Minimally Invasive Video-Assisted Thyroidectomy: Almost a Decade of Experience at an Academic Center

Minimally invasive video-assisted thyroidectomy (MIVAT) has gained acceptance as an alternative to conventional thyroidectomy. This technique results in less bleeding, postoperative pain, shorter recovery time, and better cosmetic results without increasing morbidity. We retrospectively assessed outcomes in 583 patients having MIVAT from May 2005 to September 2014. The study population was divided into groups according to periods: 2005 to 2009 and 2010 to 2014. Operative data, complications, and length of stay were collected and compared. Total thyroidectomy was undertaken in 185, completion thyroidectomy in 49, and hemithyroidectomy in 349. Malignancy was present in 127 (21.8%). Mean incision was 3.4 ± 0.7 cm and estimated blood loss was 23.7 ± 21.7 mL. Mean operative time was 86.5 ± 39.3 minutes for all operations, 78.5 ± 37.0 minutes for hemithyroidectomy, 70.9 ± 30.1 minutes for completion thyroidectomy, and 106.8 ± 41.3 minutes for total thyroidectomy. Postoperatively, 56 (9.6%) had unilateral vocal cord dysfunction, which resolved except for one case (0.17%). Fifty-nine patients (10.1%) developed hypocalcemia, but only three cases (0.51%) became permanent. Only one patient required readmission. In conclusion, MIVAT results in short operative times, minimal blood loss, and few complications and is safely performed in an academic institution.

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Genitofemoral Nerve Protection During the Lateral Retroperitoneal Transpsoas Approach

Operative Neurosurgery ◽

10.1227/01.neu.0000431473.49042.95 ◽

2013 ◽

Vol 73 (2) ◽

pp. ons192-ons197 ◽

Cited By ~ 6

Author(s):

Gabriel C. Tender ◽

Daniel Serban

Keyword(s):

Length Of Stay ◽

Blood Loss ◽

Minimally Invasive ◽

Operative Time ◽

Femoral Nerve ◽

Psoas Muscle ◽

Lateral Approach ◽

Direct Visualization ◽

Genitofemoral Nerve ◽

Estimated Blood Loss

Abstract BACKGROUND: The minimally invasive lateral retroperitoneal approach for lumbar fusions is a novel technique with good results, but also with significant sensory and motor complications. OBJECTIVE: To present the early results of a modified surgical technique, in which the psoas muscle is dissected under direct visualization. METHODS: Thirteen consecutive patients with L4-5 or L3-4 pathology were prospectively followed after being treated using a minimally invasive lateral approach with direct exposure of the psoas muscle before dissection. There were 7 woman and 6 men with a mean age of 52.3 years. Perioperative parameters like operative time, estimated blood loss, and length of stay, were noted. Pain, paresthesia, and motor weakness, as well as any other complications, were evaluated at 2 weeks and 3 months postoperatively. RESULTS: The mean operative time, estimated blood loss, and length of stay were 163 minutes, 126 mL, and 3 days, respectively. One patient exhibited anterior thigh pain and paresthesia at 2 weeks, both of which resolved by 3 months. Two patients experienced superficial wound infections that healed with antibiotics. The genitofemoral nerve was identified and protected in 7 patients; in 4 patients, it had a more posterior anatomic location than expected. The femoral nerve was not exposed or detected in the operative field by neuromonitoring, nor were there any symptoms related to a femoral nerve injury in any patient. CONCLUSION: Dissection of the psoas muscle under direct visualization during the minimally invasive lateral approach may provide increased safety to the genitofemoral and femoral nerves.

