Traditional Open Procedures Research Articles

An emerging, less explored Subcutaneous onlay laparoscopic approach for ventral hernias with concomitant diastasis recti

Ventral Hernia (VH) is a common issue in patients with Diastasis Recti (DR). VH with concomitant DR presents a challenging scenario for surgical repair due to complexity of abdominal wall defects. Traditional open surgical procedure is associated with prolonged discomfort and poor cosmesis and resultant patients’ unacceptability. Minimal access surgery such as Sub Cutaneous Onlay Laparoscopic Approach (SCOLA), offers innovative solution in addressing both hernia defects and DR comprehensively and circumvent drawbacks of open surgery. In this prospective observational study, 33 patients with VH and DR underwent SCOLA in a tertiary care hospital in Jamnagar, India over a period of 15 months. Reconstruction of abdominal wall was done by suturing hernia defect, plication of DR and onlay polypropylene mesh augmentation by using this technique. No recurrence was detected at follow up from 4 to 18 month. Overall patient satisfaction rate was 90.9%. We conclude that, the SCOLA is a promising advancement in the treatment of patients of VH with DR with many benefits.

Retrograde open mesenteric stenting and outcomes for acute mesenteric ischemia.

Data regarding retrograde open mesenteric stenting (ROMS) for urgent mesenteric ischemia is limited to small single center and case series, with variable utilization across patient populations and ill-defined outcomes. We aimed to evaluate characteristics and outcomes of patients with acute mesenteric ischemia requiring urgent surgical intervention. Retrospective cohort study of patients with mesenteric ischemia requiring urgent surgical intervention from 2018 to 2020 was queried from the National Inpatient Sample (NIS) database. Study groups were defined as those requiring an open bypass (BYPASS), an open superior mesenteric artery embolectomy (OPEN), or ROMS. Descriptive statistics were used to report variables. Comparisons were mad using t test, chi-squares tests, and multivariate regression reported as odds ratio (OR), 95% confidence interval (CI) where appropriate. 898 patients with mesenteric ischemia requiring urgent surgical intervention were included: Bypass: 284, OPEN: 363, ROMS: 251. There was no difference in gender or race between groups. Patients requiring ROMS were more likely to be older 70.2 + 11.3versus Bypass 66.81 + 11.6 and OPEN 67.17 + 14.5, p = 0.0035. ROMS patients had the highest Charlson Comorbidity Index (CCI) 2.9 versus 2.5 Bypass and 2.6 OPEN, p = 0.0292 with the most frequent comorbidities: Diabetes 37% (p = 0.01), renal disease 24.3% (p = 0.5), and previous preoperative myocardial infarction 9.2%, p = 0.05; however, the lowest mortality rate was seen within this Group 15.9% versus bypass 19.7%, OPEN 34.5%, p < 0.0001. Patients requiring bypass were more likely to have chronic pulmonary disease 34.5% versus OPEN 24.2% and ROMS 31.5%, p = 0.013, peripheral vascular disease (PVD) 38% versus OPEN 16%, and ROMS 29.9%, p < 0.0001. On multivariate regression, ROMS was associated with 50% decreased incidence of mortality (OR 0.45, 95% CI 0.27-0.75). Open SMA embolectomy was associated with nearly 2x mortality rate compared to bypass procedures OR 2.0, 95% CI 1.3-3.0, p < 0.001. Previous MI was also associated with nearly 2x incidence of mortality (OR 1.9, 95% CI 1.01-3.6), while pre-existing PVD conferred a protective effect (OR 0.56, 95% CI 0.36-0.89). Higher CCI and age were associated with slightly increased risk for mortality OR 1.2 and 1.03, p < 0.05 for both. In patients with acute mesenteric ischemia, ROMS demonstrated a significant mortality benefit compared to traditional open procedures. Advanced age, history of MI, and open SMA embolectomy were associated with increased mortality. Little data exists regarding ROMS in a real-world population evaluating ROMS, which is a newer technique. These data suggest that ROMS may be a superior alternative to restore mesenteric flow in the acute setting and further prospective studies evaluating ROMS to other procedural types in urgent and elective settings are needed.

Clinical Implementation of Tissue-Sparing Posterior Cervical Fusion: Addressing Market Access Challenges.

