Minimally Invasive Surgical Techniques Research Articles

Encuesta sobre las preferencias quirúrgicas entre los glaucomatólogos en España

PurposeTo evaluate the spectrum of glaucoma surgery undertaken among members of the Spanish Glaucoma Society (SEG). MethodsA 10 question web-based anonymous survey was mailed through the Annals of the Spanish Glaucoma Society to all its members on January, February and July 2019 to determine their preferred surgical approach. Main outcome measuresAge, type of Glaucoma, surgery undertaken, type of anti-scarring strategy and prothesis introduced for the last 10 surgeries since the survey was received. The surgeon experience was registered in years of practice. ResultsA total of 97 SEG members across the country answered the survey. Sixty-two (63.4%) responders had more than 10 years of experience. Primary open angle glaucoma was the most frequent type of glaucoma (60.6%). The most popular surgery was deep-sclerectomy (37.3%) followed by trabeculectomy (17.6%) and the collagen microshunt (XEN® Allergan Inc., Irvine, CA) (14.1%). Glaucoma drainage device (GDD) was used in 10.5% of the cases. Up to 21.7% of surgeries were reinterventions, where GDD was used in 27.3% and trabeculectomy in 20.3% of the cases. Glaucoma surgery was combined with phacoemulsification in 47.3% of the eyes. Mitomycin C (MMC) was used in 54.8% of the cases, collagen matrix (Ologen®, Aeon Astron Corporation, Taipei, Taiwan) was used alone in 8.2% of the cases and in 13.7% combined with MMC. MMC was used in a soaked sponge in 79% of cases (concentrations of 0.02% in 99% and 0.04% in 1%) and in 21% of cases MMC was injected subconjunctivally (concentrations of 0.01% in 81% and 0.02% in 19%). ConclusionsAlthough the glaucoma surgeon performs a wide range of surgical techniques, deep sclerectomy remains the most widely used surgical technique in Spain. Combined cataract and glaucoma surgery is performed almost in half of the patients and MMC is the most frequently selected antifibrotic agent, alone or combined with collagen matrix. The new minimal invasive surgical techniques represent the 20% of the total.

Minimally Invasive Surgical Technique in Double Aortic Arch with Distal Atretic Left-Side in Infant: From a Single-Surgeon Clinical Experience

Background: Double aortic arch (DAA) with distal left-sided aortic arch atresia (LAAA) can form complete vascular ring by ligamentum connection. We aimed to introduce an uncommon DAA-LAAA diagnosis and treatment by the minimally invasive surgical technique (MIST). Methods: We retrospectively reviewed 7 cases of DAA-LAAA that were treated from January 2017 to July 2021. All infant patients underwent surgical repair by minimally invasive surgical technique. Mean follow-up was 14.43 months (range, 5–21 months). Results: There were seven patients with DAA-LAAA, including six males and one female. Median age was 19.29 months (range, 9.0–29.0 months). Median weight was 11.30 kg (range, 9.6–13.0 kg). Three patients were found severe tracheal compression by cardiac computed tomography angiography (cCTA). Six patients with isolated DAA-LAAA were performed operations through left subaxillary minithoracotomy, and one patient with ventricular septal defect (VSD) was performed operation concurrently under the cardiopulmonary bypass (CPB) through right subaxillary minithoracotomy. All patients had symptom improvement in the postoperative period and discharged successfully. Follow-up data showed good results in short-term. Conclusions: We introduce a new surgical pathway for DAA-LAAA treatment with good symptomatic relief in short-term. MIST is a safe, feasible and economical approach for infant patients.

Minimally Invasive Surgical Approach for the Treatment of Miller’s Class I Recession Defects- A Report of 2 Cases

Gingival recession is defined as the apical displacement of the gingival margin leading to exposure of the root surface. Occurrence of the gingival recessions in the anterior teeth is a major concern for the patients as it leads to compromised esthetics and achieving the esthetic and functional requirements of the patients remains a major therapeutic challenge for the treating dental surgeon. Incorporating the principles of Minimally Invasive Surgical Technique (MIST), surgical trauma is minimized, thus causing less cell damage, eventually resulting in less inflammation and less discomfort. Minimally invasive surgical technique aims to achieve esthetically superior outcomes that are made possible due to improved visual acuity. Therefore, the intent of this case report was to emphasize the impact of implementing the minimally invasive surgical procedure in the management of marginal gingival recessions using the conventional coronally advanced flap (CAF) and the Tarnow’s technique, with the use of microsurgical instruments and magnifying surgical loupes.

