Surgical outcomes of hysterectomy for endometriosis: Benefits of a minimally invasive approach

Introduction: We aimed to evaluate surgical outcomes of hysterectomy for endometriosis performed by general obstetricians and gynecologists (OB/GYNs) based on surgical approach. Methods: Using the 2016–2018 National Surgical Quality Improvement Program (NSQIP) database, we examined surgical outcomes including 30-day complication rates based on surgical approach in patients who underwent a hysterectomy for endometriosis by OB/GYNs. Results: From 2016 to 2018, 3641 hysterectomies were performed by OB/GYNs for endometriosis. 86.0% were performed via a minimally invasive (MIS) approach, with 2882 (79.2%) via a laparoscopic and 247 (6.8%) via a vaginal approach. Compared to MIS hysterectomies, those who underwent an abdominal hysterectomy included a higher proportion of African American and a lower proportion of non-Hispanic white patients, had heavier uteri, lower parity, and were more likely obese (all p < 0.05). There were no differences in age, American Society of Anesthesiologists class, comorbidities other than obesity, or a history of prior abdominal or pelvic surgery (all p > 0.05). Women undergoing hysterectomy for endometriosis experienced an overall 9.8% complication rate. Compared to abdominal approaches, MIS had a lower rate of overall complications (8.5% vs 17.8%) including wound (2.7% vs 7.2%) and major (4.4% vs 8.8%) complications (all p < 0.001). MIS had shorter operative time (129.2 ± 60.9 vs 143.8 ± 71.9), shorter length of stay (0.9 ± 1.6 vs 2.4 ± 1.8), and fewer readmissions (2.8% vs 5.5%) (all p < 0.001). Conclusion: While hysterectomy for endometriosis is a challenging procedure to perform, OB/GYNs are performing this procedure predominantly via a minimally invasive approach with fewer complications and more favorable surgical outcomes than an abdominal approach.

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Surface Electromyography Reliably Records Electrophysiologically Evoked Internal Anal Sphincter Activity: A More Minimally Invasive Approach for Monitoring Extrinsic Innervation

European Surgical Research ◽

10.1159/000445683 ◽

2016 ◽

Vol 57 (1-2) ◽

pp. 81-88 ◽

Cited By ~ 6

Author(s):

Daniel W. Kauff ◽

Nicolas Wachter ◽

Axel Heimann ◽

Thilo B. Krüger ◽

Klaus-Peter Hoffmann ◽

...

Keyword(s):

Minimally Invasive ◽

Anal Sphincter ◽

Internal Anal Sphincter ◽

Autonomic Nerve ◽

Pelvic Surgery ◽

Transanal Total Mesorectal Excision ◽

Minimally Invasive Approach ◽

Invasive Approach ◽

Anterior Rectal Resection ◽

Extrinsic Innervation

Background: Even in the case of minimally invasive pelvic surgery, sparing of the autonomic nerve supply is a prerequisite for maintaining anal sphincter function. Internal anal sphincter (IAS) innervation could be electrophysiologically identified based on processed electromyographic (EMG) recordings with conventional bipolar needle electrodes (NE). This experimental study aimed for the development of a minimally invasive approach via intra-anal surface EMG for recordings of evoked IAS activity. Methods: Six male pigs underwent nerve-sparing low anterior rectal resection. Electric autonomic nerve stimulations were performed under online-processed EMG of the IAS. EMG recordings were simultaneously carried out with conventional bipolar NE as the reference method and newly developed intra-anal surface electrodes (SE) in different designs. Results: In all experiments, the IAS activity could be continuously visualized via EMG recordings based on NE and SE. The median number of bipolar electric stimulations per animal was 27 (range 5-52). The neurostimulations resulted in significant EMG amplitude increases for both recording types [NE: median 3.0 µV (interquartile range, IQR 2.8-3.5) before stimulation vs. 7.1 µV (IQR 3.9-13.8) during stimulation, p < 0.001; SE: median 3.6 µV (IQR 3.1-4.3) before stimulation vs. 6.8 µV (IQR 4.8-10.3) during stimulation, p < 0.001]. Conclusions: Intra-anal SE enabled reliable EMG of electrophysiologically evoked IAS activity similar to the conventional recording via NE. The transfer of the method to access platforms for transanal total mesorectal excision or robotics may offer a practical more minimally invasive approach for monitoring extrinsic innervation.

