scholarly journals VP028 TAPP REPAIR FOR INCISIONAL LUMBAR HERNIA

2021 ◽  
Vol 108 (Supplement_8) ◽  
Author(s):  
Sónia Ribas ◽  
Ana Peixoto Pereira ◽  
Conceição Antunes
Keyword(s):  
Minimally Invasive ◽  
Abdominal Cavity ◽  
Lumbar Hernia ◽  
Barbed Suture ◽  
Invasive Approach ◽  
Incisional Hernias ◽  
Tapp Repair ◽  
Duration Of Surgery ◽  
Invasive Techniques

Abstract Aim “Incisional hernias are very common and can present even after minimally invasive surgery for other pathologies. Laparoscopic ventral hernia repair first described by LeBlanc in 1992, gained great popularity, because of its known advantages over the open techniques. In the last decade because of increasing concerns about the future risks of using an intra-peritoneal mesh, several minimally invasive techniques using a mesh outside abdominal cavity have been described. We report the use of a TAPP technique.” Material and Methods “48 yo female patient, that underwent a laparoscopic right adrenalectomy, for myelolipoma, in 2015, with subsequent incisional lumbar hernia (L4W1) in the extraction incision.” Results “The patient was submitted to a laparoscopic TAPP repair in ambulatory surgery with extended recovery. The hernia defect was closed with a barbed suture and it was used a 15x15cm medium weight polypropylene mesh without traumatic fixation. For pain control it was done a TAP block guided by laparoscopy. The duration of surgery was 90 minutes. The patient had no complications. No recurrence on follow-up (4 months).” Conclusions “New minimally invasive procedures for the repair of incisional hernias avoid the intraperitoneal mesh position and maintain all the advantages of the minimally invasive approach. Some of these techniques may be complex and have a long learning curve. TAPP seems reproducible and a good option if a good extra-peritoneal dissection is possible. Larger series are needed, to accurately compare these new techniques with IPOM, open sublay and to select the best technique for each patient.”

scholarly journals Standardized subannular repair for type IIIb functional mitral regurgitation in a minimally invasive mitral valve surgery setting†

2019 ◽  
Vol 56 (5) ◽  
pp. 968-975 ◽  
Author(s):  
Jonas Pausch ◽  
Eva Harmel ◽  
Christoph Sinning ◽  
Hermann Reichenspurner ◽  
Evaldas Girdauskas
Keyword(s):  
Mitral Valve ◽  
Mitral Regurgitation ◽  
Minimally Invasive ◽  
Functional Mitral Regurgitation ◽  
Invasive Approach ◽  
Type Iiib ◽  
Duration Of Surgery ◽  
Group A ◽  
Group B

Abstract OBJECTIVES Subannular repair techniques in addition to undersized ring annuloplasty have been developed to address high mitral regurgitation (MR) recurrence rates after mitral valve repair in type IIIb MR. We compared the results of annuloplasty with simultaneous standardized subannular repair versus isolated annuloplasty, focusing on the periprocedural outcomes of minimally invasive procedures. METHODS A consecutive series of 108 patients with type IIIb functional MR with severe signs of bileaflet tethering underwent an annuloplasty + subannular repair (group A; n = 60) versus isolated annuloplasty (group B; n = 48). The primary end point of this prospective, parallel cohort study was death or recurrent MR >2, 1 year postoperatively. The secondary end points were survival and clinical outcomes, with special regard for the minimally invasively treated subgroups. RESULTS Duration of surgery, cardiopulmonary bypass time and aortic cross-clamp time were comparable between both study groups. Procedural outcomes as well as echocardiographic outcome parameters were similar and independent of access (fully endoscopic versus full sternotomy). At the 12-month follow-up, death or MR >2 occurred in 3.3% (2/60) of patients in group A vs in 20.8% (10/48) of patients in group B (P = 0.037). The overall mortality rate during the follow-up period was 1.7% (1/60) in group A vs 12.5% (6/48) in group B (P = 0.041). CONCLUSIONS Standardized realignment of papillary muscles is feasible and reproducible via a minimally invasive approach, resulting in excellent periprocedural outcomes, and has a clear potential to significantly decrease MR recurrence and improve 1-year outcomes compared to isolated annuloplasty.

