Minimum Incision Research Articles

Mid-Term Outcome of the Hybrid Method of Ventricular Septal Defect Closure in Children.

<b>Objective: </b>To describe the clinical experiences and mid-term follow-up results of the hybrid method of ventricular septal defect closure in children.<br /> <b>Methods: </b>This study was a combined - multidirectional cohort. Between May 2016 and December 2020, 250 patients with isolated VSD (or residual VSD after a previous repair) underwent surgery by the hybrid method at the pediatric cardiac surgery department in the National Scientific Medical Center. This study adopted a combined and multidirectional cohort approach, initially starting as a retrospective cohort and later transitioning into a prospective cohort.<br /> <b>Results: </b>A total of 250 patients in this cohort underwent hybrid VSD closure, of which 233 (93.2%) patients were successful, 16 (6.4%) patients were converted to the traditional method and 1 (0.4%) death occurred. New trivial or mild tricuspid regurgitation was detected in 35 patients (15%) and aortic regurgitation in 9 patients (3.9%) by intraoperative TEE. For the remaining 10 patients with incomplete right bundle branch blocks the sinus rhythm was restored in follow-up. In addition, the left ventricular ejection fraction improved over time. One of the important points after surgery is the deformation of the chest. In 122 (91%) patients, there is no deformation; unfortunately, in 12 (9%) patients, there is deformation. <br /> <b>Conclusions: </b>The hybrid method is a rapidly developing technique that has been safe and effective in a selected group of patients in recent years. The advantages of this method are minimum incision namely the size and length of the postoperative scar from 2 to 4 cm. Also, no myocardial injury, and reduces operation time, intensive care unit stay, and hospital stays.

Trends of radical cystectomy and comparisons of surgical outcomes among surgical approaches focusing on robot-assisted radical cystectomy: A Japanese nationwide database study.

To clarify the trends in radical cystectomy and to compare surgical outcomes among surgical approaches focusing on robot-assisted radical cystectomy based on a Japanese nationwide database. The Diagnosis Procedure Combination database was used to extract data on radical cystectomy cases. Trends in open radical cystectomy, laparoscopic radical cystectomy, minimum incision endoscopic radical cystectomy, and robot-assisted radical cystectomy between April 2012 and March 2021 were evaluated. Basic characteristics and peri-operative indicators were compared among the four groups. Propensity score matching was applied to assess the differences between open radical cystectomy and robot-assisted radical cystectomy. During the study period, a decreasing number of open radical cystectomies and an increasing number of minimally invasive radical cystectomies were shown in the total cohort of 28 345 cases. The number of robot-assisted radical cystectomies rapidly increased after government approval in 2018. Minimally invasive radical cystectomies, including robot-assisted radical cystectomies, had a significantly lower complication rate, a shorter length of stay, and a lower blood transfusion rate, but a longer anesthesia time than open radical cystectomies. In the propensity score matching analysis comparing the surgical outcomes of robot-assisted radical cystectomy and open radical cystectomy, similar results were demonstrated, and blood transfusion rates were equivalent. For the past decade, the number of minimally invasive radical cystectomies has steadily increased without compromised surgical outcomes, except for anesthesia time. Robot-assisted radical cystectomies in particular rapidly became widespread in Japan after government approval in 2018 and became a standard surgery within the first 3 years.

Estimating the long-term slip rate of active normal faults: The case of the Paganica Fault (Central Apennines, Italy)