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Calcaneal fractures: a management dilemma-minimally invasive approach for intra and extra articular calcaneal fractures

International Journal of Research in Medical Sciences ◽

10.18203/2320-6012.ijrms20190512 ◽

2019 ◽

Vol 7 (3) ◽

pp. 756

Author(s):

Kawade M. S. ◽

Madan H. S. ◽

Shailesh Khachane ◽

Manjeet Singh Dhanda

Keyword(s):

Minimally Invasive ◽

Open Reduction ◽

Wound Complications ◽

Walking Ability ◽

Complication Rates ◽

Ct Reconstruction ◽

Minimally Invasive Approach ◽

Calcaneal Fractures ◽

Invasive Approach ◽

Minimally Invasive Methods

Background: Calcaneal fractures which constitutes 2% of total fractures are frequent and very debilitating if not treated properly. Calcaneal fractures generally affect younger population leading to significant man-days loss(around 2-5 years3) and in-turn leading significant economic burden on the society. The goal of treatment for calcaneal fractures is elimination of pain and restoration of normal foot shape, biomechanics, and walking ability. Wound related complications are common with open surgeries. After open reduction internal fixation with perimeter plates for displaced calcaneal fractures, wound edge necrosis is commonly observed with the extended lateral approach. Because of such high incidence of wound complications in open reduction of calcaneum fractures, minimally invasive approach takes priority over open reduction of these fractures.Methods: The study aimed to evaluate the results of minimally invasive approach for calcaneal fractures. To reduce the operative complications, 30 patients were treated with minimally invasive methods in both extra articular and intra-articular calcaneal fractures and the results were evaluated. All patients were evaluated clinically , functionally and radiologically 3D- CT reconstruction images.Results: All cases were followed up for 2 years at specified intervals. The outcome measures were evaluated by AOFAS scores10 with excellent result in 13 cases and good to fair results in the rest. Operated patients had no wound infection, no skin necrosis, 5 patients had mild subtalar arthrosis and 3 patients complained slight difficulty in wearing shoes. None of them have any gait abnormalities.Conclusions: Our study suggests that the minimally invasive methods will reduce the operative complication rates. The minimally invasive surgical intervention in an expert hand can yield better results with less complication rates.

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Mouse Surgery – Transplantation of human thymus into the kidney capsule of NSG mice v1

10.17504/protocols.io.bvuen6te ◽

2021 ◽

Author(s):

Austin Chen ◽

Mohsen Khosravi-Maharlooei ◽

Markus Holzl ◽

Megan Sykes

Keyword(s):

Minimally Invasive ◽

Minimally Invasive Approach ◽

Invasive Approach ◽

Kidney Capsule ◽

Human Thymus ◽

Nsg Mice ◽

Abdominal Approach ◽

Dorsal Aspect ◽

Thymus Tissue

This protocol details our minimally invasive approach for implanting human thymus tissue under the kidney capsule of NSG mice. In contrast to our open abdominal approach, this approach is from the dorsal aspect of the mouse and requires only two interrupted sutures and 1-2 staples to close the incision. The technique can be applied to other strains of mice, though we have found the NSG kidney capsule to be more delicate, and thus more challenging to manipulate during surgery.

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

Operative Neurosurgery ◽

10.1227/neu.0b013e318207b6cb ◽

2011 ◽

Vol 68 (suppl_1) ◽

pp. ons32-ons39 ◽

Cited By ~ 14

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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MINIMALLY INVASIVE POSTEROLATERAL THORACIC CORPECTOMY

Neurosurgery ◽

10.1227/01.neu.0000340783.83964.27 ◽

2009 ◽

Vol 64 (4) ◽

pp. 746-753 ◽

Cited By ~ 27

Author(s):

Dae-Hyun Kim ◽

John E. O'Toole ◽

Alfred T. Ogden ◽

Kurt M. Eichholz ◽

John Song ◽

...

