When is a patient high risk for resection? A changing paradigm with minimally invasive lung surgery.

e20059 Background: The predicted post-operative forced expiratory volume after 1 second (FEV1) and the diffusing capacity of the lung for carbon monoxide (DLCO) are predictors of postoperative complications and survival. Despite the benefits of minimally invasive surgery in patients with marginal lung function current practice guidelines advocates non-surgical approach for treatment from evidence derived from patients undergoing thoracotomy. It is necessary to define what should be minimum acceptable lung function for resection in the era of minimally invasive surgery. Methods: Single institution retrospective study of 61 patients with pre-operative predicted FEV1 and DLCO < 60% that underwent lung resection for pulmonary lung nodules suspected to be malignant between January 2017 to June 2018. Patient demographic and clinical data were collected and the 30-day or in-hospital morbidity and mortality were assessed. Results: 28 (46%) patients with pre-operative predicted FEV1 < 60% and 33 (54%) with DLCO < 60% were reviewed. 10 patients had both FEV1 and DLCO < 60%. There were 12 patients (28% in FEV1, 12% in DLCO group) who had < 40% of pre-operative predicted values. 15 (65%) of FEV1 group and 15 (45%) of DLCO group had anatomic lung resections with either a lobectomy or a segmentectomy. 24 (39%) of cases were done robotically and the remaining with VATS. 80% of patients had cancer in their final pathology. Patients were 68± 7 years old, 34 (56%) were male. Significant baseline clinical findings include high incidence of smoking (82% in FEV1, 97% in DLCO group), HTN (71% in FEV1, 81% in DLCO group), COPD (61% in FEV1, 48% in DLCO group), CAD (25% in FEV1, 30% in DLCO group), and a total of 2 patients suffered previous CVD. Most common complications included persistent air leak > 5 days (21% in FEV1 and DLCO group) and arrhythmia (14% in FEV1, 15% in DLCO group). Of those with an air leak, 50% in the FEV1 group and 29% in the DLCO group had predicted values < 40%. Three patients developed pneumothorax post chest tube removal necessitating chest tube replacement, all of whom had predicted values < 40%. One patient developed acute DVT and PE and another patient required mechanical ventilation for > 48 hours. There were no 30-day mortalities. Conclusions: Lung resection using minimally invasive technique had low rates of 30-day morbidity in patients with reduced pulmonary function. Majority of complications observed were minor. Minimally invasive lung resection is possible and may be extended to selected patients with pre-operative predicted DLCO or FEV1 < 40% suspected of malignancy.

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Minimally invasive decompression for lumbar stenosis and disc herniation

Neurosurgical FOCUS ◽

10.3171/foc/2008/25/8/e11 ◽

2008 ◽

Vol 25 (2) ◽

pp. E11 ◽

Cited By ~ 29

Author(s):

Sean S. Armin ◽

Langston T. Holly ◽

Larry T. Khoo

Keyword(s):

Minimally Invasive Surgery ◽

Minimally Invasive ◽

Disc Herniation ◽

Invasive Surgery ◽

Lumbar Disc ◽

Invasive Technique ◽

Lumbar Stenosis ◽

New Techniques ◽

Pathological Conditions ◽

Minimally Invasive Decompression

For decades, lumbar disc herniation and lumbar stenosis have been treated surgically via traditional open techniques. With recent emphasis on minimally invasive approaches in spine surgery, a number of new techniques has been introduced that are aimed at treating these 2 common pathological conditions. Currently the most widely used and efficacious minimally invasive technique for treating these disorders is direct decompression with minimally invasive surgery. Due to the scarcity of large randomized studies, however, it is difficult to compare the effectiveness and possible superiority of this technique with traditional decompression. Further studies are needed to evaluate this issue.

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Arthroscopic Management of Scaphoid Nonunions

Hand Surgery ◽

10.1142/s0218810415400031 ◽

2015 ◽

Vol 20 (02) ◽

pp. 215-221 ◽

Cited By ~ 6

Author(s):

Midum Jegal ◽

Jeong Sang Kim ◽

Jong Pil Kim

Keyword(s):

Minimally Invasive Surgery ◽

Minimally Invasive ◽

Invasive Surgery ◽

Functional Outcomes ◽

Bone Repair ◽

Invasive Technique ◽

Scaphoid Nonunion ◽

Fracture Fragment ◽

Arthroscopic Management ◽

Minimal Morbidity

The difficulty in healing scaphoid nonunions is challenged further by the dynamic, unstable nature of the fracture-fragment interface. Recently, several investigators have introduced a minimally invasive technique for scaphoid nonunion repair, which has the advantages of minimal morbidity and accurate articular reduction, resulting in less postoperative stiffness and increased functional outcomes. However, failure to recognize the critical steps during minimally invasive surgery can result in incorrect treatment or limit any chances for successful bone repair. We reviewed the selected literature pertinent to arthroscopic techniques in the treatment of scaphoid nonunions. Furthermore, we presented a new arthroscopic approach that can be used in place of traditional formal open exposures in challenging cases of nonunion.

