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Sample records for advanced minimally invasive

  1. [Advanced coronary artery surgery for minimally invasiveness].

    PubMed

    Yamaguchi, Shohjiro; Tomita, Shigeyuki; Watanabe, Go

    2008-07-01

    Since the development of drug-eluting stents, the conditions of coronary artery surgery have changed. The selection criteria for candidates for coronary artery bypass grafting (CABG) have become more stringent. In this era, surgeons should perform less invasive surgery to save such candidates. Off-pump coronary artery bypass (OPCAB) will become the gold standard surgical procedure for the treatment of ischemic heart disease. This paper describes how to perform less invasive OPCAB with some useful devices and points out the pitfalls of the standard procedure. We have also introduced robotic surgery using the DaVinci system. This procedure decreases the length of dermal incisions. Robotic surgery has other advantages compared with the standard endoscopic surgery. The arm of the robot absorbs the vibrations of human hands and the command function can decrease movement significantly. This arm has five joints, allowing the operator to manipulate the equipment easily inside the body. We have also performed awake CABG with high epidural anesthesia for minimally invasive surgery. This procedure is performed especially in patients with severe cerebrovascular disease and lung injury. In our institution, patients can be discharged only 5 days after this surgical procedure. Less invasive surgery will be the standard procedure in future. PMID:18681162

  2. Advanced titanium alloys and processes for minimally invasive surgery

    NASA Astrophysics Data System (ADS)

    Rack, H. J.; Qazi, Javaid

    2005-11-01

    Major advances continue to be made in enhancing patient care while at the same time attempting to slow ever-rising health costs. Among the most innovative of these advances are minimally invasive surgical techniques, which allow patients to undergo life-saving and quality-of-life enhancing surgery with minimized risk and substantially reduced hospital stays. Recently this approach was introduced for orthopedic procedures (e.g., during total hip replacement surgery). In this instance, the implantable devices will bear the same loads and will therefore be subject to higher stress. This paper provides a brief overview of several potential approaches for developing new advanced titanium alloys and processes that should provide substantial benefit for this application in minimally invasive devices.

  3. [Advances of minimally invasive technique in colorectal cancer surgery].

    PubMed

    Wang, Xishan

    2016-06-01

    Colorectal surgery is rapidly developing in the direction of minimally invasive surgery and functional surgery. New technology and ideas are constantly emerging recently. Laparoscopic colon surgery has already been recommended by NCCN guideline. However, laparoscopic rectal cancer surgery still needs to wait for survival and recurrence rates of long-term follow-up data for verification. In recent years, with the rapid progression of imaging equipment of laparoscope, the new 3D laparoscopic system will process image more quickly, and surgeons can get space depth feeling like open surgery only with a pair of glasses. The new 3D laparoscopic system has many advantages, and can also shorten the learning curve of the beginners. But it does not mean the traditional 2D laparoscopy has been out of date. It is admitted that dialectical view on the development of the technology and equipment is still required. New things also need the accumulation of time and validation, and the deficiency of imaging system remains to be improved. At present, the robotic colorectal cancer surgery is still in its infancy, and its application is relatively common in colon surgery. In respect of robotic rectal cancer surgery, it still lacks of long-term follow-up survival results for verification. To reduce physical and psychological trauma for patients is the goal of the surgeon. Surgeons are experiencing the change from minimally invasion to non-invasion. Natural orifice translumenal endoscopic surgery (NOTES) and natural orifice specimen extraction surgery (NOSES) arise at the historic moment. Among them, transanal total mesorectal excision (taTME) incorporates the concepts of NOTES, anal minimally invasive surgery and total mesorectum excision, guaranteeing the radical cure and no scar of abdomen, but it still needs multicenter, large sample and long-term follow-up clinical data to prove its safety, efficacy and indication. Therefore, surgical procedure is transforming from conventional

  4. Workshop on Advances in NASA-Relevant, Minimally Invasive Instrumentation

    NASA Technical Reports Server (NTRS)

    1985-01-01

    The purpose of this meeting is to highlight those advances in instrumentation and methodology that can be applied to the medical problems that will be encountered as the duration of manned space missions is extended. Information on work that is presently being done by NASA as well as other approaches in which NASA is not participating will be exchanged. The NASA-sponsored efforts that will be discussed are part of the overall Space Medicine Program that has been undertaken by NASA to address the medical problems of manned spaceflight. These problems include those that have been observed in the past as well as those which are anticipated as missions become longer, traverse different orbits, or are in any way different. This conference is arranged in order to address the types of instrumentation that might be used in several major medical problem areas. Instrumentation that will help in the cardiovascular, musculoskeletal, and psychological areas, among others will be presented. Interest lies in identifying instrumentation which will help in learning more about ourselves through experiments performed directly on humans. Great emphasis is placed on non-invasive approaches, although every substantial program basic to animal research will be needed in the foreseeable future. Space Medicine is a rather small affair in what is primarily an engineering organization. Space Medicine is conducted throughout NASA by a very small skeleton staff at the headquarters office in Washington and by our various field centers. These centers include the Johnson Space Center in Houston, Texas, the Ames Research Center in Moffett Field, California, the Jet Propulsion Laboratory in Pasadena, California, the Kennedy Space Center in Florida, and the Langley Research Center in Hampton, Virginia. Throughout these various centers, work is conducted in-house by NASA's own staff scientists, physicians, and engineers. In addition, various universities, industries, and other government laboratories

  5. Esophagectomy - minimally invasive

    MedlinePlus

    Minimally invasive esophagectomy; Robotic esophagectomy; Removal of the esophagus - minimally invasive; Achalasia - esophagectomy; Barrett esophagus - esophagectomy; Esophageal cancer - esophagectomy - laparoscopic; Cancer of the ...

  6. Minimally invasive pancreatic surgery.

    PubMed

    Yiannakopoulou, E

    2015-12-01

    Minimally invasive pancreatic surgery is feasible and safe. Laparoscopic distal pancreatectomy should be widely adopted for benign lesions of the pancreas. Laparoscopic pancreaticoduodenectomy, although technically demanding, in the setting of pancreatic ductal adenocarcinoma has a number of advantages including shorter hospital stay, faster recovery, allowing patients to recover in a timelier manner and pursue adjuvant treatment options. Furthermore, it seems that progression-free survival is longer in patients undergoing laparoscopic pancreaticoduodenectomy in comparison with those undergoing open pancreaticoduodenectomy. Minimally invasive middle pancreatectomy seems appropriate for benign or borderline tumors of the neck of the pancreas. Technological advances including intraoperative ultrasound and intraoperative fluorescence imaging systems are expected to facilitate the wide adoption of minimally invasive pancreatic surgery. Although, the oncological outcome seems similar with that of open surgery, there are still concerns, as the majority of relevant evidence comes from retrospective studies. Large multicenter randomized studies comparing laparoscopic with open pancreatectomy as well as robotic assisted with both open and laparoscopic approaches are needed. Robotic approach could be possibly shown to be less invasive than conventional laparoscopic approach through the less traumatic intra-abdominal handling of tissues. In addition, robotic approach could enable the wide adoption of the technique by surgeon who is not that trained in advanced laparoscopic surgery. A putative clinical benefit of minimally invasive pancreatic surgery could be the attenuated surgical stress response leading to reduced morbidity and mortality as well as lack of the detrimental immunosuppressive effect especially for the oncological patients. PMID:26530291

