Small-incision Surgery Research Articles

English

ABSTRACT: The conventional technique of thyroidectomy normally requires a long skin incision and wide skin flaps on the anterior neck. The target of Minimal invasive surgery is to achieve the same results as those obtained with traditional surgery, less trauma, better postoperative course and improved cosmetic results. The aim of this Prospective Cohort study is to compare Small Incision (3.5-4cm) Thyroidectomy with conventional large incision Thyroidectomy with respect to post-op complications & Cosmesis. Most of the patients were in the age group 30-50yrs. There was no statistically significant difference between the two groups with respect to complications, which were Hematoma (6%), Seroma (25%), Hypocalcemia (52.5%)[Transient (37%), Permanent (15%)], Recurrent Laryngeal Nerve Involvement (33%) [Complete (6%)]. The scar in Small Incision surgery was cosmetically far better compared to the large incision Surgery & this difference was statistically significant. This technique not recommended in huge goiter, Retro-sternal goiter, thryroiditis and malignant thyroid. We believe that MINET can be an alternative to the classic approach in selected cases, but cannot be recommended as a standard therapy. Study on a large number of patients and longer follow up periods is recommended.

Videoscope-assisted minimally invasive periodontal surgery (V-MIS).

Small incision surgery has become routine in many areas of medicine but has not been widely accepted in periodontal therapy. A videoscope to assist minimally invasive surgery (MIS) has been developed. The clinical outcomes from MIS performed using this videoscope (V-MIS) are reported. Patients were evaluated for residual defects following non-surgical therapy consisting of root planing with local anaesthetic. Thirty patients having 110 sites with residual pocket probing depth (PPD) of at least 5mm, 2mm loss of clinical attachment level (CAL), and radiographic evidence of bone loss were surgically treated. V-MIS was performed utilizing the videoscope for surgical visualization. At re-evaluation 6months post surgery, there was a statistically significant improvement (p<.001) in mean PPD and CAL (PPD 3.88±1.02mm, CAL 4.04±1.38mm) in 1, 2, and 3 wall defects. All PPD at re-evaluation were 3mm or less. There was a mean post-surgical increase in soft tissue height (0.13±0.61mm, p=0.168) with a decrease in recession. The improvement in PPD and CAL from V-MIS, in the authors' opinion, appears to be favourable when compared to previously reported results of periodontal regenerative surgery. The lack of post-surgical recession following V-MIS has not been reported with traditional regenerative surgery.

Comparison of postoperative macular thickness in diabetic patients after phacoemulsification or manual small-incision cataract surgery

Objective To compare the macular central foveal thickness in cataract patients with type Ⅱ diabetes after phacoemulsification or manual small incision cataract surgery.Methods Fifty-six eyes of 56 cataract patients with type Ⅱ diabetes were randomly divided into two groups.Patients were treated by phacoemulsificaiton or manual small incision cataract surgery,respectively.All patients underwent fundus examination and fundus photography before operation.The foveal thickness measurement by OCT was performed on 1 month before surgery and 1 week,4 weeks,6 weeks and 3 months after operation.The correlation between foveal thickness and postoperative best corrected visual acuity was analyzed.Results The manual small incision cataract surgery was performed on 26 eyes and phacoemulsification cataract surgery was performed on 30 eyes.No significant difference in postoperative macular edema was found between the two groups.One week after operation,compared with the phacoemulsification group,the retinal neuroepithelial thickness in central fovea of macula in manual small incision surgery group was significantly higher (t =4.602,P =0.006),the best corrected visual acuity was significantly lower (x2 =9.753,P =0.009).Four weeks after operation,neither the retinal neuroepithelial thickness nor the best corrected visual acuity between two groups was significantly different.A negative correlation was found between the postoperative retinal neuroepithelial thickness and the best corrected visual acuity.Conclusion Although the incidence of postoperative macular edema in the two groups was not significantly different from each other,the postoperative retinal neuroepithelial thickness and the best corrected visual acuity were obviously infected by manual small incision surgery in short term after operation. Key words: Diabetics, type Ⅱ ; Surgery, cataract, small incision, manual; Phacoemulsificaiton; Thickness, foveal

