Feasibility of Endoscopy-Assisted Laparoscopic Full-Thickness Resection for Superficial Duodenal Neoplasms

Background. Superficial duodenal neoplasms (SDNs) are a challenging target in the digestive tract. Surgical resection is invasive, and it is difficult to determine the site and extent of the lesion from outside the intestine and resect it locally. Endoscopic submucosal dissection (ESD) has scarcely been utilized in the treatment of duodenal tumors because of technical difficulties and possible delayed perforation due to the action of digestive juices. Thus, no standard treatments for SDNs have been established. To challenge this issue, we elaborated endoscopy-assisted laparoscopic full-thickness resection (EALFTR) and analyzed its feasibility and safety.Methods. Twenty-four SDNs in 22 consecutive patients treated by EALFTR between January 2011 and July 2012 were analyzed retrospectively.Results. All lesions were removed en bloc. The lateral and vertical margins of the specimens were negative for tumor cells in all cases. The mean sizes of the resected specimens and lesions were 28.9 mm (SD ± 10.5) and 13.3 mm (SD ± 11.6), respectively. The mean operation time and intraoperative estimated blood loss were 133 min (SD ± 45.2) and 16 ml (SD ± 21.1), respectively. Anastomotic leakage occurred in three patients (13.6%) postoperatively, but all were minor leakage and recovered conservatively. Anastomotic stenosis or bleeding did not occur.Conclusions. EALFTR can be a safe and minimally invasive treatment option for SDNs. However, the number of cases in this study was small, and further accumulations of cases and investigation are necessary.

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Management of intended durotomy in minimally invasive intradural spine surgery

Journal of Neurosurgery Spine ◽

10.3171/2014.3.spine13719 ◽

2014 ◽

Vol 21 (2) ◽

pp. 279-285 ◽

Cited By ~ 14

Author(s):

Lee A. Tan ◽

Ippei Takagi ◽

David Straus ◽

John E. O'Toole

Keyword(s):

Blood Loss ◽

Minimally Invasive ◽

Length Of Hospital Stay ◽

Bed Rest ◽

Tubular Retractor ◽

Specific Patient ◽

Dural Closure ◽

Estimated Blood Loss ◽

The Mean ◽

Operative Notes

Object Minimally invasive surgery (MIS) has been increasingly used for the treatment of various intradural spinal pathologies in recent years. Although MIS techniques allow for successful treatment of intradural pathology, primary dural closure in MIS can be technically challenging due to a limited surgical corridor through the tubular retractor system. The authors describe their experience with 23 consecutive patients from a single institution who underwent MIS for intradural pathologies, along with a review of pertinent literature. Methods A retrospective review of a prospectively collected surgical database was performed to identify patients who underwent MIS for intradural spinal pathologies between November 2006 and July 2013. Patient demographics, preoperative records, operative notes, and postoperative records were reviewed. Primary outcomes include operative duration, estimated blood loss, length of bed rest, length of hospital stay, and postoperative complications, which were recorded prospectively. Results Twenty-three patients who had undergone MIS for intradural spinal pathologies during the study period were identified. Fifteen patients (65.2%) were female and 8 (34.8%) were male. The mean age at surgery was 54.4 years (range 30–74 years). Surgical pathologies included neoplastic (17 patients), congenital (3 patients), vascular (2 patients), and degenerative (1 patient). The most common spinal region treated was lumbar (11 patients), followed by thoracic (9 patients), cervical (2 patients), and sacral (1 patient). The mean operative time was 161.1 minutes, and the mean estimated blood loss was 107.2 ml. All patients were allowed full activity less than 24 hours after surgery. The median length of stay was 78.2 hours. Primary sutured dural closure was achieved using specialized MIS instruments with adjuvant fibrin sealant in all cases. The rate of postoperative headache, nausea, vomiting, and diplopia was 0%. No case of cutaneous CSF fistula or symptomatic pseudomeningocele was identified at follow-up, and no patient required revision surgery. Conclusions Primary dural closure with early mobilization is an effective strategy with excellent clinical outcomes in the use of MIS techniques for intradural spinal pathology. Prolonged bed rest after successful primary dural closure appears unnecessary, and the need for watertight dural closure should not prevent the use of MIS techniques in this specific patient population.

