUG STATUS This abstract does not discuss or include any applicable devices or drugs.

Wednesday, September 26, 2018 1:00 PM – 2:00 PM What's New in MIS: 42. Diminishing clinical returns of multilevel minimally invasive lumbar interbody fusion

BACKGROUND CONTEXT Minimally invasive surgical (MIS) techniques for spinal fusion aim to reduce the morbidity and considerable soft-tissue damage associated with conventional open surgery. As longer, multilevel arthrodesis procedures are increasingly performed using MIS techniques, it is necessary to weigh the risks and benefits of multilevel MIS lumbar fusion as a function of fusion length. PURPOSE Investigate the relationship between number of levels fused and clinical outcomes in patients undergoing open and MIS lumbar fusion procedures. STUDY DESIGN/SETTING Retrospective clinical review at single institution. PATIENT SAMPLE A total of 437 patients undergoing lumbar interbody fusion by open or MIS technique. OUTCOME MEASURES Complication rates, length of stay (LOS), estimated blood loss (EBL) METHODS Patients undergoing RESULTS Included: 437 patients (57±13 years, 51% F, 29.5 kg/m2) undergoing lumbar interbody fusion(1.6±0.9 levels fused, 72% involved transforaminal approach, 18% anterior, 14% lateral). Overall breakdown of fusion length groups was: 64% 1-level, 21% 2-level, 16% 3+ level. By surgical technique, 37.5% of cases were MIS and 62.5% were open. Patients undergoing open surgery were older (58 years vs. 55, p=.022) with more comorbidities(mean CCI: 1.5 vs. 0.9, p .05). While periop complication rates were significantly lower for MIS patients at 1-level (16% vs. 29%, p=.012) and 2-levels (12% vs. 30%, p=.043), at 3+ levels, complication rates were comparable between MIS and open groups (38% vs. 36%, p=.921). Furthermore, despite no differences in rates of pulmonary and GI complications between MIS and open groups at 1-level and 2-levels (both p>.05), MIS patients undergoing 3+ level fusions had higher rates of ileus (13% vs. 0%, p=.003) and showed a trend of increased adverse pulmonary events (25% vs. 6%, p=.052). For all categories of fusion length, MIS procedures resulted in significantly less blood loss (all p CONCLUSIONS As compared to corresponding open surgeries, minimally invasive lumbar interbody fusions provided diminishing clinical returns for multilevel procedures. While MIS patients had lower rates of perioperative complications for 1- and 2-level fusions, 3+ level MIS fusions resulted in overall complication rates comparable to those of open patients, and higher rates of adverse pulmonary and ileus events. These results can be used to improve counseling of patients indicated for multilevel lumbar interbody fusion. FDA DEVICE/DRUG STATUS This abstract does not discuss or include any applicable devices or drugs.

Minimally Invasive Staging of Apparent Stage I Malignant Ovarian Germ Cell Tumors: Prevalence and Outcomes

Study ObjectiveEvaluate the prevalence, trends, and outcomes of minimally invasive surgical (MIS) staging of malignant ovarian germ cell tumors (MOGCTs) apparently confined to the ovary. DesignRetrospective cohort study (Canadian Task Force classification II-2). SettingParticipating hospitals in the National Cancer Data Base. PatientsWomen diagnosed between 2010 and 2014 with a MOGCT apparently confined to the ovary with information on the planned surgical approach. InterventionsStaging with MIS or laparotomy. Measurement and Main ResultsA total of 918 patients were identified. MIS was planned for 294 patients (32%): a laparoscopic approach for 237 patients and a robotic-assisted approach for 57 patients. Rate of conversion to laparotomy was 11% (46 cases), 1.7% and 15.6% in the robotic and laparoscopy groups, respectively (p = .003). No difference in the use of MIS was noted based on year of diagnosis (p = .38). By multivariate analysis white race, higher level of education, and smaller tumor size were associated with the receipt of MIS. Patients in the MIS group were less likely to undergo lymph node dissection (39.6% vs 51.3%, p = .001) and omentectomy (18.7% vs 28.5%, p = .002). Hospital stay after surgery was shorter for patients who had MIS (median, 2 vs 3 days; p <.001). Unplanned 30-day readmission rate was also lower in the MIS group (1.4% vs 3.9%, p = .043). No difference in overall survival was noted between the 2 groups (p = .81). ConclusionMIS for apparent early-stage MOGCTs was less comprehensive but associated with a decreased hospital stay and unplanned readmission rate.