  7. Minimally invasive procedures

    PubMed Central

    Baltayiannis, Nikolaos; Michail, Chandrinos; Lazaridis, George; Anagnostopoulos, Dimitrios; Baka, Sofia; Mpoukovinas, Ioannis; Karavasilis, Vasilis; Lampaki, Sofia; Papaiwannou, Antonis; Karavergou, Anastasia; Kioumis, Ioannis; Pitsiou, Georgia; Katsikogiannis, Nikolaos; Tsakiridis, Kosmas; Rapti, Aggeliki; Trakada, Georgia; Zissimopoulos, Athanasios; Zarogoulidis, Konstantinos

    2015-01-01

    Minimally invasive procedures, which include laparoscopic surgery, use state-of-the-art technology to reduce the damage to human tissue when performing surgery. Minimally invasive procedures require small “ports” from which the surgeon inserts thin tubes called trocars. Carbon dioxide gas may be used to inflate the area, creating a space between the internal organs and the skin. Then a miniature camera (usually a laparoscope or endoscope) is placed through one of the trocars so the surgical team can view the procedure as a magnified image on video monitors in the operating room. Specialized equipment is inserted through the trocars based on the type of surgery. There are some advanced minimally invasive surgical procedures that can be performed almost exclusively through a single point of entry—meaning only one small incision, like the “uniport” video-assisted thoracoscopic surgery (VATS). Not only do these procedures usually provide equivalent outcomes to traditional “open” surgery (which sometimes require a large incision), but minimally invasive procedures (using small incisions) may offer significant benefits as well: (I) faster recovery; (II) the patient remains for less days hospitalized; (III) less scarring and (IV) less pain. In our current mini review we will present the minimally invasive procedures for thoracic surgery. PMID:25861610

  8. Minimally Invasive Parathyroidectomy

    PubMed Central

    Starker, Lee F.; Fonseca, Annabelle L.; Carling, Tobias; Udelsman, Robert

    2011-01-01

    Minimally invasive parathyroidectomy (MIP) is an operative approach for the treatment of primary hyperparathyroidism (pHPT). Currently, routine use of improved preoperative localization studies, cervical block anesthesia in the conscious patient, and intraoperative parathyroid hormone analyses aid in guiding surgical therapy. MIP requires less surgical dissection causing decreased trauma to tissues, can be performed safely in the ambulatory setting, and is at least as effective as standard cervical exploration. This paper reviews advances in preoperative localization, anesthetic techniques, and intraoperative management of patients undergoing MIP for the treatment of pHPT. PMID:21747851

  9. A Manually Operated, Advance Off-Stylet Insertion Tool for Minimally Invasive Cochlear Implantation Surgery

    PubMed Central

    Kratchman, Louis B.; Schurzig, Daniel; McRackan, Theodore R.; Balachandran, Ramya; Noble, Jack H.; Webster, Robert J.; Labadie, Robert F.

    2014-01-01

    The current technique for cochlear implantation (CI) surgery requires a mastoidectomy to gain access to the cochlea for electrode array insertion. It has been shown that microstereotactic frames can enable an image-guided, minimally invasive approach to CI surgery called percutaneous cochlear implantation (PCI) that uses a single drill hole for electrode array insertion, avoiding a more invasive mastoidectomy. Current clinical methods for electrode array insertion are not compatible with PCI surgery because they require a mastoidectomy to access the cochlea; thus, we have developed a manually operated electrode array insertion tool that can be deployed through a PCI drill hole. The tool can be adjusted using a preoperative CT scan for accurate execution of the advance off-stylet (AOS) insertion technique and requires less skill to operate than is currently required to implant electrode arrays. We performed three cadaver insertion experiments using the AOS technique and determined that all insertions were successful using CT and microdissection. PMID:22851233

  10. Minimally Invasive Valve Surgery

    PubMed Central

    Pope, Nicolas H.; Ailawadi, Gorav

    2014-01-01

    Cardiac valve surgery is life saving for many patients. The advent of minimally invasive surgical techniques has historically allowed for improvement in both post-operative convalescence and important clinical outcomes. The development of minimally invasive cardiac valve repair and replacement surgery over the past decade is poised to revolutionize the care of cardiac valve patients. Here, we present a review of the history and current trends in minimally invasive aortic and mitral valve repair and replacement, including the development of sutureless bioprosthetic valves. PMID:24797148

  11. Minimally invasive parathyroid surgery

    PubMed Central

    Noureldine, Salem I.; Gooi, Zhen

    2015-01-01

    Traditionally, bilateral cervical exploration for localization of all four parathyroid glands and removal of any that are grossly enlarged has been the standard surgical treatment for primary hyperparathyroidism (PHPT). With the advances in preoperative localization studies and greater public demand for less invasive procedures, novel targeted, minimally invasive techniques to the parathyroid glands have been described and practiced over the past 2 decades. Minimally invasive parathyroidectomy (MIP) can be done either through the standard Kocher incision, a smaller midline incision, with video assistance (purely endoscopic and video-assisted techniques), or through an ectopically placed, extracervical, incision. In current practice, once PHPT is diagnosed, preoperative evaluation using high-resolution radiographic imaging to localize the offending parathyroid gland is essential if MIP is to be considered. The imaging study results suggest where the surgeon should begin the focused procedure and serve as a road map to allow tailoring of an efficient, imaging-guided dissection while eliminating the unnecessary dissection of multiple glands or a bilateral exploration. Intraoperative parathyroid hormone (IOPTH) levels may be measured during the procedure, or a gamma probe used during radioguided parathyroidectomy, to ascertain that the correct gland has been excised and that no other hyperfunctional tissue is present. MIP has many advantages over the traditional bilateral, four-gland exploration. MIP can be performed using local anesthesia, requires less operative time, results in fewer complications, and offers an improved cosmetic result and greater patient satisfaction. Additional advantages of MIP are earlier hospital discharge and decreased overall associated costs. This article aims to address the considerations for accomplishing MIP, including the role of preoperative imaging studies, intraoperative adjuncts, and surgical techniques. PMID:26425454

  12. Minimally invasive hip replacement

    MedlinePlus

    ... Smits SA, Swinford RR, Bahamonde RE. A randomized, prospective study of 3 minimally invasive surgical approaches in total hip arthroplasty: comprehensive gait analysis. J Arthroplasty . 2008;23:68-73. PMID: 18722305 ...