Background: The traditional open midline posterior cervical spine fusion procedure has several shortcomings. It can cause soft tissue damage, muscle atrophy, compromise of the lateral masses and painful prominent posterior cervical instrumentation or spinous process if there is dehiscence of the fascia. Additionally, patients frequently experience the rapid development of adjacent segment disease, which can result in the reemergence of debilitating pain and functional impairment. Clinical relevance: Tissue-sparing posterior cervical fusion is an alternative method for treating patients with symptomatic cervical degenerative disc disease. However, widespread clinical adoption has been challenged by ambiguity, misunderstandings and misinterpretations regarding appropriate procedural reimbursement coding. Technological advancement: The tissue-sparing posterior cervical fusion procedure was approved by the US Food and Drug Administration (FDA) in 2018 (CORUS™ Spinal System and CAVUX® Facet Fixation System (CORUS/CAVUX); Providence™ Medical Technology). This technique addresses the concerns with traditional spine fusion methods by achieving the stability and outcomes of posterior cervical fusion without the morbidity associated with significant muscle stripping in the traditional approach. This technology uses specialized implants and instrumentation to perform all of the steps required to facilitate bone fusion and provide stability while minimizing tissue disruption. The technique involves extensive bone preparation for fusion and placement of specialized stabilization implants that span the facet joint, promoting natural bone growth and fusion while reducing the need for extensive exposure. This procedure provides an effective, less invasive solution for patients with cervical degenerative disc disease. Reimbursement and coding clarity: The article provides a comprehensive rationale for appropriate reimbursement coding for tissue-sparing posterior cervical fusion. This is a critical aspect for the adoption and accessibility of medical technologies. This information is crucial for practitioners and healthcare administrators, ensuring that innovative procedures are accurately coded and reimbursed. Procedural details and clinical evidence: By detailing the procedural steps, instruments used and the physiological basis for the procedure, this article serves as a valuable educational resource for spine surgeons and payers to appropriately code for this procedure. Conclusions: The description of work for CORUS/CAVUX is equivalent to the current surgical standard of lateral mass screw fixation with decortication and onlay posterior grafting to facilitate posterior fusion. Thus, it is recommended that CPT codes 22600/22840 be used, as they best reflect the surgical approach, instrumentation, decortication, posterior cervical fusion and bone grafting procedures.

Minimally Invasive Surgery for Hirschsprung Disease: Current Practices and Future Directions.

Hirschsprung disease (HD) is a congenital disorder characterized by the absence of ganglion cells in the distal colon and rectum, leading to functional obstruction and severe constipation. Over the past decades, the surgical management of HD has significantly evolved, with minimally invasive surgery (MIS) techniques revolutionizing treatment approaches. This review explores recent innovations in MIS for HD, focusing on laparoscopic, transanal endorectal pull-through (TERPT), and robotic-assisted techniques. These approaches offer numerous advantages over traditional open procedures, including reduced surgical trauma, improved cosmesis, faster recovery times, and potentially lower complication rates. Laparoscopic surgery has become widely adopted, providing excellent visualization and precise dissection. TERPT has gained popularity for short-segment disease, offering a completely transanal approach with minimal scarring. Robotic-assisted surgery represents the cutting edge, enhancing surgical precision and dexterity. The review also examines emerging technologies and future directions, such as advanced imaging techniques, artificial intelligence applications, and potential developments in tissue engineering. While MIS techniques have shown promising outcomes, challenges remain in standardizing approaches, addressing long-segment disease, and optimizing long-term functional results. The future of HD surgery lies in personalized approaches that integrate genetic and molecular profiling with advanced surgical technologies. As the field continues to evolve, comprehensive long-term studies and efforts to improve access to specialized care will be crucial to further enhancing outcomes for patients with HD.

Pushing the Limits of Minimally Invasive Spine Surgery-From Preoperative to Intraoperative to Postoperative Management.

The introduction of minimally invasive surgery ushered in a new era of spine surgery by minimizing the undue iatrogenic injury, recovery time, and blood loss, among other complications, of traditional open procedures. Over time, technological advancements have further refined the care of the operative minimally invasive spine patient. Moreover, pre-, and postoperative care have also undergone significant change by way of artificial intelligence risk stratification, advanced imaging for surgical planning and patient selection, postoperative recovery pathways, and digital health solutions. Despite these advancements, challenges persist necessitating ongoing research and collaboration to further optimize patient care in minimally invasive spine surgery.

A Propensity Score-Matched Cohort Study Comparing 3 Different Spine Pedicle Screw Fixation Methods: Freehand, Fluoroscopy-Guided, and Robot-Assisted Techniques.