MP61-02 MINIMALLY INVASIVE VERSUS OPEN URETERAL REIMPLANTATION: IS THERE A DIFFERENCE IN RATES OF REOPERATION? COMPARISON FROM A LARGE NATIONAL DATABASE

You have accessJournal of UrologyPediatrics: Urinary Tract Infection and Vesicoureteral Reflux1 Apr 2017MP61-02 MINIMALLY INVASIVE VERSUS OPEN URETERAL REIMPLANTATION: IS THERE A DIFFERENCE IN RATES OF REOPERATION? COMPARISON FROM A LARGE NATIONAL DATABASE Eric D. Schadler, William R. Boysen, Christopher Lyttle, Vignesh T. Packiam, Charles U. Nottingham, and Mohan S. Gundeti Eric D. SchadlerEric D. Schadler More articles by this author , William R. BoysenWilliam R. Boysen More articles by this author , Christopher LyttleChristopher Lyttle More articles by this author , Vignesh T. PackiamVignesh T. Packiam More articles by this author , Charles U. NottinghamCharles U. Nottingham More articles by this author , and Mohan S. GundetiMohan S. Gundeti More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2017.02.1860AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Minimally invasive surgical (MIS) approaches to ureteral reimplantation (UR) for vesicoureteral reflux (VUR) are being used with increasing frequency, despite variability in published rates of complications and reoperation. We assessed rates of secondary procedures following ureteral reimplantation in a prospectively maintained national database. METHODS We queried MarketScan, a national employer based insurance database, to identify patients less than 18 years of age who underwent an open or MIS UR between 2008 and 2014. Rates of secondary procedures related to ureteral obstruction (placement of stent or nephrostomy tube, or dilation of ureteral stricture) within 120 days of UR and rates of repeat UR at any time point were assessed. Statistical analysis was performed using t-test, chi-square test, Wilcoxon rank-sum test, and multivariate regression. RESULTS Between 2008 and 2014, 2,752 patients underwent UR with an open approach in 2,601 (94.5%) and MIS in 151 (5.5%). There was a trend toward increased utilization of MIS, with MIS comprising 2.5% of cases in 2008 and 9.3% in 2014 (p=0.026). Relative to the open group, mean age in years was higher in the MIS group (5.6 vs 4.3, p<0.01) and mean length of stay in days was shorter (1.44 vs 2.15, p<0.01). Mean inpatient hospital charges did not differ between the groups ($21,660 vs $20,621, p=0.59). The rate of secondary ureteral procedures within 120 days did not differ between the MIS and open groups (0.7% vs 0.3%%, p=0.76), but rate of subsequent open UR at any time was higher in the MIS group (3.97% vs 0.69%, p<0.01). On univariate analysis, patient age, gender, LOS, and surgical approach did not predict subsequent secondary procedures within 120 days (Table 1). CONCLUSIONS From 2008 to 2014 there has been a trend toward increased utilization of MIS UR. Relative to the open approach, MIS approach is associated with a shorter length of hospital stay with no difference in inpatient hospital charges. The rate of secondary ureteral procedure within 120 days of UR did not differ by approach, but patients treated with MIS UR had a higher rate of subsequent open UR. © 2017FiguresReferencesRelatedDetails Volume 197Issue 4SApril 2017Page: e798-e799 Advertisement Copyright & Permissions© 2017MetricsAuthor Information Eric D. Schadler More articles by this author William R. Boysen More articles by this author Christopher Lyttle More articles by this author Vignesh T. Packiam More articles by this author Charles U. Nottingham More articles by this author Mohan S. Gundeti More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Multi-institutional comparison of open, laparoscopic, hand-assisted laparoscopic, and robotic techniques for distal pancreatectomy

