scholarly journals Cost minimization in treatment of adult degenerative scoliosis

2015 ◽  
Vol 23 (6) ◽  
pp. 798-806 ◽  
Author(s):  
Omar M. Uddin ◽  
Raqeeb Haque ◽  
Patrick A. Sugrue ◽  
Yousef M. Ahmed ◽  
Tarek Y. El Ahmadieh ◽  
...  
Keyword(s):  
Minimally Invasive Surgery ◽  
Blood Loss ◽  
Minimally Invasive ◽  
Invasive Surgery ◽  
Open Surgery ◽  
Cost Minimization ◽  
Degenerative Scoliosis ◽  
Adult Degenerative Scoliosis ◽  
Vas Scores

OBJECT Back pain is an increasing concern for the aging population. This study aims to evaluate if minimally invasive surgery presents cost-minimization benefits compared with open surgery in treating adult degenerative scoliosis. METHODS Seventy-one patients with adult degenerative scoliosis received 2-stage, multilevel surgical correction through either a minimally invasive spine surgery (MIS) approach with posterior instrumentation (n = 38) or an open midline (Open) approach (n = 33). Costs were derived from hospital and rehabilitation charges. Length of stay, blood loss, and radiographic outcomes were obtained from electronic medical records. Functional outcomes were measured with Oswestry Disability Index (ODI) and visual analog scale (VAS) surveys. RESULTS Patients in both cohorts were similar in age (AgeMIS = 65.68 yrs, AgeOpen = 63.58 yrs, p = 0.28). The mean follow-up was 18.16 months and 21.82 months for the MIS and Open cohorts, respectively (p = 0.34). MIS and Open cohorts had an average of 4.37 and 7.61 levels of fusion, respectively (p < 0.01). Total inpatient charges were lower for the MIS cohort ($269,807 vs $391,889, p < 0.01), and outpatient rehabilitation charges were similar ($41,072 vs $49,272, p = 0.48). MIS patients experienced reduced length of hospital stay (7.03 days vs 14.88 days, p < 0.01) and estimated blood loss (EBL) (EBLMIS = 470.26 ml, EBLOpen= 2872.73 ml, p < 0.01). Baseline ODI scores were lower in the MIS cohort (40.03 vs 48.04, p = 0.03), and the cohorts experienced similar 1-year improvement (ΔODIMIS = −15.98, ΔODIOpen = −21.96, p = 0.25). Baseline VAS scores were similar (VASMIS = 6.56, VASOpen= 7.10, p = 0.32), but MIS patients experienced less reduction after 1 year (ΔVASMIS = −3.36, ΔVASOpen = −4.73, p = 0.04). Preoperative sagittal vertical axis (SVA) were comparable (preoperative SVAMIS = 63.47 mm, preoperative SVAOpen = 71.3 mm, p = 0.60), but MIS patients had larger postoperative SVA (postoperative SVAMIS = 51.17 mm, postoperative SVAOpen = 28.17 mm, p = 0.03). CONCLUSIONS Minimally invasive surgery demonstrated reduced costs, blood loss, and hospital stays, whereas open surgery exhibited greater improvement in VAS scores, deformity correction, and sagittal balance. Additional studies with more patients and longer follow-up will determine if MIS provides cost-minimization opportunities for treatment of adult degenerative scoliosis.

scholarly journals The minimally invasive approach, laparoscopic and robotic, in rectal resection for cancer: A single center experience

2010 ◽  
Vol 57 (3) ◽  
pp. 29-35 ◽  
Author(s):  
I. Popescu ◽  
C. Vasilescu ◽  
V. Tomulescu ◽  
S. Vasile ◽  
O. Sgarbura
Keyword(s):  
Rectal Cancer ◽  
Minimally Invasive Surgery ◽  
Blood Loss ◽  
Minimally Invasive ◽  
Invasive Surgery ◽  
Metastatic Lymph Node ◽  
Robotic Approach ◽  
Invasive Approach ◽  
Significant Difference