Minimally invasive removal of thoracic and lumbar spinal tumors using a nonexpandable tubular retractor

2013 ◽  
Vol 19 (6) ◽  
pp. 708-715 ◽  
Author(s):  
Andre Nzokou ◽  
Alexander G. Weil ◽  
Daniel Shedid
Keyword(s):  
Minimally Invasive ◽  
Spinal Tumors ◽  
Subtotal Resection ◽  
Minimally Invasive Approach ◽  
Tubular Retractor ◽  
Invasive Approach ◽  
Duration Of Surgery ◽  
Intradural Extramedullary ◽  
Mini Open

Object Resection of spinal tumors traditionally requires bilateral subperiosteal muscle stripping, extensive laminectomy, and, in cases of foraminal extension, partial or radical facetectomy. Fusion is often warranted in cases of facetectomy to prevent deformity, pain, and neurological deterioration. Recent reports have demonstrated safety and efficacy of mini-open removal of these tumors using expandable tubular retractors. The authors report their experience with the minimally invasive removal of extradural foraminal and intradural-extramedullary tumors using the nonexpandable tubular retractor. Methods A retrospective chart review of consecutive patients who underwent minimally invasive resection of spinal tumors at Notre Dame Hospital was performed. Results Between December 2005 and March 2012, 13 patients underwent minimally invasive removal of spinal tumors at Notre Dame Hospital, Montreal. There were 6 men and 7 women with a mean age of 55 years (range 20–80 years). There were 2 lumbar and 2 thoracic intradural-extramedullary tumors and 7 thoracic and 2 lumbar extradural foraminal tumors. Gross-total resection was achieved in 12 patients. Subtotal resection (90%) was attained in 1 patient because the tumor capsule was adherent to the diaphragm. The average duration of surgery was 189 minutes (range 75–540 minutes), and the average blood loss was 219 ml (range 25–500 ml). There were no major procedure-related complications. Pathological analysis revealed benign schwannoma in 8 patients and meningioma, metastasis, plasmacytoma, osteoid osteoma, and hemangiopericytoma in 1 patient each. The average equivalent dose of postoperative narcotics after surgery was 66.3 mg of morphine. The average length of hospitalization was 66 hours (range 24–144 hours). All working patients returned to normal activities within 4 weeks. The average MRI and clinical follow-up were 13 and 21 months, respectively (range 2–68 months). At last follow-up, 92% of patients had improvement or resolution of pain with a visual analog scale score that improved from 7.8 to 1.2. All patients with neurological impairment improved. The American Spinal Injury Association grade improved in all but 1 patient. Conclusions Intradural-extramedullary and extradural tumors can be completely and safely resected through a minimally invasive approach using the nonexpandable tubular retractor. This approach may be associated with even less tissue destruction than mini-open techniques, translating into a quicker functional recovery. In cases of foraminal tumors, by eliminating the need for facetectomy, this minimally invasive approach may decrease the incidence of postoperative deformity and eliminate the need for adjunctive fusion surgery.

scholarly journals Minimally Invasive Approach for Improving Anterior Dental Aesthetics: Case Report with 1-Year Follow-Up

2018 ◽  
Vol 2018 ◽  
pp. 1-5 ◽  
Author(s):  
H. Sevilay Bahadır ◽  
Gökhan Karadağ ◽  
Yusuf Bayraktar
Keyword(s):  
Minimally Invasive ◽  
Canine Tooth ◽  
Invasive Approach ◽  
Resin Infiltration ◽  
Anterior Teeth ◽  
Dental Aesthetics ◽  
Infiltration Technique ◽  
The Right ◽  
Invasive Techniques

Dental aesthetics have become highly important in recent years. Treating aesthetic demands with noninvasive or minimally invasive techniques can preserve the natural tissues. A 20-year-old female patient presented to the clinic with aesthetic concerns. After the clinical and radiographic examinations, hypomineralization was identified in the maxillary anterior teeth except the maxillary right canine. An external discoloration was also identified in the maxillary left canine tooth. Moreover, the right canine tooth was identified as a Turner’s tooth according to the patient’s anamnesis. The resin infiltration technique was applied to the maxillary anterior teeth except the maxillary right canine. The bleaching treatment was applied to the maxillary left canine tooth. Then, a laminate veneer restoration was applied to the upper right canine tooth with Turner’s hypoplasia. Following the treatment, a satisfactory aesthetic restoration was achieved. After 1-year examination, no clinical failures were observed.