  13. Minimally Invasive Radiofrequency Devices.

    PubMed

    Sadick, Neil; Rothaus, Kenneth O

    2016-07-01

    This article reviews minimally invasive radiofrequency options for skin tightening, focusing on describing their mechanism of action and clinical profile in terms of safety and efficacy and presenting peer-reviewed articles associated with the specific technologies. Treatments offered by minimally invasive radiofrequency devices (fractional, microneedling, temperature-controlled) are increasing in popularity due to the dramatic effects they can have without requiring skin excision, downtime, or even extreme financial burden from the patient's perspective. Clinical applications thus far have yielded impressive results in treating signs of the aging face and neck, either as stand-alone or as postoperative maintenance treatments. PMID:27363771

  14. Minimally invasive mediastinal surgery.

    PubMed

    Melfi, Franca M A; Fanucchi, Olivia; Mussi, Alfredo

    2016-01-01

    In the past, mediastinal surgery was associated with the necessity of a maximum exposure, which was accomplished through various approaches. In the early 1990s, many surgical fields, including thoracic surgery, observed the development of minimally invasive techniques. These included video-assisted thoracic surgery (VATS), which confers clear advantages over an open approach, such as less trauma, short hospital stay, increased cosmetic results and preservation of lung function. However, VATS is associated with several disadvantages. For this reason, it is not routinely performed for resection of mediastinal mass lesions, especially those located in the anterior mediastinum, a tiny and remote space that contains vital structures at risk of injury. Robotic systems can overcome the limits of VATS, offering three-dimensional (3D) vision and wristed instrumentations, and are being increasingly used. With regards to thymectomy for myasthenia gravis (MG), unilateral and bilateral VATS approaches have demonstrated good long-term neurologic results with low complication rates. Nevertheless, some authors still advocate the necessity of maximum exposure, especially when considering the distribution of normal and ectopic thymic tissue. In recent studies, the robotic approach has shown to provide similar neurological outcomes when compared to transsternal and VATS approaches, and is associated with a low morbidity. Importantly, through a unilateral robotic technique, it is possible to dissect and remove at least the same amount of mediastinal fat tissue. Preliminary results on early-stage thymomatous disease indicated that minimally invasive approaches are safe and feasible, with a low rate of pleural recurrence, underlining the necessity of a "no-touch" technique. However, especially for thymomatous disease characterized by an indolent nature, further studies with long follow-up period are necessary in order to assess oncologic and neurologic results through minimally invasive

  15. Minimally invasive mediastinal surgery

    PubMed Central

    Melfi, Franca M. A.; Mussi, Alfredo

    2016-01-01

    In the past, mediastinal surgery was associated with the necessity of a maximum exposure, which was accomplished through various approaches. In the early 1990s, many surgical fields, including thoracic surgery, observed the development of minimally invasive techniques. These included video-assisted thoracic surgery (VATS), which confers clear advantages over an open approach, such as less trauma, short hospital stay, increased cosmetic results and preservation of lung function. However, VATS is associated with several disadvantages. For this reason, it is not routinely performed for resection of mediastinal mass lesions, especially those located in the anterior mediastinum, a tiny and remote space that contains vital structures at risk of injury. Robotic systems can overcome the limits of VATS, offering three-dimensional (3D) vision and wristed instrumentations, and are being increasingly used. With regards to thymectomy for myasthenia gravis (MG), unilateral and bilateral VATS approaches have demonstrated good long-term neurologic results with low complication rates. Nevertheless, some authors still advocate the necessity of maximum exposure, especially when considering the distribution of normal and ectopic thymic tissue. In recent studies, the robotic approach has shown to provide similar neurological outcomes when compared to transsternal and VATS approaches, and is associated with a low morbidity. Importantly, through a unilateral robotic technique, it is possible to dissect and remove at least the same amount of mediastinal fat tissue. Preliminary results on early-stage thymomatous disease indicated that minimally invasive approaches are safe and feasible, with a low rate of pleural recurrence, underlining the necessity of a “no-touch” technique. However, especially for thymomatous disease characterized by an indolent nature, further studies with long follow-up period are necessary in order to assess oncologic and neurologic results through minimally

  16. [Three procedures of transanal minimally invasive surgery (TAMIS) for advanced mid-low rectal tumor].

    PubMed

    Shen, Zhanlong; Ye, Yingjiang; Atallah, Sam; Xie, Qiwei; Jiang, Kewei; Wang, Shan

    2015-10-25

    Transanal minimally invasive surgery (TAMIS) is a novel minimally invasive procedure which is performed by normal laparoscopic instruments through the single port transanally. Three kinds of procedures have been performed based on the TAMIS platform by now, including TAMIS-TME(total mesorectal excision), TAMIS-APE(Abdominoperineal excision) and TAMIS-Hartmann. Transanal total mesorectal excision (taTME) with dissection from bottom to up through the platform of TAMIS is also called TAMIS-TME. The greatest advantage of TAMIS-TME is that it increases the quality of specimen and decrease the adverse injury due to the sufficient vision of lower part of mesorectum in the operation. TAMIS-APE and TAMIS-Hartmann procedures emerge after the experience of TAMIS-TME. TAMIS-APE procedure not only firstly make the dissection of perineal phase minimally invasive, but also make the perineal vision more clear, the resection of levator ani muscle more precise, eventually the tailored APE procedure comes true under the laparoscopy of perineal phase. The dissection of mid-low mesorectum for recurrent tumor is usually difficult just from above, TAMIS facilitates the resection through entering the normal anatomical space under the tumor. If the tumor has the risk of recurrence, distal rectum is closed and proximal colostomy is made, we firstly performed this procedure and name it TAMIS-Hartmann. Therefore, TAMIS is not only a platform for taTME, but also it provides a transanal approach and a "button to up" conception for the mid-low rectal tumor. PMID:26499144

  17. I-SPINE: a software package for advances in image-guided and minimally invasive spine procedures

    NASA Astrophysics Data System (ADS)

    Choi, Jae Jeong; Cleary, Kevin R.; Zeng, Jianchao; Gary, Kevin A.; Freedman, Matthew T.; Watson, Vance; Lindisch, David; Mun, Seong K.

    2000-05-01

    While image guidance is now routinely used in the brain in the form of frameless stereotaxy, it is beginning to be more widely used in other clinical areas such as the spine. At Georgetown University Medical Center, we are developing a program to provide advanced visualization and image guidance for minimally invasive spine procedures. This is a collaboration between an engineering-based research group and physicians from the radiology, neurosurgery, and orthopaedics departments. A major component of this work is the ISIS Center Spine Procedures Imaging and Navigation Engine, which is a software package under development as the base platform for technical advances.