The footwall of the surface rupturing Paganica normal fault, the source of the 2009 L’Aquila earthquake (Mw 6.1) in the Central Apennines (Italy), was investigated using integrated geological and geomorphological approaches. The aim was to constrain the active tectonics by studying the Raiale River that orthogonally crosscuts the fault trace, where it provides a useful geomorphological marker of long-term fluvial incision and footwall uplift. Using morphostratigraphy and paleomagnetic analysis, the Plio–Pleistocene morphotectonic evolution of the area was reconstructed, comprising an ancient continental basin and paleolandforms that predate the footwall incision. Starting from the Late Early Pleistocene–Middle Pleistocene, fluvial dissection was mainly due to marked river downcutting triggered by significant activity of the Paganica Fault, which caused progressive base-level lowering. The Raiale River downcutting formed five Middle–Late Pleistocene fluvial terraces, that, along with absolute Optically Stimulated Luminescence (OSL) dating, allowed the identification of paleolongitudinal profiles with a diverging downstream configuration. Terrace dating yielded a minimum incision rate of 0.25 ± 0.02 mm/a, which only partially compensates the footwall uplift and can thus be considered as a minimum value for the Paganica Fault throw rate, which could reach up to ~0.45 mm/a. In parallel, using terrestrial cosmogenic nuclides, a denudation rate of 0.02–0.04 mm/a was measured on the summit of the footwall block. This denudation is in keeping with the drainage incision, suggesting a non-steady state for the fault footwall topography and a dominance of relief growth. Last, the analysis of the modern Raiale River longitudinal profile denoted an ungraded status, with two main knickzones that we interpret as transient forms due to tectonic perturbations, likely triggered by activity of the Paganica Fault during the end Early Pleistocene and the Late Pleistocene. Considering the 2009 L’Aquila earthquake coseismic rupture, we observe that the younger transience on the Raiale River longitudinal profile, if it is of tectonic origin, could have only been produced by much larger seismic events (i.e., Mw > 6.5) than those documented in the area by paleoseismological investigations. The collective results confirmed that in the Central Apennines, conditions of dynamic equilibrium are often not met, and that the persistence of transient perturbations induced by tectonics should be accounted for.

Short or Minimum Incision Deep Plane/Extended Deep Plane Facelift/Rhytidectomy.

The mini facelift, often referred to as short scar or minimum incision facelift or rhytidectomy, is a facial rejuvenation procedure with limited incisions. It aims to lift and tighten the superficial musculo-aponeurotic system to restore the lower midface and the mandibular contour, thus eliminating undesirable jowls. By performing the deep plane or extended deep plane facelift with short incisions, the midface and upper neck can also be improved without the full face and neck incisions as in the typical rhytidectomy. With its decreased operative time and expense, rapid recovery, less complications, as well as more limited incisions with resultant less evidence of scars, mini facelift techniques have boomed over a decade for younger patients who seek facial rejuvenation. We describe our concept of the short or minimum incision deep plane/extended deep plane facelift or rhytidectomy and address what results can be expected.

Rapid incision events since 3.7 ka in the Anjihaihe Gorge along the northern Tianshan range, China

Young river terrace levels distributed along active tectonic regions and major river channels record the histories of the most recent tectonic activities and geomorphological evolution. There are 18 terraces in the upper reach of the Anjihaihe River, along active zones of the northern Tianshan in China. The surface of these young terrace insets is covered by Aeolian loess and fluvial deposits. Consequently, optically stimulated luminescence (OSL) dating was used to reveal the burial ages of those sediments, and to calculate the tectonic deformation and fluvial incision rate. However, the ages of young quartz sediments are difficult to determine due to the weak and dim OSL signal characteristics, and therefore geological and geomorphological information was not forthcoming. Recently, however, a “simplified procedures” methodology was developed to overcome these dating problems. Loess deposits can constrain the minimum abandonment age and fluvial sands were used to provide the age limits of formation, which correspond to the maximum and minimum incision rates. The elevation of each terrace above the modern river bed was obtained using a Digital Elevation Map with 12-m resolution, Google Earth images, and portable Global Positioning System measurements. Together with the results of the OSL dating and the elevation measurements, we conclude that the Anjihaihe River has incised the gorge to a depth of ~260 m since 3.7±0.2 ka, with a maximum average incision rate of 7.2±0.1 cm/a. The incision record can be divided into four major stages: ~3.7−3.0, ~3.0−2.4, ~2.4−1.3 ka, and from 1.3 ka to the present; the respective average incisive rates are 3.1±0.3, 15±0.3, 8.5±0.2, and 4.6±0.4 cm/a. The results indicate that the incision occurred in a series of steps which coincided with environmental changes in the region. As a result, this set of 18 strath terrace levels has recorded the aggradational-degradational surface processes of the Anjihaihe River gorge since ~3.7 ka. Before ~3.7 ka, a thickness of ~260 m of fluvial sands was aggraded above the pre-Quaternary bedrock. Subsequently, the river incised these sand layers until T11, and then, before the formation of T11, younger fluvial sands were deposited on the top of older deposits after 2.4 ka. The AJH River then continued to vertically erode these younger sands until 1.3 ka, when the incision reached the pre-Quaternary bedrock. From 1.3 ka to the present, at least five strath terraces were formed in the gorge. These surface processes and rapid incisive rates are ascribed to the specific lithological and geomorphological characteristics of the area, under the influence of climate change. First, the bedrock of the terrace levels is composed of pre-Quaternary sandstones, and more homogeneous, less consolidated siltstones and sandy mudstones. In addition, the upper terraces are covered by mixed cobbles and sands with a thickness of ~100 m above the bedrock, and the lower terraces by a thin layer of fluvial sands above the pre-Quaternary bedrock. Second, the variations in the flux of river water and sediments during episodes of climate change influenced the slope of the terrace surface, resulting in changes in aggradational-degradational processes and in the energy of the incision. Climate change was also a driving force, because the abrupt changes in incision rate correspond well to anomalous climatic events. Overall, the specific geomorphological characteristics and location of the Anjihaihe River have resulted in its recording an unusually rapid incision rate within the Anjihaihe Gorge.