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Minimally Invasive Spine Metastatic Tumor Resection and Stabilization: New Technology Yield Improved Outcome

BioMed Research International ◽

10.1155/2015/948373 ◽

2015 ◽

Vol 2015 ◽

pp. 1-6 ◽

Cited By ~ 3

Author(s):

Ran Harel ◽

Omer Doron ◽

Nachshon Knoller

Keyword(s):

Blood Loss ◽

Minimally Invasive ◽

Operative Time ◽

Medical Condition ◽

Tumor Resection ◽

Spinal Metastases ◽

Medical Emergency ◽

Tubular Retractor ◽

Estimated Blood Loss ◽

Index Level

Spinal metastases compressing the spinal cord are a medical emergency and should be operated on if possible; however, patients’ medical condition is often poor and surgical complications are common. Minimizing surgical extant, operative time, and blood loss can potentially reduce postoperative complications. This is a retrospective study describing the patients operated on in our department utilizing a minimally invasive surgery (MIS) approach to decompress and instrument the spine from November 2013 to November 2014. Five patients were operated on for thoracic or lumbar metastases. In all cases a unilateral decompression with expandable tubular retractor was followed by instrumentation of one level above and below the index level and additional screw at the index level contralateral to the decompression side. Cannulated fenestrated screws were used (Longitude FNS) and cement was injected to increase pullout resistance. Mean operative time was 134 minutes and estimated blood loss was minimal in all cases. Improvement was noticeable in neurological status, function, and pain scores. No complications were observed. Technological improvements in spinal instruments facilitate shorter and safer surgeries in oncologic patient population and thus reduce the complication rate. These technologies improve patients’ quality of life and enable the treatment of patients with comorbidities.

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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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Perioperative results following lumbar discectomy: comparison of minimally invasive discectomy and standard microdiscectomy

Neurosurgical FOCUS ◽

10.3171/foc/2008/25/8/e20 ◽

2008 ◽

Vol 25 (2) ◽

pp. E20 ◽

Cited By ~ 60

Author(s):

John W. German ◽

Mathew A. Adamo ◽

Regis G. Hoppenot ◽

Jessin H. Blossom ◽

Henry A. Nagle

Keyword(s):

Cerebrospinal Fluid ◽

Length Of Stay ◽

Blood Loss ◽

Minimally Invasive ◽

Operative Time ◽

Cerebrospinal Fluid Leak ◽

Lumbar Discectomy ◽

Estimated Blood Loss ◽

Fluid Leak ◽

First Time

Object Minimally invasive lumbar discectomy is a refinement of the standard open microsurgical discectomy technique. Proponents of the minimally invasive technique suggest that it improves patient outcome, shortens hospital stay, and decreases hospital costs. Despite these claims there is little support in the literature to justify the adoption of minimally invasive discectomy over standard open microsurgical discectomy. In the present study, the authors address some of these issues by comparing the short-term outcomes in patients who underwent first time, single-level lumbar discectomy at L3–4, L4–5, or L5–S1 using either a minimally invasive percutaneous, muscle splitting approach or a standard, open, muscle-stripping microsurgical approach. Methods A retrospective chart review of 172 patients who had undergone a first-time, single-level lumbar discectomy at either L3–4, L4–5, or L5–S1 was performed. Perioperative results were assessed by comparing the following parameters between patients who had undergone minimally invasive discectomy and those who received standard open microsurgical discectomy: length of stay, operative time, estimated blood loss, rate of cerebrospinal fluid leak, post-anesthesia care unit narcotic use, need for a physical therapy consultation, and need for admission to the hospital. Results Forty-nine patients underwent minimally invasive discectomy, and 123 patients underwent open microsurgical discectomy. At baseline the groups did differ significantly with respect to age, but did not differ with respect to height, weight, sex, body mass index, level of radiculopathy, side of radiculopathy, insurance status, or type of preoperative analgesic use. No statistically significant differences were identified in operative time, rate of cerebrospinal fluid leak, or need for a physical therapy consultation. Statistically significant differences were identified in length of stay, estimated blood loss, postanesthesia care unit narcotic use, and need for admission to the hospital. Conclusions In this retrospective study, patients who underwent minimally invasive discectomy were found to have similiar perioperative results as those who underwent open microsurgical discectomy. The differences, although statistically significant, are of modest clinical significance.