Comparing Open vs Minimally Invasive Techniques for the Correction of Hallux Valgus: Clinical and Patient Reported Outcomes

Category:BunionIntroduction/Purpose:Multiple operative techniques have been developed for hallux valgus with varying success. While correction has been traditionally achieved through open surgical approaches, there has been a growing interest in minimally invasive surgical (MIS) techniques. The purpose of this study was to compare clinical and patient-reported outcomes for patients undergoing hallux valgus correction with Lapidus, Scarf and MIS. Our hypothesis was that while a superior clinical correction would be achieved with open techniques there would be similar patient-reported outcomes among open and MIS techniques.Methods:A total of 257 patients who underwent Lapidus (n=82), Scarf (n=82) or MIS (n=93) hallux valgus correction between January 2017- January 2020 at one of two academic institutions by 1 of 9 foot and ankle-fellowship trained orthopedic surgeons were included in this study. Only 3 of 9 performed MIS correction. The average age at the time of surgery 55.4 (range 14-79). Patients were required to have a minimum baseline and 1-year postoperative Patient-Reported Outcomes Measurement Information Scores (PROMIS) and minimum 3-month clinical follow-up. Retrospective chart review was performed to assess the incidence of postoperative complications and reoperations, with an average clinical follow-up of 8 months.Results:All groups had statistically significant differences between pre- and post-operative measurements of HVA, IMA, DMAA, and tibial sesamoid position (<0.05). In addition, the Lapidus group demonstrated change in all parameters measured including Meary's angle, sagittal IMA and Seiberg index. All groups had statistically significant improvement in the PROMIS physical function, pain interference, and global health physical at 1 year (p<0.05). The Lapidus group had significant improvement in all 6 PROMIS domains measured. There were no significant differences in PROMIS score changes from pre to post-op for any PROMIS domain when comparing MIS vs Scarf vs Lapidus. Complications: Minor Complications were classified as infection, symptomatic hardware, delayed union, nerve irritation, transfer metatarsalgia (Lapidus n=14 (17.1%), Scarf n=2 (2.4%), MIS n=15 (16.1%)). Major complications were classified as nonunion, recurrence, hallux varus, recurrence (HVA >20) (Lapidus n=7 (8.5%), Scarf n=9 (11.0%), MIS n=9 (9.7%)).Conclusion:In the last decade, there has been a growing interest in the use of minimally invasive surgical MIS techniques for the treatment of hallux valgus. When compared with traditional open techniques using Lapidus and Scarf osteotomies MIS presents a safe and effective approach to treating hallux valgus.

Cost-utility of two minimally-invasive surgical techniques for operable oropharyngeal cancer: transoral robotic surgery versus transoral laser microsurgery

BackgroundIn the past few decades, a re-evaluation of treatment paradigms of head and neck cancers with a desire to spare patients the treatment-related toxicities of open surgery, has led to the development of new minimally invasive surgical techniques to improve outcomes. Besides Transoral Laser Microsurgery (TLM), a new robotic surgical technique namely Transoral Robotic Surgery (TORS) emerged for the first time as one of the two most prominent and widely used minimally invasive surgical approaches particularly for the treatment of oropharyngeal cancer, a sub-entity of head and neck cancers. Recent population-level data suggest equivalent tumor control, but different total costs, and need for adjuvant chemoradiation. A comparative analysis of these two techniques is therefore warranted from the cost-utility (C/U) point of view.MethodsA cost-utility analysis for comparing TORS and TLM was performed using a decision-analytical model. The analyses adopted the perspective of a Swiss hospital. Two tertiary referral centers in Lausanne and Zurich provided data for model quantificantion.ResultsIn the base case analysis TLM dominates TORS. This advantage remains robust, even if the costs for TORS reduce by up to 25%. TORS begins to dominate TLM, if less than 59,7% patients require adjuvant treatment, whereby in an interval between 55 and 62% cost effectiveness of TORS is sensitive to the prescription of adjuvant chemoradiation therapy (CRT). Exceeding 29% of TLM patients requiring a revision of surgical margins renders TORS more cost-effective.ConclusionNon-robotic endoscopic surgery (TLM) is more cost-effective than robotic endoscopic surgery (TORS) for the treatment of oropharyngeal cancers. However, this advantage is sensitive to various parameters, i.e.to the number of re-operations and adjuvant treatment.