Emergency cricothyroidotomy: an observational study to estimate optimal incision position and length

BackgroundA vertical incision is recommended for cricothyroidotomy when the anatomy is impalpable, but no evidence-based guideline exists regarding optimum site or length. The Difficult Airway Society guidelines, which are based on expert opinion, recommend an 80–100 mm vertical caudad to cephalad incision in the extended neck position. However, the guidelines do not advise the incision commencement point. We sought to determine the minimum incision length and commencement point above the suprasternal notch required to ensure that the cricothyroid membrane would be accessible within its margins. MethodsWe measured using ultrasound, in 80 subjects (40 males and 40 females) without airway pathology, the distance between the suprasternal notch and the cricothyroid membrane, in the neutral and extended neck positions. We assessed the inclusion of the cricothyroid membrane within theoretical incisions of 0–100 mm in length made at 10 mm intervals above the suprasternal notch. ResultsIn the 80 subjects, the distance ranged from 27 to 105 mm. Movement of the cricothyroid membrane on transition from the neutral to extended neck position varied from 15 mm caudad to 27 mm cephalad. The minimum incision required in the extended position was 70 mm in males and 80 mm in females, commencing 30 mm above the suprasternal notch. ConclusionsAn 80 mm incision commencing 30 mm above the suprasternal notch would include all cricothyroid membrane locations in the extended position in patients without airway pathology, which is in keeping with the Difficult Airway Society guidelines recommended incision length.

Visualization During Endoscopic Versus Open Cubital Tunnel Decompression: A Cadaveric Study

To determine the minimum incision size needed using an open cubital tunnel technique to obtain equivalent visualization comparable with an endoscopic technique. Visualization was assessed in 10 fresh-frozen cadavers with a 2-cm incision, using percutaneous needle localization with the endoscopic system. The most proximal and distal extent of the field of view was marked. Next, an open cubital tunnel release was performed on each cadaver specimen. The incision size was increased incrementally, and the most proximal and distal extents of visualization were recorded for each incision size. The mean visualization distance and standard deviation for each incisional length were calculated. The mean proximal field of view with the endoscopic technique was 8.1 cm. The mean distal field of view was 8.3 cm. Using the open technique, a 2-cm incision allowed 5.9 cm visualization proximally and 5.2 cm distally, which was significantly less than the endoscopic view. A 4-cm open incision provided similar visualization as the endoscopic technique. A 6-cm open incision was required to obtain statistically significant improvements in visualization compared with an endoscopic technique. A 4-cm open incision allowed visualization of approximately 9 cm proximal and 9 cm distal to the medial epicondyle, which was equivalent to the 2-cm endoscopic technique for cubital tunnel release. Although the endoscopic release allows greater visualization of the ulnar nerve with a smaller incision, it is unclear whether this improvement in visualization improves the surgeon's ability to decompress the ulnar nerve.

