Role of Minimally Invasive Surgery in Management of Penetrating Abdominal Trauma in Children

2021 ◽  
Author(s):  
Muhammad Abdelhafez Mahmoud ◽  
Mohammad Alsayed Daboos ◽  
Ahmed Said Sayed Bayoumi ◽  
Ahmed Abdelghaffar Helal ◽  
Abdulrahman Almaawi ◽  
...  
Keyword(s):  
Minimally Invasive Surgery ◽  
Minimally Invasive ◽  
Invasive Surgery ◽  
Pediatric Patients ◽  
Operative Time ◽  
Length Of Hospital Stay ◽  
Penetrating Abdominal Trauma ◽  
Missed Injury ◽  
The Mean ◽  
Laparoscopic Assisted

Abstract Introduction Traditionally, exploratory laparotomy was used to treat penetrating abdominal trauma (PAT). At present, minimally invasive surgery (for diagnostic and therapeutic purposes) has developed and represents a rapidly evolving modality for dealing with PAT in stable children. In this article, we aim to present our experience, evaluate the effectiveness, and report the results of minimally invasive surgery (MIS) for PAT in stable pediatric patients. Materials and Methods This prospective study involved 117 hemodynamically stable pediatric cases of PAT (caused by gunshots, stab, and accidental stab), admitted, and managed according to the severity of injury. The information recorded for analysis included demographic data, the anatomical location of injury, the initial vital data and scoring systems, the organs affected, the procedures done, operative time, need for conversion to laparoscopic-assisted approach, length of hospital stay, complications, missed injury, and mortality rate. Results Among 117 pediatric patients with PAT, 15 cases were treated conservatively and 102 cases were managed by MIS. They were 70 males and 47 females with a mean age of 7.3 ± 0.6 years (range = 1–14 years). They included 48 cases of gunshot injury, 33 cases of abdominal stab, and 36 cases of accidental stab. Laparoscopy was diagnostic (DL) in 33.3% (n = 34) and therapeutic (TL) in 66.7% (n = 68) of cases. Of the 68 TL cases, we completely managed 59 cases (86.8%) by laparoscopy, while 9 cases (13.2%) were converted to limited laparotomy. The mean operative time was 17 ± 1 minutes (range = 12–25 minutes) for DL, 85 ± 9 minutes (range = 41–143 minutes) for complete TL cases, and 89 ± 3 minutes (range = 47–149 minutes) for laparoscopic-assisted procedures. For DL cases, the mean length of hospital stay was 2 ± 0.4 days, while for complete TL cases, it was 5.4 ± 0.83 days, and for laparoscopic-assisted cases, it was 5.8 ± 0.37 days. Postoperative complications occurred in eight cases (7.84%), with five cases (4.9%) required reintervention. No missed injury or mortality was recorded in the study. The patients were followed up for a median period of 52 months. Conclusion For management of PAT in children, MIS has 100% accuracy in defining the injured organs with zero percent missed injuries.

scholarly journals Orthotic Bracing or Minimally Invasive Surgery? A Summary of 767 Pectus Carinatum Cases for 9 Years

2021 ◽  
Vol 2021 ◽  
pp. 1-8
Author(s):  
Ziyin Shang ◽  
Chun Hong ◽  
Xianlun Duan ◽  
Xiangyong Li ◽  
Yuan Si
Keyword(s):  
Minimally Invasive Surgery ◽  
Minimally Invasive ◽  
Invasive Surgery ◽  
Pediatric Patients ◽  
Average Length ◽  
Length Of Hospital Stay ◽  
Operation Time ◽  
Pectus Carinatum ◽  
Treatment Methods

Orthotic bracing and minimally invasive surgery are currently the treatment methods for pectus carinatum. We present our experience with the advantages, method selection criteria, and precautions for both treatment methods. A total of 767 pediatric patients (596 boys and 171 girls) with pectus carinatum were retrospectively analyzed. All of them received orthotic bracing, and 108 pediatric patients received minimally invasive surgery, achieving good outcomes. Among the 767 pediatric patients, 644 obtained satisfactory chest appearance through orthotic bracing, with a success rate of 84.0%. Younger pediatric patients had better orthotic outcomes. Among the 123 failure cases, 108 pediatric patients underwent minimally invasive surgery as the treatment. Seventy-six pediatric patients with simple chondrogladiolar prominence underwent a minimally invasive sternal depression procedure, whereas 32 pediatric patients with complex chondromanubrial prominence underwent surgery. All 108 pediatric patients successfully completed the surgery. The operation time was 112.8 ± 23.5  min, and the average length of hospital stay after the surgery was 7 days. A follow-up was conducted for at least 3 months and up to 3 years. The orthotic effect was satisfactory. For younger pediatric patients with pectus carinatum, noninvasive orthotic bracing treatment should be considered first. For older pediatric patients, the failure rate of the bracing was higher, and the outcomes were often unsatisfactory. Especially for patients over 15 years old, minimally invasive sternal depression may be the preferred treatment for pectus carinatum.