Curative effect analysis of two kinds of small incision surgery treating senile cataract patients

Curative effect analysis of two kinds of small incision surgery treating senile cataract patients

English

ABSTACT: AIM: To test the efficacy of topical betaxolol to recover unexplained visual loss after uneventful cataract surgery in hypertensive patients. Study design: Randomized clinical trial. MATERIALS AND METHODS: One hundred patients of decreased visual acuity (20\40 to 20/50 after best correction after 6 weeks of uncomplicated small incision surgery in hypertensive patients were enrolled. Fifty eyes received topical betaxolol twice daily and fifty eyes received placebo eye drops as a randomized comparison group and followed up for more than six months. Change in best-corrected visual acuity was considered as change of five letters (0.1 log MAR) or more. Statistical analysis: Significance of difference of results between study and control groups is determined by MannWhitney U test and Fisher Exact test. RESULTS: 14 (28 %) patients demonstrated three lines and 31 (62 %) patients showed two line improvement in best-corrected visual acuity under treatment group. Whereas one (0.3 to 0.0) and 11 (0.4 to 0.2) eyes of the placebo group demonstrated same amount visual improvement. CONCLUSION: Topical betaxolol significantly improves visual acuity in unexplained visual loss after uneventful small incision cataract surgery in hypertensive patients.

Influence of corneal biomechanical properties on surgically induced astigmatism in cataract surgery

To perform an overall follow-up of the morphologic, optical, and biomechanical properties of the cornea to determine new parameters influencing the refractive outcomes of cataract surgery. Clinical study. Patients scheduled for cataract surgery were assessed for surgically induced corneal astigmatism (SIA) and higher-order aberrations, (HOAs) using a Scheimpflug rotating camera (Pentacam) together with corneal imaging by optical coherence tomography (Spectralis) and biomechanical analysis by the Ocular Response Analyzer preoperatively and 1, 7, and 30 days postoperatively. The central and peripheral corneal thicknesses; incision width, length, and architecture; corneal hysteresis (CH); and corneal resistance factor (CRF) were computed to identify new parameters influencing corneal optical changes that determine the final refractive result. The study enrolled 40 patients (40 eyes). The SIA and HOAs were significantly lower after microincision surgery (≤ 2.2 mm) than after small-incision surgery (2.75 mm) (both P<.01). The CRF was significantly reduced with a direct corneal incision compared with a constructed incision (P<.01). Multivariate analysis showed that SIA was correlated not only with incision width (P<.05) but also with preoperative CH (P<.01). Corneal 3rd-order trefoil depended on incision width (P<.01). In addition to the well-known influence of incision size on SIA, CH also modulates optical changes. The biomechanical features of the cornea should be taken into account preoperatively to better predict the refractive outcomes of cataract surgery.

A comparison study of axillary small incision and assisted thoracic surgery for spontaneous pneumothorax

Objective To study the clinical efficacy of axillary incision and thoracoscopic surgery for spontaneous pneumothorax.Methods 106 cases of spontaneous pneumothorax in our hospital were given axillary incision surgery(axillary incision group) and thoracoscopic surgery(thoracoscopy group).The intraoperative blood loss,operative time,chest tube drainage time,postoperative hospital stay and surgery costs were compared between the two groups,and the occurrence of complications were observed.Results The armpit small incision group,intraoperative blood loss was (44.5 ± 5.2) ml,the thoracoscopic amount of blood loss was (38.3 ± 6.5) ml (t =6.378,P ＜ 0.01) ;armpit operation time of the small incision group was (68.0 ± 5.3) min,thoracoscopic operative time was (60.8 ±6.0)min; armpit chest tube drainage time of small incision group was (2.8 ± 0.8)d,thoracoscopic group of chest tube drainage time was (2.0 ± 0.5) d; axillary small incision group,length of stay was (4.8 ± 0.7) d,the thoracoscopic group hospitalization time was (4.0 ± 0.6) d,(t =3.552,4.215,3.076,all P ＜ 0.05) ; axillary incision surgery costs was (1 550 ± 348) Yuan,the thoracoscopic group cost of surgery was (4 290 ± 573) Yuan (t =-24.823,P ＜ 0.05).Two groups of patients with no surgical complications,chest X-ray review of lung reexpansion good thoracoscopic group one cases of recurrence of pneumothorax,axillary incision group without recurrence (P ＞ 0.05).Conclusion Axillary small incision and thoracoscopic surgery for spontaneous pneumothorax have the similar efficacy,thoracoscopic surgery is less trauma,faster recovery,shorter hospital stay,but the high cost of surgery,if patients physical condition is acceptable,which can be used axillary incision surgery. Key words: Pneumothorax; Small incision in the armpit; Thoracoscopy