215P - Comparison between robot-assisted radical prostatectomy and minimum incision endoscopic radical prostatectomy for high-risk prostate cancer following neoadjuvant therapy: A propensity score-matched analysis

215P - Comparison between robot-assisted radical prostatectomy and minimum incision endoscopic radical prostatectomy for high-risk prostate cancer following neoadjuvant therapy: A propensity score-matched analysis

Robotic cross-folded U-configuration intracorporeal ileal neobladder for muscle-invasive bladder cancer: Initial experience and functional outcomes.

BackgroundThis study compared the surgical and urinary functional outcomes in patients with muscle‐invasive bladder cancer (MIBC) who underwent robot‐assisted radical cystectomy (RARC) followed by intracorporeal ileal neobladder reconstruction (ICNB) to those in patients who underwent minimum incision endoscopic radical cystectomy (MIE‐RC) followed by extracorporeal ileal neobladder reconstruction (ECNB).Materials and MethodsThis study reviewed the clinical records of 153 consecutive MIBC patients who underwent neoadjuvant chemotherapy followed by radical cystectomy and ileal neobladder reconstruction.ResultsThe operative time in the ICNB group was significantly longer than that in the ECNB group. The median estimated blood loss was significantly less in the ICNB group than in the ECNB group. The neobladder capacity gradually increased in both groups. The maximum neobladder pressure and urethral closure pressure gradually improved in both groups.ConclusionOur initial experience with ICNB was favourable, with acceptable surgical and urinary functional outcomes.

Theoretical optimal cricothyroidotomy incision length in female subjects, following identification of the cricothyroid membrane by digital palpation

BackgroundMisidentification of the cricothyroid membrane is frequent in females, placing them at risk of difficult or failed cricothyroidotomy in the event of failed oxygenation. If anatomy is impalpable, the current guidelines of the Difficult Airway Society, based on expert opinion, recommend an 8–10 cm vertical incision to facilitate access to the cricothyroid membrane. At present no evidence-based guideline exists regarding optimum site or length. We investigated the likelihood of inclusion of the cricothyroid membrane, within hypothetical vertical midline incisions, in a female population. MethodsWe asked clinicians to identify the cricothyroid membrane in both the neutral and extended head positions using palpation, the point identified acting as the theoretical midpoint of a cricothyroidotomy incision. We then identified the cricothyroid membrane using ultrasound. We determined the minimum incision length that would be required to ensure that the cricothyroid membrane lay within its boundaries, if clinician digital palpation was the method of cricothyroid membrane localisation. ResultsNinety female subjects were recruited. Theoretical incisions of 7 and 8 cm were required for successful cricothyroidotomy in the neutral and extended head positions respectively. This was necessary because of the high failure rate of cricothyroid membrane identification (80.9%) and the wide range of error (7.2 cm in a vertical plane). ConclusionsBased on clinical estimation of the location of the cricothyroid membrane, an incision length of 8 cm, using the clinician’s best estimate as its midpoint, would overlie all cricothyroid membrane locations. Our data support the current Difficult Airway Society guidelines for cricothyroidotomy incision length.

Introduction of Minimum Incision Endoscopic Radical Prostatectomy with Intentional Wide Resection for Locally Advanced Prostate Cancer at the St. Marianna University School of Medicine

Introduction of Minimum Incision Endoscopic Radical Prostatectomy with Intentional Wide Resection for Locally Advanced Prostate Cancer at the St. Marianna University School of Medicine

TCT-362 A novel fully percutaneous thrombectomy technique with balloon occlusion guiding catheter and over-the-wire Fogarty catheter for acute limb ischemia

Before the “Fogarty” era, direct incision was the only way to save the patient with atrial thrombi. After Dr. Fogarty invented the unique catheter, we can retrieve it with minimum incision. But it really needs “incision”. We invented a novel fully percutaneous thrombectomy technique and

Detection of digestive malignancies and post-gastrectomy complications via gastrointestinal fluid examination.

