scholarly journals Surgical approach to solid pseudopapillary neoplasms of the proximal pancreas: minimally invasive vs. open

2019 ◽  
Vol 17 (1) ◽  
Author(s):  
Emmanuel II Uy Hao ◽  
Seoung Yoon Rho ◽  
Ho Kyoung Hwang ◽  
Jae Uk Chung ◽  
Woo Jung Lee ◽  
...  
Keyword(s):  
Minimally Invasive Surgery ◽  
Minimally Invasive ◽  
Head And Neck ◽  
Surgical Approach ◽  
Tumor Size ◽  
Open Surgery ◽  
Hospital Length ◽  
Hospital Length Of Stay ◽  
Minimally Invasive Surgical ◽  
Solid Pseudopapillary Neoplasms

Abstract Background Solid pseudopapillary neoplasms (SPN) of the pancreas are rare pancreatic neoplasms where complete resection is the cornerstone in management. It has been demonstrated in previous studies that minimally invasive surgical approaches are effective management options in treating SPNs of the distal pancreas. The purpose of this study is to evaluate the feasibility of minimally invasive surgery in treating SPNs of the uncinate, head, and neck of the pancreas. Methods Data from 2005 to 2017 at Severance Hospital of the Yonsei University Health systems in Seoul, South Korea, were retrospectively collected for 25 patients who were diagnosed with SPN of the uncinate, head, and neck of the pancreas and who underwent curative resection. Three groups of patients were considered, depending on the year of surgery, in order to determine trends in the surgical management of SPN. The patients were also divided into two groups corresponding to the type of operation done (minimally invasive surgery vs. open surgery). Perioperative patient data, including age, gender, body mass index (BMI), tumor size, and operation done, were compared and analyzed statistically. Long-term nutritional effects were measured using the Controlling Nutritional Status (CONUT) scoring system. Results There were no statistically significant differences in age, gender, BMI, symptomatic presentation, operation type, tumor size, and tumor stage between the three time periods. In comparing between minimally invasive and open surgery, there were no statistically significant differences in age, gender, symptomatic presentation, BMI, tumor size, preoperative stage, type of operation, operation time, pancreatic duct size, post-operative pancreatic fistula (POPF) grade, death associated with disease, recurrence, pathological parameters, and change in CONUT score. There was a significant difference in tumor size (4.5 ± 1.8 vs. 2.6 ± 1.0 cm, p = 0.004), blood loss (664.2 ± 512.4 vs. 277.7 ± 250.8 mL, p = 0.024), need to transfuse (33% vs. 0%, p = 0.023), hospital length of stay (27.4 ± 15.3 vs. 11.5 ± 5.3 days, p = 0.002), and complication rate (75% vs. 30.8%, p = 0.027) between the two groups. Conclusions In appropriately selected patients with SPNs of the uncinate, head, and neck of the pancreas, a minimally invasive surgical approach offers at least equal oncologic and nutritional outcomes, while demonstrating decreased complications and decreased hospital length of stay compared with that of an open surgical approach.

Thoracoscopic Repair of Congenital Diaphragmatic Hernia

2020 ◽  
Vol 30 (02) ◽  
pp. 137-141
Author(s):  
Richard Wagner ◽  
Steffi Mayer ◽  
Xiaoyan Feng ◽  
Jan-Hendrik Gosemann ◽  
Peter Zimmermann ◽  
...  
Keyword(s):  
Minimally Invasive ◽  
Congenital Diaphragmatic Hernia ◽  
Diaphragmatic Hernia ◽  
Open Surgery ◽  
Hospital Length ◽  
Hospital Length Of Stay ◽  
Patch Repair ◽  
Minimally Invasive Approach ◽  
Invasive Approach ◽  
Thoracoscopic Repair

AbstractThe surgical management of patients with congenital diaphragmatic hernia (CDH) is challenging and ever changing. It requires the highest expertise not only on the surgical level but also of neonatologists and anesthesiologists. In selected patients traditional open surgery is increasingly replaced by thoracoscopic CDH repair in many centers worldwide. Despite obvious and well-described advantages of the minimally invasive approach like a shorter ventilatory time, less pain, a shorter hospital length of stay, and a better cosmesis, important controversies remain. This review discusses hot topics of minimally invasive CDH repair, such as extracorporeal membrane oxygenation, hypercapnia/acidosis, patch repair, surgical training, and recurrence.

scholarly journals Minimally invasive management versus open surgery in the treatment of penetrating bladder injuries: a retrospective cohort study