Background: Robotic approach for rectal cancer competes with laparoscopy in centers dedicated to minimally invasive surgery (MIS) due to the technologic advantage. This is a report of our experience with MIS for rectal cancer. Methods: A series of 84 consecutive patients with laparoscopic resection (between 1995-2010) and 38 consecutive patients with robotic resection (between 2008-2010) for primary rectal cancer were analyzed. Hartmann's procedures were excluded. Clinical and pathologic outcomes were reviewed retrospectively. Results: In the laparoscopic group (LG), 50 anterior rectal resections (ARR), 34 abdominal perineal resections (APR) were performed while in the robotic group(RG) there were 30 ARR and 8 APR. The median operative time was 182 min (140-220 min) in LG and 208 min (180- 300 min) in RG (p=0.0002). No statistically significant difference was noticed between the groups in terms of conversion, morbidity, anastomotic leak and postoperative stay rates. Margin clearance was obtained in all patients and the median number of removed lymph nodes was similar: 11.37 in RG vs 11.07 in the LG (p=0.65) with a higher rate of metastatic lymph node involvement in laparoscopy (p=0.0012). Blood loss was higher in LG (150 ml vs. 100 ml; p=0.0001). There were 5 (5.9%) local recurrences in the LG at a median follow- up of 27.5 months and 2 (5.2%) in the RG at a median follow-up of 13 months (p=0.43). Conclusions: Minimally invasive surgery for rectal cancer proved to be safe and efficient with similar results in the two groups. Technological advances of robotic approach compared to laparoscopy allowed better ergonomics, more refined dissection, easier preserving of hypogastric nerves and less blood loss. Long term outcomes are to be assessed in prospective randomized studies.

Comparison of two minimally invasive surgery strategies to treat adult spinal deformity

2015 ◽  
Vol 22 (4) ◽  
pp. 374-380 ◽  
Author(s):  
Paul Park ◽  
Michael Y. Wang ◽  
Virginie Lafage ◽  
Stacie Nguyen ◽  
John Ziewacz ◽  
...  
Keyword(s):  
Minimally Invasive Surgery ◽  
Minimally Invasive ◽  
Cobb Angle ◽  
Invasive Surgery ◽  
Spinal Deformity ◽  
Adult Spinal Deformity ◽  
Significant Difference ◽  
Vas Scores ◽  
The Mean

OBJECT Minimally invasive surgery (MIS) techniques are becoming a more common means of treating adult spinal deformity (ASD). The aim of this study was to compare the hybrid (HYB) surgical approach, involving minimally invasive lateral interbody fusion with open posterior instrumented fusion, to the circumferential MIS (cMIS) approach to treat ASD. METHODS The authors performed a retrospective, multicenter study utilizing data collected in 105 patients with ASD who were treated via MIS techniques. Criteria for inclusion were age older than 45 years, coronal Cobb angle greater than 20°, and a minimum of 1 year of follow-up. Patients were stratified into 2 groups: HYB (n = 62) and cMIS (n = 43). RESULTS The mean age was 60.7 years in the HYB group and 61.0 years in the cMIS group (p = 0.910). A mean of 3.6 interbody fusions were performed in the HYB group compared with a mean of 4.0 interbody fusions in the cMIS group (p = 0.086). Posterior fusion involved a mean of 6.9 levels in the HYB group and a mean of 5.1 levels in the cMIS group (p = 0.003). The mean follow-up was 31.3 months for the HYB group and 38.3 months for the cMIS group. The mean Oswestry Disability Index (ODI) score improved by 30.6 and 25.7, and the mean visual analog scale (VAS) scores for back/leg pain improved by 2.4/2.5 and 3.8/4.2 for the HYB and cMIS groups, respectively. There was no significant difference between groups with regard to ODI or VAS scores. For the HYB group, the lumbar coronal Cobb angle decreased by 13.5°, lumbar lordosis (LL) increased by 8.2°, sagittal vertical axis (SVA) decreased by 2.2 mm, and LL–pelvic incidence (LL-PI) mismatch decreased by 8.6°. For the cMIS group, the lumbar coronal Cobb angle decreased by 10.3°, LL improved by 3.0°, SVA increased by 2.1 mm, and LL-PI decreased by 2.2°. There were no significant differences in these radiographic parameters between groups. The complication rate, however, was higher in the HYB group (55%) than in the cMIS group (33%) (p = 0.024). CONCLUSIONS Both HYB and cMIS approaches resulted in clinical improvement, as evidenced by decreased ODI and VAS pain scores. While there was no significant difference in degree of radiographic correction between groups, the HYB group had greater absolute improvement in degree of lumbar coronal Cobb angle correction, increased LL, decreased SVA, and decreased LL-PI. The complication rate, however, was higher with the HYB approach than with the cMIS approach.

