Short-term Follow-up Results Research Articles

Transperitoneal laparoscopic surgery in large adrenal masses.

IntroductionThe laparoscopic adrenalectomy (LA) has become the gold standard since the transperitoneal laparoscopic approach was first reported.AimTo evaluate the applicability, safety and short-term results of laparoscopic surgery in adrenal masses over 6 cm.Material and methodsDemographic data, hormonal activities, imaging modalities, operative findings, operation time, conversion rates, complications, duration of hospital stay and histopathologic results of 128 patients who underwent laparoscopic adrenalectomy were evaluated retrospectively. Patients included in the learning curve (n = 23), robotic surgery cases (n = 15) and patients with suspected metastasis (n = 4) were excluded from the study. Six cm mass size was taken as a reference and two groups were formed (group 1: < 6 cm, group 2: ≥ 6 cm). The results of the two groups were compared.ResultsThere were 64 cases in group 1 and 22 cases in group 2. Functional mass ratio and mass sides were similar between the groups (p = 0.30 and p = 0.17, respectively). The mean mass size in group 1 was 36.4 ±11.2 mm and in group 2 82.4 ±15.5 mm. The conversion rate was similar between the two groups (p = 0.18). The duration of surgery was 135.5 ±8.29 min in group 1, 177.0 ±14.9 min in group 2 (p = 0.014). Morbidity and lengths of hospital stay were similar (p = 0.76, p = 0.34 respectively). Adrenocortical carcinoma was detected in three cases in group 1, which were completed laparoscopically, and in two cases in group 2, which were converted to open surgery (p = 0.46).ConclusionsAlthough open surgery is still recommended in the guidelines, studies are now being carried out to ensure that laparoscopy can be safely performed on masses over 6 cm. There was no difference between short-term follow-up and histopathologic results in our study.

Minimum One-Year Outcomes after Revision Hip Arthroplasty with Custome-Made Implants: Function, Quality of Life and Patients Satisfaction

Purposes of our study were to estimate clinical short-term results of custom acetabular implants using in revision hip arthroplasty, to determine bone ingrowth percentage in the custom implant 3d printed coverage, and to estimate the custom malposition influence on the clinical results.Materials and method. 30 patients were performed revision hip arthroplasty with using custom acetabular implants in 2016. Oxford hip score, life quality, expectation and satisfaction of patients were assessed in 12 months and more. Osteointegration was assessed with x-ray. Influence of malposition on clinical results was assessed with Pirson’s χ2.Results. Oxford Hip Scores were increased from mean 16.8 to 34.4 (p0.01). Life quality index EO-5D were increased from mean 0.315 to 0.651 (p0.01). Osteointegration was confirmed in 96% cases, component migration was in 1 case. The influence of malposition on clinical results in short-term follow-up was absent.Conclusion. The using of custom acetabular implants in revision hip arthroplasty improves hip function and life quality of patient. 3D printed custom implants coverage provides high percentage of inplants osteointegration, besides components malposiotion. Further followup requires for assessment long-term results.

Hybrid treatment of an unusual traumatic aortic arch rupture with pseudoaneurysm: a case report

BackgroundTraumatic aortic arch rupture with pseudoaneurysm is a rare high fatal injury. Thoracic endovascular aortic repair(TEVAR) is widely used in the treatment of aortic diseases. However a unified traumatic aortic injury risk stratification tool still lacks. The patients’ disease assessment and operation method still rely on the doctors’ subjective anticipation of disease and surgical results.Case presentationA 31-year-old male presented with chest pain and hoarseness of recent onset. Imageological examination showed aortic rupture with mediastinal pseudoaneurysm in Zone 1. Debranching + TEVAR hybrid operation was considered: Using artificial blood vessels rebuild the arch branches, the covered stent was placed in aortic arch for endovascular repair via femoral artery. The follow-up was good in postoperative 7d, 1 year and > 2 years.ConclusionThe traumatic aortic arch rupture with pseudoaneurysm treated by Debranching+TEVAR hybrid operation is feasible. The short-term and medium-term follow-up results are satisfactory. For traumatic aortic arch injury, hybrid operation is recommended to reduce the risk of cardiopulmonary bypass and deep hypothermia circulatory arrest under no open operation conditions or emergency situation.

