822 HOW THE OPERATING SURGEON'S ASSESSMENT OF RADICALITY INFLUENCES SURVIVAL AFTER ESOPHAGEAL CANCER SURGERY

Abstract The operating surgeon’s assessment of surgical radicality following esophagectomy is reported to the Swedish National Registry for Esophageal and Gastric cancer(NREV). The variable provides means to identify risk factors for non-curative resections and study whether the surgeon’s assessment independently prognosticates survival. Methods All patients in NREV undergoing esophagectomy between 2006–2018 was grouped according to the surgeon’s assessment of radicality: Curative-, Borderline-curative- and Palliative resection. The cohort was followed until death, emigration or end of follow-up. Factors affecting group allocation was studied with multivariable logistic regression and survival with cox-regression and the Kaplan–Meier method. Results Of 1860 resected patients, esophagectomy was deemed curative in 1515(81%), borderline-curative in 179(10%), palliative in 63(3%) and missing in 103(6%). Median survival was 44.6, 20.0, 11.5 and 29.6 months respectively. Advanced stage (e.g., stage IVa), OR 7,37 (1,93–28,1 95%CI) and blood-loss >1000 mL, OR 1.90 (1,17-3,08), increased the risk of borderline-curative resection. Minimally invasive surgery and multidisciplinary treatment decision (MDT) decreased the risk of borderline-curative resection, OR 0.42 (0,23-0,77) and OR 0.41 (0,22-0,77). Adjusted for well-established prognostic factors, e.g. age, p-TNM and R1-resection, the surgeon’s assessment was an independent variable for survival; borderline-curative HR 1,38 (1,11-1,72), palliative HR 1,91 (1,38-2,63). Conclusion The surgeon’s operative assessment of radicality following esophagectomy appears to independently prognosticate survival. Advanced stage and large-volume intraoperative blood loss increases the risk while minimally invasive surgery and MDT decreases the risk for borderline-curative resection.

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Comparison of Minimally Invasive Surgery versus Laparotomy for Surgical Staging of Endometrial Carcinoma: A Retrospective Study

Birat Journal of Health Sciences ◽

10.3126/bjhs.v5i1.29613 ◽

2020 ◽

Vol 5 (1) ◽

pp. 916-920

Author(s):

Mona Priyadarshini ◽

Rani Akhil Bhat

Keyword(s):

Endometrial Cancer ◽

Minimally Invasive Surgery ◽

Blood Loss ◽

Minimally Invasive ◽

Hospital Stay ◽

Endometrial Carcinoma ◽

Invasive Surgery ◽

Surgical Staging ◽

Duration Of Hospital Stay ◽

Significant Difference

Introduction: Endometrial carcinoma is one of the commonest gynaecological cancer in developed countries as well as developing countries. The mainstay of initial treatment of endometrial carcinoma is surgical staging which may be performed by either the conventional abdominal approach or by minimally invasive route i.e. laparoscopic or robotic. Objectives: The purpose of this study was to compare and evaluate the surgical staging, safety and clinical benefits of minimally invasive surgeries versus. laparotomy in patients with endometrial cancer. Methodology: We retrospectively analyzed 105 patients with endometrial cancer over a period of five years and compared the outcome of total hysterectomy with pelvic and para-aortic lymphadenectomy by abdominal, laparoscopic approach or robotic-assisted surgery. Comparison was done with respect to operative time, blood loss, number of lymph nodes retrieved, length of hospital stay, intraoperative and postoperative complications. The data were analyzed using paired “t”- test / Wilcoxon signed rank test ,χ2 - test, Pearson correlation coefficient “r” whenever found suitable. P value of less than 0.05 was considered as statistically significant. Result: There was no statistically significant difference seen in the baseline characteristics like age and BMI between the two groups. The laparotomies were done in a shorter time than the minimally invasive approach (p<0.001). The amount of blood loss (p=0.002), and the duration of hospital stay (p<0.001) was significantly less in the minimally invasive surgery group than the laparotomies. Not much difference in the lymph node retrieval was observed between the two arms (p=0.614). The number of complications were almost similar in both the groups. Conclusion: Minimally invasive surgery for surgical staging of endometrial carcinoma is feasible and effective than laparotomy. The amount of blood loss and duration of hospital stay is seen much lesser with MIS than laparotomy.