Assessing outcomes of surgical treatment in adult spinal deformity: a critical approach

Adult spinal deformity (ASD) comprises a range of aetiologies and pathologies affecting the lumbar, thoracic or thoracolumbar region during the ageing process. Management of ASD is an increasing health-care burden due to its prevalence in patients aged over 65 years and increasing age of populations in developed countries. Non-operative management of ASD has limited benefit, but may be appropriate for patients with a mild spinal deformity, who can cope with their level of symptoms, or those patients too frail for major spinal surgery. Surgical management of ASD is a major undertaking, associated with significant risks. Minimally invasive surgical (MIS) techniques are rapidly evolving and further research is required to determine the most suitable ASD patient profiles and clinical parameters for treatment by MIS, hybrid, or open techniques. Understanding the resources available for preoperative risk stratification, patient optimization and outcomes assessment following surgery can help to personalize risk-benefit discussions with patients and to develop pragmatic patient-specific surgical strategies for patients with ASD to obtain successful outcomes and reduce the risk of complications. This narrative review discusses patient assessment, treatment outcomes, and surgical strategies to manage patients with ASD.

Pregnancy Outcome after Vaginal Natural Orifice Transluminal Endoscopic Surgery, a First Retrospective Observational Cohort Study

Study Objective: Vaginal natural orifice transluminal endoscopic surgery (vNOTES) is a novel minimal invasive surgical technique allowing a variety of gynecological procedures. The current literature describes improved patient comfort, improved better cosmetic results, and reduced operation time. This is a first study to assess pregnancy outcome after fertility-preserving vNOTES procedures. Design/Participants/Materials/Setting/Methods: We performed a retrospective observational cohort study including 125 patients under 43 years that underwent fertility-preserving vNOTES over a 5-year period (2014–2019). The gynecological surgical procedures included were vNOTES myomectomy, vNOTES salpingectomy for ectopic pregnancy, vNOTES unilateral adnexectomy, and vNOTES cystectomy. A total of 26 pregnancies in 21 cases were observed, with deliveries between 2015 and 2020. Results: Retrospective analysis in this patient group showed that 18 pregnancies were diagnosed within 1 year after vNOTES (85.7%). Mean interval between surgery and pregnancy was 6 months. Fertility treatment was performed in 28.6%. In the 26 observed pregnancies, no vNOTES-related complications were observed and delivery was at term in all cases. Mode of delivery was a vaginal delivery in twenty cases (76.9% of total) of which 2 cases vacuum assisted (7.7%) and a Caesarean section in 6 cases (23.1% of total). Two cases of trial of labor after Caesarean are described after vNOTES surgery, both ended in an uncomplicated vaginal delivery. In case of vaginal delivery, the perineum was intact in 15%, a mediolateral episiotomy was performed in 50 and 35% a grade 1–2 perineal rupture was described. No grade 3–4 perineal ruptures are described. Limitations: A limitation of this study is the retrospective design which does not correct for confounding factors. Further larger multicenter studies are needed to validate these data. Conclusions: This is the first study describing pregnancy outcome after fertility-preserving vNOTES procedures. vNOTES did not affect the mode of delivery or cause pregnancy-related complications. vNOTES did not increase the risk of extensive perineal tears during vaginal delivery. These preliminary data show no adverse events when vNOTES is performed in women of reproductive age. Posterior colpotomy as performed in all vNOTES procedures is by itself not an indication for an elective Caesarean section.