  18. [Minimally invasive breast surgery].

    PubMed

    Mátrai, Zoltán; Gulyás, Gusztáv; Kunos, Csaba; Sávolt, Akos; Farkas, Emil; Szollár, András; Kásler, Miklós

    2014-02-01

    Due to the development in medical science and industrial technology, minimally invasive procedures have appeared in the surgery of benign and malignant breast diseases. In general , such interventions result in significantly reduced breast and chest wall scars, shorter hospitalization and less pain, but they require specific, expensive devices, longer surgical time compared to open surgery. Furthermore, indications or oncological safety have not been established yet. It is quite likely, that minimally invasive surgical procedures with high-tech devices - similar to other surgical subspecialties -, will gradually become popular and it may form part of routine breast surgery even. Vacuum-assisted core biopsy with a therapeutic indication is suitable for the removal of benign fibroadenomas leaving behind an almost invisible scar, while endoscopically assisted skin-sparing and nipple-sparing mastectomy, axillary staging and reconstruction with latissimus dorsi muscle flap are all feasible through the same short axillary incision. Endoscopic techniques are also suitable for the diagnostics and treatment of intracapsular complications of implant-based breast reconstructions (intracapsular fluid, implant rupture, capsular contracture) and for the biopsy of intracapsular lesions with uncertain pathology. Perception of the role of radiofrequency ablation of breast tumors requires further hands-on experience, but it is likely that it can serve as a replacement of surgical removal in a portion of primary tumors in the future due to the development in functional imaging and anticancer drugs. With the reduction of the price of ductoscopes routine examination of the ductal branch system, guided microdochectomy and targeted surgical removal of terminal ducto-lobular units or a "sick lobe" as an anatomical unit may become feasible. The paper presents the experience of the authors and provides a literature review, for the first time in Hungarian language on the subject. Orv. Hetil

  19. Minimally Invasive Cardiovascular Surgery: Incisions and Approaches

    PubMed Central

    Langer, Nathaniel B.; Argenziano, Michael

    2016-01-01

    Throughout the modern era of cardiac surgery, most operations have been performed via median sternotomy with cardiopulmonary bypass. This paradigm is changing, however, as cardiovascular surgery is increasingly adopting minimally invasive techniques. Advances in patient evaluation, instrumentation, and operative technique have allowed surgeons to perform a wide variety of complex operations through smaller incisions and, in some cases, without cardiopulmonary bypass. With patients desiring less invasive operations and the literature supporting decreased blood loss, shorter hospital length of stay, improved postoperative pain, and better cosmesis, minimally invasive cardiac surgery should be widely practiced. Here, we review the incisions and approaches currently used in minimally invasive cardiovascular surgery. PMID:27127555

  20. Minimally Invasive Forefoot Surgery in France.

    PubMed

    Meusnier, Tristan; Mukish, Prikesht

    2016-06-01

    Study groups have been formed in France to advance the use of minimally invasive surgery. These techniques are becoming more frequently used and the technique nuances are continuing to evolve. The objective of this article was to advance the awareness of the current trends in minimally invasive surgery for common diseases of the forefoot. The percutaneous surgery at the forefoot is less developed at this time, but also will be discussed. PMID:27261810

  1. Minimally invasive radioguided parathyroidectomy.

    PubMed

    Costello, D; Norman, J

    1999-07-01

    The last decade has been characterized by an emphasis on minimizing interventional techniques, hospital stays, and overall costs of patient care. It is clear that most patients with sporadic HPT do not require a complete neck exploration. We now know that a minimal approach is appropriate for this disease. Importantly, the MIRP technique can be applied to most patients with sporadic HPT and can be performed by surgeons with modest advanced training. The use of a gamma probe as a surgical tool converts the sestamibi to a functional and anatomical scan eliminating the need for any other preoperative localizing study. Quantification of the radioactivity within the removed gland eliminates the need for routine frozen section histologic examination and obviates the need for costly intraoperative parathyroid hormone measurements. This radioguided technique allows the benefit of local anesthesia, dramatically reduces operative times, eliminates postoperative blood tests, provides a smaller scar, requires minimal time spent in the hospital, and almost assures a rapid, near pain-free recovery. This combination is beneficial to the patient whereas helping achieve a reduction in overall costs. PMID:10448697

  2. Anaesthesia for minimally invasive surgery

    PubMed Central

    Dec, Marta

    2015-01-01

    Minimally invasive surgery (MIS) is rising in popularity. It offers well-known benefits to the patient. However, restricted access to the surgical site and gas insufflation into the body cavities may result in severe complications. From the anaesthetic point of view MIS poses unique challenges associated with creation of pneumoperitoneum, carbon dioxide absorption, specific positioning and monitoring a patient to whom the anaesthetist has often restricted access, in a poorly lit environment. Moreover, with refinement of surgical procedures and growing experience the anaesthetist is presented with patients from high-risk groups (obese, elderly, with advanced cardiac and respiratory disease) who once were deemed unsuitable for the laparoscopic technique. Anaesthetic management is aimed at getting the patient safely through the procedure, minimizing the specific risks arising from laparoscopy and the patient's coexisting medical problems, ensuring quick recovery and a relatively pain-free postoperative course with early return to normal function. PMID:26865885

  3. Future of Minimally Invasive Colorectal Surgery.

    PubMed

    Whealon, Matthew; Vinci, Alessio; Pigazzi, Alessio

    2016-09-01

    Minimally invasive surgery is slowly taking over as the preferred operative approach for colorectal diseases. However, many of the procedures remain technically difficult. This article will give an overview of the state of minimally invasive surgery and the many advances that have been made over the last two decades. Specifically, we discuss the introduction of the robotic platform and some of its benefits and limitations. We also describe some newer techniques related to robotics. PMID:27582647

  4. Heart bypass surgery - minimally invasive

    MedlinePlus

    ... in 30-day outcomes in high-risk patients randomized to off-pump versus on-pump coronary bypass ... Thiele H, Neumann-Schniedewind P, Jacobs S, et al. Randomized comparison of minimally invasive direct coronary artery bypass ...

  5. Mitral valve surgery - minimally invasive

    MedlinePlus

    ... that does many of these procedures. Minimally invasive heart valve surgery has improved greatly in recent years. These ... WT, Mack MJ. Transcatheter cardiac valve interventions. Surg Clin North Am . 2009;89:951-66. ...

  6. Prostate resection - minimally invasive

    MedlinePlus

    ... are: Erection problems (impotence) No symptom improvement Passing semen back into your bladder instead of out through ... Whelan JP, Goeree L. Systematic review and meta-analysis of transurethral resection of the prostate versus minimally ...

  7. Minimally Invasive Surgery in Gynecologic Oncology

    PubMed Central

    Mori, Kristina M.; Neubauer, Nikki L.

