Minimally Invasive vs Open Akin Osteotomy

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.

scholarly journals Minimally Invasive Versus Open Akin Osteotomy: A Comparative Study

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.

Computed tomography–guided percutaneous facet screw fixation in the lumbar spine

2007 ◽  
Vol 7 (1) ◽  
pp. 95-98 ◽  
Author(s):  
Ho Yeong Kang ◽  
Sang-Ho Lee ◽  
Sang Hyeop Jeon ◽  
Song-Woo Shin
Keyword(s):  
Computed Tomography ◽  
Minimally Invasive ◽  
Screw Fixation ◽  
Degenerative Spondylolisthesis ◽  
Pedicle Screw Fixation ◽  
Invasive Technique ◽  
Primary Therapy ◽  
Disc Disease ◽  
Ct Guided ◽  
Minimally Invasive Surgical

✓ The authors describe a new minimally invasive technique for posterior supplementation using percutaneous trans-laminar facet screw (TFS) fixation with computed tomography (CT) guidance. Oblique axial images were used to determine facet screw fixation sites. After the induction of local anesthesia and conscious sedation, a guide pin was inserted and guided with a laser mounted on the CT gantry. Cannulated TFSs were placed via a percutaneous approach. From December 2002 to August 2003, 18 patients underwent CT-guided TFS. In 17 of these patients this procedure was supplementary to anterior lumbar interbody fusion, which had been performed several days earlier; in the remaining patient, CT-guided TFS fixation was undertaken as the primary therapy. Twelve patients had painful degenerative disc disease or unstable degenerative spondylolisthesis, three had infections, and three had deformities. All screws were inserted accurately and there were no complications. This new minimally invasive surgical technique may offer an alternative to pedicle screw fixation as a method of posterior supplementation.

scholarly journals Percutaneous iliosacral screw fixation for posterior pelvic ring injuries: the first experience, complicatons

2013 ◽  
Vol 12 (4) ◽  
pp. 233-237
Author(s):  
Valentinas Uvarovas ◽  
Andrius Vaitiekus ◽  
Igoris Šatkauskas ◽  
Donatas Ulevičius
Keyword(s):  
Screw Fixation ◽  
Pelvic Ring ◽  
Operation Time ◽  
Definitive Treatment ◽  
Invasive Technique ◽  
Iliosacral Screw ◽  
Early Results ◽  
First Results ◽  
Group B ◽  
Iliosacral Screw Fixation

