Gasless Videoendoscopic Implantation of an Aortobifemoral Vascular Prosthesis via a Transperitoneal versus Extraperitoneal Approach: An Experimental Study

1996 ◽  
Vol 3 (3) ◽  
pp. 290-296 ◽  
Author(s):  
Christiane Bruns ◽  
Bernd Wolfgarten ◽  
Michael Walter ◽  
Heinz Pichlmaier ◽  
Jürgen Koebke
Keyword(s):  
Experimental Study ◽  
Minimally Invasive ◽  
Vascular Prostheses ◽  
Invasive Approach ◽  
Minimally Invasive Surgical ◽  
Vascular Walls ◽  
Human Cadavers ◽  
Average Operative Time ◽  
Endoscopic Guidance ◽  
Lifting System

Purpose: To report progress in the development of a new minimally invasive surgical technique for aortobifemoral grafting utilizing gasless videoendoscopy. Methods: In an experimental study, aortobifemoral Dacron vascular prostheses were implanted in 20 human cadavers using videoendoscopic techniques in both transperitoneal and extraperitoneal approaches. Rather than inducing pneumoperitoneum, the abdominal wall was elevated with an electrically powered lifting system. Results: Each approach was utilized in 10 cadavers for implantation of 20 aortobifemoral grafts under endoscopic guidance in a gasless field. Average operative time for the transperitoneal approach was 3.8 hours (range 3.0 to 5.5), slightly less than the average 4.1 hours (range 3.0 to 6.0) for the extraperitoneal access. Both access routes provided adequate visualization of the operative field. Conclusions: Advantages of gasless endoscopy include the use of conventional instruments and the potential benefits associated with a minimally invasive approach. Optical magnification facilitates suturing of the femoral anastomosis, improves examination of the vascular walls, and allows a more accurate suturing technique.

scholarly journals Robotic Pelvic Exenteration for Gynecologic Malignancies, Anatomic Landmarks, and Surgical Steps: A Systematic Review

2021 ◽  
Vol 8 ◽  
Author(s):  
Stefano Cianci ◽  
Martina Arcieri ◽  
Giuseppe Vizzielli ◽  
Canio Martinelli ◽  
Roberta Granese ◽  
...  
Keyword(s):  
Minimally Invasive ◽  
Pelvic Exenteration ◽  
Gynecologic Oncology ◽  
Perioperative Outcomes ◽  
Resection Margins ◽  
Salvage Procedure ◽  
Invasive Approach ◽  
Robotic Assisted ◽  
Gynecological Malignancy ◽  
Minimally Invasive Surgical

Pelvic exenteration represents the last resort procedure for patients with advanced primary or recurrent gynecological malignancy. Pelvic exenteration can be divided into different subgroup based on anatomical extension of the procedures. The growing application of the minimally invasive surgical approach unlocked new perspectives for gynecologic oncology surgery. Minimally invasive surgery may offer significant advantages in terms of perioperative outcomes. Since 2009, several Robotic Assisted Laparoscopic Pelvic Exenteration experiences have been described in literature. The advent of robotic surgery resulted in a new spur to the worldwide spread of minimally invasive pelvic exenteration. We present a review of the literature on robotic-assisted pelvic exenteration. The search was conducted using electronic databases from inception of each database through June 2021. 13 articles including 53 patients were included in this review. Anterior exenteration was pursued in 42 patients (79.2%), 2 patients underwent posterior exenteration (3.8%), while 9 patients (17%) were subjected to total exenteration. The most common urinary reconstruction was non-continent urinary diversion (90.2%). Among the 11 women who underwent to total or posterior exenteration, 8 (72.7%) received a terminal colostomy. Conversion to laparotomy was required in two cases due to intraoperative vascular injury. Complications' report was available for 51 patients. Fifteen Dindo Grade 2 complications occurred in 11 patients (21.6%), and 14 grade 3 complications were registered in 13 patients (25.5%). Only grade 4 complications were reported (2%). In 88% of women, the resection margins were negative. Pelvic exenteration represents a salvage procedure in patients with recurrent or persistent gynecological cancers often after radiotherapy. A careful patient selection remains the milestone of such a mutilating surgery. The introduction of the minimally invasive approach has led to advantages in terms of perioperative outcomes compared to classic open surgery. This review shows the feasibility of robotic pelvic exenteration. An important step forward should be to investigate the potential equivalence between robotic approaches and the laparotomic one, in terms of long-term oncological outcomes.