This study aimed to compare the accuracy of robotic spine surgery and conventional pedicle screw fixation in lumbar degenerative disease. We evaluated clinical and radiological outcomes to demonstrate the noninferiority of robotic surgery. This study employed propensity score matching and included 3 groups: robot-assisted mini-open posterior lumbar interbody fusion (PLIF) (robotic surgery, RS), c-arm guided minimally invasive surgery transforaminal lumbar interbody fusion (C-arm guidance, CG), and freehand open PLIF (free of guidance, FG) (54 patients each). The mean follow-up period was 2.2 years. The preoperative spine condition was considered. Accuracy was evaluated using the Gertzbein-Robbins scale (GRS score) and Babu classification (Babu score). Radiological outcomes included adjacent segmental disease (ASD) and mechanical failure. Clinical outcomes were assessed based on the visual analogue scale, Oswestry Disability Index, 36-item Short Form health survey, and clinical ASD rate. Accuracy was higher in the RS group (p < 0.01) than in other groups. The GRS score was lower in the CG group, whereas the Babu score was lower in the FG group compared with the RS group. No significant differences were observed in radiological and clinical outcomes among the 3 groups. Regression analysis identified preoperative facet degeneration, GRS and Babu scores as significant variables for radiological and clinical ASD. Mechanical failure was influenced by the GRS score and patients' age. This study showed the superior accuracy of robotic spine surgery compared with conventional techniques. When combined with minimally invasive surgery, robotic surgery is advantageous with reduced ligament and muscle damage associated with traditional open procedures.

Development of robotic surgical devices and its application in colorectal surgery

Due to greater accessibility, robotic technology is becoming increasingly common in a wide range of general surgical procedures. In relation to traditional laparoscopic techniques, robotic surgery has four significant advantages: greater accessibility, visibility, accuracy, and comfortability. For example, robotic surgery is particularly beneficial for procedures in hard-to-reach areas (e.g., pelvis, rectum, and endoluminal areas) because it offers a greater range of motion and precision. In addition, surgical visibility and accuracy can be improved by providing 3D and magnified visualization of the surgical field. Robotic systems are also designed for surgeons’ comfort, allowing the operator to sit while working. For these reasons, robotic surgery is preferable for colorectal and other abdominal surgical procedures. As interest in minimally invasive surgery increases, so does the need to develop new approaches and procedures in colorectal surgery. While robotic surgery has great potential for improving outcomes, there may be disadvantages over traditional laparoscopic and open surgical procedures. For example, possible disadvantages include increased maintenance, training, and cost. This review discusses the evolution of robot-assisted surgery with respect to short-term and long-term outcomes. The development of robotic surgical devices, the new devices entering the market, and the possible future directions of robotic surgery will also be discussed.

Bochdalek Hernia: A Comprehensive Review of Pathophysiology, Clinical Presentation, Diagnostic Modalities, and Contemporary Management Strategies

Bochdalek hernia, a rare congenital diaphragmatic anomaly, has garnered substantial attention due to its intricate pathophysiological underpinnings and multifaceted clinical implications. This article endeavors to provide an exhaustive analysis of Bochdalek hernia, encompassing its embryological origins, intricate pathophysiology involving the posterolateral diaphragmatic defect, and the subsequent herniation of abdominal contents into the thoracic cavity. A meticulous exploration of the clinical presentation underscores the considerable variation in symptomatology, ranging from asymptomatic cases incidentally detected on imaging, to severe respiratory distress and life-threatening consequences in neonates. The diagnostic armamentarium, including radiographic, ultrasonographic, and tomographic modalities, is scrutinized with a focus on their respective sensitivities and specificities in discerning this anatomical aberration. In light of contemporary advancements, the article elucidates the expanding role of three-dimensional reconstructions and minimally invasive techniques in achieving accurate diagnosis and surgical planning. Furthermore, the management landscape is delineated, encompassing conservative approaches for asymptomatic cases, urgent surgical interventions for acute presentations, and the nuanced perioperative considerations for neonates and pediatric patients. A comprehensive overview of surgical techniques, ranging from traditional open procedures to the evolving realm of robotic-assisted and laparoscopic repairs, is provided, with emphasis on individualized strategies tailored to patient-specific factors. In summation, this article offers a comprehensive and sophisticated exploration of Bochdalek hernia, amalgamating embryology, pathophysiology, clinical presentation, diagnostic modalities, and contemporary management paradigms. It is envisaged that this review will serve as a valuable resource for medical practitioners, surgeons, and researchers, fostering an enriched understanding of this intricate condition and facilitating informed decision-making in its management.

