What is the role of minimally invasive surgery in a fast track hip and knee replacement pathway?

Introduction Minimally invasive hip and knee replacement surgery (MIS) continues to receive coverage in both the popular press and scientific literature. The cited benefits include a smaller scar, less soft tissue trauma, faster recovery, reduced hospital stay, decreased blood loss and reduced post-operative pain. These outcomes are highly desirable and consistent with the aims of fast track hip and knee pathways. This paper evaluates the literature and discusses whether performing MIS over conventional surgical techniques offers advantages in a fast track hip and knee pathway. Methods An English language literature search was performed using the MEDLINE® and PubMed databases. Case series, randomised controlled trials and systematic reviews were included in the review. Results The reported improvements in recovery brought about by MIS must be considered multifactorial. In combination with improved clinical pathways, MIS can be associated with quicker recovery and shorter length of hospital stay. Conclusions There is insufficient evidence to indicate that surgical technique alone makes a significant difference to recovery or reduces soft tissue trauma. No consensus on whether to use MIS techniques in fast track hip and knee replacement pathways can therefore be drawn. This is especially important given that the complication rates of MIS in the low to medium volume surgeon appear unacceptably high compared with standard approaches. It is also too early to assess the long-term effects of MIS on implant survival.

Download Full-text

Comparison of Iatrogenic Soft Tissue Trauma in Robotic-Assisted versus Manual Partial Knee Arthroplasty

Surgical Technology Online ◽

10.52198/21.sti.39.os1465 ◽

2021 ◽

Vol 39 ◽

Author(s):

Emily Hampp ◽

◽

Laura Scholl ◽

Ahmad Faizan ◽

Nipun Sodhi ◽

...

Keyword(s):

Soft Tissue ◽

Knee Arthroplasty ◽

Statistical Tests ◽

Cruciate Ligament ◽

Soft Tissue Injuries ◽

Quadriceps Tendon ◽

Soft Tissue Trauma ◽

Partial Knee Arthroplasty ◽

Significant Difference ◽

Tissue Trauma

Partial knee arthroplasty (PKA) is performed to treat end-stage osteoarthritis in a single compartment. There are minimal data characterizing soft-tissue injuries for PKA with robotic and manual techniques. This cadaver study compared the extent of soft-tissue trauma sustained through robotic-arm assisted PKA (RPKA) and manual PKA (MPKA). Five surgeons prepared 24 cadaveric knees for medial PKA, including six MPKA controls and 18 RPKA assigned into three different workflows: RPKA-LB (six knees) – RPKA with legacy burr; RPKA-NB (six knees) – RPKA with new burr design; and RPKA-NBS (six knees) – RPKA with new burr design and oscillating saw. Two surgeons estimated trauma to the patellar tendon, quadriceps tendon, anterior cruciate ligament (ACL), medial collateral ligament (MCL), medial capsule, posterior capsule, and posterior cruciate ligament (PCLs) using a five-grade system: Grade 1 – complete soft tissue preservation; Grade 2 – ≤25%; Grade 3 – 26 to 50%; Grade 4 – 51 to 75%; and Grade 5 – ≥76% trauma. A total trauma grade was assigned by summing the grades. Kruskal-Wallis statistical tests were used to assess outcomes. When compared to the MPKA group, all RPKA subgroups had lower total trauma grading (p<0.01), lower posterior capsular damage (p<0.01), and less severe ACL damage (p<0.01). The analysis demonstrated no significant difference between the three RPKA workflows. As this study was performed using cadaveric specimens, additional investigations are necessary to determine associations between robotic or manual-assisted technique, observed soft tissue damage, and postoperative clinical outcomes following PKA.

Download Full-text

Intracorporeal and extracorporeal anastomosis for robotic-assisted and laparoscopic right colectomy: short-term outcomes of a multi-center prospective trial

Surgical Endoscopy ◽

10.1007/s00464-021-08780-9 ◽

2021 ◽

Author(s):

Robert K. Cleary ◽

Matthew Silviera ◽

Tobi J. Reidy ◽

James McCormick ◽

Craig S. Johnson ◽

...