scholarly journals Percutaneous and Minimally Invasive Surgical Technique for Achilles Tendon Repair

2020 ◽  
Vol 5 (4) ◽  
pp. 2473011420S0025
Author(s):  
Tyler Hoskins ◽  
David Goyette ◽  
Jay Patel ◽  
Christopher Mazzei ◽  
Arianna L. Gianakos ◽  
...  
Keyword(s):  
Surgical Technique ◽  
Minimally Invasive ◽  
Achilles Tendon ◽  
Functional Outcome ◽  
Tendon Rupture ◽  
Achilles Tendon Rupture ◽  
P Value ◽  
Invasive Approach ◽  
Minimally Invasive Surgical ◽  
Iatrogenic Nerve Injury

Category: Ankle; Sports; Trauma Introduction/Purpose: Achilles tendon rupture is a traumatic injury that can cause considerable morbidity and reduced function. The optimal treatment method for this injury remains controversial. Non-operative intervention puts patients at higher risk of re-rupture whereas surgical intervention has risks of infection and iatrogenic nerve injury. Recently, surgeons have established a less invasive surgical approach to repairing the achilles tendon. The ‘Percutaneous or Mini-Invasive’ technique was adopted in order to reduce infection rates and wound breakdown. However, due to the scarce amount of literature reported, the efficacy of this procedure still remains under scrutiny. The goal of this study was to examine the functional outcomes of patients treated at our facility for a ruptured achilles tendon using the percutaneous and minimally invasive surgical technique. Methods: From 2014 to 2020 eighty-one patients underwent a percutaneous or mini invasive surgery at our facility for the treatment of a ruptured achilles tendon. Functional outcome scores were assessed using the American Orthopaedic Foot & Ankle scoring system (AOFAS) and the Achilles Tendon Rupture Score (ATRS). Outcomes, complications, and any reoperations were recorded through retrospective chart review, direct patient examination, and phone calls to patients and their families. A statistical analysis was performed using Fischer’s Exact Test. Results were deemed statistically significant if the calculated p-value was less than 0.05. Results: The mean follow up for our patient cohort was 36.40 months (range, 6 to 71). The average age was 41.46 years (range, 17- 65). Mean pre-op AOFAS and ATRS were 45.60 and 47.18 respectively, compared to 90.29 and 87.97 after surgery (p-value <0.05). There were two significant complications reported post-operatively. One patient re-ruptured their Achilles tendon four months post-operatively. This patient was successfully treated with a mini invasive approach and reconstruction of the tendon. A second patient developed a superficial infection ten months post-operatively. This patient successfully underwent irrigation and debridement of the wound. Conclusion: The pre-op and post-op AOFAS and ATRS scores were deemed statistically significant. A percutaneous and mini invasive approach to repair a ruptured achilles tendon, although new, offers promising functional outcome results and remains a viable treatment option to decrease the incidence rate of post-operative infection and iatrogenic nerve injury. However, a prospective randomized controlled trial comparing the efficacy of this procedure to other surgical methods would be necessary to further evaluate and validate our findings.

scholarly journals Bilateral tubular minimally invasive approach for decompression, reduction and fixation in lumbosacral lythic spondylolisthesis

2013 ◽  
Vol 35 (v2supplement) ◽  
pp. Video9 ◽  
Author(s):  
Giuseppe M.V. Barbagallo ◽  
Francesco Certo ◽  
Giovanni Sciacca ◽  
Vincenzo Albanese
Keyword(s):  
Minimally Invasive ◽  
Postoperative Recovery ◽  
Pedicle Screw Fixation ◽  
Invasive Technique ◽  
Surgical Morbidity ◽  
Nerve Roots ◽  
Invasive Approach ◽  
Minimally Invasive Surgical ◽  
Pull Out ◽  
Mini Open