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Mid-term to long-term clinical and functional outcomes of minimally invasive correction and fusion for adults with scoliosis

Neurosurgical FOCUS ◽

10.3171/2010.1.focus09272 ◽

2010 ◽

Vol 28 (3) ◽

pp. E6 ◽

Cited By ~ 159

Author(s):

Neel Anand ◽

Rebecca Rosemann ◽

Bhavraj Khalsa ◽

Eli M. Baron

Keyword(s):

Blood Loss ◽

Minimally Invasive ◽

Interbody Fusion ◽

Short Form ◽

Operating Time ◽

Adult Scoliosis ◽

Estimated Blood Loss ◽

The Mean

Object The goal of this study was to assess the operative outcomes of adult patients with scoliosis who were treated surgically with minimally invasive correction and fusion. Methods This was a retrospective study of 28 consecutive patients who underwent minimally invasive correction and fusion over 3 or more levels for adult scoliosis. Hospital and office charts were reviewed for clinical data. Functional outcome data were collected at each visit and at the last follow-up through self-administered questionnaires. All radiological measurements were obtained using standardized computer measuring tools. Results The mean age of the patients in the study was 67.7 years (range 22–81 years), with a mean follow-up time of 22 months (range 13–37 months). Estimated blood loss for anterior procedures (transpsoas discectomy and interbody fusions) was 241 ml (range 20–2000 ml). Estimated blood loss for posterior procedures, including L5–S1 transsacral interbody fusion (and in some cases L4–5 and L5–S1 transsacral interbody fusion) and percutaneous screw fixation, was 231 ml (range 50–400 ml). The mean operating time, which was recorded from incision time to closure, was 232 minutes (range 104–448 minutes) for the anterior procedures, and for posterior procedures it was 248 minutes (range 141–370 minutes). The mean length of hospital stay was 10 days (range 3–20 days). The preoperative Cobb angle was 22° (range 15–62°), which corrected to 7° (range 0–22°). All patients maintained correction of their deformity and were noted to have solid arthrodesis on plain radiographs. This was further confirmed on CT scans in 21 patients. The mean preoperative visual analog scale and treatment intensity scale scores were 7.05 and 53.5; postoperatively these were 3.03 and 25.88, respectively. The mean preoperative 36-Item Short Form Health Survey and Oswestry Disability Index scores were 55.73 and 39.13; postoperatively they were 61.50 and 7, respectively. In terms of major complications, 2 patients had quadriceps palsies from which they recovered within 6 months, 1 sustained a retrocapsular renal hematoma, and 1 patient had an unrelated cerebellar hemorrhage. Conclusions Minimally invasive surgical correction of adult scoliosis results in mid- to long-term outcomes similar to traditional surgical approaches. Whereas operating times are comparable to those achieved with open approaches, blood loss and morbidity appear to be significantly lower in patients undergoing minimally invasive deformity correction. This approach may be particularly useful in the elderly.

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Perioperative morbidity of different operative approaches in early cervical carcinoma: a systematic review and meta-analysis comparing minimally invasive versus open radical hysterectomy

Archives of Gynecology and Obstetrics ◽

10.1007/s00404-021-06248-8 ◽

2021 ◽

Author(s):

J. Kampers ◽

E. Gerhardt ◽

P. Sibbertsen ◽

T. Flock ◽

H. Hertel ◽

...

Keyword(s):

