Minimally Invasive Separation Surgery for Metastases in the Vertebral Column: A Technical Report

2019 ◽  
Vol 18 (6) ◽  
pp. 606-613
Author(s):  
Rafael A Vega ◽  
Jeffrey I Traylor ◽  
Ahmed Habib ◽  
Laurence D Rhines ◽  
Claudio E Tatsui ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Spinal Cord ◽  
Minimally Invasive ◽  
Definitive Treatment ◽  
Invasive Technique ◽  
Thoracic Vertebrae ◽  
Minimally Invasive Techniques ◽  
Invasive Approach ◽  
Invasive Techniques

Abstract BACKGROUND Epidural spinal cord compression (ESCC) is a common and severe cause of morbidity in cancer patients. Minimally invasive surgical techniques may be utilized to preserve neurological function and permit the use of radiation to maximize local control. Minimally invasive techniques are associated with lower morbidity. OBJECTIVE To describe a novel, minimally invasive operative technique for the management of metastatic ESCC. METHODS A minimally invasive approach was used to cannulate the pedicles of the thoracic vertebrae, which were then held in place by Kirschner wires (K-wires). Following open decompression of the spinal cord, cannulated screws were placed percutaneously with stereotactic guidance through the pedicles followed by cement induction. Stereotactic radiosurgery is performed in the postoperative period for residual metastatic disease in the vertebral body. RESULTS The minimally invasive technique used in this case reduced tissue damage and optimized subsequent recovery without compromising the quality of decompression or the extent of metastatic tumor resection. Development of more minimally invasive techniques for the management of metastatic ESCC has the potential to facilitate healing and preserve quality of life in patients with systemic malignancy. CONCLUSION ESCC from vertebral metastases poses a challenge to treat in the context of minimizing potential risks to preserve quality of life. Percutaneous pedicle screw fixation with cement augmentation provides a minimally invasive alternative for definitive treatment of these patients.

scholarly journals Robot-assisted revision of sacroiliac joint fusion using a triangular titanium implant in an S2-alar-iliac trajectory: illustrative case

2021 ◽  
Vol 2 (1) ◽  
Author(s):  
Matthew Triano ◽  
Islam Fayed ◽  
Faheem A. Sandhu
Keyword(s):  
Quality Of Life ◽  
Minimally Invasive ◽  
Elderly Patients ◽  
Sacroiliac Joint ◽  
Titanium Implant ◽  
Invasive Technique ◽  
Illustrative Case ◽  
Robot Assisted ◽  
Invasive Approach

BACKGROUND Sacroiliac joint (SIJ) dysfunction can lead to significant pain and disability, greatly impairing quality of life. Arthrodesis may take up to 1 year to occur, after which revision can be considered. There is a need for highly accurate and reproducible techniques for revision that allow for purchase through undisturbed bone to prevent prolonged pain and disability. Moreover, a minimally invasive technique for revision would be favorable for recovery, particularly in elderly patients. OBSERVATIONS An 84-year-old man with a prior history of lumbar fusion presented with severe buttock pain limiting ambulation and sitting because of the failure of arthrodesis after SIJ fusion 1 year earlier. He underwent revision using a triangular titanium implant (TTI) in an S2-alar-iliac (S2-AI) trajectory under robotic guidance, which is a novel technique not yet described in the literature. The patient’s pain largely resolved, he was able to ambulate independently, and his quality of life improved tremendously. There were no complications of surgery. LESSONS Placement of a TTI using an S2-AI trajectory is a safe and effective method for revision that can be considered for elderly patients. Robot-assisted navigation can be used to facilitate an accurate and reproducible approach using a minimally invasive approach.

scholarly journals Neurospinal Surgery Innovations

2017 ◽  
Vol 3 (3) ◽  
pp. 121-122
Author(s):  
James Wang
Keyword(s):  
Spinal Cord ◽  
Minimally Invasive ◽  
Treatment Plan ◽  
Invasive Technique ◽  
Surgical Trauma ◽  
The Past ◽  
The World ◽  
Spine Diseases ◽  
Invasive Techniques ◽  
Important Branch

Over the past few decades, majority of neurosurgeons only specialize in spinal cord diseases. However, with the advances in spine surgery, more and more neurosurgeons focus on spine diseases. Precision minimally invasive technique in surgery of spine and spinal cord is an important branch of neurosurgery. As traditional surgery has been gradually replaced by precision surgery, open surgery has been gradually replaced by minimally invasive surgery (MIS), the diagnosis and treatment of spine diseases has been benefiting from minimally invasive techniques. With minimal surgical trauma, precise localization, MIS has become the inevitable trend of new neurosurgery. The model of multidisciplinary team is gradually becoming universal in the world in order to make the best treatment plan for the patient with spine diseases on the basis of the comprehensive disciplinary opinion.

scholarly journals Minimally invasive treatment of peristomal metastases from gastric cancer at an ileostomy site by electrochemotherapy