Secondary osteoarthritis hip in young individuals managed with primary uncemented total hip replacement using ha-coated conventional stem and acetabular component

Background: The management of young individuals seeking medical attention due to progressive hip pain as a result of secondary osteoarthritis and who want active and pain-free hip was challenging in past. The actual incidenece of secondary osteoarthritis is difficult to ascertain. Young individuals with secondary osteoarthritis hip due to developmental dysplasia of hip, coxa plana (Legg-Calvé-Perthes disease), post-traumatic, slipped capital femoral epiphysis, Paget disease, Haemophilia, Avascular necrosis of femoral head, and so on can be effectively managed with primary uncemented total hip replacement (THR) with good functional outcome in short-term follow-up. This will increase the revision THR rate later. Long-term follow-up is required to watch for prosthesis-related complications Materials and Methods: Material includes 64 patients who attended our OPD from Oct 2013 to Dec2017 and all of them were diagnosed to have secondary osteoarthritis hip with poor hip function as assessed by Harris hip score. All of them underwent uncemented total hip replacement (THR) through posterior/anterolateral approach to hip. Conventional HA-coated stem and acetabular components were used. They were post-operatively assessed at regular intervals with Harris hip score and were found to have excellent functional outcome with high level of patient satisfaction. Result: All patients have excellent Harris hip scorepost-operatively. Patients became independent and were able to carry out day-to-day activities with ease. No complications were noticed. The dramatic change in their hip function was appreciable even on the day of surgery itself. Conclusion: We conclude that uncemented THR using conventional HA-coated components is an excellent surgical modality for the management of secondary osteoarthritis in young individuals with poor hip function. The functional outcome is promising and makes patient independent and pain free. The said procedure is cost-effective and reliable based on excellent hip function achieved in immediate post-operation. Long-term follow-up is recommended.

Sacral neuromodulation in congenital lumbo-sacral and traumatic spinal cord defects with neurogenic lower urinary tract symptoms: a single-center experience in children and adolescents.

This study evaluated sacral neuromodulation's effectiveness for managing refractory neuropathic lower urinary tract dysfunction in children and adolescents. Twenty-five children and adolescents underwent peripheral nerve evaluation test phase of sacral neuromodulation at our center. Thirteen (seven boys and six girls) cases suffered from neuropathic lower urinary tract dysfunction refractory to the maximum medical treatment. The test was done with temporary wire in all patients. Patients with more than 50% improvement in symptoms were chosen for the second stage of implantation of quadripolar tined lead and implantable pulse generator. Bowel transit symptoms were recorded before and after the surgery. Eight patients (61.53%; five boys and three girls) had positive responses to the peripheral nerve evaluation test phase. They underwent implantation of permanent quadripolar tined lead and implantable pulse generator. The etiologies were lumbosacral myelomeningocele, occult spina bifida, partial sacral agenesis and incomplete spinal cord injury. Positive clinical response (> 50% improvement in symptoms) was achieved in seven (85%) at a mean follow-up of 14.25months. Three patients became capable to stop clean intermittent catheterization (P =0.125). The 24-h pad test decreased from 484 to 78g from before to after the surgery (P =0.043). This clinical study on a small sample size of children and adolescents demonstrates positive results in short-term follow-up. However, as the procedure is still not approved officially, multicenter studies with more patients can prove the safety and efficacy of sacral neuromodulation in long term among this special group of patients.

Abstract P113: The Primordial Prevention Project: Pilot Study of Disclosing Child’s Diabetes Genetic Risk Information