The role of surgical flap design (minimally invasive flap vs. extended flap with papilla preservation) on the healing of intrabony defects treated with an enamel matrix derivative: a 12-month two-center randomized controlled clinical trial

ObjectivesMinimally invasive flap designs have been introduced to enhance blood clot stability and support wound healing. Limited data appear to suggest, that in intrabony defects, better clinical outcomes can be achieved by means of minimally invasive flap compared to more extended flaps. The aim of this study was to evaluate the healing of intrabony defects treated with either minimally invasive surgical flaps or with modified or simplified papilla preservation techniques in conjunction with the application of an enamel matrix derivative (EMD).Materials and methodsForty-seven subjects were randomly assigned to either test (N = 23) or control (N = 24) procedures. In the test group, the intrabony defects were accessed by means of either minimally invasive surgical technique (MIST) or modified minimally invasive surgical technique (M-MIST) according to the defect localization while the defects in the control group were treated with either the modified or simplified papilla preservation (MPP) or the simplified papilla preservation technique (SPP). EMD was used as regenerative material in all defects. The following clinical parameters were recorded at baseline and after 12 months: full-mouth plaque score (FMPS), full-mouth bleeding score (FMBS), probing depths (PD), clinical attachment level (CAL), and gingival recession (GR). Early healing index (EHI) score was assessed in both groups 1 week following the surgery. CAL gain was set as primary outcome.ResultsAfter 12 months follow-up, the CAL gain was 4.09 ± 1.68 mm in test group and 3.79 ± 1.67 mm in control group, while the PD reduction was 4.52 ± 1.34 mm and 4.04 ± 1.62 mm for test and control sites. In both groups, a minimal GR increase (0.35 ± 1.11 mm and 0.25 ± 1.03 mm) was noted. No residual PDs ≥ 6 mm were recorded in both groups. CAL gains of 4–5 mm were achieved in 30.4% and in 29.2% of test and control group, respectively. Moreover, CAL gains ≥ 6 mm were recorded in 21.7% of experimental sites and in 20.8% of control sites. No statistically significant differences in any of the evaluated parameters were found between the test and control procedures (P > 0.05). After 1 week post-surgery, a statistically significant difference (P < 0.05) between the groups was found in terms of EHI score.ConclusionsWithin the limits of this pilot RCT, the results have failed to show any differences in the measured parameters following treatment of intrabony defects with EMD, irrespective of the employed surgical technique.Clinical relevanceIn intrabony defects, the application of EMD in conjunction with either MIST/M-MIST or M-PPT/SPPT resulted in substantial clinical improvements.

MP01-18 PROSTATIC ARTERY EMBOLIZATION: RESULTS FROM A LARGE MULTI-INSTITUTIONAL ITALIAN SERIES

MP01-18 PROSTATIC ARTERY EMBOLIZATION: RESULTS FROM A LARGE MULTI-INSTITUTIONAL ITALIAN SERIES

Feasibility of unilateral hemilaminectomy utilizing a Williams retractor for the resection of intradural-extramedullary spinal neoplasms

BackgroundWhile open approaches have historically been used in the surgical treatment of intradural-extramedullary spine tumors, minimally-invasive surgical (MIS) techniques are frequently applied to minimize post-operative complications associated with open surgery. Tubular retractor systems in particular have been employed in combination with the unilateral hemilaminectomy (UHL) approach. Here we describe the use of a Williams retractor as a safe and effective minimally-invasive alternative to tubular retractor systems with similar post-operative outcomes. MethodsWe retrospectively reviewed a cohort of eight patients who underwent unilateral hemilaminectomy using a Williams retractor for the minimally-invasive resection of intradural-extramedullary neoplasms at a large tertiary academic center from 2017 to 2019. Patient demographics, pathologic specimens, radiographic studies, and intraoperative parameters were collected and analyzed. ResultsIn our series, gross total resection was achieved in all cases. Average operative time was 158±40minutes, the mean estimated blood loss (EBL) was 44.4±30.4mL, and mean length of stay was three days. All patients reported symptomatic improvement at follow-up as reported by Visual Analog Scale scores. ConclusionA Williams retractor yields similar outcomes with respect to post-operative pain, operative time, and EBL as it maintains the advantages of the UHL approach in the resection of intradural-extramedullary spine tumors while enhancing feasibility and providing significant cost savings.

Minimally invasive surgery for benign prostatic obstruction: new insights and future technical standards.