    2013-01-01

    Minimally invasive surgery has been utilized in the field of obstetrics and gynecology as far back as the 1940s when culdoscopy was first introduced as a visualization tool. Gynecologists then began to employ minimally invasive surgery for adhesiolysis and obtaining biopsies but then expanded its use to include procedures such as tubal sterilization (Clyman (1963), L. E. Smale and M. L. Smale (1973), Thompson and Wheeless (1971), Peterson and Behrman (1971)). With advances in instrumentation, the first laparoscopic hysterectomy was successfully performed in 1989 by Reich et al. At the same time, minimally invasive surgery in gynecologic oncology was being developed alongside its benign counterpart. In the 1975s, Rosenoff et al. reported using peritoneoscopy for pretreatment evaluation in ovarian cancer, and Spinelli et al. reported on using laparoscopy for the staging of ovarian cancer. In 1993, Nichols used operative laparoscopy to perform pelvic lymphadenectomy in cervical cancer patients. The initial goals of minimally invasive surgery, not dissimilar to those of modern medicine, were to decrease the morbidity and mortality associated with surgery and therefore improve patient outcomes and patient satisfaction. This review will summarize the history and use of minimally invasive surgery in gynecologic oncology and also highlight new minimally invasive surgical approaches currently in development. PMID:23997959

  8. Advances in the clinical research of the minimally invasive treatment for the posterior edge of vertebral-body defects by spinal metastases

    PubMed Central

    LIU, XUEFENG; YANG, ZUOZHANG; XIE, LIN; YUAN, ZONGQIN; REN, MINGYAN; HAN, LEI

    2015-01-01

    Spinal metastasis is one of the commonly observed complications in the advanced stages of cancer patients, and is a serious threat to human life and health. Malignant tumor invasion usually leads to defects in the posterior margins of the vertebral body, which caused significant cancer pains to patients and increased the risk of surgery. Currently, minimally invasive treatments of vertebral defects caused by spinal metastases include percutaneous vertebroplasty (PVP) combined with radiofrequency ablation and PVP combined with 125I seed implantation. These minimally invasive techniques have particular superiority to control pain in patients with spinal metastases, improve nerve function, reduce the incidence of fractures and surgical risk, and improve the quality of life. The present study reviewed the progress in clinical research on vertebral defects caused by spinal metastases, and the mechanisms and minimally invasive treatment. PMID:26405535

  9. Minimally legally invasive dentistry.

    PubMed

    Lam, R

    2014-12-01

    One disadvantage of the rapid advances in modern dentistry is that treatment options have never been more varied or confusing. Compounded by a more educated population greatly assisted by online information in an increasingly litigious society, a major concern in recent times is increased litigation against health practitioners. The manner in which courts handle disputes is ambiguous and what is considered fair or just may not be reflected in the judicial process. Although legal decisions in Australia follow a doctrine of precedent, the law is not static and is often reflected by community sentiment. In medical litigation, this has seen the rejection of the Bolam principle with a preference towards greater patient rights. Recent court decisions may change the practice of dentistry and it is important that the clinician is not caught unaware. The aim of this article is to discuss legal issues that are pertinent to the practice of modern dentistry through an analysis of legal cases that have shaped health law. Through these discussions, the importance of continuing professional development, professional association and informed consent will be realized as a means to limit the legal complications of dental practice. PMID:25160114

  10. Minimally invasive aortic valve surgery.

    PubMed

    Castrovinci, Sebastiano; Emmanuel, Sam; Moscarelli, Marco; Murana, Giacomo; Caccamo, Giuseppa; Bertolino, Emanuela Clara; Nasso, Giuseppe; Speziale, Giuseppe; Fattouch, Khalil

    2016-09-01

    Aortic valve disease is a prevalent disorder that affects approximately 2% of the general adult population. Surgical aortic valve replacement is the gold standard treatment for symptomatic patients. This treatment has demonstrably proven to be both safe and effective. Over the last few decades, in an attempt to reduce surgical trauma, different minimally invasive approaches for aortic valve replacement have been developed and are now being increasingly utilized. A narrative review of the literature was carried out to describe the surgical techniques for minimally invasive aortic valve surgery and report the results from different experienced centers. Minimally invasive aortic valve replacement is associated with low perioperative morbidity, mortality and a low conversion rate to full sternotomy. Long-term survival appears to be at least comparable to that reported for conventional full sternotomy. Minimally invasive aortic valve surgery, either with a partial upper sternotomy or a right anterior minithoracotomy provides early- and long-term benefits. Given these benefits, it may be considered the standard of care for isolated aortic valve disease. PMID:27582764

  11. Minimally invasive aortic valve surgery

    PubMed Central

    Castrovinci, Sebastiano; Emmanuel, Sam; Moscarelli, Marco; Murana, Giacomo; Caccamo, Giuseppa; Bertolino, Emanuela Clara; Nasso, Giuseppe; Speziale, Giuseppe; Fattouch, Khalil

    2016-01-01

    Aortic valve disease is a prevalent disorder that affects approximately 2% of the general adult population. Surgical aortic valve replacement is the gold standard treatment for symptomatic patients. This treatment has demonstrably proven to be both safe and effective. Over the last few decades, in an attempt to reduce surgical trauma, different minimally invasive approaches for aortic valve replacement have been developed and are now being increasingly utilized. A narrative review of the literature was carried out to describe the surgical techniques for minimally invasive aortic valve surgery and report the results from different experienced centers. Minimally invasive aortic valve replacement is associated with low perioperative morbidity, mortality and a low conversion rate to full sternotomy. Long-term survival appears to be at least comparable to that reported for conventional full sternotomy. Minimally invasive aortic valve surgery, either with a partial upper sternotomy or a right anterior minithoracotomy provides early- and long-term benefits. Given these benefits, it may be considered the standard of care for isolated aortic valve disease. PMID:27582764

  12. Minimally invasive video-assisted versus minimally invasive nonendoscopic thyroidectomy.

    PubMed

    Fík, Zdeněk; Astl, Jaromír; Zábrodský, Michal; Lukeš, Petr; Merunka, Ilja; Betka, Jan; Chovanec, Martin

    2014-01-01

    Minimally invasive video-assisted thyroidectomy (MIVAT) and minimally invasive nonendoscopic thyroidectomy (MINET) represent well accepted and reproducible techniques developed with the main goal to improve cosmetic outcome, accelerate healing, and increase patient's comfort following thyroid surgery. Between 2007 and 2011, a prospective nonrandomized study of patients undergoing minimally invasive thyroid surgery was performed to compare advantages and disadvantages of the two different techniques. There were no significant differences in the length of incision to perform surgical procedures. Mean duration of hemithyroidectomy was comparable in both groups, but it was more time consuming to perform total thyroidectomy by MIVAT. There were more patients undergoing MIVAT procedures without active drainage in the postoperative course and we also could see a trend for less pain in the same group. This was paralleled by statistically significant decreased administration of both opiates and nonopiate analgesics. We encountered two cases of recurrent laryngeal nerve palsies in the MIVAT group only. MIVAT and MINET represent safe and feasible alternative to conventional thyroid surgery in selected cases and this prospective study has shown minimal differences between these two techniques. PMID:24800227

  13. Minimally Invasive Surgical Therapies for Atrial Fibrillation

    PubMed Central

    Nakamura, Yoshitsugu; Kiaii, Bob; Chu, Michael W. A.

