Small-incision Surgery Research Articles

Refractive Results, Visual Outcomes, and Predictive Error in Patients Undergoing Cataract Surgery with Manual Small Incision Surgery

Refractive Results, Visual Outcomes, and Predictive Error in Patients Undergoing Cataract Surgery with Manual Small Incision Surgery

Currently Recommended Small Incision Vitrectomies and Bimanual Surgery in Diabetic Vitrectomy

In recent years, retinal specialists have benefited from significant advances in the surgical treatment of proliferative diabetic retinopathy, including improved preoperative planning, vitreoretinal instrumentation, and new surgical maneuvers. In light of these developments, surgical indications in proliferative diabetic retinopathy patients have been expanded, success rates have increased, and complication rates have decreased over the years. Transconjunctival small-incision surgery, vitrectomes with high cutting speed, and bimanual approaches allowed by chandelier lighting have been preferred by more and more surgeons. In this review, we will discuss the benefits of small incision surgery and the clinical results of bimanual surgery in the treatment of PDR patients with historical development steps.

A rare case of spontaneous anterior dislocation of cataractous lens in coloboma

We present a case of a young patient who developed leukocoria as a result of spontaneous anterior dislocation of lens in conjunction with an iridolenticular coloboma. Patient presented to us owing to sudden onset accentuation of leukocoria since she had no perception of light due to a long-standing retinal detachment. The catarctous lens was extracted by manual small incision surgery, preventing further complications from arising and improving cosmetics.

Septum-sparing minimally invasive technique for levator advancement surgery in aponeurotic ptosis.

To evaluate the outcome of small incision levator advancement with septum-sparing technique and compare it with standard levator advancement. The surgical findings and clinical data of patients with aponeurotic ptosis who underwent small incision or standard levator advancement surgery in our clinic between 2018 and 2020 were analyzed retrospectively. For both groups; age, gender, systemic and ophthalmic comorbidities, levator function, preoperative and postoperative margin-reflex distance, change in margin-reflex distance after surgery, symmetry between the eyes, follow-up time, perioperative and postoperative complications (under/overcorrection, contour irregularity, lagophthalmos) were all evaluated and recorded. The study included 82 eyes, 46 from 31 patients in Group I who had small incision surgery, and 36 from 26 patients in Group II who had standard levator surgery. There was no statistically significant difference in surgical success between the two groups (80% and 81% respectively, p = 0.692). The levator function and preoperative margin-reflex distance correlated positively with surgical success. Small incision levator advancement is a less invasive procedure than standard levator advancement because of the smaller skin incision and preservation of orbital septum integrity, but it requires good knowledge of eyelid anatomy and experience in eyelid surgery. In patients with aponeurotic ptosis, this surgery can be performed as a safe and effective surgical technique with a similar success rate as standard levator advancement.

Retracted: Advantages of Small Incision Surgery in Thyroid Tumors.

[This retracts the article DOI: 10.1155/2022/7794819.].

Snare assisted manual small-incision cataract surgery: Single solution for any grade of cataract.

Cataract surgery is constantly evolving with new techniques, machines, and procedures entering the lexicon. With the modernization, the cost of surgery is increasing with respect to the surgeon, patient, and the society. Early rehabilitation with modern minimal access techniques reduces the societal cost of intervention. Manual small-incision surgery is simple, safer, and cheaper when contrasted with the cost and steep learning curve of machine-driven surgeries. A nucleus of a normal size is 6 mm, which can be bisected; 3 mm longitudinal fragments can be removed through 3.5 to 4.5 mm incision, and a large nucleus of 9.0 mm can trisected and removed through 3.5 to 4.5 mm. The limbal tunnel incision is 3.5 mm, which is close to 2.8 mm phacoincision, so it gives all the advantages of modern phacosurgery. The search of an ideal technique for manual phaco-fragmentation leads us to this specially designed snare (designed by the first author AS) which can tackle any grade nucleus. The nucleus can be bisected or trisected with ease. The technique has been around for 2 decades. There is a small learning curve. The complications are few and can be minimized with practice and simulation. It is a safe, valid, repeatable, and generalizable surgical procedure.

Relevance of manual small-incision surgery in today's private practice setting.

Relevance of manual small-incision surgery in today's private practice setting.

