scholarly journals Transposition of brachiobasilic arteriovenous fistulae: improving the cosmetic effect without compromising patency

2016 ◽  
Vol 98 (1) ◽  
pp. 24-28
Author(s):  
David van Dellen ◽  
Muneer Junejo ◽  
Hussein Khambalia ◽  
Babatunde Campbell
Keyword(s):  
Minimally Invasive ◽  
Anastomotic Stricture ◽  
Intraoperative Complications ◽  
Late Complications ◽  
Primary Patency ◽  
Arteriovenous Fistulae ◽  
Invasive Approach ◽  
Arteriovenous Fistulas ◽  
Novel Approach ◽  
One Year

Introduction Subjects who undergo haemodialysis are living longer, which necessitates increasingly complex procedures for formation of arteriovenous fistulas. Basilic veins provide valuable additional venous ‘real estate’ but surgical transposition of vessels is required, which required a cosmetically disfiguring incision. A minimally invasive transposition method provides an excellent aesthetic alternative without compromised outcomes. Methods A retrospective review was made of minimally invasive brachiobasilic fistula transpositions (using two short incisions of <4 cm) between February 2005 and July 2011. Primary endpoints were one-year patency as well as the perioperative and late complications of the procedure. Results Thirty-one patients underwent 32 transposition procedures (eight pre-dialysis cases; 24 haemodialysis patients). All patients were treated with a minimally invasive method. Thirty-one procedures resulted in primary patency, with the single failure refashioned successfully. The only indication for a more invasive approach was intraoperative complications (two haematomas). All other complications presented late and were amenable to intervention (one aneurysm, one peri-anastomotic stricture). Conclusion Formation of arteriovenous fistulae using minimally invasive methods is a novel approach that ensures fistula patency with improved aesthetic outcomes and without significant morbidity.

Tissue Engineered Successful Reconstruction of a Complex Traumatized Lower Extremity

2021 ◽  
Vol 11 (9) ◽  
Author(s):  
Srinjoy Saha
Keyword(s):  
Minimally Invasive ◽  
Soft Tissues ◽  
Platelet Rich Plasma ◽  
Thigh Muscle ◽  
Muscle Injuries ◽  
Invasive Approach ◽  
Novel Approach ◽  
Duration Of Surgery ◽  
Biomaterial Application ◽  
Split Skin

Introduction: Tissue engineered reconstruction is a minimally invasive approach for healing major complex wounds successfully. It combines accurate, conservative debridement with a specially adapted suction method, platelet-rich plasma (PRP) injections, and biomaterial application to salvage injured tissues and grows new soft tissues over wounds. Case Report: A healthy young man in his early 30s presented to our emergency department with complex knee-thigh injuries following a high-velocity automobile accident. Degloved anterolateral thigh, severe thigh muscle injuries, and ruptured extensor patellar mechanism were observed. Accurate conservative (as opposed to radical) debridement and PRP injections salvaged the injured muscles and tendons. Specially carved reticulated foam wrapped around the injured ischemic muscles, followed by low negative, short intermittent, cyclical suction therapy. Wound exploration 4 days apart revealed progressive improvements with considerable vascularization of the injured soft tissues within 2 weeks. Thereafter, meticulous reconstruction of the salvaged muscles and tendons restored anatomical congruity. An absorbable synthetic biomaterial covered the sizeable open wound with vast areas of exposed tendons. Five weeks later, exuberant granulating tissue ingrowth within the biomaterial filled up the tissue defect. A split-skin graft covered the remaining raw areas, which “took” completely. Early rehabilitation enabled the patient to return to active work, play contact sports, and perform strenuous activities effortlessly. Conclusion: Minimally invasive tissue engineered reconstruction is a novel approach using a series of simple minimally invasive procedures. It lessens the duration of surgery and anesthesia, maximizes soft-tissue salvage, lowers morbidity, minimizes hospitalization, saves costs, and improves the patient’s quality of life significantly. Keywords: Mangled extremity, Limb salvage, Financial, Trauma, Modified negative pres

scholarly journals The Arrowhead Ministernotomy with Rigid Sternal Plate Fixation: A Minimally Invasive Approach for Surgery of the Ascending Aorta and Aortic Root