scholarly journals Partial Plantar Fasciotomy Using Endoscope with Inner Two-Channel Portals Produced Better Functional Outcomes Than Mini-Open Procedures for The Treatment of Refractory Plantar Fasciitis

2019 ◽  
Author(s):  
Shi-Ming Feng ◽  
Ai-Guo Wang ◽  
Zai-Yi Zhang
Keyword(s):  
Minimally Invasive Surgery ◽  
Minimally Invasive ◽  
Invasive Surgery ◽  
Plantar Fasciitis ◽  
Open Surgery ◽  
Clinical Effects ◽  
Surgery Group ◽  
Sf 36 ◽  
Medial Access

Abstract Objective: To evaluate the clinical efficacy of partial fasciotomy using two-channel arthroscope in the treatment of refractory plantar fasciitis, and to compare it with the clinical effects of partial fasciotomy using minimally invasive open. Methods: Sixty-two patients with refractory fasciitis admitted from January 2015 to July 2017 were randomly assigned to the arthroscopic group and the open surgery group. Arthroscopic partial section was performed using endoscope with inner two-channel portals. The open surgery group underwent partial sacral fascia resection with minimally invasive medial incision. Then compare the pain visual analogue scale (VAS), the American foot and ankle surgery association score (AOFAS), the calcaneodynia score (CS), and the medical outcomes short form 36-item (SF-36) health survey between the two groups. Results: All patients were followed up for at least 24 months, and there was no difference in follow-up between two groups. At the last follow-up, the patient's plantar pain symptoms completely disappeared. There was no recurrence of the bone spurs, and the ankle and foot movements were normal. There was no statistically significant difference in VAS, AOFAS, and CS scores between the two groups. The SF-36 score of the arthroscopy group is significantly higher than the open surgery group. Conclusions: Arthroscopic partial fascia resection with medial access provides better clinical outcomes than the open minimally-invasive surgery. Arthroscopic partial fasciotomy with the medial access provides a new option better than the open minimally-invasive surgery for postoperative daily life.

scholarly journals Prospective, observational, multicenter study on minimally invasive gastrectomy for gastric cancer: robotic, laparoscopic and open surgery compared on operative and follow-up outcomes - IMIGASTRIC II study protocol: IMIGASTRIC II

2019 ◽  
Vol 1 (1) ◽  
pp. 9-15
Author(s):  
Jacopo Desiderio ◽  
Jian-Xian Lin ◽  
Enrique Norero ◽  
Felice Borghi ◽  
Alessandra Marano ◽  
...  
Keyword(s):  
Gastric Cancer ◽  
Minimally Invasive Surgery ◽  
Minimally Invasive ◽  
Invasive Surgery ◽  
Open Surgery ◽  
Data Repository ◽  
Time Data ◽  
Level Of Evidence

Background: Several meta-analyses have tried to defi ne the role of minimally invasive approaches. However, further evidence to get a wider spread of these methods is necessary. Current studies describe minimally invasive surgery as a possible alternative to open surgery but deserving further clarifi cation. However, despite the increasing interest, the difficulty of planning prospective studies of adequate size accounts for the low level of evidence, which is mostly based on retrospective experiences. A multi-institutional prospective study allows the collection of an impressive amount of data to investigate various aspects of minimally invasive procedures with the opportunity of developing several subgroup analyses. A prospective data collection with high methodological quality on minimally invasive and open gastrectomies can clarify the role of diff erent procedures with the aim to develop specifi c guidelines. Methods and analysis: a multi-institutional prospective database will be established including information on surgical, clinical and oncological features of patients treated for gastric cancer with robotic, laparoscopic or open approaches and subsequent follow-up. The study has been shared by the members of the International study group on Minimally Invasive surgery for GASTRIc Cancer (IMIGASTRIC) The database is designed to be an international electronic submission system and a HIPPA protected real time data repository from high volume gastric cancer centers. Ethics: This study is conducted in compliance with ethical principles originating from the Helsinki Declaration, within the guidelines of Good Clinical Practice and relevant laws/regulations. Trial registration number: NCT02751086

scholarly journals Minimally invasive surgery versus open surgery for the treatment of solid abdominal and thoracic neoplasms in children