The comparition between small incision surgery and traditional surgery on patients with thyroid tumor

Objective To compare the effects between small incision surgery and traditional surgery on patients with thyroid tumor.Methods 96 patients with thyroid tumor were randomly divided into two groups,the control group(n =48 cases) and the observation group (n =48 cases).The control group received traditional surgery while the observation group received small incision surgery.Results The patients in two groups had low complication rate,and had no significant difference between two groups.Surgical scars,hospital time,operation time and bleeding,of the observation group were less than these of the control group(P ＜0.01).The patients in the observation group were satisfied with the cosmetic results.Followed up for five to thirty-seven months,there wasn't relapse.Conclusion Small incision surgery via thyroid tumor has the advantages of simple operation,little trauma and veiled incision,which is worthy of clinical generalization Key words: Thyroid tumor; Small incision surgery; Comparison

Unicompartmental Knee Replacement With New Oxford Instruments

The Oxford unicompartmental knee arthroplasty was developed for the treatment of anteromedial osteoarthritis of the knee. Following strict adherence to the clinical indications, this mobile-bearing device has shown >90% survivorship at 20 years and good to excellent clinical results after 10 years. The addition of small incision surgery to the Oxford technique along with rapid recovery protocols has resulted in quicker functional recovery with less morbidity and mortality, thus making the procedure truly minimally invasive compared with total knee replacement. The most recent evolutionary change to the Oxford technique has been the addition of new instrumentation (Oxford Microplasty) that allows for more reproducible execution of the operation, which might improve the long-term success of the surgery. This article outlines the Oxford surgical technique using the Oxford Microplasty instruments.

Laparoscopic Radical Hysterectomy Duplicated by Orifice Assisted Small Incision Surgery (OASIS)

Orifice-assisted small-incision surgery (OASIS) is a new milestone in MIS. It incorporates benefits of single-incision and natural-orifice surgery and overcomes the challenges of both, like instrument and optical access clashing and instrument crowding thus allowing the performance of advanced laparoscopic procedures with ease. The optical access is gained via the posterior cul-de-sac by placing a flexible 13mm sigmoidoscope through a 15 mm trocar. Two 5 mm ports are placed on the either side of umbilicus. The steps of laparoscopic radical hysterectomy by the Pune technique were duplicated by this approach. The oncological clearance achieved was 3cm of paracervical margins and 2cm of distal vaginal margins, with a average nodal yield of 16 lymph nodes. OASIS appears to be a safe and feasible. The important drawbacks of single incision surgery are overcome by this technique. The oncological clearance is comparable to laproscopic radical hysterectomy.

Phaco-emulsification versus manual small-incision cataract surgery in South Africa

To compare the results of phaco-emulsification cataract surgery and manual small-incision cataract surgery. Consecutive patients aged >50 years undergoing surgery for age-related cataract were recruited into a randomised prospective clinical trial. Randomisation was done using opaque sequentially numbered envelopes opened by the surgeon immediately prior to surgery. The patients were seen after 1 day, 2 weeks, and 8 weeks. Outcome measures. The primary outcome measure was the uncorrected visual acuity at week 8. The secondary outcome measures were the uncorrected visual acuity on day 1, the best corrected visual acuity at week 8, the refraction at week 8, and the intra- and postoperative complications. One hundred patients were recruited into each arm of the study. There was no difference in the incidence of intra-ocular complications (p=0.19). There was no difference in the day 1 visual acuities (p=0.28). However, both the uncorrected and the corrected week 8 visual acuities were better in the eyes that had phaco-emulsification (p=0.02 and p=0.03), and there was less astigmatism (p=0.001) at week 8 in the eyes that had phaco-emulsification. While manual small-incision surgery has been recommended as an acceptable alternative to phaco-emulsification in middle- and low-income countries, we have found that the results of phaco-emulsification are better. Where appropriate, consideration should be given to encouraging a transition to phaco-emulsification in our Vision 2020 programmes in Africa.

