Minimally invasive pancreatic resection for patients with benign to low-grade malignancies

Abstract BACKGROUND Advances in operative techniques and minimally invasive technologies have evolved to maximize patient outcomes and radiographic results, while reducing morbidity and recovery time. OBJECTIVE To describe the operative technique for a transfacet minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF) as a proposed modification to the standard approach MIS-TLIF. METHODS We present the case of a 72-yr-old man with left-sided lumbar radiculopathy. Preoperative imaging demonstrated degenerative lumbar anterolisthesis at L4-5, with associated canal and neuroforaminal stenosis. The patient underwent transfacet MIS-TLIF at L4-L5. We describe the preoperative planning, patient positioning, incision and dissection, pedicle screw insertion, transfacet approach to the working access corridor, discectomy, interbody device placement, fixation, and closure. RESULTS The transfacet MIS-TLIF utilizes 3 key techniques to safely maximize surgical correction: (1) a limited bony resection based on the superior articular process, leaving the medial inferior articular process, lateral superior articular process, and rostral pars intact, providing a working bony corridor that protects the traversing and exiting nerve roots; (2) decortication and release of the contralateral facet joint to provide additional capacity for indirect decompression and provide the first point of osseous fusion; and (3) placement of an expandable interbody device that provides additional indirect decompression to the working side and contralateral foramen. CONCLUSION The transfacet MIS-TLIF uniquely leverages a bony working corridor to access the disc space for discectomy and interbody placement. Transfacet MIS-TLIF is a feasible solution for lumbar spinal reconstruction to maximize direct and indirect decompression of the neuroforamina and central spinal canal in patients with lumbar degenerative diseases and low-grade spondylolisthesis.

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Stand-Alone Lateral Interbody Fusion for the Treatment of Low-Grade Degenerative Spondylolisthesis

The Scientific World JOURNAL ◽

10.1100/2012/456346 ◽

2012 ◽

Vol 2012 ◽

pp. 1-7 ◽

Cited By ~ 77

Author(s):

Luis Marchi ◽

Nitamar Abdala ◽

Leonardo Oliveira ◽

Rodrigo Amaral ◽

Etevaldo Coutinho ◽

...

Keyword(s):

Minimally Invasive ◽

Interbody Fusion ◽

Degenerative Spondylolisthesis ◽

Lateral Approach ◽

Low Grade ◽

Mean Values ◽

Single Level ◽

Lateral Interbody Fusion ◽

Cage Subsidence ◽

Lateral Interbody

The purpose of this paper was to investigate the stand-alone lateral interbody fusion as a minimally invasive option for the treatment of low-grade degenerative spondylolisthesis with a minimum 24-month followup. Prospective nonrandomized observational single-center study. 52 consecutive patients (67.6±10 y/o; 73.1% female;27.4±3.4 BMI) with single-level grade I/II single-level degenerative spondylolisthesis without significant spine instability were included. Fusion procedures were performed as retroperitoneal lateral transpsoas interbody fusions without screw supplementation. The procedures were performed in average 73.2 minutes and with less than 50cc blood loss. VAS and Oswestry scores showed lasting improvements in clinical outcomes (60% and 54.5% change, resp.). The vertebral slippage was reduced in 90.4% of cases from mean values of 15.1% preoperatively to 7.4% at 6-week followup (P<0.001) and was maintained through 24 months (7.1%,P<0.001). Segmental lordosis (P<0.001) and disc height (P<0.001) were improved in postop evaluations. Cage subsidence occurred in 9/52 cases (17%) and 7/52 cases (13%) spine levels needed revision surgery. At the 24-month evaluation, solid fusion was observed in 86.5% of the levels treated. The minimally invasive lateral approach has been shown to be a safe and reproducible technique to treat low-grade degenerative spondylolisthesis.

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Worldwide survey on current use, value and safe implementation of minimally invasive pancreatic resection

HPB ◽

10.1016/j.hpb.2017.02.018 ◽

2017 ◽

Vol 19 ◽

pp. S40

Author(s):

J. van Hilst ◽

T. de Rooij ◽

M. Abu Hilal ◽

H. Asbun ◽

J. Barkun ◽

...