2012 ◽  
Author(s):  
Manou S de Lijster ◽  
Rosemarijn M Bergevoet ◽  
Elvira C van Dalen ◽  
Erna MC Michiels ◽  
Huib N Caron ◽  
...  
Keyword(s):  
Minimally Invasive Surgery ◽  
Minimally Invasive ◽  
Invasive Surgery ◽  
Open Surgery ◽  
Thoracic Neoplasms

Video Tutorials Increase Precision in Minimally Invasive Surgery Training – a Prospective Randomised Trial and Follow-up Study

2018 ◽  
Vol 144 (02) ◽  
pp. 153-162
Author(s):  
Michael Thomaschewski ◽  
Hamed Esnaashari ◽  
Anna Höfer ◽  
Lotta Renner ◽  
Claudia Benecke ◽  
...  
Keyword(s):  
Minimally Invasive Surgery ◽  
Minimally Invasive ◽  
Invasive Surgery ◽  
Randomised Trial ◽  
Prospective Randomised Trial ◽  
Simulation Based ◽  
Video Tutorials ◽  
Group A ◽  
Group B

Abstract Background Simulation-based practice has become increasingly important in minimally invasive surgery (MIS) training. Nevertheless, personnel resources for demonstration and mentoring simulation-based practice are limited. Video tutorials could be a useful tool to overcome this dilemma. However, the effect of video tutorials on MIS training and improvement of MIS skills is unclear. Methods A prospective randomised trial (n = 24 MIS novices) was conducted. A video-trainer with three different tasks (#1 – 3) was used for standardised goal-directed MIS training. The subjects were randomised to two groups with standard instructional videos (group A, n = 12) versus comprehensive video tutorials for each training task watched at specific times of repetition (group B, n = 12). Performance was analysed using the MISTELS score. At the beginning and following the curriculum, an MIS cholecystectomy (CHE) was performed on a porcine organ model and analysed using the GOALS score. After 18 weeks, participants performed 10 repetitions of tasks #1 – 3 for follow-up analysis. Results More participants completed tasks #1 and #2 in group B (83.3 and 75%) than in group A (66.7 and 50%, ns). For task #2, there was a significant improvement in precision in group B (p < 0.001). For the entire cohort, the GOALS-Scores were 12.9 before and 18.9 after the curriculum (p < 0.001), with no significant difference between groups. Upon follow-up, 84.2% (task#1), 26.3% (task#2) and 100% (task#3) of MIS novices were able to reach the defined goals (A vs. B ns). There was a trend for a better MISTELS score in group B upon follow-up. Conclusions Standardised comprehensive video tutorials watched frequently throughout practice can significantly improve precision in MIC training. This aspect should be incorporated in MIS training.

scholarly journals Initial CT blend sign is not associated with poor outcome in patients following stereotactic minimally invasive surgery

2021 ◽  
Author(s):  
Xu Yang ◽  
Yan Zhu ◽  
Linshan Zhang ◽  
Likun Wang ◽  
Yuanhong Mao ◽  
...  
Keyword(s):  
Minimally Invasive Surgery ◽  
Minimally Invasive ◽  
Invasive Surgery ◽  
Cardiac Complications ◽  
Control Group ◽  
Haematoma Expansion ◽  
Poor Outcomes ◽  
The Impact ◽  
The Relationship

Abstract Background: The initial computed tomography (CT) blend sign has been used as an imaging marker to predict haematoma expansion and poor outcomes in patients with a small volume intracerebral haemorrhage (ICH). However, the relationship between the blend sign and outcomes remains elusive. The present study aimed to retrospectively measure the impact of initial CT blend signs on short-term outcomes in patients with hypertensive ICH who underwent stereotactic minimally invasive surgery (sMIS). Methods: We enrolled 242 patients with spontaneous ICH. Based on the initial CT features, the patients were assigned to a blend sign group (91 patients) or a nonblend sign (control) group (151 patients). The NIHSS, GCS and mRS were used to measure the effects of sMIS. The rates of severe pulmonary infection and cardiac complications were also compared between the two groups. Results: No significant differences in NIHSS and GCS scores were observed between the two groups. The proportion of patients with good outcomes during follow-up was not different between the two groups. The rate of rehaemorrhaging increased in the blend sign group. No significant differences in severe pulmonary infections and cardiac complications were noted between the two groups. Conclusions: The initial CT blend sign was not associated with poor outcomes in patients with hypertensive ICH who underwent sMIS. ICH patients with CT blend signs should undergo sMIS if they are suitable candidates for surgery.

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