Treatment of ureteropelvic junction obstruction and urolithiasis in children with minimally invasive surgery

2021 ◽  
pp. 039156032110261
Author(s):  
Lorenzo Masieri ◽  
Simone Sforza ◽  
Alekseja Manera ◽  
Luca Lambertini ◽  
Alfonso Crisci ◽  
...  
Keyword(s):  
Minimally Invasive Surgery ◽  
Minimally Invasive ◽  
Invasive Surgery ◽  
Pediatric Patients ◽  
Ureteropelvic Junction Obstruction ◽  
Ureteropelvic Junction ◽  
Tertiary Referral Center ◽  
Flexible Cystoscope ◽  
Effective Option ◽  
Open Pyeloplasty

Background: Ureteropelvic Junction Obstruction (UPJO) is the most common congenital ureteral anomaly. Nowadays, according to the increasing incidence of urolithiasis, 20% of children with UPJO presents urolithiasis. Open pyeloplasty was the standard treatment before the introduction of minimally invasive surgery (MIS). Nevertheless, only scattered experiences on MIS were previously described and universal agreement on the treatment of UPJO plus urolithiasis is still missing. Objective: The study aim was to describe our experience with a series of pediatric patients affected by UPJO and urolithiasis treated with robot-assisted pyeloplasty (RAP) and endoscopic removal of stones using a flexible cystoscope and a stones basket in a singular tertiary referral center. Material and methods: We retrospectively reviewed our data from pediatric patients affected by UPJO and urolithiasis undergoing RAP between April 2013 and December 2019. The analysis was conducted on seven patients. All procedures were performed by one expert robotic surgeon and one endoscopic surgeon skilled in the management of urolithiasis. Results: The mean age was 7 years (IQR 4–16). The median stone area was 77.7 mm two (IQR 50.2–148.4). Most of them (71.4%) presented preoperative symptoms. The median operative time was 110 min (IQR 104–125) with a console time of 90 (IQR 90–105). The median length of stay was 5 days (IQR 4–5). Median follow-up was 16 months (IQR 10–25). Conclusion: RAP with concomitant flexible ureteroscope is a safe and effective option for the simultaneous management of UPJO with urolithiasis with excellent outcomes in children.

Minimally invasive surgery under local anaesthesia for chronic rhinosinusitis with nasal polyps: our experience in older adults

2020 ◽  
Vol 134 (2) ◽  
pp. 145-149
Author(s):  
M Casale ◽  
A Costantino ◽  
L Sabatino ◽  
A Luchena ◽  
A Moffa ◽  
...  
Keyword(s):  
Minimally Invasive Surgery ◽  
Visual Analogue Scale ◽  
Minimally Invasive ◽  
Chronic Rhinosinusitis ◽  
Invasive Surgery ◽  
Local Anaesthesia ◽  
Analogue Scale ◽  
Nasal Polyps ◽  
Post Operative Pain ◽  
The Mean

AbstractObjectiveThis paper aims to report our experience with a minimally invasive surgical procedure for the treatment of chronic rhinosinusitis with nasal polyps, performed in a day-surgery setting under local anaesthesia.MethodsA retrospective study of 30 patients with chronic rhinosinusitis with nasal polyps was conducted. Sino-Nasal Outcome Test 22 and modified Lund–Kennedy scores were collected. Intra- and post-operative pain was evaluated using a 10-point visual analogue scale.ResultsThe mean Sino-Nasal Outcome Test 22 score decreased from 41.8 ± 15.8 pre-operatively to 13.3 ± 9.5 post-operatively (p < 0.001). Accordingly, the mean endoscopic score decreased from 6.8 ± 1.8 to 0.2 ± 0.7 (p < 0.001). The mean intra-operative pain score was 2.9 ± 3.2, and 29 patients (96.7 per cent) reported no pain in the post-operative period (visual analogue scale score = 0).ConclusionOur study confirms that minimally invasive surgery represents a safe, repeatable procedure that results in remarkable subjective and objective improvement, without intra- and post-operative pain or discomfort.