Keyword(s):

Minimally Invasive ◽

Cancer Metastasis ◽

Burst Fracture ◽

Invasive Technique ◽

Complication Rates ◽

Minimally Invasive Approach ◽

Tubular Retractor ◽

Invasive Approach ◽

Vertebral Bodies ◽

Clinical Cases

Abstract OBJECTIVE To demonstrate the feasibility of and initial clinical experience with a novel minimally invasive posterolateral thoracic corpectomy technique. METHODS Seven procedures were performed on 6 cadavers to determine the feasibility of thoracic corpectomy using a minimally invasive approach. The posterolateral thoracic corpectomies were performed with expandable 22 mm diameter tubular retractor paramedian incisions. The posterolateral aspects of the vertebral bodies were accessed extrapleurally, and complete corpectomies were performed. Intraprocedural fluoroscopy and postoperative computed tomography were used to assess the degree of decompression. In addition, 2 clinical cases of T6 burst fracture, 1 T4–T5 plasmacytoma, and 1 T12 colon cancer metastasis were treated using this minimally invasive approach. RESULTS In the cadaveric study, an average of 93% of the ventral canal and 80% of the corresponding vertebral body were removed. The pleura and intrathoracic contents were not violated. Adequate exposure was obtained to allow interbody grafting between the adjacent vertebral bodies. The procedures were successfully performed in the 4 clinical cases using a minimally invasive technique, and the patients demonstrated good outcomes. CONCLUSION Based on this study, minimally invasive posterolateral thoracic corpectomy safely and successfully allows complete spinal canal decompression without the tissue disruption associated with open thoracotomy. This approach may improve the complication rates that accompany open or even thoracoscopic approaches for thoracic corpectomy and may even allow surgical intervention in patients with significant comorbidities.

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Laparoscopic Versus Open Abdominoperineal Resection for Rectal Cancer: Is There a Short-Term Advantage in Complication Rates With a Minimally Invasive Approach?

Gastroenterology ◽

10.1016/s0016-5085(11)64168-1 ◽

2011 ◽

Vol 140 (5) ◽

pp. S-1003-S-1004

Author(s):

David B. Stewart ◽

Christopher S. Hollenbeak ◽

Melissa M. Boltz

Keyword(s):

Rectal Cancer ◽

Minimally Invasive ◽

Abdominoperineal Resection ◽

Complication Rates ◽

Minimally Invasive Approach ◽

Short Term ◽

Invasive Approach

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The Role of Laparoscopy in Anorectal Malformations

European Journal of Pediatric Surgery ◽

10.1055/s-0040-1701700 ◽

2020 ◽

Vol 30 (02) ◽

pp. 156-163 ◽

Cited By ~ 2

Author(s):

Rebecca M. Rentea ◽

Devin R. Halleran ◽

Richard J. Wood ◽

Marc A. Levitt

Keyword(s):

Minimally Invasive ◽

Surgical Approach ◽

Perioperative Complications ◽

Anorectal Malformations ◽

Urinary Continence ◽

Minimally Invasive Approach ◽

Invasive Approach ◽

Long Term Follow Up

AbstractThe use of laparoscopy in the minimally invasive management of anorectal malformations (ARMs) continues to evolve, although the principles guiding the anatomic surgical repair and clinical follow-up remain unchanged. In this review, we detail the advantages, indications, contraindications, complications, and issues unique to the minimally invasive approach to ARM. A comprehensive search of the PubMed and Embase databases was performed (2014–2018). Full-text screening, data abstraction, and quality appraisal were performed of articles describing the use of laparoscopy in ARM and cloaca. While new developments and approaches to ARM utilizing minimally invasive techniques and timing for surgical approach have been detailed, a unique complication profile involving greater risk of rectal prolapse and retention of a remnant of the original fistula are still consistently reported. Analysis of perioperative complications and long-term functional outcomes, including rates of fecal and urinary continence, are lacking. It is clear that patient selection for the choice of surgical approach based on precise preoperative delineation of the anatomy is the key. Adherence to the principles of ARM repair as well as application of operative/imaging adjuncts will yield the best technically safe minimally invasive approach to ARM. Continued efforts for standardized reporting and long-term follow-up are required.