The prevalence of type 2 diabetes (T2D) in children has risen dramatically. NHANES data of 12-19 years old showed a significant increase, from 9% to 23%, in pre-diabetes and diabetes from 1999-2008, which was related to increases in BMI. Lifestyle interventions in adults have been shown to be effective at reducing T2D risk, however, interventions in families have been inconclusive in demonstrating the benefit of lifestyle change in reducing T2D risk. We hypothesized that using child’s genetic risk information in families at high risk of developing T2D would serve as a motivator to improve behaviors related to risk factors for T2D. We conducted a pilot study of 44 families and their children aged 2-8 who consented to participate in baseline, risk-disclosure and 3-month follow-up sessions. We identified families as high risk based on a maternal history of gestational diabetes, large for gestational age, or paternal obesity. Parents were surveyed on their family’s physical activity and dietary behaviors, and attitudes and motivations for lifestyle change at baseline and 3-month follow-up. At baseline, saliva samples were collected from children for genotyping of variants previously associated with obesity and T2D risk in genome-wide association studies. When genotyping was completed families were then scheduled to receive results. Parents completed questionnaires related to their anxiety (STAI-State) and depressive symptoms (POMS) prior to receiving their child’s genetic risk and immediately after the intervention. Parents received their child’s genetic risk report, in combination with a quasi-motivational interviewing session and educational materials. At the end of the session parents set individualized behavior goals for themselves and their children based on their responses to baseline questionnaires related to dietary and PA behaviors. Follow-up at 3 months are still being collected. Results from the risk disclosure session are reported here. Parents were 35±5 years old; 11% Latino, 26% black and 63% White; and 60% were mothers. Parents reported a significant increase in fatigue (ß =0.98, p=0.001), depressiveness (ß=0.35, p=0.04), and anxiety (ß =3.0, p=0.001) from pre-risk disclosure compared to post risk-disclosure. Parents reported a significant increase in their confidence to change their family’s behaviors after receiving the intervention (ß=0.34, p=0.001). All parents committed to a personalized health behavior change after learning of their child’s risk. In conclusion, we were able to demonstrate that genetic risk may be a useful motivator to encourage parents to take immediate action to make improvements to their family’s health behaviors. Short-term follow-up results will determine whether changes were meaningful in actual behavior changes.

Endoscopic Ventral Decompression for Spinal Stenosis with Degenerative Spondylolisthesis by Partially Removing Posterosuperior Margin Underneath the Slipping Vertebral Body: Technical Note and Outcome Evaluation

Decompression alone is a treatment option in patients with lumbar spinal stenosis (LSS) and degenerative lumbar spondylolisthesis (DLS). This study aims to describe the procedure of percutaneous transforaminal endoscopic ventral decompression technique and to demonstrate the clinical outcomes. Two years of retrospective data were collected from 26 patients with predominant unilateral leg pain caused by LSS and low-grade DLS (Meyerding grades I and Ⅱ). All patients underwent endoscopic ventral decompression by removing the posterosuperior margin underneath the slipping vertebral body, combined with dorsal decompression without excessive resection of facet joints. The surgical outcomes were assessed using the visual analog scale (VAS), Oswestry Disability Index (ODI), modified MacNab criteria, and walking distance improvement evaluation. The mean age of the 18 women and 8 men was 69.2 years. The mean preoperative ODI and VAS of the leg and the back scores were 64.7 ± 8.1, 7.0 ± 1.4, and 3.0 ± 1.2, respectively. All mean scores improved postoperatively to 31.4 ± 5.6, 2.4 ± 1.1, and 1.7 ± 1.1 at the final follow-up. In 88.5% of cases, patients' estimated walking distance improved. The outcomes of the modified MacNab criteria showed that 81.3% of patients obtained good-to-excellent rate. There were no statistically significant differences between the percent slip of spondylolisthesis before surgery and at the end of follow-up. Based on the initial short-term follow-up results, transforaminal endoscopic ventral decompression by partially removing the posterosuperior margin underneath the slipping vertebral body, combined with dorsal decompression, might be an efficient alternative treatment for leg dominant symptoms in patients with LSS and low-grade DLS.

Intraoperative graft-related complications are a risk factor for recurrence in arthroscopic Latarjet stabilisation