2014 ◽  
Vol 2014 ◽  
pp. 1-3 ◽  
Author(s):  
Mark J. Russo ◽  
John Gnezda ◽  
Aurelie Merlo ◽  
Elizabeth M. Johnson ◽  
Mohammad Hashmi ◽  
...  
Keyword(s):  
Minimally Invasive ◽  
Aortic Root ◽  
Plate Fixation ◽  
Aortic Surgery ◽  
Case Series ◽  
Ascending Aorta ◽  
The Body ◽  
Minimally Invasive Approach ◽  
Invasive Approach ◽  
Novel Approach

Background. Ministernotomy incisions have been increasingly used in a variety of settings. We describe a novel approach to ministernotomy using arrowhead incision and rigid sternal fixation with a standard sternal plating system.Methods. A small, midline, vertical incision is made from the midportion of the manubrium to a point just above the 4th intercostal mark. The sternum is opened in the shape of an inverted T using two oblique horizontal incisions from the midline to the sternal edges. At the time of chest closure, the three bony segments are aligned and approximated, and titanium plates (Sternalock, Jacksonville, Florida) are used to fix the body of the sternum back together.Results. This case series includes 11 patients who underwent arrowhead ministernotomy with rigid sternal plate fixation for aortic surgery. The procedures performed were axillary cannulation (n=2), aortic root replacement (n=3), valve sparing root replacement (n=3), and replacement of the ascending aorta (n=11) and/or hemiarch (n=2). Thirty-day mortality was 0%; there were no conversions, strokes, or sternal wound infections.Conclusions. Arrowhead ministernotomy with rigid sternal plate fixation is an adequate minimally invasive approach for surgery of the ascending aorta and aortic root.

scholarly journals PRIMARY ABANDON-OF-THE-SAC (PAS) TECHNIQUE: PRELIMINARY RESULTS OF A NOVEL MINIMALLY INVASIVE APPROACH FOR INGUINOSCROTAL HERNIA REPAIR

2020 ◽  
Vol 33 (2) ◽  
Author(s):  
Alexander Charles MORRELL ◽  
Andre Luiz Gioia MORRELL ◽  
Flavio MALCHER ◽  
Allan Gioia MORRELL ◽  
Alexander Charles MORRELL-JUNIOR
Keyword(s):  
Minimally Invasive ◽  
Average Length ◽  
Intraoperative Complications ◽  
Case Series ◽  
Surgical Site Infections ◽  
Postoperative Outcomes ◽  
Minimally Invasive Approach ◽  
Invasive Approach ◽  
Preliminary Results ◽  
Average Length Of Stay

ABSTRACT Background: Laparoscopic best approach of repairing inguinoscrotal hernias are still debatable. Incorrect handling of the distal sac can possibly result in damage to cord structures and negative postoperative outcomes as ischemic orquitis or inguinal neuralgia. Aim: To describe a new technique for a minimally invasive approach to inguinoscrotal hernias and to analyze the preliminary results of patients undergoing the procedure. Methods: A review of a prospectively maintained database was conducted in patients who underwent minimally invasive repair using the “primary abandon-of-the-sac” (PAS) technique for inguinoscrotal hernias. Patient´s demographics, as well as intraoperative variables and postoperative outcomes were also analyzed. Results: Twenty-six male were submitted to this modified procedure. Mean age of the case series was 53.8 years (range 34-77) and body mass index was 26.8 kg/m2 (range 20.8-34.2). There were no intraoperative complications or conversion. Average length of stay was one day. No surgical site infections, pseudo hydrocele or neuralgia were reported after the procedure and two patients presented seroma. No inguinal hernia recurrence was verified during the mean 21.4 months of follow up. Conclusion: The described technique is safe, feasible and reproducible, with good postoperative results.

scholarly journals A Simple and Novel Approach in Treating Congenital Symmastia (Using Tisseel in a 2-Step Approach)