High risk medicolegal autopsies: is a full postmortem examination necessary?

2012 ◽  
Vol 66 (1) ◽  
pp. 1-7 ◽  
Author(s):  
Eve Patricia Fryer ◽  
Zoe C Traill ◽  
Rachel E Benamore ◽  
Ian S D Roberts
Keyword(s):  
High Risk ◽  
Minimally Invasive ◽  
Cause Of Death ◽  
Drug Abusers ◽  
Minimally Invasive Approach ◽  
Invasive Approach ◽  
External Examination ◽  
Invasive Techniques ◽  
Cocaine Toxicity ◽  
Selection Of

AimsAiming to reduce the numbers of high risk autopsies, we use a minimally invasive approach. HIV/hepatitis C virus (HCV)-positive coronial referrals, mainly intravenous drug abusers, have full autopsy only if external examination, toxicology and/or postmortem CT scan do not provide the cause of death. In this study, we review and validate this protocol.Methods and results62 HIV/HCV-positive subjects were investigated. All had external examination, 59 toxicology and 24 CT. In 42/62, this minimally invasive approach provided a cause of death. Invasive autopsy was required in 20/62, CT/toxicology being inconclusive, giving a potential rather than definite cause of death. Autopsy findings provided the cause of death in 6/20; in the remainder, a negative autopsy allowed more weight to be given to toxicological results previously regarded as inconclusive. In order to validate selection of cases for invasive autopsy using history, external examination and toxicology, a separate group of 57 non-infectious full autopsies were analysed. These were consecutive cases in which there was a history that suggested drug abuse. A review pathologist, provided only with clinical summary, external findings and toxicology, formulated a cause of death. This formulation was compared with the original cause of death, based on full autopsy. The review pathologist correctly identified a drug-related death or requirement for full autopsy in 56/57 cases. In one case, diagnosed as cocaine toxicity by the review pathologist, autopsy additionally revealed subarachnoid haemorrhage and Berry aneurysm.ConclusionsThese findings support the use of minimally invasive techniques in high risk autopsies, which result in a two-thirds reduction in full postmortems.

Impact of biomineralization on resin/biomineralized dentin bond longevity in a minimally invasive approach: An “in vitro” 18-month follow-up

2021 ◽  
Vol 37 (5) ◽  
pp. e276-e289
Author(s):  
Kelly Maria Moreira ◽  
Luiz Eduardo Bertassoni ◽  
Robert Phill Davies ◽  
Felipe Joia ◽  
José Francisco Höfling ◽  
...  
Keyword(s):  
Minimally Invasive ◽  
Minimally Invasive Approach ◽  
Invasive Approach

Endoscopy-Assisted Achilles Tendon Reconstruction With a Central Turndown Flap and Semitendinosus Augmentation

2016 ◽  
Vol 37 (12) ◽  
pp. 1333-1342 ◽  
Author(s):  
Prashant N. Gedam ◽  
Faizaan M. Rushnaiwala
Keyword(s):  
Minimally Invasive ◽  
Achilles Tendon ◽  
Achilles Tendon Rupture ◽  
Wound Complication ◽  
Reconstruction Technique ◽  
Level Of Evidence ◽  
Invasive Approach ◽  
Perioperative Morbidity ◽  
The Mean

Background: The objective of this study was to report the results of a new minimally invasive Achilles reconstruction technique and to assess the perioperative morbidity, medium- to long-term outcomes, and functional results. Methods: Our series was comprised 14 patients (11 men and 3 women), with a mean age of 45.6 years at surgery. Each patient had a chronic Achilles tendon rupture. The mean interval from rupture to surgery was 5.5 months (range, 2-10). The mean total follow-up was 30.1 months (range, 12-78). All patients were operated with a central turndown flap augmented with free semitendinosus tendon graft and percutaneous sutures in a minimally invasive approach assisted by endoscopy. The patients underwent retrospective assessment by clinical examination, the American Orthopaedic Foot & Ankle Society (AOFAS) ankle and hindfoot score, and the Achilles Tendon Total Rupture Score (ATRS). Paired t tests were used to assess the preoperative and postoperative AOFAS scores, ATRS scores, and ankle range of motion. Results: The length of the defect ranged from 3 to 8 cm (mean, 5.1), while the length of the turndown flap ranged from 8 to 13 cm (mean, 10.1). The mean AOFAS score improved from 64.5 points preoperatively to 96.9 points at last follow-up. The mean ATRS score improved from 49.4 preoperatively to 91.4 points at last follow-up. None of the patients developed a wound complication. No patient had a rerupture or sural nerve damage. Conclusion: All patients in our study had a favorable outcome with no complications. We believe that with this triple-repair technique, one can achieve a strong and robust repair such as in open surgery while at the same time reducing the incidence of complications. Level of Evidence: Level III, retrospective comparative study.