Short-Term Outcome of Laparoscopic Intraperitoneal Hernioplasty of Incisional Hernia in Khulna Medical College Hospital

Background: Herniorrhaphies that apply a large prosthetic mesh appear to have a lower failure rate, but extensive dissection of soft tissue contributes to an increased incidence of wound infections and wound-related complications. The method of laparoscopic incisional hernia repair was developed in the early 1990s. This technique is based on the same physical and surgical principles as the open underlay procedure. Therefore, this operation has increased in popularity promising shorter hospital stay, improved outcome and fewer complications than traditional open procedures. The aim of the study was to see the short-term outcome of laparoscopic intraperitoneal hernioplasty of incisional hernia in Khulna medical college hospital. Material &amp; Methods: This study was prospective single-cantered observational study carried out at the department of surgery; Khulna Medical College Hospital included 30 patients of incisional hernia those who underwent laparoscopic intraperitoneal on lay mesh (IPOM) technique using polypropylene mesh and the mesh was fixed with Tacker. The duration of the period from January, 2013 to June, 2013. Data was collected by researcher himself with face-to-face interview using a prepared structured questionnaires &amp; checklist and analyzed on SPSS 22. Results: The study was done on 30 patients among which 13 (43.3%) were male and 17 (56.6%) were female patients. Among them the maximum male and female came from 41-50 years age group. Among the 30 patients 16 belonged vertical incisional hernia, whereas 13 patients belonged transverse incisional hernia and the size of the defect of hernia in 27 were medium (defect is 5-10cm) and in 3 were small (defect is &lt;5cm). 21 patients underwent emergency surgery, whereas 9 patients underwent elective surgery for different diseases previously. Every patient in this study group had some predisposing factors to appear incisional hernia. Of them, 16 (53.33%) patients were suffering from Diabetes mellitus, 6 (20%) patients were suffering from chronic cough 2 (6%) patients from chronic retention of urine, 4(13.33%) from chronic constipation and 8 (26.67%) patients from immunocompromised condition due to diseases or drugs taken by them. In case of preoperative complication, only 1 (3.3%) patient each experienced omental haemorrhage, visceral haemorrhage, bowel injury and open conversion whereas 2 (6.6%) patients featured port site bleeding. As postoperative complication, the study shows that 4 (13.3%) patients developed paralytic ileus in followed by port site infection in 3(10%) patients. Conclusion: Laparoscopic hernioplasty is safe and convenient repair in short-term in our clinical setup. But to reach a precise conclusion a long-term case control study with conventional mesh hernioplasty in multiple centres should be done.

Advanced non-medical roles within surgery and their engagement with assistive health technologies.

The role of the surgical care practitioner (SCP) is common in UK surgical centres. The SCP curriculum is robust and well developed in multiple specialties since it was first developed in 1989. The SCP role can often concentrate on technical skills, developing a skillset that is highly effective during traditional open surgical procedures. This skillset requires further investigation because technology-assisted surgeries are becoming more common, including the use of novel approaches to developing non-technical skills. To effectively develop this skillset, analysis of robust advanced practice frameworks is necessary, alongside clear alignment to the advanced practitioners' professional regulations. This article examines the interpretation of the advanced practice concept within technology-assisted surgeries, which is potentially guiding the evolution of advanced practice within operating theatres and improving patient care.

Endoscopic Pilonidal Sinus Treatment: Preliminary Results, Learning Curve and Comparison with Standard Open Approach.

Background: Pilonidal sinus (PNS) is a common disease which can lead to complications including infection and abscess formation. Different surgical approaches have been suggested, based on primary or secondary wound closure intention healing or endoscopic treatment (EPSiT). The aim of this study is to verify the superior outcomes of EPSiT, especially in comparison with the traditional open approach, and discuss the operators' learning curve. Methods: A retrospective study was conducted identifying all the patients who underwent surgical treatment for PNS with EPSiT technique between 2019 and 2022 and with open technique between 2002 and 2022. We divided patients in two groups: open procedure (group 1) and EPSiT (group 2). We considered a p value < 0.05 as statistically significant. Results: The mean operative time was 58.6 ± 23.7 min for group 1 and 42.8 ± 17.4 min for group 2 (p < 0.01). The mean hospital stay was 2.6 ± 1.7 days for group 1 patients and of 0.8 ± 0.4 days for group 2 (p < 0.01). Complete healing was obtained in 18.7 ± 5.6 days for group 1 and 38.3 ± 23.5 days for group 2 (p < 0.01). Recurrences were of 23.4% for group 1 and 5.4% for group 2 (p = 0.03). Conclusions: EPSiT is a minimally invasive and effective approach for the treatment of pilonidal cyst that can be safely performed in pediatric patients with promising results concerning aesthetic outcome and pain control, and with a rapid and less complicated recovery compared to traditional open procedures.