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Transanal Minimally Invasive Surgery (TAMIS): New Treatment for Early Rectal Cancer and Large Rectal Polyps—Experience of an Italian Center

The American Surgeon ◽

10.1177/000313481508100329 ◽

2015 ◽

Vol 81 (3) ◽

pp. 273-277 ◽

Cited By ~ 19

Author(s):

Riccardo Maglio ◽

Gallinella Marco Muzi ◽

Massimo Meucci Massimo ◽

Luigi Masoni

Keyword(s):

Rectal Cancer ◽

Minimally Invasive Surgery ◽

Minimally Invasive ◽

Local Excision ◽

Invasive Surgery ◽

Invasive Technique ◽

Single Incision Laparoscopic Surgery ◽

Early Rectal Cancer ◽

Transanal Minimally Invasive Surgery ◽

Laparoscopic Instruments

Transanal endoscopic microsurgery (TEM) is a minimally invasive technique for excision of rectal tumors that avoids conventional pelvic resectional surgery along with its risks and side effects. Although appealing, the associated cost and complex learning curve limit TEM use by colorectal surgeons. Transanal minimally invasive surgery (TAMIS) has emerged as an alternative to TEM. This platform uses ordinary laparoscopic instruments to achieve high-quality local excision. The aim of the study is to assess reliability of the technique. From July 2012 to August 2013, 15 consecutive patients with rectal pathology underwent TAMIS. After a single-incision laparoscopic surgery port was introduced into the anal canal, a pneumorectum was established with a laparoscopic device followed by transanal excision with conventional laparoscopic instruments, including graspers, electrocautery, and needle drivers. Patient demographics, operative data, and pathologic data were recorded. Of the 15 patients, 10 had rectal cancers (six T1 lesions and four T2 after preoperative chemoradiotherapy). The remainder of patients had a local excision for voluminous benign rectal adenomas. The median length of the lesions from the anal verge was 7 cm (range, 4 to 20 cm). The median operating time was 86 minutes (range, 33 to 160 minutes). There was no surgical morbidity or mortality. The median postoperative hospital stay was two days (range, 1 to 4 days). TAMIS seems to be a feasible and safe treatment option for early rectal cancer. We believe that this new technique is easy to perform, cost-effective, and less traumatic to the anal sphincter compared with traditional TEM.

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Routine Chest X-ray After Chest Tube Removal Is Not Indicated for Minimally Invasive Lung Resection

The Annals of Thoracic Surgery ◽

10.1016/j.athoracsur.2021.10.024 ◽

2021 ◽

Author(s):

Aaron R. Dezube ◽

Ashley Deeb ◽

Luis E. De Leon ◽

Suden Kucukak ◽

M. Blair Marshall ◽

...

Keyword(s):

Minimally Invasive ◽

Chest Tube ◽

Lung Resection ◽

X Ray ◽

Tube Removal ◽

Chest X Ray ◽

Chest Tube Removal ◽

Routine Chest

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MINIMALLY INVASIVE SURGERY FOR RADIAL NECK FRACTURES USING BONE PASTE

Hand Surgery ◽

10.1142/s0218810414970089 ◽

2014 ◽

Vol 19 (03) ◽

pp. 463-467

Author(s):

Kazuyoshi Yamanaka ◽

Takashi Sasaki

Keyword(s):

Minimally Invasive Surgery ◽

Minimally Invasive ◽

Range Of Motion ◽

Invasive Surgery ◽

Minimally Invasive Technique ◽

Invasive Technique ◽

Surgical Scar ◽

Radial Neck ◽

Radial Neck Fractures ◽

The Average Range

We treat radial neck fractures by a minimally invasive technique using bone paste. The indication of this technique is radial neck fractures in which the continuity with the radius shaft is retained. We have treated 13 patients using this technique. As a result, the average range of motion of the elbow was 90° for supination and 92° for pronation, +5° for extension, and 141° for flexion. The reduced position at surgery was kept unchanged until bone union. None of the patients complained of pain. The surgical scar was unnoticeable. This technique is recommended surgery for the radial neck fractures when the indication is appropriate.