Tissue Engineered Successful Reconstruction of a Complex Traumatized Lower Extremity

2021 ◽  
Vol 11 (9) ◽  
Author(s):  
Srinjoy Saha
Keyword(s):  
Minimally Invasive ◽  
Soft Tissues ◽  
Platelet Rich Plasma ◽  
Thigh Muscle ◽  
Muscle Injuries ◽  
Invasive Approach ◽  
Novel Approach ◽  
Duration Of Surgery ◽  
Biomaterial Application ◽  
Split Skin

Introduction: Tissue engineered reconstruction is a minimally invasive approach for healing major complex wounds successfully. It combines accurate, conservative debridement with a specially adapted suction method, platelet-rich plasma (PRP) injections, and biomaterial application to salvage injured tissues and grows new soft tissues over wounds. Case Report: A healthy young man in his early 30s presented to our emergency department with complex knee-thigh injuries following a high-velocity automobile accident. Degloved anterolateral thigh, severe thigh muscle injuries, and ruptured extensor patellar mechanism were observed. Accurate conservative (as opposed to radical) debridement and PRP injections salvaged the injured muscles and tendons. Specially carved reticulated foam wrapped around the injured ischemic muscles, followed by low negative, short intermittent, cyclical suction therapy. Wound exploration 4 days apart revealed progressive improvements with considerable vascularization of the injured soft tissues within 2 weeks. Thereafter, meticulous reconstruction of the salvaged muscles and tendons restored anatomical congruity. An absorbable synthetic biomaterial covered the sizeable open wound with vast areas of exposed tendons. Five weeks later, exuberant granulating tissue ingrowth within the biomaterial filled up the tissue defect. A split-skin graft covered the remaining raw areas, which “took” completely. Early rehabilitation enabled the patient to return to active work, play contact sports, and perform strenuous activities effortlessly. Conclusion: Minimally invasive tissue engineered reconstruction is a novel approach using a series of simple minimally invasive procedures. It lessens the duration of surgery and anesthesia, maximizes soft-tissue salvage, lowers morbidity, minimizes hospitalization, saves costs, and improves the patient’s quality of life significantly. Keywords: Mangled extremity, Limb salvage, Financial, Trauma, Modified negative pres

Sutureless Aortic Valve Implantation through an Upper V-Type Ministernotomy: An Innovative Approach in High-Risk Patients

2013 ◽  
Vol 8 (1) ◽  
pp. 23-28 ◽  
Author(s):  
Giovanni Concistrè ◽  
Antonio Miceli ◽  
Francesca Chiaramonti ◽  
Pierandrea Farneti ◽  
Stefano Bevilacqua ◽  
...  
Keyword(s):  
High Risk ◽  
Aortic Valve ◽  
Minimally Invasive ◽  
Minimally Invasive Approach ◽  
Invasive Approach ◽  
High Risk Patients ◽  
Risk Patients ◽  
The Mean ◽  
Valve Implantation

