Computed tomography as a method of substantiating a minimally invasive approach in the treatment of esophageal injuries and their complications

The purpose of the study. To analyze possibilities of computed tomography (CT) for esophageal injuries and their complications as part of a differentiated approach to the choice of a minimally invasive treatment method.Materials and methods. The results of CT scans were analyzed in 25 patients with esophageal injuries of various etiologies who were treated at the N.V. Sklifosovsky Research Institute of SP in the period 2019–2020. CT was performed with oral and intravenous bolus contrast, primarily at admission and in dynamics, a total of 77 studies.Results. In all cases, direct and indirect CT signs of esophageal damage were detected, and the degree of involvement of surrounding organs and tissues in the pathological process was assessed. Based on the data obtained, the following variants of esophageal damage and its complications were identified: intramural esophageal hematoma (2); rupture of the thoracic esophagus without the development of purulent complications (2); rupture of the thoracic esophagus complicated by the development of mediastinitis (4); rupture of the thoracic esophagus with the development of mediastinitis and pleural empyema (13); rupture of the cervical calving of the esophagus, complicated by phlegmon of the neck and descending mediastinitis (4). Different patient management tactics were used for each variant. Thus, the selection and sequence of minimally invasive interventions, such as thoracoscopic sanitation mediastinal and pleural cavity, esophageal stenting, percutaneous endoscopic gastrostomy (CEG) and endoscopic vacuum aspiration system (E-VAS), were carried out taking into account CT data, including observations in dynamics.Conclusion. CT scan for esophageal injuries allows you to get complete information about both the nature of esophageal damage and its complications, to determine their type, localization and volume. CT data allow us to justify a minimally invasive approach in the treatment of esophageal injuries, to determine the order of interventions. CT studies performed in dynamics allow us to evaluate the effectiveness of treatment and to carry out timely correction of tactics.

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Short-Term Radiographic Outcomes of Calcaneus Fractures Treated With 2-Incision, Minimally Invasive Approach

Foot & Ankle International ◽

10.1177/1071100719853872 ◽

2019 ◽

Vol 40 (9) ◽

pp. 1060-1067

Author(s):

Snow B. Daws ◽

Kaitlin Neary ◽

Gregory Lundeen

Keyword(s):

Minimally Invasive ◽

Sensory Nerve ◽

Case Series ◽

Fracture Reduction ◽

Minimally Invasive Approach ◽

Invasive Treatment ◽

Level Of Evidence ◽

Invasive Approach ◽

Calcaneus Fractures ◽

Böhler’S Angle

Background: The treatment of displaced, intra-articular calcaneus fractures is controversial. The extensile lateral approach has been historically preferred because it provides excellent exposure and visualization for fracture reduction. However, soft tissue complications with this approach can lead to poor outcomes for patients. Recently, there has been an interest in the minimally invasive treatment of calcaneus fractures. The purpose of the present study was to determine the radiographic reduction of displaced, intra-articular calcaneus fractures and the rate of complications using a 2-incision, minimally invasive approach. Methods: A dual-incision, minimally invasive approach with plate and screw fixation was utilized for the treatment of 32 patients with displaced, intra-articular calcaneus fractures. Preoperative and postoperative calcaneal measurements were taken to assess fracture reduction. Additionally, a retrospective chart review was performed to assess for complications. Results: The mean preoperative Bohler’s angle measurement was 12.9 (range, –5 to 36) degrees and the final postoperative Bohler’s angle was 31.7 (range, 16-40) degrees. One patient (3.1%) had postoperative numbness related to the medial incision in the calcaneal branch sensory nerve distribution. Two patients (6.2%) had a wound infection treated with local wound care and oral antibiotics, while 1 patient (3.1%) had a deep infection that required a secondary surgery for irrigation and debridement. Two patients (6.2%) returned to the operating room for removal of symptomatic hardware. Conclusion: Operative fixation of displaced, intra-articular calcaneus fractures treated with a 2-incision, minimally invasive approach resulted in acceptable fracture reduction with a minimal rate of complications. Level of Evidence: Level IV, retrospective case series.