This review aims to give a brief description of the latest minimally invasive surgical techniques (MISTs) for the treatment of benign prostatic obstruction (BPO). In recent years technological advances have made the implementation of MISTs in the armamentarium of BPO surgery possible and in many cases could replace standard procedures.These techniques offer many advantages -short recovery time, rapid symptomatic relief, few adverse effects, lower risk of sexual/ejaculatory dysfunction, acceptable durability and most can be performed as an outpatient procedure.Many of the newer MISTs can be performed outside the operating room under local anesthesia, hence the term office-based MIST. A tailored BPO surgical treatment should not only take into account the prostate volume, but also many other factors including possible adverse events and the patient's expectations.Further studies and long-term data are necessary to standardize methods for evaluating the outcomes of these new procedures and to see which will pass the test of time and end-up replacing the gold standard procedures.

Minimally invasive surgical management of a cornual ectopic pregnancy, with and without a concurrent intrauterine pregnancy

To describe techniques for resection of a cornual heterotopic pregnancy. This video demonstrates a surgical technique for excision of a cornual heterotopic pregnancy with narrative video footage using two case examples. The incidence of cornual heterotopic pregnancy is unknown; however, the incidence of heterotopic pregnancy itself has increased through the use of assisted reproductive technologies and the majority of cornual heterotopic pregnancies occur after assisted reproductive technologies use. These cases have been treated traditionally using exploratory laparotomy and cornual wedge resection with good outcomes. With advancements in minimally-invasive surgical techniques, laparoscopic resection of cornual heterotopic pregnancies has been demonstrated to be safe and feasible. A patient with an 8-week cornual heterotopic pregnancy and a patient with a 10-week cornual ectopic pregnancy. Laparoscopic resection of the cornual ectopic pregnancy. Feasibility of a "purse-string" technique for the resection of a heterotopic cornual pregnancy. Robotic-assisted laparoscopic resection of a cornual heterotopic pregnancy can be performed with minimal blood loss with the use of the "purse-string" technique in settings where vasopressin cannot be used for hemostasis. This technique includes the use of a 2-0 V-Loc suture in a circumferential fashion around the ectopic pregnancy, which allows for faster suturing and immediate tension at the myometrium. The same suture is then used to close the defect, which allows for a simpler and efficient closure with minimal entry into the myometrium. In this video, we demonstrate the successful resection of cornual heterotopic pregnancy using a "purse-string" surgical technique. This technique allows for minimal blood loss in cases where additional techniques for hemostasis cannot be used, such as injection of vasopressin and uterine artery ligation.

Contemporary practice patterns of transurethral therapies for benign prostate hypertrophy: results of a worldwide survey.

To perform a global survey to identify contemporary practice patterns of transurethral therapies for benign prostatic hypertrophy. A REDCap survey was distributed to the ~ 3500 members of the Endourological Society. Surgeons completed demographic information and then selected the BPH therapies they perform 10 cases/year. There were four categories of BPH therapies: ablation, enucleation, resection/vaporization, and MIST (minimally invasive surgical technique). Within each category, there were subcategories to account for different energy modalities. All statistical analyses were performed using SAS 9.4. A total of 175 surgeons responded to our survey. Prostate resection/vaporization remained the most commonly utilized technique (51.9%, n = 147/283) followed by enucleation (22.6%, n = 64/283). Bipolar TURP (bTURP) was the most common modality for prostate resection (69.4%, n = 102/147). Holmium laser enucleation (HoLEP) was the most common modality for enucleation (46.9%, n = 30/64). Urolift® was performed more often than Rezūm™ (55.9% vs. 44.1%, n = 19/34 vs. 15/34, respectively). Among surgeons performing ablation, country of practice was a significantly associated with length of stay (LOS), p < 0.0001. For surgeons performing enucleation, academic institution and completion of a fellowship were associated with postoperative day (POD) 1 catheter removal (p = 0.0240 and p = 0.020, respectively). In this contemporary, global survey of the Endourology Society, resection/vaporization techniques were the most commonly performed. Rates of MISTs remained relatively low at 12.1%. Academic institution and fellowship status were associated with shorter catheterization times and LOS for certain surgical categories.