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The minimally invasive approach, laparoscopic and robotic, in rectal resection for cancer: A single center experience

Acta chirurgica iugoslavica ◽

10.2298/aci1003029p ◽

2010 ◽

Vol 57 (3) ◽

pp. 29-35 ◽

Cited By ~ 29

Author(s):

I. Popescu ◽

C. Vasilescu ◽

V. Tomulescu ◽

S. Vasile ◽

O. Sgarbura

Keyword(s):

Rectal Cancer ◽

Minimally Invasive Surgery ◽

Blood Loss ◽

Minimally Invasive ◽

Invasive Surgery ◽

Metastatic Lymph Node ◽

Robotic Approach ◽

Invasive Approach ◽

Significant Difference

Background: Robotic approach for rectal cancer competes with laparoscopy in centers dedicated to minimally invasive surgery (MIS) due to the technologic advantage. This is a report of our experience with MIS for rectal cancer. Methods: A series of 84 consecutive patients with laparoscopic resection (between 1995-2010) and 38 consecutive patients with robotic resection (between 2008-2010) for primary rectal cancer were analyzed. Hartmann's procedures were excluded. Clinical and pathologic outcomes were reviewed retrospectively. Results: In the laparoscopic group (LG), 50 anterior rectal resections (ARR), 34 abdominal perineal resections (APR) were performed while in the robotic group(RG) there were 30 ARR and 8 APR. The median operative time was 182 min (140-220 min) in LG and 208 min (180- 300 min) in RG (p=0.0002). No statistically significant difference was noticed between the groups in terms of conversion, morbidity, anastomotic leak and postoperative stay rates. Margin clearance was obtained in all patients and the median number of removed lymph nodes was similar: 11.37 in RG vs 11.07 in the LG (p=0.65) with a higher rate of metastatic lymph node involvement in laparoscopy (p=0.0012). Blood loss was higher in LG (150 ml vs. 100 ml; p=0.0001). There were 5 (5.9%) local recurrences in the LG at a median follow- up of 27.5 months and 2 (5.2%) in the RG at a median follow-up of 13 months (p=0.43). Conclusions: Minimally invasive surgery for rectal cancer proved to be safe and efficient with similar results in the two groups. Technological advances of robotic approach compared to laparoscopy allowed better ergonomics, more refined dissection, easier preserving of hypogastric nerves and less blood loss. Long term outcomes are to be assessed in prospective randomized studies.

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Design and Fabrication of a Focused Ultrasound Device for Minimallyinvasive Neurosurgery: Reporting a Second, Miniaturized and Mrcompatible Prototype with Steering Capabilities

2021 Design of Medical Devices Conference ◽

10.1115/dmd2021-1062 ◽

2020 ◽

Author(s):

Molly Acord ◽

Tarana Parvez Kaovasia ◽

Nao J. Gamo ◽

Tim Xiong ◽

Eli Curry ◽

...

Keyword(s):

Minimally Invasive Surgery ◽

Blood Loss ◽

Minimally Invasive ◽

Patient Outcomes ◽

Invasive Surgery ◽

Focused Ultrasound ◽

Brain Lesions ◽

Brain Surgery ◽

Ultrasound Device ◽

Electronic Steering

Abstract Many surgeons are faced with inoperable or only partially operable brain lesions, such as tumors. Even when surgery is feasible, patient outcomes are greatly affected by blood loss or infection. This has led many physicians toward non- or minimally-invasive surgery, which demands specialized toolkits. Focused ultrasound has great potential for assisting in such procedures due to its ability to focus a few centimeters away from the surface of the transducer. In a prior study, we developed a focused ultrasound prototype that could fit within a BrainPath trocar, specifically made for minimally invasive brain surgery. Here, we present the design and fabrication of a second prototype that reduces size, is MR-compatible, and has electronic steering capabilities.

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Cost minimization in treatment of adult degenerative scoliosis

Journal of Neurosurgery Spine ◽

10.3171/2015.3.spine14560 ◽

2015 ◽

Vol 23 (6) ◽

pp. 798-806 ◽

Cited By ~ 29

Author(s):

Omar M. Uddin ◽

Raqeeb Haque ◽

Patrick A. Sugrue ◽

Yousef M. Ahmed ◽

Tarek Y. El Ahmadieh ◽

...