BMC Urology ◽  
2021 ◽  
Vol 21 (1) ◽  
Author(s):  
John Culhane ◽  
Johar Raza Syed ◽  
Sameer Siddiqui
Keyword(s):  
Length Of Stay ◽  
Minimally Invasive ◽  
Open Surgery ◽  
Data Bank ◽  
Hospital Length ◽  
Hospital Length Of Stay ◽  
Bladder Injury ◽  
Significant Independent Predictor ◽  
National Trauma Data Bank ◽  
Invasive Management

Abstract Background While blunt extra-peritoneal bladder injury is typically treated non-operatively or with minimally invasive management, the treatment for penetrating bladder injury is generally open surgery. We identify a group of patients with penetrating bladder injury who were treated with minimally invasive management and compare the results with those who underwent traditional open surgical treatment. Methods This retrospective cohort study analyzes penetrating bladder injuries from a single trauma center from 2012 through 2019, and from the National Trauma Data Bank for 2016 and 2017. Mortality, complications, and length of stay were compared for minimally invasive management versus open surgery. We used Chi square to test significance for categorical variables, Mann–Whitney U test for ordinal variables, and T-test for continuous variables. Multivariate analysis was performed with multiple logistic, ordinal, and linear regression. Results Local: 117 (0.63%) had a bladder injury; 30 (25.6%) were penetrating. 6 (20.0%) were successfully treated with minimally invasive management with no complication versus 24 complications in 11 patients (45.8%) for open surgery (p = 0.047). Open surgical management was not a significant independent predictor of mortality or hospital length of stay. National Trauma Data Bank: 5330 (0.27%) had a bladder injury; 963 (19.5%) were penetrating. 97 (10.1%) were treated with minimally invasive management. The minimally invasive management group had 12 complications in 5 patients (4.9%) versus 280 complications in 169 patients (19.7%) for open surgery (p =  < 0.001). Open surgery was a significant independent predictor of complications (OR 1.57, p = 0.003) and longer hospital length of stay (B = 5.31, p < 0.001). Conclusions Most penetrating bladder injury requires open surgery, however a small proportion can safely be managed with minimally invasive management. Minimally invasive management is associated with lower total complications and shorter hospital length of stay in select patients.

scholarly journals Survival in endometrial cancer in relation to minimally invasive surgery or open surgery – a Swedish Gynecologic Cancer Group (SweGCG) study

BMC Cancer ◽  
2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Christer Borgfeldt ◽  
Erik Holmberg ◽  
Janusz Marcickiewicz ◽  
Karin Stålberg ◽  
Bengt Tholander ◽  
...  
Keyword(s):  
Risk Factors ◽  
Overall Survival ◽  
Endometrial Cancer ◽  
Minimally Invasive ◽  
Cancer Patients ◽  
Surgical Approach ◽  
Open Surgery ◽  
Gynecologic Cancer ◽  
Multivariable Analysis ◽  
Figo Stage

Abstract Background The aim of this study was to analyze overall survival in endometrial cancer patients’ FIGO stages I-III in relation to surgical approach; minimally invasive (MIS) or open surgery (laparotomy). Methods A population-based retrospective study of 7275 endometrial cancer patients included in the Swedish Quality Registry for Gynecologic Cancer diagnosed from 2010 to 2018. Cox proportional hazard models were used in univariable and multivariable survival analyses. Results In univariable analysis open surgery was associated with worse overall survival compared with MIS hazard ratio, HR, 1.39 (95% CI 1.18–1.63) while in the multivariable analysis, surgical approach (MIS vs open surgery) was not associated with overall survival after adjustment for known risk factors (HR 1.12, 95% CI 0.95–1.32). Higher FIGO stage, non-endometrioid histology, non-diploid tumors, lymphovascular space invasion and increasing age were independent risk factors for overall survival. Conclusion The minimal invasive or open surgical approach did not show any impact on survival for patients with endometrial cancer stages I-III when known prognostic risk factors were included in the multivariable analyses.