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Minimally Invasive Scoliosis Surgery Is a Feasible Option for Management of Idiopathic Scoliosis and Has Equivalent Outcomes to Open Surgery: A Meta-Analysis

Global Spine Journal ◽

10.1177/2192568220988267 ◽

2021 ◽

pp. 219256822098826

Author(s):

Abduljabbar Alhammoud ◽

Yahya Alborno ◽

Abdul Moeen Baco ◽

Yahya Azhar Othman ◽

Yoji Ogura ◽

...

Keyword(s):

Postoperative Pain ◽

Blood Loss ◽

Minimally Invasive ◽

Idiopathic Scoliosis ◽

Operative Time ◽

Meta Analysis ◽

Scoliosis Surgery ◽

Curve Correction ◽

Estimated Blood Loss ◽

Feasible Option

Study Design: Meta-analysis. Objective: To compare outcomes between minimally invasive scoliosis surgery (MISS) and traditional posterior instrumentation and fusion in the correction of adolescent idiopathic scoliosis (AIS). Methods: A literature search was performed using MEDLINE, PubMed, EMBASE, Google scholar and Cochrane databases, including studies reporting outcomes for both MISS and open correction of AIS. Study details, demographics, and outcomes, including curve correction, estimated blood loss (EBL), operative time, postoperative pain, length of stay (LOS), and complications, were collected and analyzed. Results: A total of 4 studies met the selection criteria and were included in the analysis, totaling 107 patients (42 MIS and 65 open) with a mean age of 16 years. Overall there was no difference in curve correction between MISS (73.2%) and open (76.7%) cohorts. EBL was significantly lower in the MISS (271 ml) compared to the open (527 ml) group, but operative time was significantly longer (380 min for MISS versus 302 min for open). There were no significant differences between the approaches in pain, LOS, complications, or reoperations. Conclusion: MISS was associated with less blood loss but longer operative times compared to traditional open fusion for AIS. There was no difference in curve correction, postoperative pain, LOS, or complications/reoperations. While MISS has emerged as a feasible option for the surgical management of AIS, further research is warranted to compare these 2 approaches.

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Minimally invasive lateral corpectomy for thoracolumbar traumatic burst fractures

Neurosurgical FOCUS ◽

10.3171/2020.6.focus20366 ◽

2020 ◽

Vol 49 (3) ◽

pp. E12

Author(s):

Adam G. Podet ◽

Kevin D. Morrow ◽

Jared M. Robichaux ◽

Jessica A. Shields ◽

Anthony M. DiGiorgio ◽

...

Keyword(s):

Blood Loss ◽

Minimally Invasive ◽

Operative Time ◽

Thoracolumbar Spine ◽

Tube Placement ◽

Control Group ◽

Thoracolumbar Fractures ◽

Burst Fractures ◽

Estimated Blood Loss ◽

Significant Difference

OBJECTIVEThe need for anterior column reconstruction after thoracolumbar burst fractures remains controversial. Here, the authors present their experience with minimally invasive lateral thoracolumbar corpectomies for traumatic fractures.METHODSBetween 2012 and 2019, 59 patients with 65 thoracolumbar fractures underwent 65 minimally invasive lateral corpectomies (MIS group). This group was compared to 16 patients with single-level thoracolumbar fractures who had undergone open lateral corpectomies with the assistance of general surgery between 2007 and 2011 (open control group). Comparisons of the two groups were made with regard to operative time, estimated blood loss, time to ambulation, and fusion rates at 1 year postoperatively. The authors further analyzed the MIS group with regard to injury mechanism, fracture characteristics, neurological outcome, and complications.RESULTSPatients in the MIS group had a significantly shorter mean operative time (228.3 ± 27.9 vs 255.6 ± 34.1 minutes, p = 0.001) and significantly shorter mean time to ambulation after surgery (1.8 ± 1.1 vs 5.0 ± 0.8 days, p < 0.001) than the open corpectomy group. Mean estimated blood loss did not differ significantly between the two groups, though the MIS group did trend toward a lower mean blood loss. There was no significant difference in fusion status at 1 year between the MIS and open groups; however, this comparison was limited by poor follow-up, with only 32 of 59 patients (54.2%) in the MIS group and 8 of 16 (50%) in the open group having available imaging at 1 year. Complications in the MIS group included 1 screw misplacement requiring revision, 2 postoperative femoral neuropathies (one of which improved), 1 return to surgery for inadequate posterior decompression, 4 pneumothoraces requiring chest tube placement, and 1 posterior wound infection. The rate of revision surgery for the failure of fusion in the MIS group was 1.7% (1 of 59 patients).CONCLUSIONSThe minimally invasive lateral thoracolumbar corpectomy approach for traumatic fractures appears to be relatively safe and may result in shorter operative times and quicker mobilization as compared to those with open techniques. This should be considered as a treatment option for thoracolumbar spine fractures.