Minimally invasive surgery for thoracolumbar spinal deformity: initial clinical experience with clinical and radiographic outcomes

2010 ◽  
Vol 28 (3) ◽  
pp. E9 ◽  
Author(s):  
Michael Y. Wang ◽  
Praveen V. Mummaneni
Keyword(s):  
Minimally Invasive Surgery ◽  
Minimally Invasive ◽  
Invasive Surgery ◽  
Interbody Fusion ◽  
Complication Rates ◽  
Surgical Morbidity ◽  
Minimally Invasive Surgical ◽  
Csf Leakage ◽  
The Mean

Object Adult degenerative scoliosis can be a cause of intractable pain, decreased mobility, and reduced quality of life. Surgical correction of this problem frequently leads to substantial clinical improvement, but advanced age, medical comorbidities, osteoporosis, and the rigidity of the spine result in high surgical complication rates. Minimally invasive surgery is being applied to this patient population in an effort to reduce the high complication rates associated with adult deformity surgery. Methods A retrospective study of 23 patients was undertaken to assess the clinical and radiographic results with minimally invasive surgery for adult thoracolumbar deformity surgery. All patients underwent a lateral interbody fusion followed by posterior percutaneous screw fixation and possible minimally invasive surgical transforaminal lumbar interbody fusion if fusion near the lumbosacral junction was necessary. A mean of 3.7 intersegmental levels were treated (range 2–7 levels). The mean follow-up was 13.4 months. Results The mean preoperative Cobb angle was 31.4°, and it was corrected to 11.5° at follow-up. The mean blood loss was 477 ml, and the operative time was 401 minutes. The mean visual analog scale score improvement for axial pain was 3.96. Clear evidence of fusion was seen on radiographs at 84 of 86 treated levels, with no interbody pseudarthroses. Complications included 2 returns to the operating room, one for CSF leakage and the other for hardware pullout. There were no wound infections, pneumonia, deep venous thrombosis, or new neurological deficits. However, of all patients, 30.4% experienced new thigh numbness, dysesthesias, pain, or weakness, and in one patient these new symptoms were persistent. Conclusions The minimally invasive surgical treatment of adult deformities is a promising method for reducing surgical morbidity. Numerous challenges exist, as the surgical technique does not yet allow for all correction maneuvers used in open surgery. However, as the techniques are advanced, the applicability of minimally invasive surgery for this population will likely be expanded and will afford the opportunity for reduced complications.

scholarly journals The Hallux Metatarsophalangeal Capsule: An Anatomic Study with Respect to Percutaneous Hallux Valgus Correction

2019 ◽  
Vol 4 (4) ◽  
pp. 2473011419S0001
Author(s):  
Kenneth M. Chin ◽  
Nicholas S. Richardson ◽  
John T. Campbell ◽  
Clifford L. Jeng ◽  
Matthew W. Christian ◽  
...  
Keyword(s):  
Minimally Invasive Surgery ◽  
Minimally Invasive ◽  
Hallux Valgus ◽  
Invasive Surgery ◽  
Metatarsal Head ◽  
Anatomic Study ◽  
Popular Knowledge ◽  
Fresh Frozen ◽  
The Mean ◽  
Anatomic Relationship

Category: Bunion Introduction/Purpose: Minimally invasive surgery for the treatment of hallux valgus deformities has become increasingly popular. Knowledge of the location of the hallux MTP proximal capsular origin on the metatarsal neck is critical for surgeons in planning and executing extra-capsular corrective osteotomies. A cadaveric study was undertaken to further study this anatomic relationship. Methods: Ten nonpaired fresh-frozen frozen cadaveric specimens were used for this study. Careful dissection was performed, and the capsular origin of the hallux MTP joint was measured from the central portion of the metatarsal head in the medial, lateral, dorsal, plantarmedial, and plantarlateral dimensions. Results: The ten specimens had a mean age of 77 years, five female and five male. The mean distances from the central hallux metatarsal head to the MTP capsular origin was 15.2 mm dorsally, 8.4 mm medially, 9.6 mm laterally, 19.3 mm plantarmedially, and 21.0 mm plantarlaterally. Conclusion: The MTP capsular origin at the hallux metatarsal varies at different anatomic positions. Knowledge of this capsular anatomy is critical for orthopaedic surgeons when planning and performing minimally invasive distal metatarsal osteotomies for the correction of hallux valgus.