Blood Loss ◽

Minimally Invasive ◽

Hospital Stay ◽

Radical Hysterectomy ◽

Postoperative Morbidity ◽

Meta Analysis ◽

Operation Time ◽

Mean Difference ◽

Inclusion Criteria ◽

Estimated Blood Loss

Abstract Purpose Radical hysterectomy and pelvic lymphadenectomy is the standard treatment for early cervical cancer. Studies have shown superior oncological outcome for open versus minimal invasive surgery, but peri- and postoperative complication rates were shown vice versa. This meta-analysis evaluates the peri- and postoperative morbidities and complications of robotic and laparoscopic radical hysterectomy compared to open surgery. Methods Embase and Ovid-Medline databases were systematically searched in June 2020 for studies comparing robotic, laparoscopic and open radical hysterectomy. There was no limitation in publication year. Inclusion criteria were set analogue to the LACC trial. Subgroup analyses were performed regarding the operative technique, the study design and the date of publication for the endpoints intra- and postoperative morbidity, estimated blood loss, hospital stay and operation time. Results 27 studies fulfilled the inclusion criteria. Five prospective, randomized-control trials were included. Meta-analysis showed no significant difference between robotic radical hysterectomy (RH) and laparoscopic hysterectomy (LH) concerning intra- and perioperative complications. Operation time was longer in both RH (mean difference 44.79 min [95% CI 38.16; 51.42]), and LH (mean difference 20.96 min; [95% CI − 1.30; 43.22]) than in open hysterectomy (AH) but did not lead to a rise of intra- and postoperative complications. Intraoperative morbidity was lower in LH than in AH (RR 0.90 [0.80; 1.02]) as well as in RH compared to AH (0.54 [0.33; 0.88]). Intraoperative morbidity showed no difference between LH and RH (RR 1.29 [0.23; 7.29]). Postoperative morbidity was not different in any approach. Estimated blood loss was lower in both LH (mean difference − 114.34 [− 122.97; − 105.71]) and RH (mean difference − 287.14 [− 392.99; − 181.28]) compared to AH, respectively. Duration of hospital stay was shorter for LH (mean difference − 3.06 [− 3.28; − 2.83]) and RH (mean difference − 3.77 [− 5.10; − 2.44]) compared to AH. Conclusion Minimally invasive radical hysterectomy appears to be associated with reduced intraoperative morbidity and blood loss and improved reconvalescence after surgery. Besides oncological and surgical factors these results should be considered when counseling patients for radical hysterectomy and underscore the need for new randomized trials.

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Treatment of irreducible atlantoaxial dislocation using one-stage retropharyngeal release and posterior reduction

Journal of Orthopaedic Surgery ◽

10.1177/2309499019870465 ◽

2019 ◽

Vol 27 (3) ◽

pp. 230949901987046 ◽

Cited By ~ 2

Author(s):

Xianfeng Ren ◽

Feng Gao ◽

Siyuan Li ◽

Jiankun Yang ◽

Yongming Xi

Keyword(s):

Blood Loss ◽

Operative Time ◽

Japanese Orthopaedic Association ◽

Operation Time ◽

Atlantoaxial Dislocation ◽

Efficacy And Safety ◽

Estimated Blood Loss ◽

Irreducible Atlantoaxial Dislocation ◽

The Mean

Introduction: Irreducible atlantoaxial dislocation (IAAD) has been challenging for spine surgeons. Various methods have been used to treat IAAD, but no consensus has been reached. This study aimed to retrospectively analyze the efficacy of anterior submandibular retropharyngeal release and posterior reduction and fixation for IAAD. Methods: From March 2007 to May 2015, 13 patients diagnosed with IAAD underwent anterior submandibular retropharyngeal release and sequential posterior reduction and fixation. The operation time, blood loss, postoperative complications, and Japanese Orthopaedic Association (JOA) scores were retrospectively recorded. Results: The surgeries were accomplished successfully. The mean operative time was about 3.8 h. The mean estimated blood loss was about 130 mL. The patients experienced postoperative pharyngeal pain. Only one patient had a vague voice and increased oral discharge postoperatively. At the final follow-up, JOA scores had significantly increased ( p < 0.05), and all the patients had solid bony fusion. Conclusion: The present study reinforces the efficacy and safety of anterior submandibular retropharyngeal release and posterior reduction and fixation for IAAD. It can achieve satisfactory clinical outcomes and is safe for experienced spine surgeons.

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Minimally invasive subtalar arthrodesis for traumatic subtalar arthritis

Journal of International Medical Research ◽

10.1177/0300060519847814 ◽

2019 ◽

Vol 47 (12) ◽

pp. 6129-6138 ◽

Cited By ~ 1

Author(s):

Lei Sun ◽

Zhigang Kong ◽

Ming Xu

Keyword(s):