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Comparison of Early Outcomes between Percutaneous Endoscopic and Minimally Invasive Transforaminal Lumbar Interbody Fusion for Lumbar Spondylolisthesis

10.21203/rs.3.rs-89182/v1 ◽

2020 ◽

Author(s):

Hao Zhang ◽

Chuanli Zhou ◽

Chao Wang ◽

Kai Zhu ◽

Qihao Tu ◽

...

Keyword(s):

Back Pain ◽

Blood Loss ◽

Minimally Invasive ◽

Interbody Fusion ◽

Operative Time ◽

Japanese Orthopaedic Association ◽

Transforaminal Lumbar Interbody Fusion ◽

Lumbar Interbody Fusion ◽

Estimated Blood Loss ◽

Lumbar Spondylolisthesis

Abstract BackgroundWith the rapid development of less-invasive techniques, the percutaneous endoscopic transforaminal lumbar interbody fusion (Endo-TLIF) as a novel minimal surgical technique for treating lumbar spondylolisthesis in recent years. To compare the preliminary efficacy of Endo-TLIF with that of minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF) for the treatment of lumbar spondylolisthesis.MethodsBetween May and August 2019, 62 patients with single-segment lumbar spondylolisthesis treated by a single surgeon were enrolled in this clinical study: there were 32 patients in the Endo-TLIF group and 30 patients in the MIS-TLIF group. Perioperative parameters, including operative time, estimated blood loss (EBL), interoperative fluoroscopy time, ambulation time and operative complications, were recorded. At preoperatively, 1 week, 3 months, 6 months and 12 months postoperatively, the results of clinical metrics such as the Visual Analog Scale (VAS) for back pain, the Oswestry Disability Index (ODI) and the Japanese Orthopaedic Association (JOA) score were obtained and used to compare early outcomes between the two groups. Postoperative fusion rates were assessed by CT scans 12 months after surgery.ResultsNo significant differences were found in the demographic data, including sex, age, body mass index (BMI), segment distribution and spondylolisthesis severity, between the two groups. Compared with MIS-TLIF group, Endo-TLIF group had a similar operative time (202.6±31.4 minutes), less intraoperative blood loss (73.0±26.0 ml) and a shorter ambulation time (1.6±0.6 days) but had a longer duration of X-ray radiation (46.3±5.1 seconds). The postoperative VAS scores for back pain as well as the ODI and JOA scores were improved compared with the preoperative scores in the two groups, but the Endo-TLIF group showed more significant improvement in the early follow-up. There were no significant differences in terms of the interbody fusion rate between the two groups. However, no obvious postoperative complications were observed in the study.ConclusionEndo-TLIF technique shows relatively better outcomes compared with MIS-TLIF in terms of an early curative effect, especially one week and six months postoperatively.

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Minimally invasive resection of lumbar intraspinal synovial cysts via a contralateral approach: review of 13 cases

Journal of Neurosurgery Spine ◽

10.3171/2015.1.spine14996 ◽

2015 ◽

Vol 23 (4) ◽

pp. 444-450 ◽

Cited By ~ 14

Author(s):

Hamdi G. Sukkarieh ◽

Patrick W. Hitchon ◽

Olatilewa Awe ◽

Jennifer Noeller

Keyword(s):