This video demonstrates the minimally invasive surgical technique used in a 56-year-old woman suffering from L-5 spondylolysis and grade 2 L5–S1 spondylolisthesis. The first author used expandable tubular retractors bilaterally to perform neural decompression, mini-open TLIF, spondylolysthesis reduction and L5–S1 pedicle screw fixation. L-5 cement augmentation was performed through cannulated and fenestrated screws to enhance resistance to screw pull-out secondary to reduction maneuvers.Sequential surgical steps related to microsurgery, spondylolysthesis reduction and instrumentation are shown and commented.We submit that in cases of lythic spondylolisthesis a bilateral traversing and exiting nerve roots decompression is a safer option prior to performing the deformity reduction and fixation; the proposed minimally invasive technique may help in reducing surgical morbidity and improving postoperative recovery.The video can be found here: http://youtu.be/G4Qdg-A-Y3M.

scholarly journals Hybrid Surgical and Catheter Treatment for Atrial Fibrillation

2013 ◽  
Vol 2013 ◽  
pp. 1-5 ◽  
Author(s):  
Tsuyoshi Kaneko ◽  
Sary F. Aranki
Keyword(s):  
Atrial Fibrillation ◽  
Minimally Invasive ◽  
Median Sternotomy ◽  
Hybrid Procedure ◽  
Minimally Invasive Approach ◽  
Surgical Ablation ◽  
Invasive Approach ◽  
Minimally Invasive Surgical ◽  
Linear Ablation ◽  
New Energy

Advances in surgery for atrial fibrillation from cut and sew technique to thoracoscopy and new energy source have enabled minimally invasive approach which avoids median sternotomy and cardiopulmonary bypass. However, minimally invasive approach is unable to match the outcome of classic surgical technique due to difficulty in creating some of linear ablation lines. Hybrid procedure using catheter mapping and ablation in addition to minimally invasive surgical ablation has gained interest to combine the advantages of both procedures. No large study has been conducted to date comparing this new technique to other existing treatments. The aim of this paper is to review the data on hybrid procedure for atrial fibrillation and assess its early outcome and efficacy.

Incidence of minimally invasive colorectal cancer (CRC) surgery in patients treated at NCCN institutions

2007 ◽  
Vol 25 (18_suppl) ◽  
pp. 6575-6575
Author(s):  
M. Weiser ◽  
D. Romanus ◽  
A. terVeer ◽  
A. Rajput ◽  
J. Skibber ◽  
...  
Keyword(s):  
Rectal Cancer ◽  
Minimally Invasive ◽  
Open Surgery ◽  
Early Stage ◽  
Oncologic Outcome ◽  
Stage I ◽  
Invasive Approach ◽  
Conversion To Open Surgery ◽  
The North ◽  
Minimally Invasive Surgical

6575 Background: In May 2004 the Clinical Outcomes of Surgical Therapy Study Group published the results of the North American randomized trial demonstrating that oncologic outcome is similar for laparoscopic assisted and open surgery for CRC. This and other studies have shown quicker recovery with laparoscopic CRC surgery including earlier resolution of postoperative ileus, less discomfort, and earlier discharge from the hospital. The extent to which surgeons have adopted the minimally invasive surgical (MIS) approach in CRC is unknown. Methods: Using the NCCN Colon/Rectal Cancer Outcomes Project Database, 715 patients were identified who underwent CRC resection in 2005–6. The distribution of lesions included right colon (39%), left colon (31%), and rectum (30%). The incidence of MIS for CRC and clinicopathologic features associated with this approach were analyzed by logistic regression; results are reported as odd ratio (OR) with 95% confidence intervals (CI), and significance defined at p<0.05 level. Results: A total of 167 (23%) patients underwent MIS colorectal surgery (laparoscopy in 98% and robotic in 2%). Conversion to open surgery was noted in 33 cases (20%). Surgery was performed in outside institutions in 21% of cases prior to patients presenting to NCCN institutions for further treatment. The MIS approach was more common in colon than rectal cancer (30% vs.12%, OR 2.96, CI 1.94–4.51, p<0.0001). Within the colon cancer cohort, right sided lesions were more likely to be approached with MIS techniques rather than left sided lesions (32% vs. 25%; OR 1.42, CI 1.96–2.21, p<0.0001). Stage I tumors were also more likely to be managed with the less invasive approach: Stage I-41%; II-20%; III-21%; IV-19% (Stage I vs. IV, OR=3.00, CI 1.74–5.16 p<0.0001). No differences in surgical approach were noted based on age, gender, race, Charlson comorbidity score, insurance type, or location of surgery (NCCN vs outside facility). Conclusion: The majority of CRC surgery for patients presenting to NCCN institutions is performed by open techniques. Right sided and early stage CRCs were more likely treated with MIS, possibly related to the less demanding nature of the procedure. The adoption of MIS is expected to rise as surgeons become trained in MIS techniques for CRC. No significant financial relationships to disclose.