    2012-01-01

    Atrial fibrillation is the most common sustained arrhythmia and is associated with significant risks of thromboembolism, stroke, congestive heart failure, and death. There have been major advances in the management of atrial fibrillation including pharmacologic therapies, antithrombotic therapies, and ablation techniques. Surgery for atrial fibrillation, including both concomitant and stand-alone interventions, is an effective therapy to restore sinus rhythm. Minimally invasive surgical ablation is an emerging field that aims for the superior results of the traditional Cox-Maze procedure through a less invasive operation with lower morbidity, quicker recovery, and improved patient satisfaction. These novel techniques utilize endoscopic or minithoracotomy approaches with various energy sources to achieve electrical isolation of the pulmonary veins in addition to other ablation lines. We review advancements in minimally invasive techniques for atrial fibrillation surgery, including management of the left atrial appendage. PMID:22666609

  14. Minimally invasive procedures on the lumbar spine.

    PubMed

    Skovrlj, Branko; Gilligan, Jeffrey; Cutler, Holt S; Qureshi, Sheeraz A

    2015-01-16

    Degenerative disease of the lumbar spine is a common and increasingly prevalent condition that is often implicated as the primary reason for chronic low back pain and the leading cause of disability in the western world. Surgical management of lumbar degenerative disease has historically been approached by way of open surgical procedures aimed at decompressing and/or stabilizing the lumbar spine. Advances in technology and surgical instrumentation have led to minimally invasive surgical techniques being developed and increasingly used in the treatment of lumbar degenerative disease. Compared to the traditional open spine surgery, minimally invasive techniques require smaller incisions and decrease approach-related morbidity by avoiding muscle crush injury by self-retaining retractors, preventing the disruption of tendon attachment sites of important muscles at the spinous processes, using known anatomic neurovascular and muscle planes, and minimizing collateral soft-tissue injury by limiting the width of the surgical corridor. The theoretical benefits of minimally invasive surgery over traditional open surgery include reduced blood loss, decreased postoperative pain and narcotics use, shorter hospital length of stay, faster recover and quicker return to work and normal activity. This paper describes the different minimally invasive techniques that are currently available for the treatment of degenerative disease of the lumbar spine. PMID:25610845

  15. Minimally Invasive Surgery for Inflammatory Bowel Disease

    PubMed Central

    Holder-Murray, Jennifer; Marsicovetere, Priscilla

    2015-01-01

    Abstract: Surgical management of inflammatory bowel disease is a challenging endeavor given infectious and inflammatory complications, such as fistula, and abscess, complex often postoperative anatomy, including adhesive disease from previous open operations. Patients with Crohn's disease and ulcerative colitis also bring to the table the burden of their chronic illness with anemia, malnutrition, and immunosuppression, all common and contributing independently as risk factors for increased surgical morbidity in this high-risk population. However, to reduce the physical trauma of surgery, technologic advances and worldwide experience with minimally invasive surgery have allowed laparoscopic management of patients to become standard of care, with significant short- and long-term patient benefits compared with the open approach. In this review, we will describe the current state-of the-art for minimally invasive surgery for inflammatory bowel disease and the caveats inherent with this practice in this complex patient population. Also, we will review the applicability of current and future trends in minimally invasive surgical technique, such as laparoscopic “incisionless,” single-incision laparoscopic surgery (SILS), robotic-assisted, and other techniques for the patient with inflammatory bowel disease. There can be no doubt that minimally invasive surgery has been proven to decrease the short- and long-term burden of surgery of these chronic illnesses and represents high-value care for both patient and society. PMID:25989341

  16. Esophageal surgery in minimally invasive era.

    PubMed

    Bencini, Lapo; Moraldi, Luca; Bartolini, Ilenia; Coratti, Andrea

    2016-01-27

    The widespread popularity of new surgical technologies such as laparoscopy, thoracoscopy and robotics has led many surgeons to treat esophageal diseases with these methods. The expected benefits of minimally invasive surgery (MIS) mainly include reductions of postoperative complications, length of hospital stay, and pain and better cosmetic results. All of these benefits could potentially be of great interest when dealing with the esophagus due to the potentially severe complications that can occur after conventional surgery. Moreover, robotic platforms are expected to reduce many of the difficulties encountered during advanced laparoscopic and thoracoscopic procedures such as anastomotic reconstructions, accurate lymphadenectomies, and vascular sutures. Almost all esophageal diseases are approachable in a minimally invasive way, including diverticula, gastro-esophageal reflux disease, achalasia, perforations and cancer. Nevertheless, while the limits of MIS for benign esophageal diseases are mainly technical issues and costs, oncologic outcomes remain the cornerstone of any procedure to cure malignancies, for which the long-term results are critical. Furthermore, many of the minimally invasive esophageal operations should be compared to pharmacologic interventions and advanced pure endoscopic procedures; such a comparison requires a difficult literature analysis and leads to some confounding results of clinical trials. This review aims to examine the evidence for the use of MIS in both malignancies and more common benign disease of the esophagus, with a particular emphasis on future developments and ongoing areas of research. PMID:26843913

  17. Esophageal surgery in minimally invasive era

    PubMed Central

    Bencini, Lapo; Moraldi, Luca; Bartolini, Ilenia; Coratti, Andrea

    2016-01-01

    The widespread popularity of new surgical technologies such as laparoscopy, thoracoscopy and robotics has led many surgeons to treat esophageal diseases with these methods. The expected benefits of minimally invasive surgery (MIS) mainly include reductions of postoperative complications, length of hospital stay, and pain and better cosmetic results. All of these benefits could potentially be of great interest when dealing with the esophagus due to the potentially severe complications that can occur after conventional surgery. Moreover, robotic platforms are expected to reduce many of the difficulties encountered during advanced laparoscopic and thoracoscopic procedures such as anastomotic reconstructions, accurate lymphadenectomies, and vascular sutures. Almost all esophageal diseases are approachable in a minimally invasive way, including diverticula, gastro-esophageal reflux disease, achalasia, perforations and cancer. Nevertheless, while the limits of MIS for benign esophageal diseases are mainly technical issues and costs, oncologic outcomes remain the cornerstone of any procedure to cure malignancies, for which the long-term results are critical. Furthermore, many of the minimally invasive esophageal operations should be compared to pharmacologic interventions and advanced pure endoscopic procedures; such a comparison requires a difficult literature analysis and leads to some confounding results of clinical trials. This review aims to examine the evidence for the use of MIS in both malignancies and more common benign disease of the esophagus, with a particular emphasis on future developments and ongoing areas of research. PMID:26843913