PurposeThe goal of this study was to evaluate clinical and radiological outcomes after arthroscopic Latarjet stabilisation in anterior shoulder instability.MethodsNinety-three patients after primary arthroscopic Latarjet stabilisation were reviewed. Satisfaction, subjective shoulder value (SSV), Walch–Duplay and Rowe scores, and range of motion and stability were evaluated on clinical examination. Computed tomography (CT) was used to analyse graft position and fusion.ResultsNinety patients (96.8%) were available for clinical and 85 for CT evaluation. The mean follow-up was 23.7 months (13–50, SD 7.1) and age at surgery was 26.2 years (16–44, SD 5.6). Intraoperative complications were reported in eight patients (8.9%) and recurrence in three (3.3%). Significantly, two out of three patients with recurrence had intraoperative graft complications (p = 0.0107). Forty-one patients (45.6%) reported the feeling of “subjective return to sport anxiety”. External rotation with arm at the side was 59° (10–90°, SD 20) with 15° (0–70°, SD 17) of loss of rotation. These two factors correlated with results the most. Patient satisfaction was evaluated as 92% (40–100, SD 14) and SSV 90% (30–100, SD12). Revision rate after primary surgery was 10%. CT showed graft healing in 81 (95.3%) patients. A graft position between 2 and 5 o’clock was found in 70 (83.4%) patients and flush to the anterior glenoid rim in 34 (40.5%). Osteolysis of the superior part of the graft was found in 55 (64.7%) patients. CT evaluation showed no correlation with clinical results.ConclusionArthroscopic Latarjet stabilisation demonstrates satisfactory results in short-term follow-up; however, intraoperative graft-related complications are a risk factor for recurrence. “Subjective return to sport anxiety” and loss of external rotation with the arm at the side are factors worsening the results. Graft position imperfections and osteolysis of the superior part of the graft reported in CT evaluation do not influence the clinical results.

Outcomes of prostate artery embolisation for benign prostatic hyperplasia in 10 cases at Steve Biko Academic Hospital.

BackgroundBenign prostate hyperplasia (BPH) remains a common cause of lower urinary tract symptoms (LUTS) in ageing men in South Africa and can impact significantly on the quality of life (QOL) of these patients. The Urology Department at Steve Biko Academic Hospital (SBAH) can generally only offer men with LUTS the following treatment options: watchful waiting, medical treatment and surgical management. In men with symptomatic BPH, who are refractory to medical treatment, where anaesthesia is contra-indicated because of co-morbidities or transurethral resection of the prostate (TURP) is contra-indicated because of the prostate size, the Urology and Radiology departments at SBAH recently introduced prostate artery embolisation (PAE).AimTo assess the outcome of PAE in 10 men with LUTS, secondary to BPH, by comparing their urinary symptoms, QOL and prostate volume before and 3 months after they underwent PAE in the Radiology Department at SBAH.MethodThe review included the first 10 men who had undergone therapeutic PAE for symptomatic BPH from May 2016 to September 2016. The subjective symptomatic feedback was assessed according to the International Prostate Symptom Score (IPSS) and the Global Quality of Life questionnaire, created by the American Urological Association (AUA). The reduction in the size of the prostate was measured on magnetic resonance imaging (MRI).ResultsEmbolisation was technically achieved in all 10 patients. Bilateral embolisation was performed on nine patients. One patient received unilateral embolisation secondary to unilateral tortuous and atherosclerotic changes of the iliac arteries. Within the 3-month follow-up, the mean IPSS score improved by 15.7 points (p < 0.0039), the mean QOL improved by 4.1 points (p < 0.0039) and the mean prostate volume reduction was 21.8 mL (p < 0.0039). Despite improvements observed, there was one clinical failure. No major complications were reported that increased hospital stay, required hospital readmission or required surgery.ConclusionThe study on the first 10 PAE performed in SBAH concludes that PAE is a safe and effective procedure with favourable short-term follow-up results. This indicates that PAE can safely be offered to patients, who are refractory to medical treatment and not suitable candidates for surgery, in urology departments such as in SBAH.

Thoracoscopic thymectomy with partial superior vena cava resection for locally advanced thymomas.

Video-assisted thoracoscopic surgery (VATS) is now increasingly used for the treatment of early stage thymic malignancies. However, VATS has not been advocated for patients with locally advanced diseases. We reviewed our initial experience in VATS thymectomy with partial superior vena cava (SVC) resection for IASLC/ITMIG stage III thymic tumors. From August 2017 to October 2018, patients who underwent VATS thymectomy with partial SVC resection were retrospectively reviewed, and peri-operative outcomes and short-term follow-up results were analyzing. Four patients with partial SVC resection via VATS were identified. All of them had pathologically confirmed IASLC/ITMIG stage III thymic tumors invading the SVC. The average of operative time was 228 minutes and mean blood loss was 88 mL. The mean duration of chest tube drainage and post-operative hospital stay were 4.5 and 7.3 days respectively. No major complication was encountered after surgery. No mortality was observed. And no recurrence was detected with the longest follow-up time of 14 months. With careful patient selection and plenty surgical expertise, VATS thymectomy for locally invasive thymic tumors with limited the SVC invasion is challenging yet technically feasible.