Predicting the Success of Catheter Drainage in Infected Necrotising Pancreatitis: A Cross-Sectional Observational Study.

Background Management of acute necrotising pancreatitis is often challenging for clinicians. Secondary infection of the necrotic collections leads to sepsis and warrants intervention. Minimally invasive techniques like catheter drainage have recently been proposed over more risky and morbid traditional open procedures. Factors that can predict successful catheter drainage of the necrotic pancreatic collection are still unclear and not well established. Materials and methods This study is designed as a retrospective cross-sectional observational study to investigate the association of 21 factors in predicting successful catheter drainage. Data from 30 patients admitted with acute necrotising pancreatitis treated with catheter drainage were collected and analysed. Twenty-one factors, including demographic variables, disease severity factors, drainage criteria, and morphological criteria on imaging, were studied for their predictive association with successful outcomes. Univariate analysis was done for each variable against the outcome. The study was conducted between December 2012 to March 2017. P-value <0.05 was considered statistically significant. Results Patients with no organ involvement responded better to primary catheter drainage. Patients with BMI>25 and multi-organ failure were poor candidates for primary catheter drainage. Clinically unwell patients with a Bedside Index for Severity in Acute Pancreatitis (BISAP) score of ≥4 had a negative outcome on catheter drainage and usually ended up in a surgical procedure or eventually succumbed to the disease. Other variables included in our study did not statistically associate with the success or failure of percutaneous catheter drainage. Conclusion BMI >25, multiple organ failure, and BISAP score ≥ 4 are independent negative predictors for the success of catheter drainage in infected necrotising pancreatitis. No organ failure showed a positive predictor for successful catheter drainage. Further studies are required to explore these predictive factors in a larger sample size to predict the success of catheter drainage in infected pancreatic necrosis.

Robot-assisted Ivor Lewis Esophagectomy (RAILE): A review of surgical techniques and clinical outcomes.

In the past 20 years, robotic system has gradually found a place in esophagectomy which is a demanding procedure in the deep and narrow thoracic cavity containing crucial functional structures. Ivor Lewis esophagectomy (ILE) is a mainstream surgery type for esophagectomy and is widely accepted for its capability in lymphadenectomy and relatively mitigated trauma. As a minimally invasive technique, robot-assisted Ivor Lewis esophagectomy (RAILE) has been frequently compared with the video-assisted procedure and the traditional open procedure. However, high-quality evidence elucidating the advantages and drawbacks of RAILE is still lacking. In this article, we will review the surgical techniques, both short and long-term outcomes, the learning curve, and explicate the current progress and clinical efficacy of RAILE.

P40. Reduced complications but no differences in readmissions with minimally invasive versus open posterior based lumbar interbody fusion, a national study