2020 ◽  
Vol 6 ◽  
pp. 2513826X2095301
Author(s):  
Bismark Adjei ◽  
Susie Z. Yao ◽  
Ashraf Mostafa ◽  
Ommen Koshy
Keyword(s):  
Minimally Invasive ◽  
Fibrin Sealant ◽  
Minimally Invasive Approach ◽  
Invasive Approach ◽  
Root Cause ◽  
Minimal Scarring ◽  
Novel Approach ◽  
Management Approaches

Introduction: Congenital symmastia is notoriously difficult to treat. Many management approaches have been reported but none seem to address the root cause of the anatomic deformity and may result in significant scarring. Method: We propose a minimally invasive approach to treating congenital symmastia with good results and minimal scarring by liposuction and use of a fibrin sealant. Conclusion: Liposuction of the pre-sternal area and injection of fibrin sealant as an adhesive with post-operative pressure garment support worked well to create and maintain a good cleavage.

Algorithmic Salvage Techniques in Non-Maturing Radiocephalic Arteriovenous Fistulae with Their Long-Term Patency

2017 ◽  
Vol 18 (5) ◽  
pp. 443-449 ◽  
Author(s):  
Ali Kordzadeh ◽  
Yiannis P. Panayiotopolous
Keyword(s):  
Minimally Invasive ◽  
Primary Patency ◽  
Minimally Invasive Procedures ◽  
Invasive Procedures ◽  
Arteriovenous Fistulae ◽  
Functional Maturation ◽  
Vein Diameter

Introduction The aim of this study is to examine the role of five different operative salvage techniques with their long-term primary patency (PP) in an algorithmic manner in gaining primary functional maturation (FM) in radio cephalic arteriovenous fistulae (RCAVF) formation following their impairment. Methods A prospective consecutive data collection on 195 patients undergoing only autogenous RCAVF formation from July 2013 to December 2015 was conducted. Each non-maturing fistula was then exposed to a salvage technique by an algorithmic methodology and their FM and PP was prospectively recorded. Results Forty-two patients were exposed to five different salvages techniques, with a median age of 67 years (IQR, 27-90), cephalic vein diameter of 2 mm (IQR, 1.5-4 mm) and radial artery diameter of 1.8 mm (IQR, 1.2-2.1 mm), demonstrated 63.1% FM and cumulative primary patency of 15.2 months (95% CI, 12.5-17.9) over a 21-month follow-up period. Conclusions Operative salvage techniques play an important role in achieving assisted functional maturation and long-term patency in RCAVF as an alternative and/or in conjunction with other minimally invasive procedures. These procedures can maximize access outcome, minimize bridging procedures, decrease complications and optimize patient anatomical resources for longer access provisions in an era of aging population.

Three-Dimensional Endoscopic Magnification for Treatment of Thoracic Spinal Dural Arteriovenous Fistulas: Technical Note

2017 ◽  
Vol 14 (3) ◽  
pp. 259-266
Author(s):  
Alexander G Weil ◽  
Sami Obaid ◽  
Chiraz Chaalala ◽  
Daniel Shedid ◽  
Elsa Magro ◽  
...  
Keyword(s):  
Minimally Invasive ◽  
Technical Note ◽  
Minimally Invasive Approach ◽  
Tubular Retractor ◽  
Invasive Approach ◽  
Arteriovenous Fistulas ◽  
Tunnel Vision ◽  
Thoracic Spinal ◽  
Dural Arteriovenous Fistulas ◽  
Spinal Dural Arteriovenous Fistulas