Feasibility of the peroral endoscopic myotomy (POEM) procedure with a new small-caliber endoscope (thin-POEM) in patients with achalasia.

Peroral endoscopic myotomy (POEM) is a recognized technique for patients with achalasia. We aimed to evaluate the feasibility of using a small-caliber endoscope (thin-POEM) to perform POEM in patients with achalasia. Naïve or previously treated patients were included between February 2016 and April 2018. A small-caliber (5.9 mm) nasoendoscope was used, with a modified closure method using cyanoacrylate. Strict follow-up was performed. 45 patients were included, aged 45.5 years (interquartile range [IQR] 22 - 69); 53 % (24/45) had type II achalasia. Median total time for thin-POEM was 54 minutes (IQR 37 - 77) and median myotomy length was 13.5 cm (IQR 6 - 20). Results pre-procedure and 3 months post were Eckardt score 10 vs. 1 (P < 0.001), integrated relaxation pressure (IRP) 25.3 vs. 8.5 mmHg (P < 0.001), and timed barium esophagram (TBE) 100 % severely delayed vs. 86 % normal (P < 0.001), respectively. Type III patients had the longest thin-POEM times (median 58 minutes [IQR 52 - 77]). Reflux was confirmed at 3 months clinically in 17 % of patients, endoscopically in 20 %, and on pH monitoring in 53 %. At 6 months and 12 months, 40 % and 33 % of patients remained positive on pH monitoring and were medically managed. Thin-POEM seems to be a safe, effective, and efficient procedure for POEM in patients with achalasia, with good short-term follow-up results.

Arthroscopic Repair of Acetabular Labral Tears Associated with Femoroacetabular Impingement: 7-10 Years of Long-Term Follow-up Results.

BackgroundThe purpose of this study is to report the long-term follow-up results of arthroscopic repair of acetabular labral tears with femoroacetabular impingement (FAI).MethodsOf 45 patients who underwent arthroscopic labral repair under the diagnosis of acetabular labral tears with FAI from January 2008 to December 2010 and met our inclusion criteria, 41 patients who were available for a long-term follow-up were included in the analysis. We compared the long-term follow-up results with the previously reported short-term follow-up results of the same patients. The mean follow-up period was 92.4 months (range, 85 to 117 months). There were 21 males and 20 females, and their mean age at surgery was 34.6 years (range, 16 to 54 years). A modified Harris hip score (mHHS), visual analog scale (VAS), hip outcome score-activity of daily living (HOS-ADL), hip outcome score-activity-sport-specific subscale (HOS-SSS), and patient satisfaction were used for evaluation of the clinical results and Tönnis grade for detection of early osteoarthritis (OA).ResultsThe mean VAS score decreased from 6.4 points to 1.8 points (p < 0.001), the mean mHHS increased from 59.5 points to 86.8 points (p < 0.001), and the mean HOS-ADL and HOS-SSS increased from 58.3 and 51.2, respectively, to 85.2 and 82.4, respectively (p < 0.001), between the preoperative and last follow-up assessment. The mean patient satisfaction score was 7.6 of 10. The average Tönnis grade at the last follow-up (0.67; range, 0 to 3) was not significantly different from the preoperative average (0.51; range, 0 to 1). Only one case was converted to total hip arthroplasty because of progression of OA at 8 years after surgery. Five cases of secondary arthroscopic surgery were performed before maximum 5 years postoperatively because of labro-synovial adhesion (three cases), pullout of the suture anchor (one case) or symptomatic heterotrophic ossification (one case).ConclusionsThe clinical and radiological long-term follow-up revealed that improvement after arthroscopic labral repair and osteoplasty for FAI were maintained in most cases without significant progression of arthritis. Anatomical recovery of the acetabular labrum was associated with the improvement of clinical symptoms.