Blood Loss ◽

Minimally Invasive ◽

Bone Graft ◽

Iliac Crest ◽

Operation Time ◽

Iliac Crest Bone Graft ◽

Intraoperative Blood Loss ◽

Subtalar Arthrodesis ◽

Subtalar Arthritis ◽

The Mean

Objective This study was performed to introduce a new method of minimally invasive subtalar arthrodesis (MISA) and assess its clinical effects on traumatic subtalar arthritis (TSA). Methods Fifteen patients (8 male and 7 female; age range, 36–56 years; mean age, 48.67 years) with TSA who underwent MISA were included. All patients were treated using a series instrument. The intraoperative and postoperative indexes were recorded. Results Among all patients, the mean operation time was 59.67 ± 16.31 minutes and the mean intraoperative blood loss was 43.33 ± 52.87 mL. Four patients underwent iliac crest bone graft surgery, and one patient developed a complication involving fat liquefaction of the iliac crest wound. The mean bony fusion time among all patients was 3.5 months. According to the American Orthopaedic Foot and Ankle Society standard, an excellent outcome was obtained in eight patients and a good outcome was obtained in seven patients. The operation time and intraoperative blood loss were significantly different between patients who did and did not undergo iliac crest bone graft surgery. Conclusion MISA is a simple and effective method for the treatment of TSA.

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Anesthetic management of radical nephrectomy in patients with renal cell carcinoma involving renal vein or inferior vena cava

Tumori Journal ◽

10.1177/0300891619839295 ◽

2019 ◽

Vol 105 (5) ◽

pp. 411-416

Author(s):

Kun Chen ◽

Juan Wang ◽

Jinzhen Dai ◽

Ailin Luo ◽

Yuke Tian ◽

...

Keyword(s):

Blood Loss ◽

Renal Vein ◽

Radical Nephrectomy ◽

Inferior Vena ◽

Anesthetic Management ◽

Vena Cava ◽

Operation Time ◽

Level Ii ◽

Estimated Blood Loss ◽

The Mean

Objective: To investigate the perioperative anesthetic management of patients diagnosed with renal cell carcinoma (RCC) metastasized into the renal vein or inferior vena cava (IVC) after undergoing radical nephrectomy to provide clinical evidence for rational anesthetic interventions. Methods: A total of 81 patients with RCC extending into the renal vein or IVC, aged 17–73 years, undergoing radical nephrectomy were recruited. Preoperative status, intraoperative management, average operation time, average estimated blood loss, postanesthesia outcomes, and postoperative complications were retrospectively analyzed. Results: The mean operation time was 288 minutes (range 146–825 minutes). The mean estimated blood loss was recorded as 1905 mL (range 200–7000 mL). Among 81 cases, 9 patients (11.1%, 1 level II, 3 level III, and 5 level IV) were switched to undergo cardiopulmonary bypass. Significant hemodynamic fluctuations were observed in 39 patients who presented with level II–IV of tumor thrombus. One patient had pulmonary embolism and died of active cardiopulmonary resuscitation. The mean postoperative hospital stay was 12.8 days. Twenty-five cases with level III–IV tumor thrombus were transferred to the intensive care unit with endotracheal intubation due to massive intraoperative blood loss. The remaining 55 cases were transferred to the postanesthesia care unit 2 hours before being transferred to the ward. One patient had postoperative acute coronary syndrome and was discharged after effective interventions. Conclusion: Anesthetic management and intensive postoperative care play a pivotal role in the success of complete resection of RCC that metastasize into the IVC.

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Open Partial Nephrectomy with Zero Ischaemia Using a Supra 12th Rib Miniflank Incision: A Minimally Invasive Open Approach for Small Renal Masses

Advances in Urology ◽

10.1155/2021/5569254 ◽

2021 ◽

Vol 2021 ◽

pp. 1-5

Author(s):

Syed Ali Ehsanullah ◽

Abida Sultana ◽

Brian Kelly ◽

Charlotte Dunford ◽

Zaheer Shah

Keyword(s):