Trends in Diagnosis and Treatment of Sacroiliac Joint Pathology Over the Past 10 Years: Review of Scientific Evidence for New Devices for Sacroiliac Joint Fusion

Sacroiliac (SI) joint pathology is a newly appreciated contributor to lower back pain. Sacroiliac joint fusion (SIJF) has grown rapidly in popularity in association with the advent of minimally-invasive surgical techniques. This has led to an explosion of new medical devices used for SIJF. The objective of this article is to outline clinical trends, summarize the current data, and categorize novel devices for SIJF. Trends in SI joint pathology and fusion were obtained via the Healthcare Cost and Utilization Project’s (HCUP) National Inpatient Sample (NIS) database and Web of Science. To review literature on devices for SIJF, PubMed was searched using the Boolean phrase “sacroiliac joint AND (fusion OR arthrodesis)” since 2010. To establish a list of SIJF devices not represented in the literature, searches were performed on the FDA 510(k), premarket approval, and de novo databases, as well as Google and LinkedIn. Literature review yielded 11 FDA-approved devices for minimally invasive SIJF. Database query yielded an additional 22 devices for a total of 33 devices. Twenty-one devices used the lateral transiliac approach, six posterior allograft approach, three posterolateral approach, and three combined the lateral transiliac and posterolateral approaches. The evidence for the lateral transiliac approach is the most robust. Many novel devices have been developed for minimally invasive SIJF over the past 10 years. Further randomized comparative trials are warranted to evaluate different surgical approaches and novel devices at this time.

Cerebral microemboli in mini-sternotomy compared to mini- thoracotomy for aortic valve replacement: a cross sectional cohort study

BackgroundRecently adopted mini-thoracotomy approach for surgical aortic valve replacement has shown benefits such as reduced pain and shorter recovery, compared to more conventional mini-sternotomy access. However, whether limited exposure of the heart and ascending aorta resulting from an incision in the second intercostal space may lead to increased intraoperative cerebral embolization and more prominent postoperative neurologic decline, remains inconclusive. The aim of our study was to assess potential neurological complications after two different minimal invasive surgical techniques for aortic valve replacement by measuring cerebral microembolic signal during surgery and by follow-up cognitive evaluation.MethodsTrans-cranial Doppler was used for microembolic signal detection during aortic valve replacement performed via mini-sternotomy and mini-thoracotomy. Patients were evaluated using Addenbrooke’s Cognitive Examination Revised Test before and 30 days after surgical procedure.ResultsA total of 60 patients were recruited in the study. In 52 patients, transcranial Doppler was feasible. Of those, 25 underwent mini-sternotomy and 27 had mini-thoracotomy. There were no differences between groups with respect to sex, NYHA class distribution, Euroscore II or aortic valve area. Patients in mini-sternotomy group were younger (60.8 ± 14.4 vs.72 ± 5.84, p = 0.003), heavier (85.2 ± 12.4 vs.72.5 ± 12.9, p = 0.002) and had higher body surface area (1.98 ± 0.167 vs. 1.83 ± 0.178, p = 0.006). Surgery duration was longer in mini-sternotomy group compared to mini-thoracotomy (158 ± 24 vs. 134 ± 30 min, p < 0.001, respectively). There were no differences between groups in microembolic load, length of ICU or total hospital stay. Total microembolic signals count was correlated with cardiopulmonary bypass duration (5.64, 95%CI 0.677–10.60, p = 0.027). Addenbrooke’s Cognitive Examination Revised Test score decreased equivalently in both groups (p = 0.630) (MS: 85.2 ± 9.6 vs. 82.9 ± 11.4, p = 0.012; MT: 85.2 ± 9.6 vs. 81.3 ± 8.8, p = 0.001).ConclusionThere is no difference in microembolic load between the groups. Total intraoperative microembolic signals count was associated with cardiopulmonary bypass duration. Age, but not micorembolic signals load, was associated with postoperative neurologic decline.Trial registry numberclinicaltrials.gov, NCT02697786 14.