Orifice-Assisted Small-Incision Surgery: Case Series in Benign and Oncologic Gynecology

This case series describes the feasibility of orifice-assisted small-incision surgery (OASIS), a novel technique that may incorporate benefits of single-incision and natural-orifice surgery while minimizing issues such as instrument crowding and interaction of optical access with operative instrumentation. In our multiple-site series, we included patients from a large academic medical center in the northeastern United States and a private gynecology clinic in India. Between the 2 centers, a total of 14 patients (5 with benign disease and 9 with oncologic disease) underwent the following procedures: OASIS total laparoscopic hysterectomy, laparoscopic supracervical hysterectomy, laparoscopic myomectomy, or laparoscopic radical hysterectomy with pelvic lymph node dissection. The initial 14 cases were safely completed. Oncologic clearance was consistent with specialty norms. Operating time ranged from 60 to 150 minutes, and estimated blood loss ranged from 10 to 500 mL. Detailed procedure descriptions and videos are provided. Based on preliminary case series experience, OASIS seems to be a safe and feasible addition to the advanced minimally invasive surgeons’ armamentarium for both benign and oncologic cases.

Current variations of glaucoma filtration surgery

Trabeculectomy continues to be the most effective incisional surgery for uncontrolled glaucoma. Since its introduction by Cairns in 1968, the procedure has undergone numerous modifications. This article will summarize the current variations of glaucoma filtration surgery and evidence-based review of their potential advantages and disadvantages. Recent innovations in glaucoma filtration surgery have focused on wound modulation to enhance long-term surgical outcomes and the search for a small incision surgery with more predictable outcomes, lower complication rates, and rapid visual recovery. Amniotic membranes, antivascular endothelial growth factor agents, and tissue-engineered biodegradable implants are currently being investigated as alternatives to mitomycin C and 5-fluorouracil to reduce inflammation and subsequent bleb failure with fewer complications. The Ex-PRESS glaucoma filtration device appears promising with its unique feature of small-incision surgery, fewer intraoperative and postoperative complications, and its ability to lower intraocular pressure significantly, which appears to be comparable with standard trabeculectomy. Knowledge and surgical expertise in handling current variations of glaucoma filtration surgery are essential to offer an individualized approach with the overall goal of optimizing surgical outcomes and minimizing complications.

Feasibility and Complications between Phacoemulsification and Manual Small Incision Surgery in Subluxated Cataract

Purpose. To compare the feasibility of cataract surgery with implantation of endocapsular supporting devices and intraocular lens (IOL) in subluxated cataract in phacoemulsification and manual small incision cataract surgery (MSICS). Design. Prospective randomized intervention case series consisting of 60 eyes with visually significant subluxated cataract. Method. The patients were randomly distributed between the two groups equally. The main outcome measure was implantation of in-the-bag IOL, requirement of additional procedure and complications, if any. Results. Capsular bag retention in subluxated lenses is possible in 90% cases in phacoemulsification versus 76.67% cases in MSICS (P = 0.16). Both groups, achieved similar best corrected visual acuity (P = 0.73), although additional procedures, intraoperative, and postoperative complications were more common in MSICS. Conclusions. Achieving intact capsulorhexis and nuclear rotation in MSICS may be difficult in cases with large nucleus size and severe subluxation, but subluxated cataracts can be effectively managed by both phacoemuslification and MSICS.

