Original Preoperative Localization Technique of Parathyroid Adenomas by 3-Dimensional Virtual Neck Exploration

2021 ◽  
pp. 155335062110012
Author(s):  
Mihaela Ignat ◽  
Madeleine Pérouse ◽  
François Lefebvre ◽  
Deborah Kadoche ◽  
Alessio Imperiale ◽  
...  
Keyword(s):  
Minimally Invasive ◽  
Ct Scan ◽  
Recurrence Rate ◽  
Imaging Study ◽  
Neck Exploration ◽  
Preoperative Imaging ◽  
Invasive Approach ◽  
Sestamibi Scan ◽  
Line Imaging

Objective. Preoperative imaging in primary hyperparathyroidism (PHPT) is essential for planning of parathyroidectomy—particularly for selection of a minimally invasive approach. The objective of this cohort study was to evaluate the diagnostic precision of 3D virtual neck exploration (3D-VNE), to evaluate its impact on choice of surgical approach, and to document the correlation with long-term outcomes. Methods. 235 consecutive patients with PHPT were studied (January 2014 to December 2018), with 6-month follow-up. 220 patients had a preoperative computed tomography (CT), 172 of these had a 3D-VNE based on the CT, and 226 patients had a Tc-99m sestamibi scan. Results. Sensitivity of exact, per gland, adenoma localization was 57.09% (95% CI: 50.85–63.10%) for nonspecialized radiologist interpretation of CT scan, 58.17% (95% CI: 51.99–64.10%) for Tc-99m sestamibi scan, and 90.21% (95% CI: 85.21–93.64%) for 3D-VNE, and thereby favoring 3D-VNE compared to CT scan alone (OR 34.5, 95% CI: 9.19–290.56%, P < 2.2 × 10−16) and to Tc-99m sestamibi scan (OR 16.25, 95% CI: 6.05–61.42%, P = 3.1 × 10−15). Specificity was 87.38% for CT scan, 86.36% for 3D-VNE, and 90% for Tc-99m sestamibi scan ( P > .05). The cure rate was 100%. The long-term recurrence rate (RR) was 2.978%. The RR was 1.324% in the video-assisted parathyroidectomy group of 151 patients and 5.952% in the group of 84 patients with cervicotomy ( P = .0459). Conclusion. CT-based 3D-VNE proved to be the most accurate localizing study in PHPT and aided in selecting patients for targeted minimally invasive parathyroidectomy, which was associated with the lower recurrence rate. 3D-VNE could be proposed as a first-line imaging study in patients with PHPT.

scholarly journals P-OGC61 Long-term outcomes following minimally invasive oesophago-gastric resection for oesophageal and gastro-oesophageal junctional cancer: a single center experience

2021 ◽  
Vol 108 (Supplement_9) ◽  
Author(s):  
Amira Orabi ◽  
Gauri Chillarge ◽  
Davide Di Mauro ◽  
Darmarajah Veeramootoo ◽  
keith Mitchell ◽  
...  
Keyword(s):  
Minimally Invasive ◽  
Recurrence Rate ◽  
Disease Free Survival ◽  
Hospital Death ◽  
Published Data ◽  
Historical Cohort ◽  
Invasive Approach ◽  
Free Survival ◽  
Disease Free

Abstract Background Oesophago-gastric surgical resection for cancer has been associated with high morbidity and poor long-term prognosis. Medical advances have led to improvements and the con-current development of videoscopic technology enabled a paradigm shift in many areas of surgical practice. Between 2004 - 2010, a three-stage total (thoracoscopic/laparoscopic) minimally invasive oesophagectomy (MIO) with curative intent, was offered to all patients diagnosed and treated for esophageal and oesophago-gastric junctional (GOJ) cancers as an alternative to open surgery at our specialist Centre. Previously we have reported on safety, feasibility, short term outcomes, quality of life and complication profiles; this study now reports on eventualities at least a decade after surgery. Methods All patients who underwent MIO (laparoscopic/thoracoscopic) three-stage procedure from April 2004 to January 2010 for oesophageal and GOJ malignancy were identified. A retrospective analysis of patients’ records in conjunction with an updated clinical follow-up was carried out.  Patients’ demographics, oncologic stage (in accordance to the American Joint Committee on Cancer 6th and 7th Edition), overall survival, 5-year and 10-year survival, recurrence rate and disease-free survival (DFS) were retrospectively analyzed. Statistical analysis was conducted using Prism version 9.1.0 (GraphPad Holdings LLC, California). Results A total of 120 patients (majority of which were males – 84.2%) were included in the study. Mean age was 66.7 ± 0.74. 43 patients. In-hospital death occurred in 4 (3.3%) patients. Over the time period, 25 (20.8%) patients were alive. Of those deceased Sixty-six (69.5%) succumbed to cancer, and 29 (30.5%) died from other causes. 43 patients (35.8%) were alive at 5 years and 33 (27.5%) at 10 years. Excluding those with Stage 0 disease, the 5-year and 10-year survival rates were 32.4% and 24.1%, respectively. The recurrence rate was 63 (52.5%) patients and the overall median DFS was 24 months (IQR, 186); Stage 3 patients had the shortest DFS (p &lt; 0.0001). Conclusions Survival and disease-free survival in this historical cohort of patients who underwent a total MIO for cancer is comparable to published data from similar open series of that era as well as modern reported outcomes from specialist centers. Benefits of a minimally invasive approach can therefore be realized without compromise to oncological and overall prognosis.