2013 ◽  
Vol 47 (4) ◽  
pp. 370-375 ◽  
Author(s):  
Luca G. Campana ◽  
Marco Scarpa ◽  
Antonio Sommariva ◽  
Elena Bonandini ◽  
Sara Valpione ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Gastric Cancer ◽  
Minimally Invasive ◽  
Tumor Regression ◽  
Tumor Control ◽  
Invasive Treatment ◽  
Invasive Approach ◽  
Electric Pulses ◽  
Skin Conditions

Abstract Background. Peristomal metastases are rare, but potentially associated with relevant morbidity. Surgical resection, followed by stoma relocation, represent the gold standard in most patients. We describe electrochemotherapy (ECT), a minimally invasive method for locally-enhancing drug delivery by means of electric pulses, as an alternative approach. Patient and methods. A 49-year-old man with advanced gastric cancer developed skin metastases around an ileostomy site. The ulcerated and oozing tumor growth impaired patient’s quality of life due to continuous trouble in fitting the ostomy appliance, its poor adherence and consequent stools spillage. ECT consisted of a 20-minute course under mild general sedation. A bleomycin bolus of 15 000 IU/m2 was followed by the percutaneous application of multiple, 1.5 ms -long electric pulses by means of a needle electrode. Results. Post ECT course was uneventful and the patient was discharged on the same day. After one week, tumor nodules were flattened and partial tumor regression was appreciable at one-month follow-up. More importantly, peristomal skin conditions significantly improved, thus allowing for an effective application of the ostomy appliance during the following moths, until patient’s death. Conclusions. This report suggests the feasibility of ECT as a minimally invasive approach for peristomal tumors. In selected cases, ECT, by achieving a rapid tumor control, may ensure effective ostomy management and preserve patients’ quality of life.

scholarly journals Electrochemotherapy and Simultaneous Photodynamic Bone Stabilization of Upper Limbs in Metastatic Renal Cancer Disease: Case Report and Literature Review

2020 ◽  
Vol 2020 ◽  
pp. 1-7
Author(s):  
Ugo Albertini ◽  
Andrea Conti ◽  
Nicola Ratto ◽  
Pietro Pellegrino ◽  
Michele Boffano ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Minimally Invasive ◽  
Bone Disease ◽  
Metastatic Bone Disease ◽  
Invasive Technique ◽  
Bone Lesions ◽  
Disease Case ◽  
Lytic Bone Lesions

Introduction. Metastatic bone disease represents a systemic pathology that heavily affects the quality of life of oncologic patients causing pain and functional disability. Methodology. We present the case of a patient with a history of renal cell cancer presenting pathologic fractures of both humeri and proximal right radius. Results. After a careful multidisciplinary approach, an adjuvant anticancer therapy and a photodynamic bone stabilization procedure were performed with a minimally invasive technique aiming to minimize pain and local disease progression, while restoring functional autonomy and improving the patient’s quality of life. Electrochemotherapy was delivered on the lytic bone lesions with extraskeletal involvement of the proximal left humerus and the proximal right radius, and then polymeric bone stabilization was performed on both humeri. At two months of follow-up, the patient presented satisfactory functional scores (MSTS score: 12/30 bilaterally; DASH scores: 46.7/100 for the right side and 48.3/100 for the left one), and pain was well controlled with opioid analgesics. Radiographs showed good results in terms of ossification of lytic bone lesions and durability of polymeric stabilization. At four months of follow-up, the patient reported a stable clinical scenario. Six months after surgery, due to extremely poor prognosis after the progression of primary disease, the patient was referred to palliative care and died shortly thereafter. Conclusion. Over the last decade, the management of metastatic bone disease has changed. Low-toxicity and minimally invasive procedures such as electrochemotherapy and polymeric bone stabilization might be performed concomitantly in selected patients, as an alternative to radiation therapy and to more demanding surgical procedures such as plating and adjuvant cementing.

scholarly journals Impact of minimally invasive surgery in the treatment of esophageal cancer

2014 ◽  
Vol 27 (4) ◽  
pp. 237-242 ◽  
Author(s):  
Italo BRAGHETTO M ◽  
Gonzalo CARDEMIL H ◽  
Carlos MANDIOLA B ◽  
Gonzalo MASIA L ◽  
Francesca GATTINI S.
Keyword(s):  
Esophageal Cancer ◽  
Survival Rate ◽  
Mortality Rate ◽  
Minimally Invasive ◽  
Lymph Nodes ◽  
Morbidity And Mortality ◽  
Type I ◽  
Minimally Invasive Techniques ◽  
Invasive Techniques