Kinematics of a Fully-Decoupled Remote Center-of-Motion Parallel Manipulator for Minimally Invasive Surgery

2012 ◽  
Vol 6 (2) ◽  
Author(s):  
Chin-Hsing Kuo ◽  
Jian S. Dai
Keyword(s):  
Minimally Invasive Surgery ◽  
Minimally Invasive ◽  
Invasive Surgery ◽  
Inverse Kinematics ◽  
Parallel Manipulator ◽  
Degrees Of Freedom ◽  
Surgical Instruments ◽  
End Effector ◽  
Minimally Invasive Surgical ◽  
Inverse Kinematics Problem

A crucial design challenge in minimally invasive surgical (MIS) robots is the provision of a fully decoupled four degrees-of-freedom (4-DOF) remote center-of-motion (RCM) for surgical instruments. In this paper, we present a new parallel manipulator that can generate a 4-DOF RCM over its end-effector and these four DOFs are fully decoupled, i.e., each of them can be independently controlled by one corresponding actuated joint. First, we revisit the remote center-of-motion for MIS robots and introduce a projective displacement representation for coping with this special kinematics. Next, we present the proposed new parallel manipulator structure and study its geometry and motion decouplebility. Accordingly, we solve the inverse kinematics problem by taking the advantage of motion decouplebility. Then, via the screw system approach, we carry out the Jacobian analysis for the manipulator, by which the singular configurations are identified. Finally, we analyze the reachable and collision-free workspaces of the proposed manipulator and conclude the feasibility of this manipulator for the application in minimally invasive surgery.

scholarly journals Evaluating the Role of Staphylococcus aureus Nasal PCR in Pediatric Head and Neck Infections

2021 ◽  
Vol 26 (7) ◽  
pp. 734-739
Author(s):  
Chandni Patel ◽  
Guru Bhoojhawon ◽  
Lukasz Weiner ◽  
Danelle Wilson ◽  
Derek Zhorne ◽  
...  
Keyword(s):  
Staphylococcus Aureus ◽  
Treatment Failure ◽  
Head And Neck ◽  
Pediatric Patients ◽  
Total Duration ◽  
Kidney Injury ◽  
Hospital Length ◽  
Hospital Length Of Stay ◽  
Head And Neck Infections

OBJECTIVE Vancomycin is often empirically used in the management of head and neck infections (HNIs) in children. The objective of this study was to determine the utility of Staphylococcus aureus (SA) nasal PCR to facilitate de-escalation of vancomycin for pediatric HNIs. METHODS This was a single-center, retrospective cohort study of pediatric patients who received empiric intravenous vancomycin for a diagnosis of HNIs between January 2010 and December 2019. Subjects were excluded if they met any of the following: confirmed/suspected coinfection of another site, dialysis, immunocompromised status, admission to the NICU, alternative diagnosis that did not require antibiotics, or readmission for HNIs within 30 days of previous admission. The primary outcome was time to de-escalation of vancomycin. Total duration of antibiotics, treatment failure, hospital length of stay (LOS), and incidence of acute kidney injury (AKI) were also assessed. RESULTS Of the 575 patients identified, 124 patients received an SA nasal PCR. The median time to de-escalation was 39.5 hours in those patients compared with 53.7 hours in patients who did not have a SA nasal PCR (p = 0.002). No difference was noted in total duration of all methicillin-resistant Staphylococcus aureus antibiotics, hospital LOS, treatment failure, and AKI. CONCLUSIONS In a large cohort of pediatric patients with HNIs, those who underwent testing with an SA nasal PCR spent less time receiving intravenous vancomycin, although their LOS was not significantly reduced. Further investigation is needed to better define the role of SA nasal PCRs in determining antibiotic therapy for HNIs.

scholarly journals Impact of SupervIsed TraInIng on the AcquIsItIon of SImulated LaparoscopIc SkIlls

2013 ◽  
Vol 95 (6) ◽  
pp. 1-6 ◽  
Author(s):  
NA Healy ◽  
KH Chang ◽  
JB Conneely ◽  
C Malone ◽  
MJ Kerin
Keyword(s):  
Minimally Invasive Surgery ◽  
Laparoscopic Surgery ◽  
Minimally Invasive ◽  
Open Surgery ◽  
Alternative Methods ◽  
Time Constraints ◽  
Laparoscopic Skills ◽  
Supervised Training ◽  
Initial Learning ◽  
Safety Considerations

Laparoscopy or minimally invasive surgery requires surgeons to attain proficiency in skills that are fundamentally different to those required for open surgery. As a result, it both challenges junior trainees and surgeons who are experienced in open surgery. Not surprisingly, the initial learning phase of laparoscopy has been associated with an increased incidence of serious complications. Owing to time constraints and the ethical and safety considerations of allowing novices to perform laparoscopic surgery on patients, alternative methods have been sought to train junior surgeons on the basics of laparoscopic surgery.

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