Advantages of Small Incision Surgery in Thyroid Tumors.

Objective Thyroid tumor is a common thyroid disease, and the incidence of complications after traditional thyroid surgery is high, which seriously affects the prognosis of patients. With the development of minimally invasive techniques, small incision surgery has a positive impact on changing the traditional thyroid surgery treatment. However, the gap between small incision surgery and traditional thyroid surgery is unclear, so this meta-analysis was used to evaluate its application value. Methods Searching English biomedical databases, including PubMed and Science Network and Chinese major biomedical databases, including CNKI, Wanfang, and Weipu. The keywords of the searched articles are as follows: small incision surgery, traditional thyroid surgery, thyroid tumor treatment, clinical efficacy of thyroid tumor, and surgical treatment, and these keywords are searched individually or in combination to track relevant systematic reviews and literature meta-analysis, and conduct other studies. The retrieval period is from the establishment of the database to January 2022. After extracting the article data, the patients were divided into small incision surgery group and traditional thyroid surgery group due to different intervention methods. The Cochrane risk of bias tool was used to assess the quality of the included literature, and RevMan 5.30 was used for meta-analysis. Results A total of 9 articles met the inclusion criteria. There were 369 patients with small incision surgery and 364 patients with traditional thyroid surgery. Compared with traditional thyroid surgery, patients treated with small incision surgery had significant short hospitalization time (MD −2.72, 95% CI (−3.32, −2.12)), less amount of bleeding (MD −15.52, 95% CI (−20.40, −10.65)), short incision length (MD −12.73, 95% CI (−16.29, −9.17)), lower VAS score (MD −2.58, 95% CI (−4.08, −1.08)), and less complications (RR 0.30, 95% CI (0.21, 0.44)). Conclusion Compared with traditional thyroid surgery, the results show that small incision surgery can shorten the hospital stay of patients with thyroid tumor, reduce the length of incision, reduce the amount of bleeding and the occurrence of complications, reduce postoperative pain, and have a positive effect on postoperative survival of patients.

Power‐assisted rotary cutter with negative pressure suction through small incision for axillary osmidrosis

The glandular fluid secreted by apocrine sweat glands is decomposed by parasitic bacteria on the skin surface and releases a bad smell called axillary osmidrosis. To evaluate the effect of power-assisted rotary cutter with negative pressure suction through small incision for axillary osmidrosis. From January 2017 to January 2022, 647 patients with axillary osmidrosis underwent power-assisted rotary cutter with negative pressure suction through small incision surgery to treat for axillary osmidrosis. The operation time (min), intraoperative bleeding (ml) and recovery time (days) were counted. Three months after operation, the amount of underarm sweat, the disappearance of underarm hair, the incidence of operation, the effective rate of operation, and the satisfaction of operation results were evaluated by questionnaire. There were no postoperative complications except five cases of mild axillary pigmentation after 3months. All patients evaluated good odor elimination. No patient was rated as average or poor. No recurrence. Power-assisted rotary cutter with negative pressure suction through small incision is an effective and ideal surgical method to reduce the complications and recurrence of axillary osmidrosis.

Clinical Efficacy of Modified Small Incision Thyroidectomy and Analysis of Influencing Factors of Postoperative Hypocalcemia.

ObjectiveAnalyze the clinical effect of modified small incision thyroidectomy and evaluate the influencing factors of hypocalcemia (EH) in patients after operation.MethodsA total of 220 patients with thyroid cancer in our hospital from October 2019 to October 2021 were selected. The patients were randomly divided into a control group and an observation group, with 110 patients in each group. The control group were treated with traditional thyroidectomy, while the observation group were treated with modified small incision surgery. The perioperative indicators of the two groups were compared. The thyroid hormone indexes of the two groups were meansured before operation and 7 days after operation, and the incidence of complications was compared between the two groups. Serum calcium was detected 7 days after operation in both groups. According to the level of blood calcium, patients were divided into EH group and normal group. The data of two groups were compared, and the related factors affecting the occurrence of EH after operation were analyzed.ResultsThe operation time, incision length and intraoperative bleeding volume of patients in the observation group were significantly lower than those of patients in the control group (p < 0.05). There was no significant difference in drainage time and postoperative drainage volume between the two groups (p > 0.05). The postoperative PTH level of patients in the observation group was significantly higher than that in the control group (p < 0.05), but there was no significant difference in FT3, FT4 and TSH levels (p > 0.05). The incidence of postoperative complications in the observation group (11.82%) was significantly lower than that in the control group (34.55%). Logistic regression analysis showed that bilateral lymph node dissection, parathyroidectomy and decreased PTH were the independent risk factors for EH in our patient after operation (p < 0.05).ConclusionThe modified small incision operation can effectively reduce the occurrence of surgical trauma and related complications. Bilateral lymph node dissection, parathyroidectomy and PTH decrease are the risk factors for postoperative EH in patients with thyroid cancer. Taking corresponding measures to improve the metabolic function of patients during perioperative period will help to reduce the incidence of postoperative EH in patients with thyroid cancer.