Objective: The literature comparing minimally invasive distal pancreatectomy (DP) to open DP is mostly limited to one or two minimally invasive surgical (MIS) techniques. Previous studies have addressed outcomes between robotic, laparoscopic, and open DP but have not included hand-assisted laparoscopic surgery. We evaluated outcomes of these four DP techniques in a multi-center study. Methods: Data was collected from a prospectively maintained pancreas surgery consortium database at three high-volume pancreatic centers. We analyzed pre-operative, oncologic, and post-operative outcomes including complications, pancreatic fistula of any grade, and clinically relevant fistula in each DP procedure type. Results: 261 patients underwent DP. 36% underwent open, 25% laparoscopic, 14% hand-assisted, and 25% robotic DP. The most common diagnosis was cystic lesion (39%) followed by pancreatic adenocarcinoma (PDAC) (27%). Open DP was more common in patients with PDAC (p=0.001) and with greater co-morbidities, particularly HTN (p=0.02) and smoking history (p=0.02). EBL and transfusions were greater with open DP. Length of procedure was greater with MIS. Soft gland texture was more common in the MIS groups (Table 1). There was no difference in post-operative complications except for increased fistula of any grade with MIS (p=0.02). However, there was no difference in clinically relevant fistula (p=0.4). There was no difference in LOS, R0 resection, or lymph node yield. Conclusion: There is no difference in post-operative complications and oncologic outcomes between open and various MIS modalities for DP. The increased use of open DP for PDAC patients is likely a result of selection bias.Table 1ResultsOpenLapHALRoboticp-valueBaseline characteristicsHTN56 (61%)25 (44%)21 (60%)23 (38%)0.02Smoking history53 (58%)30 (47%)13 (35%)19 (28%)0.02Initial diagnosis PDAC43 (45%)7 (11%)10 (27%)9 (14%)0.001Perioperative characteristicsEBL (mL)43823960225<0.0005Transfusion10 (11%)2 (3%)02 (3%)0.009Soft gland texture69 (75%)49 (83%)32 (91%)58 (98%)0.001Post-operative complicationsFistula any grade21 (23%)25 (48%)12 (39%)17 (33%)0.02CR-POPF (ISGPS Grade B/C)9 (10%)10 (19%)3 (10%)7 (14%)0.4Patients with any complications44 (42%)33 (28%)15 (41%)23 (36%)0.3Patients with Accordion ≥ grade 3 complications20 (21%)13 (20%)5 (14%)11 (20%)0.8 Open table in a new tab

Impact of minimally invasive surgery on healthcare utilization, cost, and workplace absenteeism in patients with Incisional/Ventral Hernia (IVH).

Incisional hernia repair is one of the most common general surgery operations being performed today. With the advancement of laparoscopy since the 1990s, we have seen vast improvements in faster return to normal activity, shorter hospital stays and less post-operative narcotic use, to name a few. The key aims of this review were to measure the impact of minimally invasive surgery versus open surgery on health care utilization, cost, and work place absenteeism in the patients undergoing inpatient incisional/ventral hernia (IVH) repair. We analyzed data from the Truven Health Analytics MarketScan® Commercial Claims and Encounters Database. Total of 2557 patients were included in the analysis. Of the patient that underwent IVH surgery, 24.5% (n = 626) were done utilizing minimally invasive surgical (MIS) techniques and 75.5% (n = 1931) were done open. Ninety-day post-surgery outcomes were significantly lower in the MIS group compared to the open group for total payment ($19,288.97 vs. $21,708.12), inpatient length of stay (3.12 vs. 4.24 days), number of outpatient visit (5.48 vs. 7.35), and estimated days off (11.3 vs. 14.64), respectively. At 365 days post-surgery, the total payment ($27,497.96 vs. $30,157.29), inpatient length of stay (3.70 vs. 5.04 days), outpatient visits (19.75 vs. 23.42), and estimated days off (35.71 vs. 41.58) were significantly lower for MIS group versus the open group, respectively. When surgical repair of IVH is performed, there is a clear advantage in the MIS approach versus the open approach in regard to cost, length of stay, number of outpatient visits, and estimated days off.