Objective Aortic valve replacement in minimally invasive approach has shown to improve clinical outcomes even with a prolonged cardiopulmonary bypass and aortic cross-clamp (ACC) time. Sutureless aortic valve implantation may ideally shorten operative time. We describe our initial experience with the sutureless 3f Enable (Medtronic, Inc, ATS Medical, Minneapolis, MN USA) aortic bioprosthesis implanted in minimally invasive approach in high-risk patients. Methods Between May 2010 and May 2011, thirteen patients with severe aortic stenosis underwent aortic valve replacement with the 3f Enable bioprosthesis through an upper V-type ministernotomy interrupted at the second intercostal space. The mean ± SD age was 77 ± 3.9 years (range, 72–83 years), 10 patients were women, and the mean ± SD logistic EuroSCORE was 15% ± 13.5%. Echocardiography was performed preoperatively, at postoperative day 1, at discharge, and at follow-up. Clinical data, adverse events, and patient outcomes were recorded retrospectively. The median follow-up time was 4 months (interquartile range, 2–10 months). Results Most of the implanted valves were 21 mm in diameter (19–25 mm). The CPB and ACC times were 100.2 ± 25.3 and 66.4 ± 18.6 minutes. At short-term follow-up, the mean ± SD pressure gradient was 14 ± 4.9 mm Hg; one patient showed trivial paravalvular leakage. No patients died during hospital stay or at follow-up. Conclusions The 3f Enable sutureless bioprosthesis implanted in minimally invasive approach through an upper V-type ministernotomy is a feasible, safe, and reproducible procedure. Hemodynamic and clinical data are promising. This innovative approach might be considered as an alternative in high-risk patients. Reduction of CPB and ACC time is possible with increasing of experience and sutureless evolution of actual technology.

scholarly journals Nuss Procedure for a Patient with Negative Haller Index

2018 ◽  
Vol 06 (01) ◽  
pp. e18-e22 ◽  
Author(s):  
Mariela Dore ◽  
Paloma Triana Junco ◽  
Carlos De La Torre ◽  
Alejandra Vilanova-Sánchez ◽  
Monserrat Bret ◽  
...  
Keyword(s):  
Minimally Invasive ◽  
Pectus Excavatum ◽  
Vena Cava ◽  
Forced Expiratory Volume ◽  
Exercise Intolerance ◽  
Nuss Procedure ◽  
Invasive Approach ◽  
History Of ◽  
Ventilation Pattern

Introduction Minimally invasive repair for pectus excavatum (MIRPE) is controversial in extremely severe cases of pectus excavatum (PE) and an open repair is usually favored. Our aim is to describe a case of a patient with an extremely severe PE that underwent a minimally invasive approach. Case report An 8-year-old girl with severe sternum depression was assessed. She had a history of exercise intolerance, nocturnal dyspnea, fatigue, and shortness of breath. Chest computed tomography showed that sternum depression was posterior to the anterior vertebral column; therefore, Haller and correction index could not be measured. Spirometry indicated an obstructive ventilation pattern (forced expiratory volume in 1 second = 74.4%), and echocardiogram revealed a dilated inferior vena cava, mitral valve prolapse with normal ventricular function. After multidisciplinary committee evaluation, a MIRPE approach was performed.All symptoms had disappeared at the 3-month postoperative follow-up; the desired sternum shape was achieved and normalization of cardiopulmonary function was observed. The Nuss bars were removed after a 2-year period. After 18-month follow-up, the patient can carry out normal exercise and is content with the cosmetic result. Conclusion Nuss procedure is feasible in our 8-year-old patient. In this case, both the Haller and correction index were not useful to assess the severity of PE. Therefore, under these circumstances, other radiologic parameters have to be taken into consideration for patient evaluation.

A Simplified Technique for Correcting Mitral Valve Regurgitation via Minimally Invasive Approach

2018 ◽  
Vol 13 (3) ◽  
pp. 236-238
Author(s):  
Giuseppe Speziale ◽  
Marco Moscarelli
Keyword(s):  
Cardiopulmonary Bypass ◽  
Mitral Valve ◽  
Mitral Regurgitation ◽  
Minimally Invasive ◽  
Mitral Valve Regurgitation ◽  
Valve Regurgitation ◽  
Minimally Invasive Approach ◽  
Invasive Approach ◽  
Repair Techniques

Mitral valve regurgitation may require complex repair techniques that are challenging in minimally invasive and may expose patients to prolonged cardiopulmonary bypass and cross-clamp times. Here, we present a stepwise operative approach that may facilitate the repair of the mitral valve in a minimally invasive fashion and may be carried out even when multiple posterior segments are involved. This how-to-do article presents a method that was performed in 148 patients that were referred to our institution for severe organic mitral regurgitation between 2008 and 2016. At mean ± SD follow-up of 45.5 ± 27 months, freedom from recurrent of mitral regurgitation 2+ or greater and reoperation was 95.2%.

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