To date, gastric carcinoma (GC) is one of the common and fatal digestive malignancies worldwide. The prognosis of GC is not always satisfactory because of late diagnosis. Scholars are keen on discovering novel accurate and economical biomarkers in body liquids for GC screening to detect and evaluate the lesion before the results of imaging techniques are obtained. While traditional serum assays have limited sensitivity and specificity, gastrointestinal juice may provide relevant specific biomarkers because of its close contact with the tumor. Herein, the current progress in the relationship between gastrointestinal fluid analyses and GC is systematically and comprehensively reviewed. The detection of gastric juice pH, fluorescence spectrum, cytology, Helicobacter pylori-associated markers, nitrosamines, conventional tumor markers, amino acids, proteomics, microRNAs, long noncoding RNAs, protein-coding genes, vitamin C, etc., and combination tests of different category markers could provide important diagnostic and prognostic clues for gastrointestinal diseases. Particularly, early GC may be efficiently screened using gastric juice. Gastrointestinal fluid examination could also predict the adverse effects of postgastrectomy, such as pancreatic leakage, fistula, and abscess. Gastric fluid markers should be further studied to reveal the early predicators of malignancy and complications. The methods for obtaining the samples of gastrointestinal juice with minimum incision should also be comprehensively investigated.

Are horse age and incision length associated with surgical site infection following equine colic surgery?

It is our clinical impression that age and incision length are more strongly associated with surgical site infection (SSI) following colic surgery than skin closure or wound protection method. Therefore, the objective of this observational clinical cohort study was to identify the risks for SSI in horses undergoing colic surgery. Data collection included pre-, intra-, and postoperative variables. Variables with P < 0.2 following univariable analysis were used in a logistic regression multivariable model. Variables with P < 0.05 were included in the final model. Odds ratios (OR; 95% confidence intervals, 95% CI) were determined. The area under the curve (AUC) for the receiver-operator characteristic was calculated.The final multivariable model included breed (P = 0.008), incision length (P = 0.004), surgical procedure classification (P < 0.001), and postoperative (PO) colic (P = 0.037; overall model P < 0.001, and AUC was 0.81 [excellent discrimination between SSI vs. no SSI]). Warmbloods (OR 12.0; 95% CI 2.7–74.8), American breeds (OR 6.4; 95% CI 1.2–43.0), and Thoroughbreds (4.5; 95% CI 1.1–25.5) more commonly had SSI than other breeds (ponies/miniature horses, Draft breeds, Standardbreds, Arabians, and Crossbreeds [referent]). A higher SSI rate was associated with incision lengths >27 cm (3.7; 95% CI 1.5–9.9), heavily contaminated procedures (12.0; 95% CI 3.3–49.9), and horses with PO colic (2.7; 95% CI 1.1–6.8). SSI appeared to be more common after heavily contaminated procedures and in horses with PO colic, which probably resulted in more incisional contamination and trauma. Some breeds appeared to have higher odds of SSI. Age was not associated with SSI. The risk of developing SSI was higher for horses with an incision >27 cm; therefore, surgeons are encouraged to use the minimum incision length required to accomplish the necessary abdominal exploration and bowel manipulation in the safest manner possible.

Technique to minimize the incision length, in Minimally Invasive Dynamic Hip Screw procedure for the treatment of Intertrochanteric fractures of femur

Background: Fractures around the hip not only are very prevalent, but need more attention also, since the enhanced average life expectancy, the resultant elderly-osteoporotic-population pool has expanded, present orthopaedic surgeons are aflood with such cases[1–4]. The intertrochanteric fractures comprise 50% of the fractures around the hip[5]. Intertrochanteric fractures in the elderly are associated with high rates of mortality, ranging from 15 to 20%, as they are at a high risk for deep vein thrombosis (DVT), urinary tract infections, and pulmonary embolism when they fail to mobilize or ambulate early[6]. Early mobilization is only possible when stable fixation is achieved with less post-operative pain and when patients become haemo-dynamically stable. Aims & Objective: 1. Even though minimally invasive DHS surgery is popular since last decade, still we intended to develop a truly minimally invasive technique without the need of any special instrumentation. 2. To confirm whether the proposed minimum incision allows sound fixation, without damaging the corners of the skin incision. Materials & Methods: This is a prospective study done over a period of 2 years at the Department of Orthopaedics at a Tertiary Care Centre. Patients presenting to the Department of Orthopaedics, Index Medical College with intertrochanteric fractures were evaluated and analysed to be included in the study. 54 patients, who presented with an intertrochanteric femur fracture and who fulfilled the inclusion criteria were enrolled in the study Generally, for an AO 31 A1.1 and an A1.2 fracture, a two hole DHS plate is enough(14), but when we are not sure of the quality of implants or sound purchase of the screws in cortex, we use four hole standard barrel side 135 degrees plate. It is inserted first beneath the muscle inside-surface-out, grasping the barrel then slid along the shaft and then again turned inside-surface-inside, manually. Results: 1.