165 Cataract Surgery: What Intraoperative Factors Impact Surgical Outcomes in Low- and Middle- Income Countries (LMICs)

Abstract Aim To describe what intraoperative factors affect the outcomes of cataract surgery in LMICs. Method The following databases were screened to find relevant articles: EMBASE (1974–2019), MEDLINE (1946–2019), Global health (1973–2019), PubMed, Cochrane library and Cumulative Index to Nursing and Allied Health Literature. Following this, duplicates were removed, and articles underwent screening. Results Perioperative checks – It has been recommended for LMICs to implement similar surgical checklists to what is used in the UK, to reduce the chance of surgical complications. Having the right team - The cataract surgery team may vary in different countries. For example, in Ethiopia the staffing model includes ophthalmologists, non-physician cataract surgeons (NPCS), ophthalmic officers, ophthalmic nurses, operating room nurses and integrated eye care workers. It is common in LMICs for NPCS to outnumber ophthalmologists. Adequately skilled professionals – It’s important to consider having vitreoretinal surgical input available should surgical complications arise. This will help to optimise outcomes. Surgical technique – Techniques performed in LMICs include ICCE (intracapsular cataract extraction), ECCE (extracapsular cataract extraction and MSICS (manual small incision surgery) and phacoemulsification. ECCE and MSICS is the most commonly used in LMICS due to comparable outcomes with phacoemulsification and cost effectiveness. Surgical training and skills transfer – Various international training programmes such as the HelpMeSee programme is designed to help train ophthalmologists and NPCS in MSICS via simulation. Conclusions The above factors are important considerations which influence surgical availability and success. LMICs have an increasingly aging population and cataract services will be required to adapt to the increase demand.

Small Incisional Surgery for Small Intestinal Diseases is a Safe and Feasible Procedure for Non-Obese Patients

Small Incisional Surgery for Small Intestinal Diseases is a Safe and Feasible Procedure for Non-Obese Patients

Post-operative Reduction in Intraocular Pressure after Small Incision Surgery

Introduction: This study aims to compare pre-operative and post-operative intraocular pressure (IOP) after small incision cataract surgery (SICS). Materials and Methods: A total of 120 eyes of as many patients above the age of 40 years were operated for cataract through SICS. IOP was recorded preoperatively and postoperatively on 1 week, 2 weeks, 1 month, and 3 months with Goldmann applanation tonometer. The above data were statistically analyzed using paired “t-test.” Results: There was a statistically significant decrease in IOP after SICS as compared to mean pre-operative IOP. IOP decline started at 1 week, decreasing further at 2 weeks, 1 month, and 3 months, respectively. Conclusion: IOP starts to decrease significantly after SICS at 1 week and keeps on decreasing till 3 months.

Effect and feasibility of uniportal thoracoscopic surgery in the treatment of early-stage lung cancer in a primary hospital.