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Accuracy of Patient-Specific 3D Printed Drill Guides in the Placement of a Canine Coxofemoral Toggle Pin through a Minimally Invasive Approach

Veterinary and Comparative Orthopaedics and Traumatology ◽

10.1055/s-0040-1719169 ◽

2020 ◽

Author(s):

Brett G. Darrow ◽

Kyle A. Snowdon ◽

Adrien Hespel

Keyword(s):

Minimally Invasive ◽

Three Dimensional ◽

Bone Tunnel ◽

Patient Specific ◽

Exit Point ◽

Minimally Invasive Approach ◽

Invasive Approach ◽

Post Procedure ◽

Drill Guide ◽

Ct Data

Abstract Objective The aim of this study was to evaluate the accuracy of patient-specific three-dimensional printed drill guides (3D-PDG) for the placement of a coxofemoral toggle via a minimally invasive approach. Materials and Methods Pre-procedure computed tomography (CT) data of 19 canine cadaveric hips were used to design a cadaver-specific 3D-PDG that conformed to the proximal femur. Femoral and acetabular bone tunnels were drilled through the 3D-PDG, and a coxofemoral toggle pin was placed. The accuracy of tunnel placement was evaluated with post-procedure CT and gross dissection. Results Coxofemoral toggle pins were successfully placed in all dogs. Mean exit point translation at the fovea capitis was 2.5 mm (0.2–7.5) when comparing pre- and post-procedure CT scans. Gross dissection revealed the bone tunnel exited the fovea capitis inside (3/19), partially inside (12/19) and outside of (4/19) the ligament of the head of the femur. Placement of the bone tunnel through the acetabulum was inside (16/19), partially inside (1/19) and outside (2/19) of the acetabular fossa. Small 1 to 2 mm articular cartilage fragments were noted in 10 of 19 specimens. Clinical Significance Three-dimensional printed drill guide designed for coxofemoral toggle pin application is feasible. Errors are attributed to surgical execution and identification of the borders of the fovea capitis on CT data. Future studies should investigate modifications to 3D-PDG design and methods. Three-dimensional printed drill guide for coxofemoral toggle pin placement warrants consideration for use in select clinical cases of traumatic coxofemoral luxation.

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MINIMALLY INVASIVE POSTERIOR OSTEOTOMIES

Neurosurgery ◽

10.1227/01.neu.0000320430.37577.b7 ◽

2008 ◽

Vol 63 (suppl_3) ◽

pp. A204-A210 ◽

Cited By ~ 17

Author(s):

Jean-Marc Voyadzis ◽

Vishal C. Gala ◽

John E. O'Toole ◽

Kurt M. Eichholz ◽

Richard G. Fessler

Keyword(s):

Computed Tomography ◽

Minimally Invasive ◽

Muscle Injury ◽

Pedicle Subtraction Osteotomy ◽

Bone Resection ◽

Minimally Invasive Approach ◽

Tubular Retractor ◽

Invasive Approach ◽

Severe Postoperative Pain ◽

Human Cadavers

ABSTRACT OBJECTIVE Surgery for thoracolumbar deformity can lead to significant muscle injury, excessive blood loss, and severe postoperative pain. The aim of the following studies was to determine the feasibility of minimally invasive posterior thoracic corpectomy and thoracolumbar osteotomy techniques for deformity in human cadavers and select clinical cases. METHODS Human cadaveric specimens were procured for thoracic corpectomy and Smith-Petersen and pedicle subtraction osteotomy using a minimally invasive approach. Post-procedural computed tomography was used to assess the degree of decompression following corpectomy and the extent of bone resection after osteotomy. Pre and post-osteotomy closure Cobb angles were measured to evaluate the degree of correction achieved. RESULTS The minimally invasive lateral extracavitary approach for thoracic corpectomy provided adequate exposure and allowed excellent spinal canal decompression while minimizing tissue disruption. Nearly complete osteotomies of both types could be achieved through a tubular retractor with a modest change in Cobb angle. CONCLUSION These techniques may play a role in deformity surgery for select cases with further technological advancements.

