An Anatomic Study of the Percutaneous Endoscopically Assisted Calcaneal Osteotomy Technique to Correct Hindfoot Malalignment

Background: Open calcaneal osteotomy using traditional methods is associated with complications such as sural nerve injury and potential wound healing problems. We hypothesized that by using novel minimally invasive techniques, these potential risks could be mitigated. This anatomic cadaveric study serves to assess the safety of percutaneous endoscopically assisted calcaneal osteotomy (PECO) compared to a traditional open osteotomy technique. Methods: Anatomic safety of PECO was assessed using 8 fresh-frozen cadaver below-knee specimens. Lateral calcaneal nerve (LCN) damage was primarily noted and then secondly compared to a potential open surgical incision approach. Results: Only 1 of 11 LCN branches (n = 8 limbs) was transected using PECO, compared to up to 8 of 10 LCN branches (n = 6 limbs) that potentially would have been injured during open surgery. Conclusions: Percutaneous endoscopically assisted calcaneal osteotomy is a minimally invasive technique that had fewer nerve injuries in this cadaveric model than traditional open surgery. Clinical Relevance: Percutaneous endoscopically assisted calcaneal osteotomy due to its less invasive nature may result in fewer neurovascular injuries relative to an open procedure.

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DIAGNOSTIC LAPAROSCOPY: Utility and solving diagnostic dilemmas

JMS SKIMS ◽

10.33883/jms.v21i2.368 ◽

2019 ◽

Vol 21 (2) ◽

pp. 70-71

Author(s):

Ajaz A Malik

Keyword(s):

Laparoscopic Surgery ◽

Minimally Invasive ◽

Open Surgery ◽

Diagnostic Laparoscopy ◽

Minimal Invasive ◽

Invasive Technique ◽

Basic Procedure ◽

Almost All ◽

Minimal Invasive Techniques ◽

Invasive Techniques

Diagnostic laparoscopy is the basic procedure in laparoscopic surgery that has wide utility in practice, thus avoiding morbidity associated with open surgery. Laparoscopy is a minimally invasive technique wherein a fibre optic instrument is inserted through the abdominal wall to view the organs in abdomen/pelvis and permit the diagnosis and necessary surgical procedure. Nowadays, almost all general surgical procedures can be performed using minimal invasive techniques. Laparoscopy can be performed both for diagnostic as well as for therapeutic purposes. JMS 2018: 21 (2):70-71

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Neurospinal Surgery Innovations

Translational Neuroscience and Clinics ◽

10.18679/cn11-6030_r.2017.020 ◽

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.

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

Operative Neurosurgery ◽

10.1093/ons/opz233 ◽

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.

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Minimally Invasive Dorsal Cheilectomy of the First Metatarsal: A Cadaveric Study

Foot & Ankle International ◽

10.1177/1071100718791588 ◽

2018 ◽

Vol 39 (12) ◽

pp. 1497-1501 ◽

Cited By ~ 6

Author(s):

Kar Hao Teoh ◽

Esten Konstad Haanaes ◽

Saud Alshalawi ◽

Hiro Tanaka ◽

Kartik Hariharan

Keyword(s):

Minimally Invasive ◽

Average Distance ◽

Cadaveric Study ◽

Invasive Technique ◽

Optimal Position ◽

First Metatarsal ◽

Below The Knee ◽

Fresh Frozen ◽

Stab Incision ◽

Relationship Of

Background: Minimally invasive dorsal cheilectomy (MIDC) for hallus rigidus is gaining in popularity. The optimal position for the stab incision for MIDC is dorsomedial to allow an ergonomic sweeping movement of the burr, potentially putting the dorsomedial cutaneous nerve (DMCN) to the hallux at risk. We aimed to quantify the risk of using this minimally invasive technique with a cadaveric study. Methods: A total of 13 fresh-frozen cadaveric specimens amputated below the knee were obtained for this study. After the procedure, the specimens were dissected, and structures were inspected for damage. Results: The DMCN to the hallux was cut completely in 2 specimens (15%). All the extensor hallucis longus tendons were intact, although in 1 specimen, the tendon showed some fraying on the underside of the tendon. The average distance of the stab incision from the first metatarsophalangeal (MTP) joint was 17.7 (range, 10-23) mm. The relationship of the DMCN to the stab incision was variable. The average distance of the DMCN to the incision was 3.8 (range, 0-7) mm. The danger zone for damaging the DMCN was at one-third the length of the first metatarsal proximal to the first MTP joint. Conclusion: The DMCN has been well studied by several authors and has a variable course. This nerve was damaged in 15% of our specimens following MIDC. Clinical Relevance: We believe patients should be made aware of this risk when considering surgery. A carefully made working capsular pocket for the burr and marking this nerve before making the incision if palpable could mitigate this risk.