Evaluation of the outcomes of laparoscopic splenectomy in non-traumatic pathological splenic disorders

Background: currently,minimal invasive surgical techniques were used for several operations in general surgery. Less intra-operative blood loss,less post-operative pain and shorter hospital stay results are some of the benefits that make laparoscopy the best approach for many surgical procedures.Therefore, laparoscopic splenectomy since 1991 when was first described by Delaitre and Maignien. In general, indications for laparoscopic splenectomy are the same as those of open splenectomy, except for the trauma cases, where the role of laparoscopy is still debatable. The introduction of advanced laparoscopic tools for ligation, dissection and vessels sealing devices resulted in less operative time and less intra-operative complications. However, some contraindications still applied, more studies are needed to determine the real value of laparoscopy in massive splenomegaly. Objectives:The aim of the work is evaluation of the outcomes, safety and efficacy of laparoscopic splenectomy in non-traumatic splenic disorders. Patients and methods: This prospective study conducted on patients with hematological disorders indicated for splenectomy for one year. Results: We operated 20 patients of laparoscopic splenectomy, 70% were females, their mean of age by years were 18.9 ± 9.1. No post-operative complications the mean of operation time byhours was3.2 ± 0.7, while the mean of hospital stay was 2.3 ± 0.2 days. The total intra-operative blood loss was about 50–600 ml. Conclusion: Laparoscopic splenectomy for elective operations of the spleen is a safe method associated with a lower risk of peri-operative complications,less mortality and morbidity.

Development of surgical concepts in rectal cancer resection and challenges in minimally invasive surgical proctectomy

Since the early 1900s there have been dramatic changes in the management of patients with rectal cancer. Surgical approaches initially performed for palliation, have now been adapted, modernised and undertaken as part of a multimodal approach. This has resulted in significant improvements in long-term oncological survival and patient quality of life. With the introduction of total mesorectal excision (TME) in the 1980's, and its global acceptance by the surgical community, local and distant disease-free survival in patients with rectal malignancy has significantly improved. Since the inception of minimally invasive surgery, laparoscopy has seen dramatic changes both in the evolution of technological advances and application in multiquadrant surgery for colorectal malignancy. Favorable short-term clinical benefits and long-term oncological equivalence from many multicentre randomized controlled trials in laparoscopic colonic cancer resection has led the colorectal surgical community to translate and adapt minimally invasive surgical (MIS) techniques for proctectomy in patients with rectal tumours. MIS proctectomy is technically challenging and is associated with a steep learning curve. Reported challenges in the literature continuously identify a group within three common themes which can be divided into patient/anatomical factors, tumour characteristics and the use of neoadjuvant therapies. Despite a large body of evidence highlighting efficacy of MIS in proctectomy, significant challenges exist in male patients with a narrow pelvis and distal tumors. Such patients are at increased risk of a poor surgical specimen, positive distal and circumferential resection margins (CRMs), and increased local recurrence. Despite advances in laparoscopy and robotic platforms, approaching such lesions from a “top down” approach expose the ongoing limitations to lower pelvic access. This technically challenging issue has led to the colorectal surgical community adopting previously taught MIS techniques to develop a “bottom up” transanal approach to TME, now known as transanal TME (taTME) in order to mitigate this increased margin risk.

Open versus minimally-invasive surgical techniques in pediatric renal tumors: A population-level analysis of in-hospital outcomes

Minimally-invasive surgery (MIS) has been adopted slowly in pediatric oncology. We attempted to describe contemporary national trends in MIS use; we hypothesized that adolescents (who are more likely to have relatively small renal cell carcinomas) would have a higher proportion of MIS than younger children (who are more likely to have relatively large Wilms tumors) and that this relationship would vary by region. To explore whether pediatric urologic oncology outcomes vary by patient age or by surgical technique. We queried the 1998-2014 National Inpatient Sample (NIS) and included encounters in children aged≤18y, ICD-9 diagnostic code for renal tumor, and procedure code for open or MIS partial or radical nephrectomy. All analyses used weighted descriptive statistics and outcomes are compared based on age group (</>10y) or surgery type; Wald-Chi square test was used for differences in proportions and unadjusted weighted ANOVA was used to test for differences in means. 9259 weighted encounters were included; 91% were <10 years old and 50.7% were female. MIS surgery accounted for 1.8% of encounters; there was a difference in proportions by age group (1% <9y vs. 9.9% >9y, p<0.01). The proportion of surgery type was similar across regions within age groups, however. Complications occurred in 13.3% of encounters; mean inpatient length of stay was 8.9 days (SD: 0.3); mean cost was $ 34,457.68 (SD: $1197.00). There was no evidence of a difference between surgery type and proportion of post-operative complications, mean inpatient length of stay or mean inpatient cost. The admission-based, retrospective design of NIS left us unable to assess long-term outcomes, repeated admissions, or to track a particular patient across time; this is particularly relevant for oncologic variables on interest such as tumor stage or event-free survival. We were similarly limited in evaluating the effect of pre-surgical referral patterns on patient distributions. In this preliminary descriptive analysis, MIS techniques were infrequently used in children, but there was a higher proportion of MIS use among adolescents. There were similar proportions of surgery type across geographic regions within the United States. Whether this infrequent usage is appropriate is as yet unclear given the lack of Level I evidence regarding the relative merits of MIS and open surgery for pediatric and adolescent renal tumors.