  18. Minimally invasive posterior hamstring harvest.

    PubMed

    Wilson, Trent J; Lubowitz, James H

    2013-01-01

    Autogenous hamstring harvesting for knee ligament reconstruction is a well-established standard. Minimally invasive posterior hamstring harvest is a simple, efficient, reproducible technique for harvest of the semitendinosus or gracilis tendon or both medial hamstring tendons. A 2- to 3-cm longitudinal incision from the popliteal crease proximally, in line with the semitendinosus tendon, is sufficient. The deep fascia is bluntly penetrated, and the tendon or tendons are identified. Adhesions are dissected. Then, an open tendon stripper is used to release the tendon or tendons proximally; a closed, sharp tendon stripper is used to release the tendon or tendons from the pes. Layered, absorbable skin closure is performed, and the skin is covered with a skin sealant, bolster dressing, and plastic adhesive bandage for 2 weeks. PMID:24266003

  19. Minimally Invasive Spigelian Hernia Repair

    PubMed Central

    Baucom, Catherine; Nguyen, Quan D.; Hidalgo, Marco

    2009-01-01

    Introduction: Spigelian hernia is an uncommon ventral hernia characterized by a defect in the linea semilunaris. Repair of spigelian hernia has traditionally been accomplished via an open transverse incision and primary repair. The purpose of this article is to present 2 case reports of incarcerated spigelian hernia that were successfully repaired laparoscopically using Gortex mesh and to present a review of the literature regarding laparoscopic repair of spigelian hernias. Methods: Retrospective chart review and Medline literature search. Results: Two patients underwent laparoscopic mesh repair of incarcerated spigelian hernias. Both were started on a regular diet on postoperative day 1 and discharged on postoperative days 2 and 3. One patient developed a seroma that resolved without intervention. There was complete resolution of preoperative symptoms at the 12-month follow-up. Conclusion: Minimally invasive repair of spigelian hernias is an alternative to the traditional open surgical technique. Further studies are needed to directly compare the open and the laparoscopic repair. PMID:19660230

  20. Minimally invasive radioguided parathyroidectomy (MIRP).

    PubMed

    Goldstein, R E; Martin, W H; Richards, K

    2003-06-01

    The technique of parathyroidectomy has traditionally involved a bilateral exploration of the neck with the intent of visualizing 4 parathyroid glands and resecting pathologically enlarged glands. Parathyroid scanning using technetium-99m sestamibi has evolved and can now localize 80% to 90% of parathyroid adenomas. The technique of minimally invasive radioguided parathyroidectomy (MIRP) is a surgical option for most patients with primary hyperparathyroidism and a positive preoperative parathyroid scan. The technique makes use of a hand-held gamma probe that is used intraoperatively to guide the dissection in a highly directed manner with the procedure often performed under local anesthesia. The technique results in excellent cure rates while allowing most patients to leave the hospital within a few hours after the completion of the procedure. Current data also suggest the procedure can decrease hospital charges by approximately 50%. This technique may significantly change the management of primary hyperparathyroidism. PMID:12955045

  1. [MINIMALLY INVASIVE AORTIC VALVE REPLACEMENT].

    PubMed

    Tabata, Minoru

    2016-03-01

    Minimally invasive aortic valve replacement (MIAVR) is defined as aortic valve replacement avoiding full sternotomy. Common approaches include a partial sternotomy right thoracotomy, and a parasternal approach. MIAVR has been shown to have advantages over conventional AVR such as shorter length of stay and smaller amount of blood transfusion and better cosmesis. However, it is also known to have disadvantages such as longer cardiopulmonary bypass and aortic cross-clamp times and potential complications related to peripheral cannulation. Appropriate patient selection is very important. Since the procedure is more complex than conventional AVR, more intensive teamwork in the operating room is essential. Additionally, a team approach during postoperative management is critical to maximize the benefits of MIAVR. PMID:27295772

  2. Heart bypass surgery - minimally invasive - discharge

    MedlinePlus

    ... Thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines. Chest . ... bypass surgery - minimally invasive Heart failure - overview High blood cholesterol ...

  3. Laparoscopic total pelvic exenteration using transanal minimal invasive surgery technique with en bloc bilateral lymph node dissection for advanced rectal cancer.

    PubMed

    Hayashi, Kengo; Kotake, Masanori; Kakiuchi, Daiki; Yamada, Sho; Hada, Masahiro; Kato, Yosuke; Hiranuma, Chikashi; Oyama, Kaeko; Hara, Takuo

    2016-12-01

    A 59-year-old man presenting with fecal occult blood visited our hospital. He was diagnosed with advanced lower rectal cancer, which was contiguous with the prostate and the left seminal vesicle. There were no metastatic lesions with lymph nodes or other organs. We performed laparoscopic total pelvic exenteration (LTPE) using transanal minimal invasive surgery technique with bilateral en bloc lateral lymph node dissection for advanced primary rectal cancer after neoadjuvant chemoradiotherapy. The total operative time was 760 min, and the estimated blood loss was 200 ml. LTPE is not well established technically, but it has many advantages including good visibility of the surgical field, less blood loss, and smaller wounds. A laparoscopic approach may be an appropriate choice for treating locally advanced lower rectal cancer, which requires TPE. PMID:27460130

  4. Validation of Minimally-Invasive, Image-guided Cochlear Implantation Using Advanced Bionics, Cochlear, and Medel Electrodes in a Cadaver Model

    PubMed Central

    McRackan, Theodore R; Balachandran, Ramya; Blachon, Grégoire S; Mitchell, Jason E; Noble, Jack H; Wright, Charles G; Fitzpatrick, J. Michael; Dawant, Benoit M; Labadie, Robert F