Management of pediatric forearm fracture, a prospective study comparing the outcome of open reduction internal fixation with plate and screws method and closed reduction flexible intramedullary nailing method

Background and Objectives: to compare the outcome of open reduction-internal fixation with plate and screws method and closed reduction-flexible intramedullary nailing method in the management of pediatric patients with unstable forearm fractures as regard to functional and cosmetic outcome. Patients and Methods: The final assessments of 42 pediatric patients between the ages of 5 to 15 years old, who were operated from April 2010 to February 2011 for both-bone forearm fractures in Erbil Teaching Hospital and Private Hospital with adequate follow up, were done and their medical records were prospectively evaluated. Results:42 children with unstable forearm fractures 21 were treated with open reduction and internal fixation of both radius and ulna using plate and screws (Group1)(mean age ,13years) and 21 were treated with close reduction and flexible intramedullary fixation (Group2)( mean age ,11years). Patient characteristics in the 2 groups were compared. In Four patients of Group 2, closed reduction was not possible because of soft tissue interposition that required open reduction with minimum incision at the fracture site. All patients achieved bone union; the mean union times were similar (P value=0.81), only one patient in each group had delayed union. Operating times were shorter in flexible nailing group (100 minutes in Group1 vs. 69 minutes in Group2, p&lt;0.001). Conclusions: There was no significant difference in union rate between the methods. The functional outcome between the two groups was compared; there was no significant difference between them. Like other investigators, we also found 90.5% of excellent functional outcomes after the treatment of unstable forearm fractures by means of plating. As indicated in the literature, we found 95% of excellent functional results after flexible intramedullary nailing.

Articulated minimally invasive surgical instrument based on compliant mechanism.

In minimally invasive surgery, instruments are inserted from the exterior of the patient's body into the surgical field inside the body through the minimum incision, resulting in limited visibility, accessibility, and dexterity. To address this problem, surgical instruments with articulated joints and multiple degrees of freedom have been developed. The articulations in currently available surgical instruments use mainly wire or link mechanisms. These mechanisms are generally robust and reliable, but the miniaturization of the mechanical parts required often results in problems with size, weight, durability, mechanical play, sterilization, and assembly costs. We thus introduced a compliant mechanism to a laparoscopic surgical instrument with multiple degrees of freedom at the tip. To show the feasibility of the concept, we developed a prototype with two degrees of freedom articulated surgical instruments that can perform the grasping and bending movements. The developed prototype is roughly the same size of the conventional laparoscopic instrument, within the diameter of 4 mm. The elastic parts were fabricated by Ni-Ti alloy and SK-85M, rigid parts ware fabricated by stainless steel, covered by 3D- printed ABS resin. The prototype was designed using iterative finite element method analysis, and has a minimal number of mechanical parts. The prototype showed hysteresis in grasping movement presumably due to the friction; however, the prototype showed promising mechanical characteristics and was fully functional in two degrees of freedom. In addition, the prototype was capable to exert over 15 N grasping that is sufficient for the general laparoscopic procedure. The evaluation tests thus positively showed the concept of the proposed mechanism. The prototype showed promising characteristics in the given mechanical evaluation experiments. Use of a compliant mechanism such as in our prototype may contribute to the advancement of surgical instruments in terms of simplicity, size, weight, dexterity, and affordability.

Minimum incision no skin suture external dacryocystorhinostomy.