Keyword(s):

Minimally Invasive ◽

Hospital Stay ◽

Right Colectomy ◽

Perioperative Outcomes ◽

Complication Rates ◽

Robotic Assisted ◽

Laparoscopic Right Colectomy ◽

Conversion Rates ◽

Significant Difference ◽

Extracorporeal Anastomosis

Abstract Background Studies to date show contrasting conclusions when comparing intracorporeal and extracorporeal anastomoses for minimally invasive right colectomy. Large multi-center prospective studies comparing perioperative outcomes between these two techniques are needed. The purpose of this study was to compare intracorporeal and extracorporeal anastomoses outcomes for robotic assisted and laparoscopic right colectomy. Methods Multi-center, prospective, observational study of patients with malignant or benign disease scheduled for laparoscopic or robotic-assisted right colectomy. Outcomes included conversion rate, gastrointestinal recovery, and complication rates. Results There were 280 patients: 156 in the robotic assisted and laparoscopic intracorporeal anastomosis (IA) group and 124 in the robotic assisted and laparoscopic extracorporeal anastomosis (EA) group. The EA group was older (mean age 67 vs. 65 years, p = 0.05) and had fewer white (81% vs. 90%, p = 0.05) and Hispanic (2% vs. 12%, p = 0.003) patients. The EA group had more patients with comorbidities (82% vs. 72%, p = 0.04) while there was no significant difference in individual comorbidities between groups. IA was associated with fewer conversions to open and hand-assisted laparoscopic approaches (p = 0.007), shorter extraction site incision length (4.9 vs. 6.2 cm; p ≤ 0.0001), and longer operative time (156.9 vs. 118.2 min). Postoperatively, patients with IA had shorter time to first flatus, (1.5 vs. 1.8 days; p ≤ 0.0001), time to first bowel movement (1.6 vs. 2.0 days; p = 0.0005), time to resume soft/regular diet (29.0 vs. 37.5 h; p = 0.0014), and shorter length of hospital stay (median, 3 vs. 4 days; p ≤ 0.0001). Postoperative complication rates were comparable between groups. Conclusion In this prospective, multi-center study of minimally invasive right colectomy across 20 institutions, IA was associated with significant improvements in conversion rates, return of bowel function, and shorter hospital stay, as well as significantly longer operative times compared to EA. These data validate current efforts to increase training and adoption of the IA technique for minimally invasive right colectomy.

Download Full-text

Use of the AO Wire Passer to Aid Placement of Obstetrical Saw Wire for Osteotomy

Veterinary and Comparative Orthopaedics and Traumatology ◽

10.1055/s-0038-1633094 ◽

1994 ◽

Vol 07 (04) ◽

pp. 180-182

Author(s):

N. Gofton ◽

Joanne Cockshutt

Keyword(s):

Soft Tissue ◽

Close Contact ◽

Soft Tissue Trauma ◽

Wire Saw ◽

Tissue Dissection ◽

The Wire ◽

Tissue Trauma

The AO wire passer can be used as an effective guide for passage of obstetrical saw wire for osteotomy. Use of the wire saw and passer reduces soft tissue trauma by minimizing tissue dissection, and promoting positioning of the saw in close contact with the bone.

Download Full-text

Soft Tissue Trauma Over the Nose

Facial Plastic Surgery ◽

10.1055/s-2008-1064655 ◽

1992 ◽

Vol 8 (04) ◽

pp. 233-241 ◽

Cited By ~ 1

Author(s):

Fred Stucker ◽

Denis Hoasjoe

Keyword(s):

Soft Tissue ◽

Soft Tissue Trauma ◽

Tissue Trauma

Download Full-text

Symposium on Soft Tissue Trauma

Journal of Oral and Maxillofacial Surgery ◽

10.1016/s0278-2391(01)70015-8 ◽

2001 ◽

Vol 59 (8) ◽

pp. 11-12

Keyword(s):

Soft Tissue ◽

Soft Tissue Trauma ◽

Tissue Trauma

Download Full-text

Effect of Soft-Tissue Trauma on the Early Periosteal Response of Bone to Injury

Journal of Trauma and Acute Care Surgery ◽

10.1097/00005373-200003000-00018 ◽

2000 ◽

Vol 48 (3) ◽

pp. 479-483 ◽

Cited By ~ 36

Author(s):

Patricia S. Landry ◽

Andrew A. Marino ◽

Kalia K. Sadasivan ◽

James A. Albright

Keyword(s):

Soft Tissue ◽

Soft Tissue Trauma ◽

Tissue Trauma

Download Full-text

Abstract WP341: Difference in Acute Ischemic Post Thrombolytic Stroke Outcomes in Pre Comprehensive and Post Comprehensive Status: Single Center Experience

Stroke ◽

10.1161/str.47.suppl_1.wp341 ◽

2016 ◽

Vol 47 (suppl_1) ◽

Author(s):

Vishal B Jani ◽

Achint Patel ◽

Jillian Schurr ◽

Erin Shell ◽

Julie Bey ◽

...