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Minimally Invasive Versus Open Akin Osteotomy: A Comparative Study

Foot & Ankle Orthopaedics ◽

10.1177/2473011420s00428 ◽

2020 ◽

Vol 5 (4) ◽

pp. 2473011420S0042

Author(s):

Sebastian Schilde ◽

Natalia Gutteck ◽

Karl-Stefan Delank

Keyword(s):

Minimally Invasive ◽

Open Surgery ◽

Valgus Deformity ◽

Negative Effects ◽

Surgery Group ◽

Hallux Valgus Deformity ◽

Wound Healing Problems ◽

Akin Osteotomy ◽

K Wires ◽

Bony Consolidation

Category: Midfoot/Forefoot; Bunion Introduction/Purpose: Minimally invasive techniques of Akin osteotomy grow in popularity in order to minimize wound healing problems. To date it is recommended to keep the lateral corticalis intact during first phalanx osteotomy. The lack of direct visual control makes this a challenging goal in minimally invasive surgery. This retrospective study investigates whether or not the perforation of the lateral corticalis causes clinical or radiological negative effects. The quality of fixation with crossed K-wires and double threaded screws is compared. Methods: 184 patients (210 feet) with symptomatic mild to severe hallux valgus deformity and pathological interphalangeal angle (IPA) of at least 10° underwent surgery combined with Akin osteotomy. 124 minimally invasive Akin osteotomies were fixed with two crossing K-wires and compared to 86 Akin osteotomies in open technique with double threaded screw fixation. After 6 and 12 weeks IPA and bony consolidation were assessed. Results: Preoperative interphalangeal angles were mean 13.4° (+- 3.6°) (minimally invasive group (MI)), or 13.3° (+- 3.5°) (open surgery group (OS)) degrees (p>0.05).Perforation of the lateral corticalis occurred in 12 (13.9%) (OS), or 64 (51.6%) cases (MI), respectively.12 weeks after surgery the mean IPA was 4.1° (+- 1.4°) (MI), or 4.8° (+- 1.2°) in the open surgery group (OS) (p > 0.05).Bony consolidation was noticed after 6 weeks (OS, double threaded screw) or 12 weeks (MI, crossing K-wires).Three deep infections occurred in the OS group after Lapidus arthrodesis and two deep infections were registered in the MI group after MICA. All patients required revision with removal of implants. Pseudarthrosis did not occur in any group. Conclusion: Perforation of the lateral corticalis did not cause negative effects on bone healing or IPA. Minimally invasive Akin osteotomy provides equivalent correction of IPA compared to open surgery with a slightly prolonged radiological bony consolidation. The fixation technique had no influence on IPA correction.

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Medial Displacement Calcaneal Osteotomy Using Minimally Invasive Technique

Foot & Ankle International ◽

10.1177/1071100714557154 ◽

2014 ◽

Vol 36 (3) ◽

pp. 248-252 ◽

Cited By ~ 24

Author(s):

Ehab Kheir ◽

Vishal Borse ◽

Jon Sharpe ◽

David Lavalette ◽

Mark Farndon

Keyword(s):

Minimally Invasive ◽

Minimally Invasive Technique ◽

Invasive Technique ◽

Calcaneal Osteotomy

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Minimally Invasive Surgery for Colorectal Cancer: Past, Present, and Future

International Journal of Surgical Oncology ◽

10.1155/2011/490917 ◽

2011 ◽

Vol 2011 ◽

pp. 1-8 ◽

Cited By ~ 4

Author(s):