Blood Loss ◽

Minimally Invasive ◽

Hospital Stay ◽

Operative Time ◽

Synovial Cyst ◽

Contralateral Approach ◽

Estimated Blood Loss ◽

Synovial Cysts ◽

The Mean

OBJECT The authors sought to determine patient-related outcomes after minimally invasive surgical (MIS) lumbar intraspinal synovial cyst excision via a tubular working channel and a contralateral facet-sparing approach. METHODS All the patients with a symptomatic lumbar intraspinal synovial cyst who underwent surgery at the University of Iowa Hospitals and Clinics with an MIS excision via a contralateral approach were treated between July 2010 and August 2014. There was a total of 13 cases. Each patient was evaluated with preoperative neurological examinations, lumbar spine radiography, MRI, and visual analog scale (VAS) scores. The patients were evaluated postoperatively with neurological examinations and VAS and Macnab scores. The primary outcomes were improvement in VAS and Macnab scores. Secondary outcomes were average blood loss, hospital stay duration, and operative times. RESULTS There were 5 males and 8 females. The mean age was 66 years, and the mean body mass index was 28.5 kg/m2. Sixty-nine percent (9 of 13) of the cysts were at L4–5. Most patients had low-back pain and radicular pain, and one-third of them had Grade 1 spondylolisthesis. The mean (± SD) follow-up duration was 20.8 ± 16.9 months. The mean Macnab score was 3.4 ± 1.0, and the VAS score decreased from 7.8 preoperatively to 2.9 postoperatively. The mean operative time was 123 ± 30 minutes, with a mean estimated blood loss of 44 ± 29 ml. Hospital stay averaged 1.5 ± 0.7 days. There were no complications noted in this series. CONCLUSIONS The MIS excision of lumbar intraspinal synovial cysts via a contralateral approach offers excellent exposure to the cyst and spares the facet joint at the involved level, thus minimizing risk of instability, blood loss, operative time, and hospital stay. Prospective randomized trials with longer follow-up times and larger cohorts are needed to conclusively determine the superiority of the contralateral MIS approach over others, including open or ipsilateral minimally invasive surgery.

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The Emerging Role of Robotic Single-site Approach for Myomectomy: A Systematic Review of the Literature

Surgical Innovation ◽

10.1177/1553350620988227 ◽

2021 ◽

pp. 155335062098822

Author(s):

Eirini Giovannopoulou ◽

Anastasia Prodromidou ◽

Nikolaos Blontzos ◽

Christos Iavazzo

Keyword(s):

Blood Loss ◽

Minimally Invasive ◽

Complication Rate ◽

Operative Time ◽

Intraoperative Complications ◽

Single Site ◽

Minimally Invasive Technique ◽

Invasive Technique ◽

Robotic Myomectomy ◽

The Mean

Objective. To review the existing studies on single-site robotic myomectomy and test the safety and feasibility of this innovative minimally invasive technique. Data Sources. PubMed, Scopus, Google Scholar (from their inception to October 2019), as well as Clinicaltrials.gov databases up to April 2020. Methods of Study Selection. Clinical trials (prospective or retrospective) that reported the outcomes of single-site robotic myomectomy, with a sample of at least 20 patients were considered eligible for the review. Results. The present review was performed in accordance with the guidelines for Systematic Reviews and Meta-Analyses (PRISMA). Four (4) studies met the inclusion criteria, and a total of 267 patients were included with a mean age from 37.1 to 39.1 years and BMI from 21.6 to 29.4 kg/m2. The mean operative time ranged from 131.4 to 154.2 min, the mean docking time from 5.1 to 5.45 min, and the mean blood loss from 57.9 to 182.62 ml. No intraoperative complications were observed, and a conversion rate of 3.8% was reported by a sole study. The overall postoperative complication rate was estimated at 2.2%, and the mean hospital stay ranged from 0.57 to 4.7 days. No significant differences were detected when single-site robotic myomectomy was compared to the multiport technique concerning operative time, blood loss, and total complication rate. Conclusion. Our findings support the safety of single-site robotic myomectomy and its equivalency with the multiport technique on the most studied outcomes. Further studies are needed to conclude on the optimal minimally invasive technique for myomectomy.

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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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