BackgroundThoracoscopic radical lobectomy is a routine procedure for radical surgery of lung cancer. Meanwhile, thoracoscopic surgery has been gradually transformed from assisted small incision and multiport thoracoscopic radical surgery to uniportal thoracoscopic surgery for treatment of early-stage lung cancers. However, there are still controversies regarding the efficacy and feasibility of 2 surgical methods. The purpose of this study is to investigate the effect and feasibility of uniportal thoracoscopic surgery for treatment of early-stage lung cancer in a primary hospital.MethodsClinical data of 142 patients with early-stage lung cancer were retrospectively chosen in the period from September 2019 to March 2021 in our hospital and divided into 2 groups: a control group (66 patients) with 3-port thoracoscopic radical surgery and an experimental group (76 patients) with uniportal thoracoscopic radical surgery. The baseline clinical data, perioperative clinical data, and lymph node dissection of 2 groups were compared.ResultsThere was no significant difference in baseline general clinical data between 2 groups (P>0.05), and no significant difference in the incidence of postoperative complications, conversion rate, or operation time between 2 groups (P>0.05). The intraoperative blood loss volume, postoperative chest drainage volume, postoperative hospitalization time, and postoperative catheter time of experimental group were significantly lower than those of control group (P<0.05). There was no significant difference in the total number of lymph node dissection stations and lymph node dissections, the number of N2 lymph node dissection stations, or N2 lymph node dissections between 2 groups (P>0.05). There was also no significant difference in the number of left and right lymph node dissection stations between 2 groups (P>0.05).ConclusionsCompared with 3-port thoracoscopic radical surgery, uniportal thoracoscopic radical surgery in the treatment of patients with early-stage lung cancer provides the same effect of lymph node dissection and has advantages in reducing surgical trauma and accelerating postoperative rehabilitation, popularizing for use in primary hospitals.

Comparative Evaluation of Tear Film Parameters Following Cataract Surgery in Diabetic Patients.

Purpose: To compare the propensity of manual small incision and phacoemulsification cataract surgery in causing tear film dysfunction and dry eye syndrome in diabetic patients. Methods: Diabetic patients in group A underwent manual small Incision Cataract surgery whereas in group B underwent phacoemulsification with similar post-operative regimes. The primary outcome measures were the Ocular Surface Disease Index (OSDI), a Subjective questionnaire. The secondary outcome measures were the Subjective Dry Eye (DE) questionnaire, Corneal Fluorescein staining, Tear meniscus height, Schirmer’s II test, and Tear film break-up time. All parameters were measured pre and then postoperatively. Result: 126 patients were divided into group A (undergoing small incision cataract surgery) and group B (undergoing phacoemulsification). The OSDI and subjective DE scores continued to be worse for Group A until the first month after which they became similar to group B with no statistically significant difference (p-value of 0.726 and 0.347 respectively). The OSDI and subjective DES at 3 months were better in both groups as compared to baseline (p &lt;0.0001). The objective tear film parameters (Schirmer’s, TBUT, TMH, and fluorescein staining scores) showed statistically significant changes from the baseline in both groups but the scores remained in the normal range clinically. Schirmer’s test scores were different between the two groups at three months (p=0.007) in SICS group being higher. Conclusion: Manual Small Incision Cataract Surgery (SICS) causes subjective dry eye symptoms more than phacoemulsification until 1 month of surgery in diabetic patients after which the subjective symptoms become similar to phacoemulsification at 3 months.

Socio-demographic factors of patients who underwent free cataract surgery in Kafanchan, Nigeria

Background: The aim of this study is to determine the socio-demographic profile of people accessing cataract surgery at a free cataract surgical Camp in Kafanchan.Methods: One hundred and nine participants had manual small cataract incision surgery with intraocular lens over a three-month period (September to November 2018) and were followed up for two months. Visual acuity was assessed at first day and two months post-op along with refraction and best corrected visual acuity. Their socio-demographic features along with duration of lost vision and cause of delay in cataract surgery were also noted.Results: Fifty-five males and fifty- four females had cataract surgery and were followed up for two months post-op. Fifty (45.9%) had no formal education while fifty-nine (54.1%) had formal education. Among those with formal education 59% (34) were males while 41% (20) were females. Majority of participants earned less than two hundred and fifty thousand naira (six hundred and twenty-five US dollars) annually. Eighty-two (75%) of participants were Christians and 71 (65%) lived in rural areas. Sixty-five (60%) had lost vision in the index eye more than one year prior to presentation for surgery and the main reason in this study for delay in having cataract surgery was immaturity of the cataract.Conclusions: Some socio-demographic factors are barriers to cataract surgery.

A narrative review of acute pancreatitis and its diagnosis, pathogenetic mechanism, and management.