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Robotic Surgery for Non-Small Cell Lung Cancer

Lung Cancer - Modern Multidisciplinary Management ◽

10.5772/intechopen.95816 ◽

2021 ◽

Author(s):

Andrew X. Li ◽

Justin D. Blasberg

Keyword(s):

Lung Cancer ◽

Minimally Invasive Surgery ◽

Minimally Invasive ◽

Small Cell Lung Cancer ◽

Cell Lung Cancer ◽

Invasive Surgery ◽

Thoracoscopic Surgery ◽

Lung Resection ◽

Small Cell ◽

Robotic Assisted

Pulmonary resection has been a cornerstone in the management of patients with non-small cell lung cancer (NSCLC) for decades. In recent years, the popularity of minimally-invasive techniques as the primary method to manage NSCLC has grown significantly. With smaller incisions and a lower incidence of peri-operative complications, minimally-invasive lung resection, accomplished through keyhole incisions with miniaturized cameras and similarly small instruments that work through surgical ports, has been shown to retain equivalent oncologic outcomes to the traditional gold standard open thoracotomy. This technique allows for the safe performance of anatomic lung resection with complete lymphadenectomy and has been a part of thoracic surgery practice for three decades. Robotic-assisted thoracoscopic surgery (RATS) represents another major advancement for lung resection, broadening the opportunity for patients to undergo minimally invasive surgery for NSCLC, and therefore allowing a greater percentage of the lung cancer population to benefit from many of the advantages previously demonstrated from video assisted thoracoscopic surgery (VATS) techniques. RATS surgery is also associated with several technical advantages to the surgeon. For a surgeon who performs open procedures and is looking to adopt a minimally invasive approach, RATS ergonomics are a natural transition compared to VATS, particularly given the multiple degrees of freedom associated with robotic articulating instruments. As a result, this platform has been adopted as a primary approach in numerous institutions across the United States. In this chapter, we will explore the advantages and disadvantages of robotic-assisted surgery for NSCLC and discuss the implications for increased adoption of minimally invasive surgery in the future of lung cancer treatment.

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The Interest of Performing “On-Demand Chest X-rays” after Lung Resection by Minimally Invasive Surgery

The Thoracic and Cardiovascular Surgeon ◽

10.1055/s-0037-1599793 ◽

2017 ◽

Vol 65 (07) ◽

pp. 572-580

Author(s):

Michael Bubenheim ◽

Alain Bernard ◽

Jean Melki ◽

Christophe Peillon ◽

Jean-Marc Baste ◽

...

Keyword(s):

Minimally Invasive Surgery ◽

Postoperative Complications ◽

Minimally Invasive ◽

Invasive Surgery ◽

Lung Resection ◽

Daily Routine ◽

X Rays ◽

On Demand ◽

Length Of Hospitalization ◽

Routine Chest

Background There is a lack of consensus in hospital centers regarding costly daily routine chest X-rays after lung resection by minimally invasive surgery. Indeed, there is no evidence that performing daily chest X-rays prevents postoperative complications. Our objective was to compare chest X-rays performed on demand when there was clinical suspicion of postoperative complications and chest X-rays performed systematically in daily routine practice. Methods This prospective single-center study compared 55 patients who had on-demand chest X-rays and patients in the literature who had daily routine chest X-rays. Our primary evaluation criterion was length of hospitalization. Results The length of hospitalization was 5.3 ± 3.3 days for patients who had on-demand X-rays, compared with 4 to 9.7 days for patients who had daily routine X-rays. Time to chest tube removal (4.34 days), overall complication rate (27.2%), reoperation rate (3.6%), and mortality rate (1.8%) were comparable to those in the literature. On average, our patients only had 1.22 ± 1.8 on-demand X-rays, compared with 3.3 X-rays if daily routine protocol had been applied. Patients with complications had more X-rays (3.4 ± 1.8) than patients without complications (0.4 ± 0.7). Conclusion On-demand chest X-rays do not seem to delay the diagnosis of postoperative complications or increase morbidity–mortality rates. Performing on-demand chest X-rays could not only simplify surgical practice but also have a positive impact on health care expenses. However, a broader randomized study is warranted to validate this work and ultimately lead to national consensus.

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