scholarly journals Transorbital Endoscopic Surgery for Sphenoid Wing Meningioma: Long-Term Outcomes and Surgical Technique

2020 ◽  
Vol 81 (04) ◽  
pp. 357-368
Author(s):  
N. Goncalves ◽  
D.E. Lubbe
Keyword(s):  
Minimally Invasive ◽  
Endoscopic Surgery ◽  
Case Series ◽  
Surgical Approaches ◽  
Benign Tumors ◽  
Long Term Outcomes ◽  
Invasive Approach ◽  
Visual Outcomes ◽  
Presenting Symptoms

AbstractSphenoid wing meningiomas are benign tumors that can result in proptosis, visual impairment, and pain. Traditional open surgical approaches are associated with significant morbidity. Transorbital endoscopic surgery has been developed as a minimally invasive approach to gain access to these tumors and address the main presenting symptoms. Case series reporting transorbital endoscopic resection of sphenoid wing meningiomas using combined endonasal, pre-caruncular, and extended superior eyelid approaches have demonstrated stable and/or improved short- and medium-term visual outcomes. Earlier medial optic nerve decompression appears to result in more favorable long-term visual outcomes. Transorbital endoscopic surgery therefore represents an emerging minimally invasive alternative to deal with these challenging lesions.

scholarly journals Oxford phase 3 unicondylar knee arthroplasty through a minimally invasive approach: long-term results

2013 ◽  
Vol 37 (5) ◽  
pp. 833-838 ◽  
Author(s):  
Omar Faour-Martín ◽  
Jose Antonio Valverde-García ◽  
Miguel Ángel Martín-Ferrero ◽  
Aurelio Vega-Castrillo ◽  
María Angeles de la Red Gallego ◽  
...  
Keyword(s):  
Minimally Invasive ◽  
Knee Arthroplasty ◽  
Unicondylar Knee Arthroplasty ◽  
Long Term Results ◽  
Minimally Invasive Approach ◽  
Phase 3 ◽  
Invasive Approach

Long-Term Outcomes With a Minimally Invasive Approach for Resection of Cardiac Masses

2010 ◽  
Vol 90 (4) ◽  
pp. 1251-1255 ◽  
Author(s):  
Alexander Iribarne ◽  
Rachel Easterwood ◽  
Mark J. Russo ◽  
Jonathan Yang ◽  
Faisal H. Cheema ◽  
...  
Keyword(s):  
Minimally Invasive ◽  
Long Term Outcomes ◽  
Minimally Invasive Approach ◽  
Invasive Approach ◽  
Cardiac Masses

scholarly journals Minimally invasive versus open right hepatectomy: Comparative study with propensity score matching analysis

2020 ◽  
Author(s):  
Vinicius Campos Duarte ◽  
Fabricio Coelho ◽  
Alain Valverde ◽  
Divia Danoussou ◽  
Jaime Kruger ◽  
...  
Keyword(s):  
Propensity Score ◽  
Blood Loss ◽  
Minimally Invasive ◽  
Propensity Score Matching ◽  
Liver Tumors ◽  
Perioperative Complications ◽  
Resection Margins ◽  
Long Term Outcomes ◽  
Invasive Approach

Abstract Background Minimally invasive liver resections (MILRs) have been increasingly performed in recent years. However, the majority of MILRs are actually minor or limited resections of peripheral lesions. Due to the technical complexity major hepatectomies remain challenging for minimally invasive surgery. The aim of this study was to compare the short and long-term outcomes of patients undergoing minimally invasive right hepatectomies (MIRHs) with contemporary patients undergoing open right hepatectomies (ORHs). Methods Consecutive patients submitted to anatomic right hepatectomies between January 2013 and December 2018 in two tertiary referral centers were studied. Study groups were compared on an intention-to-treat basis after propensity score matching (PSM). Overall survival (OS) analyses were performed for the entire cohort and specific etiologies subgroups. Results During study period 178 right hepatectomies were performed. After matching, 37 patients were included in MIRH group and 60 in ORH group. The groups were homogenous for all baseline characteristics. MIRHs had significant lower blood loss (400 ml vs. 500 ml, P = 0.01), lower rate of minor complications (13.5% vs. 35%, P = 0.03) and larger resection margins (10 mm vs. 5 mm, P = 0.03) when compared to ORHs. Additionally, a non-significant decrease in hospital stay (ORH 9 days vs. MIRH 7 days, P = 0.09) was observed. No differences regarding the use of Pringle’s maneuver, operative time, major complications or perioperative mortality were observed. OS was similar between the groups (P = 0.13). Similarly, no difference in OS was found in subgroups of patients with primary liver tumors (P = 0.09) and liver metastasis (P = 0.80). Conclusions MIRHs are feasible and safe. Minimally invasive approach is associated with less blood loss, a significant reduction in minor perioperative complications, and did not negatively affect long-term outcomes.