Keyword(s):

Hospital Stay ◽

Secondary Outcome ◽

Rank Test ◽

Stroke Severity ◽

Complication Rates ◽

Single Center ◽

Stroke Treatment ◽

Significant Difference ◽

Multivariable Regression ◽

Iv Tpa

Background: In last decade there is a significant change in stroke care especialy with newer data for ischemic stroke treatment there is a movement to obtain comprehensive stroke center certification (CSCC) to provide enhanced complex care for stroke. This study aims to assess the single center quality matrix assessment pre and post CSC status Methods: We reviewed single center cohort of IV tPA (tissue plasminogen activator) in-between year 2010 to 2014 at sparrow health system in mid Michigan region. This cohort was dichotomized in pre CSCC and post CSCC era. Stroke quality matrics data was collected for these patients. Severity of stroke was categorized in mild-moderate vs moderate-severe based on NIH stroke scale (NIHSS) scale. Primary out come for this study was any complication, which is composite end point of in-hospital mortality, and hemorrhage and secondary outcome was hospital stay. Chi square, student’s t test and wilcoxon sum rank test was used to compare both groups. Multivariable regression models were utilized to calculate odd ratios after adjusting with stroke severity. Results: Cohort of IV tPA was identified in-between year 2010 to 2014 (332 hospitalizations off which 241 were pre CSCC and 91 were Post CSCC ). In- hospital complication was lower after receiving CSCC (9.89% vs. 21.99%; p:0.011). In multivariable regression analysis the trend for in hospital complication persisted [Adjusted Odds ratio (OR):0.43–95%confidence-Interval(CI):0.20-0.93–p:0.032] but there was no significant difference in hospital stay (Median days 5 vs. 5; P:673) Conclusion: There is a clear and persistent trend of low in-hospital complication rates after acquiring CSCC quality matrics.

Download Full-text

Minimally invasive direct coronary artery bypass versus off-pump coronary surgery through sternotomy

Annals of The Royal College of Surgeons of England ◽

10.1308/003588413x13629960047119 ◽

2013 ◽

Vol 95 (7) ◽

pp. 481-485 ◽

Cited By ~ 15

Author(s):

R Birla ◽

P Patel ◽

G Aresu ◽

G Asimakopoulos

Keyword(s):

Coronary Artery ◽

Blood Transfusion ◽

Minimally Invasive ◽

Hospital Stay ◽

Coronary Artery Bypass ◽

Artery Bypass ◽

Off Pump ◽

Opcab Group ◽

Significant Difference ◽

The Mean

Introduction Although it is not a new technique, minimally invasive direct coronary artery bypass (MIDCAB) is employed only by a few surgeons in the UK. We compared our experience with MIDCAB with that of single vessel off-pump coronary artery bypass (OPCAB) graft surgery through a standard median sternotomy. Methods Patients who underwent either MIDCAB or OPCAB between April 2008 and July 2011 were reviewed. Exclusion criteria included patients with an ejection fraction of <0.5 or previous cardiac surgery. Data were obtained retrospectively from our prospective database, medical records and through general practitioners. Results Overall, 74 patients were analysed in the MIDCAB group and 78 in the OPCAB group. Their demographics and EuroSCORE (European System for Cardiac Operative Risk Evaluation) values were comparable (p>0.05). There was no statistically significant difference in the two groups in terms of mortality, recurrent myocardial infarction, postoperative stroke, wound infection, atrial fibrillation or need for reintervention. The MIDCAB group had six conversions to a sternotomy. Eight patients in each group required blood transfusion, with the average transfusion being 1.8 units in the MIDCAB group and 3.2 units in the OPCAB group. The mean duration of ventilation and intensive care unit stay was 5.0 hours and 38.4 hours in the MIDCAB group and 5.4 and 47.8 hours in the OPCAB group. The mean hospital stay was significantly reduced in the MIDCAB population (6.1 vs 8.5 days, p<0.05). Conclusions MIDCAB can be performed safely in appropriately selected patients with outcomes comparable with OPCAB. The potential benefits include shorter hospital stay, reduced need for blood transfusion and faster recovery.

Download Full-text