scholarly journals Minimally invasive treatment for Hirschsprung disease

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.

Minimally invasive lumbar intradural extramedullary tumor resection

2012 ◽  
Vol 33 (Suppl1) ◽  
pp. 1 ◽  
Author(s):  
Brian Lee ◽  
Patrick C. Hsieh
Keyword(s):  
Minimally Invasive ◽  
Tumor Resection ◽  
Surgical Techniques ◽  
Csf Leak ◽  
Minimally Invasive Approach ◽  
Invasive Approach ◽  
Extramedullary Tumor ◽  
Intradural Extramedullary ◽  
Dural Opening ◽  
Invasive Techniques

Intradural, extramedullary schwannomas have long been treated with open midline incision, laminectomy, and dural opening to expose and resect the lesion. While this technique is well established, today new surgical techniques can be utilized to perform the same procedure while minimizing pain, size of incision, and trauma to adjacent tissues. In cases of intradural surgery, minimally invasive surgery limits the degree of soft tissue disruption. As a result, there is significant decreased dead space within the surgical cavity that may decrease the rate of CSF leak complications. Minimally invasive techniques have continuously improved over the years and have reached a point where they can be used for intradural surgeries. In this case presentation, we demonstrate a minimally invasive approach to the lumbar spine with resection of an intradural schwannoma. Surgical techniques and the nuances of the minimally invasive approach to intradural tumors compared to the standard open procedure will be discussed. The video can be found here: http://youtu.be/XXrvAIq_H48.

Safety and Efficacy of Intradural Extramedullary Spinal Tumor Removal Using a Minimally Invasive Approach

2011 ◽  
Vol 68 (suppl_1) ◽  
pp. ons208-ons216 ◽  
Author(s):  
Richard J. Mannion ◽  
Adrian M. Nowitzke ◽  
Johnny Efendy ◽  
Martin J. Wood
Keyword(s):  
Minimally Invasive Surgery ◽  
Minimally Invasive ◽  
Invasive Surgery ◽  
Spinous Process ◽  
Tumor Resection ◽  
Minimally Invasive Techniques ◽  
Minimally Invasive Approach ◽  
Invasive Approach ◽  
Intradural Extramedullary ◽  
Invasive Techniques

Abstract BACKGROUND: Although minimally invasive surgery for intradural tumors offers the potential benefits of less postoperative pain, a quicker recovery, and the avoidance of long-term instability from multilevel laminectomy, there are concerns over whether one can safely and effectively remove intradural extramedullary tumors in a fashion comparable to open techniques and whether the advantages of minimally invasive surgery are clinically significant. OBJECTIVE: To review our early experience with minimally invasive techniques for intradural extramedullary tumors of the spine. METHODS: Thirteen intradural tumors (1 cervical, 6 thoracic, 6 lumbar) in 11 patients were operated on using a muscle-splitting, tube-assisted paramedian oblique approach with hemilaminectomy to access the spinal canal while preserving the spinous process and ligaments. Fluoroscopy and navigation were used to determine the surgical level in all thoracic and lumbar cases. RESULTS: Satisfactory tumor resection using standard microsurgical techniques was achieved in all but 1 case using a minimally invasive approach. Surgical time and intraoperative blood loss were favorable compared with our open technique cases. There was no postoperative morbidity with the minimally invasive approach, although in 2 patients with tumors in the mid- and upper thoracic spine, the surgical incision was inaccurately placed by 1 level. In 1 case, the approach was converted to open when the tumor could not be found, and postoperatively there was a cerebrospinal fluid leak with infection that required readmission. CONCLUSION: Intradural extramedullary tumors can be safely and effectively removed using minimally invasive techniques. The pros and cons of minimally invasive vs open surgery are discussed.

scholarly journals Revisional Techniques for Secondary Cleft Lip Deformities

2021 ◽  
Vol 35 (02) ◽  
pp. 065-071
Author(s):  
Shayan M. Sarrami ◽  
Anna J. Skochdopole ◽  
Andrew M. Ferry ◽  
Edward P. Buchanan ◽  
Larry H. Hollier ◽  
...  
Keyword(s):  
Minimally Invasive ◽  
Early Life ◽  
Cleft Lip ◽  
Primary Repair ◽  
Surgical Techniques ◽  
Minimally Invasive Techniques ◽  
Adjacent Tissue ◽  
Tissue Transfer ◽  
Invasive Techniques

AbstractSecondary deformities of repaired cleft lips are an unfortunate complication despite the meticulous approach of modern primary procedures. Most of these surgeries take place in the patient's early life and must be strategically planned to provide optimal cosmesis with minimal interventions. Depending on the level of severity, treatment of the secondary deformities ranges from noninvasive or minimally invasive techniques to complete revision cheiloplasty. Many novel topical, injectable, and laser therapies have allotted physicians more technical flexibility in treating superficial distortions. Nonetheless, surgical techniques such as diamond excision and adjacent tissue transfer remain popular and useful reconstructive modalities. Deformities involving the orbicularis oris must be completely taken down to allow full access to the muscle. Complete revision cheiloplasty requires recreation of the cleft defect and reconstruction similar to the primary repair. Due to the myriad of presentations of these secondary deformities, familiarity with the various treatments available is imperative for any cleft surgeon.

High risk medicolegal autopsies: is a full postmortem examination necessary?