BackgroundPercutaneous iliosacral screw fixation is a minimally invasive technique for the treatment of unstable pelvic injuries involving the posterior ring. Nevertheless, screw malposition may result in dangerous complications involving injury to adjacent neurological structures. This study was conducted in order to evaluate the first results of using the percutaneous iliosacral screw technique at the Republican Vilnius University Hospital.ObjectiveTo report the early results and possible complications of percutaneous iliosacral screw fixation in the management of unstable pelvic ring injuries.MethodsThe data for the period 2011–2013 were collected retrospectively. Fifty-five patients who suffered from injury to the pelvic ring requiring surgical treatment were included in this study. Twenty-two operations were done using canulated screws(group A, 20 operations using 7.3 mm and 2 operations 8.3 mm screws), and 33 (group B) operations were done using noncanulated 6.5 mm screws. We compared our first results of using canulated and non-canulated screws. The data were analysedusing MS Exel.ResultsFrom the analysed 55 patients, 20 (36.4%) were men and 35 (63.6%) women; the average age of the patients was 51 (range, 21–98) years. According to the AO (Arbeitsgemeinschaft für Osteosynthesefragen) classification, there were 49 patients withtype B and 6 patients with type C. The mean operation time was 36 min (range, 10–115). Three patients from group B required reoperation because of a neurological injury. Two of these patients suffered from L5 neuropathy and one from S1 radiculalgy.The complication rate was 9.1 per cent in group B, and they were now complicationa in group B. Twelve patients underwent percutaneous iliosacral screw fixation and anterior fixation, one patient underwent percutaneous iliosacral conversion to open posterior SI fixation osteosynthesis because of neurological complications, while the other 43 patients underwent percutaneous screw fixation only.ConclusionsPercutaneous iliosacral screw fixation is a rapid, safe and definitive treatment for unstable pelvic ring injury. The technique using standard C-arm fluoroscopy may allow accurate location of the screw placed in S1 and result in fewer complications when using percutaneous canulated screws. Key words: percutaneous iliosacral fixation, canulated iliosacral screws, three-dimensional fluoroscopyPerkutaninė kryžkaulio klubikaulio sąnario fiksacija esant užpakalinio dubens žiedo sužalojimams: pirmoji patirtis, komplikacijos  Įvadas / tikslasPerkutaninė kryžkaulio klubakaulio sąnario fiksacija sraigtais yra minimaliai invazinis operacinio gydymo metodas nestabiliems užpakalinio dubens žiedo sužalojimams gydyti. Vis dėlto gretimos nervinės struktūros gali būti pažeistos dėl blogossraigto padėties. Mūsų darbo tikslas – įvertinti Respublikinės Vilniaus universitetinės ligoninės pirmuosius kryžkaulio klubikaulio sąnario operacinio gydymo perkutaninės fiksacijos būdu rezultatus ir nustatyti nestabilių dubens žiedo sužalojimųgydymo komplikacijų dažnį.MetodaiRetrospektyviai išanalizuoti 2011–2013 metais gydytų 55 pacientų duomenys. Atliktos 22 operacijos naudojant kaniuliuotus (A grupė, 20 operacijų naudojant 7,3 mm ir 2 operacijos 8,3 mm sraigtus) ir 33 (B grupė) – nekaniuliuotus 6,5 mm sraigtus.Palyginome pirmuosius operacinio gydymo kaniuliuotais ir nekaniuliuotais sraigtais rezultatus. Duomenys analizavome MS Exel programa.RezultataiOperuoti 55 pacientai, iš jų 20 (36,4 %) vyrų ir 35 (63,6 %) moterys. Tiriamųjų amžiaus vidurkis – 51 (21–98) metai. Pagal AO (Arbeitsgemeinschaft für Osteosynthesefragen) klasifikaciją buvo 49 pacientai. Trys B grupės (9,1 %) pacientai buvo peroperuoti dėl neurologinių komplikacijų (du pacientai dėl L5 neuropatijos ir vienas dėl S1 radikulialgijos). A grupės pacientams komplikacijų nebuvo. Dvylikai pacientų atlikta perkutaninė kryžkaulio klubakaulio sąnario fiksacija ir kartu priekinė fiksacija ir 43 pacientams – tik užpakalinė kryžkaulio klubakaulio sąnario fiksacija sraigtu.IšvadosPerkutaninė kryžkaulio klubakaulio sąnario fiksacija yra greitas, saugus ir galutinis nestabilių užpakalinio dubens žiedo sužalojimų operacinio gydymo metodas. Naudojant standartinį rentgeno C-lanką galima tiksliai lokalizuoti sraigto padėtį S1slankstelio lygyje. Naudojant kaniuliuotus sraigtus komplikacijų nepasitaikė, o naudojant nekaniuliuotus sraigtus galimos neurologinės komplikacijos.Reikšminiai žodžiai: perkutaninė kryžkaulio klubakaulio sąnario fiksacija, kaniuliuoti kryžkaulio klubakaulio sraigtai, trijų dimensijų fluoroskopija.

scholarly journals SURGERY FOR LUMBAR DISC HERNIATION: OPEN X MINIMALLY INVASIVE TECHNIQUE

2021 ◽  
Vol 20 (1) ◽  
pp. 47-49
Author(s):  
Rangel Roberto de Assis ◽  
Helton Luis Aparecido Defino ◽  
Herton Rodrigo Tavares Costa ◽  
Álvaro Dowling ◽  
João Paulo Machado Bergamaschi
Keyword(s):  
Minimally Invasive ◽  
Lumbar Disc Herniation ◽  
Disc Herniation ◽  
Lumbar Disc ◽  
Endoscopic Technique ◽  
Invasive Technique ◽  
Open Technique ◽  
Level Of Evidence ◽  
Unified Health System ◽  
Statistical Relevance

ABSTRACT Objective: In Brazil, there are no studies comparing endoscopic treatment of lumbar disc herniation with the conventional open technique in SUS (Unified Health System) with regard to hospitalization time and complications occurring within one year, which is the objective of this study. Methods: A survey of 32 surgeries performed in 2019 (11 open and 21 endoscopic) to evaluate pain parameters before and after surgery (VAS), days of hospitalization, and complications. The data were submitted to statistical analysis (ANOVA) using the Kruskal-Wallis test. Results: Fourteen patients were female and eighteen were male, with a mean age of 41.35 years (p> 0.05 between sexes). The pre- and postoperative VAS for pain radiating to the lower limb were similar between the groups: 8.5 ± 0.82 with the open technique and 8.19 ± 1.15 with endoscopic technique. In both groups there was an improvement in the pain pattern with a significant reduction in the VAS (p < 0.05) and there was no statistical relevance between the groups in terms of pain improvement. There was statistical relevance between the groups in the comparison of days of hospitalization required, with the group submitted to endoscopic surgery having a lower number of days. The complications reported were compatible with those found in the literature (postoperative dysesthesia, new herniation). Conclusions: The endoscopic technique resulted in an important reduction in the number of days of hospitalization, a factor with a high impact on the costs of any surgical procedure, which can be a determining factor in the feasibility of minimally invasive techniques. Level of evidence IV; Therapeutic Study.