Renal Function ◽

Blood Loss ◽

Minimally Invasive ◽

Partial Nephrectomy ◽

Operative Time ◽

Tumour Size ◽

Open Approach ◽

Open Partial Nephrectomy ◽

Estimated Blood Loss ◽

The Mean

Introduction. To assess a minimally invasive open technique for partial nephrectomy with zero ischaemia time. Methods. A review was performed in a prospectively maintained database of a single surgeon series of all patients undergoing partial nephrectomy using a supra 12th rib miniflank incision with zero ischaemia. Data of seventy one patients who underwent a partial nephrectomy over an 82-month period were analyzed. Data analyzed included operative time, estimated blood loss, pre and postoperative renal function, complications, final pathological characteristics, and tumour size. Results. Seventy one partial nephrectomies were performed from February 2009 to October 2015. None were converted to radical nephrectomy. Mean operative time was 72 minutes (range 30–250), and mean estimated blood loss was 608 mls (range 100–2500) with one patient receiving blood transfusion. The mean pre and postoperative haemoglobin levels were 144 and 112 g/l. The mean pre and postoperative creatinine levels were 82 and 103 Umol/L. There were 8 Clavian–Dindo Grade 2 complications and 1 major complication (Clavian IIIa). Histology confirmed 24 benign lesions and 47 malignant lesions, 46 cT1a lesions, 24 cT1b lesions, and 1 cT2 lesion. Median follow-up was 38 months with no local recurrence or progression of disease with 5 patients having a positive margin (7%). Conclusion. Our results demonstrate that a supra 12th miniflank incision open partial nephrectomy with zero ischaemic time for SRMs has satisfactory outcomes with preservation of renal function. A minimally invasive open partial nephrectomy remains an important option for units that cannot offer patients a laparoscopic or a robotic procedure.

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Adjuvant instant pre-operative renal artery embolization facilitates the radical nephrectomy and thrombectomy in locally advanced renal cancer with venous thrombus: A retrospective study of 54 cases

10.21203/rs.3.rs-28801/v1 ◽

2020 ◽

Author(s):

Guangxin Tang ◽

xiaoxu chen ◽

Jianwei Wang ◽

Wei He ◽

Zhihong Niu

Keyword(s):

Blood Loss ◽

Renal Artery ◽

Locally Advanced ◽

Operation Time ◽

Artery Embolization ◽

Venous Thrombus ◽

Estimated Blood Loss ◽

Transfusion Requirements ◽

Renal Artery Embolization ◽

The Mean

Abstract Background: The role of renal artery embolization (RAE) in the therapeutic armamentarium is always controversial. The present study aimed to assess the safety and the surgical outcomes of the instant renal artery embolization (I-RAE) prior to nephrectomy and thrombectomy in locally advanced renal cell carcinoma patients with venous thrombus.Methods: We performed a retrospective analysis of 54 patients treated with nephrectomy and thrombectomy between Jan 2012 and Jan 2019. Twenty-four patients were treated by I-RAE before surgery. Thirty patients were performed surgery alone (Non-RAE). The patient demographics, operation time, blood loss, transfusion requirements, complications and other surgical parameters were analyzed between the two groups.Results: The mean tumor size in I-RAE group was significantly larger than that in the Non-RAE group (11.1cm versus 7.9cm; p = .001). The mean estimated blood loss was significantly lower in I-RAE group compared to Non-RAE group (596ml versus 827ml; p = .015), and the patients in the Non-RAE group were more likely to receive blood transfusion (RBC units, 4U versus 6U, p = .025; plasma volume, 200ml versus 400ml, p = .01). No differences were found in operative duration, ICU stay, perioperative complications and length of postoperative hospitalization. Conclusions: The adjuvant instant pre-operative renal artery embolization (I-RAE) is a safe technique. It facilitates the nephrectomy and thrombectomy by reduction of blood loss, transfusion requirements and complication of delayed operation, providing the urologists with a reliable option for locally advanced RCC with tumor thrombus.

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Adjuvant instant preoperative renal artery embolization facilitates the radical nephrectomy and thrombectomy in locally advanced renal cancer with venous thrombus: A retrospective study of 54 cases

10.21203/rs.3.rs-28801/v2 ◽

2020 ◽

Author(s):

Guangxin Tang ◽

xiaoxu chen ◽

Jianwei Wang ◽

Wei He ◽

Zhihong Niu

Keyword(s):