Keyword(s):

Minimally Invasive Surgery ◽

Blood Loss ◽

Minimally Invasive ◽

Invasive Surgery ◽

Open Surgery ◽

Cost Minimization ◽

Degenerative Scoliosis ◽

Adult Degenerative Scoliosis ◽

Vas Scores

OBJECT Back pain is an increasing concern for the aging population. This study aims to evaluate if minimally invasive surgery presents cost-minimization benefits compared with open surgery in treating adult degenerative scoliosis. METHODS Seventy-one patients with adult degenerative scoliosis received 2-stage, multilevel surgical correction through either a minimally invasive spine surgery (MIS) approach with posterior instrumentation (n = 38) or an open midline (Open) approach (n = 33). Costs were derived from hospital and rehabilitation charges. Length of stay, blood loss, and radiographic outcomes were obtained from electronic medical records. Functional outcomes were measured with Oswestry Disability Index (ODI) and visual analog scale (VAS) surveys. RESULTS Patients in both cohorts were similar in age (AgeMIS = 65.68 yrs, AgeOpen = 63.58 yrs, p = 0.28). The mean follow-up was 18.16 months and 21.82 months for the MIS and Open cohorts, respectively (p = 0.34). MIS and Open cohorts had an average of 4.37 and 7.61 levels of fusion, respectively (p < 0.01). Total inpatient charges were lower for the MIS cohort ($269,807 vs $391,889, p < 0.01), and outpatient rehabilitation charges were similar ($41,072 vs $49,272, p = 0.48). MIS patients experienced reduced length of hospital stay (7.03 days vs 14.88 days, p < 0.01) and estimated blood loss (EBL) (EBLMIS = 470.26 ml, EBLOpen= 2872.73 ml, p < 0.01). Baseline ODI scores were lower in the MIS cohort (40.03 vs 48.04, p = 0.03), and the cohorts experienced similar 1-year improvement (ΔODIMIS = −15.98, ΔODIOpen = −21.96, p = 0.25). Baseline VAS scores were similar (VASMIS = 6.56, VASOpen= 7.10, p = 0.32), but MIS patients experienced less reduction after 1 year (ΔVASMIS = −3.36, ΔVASOpen = −4.73, p = 0.04). Preoperative sagittal vertical axis (SVA) were comparable (preoperative SVAMIS = 63.47 mm, preoperative SVAOpen = 71.3 mm, p = 0.60), but MIS patients had larger postoperative SVA (postoperative SVAMIS = 51.17 mm, postoperative SVAOpen = 28.17 mm, p = 0.03). CONCLUSIONS Minimally invasive surgery demonstrated reduced costs, blood loss, and hospital stays, whereas open surgery exhibited greater improvement in VAS scores, deformity correction, and sagittal balance. Additional studies with more patients and longer follow-up will determine if MIS provides cost-minimization opportunities for treatment of adult degenerative scoliosis.

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Efficacy of New Polylactic Acid Nonwoven Fabric as a Hemostatic Agent in a Rat Liver Resection Model

Surgical Innovation ◽

10.1177/1553350619833582 ◽

2019 ◽

Vol 26 (3) ◽

pp. 312-320

Author(s):

Taiga Wakabayashi ◽

Hiroshi Yagi ◽

Kazuki Tajima ◽

Kohei Kuroda ◽

Masahiro Shinoda ◽

...

Keyword(s):

Minimally Invasive Surgery ◽

Blood Loss ◽

Minimally Invasive ◽

Polylactic Acid ◽

Von Willebrand Factor ◽

Invasive Surgery ◽

Nonwoven Fabric ◽

Hemostatic Agent ◽

Von Willebrand ◽

Willebrand Factor

Background. During minimally invasive surgery, efficient and nontoxic hemostats are important for difficult to access bleeding areas. Polylactic acid is an ecofriendly hemostatic agent and we aimed to evaluate the efficacy of a polylactic acid nonwoven fabric (PLAF) developed by Toray Industries, Inc, on liver hemostasis in a preclinical study. Materials and Methods. PLAF consists of both 1-µm diameter fibers and 100-µm diameter beaded fibers. Four rats were used, and 2 trough-shaped resections of the liver parenchyma were performed (n = 8 lobes). Immediately after the resection, PLAF (PLAF group: n = 4 lobes) or rayon gauze (Rayon group: n = 4 lobes) were applied on the resected plane and compressed manually. We compared the mean time to hemostasis and blood loss per lobe, as well as histological findings between the groups. Results. The PLAF group had a significantly shorter bleeding time ( P = .006), and showed lower blood loss compared with the Rayon group ( P = .076). Histopathological evaluation showed a large amount of beads on the liver surface in the PLAF group. Aggregated red blood cells evident by electron microscopy and von Willebrand factor immunofluorescence were seen surrounding the beads. The PLAF group showed significantly greater von Willebrand factor expression than the Rayon group ( P = .004). Discussion. This new PLAF showed superior outcomes thanks to its unique characteristic of forming beaded nanofibers, and it has the potential to be an efficient hemostat in minimally invasive surgery in the human body.