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Surgical Outcomes of Minimally Invasive and Abdominal Hysterectomy for Benign Indications by Operative Time: An Analysis of the American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP)

Journal of Minimally Invasive Gynecology ◽

10.1016/j.jmig.2016.08.669 ◽

2016 ◽

Vol 23 (7) ◽

pp. S198 ◽

Cited By ~ 1

Author(s):

MV Vargas ◽

S Margulies ◽

K Denny ◽

R Amdur ◽

G Moawad ◽

...

Keyword(s):

Quality Improvement ◽

Minimally Invasive ◽

Surgical Outcomes ◽

Operative Time ◽

Abdominal Hysterectomy ◽

Quality Improvement Program ◽

Improvement Program ◽

Surgical Quality ◽

Acs Nsqip ◽

American College Of Surgeons

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Comparative study of minimally invasive and traditional approaches for the microsurgical treatment of circle of Willis unruptured intracranial aneurysms

Innovative medicine of Kuban ◽

10.35401/2500-0268-2020-19-3-20-28 ◽

2020 ◽

pp. 20-28

Author(s):

R. S. Dzhindzhikhadze ◽

G. V. Danilov ◽

O. N. Dreval ◽

V. A. Lazarev ◽

A. V. Polyakov ◽

...

Keyword(s):

Minimally Invasive ◽

Intracranial Aneurysms ◽

Traditional Approach ◽

Invasive Technique ◽

Complication Rates ◽

Minimally Invasive Approach ◽

Invasive Approach ◽

Microsurgical Treatment ◽

Unruptured Intracranial Aneurysms ◽

Surgery Duration

Objective. The study objective was to compare the effects of minimally invasive and traditional surgical approaches for treating patients with unruptured intracranial aneurysms (UIAs) to assess efficacy and safety of the keyhole concept in neurosurgery.Material and methods. We made a comparison of the microsurgical treatment outcomes of 204 patients harbouring UIAs who were operated on in the period from 2014 to 2019. Patients were divided into two groups: operated on using traditional approach (n = 85, 41.7%) and minimally invasive approach (n = 119, 58.3%). Patients of the first group were operated on using pterional (n = 31), orbitozygomatic (n = 16) and lateral supraorbital (n = 38) approaches; the second group patients underwent surgery using trans-eyebrow supraorbital (n = 35), minimal pterional (n = 38), trans-eyebrow transorbital (n = 20) and transpalpebral transorbital (n = 26) approaches. Rate of intraoperative and postoperative complications, surgery duration and postoperative in-hospital stay period were the factors to compare. The Modified Rankin Scale was used as a neurological outcomes measure. Also cosmetic results of surgery, hypesthesia from the site of the surgical approach, temporomandibular joint disorder and facial asymmetry were evaluated.Results. Compared to the traditional approach, minimally invasive technique incurred shorter surgery duration (р = 0.051) and inpatient stay (р > 0.001). Intraoperative and postoperative complication rates (р > 0.05) as well as functional outcomes (р > 0.05) were comparable between the two groups, while cosmetic effects (р < 0.05) were greater in minimally invasive group of UIA patients.Conclusion. Microsurgical treatment of UIA patients using minimally invasive approach is considered safe and effective. Adequate selection of patients for operation and exhaustive neuroimaging data assessment for choosing of neurosurgical technique are obligatory factors for keyhole surgery. The authors recommend using minimally invasive concept only for experienced neurosurgical teams in specialized clinics.

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