Clinical application of laparoscopy-assisted small incision surgery in treatment of urological diseases

Objective To apply laparoscopy-assisted small incision surgery in complicated urological operation,and to summarize our experience.Methods We retrospectively analyzed the clinical data of 9 patients with renal tumors(3 with solitary kidney tumors,2 with unilateral multiple tumors,1 with bilateral tumors,and 3 with contralateral renal insufficiency),3 patients with renal pelvic ureteropelvic junction obstruction(UPJO) and multiple stones,and 1 patient with distal ureteral tumor.All patients underwent laparoscopy-assisted small incision surgery in our department from Aug.2007 to Jun.2011.The key steps of the surgery were discussed and the clinical experience was summarized.Results (1) For 9 patients with renal tumors,the incision was 4-6 cm in length,the cold ischemia time was(15±4) min,and the operation time ranged from 90 to 180 min.Drainage tubes were removed within 48 h after operation.No patient had bleeding,urinary fistula or other serious complications.(2) For the 3 patients with UPJO,the incision was 4-5 cm in length and the operation time was 110 to 190 min.Drainage tubes were removed within 3-5 d after operation.No patient had bleeding,urinary fistula or other serious complications.No patient had fever or back pain after removal of double-J stents.Intravenous pyelography showed no hydronephrosis and the renal structure was normal.(3) For the patient with ureteral tumor,the drainage tube was removed 3 d after operation and there was no complication.No patients in the present study used analgesic pump or analgesic medications after surgery.Conclusion Laparoscopy-assisted small incision surgery can reduce the length of incision,minimize injury,and protect renal function.Besides,the method is safe and capable of handling complicated situations,especially suitable for patients who are difficult to receive total laparoscopic surgery.

The clinical observation of intraocular lens implantation in the patients of small-incision non-phacoemulsification cataract extraction with posterior capsule intraoperative rupture

Objective To study the efficacy and safety of non-phacoemulsification cataract extraction and intraocular lens implantation in the patients with intraoperative posterior capsule rupture. Methods 346 cases (381 eyes) were accepted small-incision non-phacoemulsification cataract surgery and were implanted intraocular lens. 21 cases underwent intraoperative posterior capsule rupture,of which 18 cases were accepted one-stage implantation of posterior chamber intraocular lens, 3 cases didn' t select it. The complications and postoperative visual acuity after follow-up for three months were investigated. Results Transient elevation of intraocular pressure occurred in 3 eyes ( 16. 67% ) , corneal edema in 16 eyes (88. 89% ) ,mild deviation of intraocular lens in 2 eyes ( 11. 11% ) , pupil less round and mild displacement in 5 eyes (27. 78% ). The best corrected visual acuity was more than 0. 5 in 13 eyes (72. 22% ) three months after operation. No serious complications occurred. Conclusion According to specific conditions, this technique of one-stage implantation of non-phacoemulsification intraocular lens is safe and can achieve better vision in the patients with intraoperative posterior capsule rupture during the surgery of non-phacoemulsification. Key words: non-phacoemulsification; small-incision; posterior capsular rupture; lens,intraocular

Sulcus Transscleral Intraocular Lens Suture Fixation through Small Scleral Tunnel Incision.

To evaluate the clinical efficiency and safety of sulcus transscleral intraocular lens suture fixation with small incision through scleral tunnel in eyes the with posterior capsule defect or insufficient zonula support. Thirty nine eyes with severe posterior capsule defect and zonula damages caused by small-incision cataract surgery, and those with capsule absence or intraocular lens dislocation were selected in this investigation from February 2007 to December 2009. Sulcus transscleral intraocular lens suture combined with puncture needle-guided external approachab and "one- or two-point fixation" method in the small sclera tunnel incision were employed. The mean follow-up was 12.1 months (range from 3 to 28 months). Six eyes were complicated by some eye diseases postoperatively. The best-corrected visual acuity was 20/40 or better in other 34 eyes (87.17%). All eyes with secondary IOL fixation presented equal or better naked visual acuity than best-corrected visual acuity best-corrected preoperatively. No intraoperative and postoperative complications such as hemorrhage, retinal detachment, intraocular lens tilt and decentration occurred. Sulcus transscleral intraocular lens suture fixation via small sclera tunnel incision was easy to operate and master, required less operative time, and made primary intraocular lens fixation more effective in eyes with posterior capsule defect or insufficient zonula support in small sclera tunnel incision surgery. In addition, the technique was safe and efficient for secondary intraocular lens fixation.