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Minimally invasive surgery for patients with advanced stage endometrial cancer

International Journal of Medical Sciences ◽

10.7150/ijms.52293 ◽

2021 ◽

Vol 18 (5) ◽

pp. 1153-1158

Author(s):

Sang Il Kim ◽

Dong Choon Park ◽

Sung Jong Lee ◽

Ji Geun Yoo ◽

Min Jong Song ◽

...

Keyword(s):

Endometrial Cancer ◽

Minimally Invasive Surgery ◽

Minimally Invasive ◽

Invasive Surgery ◽

Advanced Stage

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Effect of Tourniquet Application on Postoperative Outcomes in Minimally Invasive Surgery for Intra-articular Calcaneus Fractures

10.21203/rs.3.rs-345692/v1 ◽

2021 ◽

Author(s):

Hamood H.G. Zaid ◽

Wu Di ◽

Rufei Yang ◽

Tianyuan Zhao ◽

Maowei yang

Keyword(s):

Minimally Invasive Surgery ◽

Postoperative Pain ◽

Length Of Stay ◽

Blood Loss ◽

Minimally Invasive ◽

Invasive Surgery ◽

Postoperative Bleeding ◽

Operation Time ◽

Calcaneal Fractures ◽

The Mean

Abstract Background: Tourniquets are commonly used during foot and ankle surgery to provide a bloodless operative field and for the sake of the surgeon`s comfort, despite the potential risks associated with it. This study was performed to compare postoperative outcomes of tourniquet-assisted to non-tourniquet-assisted operative fixation of calcaneal fractures.Methods: A total of 131 patients with closed calcaneal fracture who underwent minimally invasive surgery of calcaneal fractures between March 2015 and December 2018 were reviewed retrospectively. Patients for whom a tourniquet was used intraoperatively (n = 62) were compared to those without (n = 69). Operating time and visualization, blood loss, postoperative pain according to visual analogue scale (VAS), the American Orthopaedic Foot & Ankle Society (AOFAS) Ankle-Hindfoot score, and hospital length of stay were recorded for all the patients.Results: Statistical analysis of the results showed significant differences between tourniquet and non-tourniquet groups in the mean operation time, visibility of the surgical field, mean estimated intraoperative and postoperative blood loss, and mean VAS pain scores 24 H, 48 H, 72 H postoperatively (P < 0.05), whereas no significant difference between two groups in the mean Serum CPK levels, post-operative swelling, mean length of stay, AOFAS score, wound and fracture healing time, and the mean time for return to work.Conclusion: Our study demonstrated that tourniquet application during minimally invasive surgery of calcaneal fractures can significantly shorten the operation time, improve surgical visualization, and reduce intraoperative blood loss. However, adverse events associated with the use of tourniquet include increased postoperative pain, and more amount of postoperative bleeding. Due to higher postoperative pain and more amount of postoperative bleeding, more attention should be paid on the postoperative phase for those who tourniquet was used. The surgeon's decision to use a tourniquet during calcaneal fractures surgery should be carefully considered.

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Surgical robotics and its development and progress

Robotica ◽

10.1017/s0263574709990877 ◽

2010 ◽

Vol 28 (2) ◽

pp. 161-161 ◽

Cited By ~ 21

Author(s):

Jian S Dai

Keyword(s):

Minimally Invasive Surgery ◽

Blood Loss ◽

Minimally Invasive ◽

Surgical Procedures ◽

Invasive Surgery ◽

Lower Risk ◽

Surgical Robotics ◽

Robotic Technology ◽

Hospital Stays ◽

Tremendous Impact

Surgical robotics is the study and application of advanced robotic technology to diverse surgical procedures, particularly to minimally invasive surgery. The advanced robotic technology in minimally invasive surgery leads to momentous change in and generates a tremendous impact on surgery, resulting in less pain and scarring, reduced blood loss and transfusions, lower risk of complication, shorter hospital stays and faster recovery periods.

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