<h3>BACKGROUND CONTEXT</h3> In single and multi-institution studies, minimally invasive (MIS) posterior and transforaminal lumbar interbody fusion (LIF) has been associated with decreased blood loss, length of stay, costs and improved short term functional outcomes. No national studies exist directly comparing MIS to traditional open posterior-based lumbar interbody fusion procedures. <h3>PURPOSE</h3> We aim to analyze the utilization of anterior MIS-LIF procedures and compare complications, readmissions and reoperations to open-LIF procedures. <h3>STUDY DESIGN/SETTING</h3> Retrospective, administrative databases. <h3>PATIENT SAMPLE</h3> National Inpatient Sample (NIS), National Readmissions Database (NRD), 2016 to 2019. <h3>OUTCOME MEASURES</h3> Readmissions, reoperations, mortality, index hospitalization complications, costs, length of stay, discharge destination. <h3>METHODS</h3> The NIS and NRD databases were queried from 2016 to 2019 to identify patients undergoing posterior-based one- or two-level LIF with a diagnosis of degenerative disc disease, spondylosis, spondylolysis and spondylolisthesis. MIS was defined as procedures utilizing percutaneous or endoscopic approaches. Multivariate regression was used to assess factors associated with procedure type, cost, LOS and discharge destination. Propensity score matching was used to compare index hospital complications, readmission and reoperations at 30, 90 and 180-day intervals. <h3>RESULTS</h3> A total 382,395 posterior-based LIF were estimated to have occurred in the US between 2016 and 2019, with 4,260 (1.1%) of those utilizing MIS techniques. The proportion of MIS procedures did not change significantly over the study period (p=0.40). Two-level procedures were identified in 27.8% and 29.4% of cases for MIS and open procedures, respectively (p=0.32). On multivariate modeling, patients receiving care in the western census regions were significantly less likely to undergo an MIS procedure (OR 0.38, p < 0.0001) relative to the midwest region, while patients receiving care in a medium sized hospital were more likely to receive an MIS procedure relative to a large hospital (OR 1.34, p=0.0003). Patients with a history of coagulopathy, cardiac arrhythmia and fluid & electrolyte disorders were significantly less likely to undergo MIS procedures. MIS procedures were associated with a decreased LOS of 0.69 days (p < 0.0001) and decreased rate of nonhome discharge (OR 0.71, p=0.003). Cost did not differ by procedure type (p=0.35). On matched analysis, MIS patients had a lower rate of overall complications (10.7 vs 14.6%, p < 0.001), neurologic complications (2.8 vs 5.2%, p < 0.001) and blood transfusion (1.7 vs 4.6%, p<0.001). In analysis of 30-day outcomes, there were no differences with regard to all cause readmission (3.5 vs 3.3%, p=0.74), related readmission (1.0 vs 1.5%, p=0.085), readmission for a specific related indication, repeat LIF or mortality. At 90 days, there were no differences in all cause readmission (6.5 vs 6.3%, p=0.81), related readmission (1.7 vs 2.5%, p=0.064), readmission for a specific related indication, repeat LIF or mortality. Finally, at 180-day analysis, there were no differences in all cause readmission (10.1 vs 9.4%, p=0.50), related readmission (2.1 vs 3.1%, p=0.076), readmission for a specific related indication, repeat LIF or mortality. <h3>CONCLUSIONS</h3> Utilization of posterior-based MIS LIF remains low nationally, with 1.1% of procedures utilizing these techniques between 2016 to 2019. MIS is associated with reduced hospital costs, length of stay and blood transfusions compared to open approaches. Short-term rates of readmission and reoperation were similar between MIS and open LIF. <h3>FDA DEVICE/DRUG STATUS</h3> This abstract does not discuss or include any applicable devices or drugs.

Minimally invasive versus open surgery for degenerative lumbar pathologies:a systematic review and meta-analysis.

IntroductionWith the increase in life expectancy and consequent aging of the population, degenerative lumbar spine diseases tend to increase its number exponentially. Several treatment options are available to treat degenerative spinal diseases, such as laminectomies, posterior fusions, and interbody fusions, depending on their locations, correction necessities, and surgeon philosophy. With the advance in technology and surgical knowledge, minimally invasive techniques (MIS) arose as a solution to reduce surgical morbidity, while maintaining the same benefits as the traditionally/open surgeries. Several studies investigated the possible advantages of MIS techniques against the traditional open procedures. However, those articles are usually focused only on one technique or on one pathology. MethodsThe electronic databases, including PubMed, Google Scholar, Ovid, and BVS, were systematically reviewed. Only original articles in English or Portuguese were added to the review, the revision was performed following the PRISMA guideline.ResultsFifty-three studies were included in the meta-analysis. Of the studied outcomes the Length of Stay Odds of complications, Blood Loss, and Surgery costs presented significantly favored MIS approaches, while the Last FUP ODI score, and Surgery Time did not differ among the groups.ConclusionMinimally invasive techniques are a remarkably interesting option to traditional open surgeries, as these procedures showed a significant reduction in blood loss, hospitalization time, complications, and surgical costs.

Video-Assisted Thoracoscopic Surgery (VATS) for Spontaneous Pneumothorax and Emphysematous Bullous Lung Disease: A Study From Northern India.