MINIMALLY INVASIVE POSTERIOR OSTEOTOMIES

Neurosurgery ◽  
2008 ◽  
Vol 63 (suppl_3) ◽  
pp. A204-A210 ◽  
Author(s):  
Jean-Marc Voyadzis ◽  
Vishal C. Gala ◽  
John E. O'Toole ◽  
Kurt M. Eichholz ◽  
Richard G. Fessler
Keyword(s):  
Computed Tomography ◽  
Minimally Invasive ◽  
Muscle Injury ◽  
Pedicle Subtraction Osteotomy ◽  
Bone Resection ◽  
Minimally Invasive Approach ◽  
Tubular Retractor ◽  
Invasive Approach ◽  
Severe Postoperative Pain ◽  
Human Cadavers

ABSTRACT OBJECTIVE Surgery for thoracolumbar deformity can lead to significant muscle injury, excessive blood loss, and severe postoperative pain. The aim of the following studies was to determine the feasibility of minimally invasive posterior thoracic corpectomy and thoracolumbar osteotomy techniques for deformity in human cadavers and select clinical cases. METHODS Human cadaveric specimens were procured for thoracic corpectomy and Smith-Petersen and pedicle subtraction osteotomy using a minimally invasive approach. Post-procedural computed tomography was used to assess the degree of decompression following corpectomy and the extent of bone resection after osteotomy. Pre and post-osteotomy closure Cobb angles were measured to evaluate the degree of correction achieved. RESULTS The minimally invasive lateral extracavitary approach for thoracic corpectomy provided adequate exposure and allowed excellent spinal canal decompression while minimizing tissue disruption. Nearly complete osteotomies of both types could be achieved through a tubular retractor with a modest change in Cobb angle. CONCLUSION These techniques may play a role in deformity surgery for select cases with further technological advancements.

scholarly journals Minimally invasive excision of gynaecomastia – a novel and effective surgical technique

2010 ◽  
Vol 92 (3) ◽  
pp. 198-200 ◽  
Author(s):  
O Qutob ◽  
B Elahi ◽  
V Garimella ◽  
N Ihsan ◽  
PJ Drew
Keyword(s):  
Minimally Invasive ◽  
Treatment Options ◽  
Invasive Approach ◽  
Anterior Axillary Line ◽  
Minimally Invasive Surgical ◽  
Invasive Surgical Approach ◽  
Male Patients ◽  
Breast Care ◽  
Average Procedure Time

INTRODUCTION More aesthetically acceptable treatment options have been sought to minimise the morbidity associated with open surgery for gynaecomastia. This study investigated the use of a vacuum-assisted biopsy device (VABD) and liposuction to provide minimally invasive approach. PATIENTS AND METHODS Patients diagnosed with idiopathic benign gynaecomastia referred to the Breast Care Unit of Castle Hill Hospital between June 2002 and April 2007 and requesting surgical intervention underwent VABD excision and liposuction. All patients underwent thorough investigations to exclude any underlying cause for their gynaecomastia. The procedure was carried out by a single consultant surgeon with special interest in breast surgery. An 8-G mammotome probe was advanced through a 4-mm incision positioned in the corresponding anterior axillary line to excise the glandular disc. Liposuction was performed through the same incision. Incision wounds were closed with Steristrips. A pressure dressing was applied over wound by corset and an inflatable device. RESULTS Thirty-six male patients with grade I and II gynaecomastia were recruited (22 bilateral, 14 unilateral). Average age was 33.3 years (range, 16–88 years). All underwent mammotome excision and liposuction. There were no conversions to an open procedure. The average procedure time was 50.3 min (range, 30–80 min). One intra-operative complication was recorded. The minimum follow-up time was 2 months. Thirty-four patients reported excellent satisfaction, two patients had residual gynaecomastia and needed a re-do procedure. Three patients developed small haematomas that resolved spontaneously. CONCLUSION This novel, minimally invasive, surgical approach for gynaecomastia gives excellent results with minimal morbidity.