scholarly journals Minimally invasive versus open right hepatectomy: comparative study with propensity score matching analysis

BMC Surgery ◽  
2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Vinícius Campos Duarte ◽  
Fabricio Ferreira Coelho ◽  
Alain Valverde ◽  
Divia Danoussou ◽  
Jaime Arthur Pirola Kruger ◽  
...  
Keyword(s):  
Propensity Score ◽  
Blood Loss ◽  
Minimally Invasive ◽  
Propensity Score Matching ◽  
Liver Tumors ◽  
Perioperative Complications ◽  
Resection Margins ◽  
Long Term Outcomes ◽  
Invasive Approach

Abstract Background Minimally invasive liver resections (MILRs) have been increasingly performed in recent years. However, the majority of MILRs are actually minor or limited resections of peripheral lesions. Due to the technical complexity major hepatectomies remain challenging for minimally invasive surgery. The aim of this study was to compare the short and long-term outcomes of patients undergoing minimally invasive right hepatectomies (MIRHs) with contemporary patients undergoing open right hepatectomies (ORHs) Methods Consecutive patients submitted to anatomic right hepatectomies between January 2013 and December 2018 in two tertiary referral centers were studied. Study groups were compared on an intention-to-treat basis after propensity score matching (PSM). Overall survival (OS) analyses were performed for the entire cohort and specific etiologies subgroups Results During study period 178 right hepatectomies were performed. After matching, 37 patients were included in MIRH group and 60 in ORH group. The groups were homogenous for all baseline characteristics. MIRHs had significant lower blood loss (400 ml vs. 500 ml, P = 0.01), lower rate of minor complications (13.5% vs. 35%, P = 0.03) and larger resection margins (10 mm vs. 5 mm, P = 0.03) when compared to ORHs. Additionally, a non-significant decrease in hospital stay (ORH 9 days vs. MIRH 7 days, P = 0.09) was observed. No differences regarding the use of Pringle’s maneuver, operative time, overall morbidity or perioperative mortality were observed. OS was similar between the groups (P = 0.13). Similarly, no difference in OS was found in subgroups of patients with primary liver tumors (P = 0.09) and liver metastasis (P = 0.80). Conclusions MIRHs are feasible and safe in experienced hands. Minimally invasive approach was associated with less blood loss, a significant reduction in minor perioperative complications, and did not negatively affect long-term outcomes.

Minimally Invasive Lateral Retropleural Thoracolumbar Approach: Cadaveric Feasibility Study and Report of 4 Clinical Cases

2011 ◽  
Vol 68 (suppl_1) ◽  
pp. ons32-ons39 ◽  
Author(s):  
Juan S. Uribe ◽  
Elias Dakwar ◽  
Rafael F. Cardona ◽  
Fernando L. Vale
Keyword(s):  
Minimally Invasive ◽  
Thoracolumbar Spine ◽  
Early Experience ◽  
Complication Rates ◽  
Minimally Invasive Approach ◽  
Lateral Aspect ◽  
Invasive Approach ◽  
Vertebral Bodies ◽  
Clinical Cases

Abstract BACKGROUND: Traditional anterior and posterior approaches to the thoracolumbar spine are associated with significant morbidity. In an effort to eliminate these drawbacks, minimally invasive retropleural approaches have been developed. OBJECTIVE: To demonstrate the feasibility and clinical experience of a minimally invasive lateral retropleural approach to the thoracolumbar spine. METHODS: Seven cadaveric dissections were performed in 7 fresh specimens to determine the feasibility of the technique. In each specimen, the lateral aspect of the vertebral body was accessed retropleurally, and a corpectomy was performed. Intraprocedural fluoroscopy and postoperative computed tomography were used to assess the extent of decompression. As an adjunct, 3 clinical cases of thoracic fractures and 1 neurofibroma were treated with this minimally invasive approach. Operative results, complications, and early outcomes were assessed. RESULTS: In the cadaveric study, adequate exposure was obtained to perform a lateral corpectomy and to allow interbody grafting between the adjacent vertebral bodies. The procedures were successfully performed in the 4 clinical cases without conversion to conventional approaches. A pleural tear was noted in the first clinical case, and a chest tube was placed without any long-term sequelae. CONCLUSION: Our early experience suggests that the minimally invasive lateral retropleural approach allows adequate vertebrectomy and canal decompression without the tissue disruption associated with posterolateral approaches. This approach may improve the complication rates that accompany open or endoscopic approaches for thoracolumbar corpectomies.

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