Abstract BACKGROUND Treatment of thoracic spinal dural arteriovenous fistulas (DAVFs) by microsurgery has recently been approached using minimally invasive spine surgery (MISS). The advantages of such an approach are offset by difficult maneuverability within the tubular retractor and by the creation of “tunnel vision” with reduced luminosity to a remote surgical target. OBJECTIVE To demonstrate how the pitfalls of MISS can be addressed by applying 3-D endoscopy to the minimally invasive approach of spinal DAVFs. METHODS We present 2 cases of symptomatic thoracic DAVFs that were not amenable to endovascular treatment. The DAVFs were excluded solely via a minimally invasive approach using a 3-D endoscope. RESULTS Two patients underwent exclusion of a DAVF following laminotomy, one through a midline 5-cm incision and the other through a paramedian 3-cm incision using minimally invasive nonexpandable tubular retractors. The dura opening, intradural exploration, fistula exclusion, and closure were performed solely under endoscopic 3-D magnification. No incidents were recorded and the postoperative course was marked by clinical improvement. Postoperative imaging confirmed the exclusion of the DAVFs. Anatomical details are exposed using intraoperative videos. CONCLUSION When approaching DAVFs via MISS, replacing the microscope with the endoscope remedies the limitations related to the “tunnel vision” created by the tubular retractor, but at the expense of losing binocular vision. We show that the 3-D endoscope resolves this latter limitation and provides an interesting option for the exclusion of spinal DAVFs.

scholarly journals Patency and functionality of radiocephalic arteriovenous fistulas with an external support device (VasQ™): Real-world single-center experience

2020 ◽  
pp. 112972982090459 ◽  
Author(s):  
Robert Shahverdyan ◽  
Tobias Meyer ◽  
Vladimir Matoussevitch
Keyword(s):  
Real World ◽  
Primary Patency ◽  
External Support ◽  
Secondary Patency ◽  
Single Center ◽  
Arteriovenous Fistulae ◽  
Arteriovenous Fistulas ◽  
Single Center Experience ◽  
Study Population ◽  
The Impact

Background: The VasQTM device was designed to improve the outcome of arteriovenous fistulae by optimizing the hemodynamics of the flow in the juxta-anastomotic region of the arteriovenous fistulae through tailored external support. The aim of the study was to evaluate the impact of the VasQ on outcome of radiocephalic arteriovenous fistulae in a real-world setting. Methods: This was a single-center, retrospective analysis of patients with either fistula creation before or after dialysis initiation with implantation of the VasQ device during creation of end-to-side radiocephalic arteriovenous fistulae between June 2018 and May 2019. The flow rate and vein diameter were evaluated intraoperatively, at discharge within 48 h postprocedure and at a follow-up of 1, 3, 6, 9, and 12 months. Results: Thirty-three VasQ devices were implanted during 33 radiocephalic arteriovenous fistula procedures. The study population comprised mostly of men, with an average age of 66 years. Mean intraoperative flow was 428 mL/min (range: 130–945). All patients were discharged with patent arteriovenous fistulae and mean fistula flow of 740 mL/min (range: 230–1300 mL/min). The primary patency was 100% and 79% at 3 and 6 months, respectively. Cumulative/secondary patency was 100% and 90% at 3 and 6 months, respectively. Conclusion: Data presented here suggest that the VasQ device has the potential to provide benefit to the functionality of radiocephalic arteriovenous fistulae.

Minimally invasive approach for the treatment of lumbar epidural arteriovenous fistulas with intradural venous reflux

2016 ◽  
Vol 62 (5) ◽  
pp. 258-262 ◽  
Author(s):  
A. Najjar ◽  
F. Zairi ◽  
T. Sunna ◽  
A. Weil ◽  
L. Estrade ◽  
...  
Keyword(s):  
Minimally Invasive ◽  
Venous Reflux ◽  
Minimally Invasive Approach ◽  
Invasive Approach ◽  
Arteriovenous Fistulas

scholarly journals Comparing Robot-Assisted Laparoscopic Pyeloplasty vs. Laparoscopic Pyeloplasty in Infants Aged 12 Months or Less

2021 ◽  
Vol 9 ◽  
Author(s):  
Yuenshan Sammi Wong ◽  
Kristine Kit Yi Pang ◽  
Yuk Him Tam
Keyword(s):  
Minimally Invasive ◽  
Intraoperative Complications ◽  
Linear Regression Analysis ◽  
Hospital Length Of Stay ◽  
Success Rates ◽  
Laparoscopic Pyeloplasty ◽  
Minimally Invasive Approach ◽  
Robot Assisted ◽  
Analgesic Requirement ◽  
Invasive Approach