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Minimally invasive treatment of spinal dural arteriovenous fistula with the use of intraoperative indocyanine green angiography

Neurosurgical FOCUS ◽

10.3171/2013.v2.focus13191 ◽

2013 ◽

Vol 35 (v2supplement) ◽

pp. Video5 ◽

Cited By ~ 6

Author(s):

Ricardo B. Fontes ◽

Lee A. Tan ◽

John E. O'Toole

Keyword(s):

Minimally Invasive ◽

Indocyanine Green ◽

Arteriovenous Fistula ◽

Dural Arteriovenous Fistula ◽

Early Mobilization ◽

Open Approach ◽

Minimally Invasive Approach ◽

Invasive Treatment ◽

Spinal Dural Arteriovenous Fistula ◽

Invasive Approach

Spinal dural arteriovenous fistula (dAVF) is the most common vascular malformation of the spinal cord. Traditionally it is treated by the standard muscle-splitting midline approach with bilateral laminectomies extending from one level above to one level below the dAVF. We present a minimally invasive approach for ligation of dAVF with concurrent use of intraoperative indocyanine green (ICG) angiography. Minimally invasive watertight dural closure technique is also demonstrated and discussed. The minimally invasive approach with intraoperative ICG results in quicker recovery, early mobilization and shorter hospital stay compared to traditional open approach.The video can be found here: http://youtu.be/mNUeJKLxL3Q.

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Preoperative planning of left-sided valve surgery with 3D computed tomography reconstruction models: sternotomy or a minimally invasive approach?†

Interactive CardioVascular and Thoracic Surgery ◽

10.1093/icvts/ivv408 ◽

2016 ◽

Vol 22 (5) ◽

pp. 587-593 ◽

Cited By ~ 16

Author(s):

Samuel Heuts ◽

Jos G. Maessen ◽

Peyman Sardari Nia

Keyword(s):

Computed Tomography ◽

Minimally Invasive ◽

Preoperative Planning ◽

Valve Surgery ◽

Minimally Invasive Approach ◽

Invasive Approach ◽

3D Computed Tomography ◽

Tomography Reconstruction ◽

Computed Tomography Reconstruction

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An Alternative Treatment Method Using a Minimally Invasive Approach Employing: Ceramic Veneer to Replace Discolored Composite Veneer: A Case Report

Indian Journal of Public Health Research & Development ◽

10.5958/0976-5506.2019.03462.4 ◽

2019 ◽

Vol 10 (11) ◽

pp. 223

Author(s):

Lora Mishra ◽

Manoj Kumar

Keyword(s):

Case Report ◽

Minimally Invasive ◽

Alternative Treatment ◽

Treatment Method ◽

Minimally Invasive Approach ◽

Invasive Approach

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Guidelines of the Italian Society of Videosurgery in Infancy (SIVI) for the minimally invasive treatment of fetal and neonatal ovarian cysts

La Pediatria Medica e Chirurgica ◽

10.4081/pmc.2020.242 ◽

2020 ◽

Vol 42 (1) ◽

Author(s):

Salvatore Fabio Chiarenza ◽

Maria Luisa Conighi ◽

Andrea Conforti ◽

Cosimo Bleve ◽

Ciro Esposito ◽

...

Keyword(s):

Minimally Invasive ◽

Prenatal Screening ◽

Minimally Invasive Treatment ◽

Ovarian Cysts ◽

Minimally Invasive Approach ◽

Invasive Treatment ◽

Invasive Approach ◽

Technological Improvement ◽

Treatment Uncertainties ◽

Screening Ultrasound

In the last three decades, fetal ovarian cysts were diagnosed more frequently, due to technological improvement and the increasing use of prenatal screening ultrasound. Nonetheless, treatment uncertainties are still present, either prenatally or postnatally. Recently, significant innovations on diagnosis and treatment have been proposed and a more conservative, minimally invasive approach may be offered to the Pediatrician or the Surgeon who face with this condition during prenatal or neonatal age. (...)