BACKGROUND: Surgical treatment of esophageal cancer is associated to a high morbidity and mortality rate. The open transthoracic or transhiatal esophagectomy are considerably invasive procedures and have been associated to high rates of complications and operative mortality. In this way, minimally invasive esophageal surgery has been suggested as an alternative to the classic procedures because would produce improvement in clinical longterm postoperative outcomes. AIM: To assess survival, mortality and morbidity results of esophagectomy due to esophageal cancer submitted to minimally invasive techniques and compare them to results published in international literature. METHOD: An observational, prospective study. Between 2003 and 2012, 69 patients were submitted to a minimally invasive esophagectomy due to cancer. It was recorded postoperative morbidity and mortality according to the Clavien-Dindo classification. The survival rate was analyzed with the Kaplan-Meier method. The number of lymph nodes obtained during the lymph node dissection, as an index of the quality of the surgical technique, was analysed. RESULTS: 63.7% of patients had minor complications (type I-II Clavien Dindo), while nine (13%) required surgical re-exploration. The most common postoperative complication corresponded to leak of the cervical anastomosis seen in 44 (63.7%) patients but without clinical repercusion, only two of them required reoperation. The mortality rate was 4.34%, and reoperation was necessary in nine (13%) cases. The average survival time was 22.59±25.38 months, with the probability of a 3-year survival rate estimated at 30%. The number of resected lymph nodes was 17.17±9.62. CONCLUSION: Minimally invasive techniques have lower morbidity and mortality rate, very satisfactory lymphnodes resection and similar long term outcomes in term of quality of life and survival compared to results observed after open surgery.

Thoracoscopic diaphragm plication

2020 ◽  
Keyword(s):  
Quality Of Life ◽  
Surgical Approaches ◽  
Minimally Invasive Techniques ◽  
Respiratory Compromise ◽  
Video Tutorial ◽  
The Past ◽  
Huge Impact ◽  
Invasive Techniques ◽  
Thoracoscopic Technique

Diaphragmatic paralysis with subsequent eventration and respiratory compromise has a huge impact on the quality of life of affected patients. Many different surgical approaches for correcting this problem have been described in the past, using both transabdominal and transthoracic pathways. Either way, since the procedure in general requires suturing of the diaphragm, minimally invasive techniques have only been adopted very slowly and most thoracic surgeons nowadays still use a minithoracotomy, even when adopting a video-assisted approach. We have developed a safe and simple completely thoracoscopic technique for diaphragmatic plication, and in this video tutorial we demonstrate our technique.

scholarly journals Advances in the Endoscopic Management of Obesity

2015 ◽  
Vol 2015 ◽  
pp. 1-9 ◽  
Author(s):  
Jason Behary ◽  
Vivek Kumbhari
Keyword(s):  
Bariatric Surgery ◽  
Minimally Invasive ◽  
Mortality Rates ◽  
Endoscopic Management ◽  
Obese Patients ◽  
Minimally Invasive Techniques ◽  
Substantial Cost ◽  
The Past ◽  
Invasive Techniques

Obesity has become a worldwide epidemic with significant impact on quality of life, morbidity, and mortality rates. Over the past two decades, bariatric surgery has established itself as the most effective and durable treatment for patients with obesity and its associated comorbidities. However, despite the use of minimally invasive techniques, bariatric surgery is associated with complications in approximately 15% of patients, has a substantial cost, and is used by only 1% of patients who are eligible. Therefore, there is a need for effective minimally invasive therapies, which will be utilized by the large proportion of obese patients who are in desperate need of treatment but are not receiving any. Endoscopic approaches to the management of obesity have been developed, with the aim of delivering more effective, durable, and safer methods of weight reduction. In this paper, we review currently available and future endoscopic therapies that will likely join the armamentarium used in the management of obesity.

Long-Term Follow-Up of Minimally Invasive Cardiac Surgery Using an Endoaortic Occlusion System

2014 ◽  
Vol 17 (2) ◽  
pp. 93 ◽  
Author(s):  
Arndt-H. Kiessling ◽  
Philipp Kisker ◽  
Alexandra Miskovic ◽  
Nestoras Papadopoulos ◽  
Andreas Zierer ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Minimally Invasive ◽  
Structural Damage ◽  
Aortic Wall ◽  
Artery Bypass ◽  
Mitral Valve Surgery ◽  
Ascending Aorta ◽  
Invasive Technique

<p><b>Objectives:</b> We reviewed the initial patient series (n=116) of our institution performing minimally invasive coronary artery bypass grafting (CABG) (n=79), mitral valve surgery (n=1), or atrial septal closure (ASD) procedures (n=26) using an endoaortic occlusion system. With this technique relevant intra-aortic pressures are exerted on the aortic wall during the clamping time. This might lead to late aortic degeneration and aneurysm formation. Our study sought to evaluate postoperative aortic complications and the quality of life (modified SF-12).</p><p><b>Methods:</b> One hundred sixteen patients (56% male; 54 years � 14.5; range 19 years to 77 years) underwent a cardiac procedure using an endoaortic clamp. The endoaortic balloon clamp catheter was used to occlude the ascending aorta at pressures >300 mmHg. Patients were rescheduled for echocardiographic examination after a mean follow-up period of 8.8 years.</p><p><b>Results:</b> The analysis performed among 78 patients showed no incidence of any structural damage to the ascending aorta at the intraoperative position of the endoaortic balloon. The physical and mental summary scores are equal to those of comparable patient groups.</p><p><b>Conclusions:</b> The endoaortic occlusion system causes no damage to the aortic wall. If the system causes any problems, they occur immediately during surgery. Patients treated with this minimally invasive technique exhibited the same quality of life as those undergoing conventional surgery.</p>

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