1092. Tuning Down Clostridioides difficile PCR Sensitivity Reduces Treatment for C. difficile Infection in Toxin-Negative Patients With No Increase in Adverse Outcomes

BackgroundStudies have shown that toxin detection identifies those who require treatment for C. difficile infection (CDI) and free toxin can be predicted with high negative predictive value from PCR cycle threshold (CT). CT-toxin was introduced at our institution in two phases: from October 2016 to October 2017, CT-toxin was reported with the PCR result (split reporting) and CDI therapy was discouraged if CT-toxin was negative (PCR+/CTtox−). Interim analysis showed that CDI treatment had no effect on outcomes in these CTtox− patients, so starting November 2017, only CT-toxin was reported. Outcomes in PCR+/CTtox− patients treated during split reporting and untreated during the toxin-only period are detailed here.MethodsPatients tested from October 2016 to February. 2018 with a positive Xpert tcdB PCR (Cepheid, Sunnyvale, CA) and CTtox− result were included. Clinical data were collected by retrospective chart review in the split reporting period and prospective review in the toxin-only period and analyzed using SPSS at α = 0.01.ResultsOf 186 unique PCR+/CTtox- patients during split reporting, 99 (53%) were treated, compared with 6 (12%, n = 51) in the toxin-only period (P < 0.001). In comparing treated patients during split reporting to untreated patients during toxin-only reporting (n = 45), there were no significant differences in age, sex, prior antibiotic use, CDI in the previous 6 months, Charlson Comorbidity Index, patient location, immune status, or data at testing, including WBC count, creatinine, albumin, and stools/day. There were no cases of fulminant CDI in either group and no difference in outcomes (table).ConclusionReporting of CT-toxin alone significantly reduced treatment for CDI compared with split reporting in CTtox− patients with no increase in adverse outcomes in short-term follow-up. Further study is needed to confirm these findings in a larger cohort. Table: Outcomes in Patients With PCR+/CTtox− Result by Treatment Status and Reporting Period. Categorical Variables Are Denoted as n (%) and Continuous Variables as Mean [Standard Deviation]OutcomesSplit ReportingTreated (n = 99)CT-Toxin Only ReportingUntreated (n = 45) P-valueDays to diarrhea resolution(<3 stools/day)2.8 [1.9]2.2 [2.1]0.2CTtox+ CDI within 8 weeks8 (8.1)4 (8.9)0.930-Day all-cause mortality9 (9.1)3 (6.7)0.8Disclosures All authors: No reported disclosures.

Short-term follow-up of anterior and posterior both column fractures of acetabulum managed through both column plating.

To evaluate the results of short-term follow-up of patients of both column acetabular fractures managed through anterior and posterior column plating. Both column acetabular fractures are challenging articular injuries. Majority of them are treated operatively. The concept of "secondary congruence" was introduced by Letournel. Despite this, biomechanical data on secondary congruence indicate that nonoperative treatment leads to an increase in peak pressures in the supraacetabular region with the potential risk of developing posttraumatic degenerative osteoarthritis. Operative management is therefore justified. A cohort of 10 patients having both column (anterior and posterior) acetabular fractures managed using bicolumnar plating between January 2016 and December 2017 were enrolled in the study and were analyzed during follow-up period. In total, 80% of the patients had excellent to good result. Average postoperative score was 85.7. Assessment was done using modified Harris Hip score.

Axillary Transcatheter Aortic Valve Replacement in Patients With Peripheral Vascular Disease

The axillary artery seems an interesting alternative in nonfemoral transaortic valve replacement (TAVR) patients. This study describes our experience with this technique and its short-term follow-up results. This is a retrospective single center study. All axillary TAVR performed in our department between 2015 and 2017 were included in the study. Mean follow-up was 13.2 ± 9.5 months. All reporting was done according to the VARC-2 criteria. During the period covered, 43 patients had an axillary TAVR. Most patients were men (62.7%), had a mean age of 83.9 ± 5.3 years and presented with EuroSCORE I, II, and STS score of 27.9 ± 13.5%, 5.6 ± 4.9%, and 7.7 ± 4.05%, respectively. Vascular access was successful in all patients with a higher frequency of left approach (69.7%, n = 30). Both Medtronic CoreValve 37.2% (n = 16) and Edwards Sapien3 62.8% (n = 27) valves were used. An apical Certitude delivery system was preferentially used (24/27) in the latter group. There were no reported instances of valve migration or need for a second valve implantation. A single case (2.3%) of arterial vascular complication was reported. Central neurologic morbidity was 2.3%. No patient experienced brachial plexus injury. A pacemaker was implanted in 18.6% of cases (n = 8), with no significant difference between the 2 valves patient groups (S3 14.8% vs CV 25%, P 0.67). The 30-day mortality was 6.9% (n = 3) and 1-year survival was 86% [95% CI 72.6, 93.4]. Axillary TAVR is associated with acceptable morbidity, mortality, and leads to satisfactory short-term clinical outcomes. It has the potential to become the main alternative access route in nonfemoral TAVR patients.