J. Holder-Murray ◽

E. J. Dozois

Keyword(s):

Colorectal Cancer ◽

Minimally Invasive ◽

Open Surgery ◽

Oncologic Outcomes ◽

Rapid Progression ◽

Barriers To Adoption ◽

Colorectal Cancer Surgery ◽

Conventional Open Surgery ◽

Invasive Techniques ◽

Innovative Techniques

A rapid progression from conventional open surgery to minimally invasive approaches in the surgical management of colorectal cancer has occurred over the last 2 decades. Initial concerns that this new approach was oncologically inferior to open surgery were ultimately refuted when several prospective randomized trials concluded that laparoscopic colectomy could achieve similar oncologic outcomes to open surgery. On the contrary, level 1 data has not yet matured regarding the oncologic safety of minimally invasive approaches for rectal cancer. We review the published literature pertaining to the evolution of minimally invasive techniques used to treat colorectal cancer surgery, including barriers to adoption, and the prospects for future advances related to innovative techniques.

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Three-port retroperitoneoscopic necrosectomy in management of acute necrotic pancreatitis

Medicina ◽

10.3390/medicina46030024 ◽

2010 ◽

Vol 46 (3) ◽

pp. 176 ◽

Cited By ~ 9

Author(s):

Audrius Šileikis ◽

Virgilijus Beiša ◽

Gintaras Simutis ◽

Albinas Tamošiūnas ◽

Kęstutis Strupas

Keyword(s):

Minimally Invasive ◽

Pancreatic Necrosis ◽

University Hospital ◽

Invasive Technique ◽

Infected Necrosis ◽

First Choice ◽

Necrotic Pancreatitis ◽

Vilnius University ◽

Fluid Collections ◽

Invasive Techniques

Introduction. Because of major morbidity and mortality after open surgery in acute necrotic pancreatitis, an interest in minimally invasive necrosectomy approaches has increased. We report the results of a recently developed minimally invasive technique that we adopted in 2007. Material and methods. This article contains a retrospective analysis of cases and description of original retroperitoneoscopic necrosectomy technique. There were eight patients aged 25–58 years, who underwent retroperitoneoscopic pancreatic necrosectomy in the Center of Abdominal Surgery, Vilnius University Hospital Santariškių Klinikos, between 2007 and 2009. All patients had at least 30% pancreatic necrosis with extensive retroperitoneal fl uid collections on the left side, proved by CT scan. Operations were performed on the 21st–56th days of illness (median, 36th day). Results. The mean postoperative hospital stay was 49 days (range, 14–99 days). All patients survived. Two patients underwent three additional procedures; two patients, one additional procedure due to remaining infected necrosis. Three patients had no requirement for additional procedures. One patient underwent laparotomy because of bleeding. Conclusions. We assume that minimally invasive techniques should be considered a first-choice surgical option in patients with acute necrotic pancreatitis, whenever it is possible. Pancreatic necrosis less than 30% with large fluid collections in the left retroperitoneal space facilitates employment of three-port retroperitoneoscopic necrosectomy.

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Minimally Invasive vs Open Akin Osteotomy

Foot & Ankle International ◽

10.1177/1071100720962411 ◽

2020 ◽

pp. 107110072096241

Author(s):

Sebastian Schilde ◽

Karl-Stefan Delank ◽

Dariusch Arbab ◽

Natalia Gutteck

Keyword(s):