PS01.241: HYBRID MINIMALLY INVASIVE TECHNIQUE OF OESOPHAGECTOMY FOR OESOPHAGEAL CARCINOMA

2018 ◽  
Vol 31 (Supplement_1) ◽  
pp. 118-118
Author(s):  
Satpal Virk ◽  
Saurabh Singla
Keyword(s):  
Postoperative Complications ◽  
Minimally Invasive ◽  
Oesophageal Cancer ◽  
Gastric Tube ◽  
Operative Time ◽  
Laparoscopic Group ◽  
Minimally Invasive Technique ◽  
Invasive Technique ◽  
Open Technique ◽  
Open Procedure

Abstract Background Oesophagectomy is challenging procedure involving multiple body cavities. The traditional open procedure being either transthoracic or transhiatal, carries significant morbidity and mortality. There is continuing debate between the two approaches. Minimally invasive oesophagectomy has swung the pendulum towards transthoracic procedure, though it remains a complex and technically demanding procedure. This study was done to assess the feasibility, and benefit of hybrid minimally invasive technique over open technique. Methods Patients of oesophageal cancer were selected from January 2005 to December 20,017. After 2012 open technique was replaced with minimally invasive technique. Open technique included Ivor Lewis, McKeown's or transhiatal. Hybrid minimally invasive technique included laparoscopic gastric mobilisation and thoracic part using small thoracotomy. Anastomosis was done using hand sewn technique. The short term outcome, including postoperative complications were analysed from prospectively collected data. Results One hundred sixty three patients underwent open procedure and 103 patients underwent hybrid minimally invasive esophagectomy. Total operative time was shorter in laparoscopic group (325.6 minutes vs 232.6 minutes, P < 0.05). The number of transfused patients were significantly smaller in laparoscopic group (40.75% vs 13.6%, P < 0.05). The postoperative course without complication was observed in 68.1% and 79.3% in open vs laparoscopic group respectively. Serious complications included myocardial infarction and gastric tube necrosis and bleed. There was no anastomotic leak in chest anastomosis but there was overall 17.3% leak in neck anastomosis, higher in open group 20.8% vs 16.6% in minimally invasive group. Mortality was higher ion open group (5.5% vs 2%, P < 0.05). On multivariate analysis, age more than 60 years, chest complications and cardiovascular comorbidity were associated with increased mortality. Conclusion Hybrid minimally invasive procedure is feasible and safe procedure for patients with oesophageal cancer. it is associated with shorter operative time and less postoperative complications. Even laparoscopic gastric tube mobilisation alone adds to in decreasing the morbidity in esophagectomy. Disclosure All authors have declared no conflicts of interest.

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

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.

scholarly journals A randomised controlled techniques saphenous vein harvest; morbidity lowering with minimally invasive technique

2018 ◽  
Vol 5 (8) ◽  
pp. 2727
Author(s):  
Sudheendra Tekalkote ◽  
Sartaj B. Hussein
Keyword(s):  
Minimally Invasive ◽  
Saphenous Vein ◽  
Minimally Invasive Technique ◽  
Controlled Study ◽  
Invasive Technique ◽  
Organ Bath ◽  
Open Technique ◽  
Long Saphenous Vein ◽  
Group A ◽  
Vein Harvesting

Background: The long incision is associated with significant intra-operative and postoperative complications. The use of minimal invasive saphenous vein harvesting has been advocated in an effort to minimize such wound related problems. The objective of this study was to compare the morbidity associated with long saphenous vein harvesting using the traditional open technique (A) against a minimally invasive technique using the Mayo vein stripper (B) that involves multiple short incisions.Methods: Authors conducted a prospective randomized controlled study in 80 patients undergoing first time coronary artery bypass grafting. Pain and healing was assessed on each postoperative day. Rings of long saphenous vein were subjected to organ-bath evaluation of endothelium-dependent and endothelium-independent relaxation. Three patients were excluded from the study, leaving 38 patients in Group A and 39 in Group B.Results: With respect to operative procedure, Group A had a greater length of vein harvested than Group B. There was no statistical difference in pain scores and endothelium-dependent or endothelium-independent relaxation between the two groups. However, there were significantly more infections in Group A compared with Group B.Conclusions: Harvesting vein through multiple incisions using the Mayo vein stripper is quicker, results in fewer infections and has no deleterious effect on endothelial function compared to open technique.

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