"U" route transforaminal percutaneous endoscopic thoracic discectomy as a new treatment for thoracic spinal stenosis.

To describe the rationale, surgical technique, and short-term follow-up results of a new minimally invasive treatment for thoracic spinal stenosis (TSS) caused by herniation, ossification of the ligamentum flavum (OLF), and/or ossification of the posterior longitudinal ligament (OPLL) with a "U" route transforaminal percutaneous endoscopic thoracic discectomy (PETD). Fourteen patients, including seven males and seven females, underwent "U" route PETD. Myelopathy was caused by OLF in 14 patients, OPLL in one, combined OLF-OPLL in ten, and intervertebral disc herniation (IDH) in five. Decompression was performed in one segment in 12 patients, and in two segments in two patients. The Japanese Orthopedic Association (JOA) scores, visual analog scale (VAS) scores, and complications were documented. The JOA scores improved from 4.64 ± 2.31 pre-operatively to 7.07 ± 1.59 one day post-operatively and 11.79 ± 1.85 at final follow-up. The difference between pre-operation and post-operation was statistically significant (P < 0.05). Moreover, the VAS score was 6.07 ± 2.06 points pre-operatively, decreasing to 3.00 ± 1.24 points at one day post-operatively, and 1.14 ± 0.86 points at last follow-up (P < 0.05). Dural tear was observed in two cases during the intervention. No patient had transient worsening of pre-operative paralysis. This retrospective analysis shows that "U" route PETD for decompression may be a feasible alternative to treat thoracic spinal stenosis.

Individualized alignment in total knee arthroplasty using image-based robotic assistance : Video article.

IntroductionOver the past decades many innovations were introduced in total knee arthroplasty (TKA) focusing on implant longevity and higher procedural precision; however, there are still a high number of dissatisfied patients. It was reported that better anatomical alignment may result in improved patient outcome; however, current technologies have limitations to achieve this. The aim of this video article is to describe the technique of individualized alignment in TKA with the use of image-based robotic assistance.MethodsThe technology is based on an individual patient knee model computed from segmented computed tomography (CT) scans. A preoperative planning of prosthesis position is conducted following the principle of kinematic alignment. Intraoperatively the soft tissue envelope is recorded and the computer predicts the gap balance based on the virtual planning. The prosthesis position is then adapted to achieve balanced gaps and to avoid soft tissue release. This technique is shown in a cadaver operation and clinical examples of two patients are described.ResultsWith the combination of anatomically oriented prosthesis positioning and minor adaptations with respect to the soft tissue, an individualized alignment is achieved with reduced need of soft tissue release. The robotic-assisted surgery guarantees a precise implementation of the planning. The initial experience showed a promising outcome in short-term follow-up.Video onlineThe online version of this article (10.1007/s00132-018-3637-1) contains a video on patient individualized alignment in total knee arthroplasty. The article and video are available in the electronic full text archive at SpringerMedizin.de under http://www.springermedizin.de/der-orthopaede. The video can be found at the end of the article as supplementary material.

Comparitive study of open vs laparoscopic surgery for pain relief in chronic calcific pancreatitis

Introduction: Chronic pancreatitis is a painful, progressive, inflammatory condition of pancreas. Various surgical strategies for the treatment of pain relief in chronic pancreatitis have been described, although the application of minimally invasive surgery is less frequently reported. This study is an attempt to examine the outcome of laparoscopic procedures in the management of chronic pancreatitis in comparison to open surgery from a tertiary care centre located in the more disease prevalent southern part of India. Methods: This is a prospective comaparitve study of patients undergoing surgery for pain relief in chronic calcific pancreatitis, either by laparoscopy or open method, between 2015-2017. The primary endpoint is postoperative pain relief at 3 months, 6 months and 1 year. Results: During the study period, 24 patients underwent laparoscopic modified frey's procedure and 26 patients underwent open procedure. There was a statistically significant difference favourable to the open group regarding shorter operative times (185 min vs 247.5 min; P = 0.002), however laparoscopic arm had lesser blood loss (120 mL vs 240 mL; P = 0.002), a shorter hospital stay (5 d vs 7 d; P = 0.004) and comparable pain relief score (Izbicki's score) at 3 months, 6 months and 1 year follow up. Post-operative weight gain and endocrine insufficiency rates were comparable in both arms. Conclusion: Laparoscopic surgery is safe, effective and feasible technique for chronic pancreatitis in selected patients in the presence of adequately dilated pancreatic duct and has a comparable outcome in short term follow-up when compared to open surgery.