Abstract WP353: Bleeding Following Removal of Intracerebral Catheters in MISTIE III

Stroke ◽  
2017 ◽  
Vol 48 (suppl_1) ◽  
Author(s):  
W. Andrew Mould ◽  
John Muschelli ◽  
Nichol McBee ◽  
Karen Lane ◽  
Mario Zuccarello ◽  
...  
Keyword(s):  
Minimally Invasive Surgery ◽  
Minimally Invasive ◽  
Invasive Surgery ◽  
Surgical Patients ◽  
Catheter Removal ◽  
Absolute Difference ◽  
Mechanical Forces ◽  
Trial Testing ◽  
The Mean ◽  
The Brain

Introduction: Minimally invasive surgery plus alteplase has been shown to effectively reduce the volume of intracerebral hemorrhage in patients with supratentorial bleeds. Removal of these catheters is a unique timepoint when bleeding may restart due to mechanical forces and/or the presence of alteplase/plasmin in the brain. We hypothesized that surgically-treated patients in the MISTIE III trial who had increased bleeding post catheter removal would have shorter periods of time between last dose and catheter removal and be less likely to have lobar ICH. Methods: MISTIE III is a prospective, randomized trial testing the efficacy of minimally invasive surgery plus alteplase for hematoma removal compared to medical management. We analyzed 107 surgically-treated patients. Semi-automated threshold based segmentation of the ICH volumes for all time points were performed using OsiriX. Results: Of the 107 surgical patients, 16 experienced an increase in ICH volume >10% between T1, the scan taken 24 hours prior to cath removal, and T2, the scan taken 24 hours post catheter removal. Mean percent difference between T1 and T2 was 37.5% for those that expanded versus those that did not, -17.4% (p<0.001) with an absolute difference in ICH volume of 3.0 cc and -2.2 cc (p<0.001). The mean residual volume at T2 for both groups was similar at 12.84 cc and 12.71 cc, respectively (p=0.96). Time from last dose to catheter removal in days was 1.27 for those that expanded and 1.44 for those that did not (p=0.09). Furthermore, 14/16 (87.5%) patients with expansion had ICH’s located in deep structures compared to 55/91 (60.4%) of patients that did not expand (p<0.01). Conclusion: Overall, incidence of bleeding following ICH catheter removal in MISTIE III was low. When bleeding was seen, it was more often found in patients with deep ICH locations and whose catheters were removed sooner after the last dose of alteplase.

scholarly journals A Management Algorithm for Retained Rectal Foreign Bodies

2016 ◽  
Vol 11 (3) ◽  
pp. 684-692 ◽  
Author(s):  
Shamir O. Cawich ◽  
Dexter A. Thomas ◽  
Fawwaz Mohammed ◽  
Nahmorah J. Bobb ◽  
Dorothy Williams ◽  
...  
Keyword(s):  
Minimally Invasive Surgery ◽  
Minimally Invasive ◽  
Invasive Surgery ◽  
Foreign Bodies ◽  
Clinical Signs ◽  
Extraction Methods ◽  
Transanal Minimally Invasive Surgery ◽  
Management Algorithm ◽  
Rectal Foreign Bodies ◽  
Laparoscopic Assisted

Few authors have proposed therapeutic protocols to manage retained rectal foreign bodies (RFBs). All patients with retained RFBs in hospitals across Trinidad and Tobago over 5 years were identified. Hospital records were retrieved and manually reviewed to extract the following data: demographics, history, foreign body retrieved, clinical signs at presentation, management strategy, duration of hospitalization, and morbidity and mortality. There were 10 patients with RFBs over the study period. The annual incidence of this phenomenon was 0.15 per 100,000 population. All patients were men at a mean age of 50.6 years (range: 27-83; SD = 15.3) who presented after a voluntary delay of 1.4 days (range: 0.5-2.5; SD = 0.7). Only one patient gave an accurate history on presentation, but all eventually admitted to self-insertion for sexual gratification. At presentation, one patient had a spontaneous rectal perforation (10%). The remaining nine patients had attempts at bedside transanal extraction, which was unsuccessful in 89% (8/9) of cases. The RFB was pushed beyond the grasp of forceps, making removal under anesthesia unsuccessful in 62.5% (5/8) cases. These patients required more invasive extraction methods including transanal minimally invasive surgery (1), laparoscopic-assisted advancement with transanal retrieval (1), and open surgery with transmural extraction and anastomoses (3). A management algorithm is proposed for the management of RFBs. Important points in this algorithm are the importance of clinician–patient rapport, early surgical referral, avoidance of bedside extraction in the emergency room, early examination under anesthesia, and the inclusion of emerging therapies such as transanal minimally invasive surgery.

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