Duodenal Atresia: Open versus MIS Repair-Analysis of Our Experience over the Last 12 Years.

Objective. Duodenal atresia (DA) routinely has been corrected by laparotomy and duodenoduodenostomy with excellent long-term results. We revisited the patients with DA treated in the last 12 years (2004–2016) comparing the open and the minimally invasive surgical (MIS) approach. Methods. We divided our cohort of patients into two groups. Group 1 included 10 patients with CDO (2004–09) treated with open procedure: 5, DA; 3, duodenal web; 2, extrinsic obstruction. Three presented with Down's syndrome while 3 presented with concomitant malformations. Group 2 included 8 patients (2009–16): 1, web; 5, DA; 2, extrinsic obstruction. Seven were treated by MIS; 1 was treated by Endoscopy. Three presented with Down's syndrome; 3 presented with concomitant malformations. Results. Average operating time was 120 minutes in Group 1 and 190 minutes in Group 2. In MIS Group the visualization was excellent. We recorded no intraoperative complications, conversions, or anastomotic leakage. Feedings started on 3–7 postoperative days. Follow-up showed no evidence of stricture or obstruction. In Group 1 feedings started within 10–22 days and we have 1 postoperative obstruction. Conclusions. Laparoscopic repair of DA is one of the most challenging procedures among pediatric laparoscopic procedures. These patients had a shorter length of hospitalization and more rapid advancement to full feeding compared to patients undergoing the open approach. Laparoscopic repair of DA could be the preferred technique, safe, and efficacious, in the hands of experienced surgeons.

Minimally Invasive and Open Distal Chevron Osteotomy for Mild to Moderate Hallux Valgus

Minimally invasive surgical (MIS) techniques are increasingly being used in foot and ankle surgery but it is important that they are adopted only once they have been shown to be equivalent or superior to open techniques. We believe that the main advantages of MIS are found in the early postoperative period, but in order to adopt it as a technique longer-term studies are required. The aim of this study was to compare the 2-year outcomes of a third-generation MIS distal chevron osteotomy with a comparable traditional open distal chevron osteotomy for mild-moderate hallux valgus. Our null hypothesis was that the 2 techniques would yield equivalent clinical and radiographic results at 2 years. This was a retrospective cohort study. Eighty-one consecutive feet (49 MIS and 32 open distal chevron osteotomies) were followed up for a minimum 24 months (range 24-58). All patients were clinically assessed using the Manchester-Oxford Foot Questionnaire. Radiographic measures included hallux valgus angle, the intermetatarsal angle, hallux interphalangeal angle, metatarsal phalangeal joint angle, distal metatarsal articular angle, tibial sesamoid position, shape of the first metatarsal head, and plantar offset. Statistical analysis was done using Student t test or Wilcoxon rank-sum test for continuous data and Pearson chi-square test for categorical data. Clinical and radiologic postoperative scores in all domains were substantially improved in both groups (P < .001), but there was no statistically significant difference in improvement of any domain between open and MIS groups (P > .05). There were no significant differences in complications between the 2 groups ( > .5). The midterm results of this third-generation technique show that it was a safe procedure with good clinical outcomes and comparable to traditional open techniques for symptomatic mild-moderate hallux valgus. Level III, retrospective comparative study.

Reoperation rates in minimally invasive, hybrid and open surgical treatment for adult spinal deformity with minimum 2-year follow-up.