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PS02.011: ESOPHAGECTOMY IN A LOW VOLUME SINGLE CENTER FAVORING A TOTAL MINIMALLY INVASIVE APPROACH: 55 PATIENTS IN 7 YEAR

Diseases of the Esophagus ◽

10.1093/dote/doy089.ps02.011 ◽

2018 ◽

Vol 31 (Supplement_1) ◽

pp. 123-123

Author(s):

Philipp Gehwolf ◽

Thomas Schmid ◽

Dietmar Öfner-Velano ◽

Heinz Wykypiel

Keyword(s):

Esophageal Cancer ◽

Minimally Invasive ◽

Conflicts Of Interest ◽

Tertiary Care ◽

Locally Advanced ◽

Esophageal Resection ◽

Thoracic Esophagus ◽

Minimally Invasive Approach ◽

Invasive Approach ◽

Low Volume

Abstract Background In Austria esophageal cancer is not very common. The incidence is 8.8/100.000 per year, thus esophageal cancer is on rank 18 of the most common carcinomas. Multimodal treatment inclouding surgery is standard for locally advanced esophageal cancer with a 5-year survival rate of around 40% in patients treated with a curative intent. Methods Retrospective single institution study in a tertiary care center using prospectively collected data we discuss our surgical procedure with patient survival as primary endpoint and morbidity as secondary endpoint. Results From 2010–1017, 55 Patients received an esophageal resection. The mean age was 61.5 years, five patients (9%) were female. Squamous cell carcinoma appeared in 37%, adenocarcinoma in 59% and a verrucous carcinoma in 4% of our patients. 98% of patients received an esophagectomy with gastric tube pull up, in 2% the colon was used for reconstruction. For patients with carcinoma located in the lower and middle thoracic esophagus a thoracic anastomosis was targeted (78%), in carcinomas of the upper thoracic esophagus a left cervical anastomosis (22%) was performed. Depending on location and comorbidities patients received either a conventional operation (11%), a hybrid operation with laparotomy and thoracoscopic esophageal resection (59%) or a totally minimal invasive approach (30%). The 60 days mortality was < 2%, the need for reoperation < 10%. Major complications (Clavien-Dindo III-V) were observed in 30%. Conclusion Esophagectomy is a high-risk operation with serious mortality and morbidity. However, patients may profit from a tailored approach with intent for the minimally invasive approach even in a low volume center when expertise in high-end endoscopic surgery is available. Disclosure All authors have declared no conflicts of interest.

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Minimally invasive treatment for Hirschsprung disease

Romanian Medical Journal ◽

10.37897/rmj.2015.3.15 ◽

2015 ◽

Vol 62 (3) ◽

pp. 289-293

Author(s):

Simona-Gabriela Tudorache ◽

◽

Felix Negoiţescu ◽

Laura Niculescu ◽

◽

...

Keyword(s):

Minimally Invasive ◽

Surgical Techniques ◽

Hirschsprung Disease ◽

Minimally Invasive Techniques ◽

Minimally Invasive Approach ◽

Invasive Treatment ◽

Invasive Approach ◽

Duhamel Procedure ◽

Pull Through ◽

Invasive Techniques

Introduction. Harold Hirschsprung, a physician at Queen Louise Children’s Hospital of Copenhagen, first described the disease that now bears his name, at the Pediatric Congress of Berlin in 1886. Since then there have been countless debates on the optimal surgical approach. This paper aims both to recap the main classical surgical techniques: Swenson, Duhamel and Soave, but the main focus is on minimally invasive techniques. Surgical techniques. In the last 25 years, the treatment for Hirschsprung disease has progressed. If classically the preferred treatment was in 2-3 stages, now the definitive intervention is per primam in most cases, thus avoiding the morbidity associated with stomas. In 1995, Georgeson describes the minimally invasive approach using laparoscopy, and then in 1998, De la Torre et al, describes the first transanal endorectal pull-through (TERPT), unattended laparoscopically. Discussions. The initial discussions were linked to comparing processes in a single stage with ones in 2 or 3 stages, finding similar results, it is now a question of comparing open techniques with minimally invasive and even minimally invasive techniques with each other, endeavoring to establish whether laparoscopically assisted approach is needed or if the transanal one is enough. Conclusion. Usually shorter forms of Hirschsprung disease are treated strictly using the transanal technique, for the forms involving the left and transverse colon laparoscopically assisted transanal pull-through is used, while for the ascending colon and for the total aganglionosis the laparoscopically assisted Duhamel procedure is preferred.

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