Minimally Invasive ◽

Bone Healing ◽

Open Surgery ◽

Screw Fixation ◽

Invasive Technique ◽

Open Technique ◽

Lateral Cortex ◽

Early Results ◽

Akin Osteotomy ◽

Bony Consolidation

Background: Minimally invasive techniques of Akin osteotomy have grown in popularity, as early results suggest faster recovery, earlier return to work, and minimized wound healing problems. Preserving lateral cortex integrity during first phalanx osteotomy thereby presents a challenge because of the lack of direct visual control. This retrospective comparative study investigated clinical and radiographic outcomes of minimally invasive and open Akin osteotomy with different fixation methods and analyzed whether or not intraoperative violation of the lateral cortex caused loss of correction or delayed bone healing. Methods: One hundred eighty-four patients (210 feet) with symptomatic hallux valgus and pathologic interphalangeal angle (IPA) of at least 10 degrees underwent surgery combined with Akin osteotomy. Minimally invasive Akin osteotomies were fixed in 124 feet with 2 crossing percutaneous K-wires and compared to 86 Akin osteotomies by open technique with double-threaded (head and shank) screw fixation. At 1 day and 6 and 12 weeks postoperatively, IPA and bony consolidation were radiographically and clinically assessed. Results: Mean preoperative IPA was 13.4 ± 3.6 degrees in minimally invasive (MI) and 13.3 ± 3.5 degrees in open surgery (OS) cases ( P > .05). Intraoperative breach of the lateral cortex occurred in 12 (13.9%) in OS and 64 (51.6%) in MI cases. Whereas the breach occurred in open technique mainly during manual correction by applying a medial closing force, it was caused predominantly by the use of the burr in minimally invasive technique. After 12 weeks, the mean IPA was 4.1 ± 1.4 degrees in MI and 4.8 ± 1.2 degrees in OS cases ( P > .05). Bony consolidation was complete after 6 and 12 weeks in OS and MI, respectively. Three deep infections occurred in the OS Group after Lapidus arthrodesis and 2 deep infections were registered in the MI Group after minimally invasive chevron and Akin osteotomy. The infections were not at the site of the Akin osteotomy. Conclusion: Breach of the lateral cortex did not impair bone healing or correction of IPA. Minimally invasive Akin osteotomy with K-wire fixation provided equivalent correction of IPA compared to open surgery with screw fixation. Level of Evidence: Level III, retrospective comparative series.

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Robotic hepatectomy and biliary reconstruction for perihilar cholangiocarcinoma: a pioneer western case series

Updates in Surgery ◽

10.1007/s13304-021-01041-3 ◽

2021 ◽

Author(s):

Umberto Cillo ◽

Francesco Enrico D’Amico ◽

Alessandro Furlanetto ◽

Luca Perin ◽

Enrico Gringeri

Keyword(s):

Minimally Invasive ◽

Open Surgery ◽

Da Vinci ◽

Video Clip ◽

Operating Time ◽

Perihilar Cholangiocarcinoma ◽

Invasive Technique ◽

Biliary Reconstruction ◽

Robot Assisted ◽

Liver Resections

AbstractOpen surgery is the standard of care for perihilar cholangiocarcinoma (pCCA). With the aim of oncologic radicality, it requires a complex major hepatectomy with biliary reconstruction. The postoperative course is consequently often complicated, with severe morbidity and mortality rates of up to 27.5–54% and 18%, respectively. Robotic liver surgery is emerging as a safe, minimally-invasive technique with huge potential for pCCA management. After the first case described by Giulianotti in 2010, here we present the first western series of robot-assisted liver resections with biliary reconstruction for pCCA with the aim to preliminarily assess the feasibility and repeatability of the procedure. At our high-volume teaching hospital center dedicated to HPB surgery, 128 pCCA patients have been surgically treated in the last 15 years whereas more than 800 laparoscopic liver resections have been performed. Since the Da Vinci Xi Robotic platform was introduced in late 2018, 6 major robotic liver resections with biliary reconstruction have been performed, 4 of which were for pCCA. All 4 cases involved a left hepatectomy with caudate lobectomy. The median operating time was 840 min, with a median blood loss of 700 ml. One case was converted to open surgery during the reconstruction due to a short mesentery preventing the hepatico-jejunostomy. None of the patients experienced major complications, while minor complications occurred in 3 out of 4 cases. One biliary leak was managed conservatively. The median postoperative stay was 9 days. Negative biliary margins were achieved in 3 of the 4 cases. An included video clip shows the most relevant technical details. This preliminary series demonstrates that robot-assisted liver resection for pCCA is feasible. We speculate that the da Vinci platform has a relevant potential in pCCA surgery with particular reference to the multi-duct biliary reconstruction. Further studies are needed to better clarify the role of this high-cost technology in the minimally-invasive treatment of pCCA.

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