Minimally invasive surgical (MIS) techniques are gaining popularity in the treatment of adult spinal deformity (ASD). The premise is that MIS techniques will lead to equivalent outcomes and a reduction in perioperative complications when compared with open techniques. Potential issues with MIS techniques are a limited capacity to correct lumbar lordosis, unknown long-term efficacy, and the potential need for revision surgery. This study compares reoperation rates and reasons for reoperation following MIS, hybrid, and open surgery for ASD through multicenter database analysis. We retrospectively analyzed a prospective multicenter ASD database comparing open and MIS correction techniques. Inclusion criteria were: age>18years with minimum 20° coronal lumbar Cobb angle, a minimum of three levels fused, and minimum 2-year follow-up. Patients were propensity matched for preoperative sagittal vertebral axis (SVA), pelvic incidence-lumbar lordosis (PI-LL), and number of levels fused. We included 189 patients from three propensity-matched subgroups of 63 patients each: (1) MIS: lateral or transforaminal lumbar interbody fusion (LIF) and percutaneous pedicle instrumentation, (2) Hybrid: MIS LIF with open posterior segmental fixation (PSF), and (3) OPEN: open posterior fixation±osteotomies. With propensity matching, there were significant differences between groups in pre-op SVA or PI-LL (p>0.05). The MIS group had significantly fewer levels fused (5.4) (0-14) than the OPEN group (7.4) (p=0.002) (0-17). The rate of revision surgery was significantly different between the groups with a higher rate of revision (27%) amongst the HYB group versus MIS=11.1%, and OPEN=12.0%. The most common reason for reoperation in the OPEN and HYB groups was a postoperative neurological deficit (7.9 and 11.1%), respectively. The most common reason for reoperation in the MIS group was pseudoarthrosis (7.9%). Reoperation rates were not statistically different among the MIS, and OPEN surgical groups, but differed significantly on multivariate analysis with HYB group. The incidence of reoperations was twice as high in the Hybrid group compared to OPEN and MIS.

Minimally Invasive Pedicle Screw Fixation Using Intraoperative 3-dimensional Fluoroscopy-based Navigation (CAMISS Technique) for Hangman Fracture.

Retrospective comparative cohort series. To evaluate the accuracy and feasibility of minimally invasive surgical (MIS) techniques incorporating with intraoperative 3-dimensional fluoroscopy-based navigation (ITFN) for treating Hangman fracture. MIS screw fixation for Hangman fracture can decrease iatrogenic soft-tissue injury, but increase the risk of instrumentation-related complications due to lack of anatomical landmarks. With the advantages of obtaining intraoperative real-time images, automatic registration, and 3-dimensional views, the ITFN system seems to be an inherent partner for MIS. 20 patients with Hangman fracture underwent C2-C3 pedicle screw fixation using ITFN. 6 patients used MIS technique, with the other 14 patients using conventional open technique. Operative time and blood loss were recorded. The accuracy of screw positions was studied by postoperative CT scan. Neck pain visual analogue score (VAS) was evaluated and the fusion status was ascertained in 6-month follow-up. The average operative time was 134.2 ± 8.0 minutes in computer-assisted orthopaedics surgery (CAOS)-MIS group and 139.3 ± 25.8 minutes in CAOS-open group (P > 0.01). The blood loss was 66.7 ± 25.8 mL in CAOS-MIS group and 250.0 ± 141.4 mL in CAOS-open group (P < 0.01). A total of 80 screws were inserted. No screw-related neurovascular injury was observed. 83.3% (20/24) screws in CAOS-MIS group and 89.3% (50/56) screws in CAOS-open group were grade 1 screw (P > 0.01). No grade 3 screw was detected in both groups. Compared with the CAOS-open group (1.7 ± 0.6), neck pain VAS in 6-month follow-up in CAOS-MIS group (0.3 ± 0.5) was significantly lower (P < 0.01). Solid fusion was demonstrated in all the cases. The integration of these 2 techniques MIS and ITFN, we call "computer assisted minimally invasive spinal surgery," is proved to be feasible and safe for treating Hangman fracture with the advantage of significantly reduced iatrogenic soft tissue injury. So we think CAMISS technique represents the most recent modification of spine surgery.