Acute pancreatitis (AP) is an inflammatory disease that can progress to severe acute pancreatitis (SAP), which increases the risk of death. AP is characterized by inappropriate activation of trypsinogen, infiltration of inflammatory cells, and destruction of secretory cells. Other contributing factors may include calcium (Ca2+) overload, mitochondrial dysfunction, impaired autophagy, and endoplasmic reticulum (ER) stress. In addition, exosomes are also associated with pathophysiological processes of many human diseases and may play a biological role in AP. However, the pathogenic mechanism has not been fully elucidated and needs to be further explored to inform treatment. Recently, the treatment guidelines have changed; minimally invasive therapy is advocated more as the core multidisciplinary participation and “step-up” approach. The surgical procedures have gradually changed from open surgery to minimally invasive surgery that primarily includes percutaneous catheter drainage (PCD), endoscopy, small incision surgery, and video-assisted surgery. The current guidelines for the management of AP have been updated and revised in many aspects. The type of fluid to be used, the timing, volume, and speed of administration for fluid resuscitation has been controversial. In addition, the timing and role of nutritional support and prophylactic antibiotic therapy, as well as the timing of the surgical or endoscopic intervention, and the management of complications still have many uncertainties that could negatively impact the prognosis and patients’ quality of life. Consequently, to inform clinicians about optimal treatment, we aimed to review recent advances in the understanding of the pathogenesis of AP and its diagnosis and management.

Clinical Analysis of Areola Small Incision Surgery for Benign Breast Tumors

Objective: To explore the clinical treatment analysis of areola small incision surgery for benign breast tumors. Methods: 100 patients with benign breast tumors were selected as the test subjects, divided into 2 groups by simple randomization method, 50 cases were the control group, 50 cases were the experimental group, and the admission time was from January 2020 to June 2021; the control group Traditional open surgical treatment was given, and the experimental group was treated with areola small incision surgery. The operation status, complications and treatment satisfaction of the two groups were compared. Results: The operation time and hospital stay of the experimental group were shorter than those of the control group, the amount of intraoperative blood loss was less than that of the control group, and the length of operation was shorter than that of the control group (P&lt;0.05); the total incidence of complications in the experimental group was lower than that of the control group ( P＜0.05); the total satisfaction of clinical treatment of the experimental group was higher than that of the control group (P＜0.05). Conclusion: The clinical treatment of benign breast tumors with areola small incision surgery is significant.

Safety of tropicamide and phenylephrine in pupillary mydriasis for cataract surgery.

PURPOSE:A prospective study to evaluate the adverse cardiovascular effects of topical phenylephrine and tropicamide used for pupillary mydriasis before cataract surgery.METHODS:A total of 517 consecutive eyes in 517 patients subjected to routine 0.8% tropicamide and 5% phenylephrine eye drops before undergoing cataract surgery (phacoemulsification and manual small-incision surgery) under local or topical anesthesia in a medical college hospital were analyzed.RESULTS:No untoward cardiovascular effects were seen. The increase in blood pressure after 0.8% tropicamide and 5% phenylephrine eye drops was statistically significant, but it was not relevant as it was within clinically permissible limits.CONCLUSION:The combination of 0.8% tropicamide and 5% phenylephrine eye drops is a safe and effective option for pupillary mydriasis before cataract surgery.

Перспективы использования микрохирургического устройства из никелида титана в хирургии осложненной катаракты

Purpose. To examine the possibility of using a tool with variable shape geometry of the operational section of titanium nickelide for small incision surgery to remove complicated cataract. Material and methods. Cadaveric eyes of 7 patients with complicated cataract were used for the study. Nickel titanium alloy was selected as the material for lens destruction, as it meets the medical requirements for design solutions of this class of surgical tools in cycles of their deformation in active and transportation conditions. The instrument operational mechanism is shaped as a loop of superelastic thin thread of titanium nickelide with a diameter of 60 microns with a porous surface coating, is used for mechanical fragmentation of the lens nucleus in complicated cataracts. Results. The size of tissue incision in the access zone is reduced. There is a decrease in capsular bag mobility at the stages of nucleus lens fragmentation. The risk of complications caused by a negative energy and other impacts on eye structures related to ultrasound fragmentation of lens nucleus in complicated cataracts is reduced. Conclusion. Use of such opportunities as material superelasticity, plasticity and strength, and its cutting properties when changing the shape of operational part of titanium nickelide micro-tool contributes to improving the intervention efficiency under complicated cataracts in small incision surgery.