2012 ◽  
Vol 66 (1) ◽  
pp. 1-7 ◽  
Author(s):  
Eve Patricia Fryer ◽  
Zoe C Traill ◽  
Rachel E Benamore ◽  
Ian S D Roberts
Keyword(s):  
High Risk ◽  
Minimally Invasive ◽  
Cause Of Death ◽  
Drug Abusers ◽  
Minimally Invasive Approach ◽  
Invasive Approach ◽  
External Examination ◽  
Invasive Techniques ◽  
Cocaine Toxicity ◽  
Selection Of

AimsAiming to reduce the numbers of high risk autopsies, we use a minimally invasive approach. HIV/hepatitis C virus (HCV)-positive coronial referrals, mainly intravenous drug abusers, have full autopsy only if external examination, toxicology and/or postmortem CT scan do not provide the cause of death. In this study, we review and validate this protocol.Methods and results62 HIV/HCV-positive subjects were investigated. All had external examination, 59 toxicology and 24 CT. In 42/62, this minimally invasive approach provided a cause of death. Invasive autopsy was required in 20/62, CT/toxicology being inconclusive, giving a potential rather than definite cause of death. Autopsy findings provided the cause of death in 6/20; in the remainder, a negative autopsy allowed more weight to be given to toxicological results previously regarded as inconclusive. In order to validate selection of cases for invasive autopsy using history, external examination and toxicology, a separate group of 57 non-infectious full autopsies were analysed. These were consecutive cases in which there was a history that suggested drug abuse. A review pathologist, provided only with clinical summary, external findings and toxicology, formulated a cause of death. This formulation was compared with the original cause of death, based on full autopsy. The review pathologist correctly identified a drug-related death or requirement for full autopsy in 56/57 cases. In one case, diagnosed as cocaine toxicity by the review pathologist, autopsy additionally revealed subarachnoid haemorrhage and Berry aneurysm.ConclusionsThese findings support the use of minimally invasive techniques in high risk autopsies, which result in a two-thirds reduction in full postmortems.

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

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.

Minimally invasive treatment for intracerebral hemorrhage

2012 ◽  
Vol 32 (4) ◽  
pp. E3 ◽  
Author(s):  
Emun Abdu ◽  
Daniel F. Hanley ◽  
David W. Newell
Keyword(s):  
Minimally Invasive ◽  
Intracerebral Hemorrhage ◽  
Public Health Problem ◽  
Consensus Conference ◽  
National Institutes Of Health ◽  
Minimally Invasive Techniques ◽  
Invasive Treatment ◽  
Promising Area ◽  
Invasive Techniques

Spontaneous intracerebral hemorrhage is a serious public health problem and is fatal in 30%–50% of all occurrences. The role of open surgical management of supratentorial intracerebral hemorrhage is still unresolved. A recent consensus conference sponsored by the National Institutes of Health suggests that minimally invasive techniques to evacuate clots appear to be a promising area and warrant further investigation. In this paper the authors review past, current, and potential future methods of treating intraparenchymal hemorrhages with minimally invasive techniques and review new data regarding the role of stereotactically placed catheters and thrombolytics.

Minimally Invasive Separation Surgery for Metastases in the Vertebral Column: A Technical Report

2019 ◽  
Vol 18 (6) ◽  
pp. 606-613
Author(s):  
Rafael A Vega ◽  
Jeffrey I Traylor ◽  
Ahmed Habib ◽  
Laurence D Rhines ◽  
Claudio E Tatsui ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Spinal Cord ◽  
Minimally Invasive ◽  
Definitive Treatment ◽  
Invasive Technique ◽  
Thoracic Vertebrae ◽  
Minimally Invasive Techniques ◽  
Invasive Approach ◽  
Invasive Techniques

Abstract BACKGROUND Epidural spinal cord compression (ESCC) is a common and severe cause of morbidity in cancer patients. Minimally invasive surgical techniques may be utilized to preserve neurological function and permit the use of radiation to maximize local control. Minimally invasive techniques are associated with lower morbidity. OBJECTIVE To describe a novel, minimally invasive operative technique for the management of metastatic ESCC. METHODS A minimally invasive approach was used to cannulate the pedicles of the thoracic vertebrae, which were then held in place by Kirschner wires (K-wires). Following open decompression of the spinal cord, cannulated screws were placed percutaneously with stereotactic guidance through the pedicles followed by cement induction. Stereotactic radiosurgery is performed in the postoperative period for residual metastatic disease in the vertebral body. RESULTS The minimally invasive technique used in this case reduced tissue damage and optimized subsequent recovery without compromising the quality of decompression or the extent of metastatic tumor resection. Development of more minimally invasive techniques for the management of metastatic ESCC has the potential to facilitate healing and preserve quality of life in patients with systemic malignancy. CONCLUSION ESCC from vertebral metastases poses a challenge to treat in the context of minimizing potential risks to preserve quality of life. Percutaneous pedicle screw fixation with cement augmentation provides a minimally invasive alternative for definitive treatment of these patients.

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

2013 ◽  
Vol 35 (v2supplement) ◽  
pp. Video5 ◽  
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.

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

2021 ◽  
Vol 25 (2) ◽  
pp. 63-73
Author(s):  
T. G. Barmina ◽  
S. N. Danielyan ◽  
L. S. Kokov ◽  
F. A.-K. Sharifullin ◽  
O. A. Zabavskaya ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Minimally Invasive ◽  
Pleural Empyema ◽  
Complete Information ◽  
Treatment Method ◽  
Thoracic Esophagus ◽  
Minimally Invasive Approach ◽  
Invasive Treatment ◽  
Invasive Approach ◽  
Ct Data

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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