To report the technique and results of 5-mm incision no skin suture external dacryocystorhinostomy procedure (Ext-DCR). In a retrospective interventional case series, 77 patients (85 procedures) with nasolacrimal duct obstruction (NLDO) were included. The size of skin incision was 5 mm. Silicone tube was inserted in all and planned to be removed 6 weeks after the operation. Functional success was defined as no symptom or just excess tear in the cold weather and anatomical success as free irrigation at last follow-up time (at least 6 months) when patients' satisfaction (visual analogue score) on the site of incision was also recorded. There were 85 procedures in 77 patients (52 women; 67.5%) with primary acquired (82) or traumatic (3) NLDO and with a mean age of 52.9 years and follow up of 12.9 months. Associated common canalicular stenosis (membrane) was found in 15 (17.6%), canalicular stenosis in 2 (2.4%), and both in 2 (2.4%) cases. Anatomical and overall functional success was 98.8% (84/85) and 95.3% (81/85), respectively. Subjects with canalicular stenosis had a lower anatomical (75%) and functional (50%) success rates, which were statistically significant (p=0.00). Wound elongation (up to 8 mm) was observed in 3 cases, which did not require skin suturing. Mean patient satisfaction score for the appearance of incision was 99.2. Minimum incision (5 mm) no skin suture Ext-DCR offers high patient satisfaction and success rates.

Gasless minimum incision access used for extracorporeal orthotopic bladder substitution after laparoscopic radical cystectomy.

IntroductionRadical cystectomy is the gold standard for treating invasive bladder cancer. We report our outcomes of gasless minimum incision access (GMIA) for extracorporeal orthotopic bladder substitution (ECOBS) after laparoscopic radical cystectomy.Material and methodsRadical surgery was performed in patients in the same hospital suffering from bladder cancer in T2N0M0 G1–2 stage. Group 1 included 11 patients aged 56.6 (42–72) years, which underwent laparoscopic radical cystectomy and ECOBS using GMIA. Group 2 included 18 patients aged 56.7 (41–76) years, which were operated by open radical cystectomy and orthotopic bladder substitution.ResultsThe average duration of operation was 492.0 ±85.7 minutes in Group 1 and 318.0 ±58.0 in Group 2 (p = 0.001). Estimated blood loss was 290.0 ±120.0 and 613.2 ±359.0 ml in groups respectively. In the postoperative period, narcotic analgesics were used in the amount of 166.0 ±28.0 mg and 264.0 ±112.0 mg (p = 0.05), intestinal function recovery was observed on 3.5 ±0.9 and 6.0 ±2.9 days after the operation (p = 0.05) in the groups respectively. Minor postoperative complications were observed in 36.4% and 56.0%, major complications – in 9.1% and 11.2% in groups respectively. Median hospitalization time was 19.0 ±2.0 days in Group 1 and 24.9 ±6.5 in Group 2 (p = 0.01).ConclusionsGMIA in ECOBS can be used as an effective surgical approach after laparoscopic radical cystectomy; this method requires further observation.

Assessment of postoperative quality of life: comparative study between laparoscopic and minimum incision endoscopic radical prostatectomies

To investigate the changes in postoperative quality of life (QOL) in patients with prostate cancer who underwent laparoscopic radical prostatectomy (LRP) or minimum incision endoscopic radical prostatectomy (MIE-RP). This study included a total of 115 Japanese patients with clinically localized prostate cancer who underwent either LRP or MIE-RP and were subsequently followed for more than 12 months. Before and 12 months after surgery, health-related QOL and disease-specific QOL were assessed using the Medical Outcomes Study 8-item Short-Form Health Survey (SF-8) and the Expanded Prostate Index Composite (EPIC), respectively. LRP and MIE-RP were performed in 57 and 58 patients, respectively, and there were no significant differences in major clinicopathological parameters between these two groups. There were no significant differences in perioperative outcomes between the two groups except for the estimated blood loss, which was lower in the LRP group. There were no significant differences between the two groups in the preoperative and postoperative all-scale scores of the SF-8 survey. Of the fourteen scores evaluated by the EPIC survey, postoperative scores for urinary summary, sexual summary, urinary function, urinary incontinence and sexual function were significantly worse than these preoperative scores in both LRP and MIE-RP groups, while there were no significant differences between the two groups in the preoperative and postoperative all-scale scores of the EPIC survey. The postoperative QOL status in patients undergoing MIE-RP appeared to be equivalent to that in those undergoing LRP.