Femoral Tunnel Techniques in ACL Reconstruction with Hamstrings Autograft: Transtibial versus Two Tunnels Technique

AbstractBackground: In spite of the considerable research focused on ACL reconstruction, the increased risk of early knee osteoarthritis and the presence of rotational instability post-surgery have not been fully investigated yet. As a result, controversy remains regarding the best technique for recon-struction; thus, it is still the subject of extensive research.Aim of the Work: To assess the radiological and clinical outcomes of arthroscopic single bundle ACL reconstruction using the transtibial or the anteromedial portal (two tunnels) technique for drilling the femoral tunnel in nonprofessional athletes.Patients and Methods: It is a prospective comparative study including forty patients with a torn ACL underwent arthroscopic reconstruction of the ACL, twenty patients had ACL reconstruction by transtibial (TT) technique and twenty patients had ACL reconstruction by Anteromedial Portal (AMP) technique using hamstring tendons as autograft for all the patients.Results: All the patients were followed-up clinically with IKDC scores, Lysholm score, Tegner activity score and Radi-ologically for assessment of tunnel widening and femoral tunnel position using plain X-ray and CT at 3, 6 and 12 months post-operatively.Conclusion: The AMP independent femoral tunnel drilling technique achieved a more horizontal and anatomic femoral tunnel, but the AMP technique has no clinical superiority compared to the TT technique in ACL reconstruction in nonprofessional athletes as reported by these short-term follow-up results.

PS02.004: THE FEASIBILITY AND EFFECTIVENESS OF ‘TOTAL ENDOSCOPIC 2.5 FIELD LYMPH NODE DISSECTION’ IN TREATMENT OF THORACIC ESOPHAGEAL SQUAMOUS CELL CARCINOMA

Abstract Background Due to the difficulty of dissection, surgical trauma, postoperative complications and other factors, the promotion of 3-field lymph node dissection is subject to certain restrictions. We try to explore and summarize a method of lymph node dissection, ‘endoscopic 2.5 lymph node dissection ’, that is, thoracoscopy combined with laparoscopic radical abdominal field, chest field and lower cervical paraesophageal lymph nodes (including 101 group below thyroid artery). Methods Retrospective analysis of 240 patients with thoracic esophageal squamous cell carcinoma from November 1, 2015 to December 31, 2017. All patients underwent endoscopic 2.5-field lymphadenectomy. The average age is (58.2 ± 9.5) years old. During the thoracoscopic part, when we do the lymphadenectomy along recurrent laryngeal nerves in the upper mediastimun and lower neck, we used a combination of ‘esophageal suspension method’, ‘lymph node rolling dissection method’ and ‘multi-angle pulling method’ to reveal the lymph nodes (Figure 1). Surgical related factors were collected and analyzed. Continuous follow-up was performed to record the recurrence and metastasis of patients and postoperative survival. Results Lymphadenectomy level of the right recurrent laryngeal nerve could reach the level above the right inferior thyroid artery, and the left could reach the level of 101 station. All operations were successfully completed. The incidence of pulmonary infection was 11.7%, the incidence of anastomotic leakage was 1.3%, the hoarseness rate was 7.9% and the incidence of chylothorax was 4.2%. The average number of total, abdominal and thoracic lymph nodes dissected were higher than the number of guidelines requirement and most of the previous literature. The average postoperative hospital stay was 8.4 days. The local recurrence rate, metastasis rate and survival rate of all the patients were not inferior to those reported in the past. Conclusion In patients with thoracic esophageal squamous cell carcinoma, the use of ‘total endoscopic 2.5-field lymph noede dissection’, could expand the range of lymph node dissection, and reached the super-thoracic and lower cervical level, which is beneficial to improve the degree of dissection along the recurrent laryngeal nerves. The procedure is safe and feasible, the results of short-term follow-up results are good, and it is worth further promotion. Disclosure All authors have declared no conflicts of interest.