Insular seizures and epilepsies: Ictal semiology and minimal invasive surgery.

The increased identification of seizures with insular ictal onset, promoted by the international development of stereo-electroencephalography (SEEG), has led to the recent description of larger cohorts of patients with insular or insulo-opercular epilepsies than those previously available. These new series have consolidated and extended our knowledge of the rich ictal semiology and diverse anatomo-clinical correlations that characterized insular seizures. In parallel, some experiences have been gained in the surgical treatment of insular epilepsies using minimal invasive procedures. The large majority of patients present with auras (mostly somatosensory and laryngeal) and motor signs (predominantly elementary and orofacial), an underlying focal cortical dysplasia, and an excellent postoperative seizure outcome. Many other subjective and objective ictal signs, known to occur in other forms of epilepsies, are also observed and clustered in five patterns, reflecting the functional anatomy of the insula and its overlying opercula, as well as preferential propagation pathways to frontal or temporal brain regions. A nocturnal predominance of seizure is frequently reported, whereas secondary generalization is infrequent. Some rare ictal signs are highly suggestive of an insular origin, including somatic pain, reflex seizures, choking spells, and vomiting. Minimal invasive surgical techniques have been applied to the treatment of insular epilepsies, including Magnetic Resonance Imaging-guided laser ablation (laser interstitial thermal therapy (LITT)), radiofrequency thermocoagulation (RFTC), gamma knife radiosurgery, and responsive neurostimulation. Rates of seizure freedom (about 50%) appear lower than that reported with open-surgery (about 80%) with yet a significant proportion of transient neurological deficit for LITT and RFTC. Significant progress has been made in the identification and surgical treatment of insular and insulo-opercular epilepsies, including more precise anatomo-clinical correlations to optimally plan SEEG investigations, and experience in using minimal invasive surgery to reduce peri-operative morbidity.

Periodontal regenerative therapy in patients with type 2 diabetes using minimally invasive surgical technique with enamel matrix derivative under 3-year observation: A prospective cohort study.

Information regarding periodontal regenerative therapy in patients with diabetes mellitus (DM) is limited. This pilot study compared the regenerative outcomes of minimally invasive periodontal surgery using enamel matrix derivative (EMD) between DM and non-DM patients. This prospective study included deep intrabony defects in patients with or without type 2 DM. Minimally invasive surgical technique (MIST) or modified MIST (M-MIST) using EMD, without bone graft materials, was performed. Periodontal examination and intraoral radiography were performed at baseline, 6 months, and 1 and 3 years after surgery. Ten sites of 10 subjects in the DM group, and 20 sites of 18 subjects in non-DM group were evaluated (mean age; 67.5 ± 7.6 and 63.1 ± 9.7, respectively). Probing depth significantly decreased from 7.1 ± 1.6 and 7.0 ± 1.3mm to 2.2 ± 0.9 and 2.3 ± 1.1mm at the 1-year examination in the DM and non-DM groups, respectively. Clinical attachment level (CAL) gain and radiographical defect fill at the 3-year examination were 3.8 ± 1.1mm and 58.3% ± 10.4%, respectively, in the DM group, and 4.1 ± 1.1mm and 65.5% ± 18.8%, respectively, in the non-DM group, showing no significant differences between the groups. Multiple regression analysis showed no significant association of CAL gain with DM or age after adjustments for relevant confounders. This is the first documented study of successful periodontal tissue regeneration in patients with DM. Minimally invasive surgery combined with EMD yielded significant clinical attachment gain and bone fill in the DM and non-DM groups at comparable levels.