Minimally Invasive Surgical Pulmonary Embolectomy

2017 ◽  
Vol 12 (6) ◽  
pp. 406-410 ◽  
Author(s):  
Chetan Pasrija ◽  
Aakash Shah ◽  
Elliot Sultanik ◽  
Michael Rouse ◽  
Mehrdad Ghoreishi ◽  
...  
Keyword(s):  
Pulmonary Embolism ◽  
Length Of Stay ◽  
Minimally Invasive ◽  
Hospital Length Of Stay ◽  
Minimally Invasive Approach ◽  
Invasive Approach ◽  
Invasive Group ◽  
Pulmonary Embolectomy ◽  
Minimally Invasive Surgical ◽  
Submassive Pulmonary Embolism

Objective Surgical pulmonary embolectomy has gained increasing popularity over the past decade with multiple series reporting excellent outcomes in the treatment of submassive pulmonary embolism. However, a significant barrier to the broader adoption of surgical pulmonary embolectomy remains the large incision and long recovery after a full sternotomy. We report the safety and efficacy of using a minimally invasive approach to surgical pulmonary embolectomy. Methods All consecutive patients undergoing surgical pulmonary embolectomy for a submassive pulmonary embolism (2015–2017) were reviewed. Patients were stratified as conventional or minimally invasive. The minimally invasive approach included a 5- to 7-cm skin incision with upper hemisternotomy to the third intercostal space. The primary outcomes were in-hospital and 90-day survival. Results Thirty patients (conventional = 20, minimally invasive = 10) were identified. Operative time was similar between the two groups, but cardiopulmonary bypass time was significantly longer in the minimally invasive group (58 vs 94 minutes, P = 0.04). While ventilator time and intensive care unit length of stay were similar between groups, hospital length of stay was 4.5 days shorter in the minimally invasive group, and there was a trend toward less blood product use. In-hospital and 90-day survival was 100%. Within the minimally invasive cohort, median right ventricular dysfunction at discharge was none-mild and no patient experienced postoperative renal failure, deep sternal wound infection, sepsis, or stroke. Conclusions Minimally invasive surgical pulmonary embolectomy appears to be a feasible approach in the treatment of patients with a submassive pulmonary embolism. A larger, prospective analysis comparing this modality with conventional surgical pulmonary embolectomy may be warranted.

scholarly journals MULTIPLE PRIMARY COLORECTAL CANCER: THE POSSIBILITIES OF MINIMALLY INVASIVE SURGICAL INTERVENTIONS

2017 ◽  
pp. 38-42 ◽  
Author(s):  
O. I. Kit ◽  
Yu. A. Gevorkyan ◽  
N. V. Soldatkina ◽  
D. A. Kharagezov ◽  
V. E. Kolesnikov ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Minimally Invasive ◽  
Morphological Characteristics ◽  
Colorectal Tumors ◽  
Primary Colorectal Cancer ◽  
Invasive Approach ◽  
Surgical Interventions ◽  
Minimally Invasive Surgical ◽  
Multiple Primary ◽  
Colon And Rectum

BACKGROUND. Study of oncobiological aspects of such a phenomenon as multiplicity of primary colorectal tumors, as well as improvement of methods of their treatment is relevant nowadays. The aim of the study was to reveal the potential of minimally invasive surgery for multiple primary colorectal cancer. MATERIAL AND METHODS. Data on 51 patients with synchronous multiple primary colorectal cancer were studied. Clinical, biological and morphological characteristics ofsynchronous colorectal tumors were analyzed. 12 of 51 patients underwent minimally invasive surgeries of the colon and rectum - laparoscopy and transanal endoscopic resection of the rectum. RESULTS showed that synchronous colorectal cancer prevailed in patients with multiple primary colorectal cancer (63,8 %), with tumors localized mainly in the sigmoid (62,75 %) and the rectum (56,86%). Minimally invasive approach allowed reduction of the number of postoperative complications by 2,5 times and improvement of rehabilitation of patients. CONCLUSION. Application of modern technologies in treatment for synchronous multiple primary colorectal cancer contributes to improvement of the treatment outcomes.

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