Introduction: Bullous lung disease is the most common cause of spontaneous pneumothorax. The management of the same is primarily surgical, aiming at the bullectomy, which was earlier performed by standard postero-lateral thoracotomy. The last two decades have seen more frequent use of video-assisted thoracoscopic surgery (VATS) for the same and has been shown to be a low morbidity, efficacious, and cost-effective method. In this study we assess the role of VATS in the spectrum of bullous lung disease.Method: The study was conducted in the Department of Surgery, Dayanand Medical College and Hospital, Ludhiana, for a period of three years from January 1, 2016 to December 31, 2019 in which patients with bullous lung diseases were enrolled and the role of video-assisted thoracoscopic surgery was assessed in them.Results: The study included a total of 75 patients who were managed operatively either by VATS or open thoracotomy. In the study group, the average age of patients was 35.6 years (range 16-68 years). The most common presentation was only bullous lung disease (BLD) in 40% of patients followed by 32% of patients having both BLD and broncho-pleural fistula (BPF). Apical segmentectomy/non-anatomical wedge resection was done in 36% of patients whereas VATS bullectomy was done in 36% of patients. Elective conversion to thoracotomy was planned in six patients because of dense adhesions and thick pleural peel. We performed pleurodesis in almost all cases (96%). Mean blood loss in the VATS procedure was 48.7 ml and mean operative time was 67.2 minutes. Mean duration of hospital stay was 4.8 days. Forced expiratory volume (FEV1) increased significantly from a mean of 65.80% to 77.60%. There was significant increase in forced vital capacity (FVC) mean from 70.30% to 79.50%.Conclusion: VATS can be used as a safe, feasible and effective procedure in patients presenting with spontaneous pneumothorax and bullous lung disease with or without a broncho-pleural fistula or parenchymal leak. It should be preferred over the traditional open thoracotomy procedure, whenever feasible to do so, in view of decreased perioperative morbidity and better functional outcome.

115 Minimally Invasive Versus Open Lumbar Spinal Fusion: A Matched Study Investigating Patient-Reported and Surgical Outcomes

INTRODUCTION: With the expanding indications for and increasing popularity of minimally invasive spine surgery (MIS) for lumbar spinal fusion, large-scale analysis of patient outcomes after MIS approaches compared to traditional open procedures is warranted. METHODS: Patients undergoing MIS and open lumbar fusion were matched at a 1:2 ratio on 33 baseline variables to create two highly homogeneous groups. Primary endpoints of interest were overall satisfaction and a decrease in Oswestry Disability Index (ODI) at 3 months postoperatively. Satisfaction was defined as score 1-2 in the North American Spine Association index; minimal clinically important disease (MCID) for ODI was defined as = 30% decrease from baseline. Secondary endpoints were satisfaction and decrease in ODI at 12 months, length of stay (LOS), operative time, and incidental durotomy rate. RESULTS: The MIS and open groups consisted of 1,483 and 2,966 patients, respectively. MIS fusion patients had a higher odds of satisfaction compared to open surgery at 3 months (OR = 1.4, p = 0.004), while maintaining non-inferior odds of satisfaction at 12 months (OR = 1.04, p = 0.67). Lumbar stenosis, single-level fusion, predominant back pain, higher ASA grade, and absence of spondylolisthesis were associated with higher odds of satisfaction with MIS compared to open surgery. Patients in the MIS group had slightly lower ODI scores at 3 months (mean difference=1.61, p = 0.006; MCID OR = 1.14, p = 0.0495), and 12 months (mean difference=2.35, p &lt; 0.001; MCID OR = 1.29, p &lt; 0.001). The groups did not differ in terms of operative time and incidental durotomy rate; however, LOS was shorter for the MIS group. CONCLUSION: These results demonstrate that MIS fusion is associated with higher odds of satisfaction and, possibly, a greater decrease in ODI than open fusion at 3 months postoperatively while maintaining a greater ODI improvement and performing non-inferiorly to open in regards to satisfaction at 12 months.

Minimally Invasive Posterolateral Approach for Surgical Resection of Dumbbell Tumors of the Lumbar Spine.