Objective: To investigate the outcomes of minimally invasive approach to infants with ureteropelvic junction (UPJ) obstruction by comparing the two surgical modalities of robot-assisted laparoscopic pyeloplasty (RALP) and laparoscopic pyeloplasty (LP).Methods: We conducted a retrospective review of all consecutive infants aged ≤12 months who underwent either LP or RALP in a single institution over the period of 2008–Jul 2020. We included primary pyeloplasty cases that were performed by or under the supervision of the same surgeon.Results: Forty-six infants (LP = 22; RALP = 24) were included with medians of age and body weight at 6 months (2–12months) and 8.0 kg (5.4–10 kg), respectively. There was no difference between the two groups in the patients' demographics and pre-operative characteristics. All infants underwent LP or RALP successfully without conversion to open surgery. None had intraoperative complications. Operative time (OT) was 242 min (SD = 59) in LP, compared with 225 min (SD = 39) of RALP (p = 0.25). Linear regression analysis showed a significant trend of decrease in OT with increasing case experience of RALP(p = 0.005). No difference was noted in the post-operative analgesic requirement. RALP was associated with a shorter hospital length of stay than LP (3 vs. 3.8 days; p = 0.009). 4/22(18%) LP and 3/24(13%) RALP developed post-operative complications (p = 0.59), mostly minor and stent-related. The success rates were 20/22 (91%) in LP and 23/24 (96%) in RALP (p = 0.49).Conclusions: Pyeloplasty by minimally invasive approach is safe and effective in the infant population. RALP may have superiority over LP in infants with its faster recovery and a more manageable learning curve to acquire the skills.

scholarly journals Transforaminal Endoscopic Discectomy with Foraminoplasty for the Treatment of Spondylolisthesis

2014 ◽  
Vol 6;17 (6;12) ◽  
pp. E703-E708 ◽  
Author(s):  
Albert E. Telfeian
Keyword(s):  
Minimally Invasive ◽  
General Anesthesia ◽  
Degenerative Spondylolisthesis ◽  
Lumbar Radiculopathy ◽  
Invasive Approach ◽  
Vas Score ◽  
Constant Pain ◽  
Endoscopic Discectomy ◽  
One Year

Background: Lumbar degenerative spondylolisthesis is a common entity and occurs mainly in elderly patients. The trend in surgery has been to offer decompression with instrumented fusion based on patient-based outcome data and the inherent instability of the condition. Objectives: Transforaminal endoscopic discectomy and foraminotomy is an ultra-minimally invasive outpatient surgical option available to patients that does not require general anesthesia and does not involve the same amount of destabilizing facet joint removal as a traditional laminectomy and medial facetectomy. The purpose of this study was to assess the benefit of tranforaminal endoscopic discectomy and foraminotomy in patients with lumbar 4-5 (L4-L5) and lumbar 5-sacral 1 (L5-S1) spondylolisthesis and lumbar radiculopathy. Methods: After Institutional Review Board Approval, charts from 21 consecutive patients with L4-L5 or L5-S1 spondylolisthesis and complaints of lower back and radicular pain who underwent endoscopic procedures between 2007 and 2012 were reviewed. Results: The average pain relief one year postoperatively was reported to be 71.9%, good results as defined by MacNab. The average pre-operative VAS score was 8.48, indicated in our questionnaire as severe and constant pain. The average one year postoperative VAS score was 2.30, indicated in our questionnaire as mild and intermittent pain. Limitations: This is a retrospective study and only offers one year follow-up data for patients with spondylolisthesis undergoing endoscopic spine surgery for treatment of lumbar radiculopathy. Conclusions: Endoscopic discectomy is a safe and effective alternative to open back surgery. The one year follow-up data presented here appears to indicate that an ultra-minimally invasive approach to the treatment of lumbar radiculopathy in the setting of spondylolisthesis that has a low complication rate, avoids general anesthesia, and is outpatient might be worth studying in a prospective, longer term way. IRB approval: Meridian Health: IRB Study # 201206071J Key words: Endoscopic discectomy, minimally-invasive, transforaminal, spondylolisthesis

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