Sulcus Suture Fixation of a Foldable IOL over Preserved Capsule for Managing Lens Subluxation in Marfan’s syndrom

Aim: To study the feasibility and efficacy of removal of the subluxated lens and sclera fixation of a foldable intraocular lens on top of the decentered preserved capsular bag. Patients and methods. Seventeen eyes of 10 patients (9 - 15 years) were done by phacoaspiration followed by trans-scleral fixation of foldable IOL in the sulcus on top of the decentered capsular bag of the subluxated lens. Results: Postoperative refraction spherical equivalent amplitude ranged from 0.25 to 1.38 diopters with a mean of 1.35 ± 1.13 diopters. The final postoperative BCVA ranged from 6/18 to 6/6 with a mean of 6/9 (0.67 ± 0.25 decimal). Intraoperative complications were hyphema in one case and accidental small zonular injury without vitreous prolapsed during needle passage in two cases. Postoperative complications were transient iridocyclitis in one case. Posterior capsular opacification (PCO) occurred in all cases but in thirteen cases the bag gets contracted and the opacity was away from the visual axis and only four cases needed YAG posterior capsulotomy. Conclusion: Combined sulcus and scleral fixation of foldable intraocular is a safe and effective method. This technique of keeping the decentered bag attached to the stretched zonules will prevent IOL tilt and avoid working on the vitreous with its known complications. Scleral fixation of the foldable IOL guarantees the long term stability and gets the benefits of small incision surgery.

Higher-Order Aberration Changes After Implantable Collamer Lens Implantation for Myopia

To investigate the changes in higher-order aberrations (HOAs) induced by implantation of Implantable Collamer Lenses (STAAR Surgical) and to explain them in relation to the surgical incision and optical properties. Prospective, observational case study. This study included 56 eyes undergoing Implantable Collamer Lens insertion for myopic correction. The corneal incision size was determined according to the amount of astigmatism. HOAs were measured before surgery and 3 months after surgery in 25 eyes having small superior incision (<3.2 mm) surgery and in 31 eyes with large superior incision (3.2 to 4.5 mm) surgery. Changes in spherical aberration, coma, trefoil, and total HOAs (third to sixth order) were analyzed. Laboratory measurements of aberration profiles of Implantable Collamer Lenses with different optical powers were performed to validate clinical measurements. In the small-incision group, trefoil (Z(3)(-3)) and spherical aberration changed significantly (P=.004). In the large-incision group, in addition to trefoil and spherical aberration, total HOA changed significantly (mean change, 0.13 ± 0.17; P=.001). Significant correlations were observed among the incision size, the astigmatism induced, and the trefoil induced. Induced trefoil showed a predominant pattern at the orientation of the incision meridian. Optical measurement of aberrations of the Implantable Collamer Lenses confirmed the postoperative negative spherical aberration. HOA changes after Implantable Collamer Lens insertion were increased trefoil and induced negative spherical aberration. These changes may be explained by the effect of the corneal incision and the negative spherical aberration in the Implantable Collamer Lens, respectively.

Lack of Glaucoma Following Infantile Cataract Surgery with Primary Posterior Chamber Intraocular Lens Implantation

To determine the incidence of glaucoma following infantile cataract surgery with primary posterior chamber lens (PC-IOL) implantation for isolated non-traumatic cataract. Retrospective institutional medical record review. Thirty-six eyes of 31 patients were identified. Small incision surgery (including posterior capsulotomy and anterior vitrectomy) was performed at a mean age of 7.6 months (median: 7 months; range: 5 to 10 months) with in-the-bag PC-IOL placement in 27 eyes and sulcus PC-IOL placement in 9 eyes. Last follow-up examination was a mean 67.1 months postoperatively (median: 65 months; range: 60 to 84 months). No eye was diagnosed as having glaucoma. In a similar population (same methods, age range, and ethnic group) that was left aphakic, the incidence of glaucoma was 22 of 57 eyes (38.6%). Primary PC-IOL implantation may confer protection against delayed-onset glaucoma following cataract surgery between 5 and 10 months of age.