Blood Loss ◽

Renal Artery ◽

Locally Advanced ◽

Operation Time ◽

Artery Embolization ◽

Venous Thrombus ◽

Estimated Blood Loss ◽

Transfusion Requirements ◽

Renal Artery Embolization ◽

The Mean

Abstract Background: The role of renal artery embolization (RAE) in the therapeutic armamentarium is always controversial. The present study aimed to assess the safety and the surgical outcomes of the instant renal artery embolization (I-RAE) prior to nephrectomy and thrombectomy in patients with locally advanced renal cell carcinoma (RCC) with venous thrombus.Methods: We performed a retrospective analysis of 54 patients treated with nephrectomy and thrombectomy between January 2012 and January 2019. Twenty-four patients were treated with I-RAE before surgery. Thirty patients received surgery alone (non-RAE group). The patient demographics, operation time, blood loss, transfusion requirements, complications and other surgical parameters were analyzed between the two groups.Results: The mean tumor size in the I-RAE group was significantly larger than that in the non-RAE group (11.1 cm versus 7.9 cm; p = .001). The mean estimated blood loss was significantly lower in the I-RAE group compared to that in the non-RAE group (596 ml versus 827 ml; p = .015), and the patients in the Non-RAE group were more likely to receive blood transfusion (red blood cell, RBC units, 4 U versus 6 U, p = .025; plasma volume, 200 ml versus 400 ml, p = .01). No differences were found in operative duration, ICU stay, perioperative complications and length of postoperative hospitalization. Conclusions: Instant preoperative adjuvant renal artery embolization (I-RAE) is a safe technique. It facilitates nephrectomy and thrombectomy by reducing blood loss, transfusion requirements and complications of delayed operations, providing urologists with a reliable option for treatment of locally advanced RCC with tumor thrombus.

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Minimally invasive anterior and lateral transpsoas approaches for closed reduction of grade II spondylolisthesis: initial clinical and radiographic experience

Neurosurgical FOCUS ◽

10.3171/2017.10.focus17574 ◽

2018 ◽

Vol 44 (1) ◽

pp. E4 ◽

Cited By ~ 11

Author(s):

David S. Xu ◽

Konrad Bach ◽

Juan S. Uribe

Keyword(s):

Blood Loss ◽

Minimally Invasive ◽

Interbody Fusion ◽

Case Series ◽

Lumbar Interbody Fusion ◽

Complete Reduction ◽

Estimated Blood Loss ◽

Grade Ii ◽

The Mean

OBJECTIVEMinimally invasive anterior and lateral approaches to the lumbar spine are increasingly used to treat and reduce grade I spondylolisthesis, but concerns still exist for their usage in the management of higher-grade lesions. The authors report their experience with this strategy for grade II spondylolisthesis in a single-surgeon case series and provide early clinical and radiographic outcomes.METHODSA retrospective review of a single surgeon’s cases between 2012 and 2016 identified all patients with a Meyerding grade II lumbar spondylolisthesis who underwent minimally invasive lateral lumbar interbody fusion (LLIF) or anterior lumbar interbody fusion (ALIF) targeting the slipped level. Demographic, clinical, and radiographic data were collected and analyzed. Changes in radiographic measurements, Oswestry Disability Index (ODI), and visual analog scale (VAS) scores were compared using the paired t-test and Wilcoxon signed rank test for continuous and ordinal variables, respectively.RESULTSThe average operative time was 199.1 minutes (with 60.6 ml of estimated blood loss) for LLIFs and 282.1 minutes (with 106.3 ml of estimated blood loss), for ALIFs. Three LLIF patients had transient unilateral anterior thigh numbness during the 1st week after surgery, and 1 ALIF patient had transient dorsiflexion weakness, which was resolved at postoperative week 1. The mean follow-up time was 17.6 months (SD 12.5 months) for LLIF patients and 10 months (SD 3.1 months) for ALIF patients. Complete reduction of the spondylolisthesis was achieved in 12 LLIF patients (75.0%) and 7 ALIF patients (87.5%). Across both procedures, there was an increase in both the segmental lordosis (LLIF 5.6°, p = 0.002; ALIF 15.0°, p = 0.002) and overall lumbar lordosis (LLIF 2.9°, p = 0.151; ALIF 5.1°, p = 0.006) after surgery. Statistically significant decreases in the mean VAS and the mean ODI measurements were seen in both treatment groups. The VAS and ODI scores fell by a mean value of 3.9 (p = 0.002) and 19.8 (p = 0.001), respectively, for LLIF patients and 3.8 (p = 0.02) and 21.0 (p = 0.03), respectively, for ALIF patients at last follow-up.CONCLUSIONSEarly clinical and radiographic results from using minimally invasive LLIF and ALIF approaches to treat grade II spondylolisthesis appear to be good, with low operative blood loss and no neurological deficits. Complete reduction of the spondylolisthesis is frequently possible with a statistically significant reduction in pain scores.

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