Minimally invasive spine surgery (MISS) has many advantages over traditional open surgical procedures that can be conducted for the therapy of different diseases of the spine. MISS provide many prospective advantages such as, for example, small incisions, less damage to soft tissues, early activation of patients, and a shorter postoperative hospital stay. The aim of the study was to evaluate institutional experience with Dumbbell tumors and metastatic lesions of the lumbar spine and compare it with traditional open surgical resection of this type of tumors. Fourteen patients underwent the surgery with minimally invasive posterolateral approach in experimental group, and 10 patients of the control group were operated using the traditional open surgery procedure at the Department of spinal neurosurgery and pathology of peripheral nervous system of JSC “National Center for Neurosurgery.” The intraoperative neuro monitoring system (ISIS IOM System Compact, Inomed, Germany) was used in both groups. Sensory and motor evoked potentials were intraoperatively recorded. The present study was approved by the local Ethics Committee of the National Center for Neurosurgery. Patients signed informed consent before the surgical procedure. The experimental group included 14 patients, that underwent the surgery during the period from January 2020 till March 2021. And the control group included 10 patients that was operated from January 2018 to December 2019. The results of the treatment in both groups were assessed according to the generally accepted visual analog scale (VAS) and the Oswestry scales before, on the third day, and 3 months after the surgery. In experimental group, average reduction of the pain syndrome of 3.36 points (from 3 to 0 points) was observed in patients postoperatively according to the VAS 3 days, and of 4.0 points (from 2 to 0 points) 3 months after surgical procedures. Improvement by 23.86% (36–16%) was also observed using the Oswestry Disease Index (ODI) 3 days after the surgery, and then reduced to 21.00% (16–34%) in average in 3 months. All patients were revived 3 h after transfer to the specialist department. The average stay in the hospital was 6.5 (9–4) days in both groups. In control group, average reduction of the pain syndrome of 2.60 points (from 4 to 1 points) was observed postoperatively according to the VAS 3 days after the operation, and of 3.9 points (from 2 to 0 points) 3 months after the surgery. The ODI of patients was also improved by an average of 35.40% (50–20%) 3 days after the surgical procedure, and reduced to 24.20% (16–32%) in average 3 months after the surgery.

Safety and Performance of Harmonic&amp;#174; HD 1000i Shears in Thoracoscopic Procedures: A Retrospective Study

Background: Ultrasonic energy devices are utilized for transection, incision, and hemostasis in traditional open and laparoscopic procedures. The Harmonic HD 1000i Shears, designed to deliver a precise amount of thermal energy during tissue transection and vessel sealing, has been utilized in many specialties. This study aimed to confirm real-world safety and performance of the Harmonic device in two thoracoscopic procedures: lobectomy and segmentectomy. Methods: The primary endpoint of this retrospective, observational, single-arm study was rate of post-operative blood transfusions related to study device or procedure. Secondary endpoints included occurrence of intra- and post-operative adverse events (AEs) or complications device- or procedure-related, and rate of required additional hemostatic measures. Adults included those who underwent thoracoscopic lobectomy or segmentectomy where HD 1000i shears were used while excluding those where additional advanced energy devices were used. The study was conducted at Severance Hospital, Yonsei University Health System, South Korea from May 1, 2018, to November 30, 2020. Results: Subjects included n = 766 lobectomies (mean age 63.79, 52% male) and n = 215 segmentectomies (mean age 63.19, 54% male). Estimated blood loss was 50 mL (0 min, 3200 max) and 20 mL (0 min, 800 max), intraoperative transfusion rate 0.001% and 0%, intraoperative complication/AE rate 1% and 2%, and post-operative complication/AE rate 9% and 4% in the lobectomy and segmentectomy groups, respectively. Median operative times were 108 min. (35 min, 395 max) for lobectomies and 105 min. (32 min, 574 max) for segmentectomies. Conclusion: Given the low rate of blood loss and intra- and post-operative complication/AE rates, HD 1000i can be used confidently for thoracoscopic pulmonary resection in adults.

Robotic-Assisted Surgery for the Treatment of Breast and Cervical Cancers.

Background:Robotic-assisted surgery facilitates the performance of numerous, complex procedures, namely conferring precision, flexibility, and control that is otherwise unavailable with conventional laparoscopy; and compared to open surgery, robotic-assisted surgery is ostensibly associated with fewer complications, reduced intraoperative complications, and shorter hospital stay duration. Nevertheless, the American College of Obstetricians and Gynecologists and the Food and Drug Administration have criticized the pervasive acceptance of robotic-assisted surgery, given the absence of randomized clinical trial data compared to traditional laparoscopy and open procedures, not to mention the increased surgical cost.Conclusions:While the research data continue to be borne out, surgeons should exercise considerable discretion in selecting the surgical approach from which their patients would derive the greatest clinical benefit.