Keyword(s):

Minimally Invasive ◽

Pancreatic Resection ◽

Use Value

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MIS-TLIF versus O-TLIF for single-level degenerative stenosis: study protocol for randomised controlled trial

BMJ Open ◽

10.1136/bmjopen-2020-041134 ◽

2021 ◽

Vol 11 (3) ◽

pp. e041134

Author(s):

Olga N Leonova ◽

Evgeny A Cherepanov ◽

Aleksandr V Krutko

Keyword(s):

Minimally Invasive ◽

Study Protocol ◽

Controlled Trial ◽

Clinical Results ◽

Patient Reported Outcome Measures ◽

Neurogenic Claudication ◽

Low Grade ◽

Clinical Safety ◽

Single Level ◽

Patient Reported

IntroductionPatients with symptomatic single-level combination of degenerative stenosis and low-grade spondylolisthesis are often treated by nerve root decompression and spinal fusion. The gold standard is traditional open decompression and fusion, but minimally invasive method is more and more prevailing. However, there is lack of high-quality studies comparing these two techniques in order to obtain the advantages and certain indications to use one of these methods. The current study includes clinical, safety and radiological endpoints to determine the effectiveness of minimally invasive decompression and fusion (MIS-TLIF) over the traditional open one (O-TLIF).Methods and analysisAll patients aged 40–75 years with neurogenic claudication or bilateral radiculopathy caused by single-level combination of degenerative stenosis and low-grade spondylolisthesis, confirmed by MRI with these symptoms persisting for at least 3 months prior to surgery, are eligible. Patients will be randomised into MIS-TLIF or traditional O-TLIF. The primary outcome measure is Oswestry Disability Index at 3-month follow-up term. The secondary outcomes are patient-reported outcome measures by the number of clinical scales, radiological parameters including sagittal balance parameters, safety endpoints and cost-effectiveness of each method. All patients will be analysed preoperatively, as well as on the 14th day of hospital stay (or on the day of hospital discharge), 3 months, 6 months, 12 months and 24 months postoperatively. The study has the design of a parallel group to demonstrate the non-inferior clinical results of MIS-TLIF compared with the traditional O-TLIF.Ethics and disseminationThe study will be performed according to Helsinki Declaration. The study protocol was approved by the Local Ethical Committee of Priorov National Medical Research Center of Traumatology and Orthopedics in August 2020. Preliminary and final results will be presented in peer-reviewed journals, especially orthopaedic and spine surgery journals, at national and international congresses.Trial registration numberNCT04594980.

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Laparoscopic versus open pancreatic resection for ductal adenocarcinoma: separate propensity score matching analyses of distal pancreatectomy and pancreaticoduodenectomy

10.21203/rs.3.rs-35303/v1 ◽

2020 ◽

Author(s):

Ke Chen ◽

Yu Pan ◽

Chao-jie Huang ◽

Qi-long Chen ◽

Ren-chao Zhang ◽

...

Keyword(s):

Propensity Score ◽

Blood Loss ◽

Propensity Score Matching ◽

Distal Pancreatectomy ◽

Pancreatic Resection ◽

Open Surgery ◽

Operative Time ◽

Ductal Adenocarcinoma ◽

Survival Outcomes ◽

Low Grade

Abstract Background: Pancreatic ductal adenocarcinoma (PDAC) is one of the most leading causes of cancer mortality worldwide. Laparoscopic pancreatic resection (LPR) has been widely used in the treatment of benign and low-grade pancreatic diseases. It is necessary to expand the current knowledge on the feasibility and safety of LPR for PDAC. Laparoscopic distal pancreatectomy (LDP) and pancreaticoduodenectomy (LPD) are two main surgical approaches for PDAC. We performed separate propensity score matching (PSM) analyses, aiming to assess the surgical and oncological outcomes of LPR for PDAC by comparing LDP with open distal pancreatectomy (ODP) as well as LPD with open pancreaticoduodenectomy (OPD).Methods: Data of patients who underwent DP and PD for PDAC from January 2004 to February 2020 in our hospital were obtained. Baseline characteristics, intraoperative effect, postoperative recovery, and survival outcomes were compared. One-to-one PSM was used to minimize selection biases by balancing factors including age, sex, BMI, and tumor size.Results: Patient demographics were well matched after PSM. The DP subgroup included 86 LDP patients and 86 ODP patients, whereas the PD subgroup included 101 LPD patients and 101 OPD patients. Compared to ODP, LDP was associated with shorter operative time, less blood loss, and comparable overall morbidity. Of the 101 patients who underwent LPD, 10 patients (9.9%) required conversion to laparotomy. LPD was associated with longer operative time, less blood loss, and comparable overall morbidity. For oncological and survival outcomes, there were no significant differences in tumor sizes, R0 resection rate and tumor stage in both DP and PD subgroup. However, laparoscopic procedures seems to have an advantage over open surgery in terms of retrieved lymph node (DP subgroup: 14.4 ± 5.2 vs. 11.7 ± 5.1, p = 0.03; PD subgroup 21.9 ± 6.6 vs. 18.9 ± 5.4, p = 0.07). There was no statistical signiﬁcance between both groups in recurrence pattern, and 3-year recurrence-free and overall survival were comparable between groups.Conclusions: Both LDP and LPD are feasible and oncologically safe procedures for PDAC. Postoperative outcomes and long-term survival of LDP and LPD are not inferior or superior to open surgery. However, the short-term surgical advantage of LPD is not as obvious as LDP mainly due to the conversions. Our findings should be further evaluated by multicenter or randomized controlled trials.

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