    2015-01-01

    Purpose Validation of a novel minimally-invasive, image-guided approach to implant electrodes from three FDA-approved manufacturers—Medel, Cochlear, and Advanced Bionics—in the cochlea via a linear tunnel from the lateral cranium through the facial recess to the cochlea. Methods Custom microstereotactic frames that mount on bone-implanted fiducial markers and constrain the drill along the desired path were utilized on seven cadaver specimens. A linear tunnel was drilled from the lateral skull to the cochlea followed by a marginal, round-window cochleostomy and insertion of the electrode array into the cochlea through the drilled tunnel. Post-insertion CT scan and histological analysis were used to analyze the results. Results All specimens (N=7) were successfully implanted without visible injury to the facial nerve. The Medel electrodes (N=3) had minimal intracochlear trauma with 8, 8, and 10 (out of 12) electrodes intracochlear. The Cochlear lateral wall electrodes (straight research arrays) (N=2) had minimal trauma with 20 and 21 of 22 electrodes intracochlear. The Advanced Bionics electrodes (N=2) were inserted using their insertion tool; one had minimal insertion trauma and 14 of 16 electrodes intracochlear while the other had violation of the basilar membrane just deep to the cochleostomy following which it remained in scala vestibuli with 13 of 16 electrodes intracochlear. Conclusions Minimally invasive, image-guided cochlear implantation is possible using electrodes from the three FDA-approved manufacturers. Lateral wall electrodes were associated with less intracochlear trauma suggesting that they may be better suited for this surgical technique. PMID:23633113

  5. Minimally invasive medial hip approach.

    PubMed

    Chiron, P; Murgier, J; Cavaignac, E; Pailhé, R; Reina, N

    2014-10-01

    The medial approach to the hip via the adductors, as described by Ludloff or Ferguson, provides restricted visualization and incurs a risk of neurovascular lesion. We describe a minimally invasive medial hip approach providing broader exposure of extra- and intra-articular elements in a space free of neurovascular structures. With the lower limb in a "frog-leg" position, the skin incision follows the adductor longus for 6cm and then the aponeurosis is incised. A slide plane between all the adductors and the aponeurosis is easily released by blunt dissection, with no interposed neurovascular elements. This gives access to the lesser trochanter, psoas tendon and inferior sides of the femoral neck and head, anterior wall of the acetabulum and labrum. We report a series of 56 cases, with no major complications: this approach allows treatment of iliopsoas muscle lesions and resection or filling of benign tumors of the cervical region and enables intra-articular surgery (arthrolysis, resection of osteophytes or foreign bodies, labral suture). PMID:25164350

  6. Minimally Invasive Aortic Valve Replacement

    MedlinePlus Videos and Cool Tools

    ... screen and open the door to informed medical care. Good afternoon and welcome to the Heart Institute ... be progressive and less invasive in how we care for our patients. 8 Here's one from one ...

  7. Imaging and minimally invasive aortic valve replacement

    PubMed Central

    Loor, Gabriel

    2015-01-01

    Cardiovascular imaging has been the most important tool allowing for innovation in cardiac surgery. There are now a variety of approaches available for treating aortic valve disease, including standard sternotomy, minimally invasive surgery, and percutaneous valve replacement. Minimally invasive cardiac surgery relies on maximizing exposure within a limited field of view. The complexity of this approach is increased as the relationship between the great vessels and the bony thorax varies between individuals. Ultimately, the success of minimally invasive surgery depends on appropriate choices regarding the type and location of the incision, cannulation approach, and cardioprotection strategy. These decisions are facilitated by preoperative imaging, which forms the focus of this review. PMID:25694979

  8. Economic impact of minimally invasive lumbar surgery

    PubMed Central

    Hofstetter, Christoph P; Hofer, Anna S; Wang, Michael Y

    2015-01-01

    Cost effectiveness has been demonstrated for traditional lumbar discectomy, lumbar laminectomy as well as for instrumented and noninstrumented arthrodesis. While emerging evidence suggests that minimally invasive spine surgery reduces morbidity, duration of hospitalization, and accelerates return to activites of daily living, data regarding cost effectiveness of these novel techniques is limited. The current study analyzes all available data on minimally invasive techniques for lumbar discectomy, decompression, short-segment fusion and deformity surgery. In general, minimally invasive spine procedures appear to hold promise in quicker patient recovery times and earlier return to work. Thus, minimally invasive lumbar spine surgery appears to have the potential to be a cost-effective intervention. Moreover, novel less invasive procedures are less destabilizing and may therefore be utilized in certain indications that traditionally required arthrodesis procedures. However, there is a lack of studies analyzing the economic impact of minimally invasive spine surgery. Future studies are necessary to confirm the durability and further define indications for minimally invasive lumbar spine procedures. PMID:25793159

  9. Minimally invasive surgery for thyroid eye disease

    PubMed Central

    Naik, Milind Neilkant; Nair, Akshay Gopinathan; Gupta, Adit; Kamal, Saurabh

    2015-01-01

    Thyroid eye disease (TED) can affect the eye in myriad ways: proptosis, strabismus, eyelid retraction, optic neuropathy, soft tissue changes around the eye and an unstable ocular surface. TED consists of two phases: active, and inactive. The active phase of TED is limited to a period of 12–18 months and is mainly managed medically with immunosuppression. The residual structural changes due to the resultant fibrosis are usually addressed with surgery, the mainstay of which is orbital decompression. These surgeries are performed during the inactive phase. The surgical rehabilitation of TED has evolved over the years: not only the surgical techniques, but also the concepts, and the surgical tools available. The indications for decompression surgery have also expanded in the recent past. This article discusses the technological and conceptual advances of minimally invasive surgery for TED that decrease complications and speed up recovery. Current surgical techniques offer predictable, consistent results with better esthetics. PMID:26669337

  10. Minimally Invasive Transcatheter Aortic Valve Replacement (TAVR)

    MedlinePlus Videos and Cool Tools

    Watch a Broward Health surgeon perform a minimally invasive Transcatheter Aortic Valve Replacement (TAVR) Click Here to view the BroadcastMed, Inc. Privacy Policy and Legal Notice © 2016 BroadcastMed, Inc. All rights reserved.

  11. Minimally Invasive Treatments for Breast Cancer

    MedlinePlus

    ... SIR login) Interventional Radiology Minimally Invasive Treatments for Breast Cancer Interventional Radiology Treatments Offer New Options and Hope ... have in the fight against breast cancer. About Breast Cancer When breast tissue divides and grows at an ...

  12. [EVOLUTION OF MINIMALLY INVASIVE CARDIAC SURGERY].

    PubMed

    Fujita, Tomoyuki; Kobayashi, Junjiro

    2016-03-01

    Minimally invasive surgery is an attractive choice for patients undergoing major cardiac surgery. We review the history of minimally invasive valve surgery in this article. Due to many innovations in surgical tools, cardiopulmonary bypass systems, visualization systems, and robotic systems as well as surgical techniques, minimally invasive cardiac surgery has become standard care for valve lesion repair. In particular, aortic cross-clamp techniques and methods for cardioplegia using the Chitwood clamp and root cannula or endoballoon catheter in combination with femoro-femoral bypass systems have made such procedures safer and more practical. On the other hand, robotically assisted surgery has not become standard due to the cost and slow learning curve. However, along with the development of robotics, this less-invasive technique may provide another choice for patients in the near future. PMID:27295770

  13. Minimally invasive surgical approach to pancreatic malignancies

    PubMed Central

    Bencini, Lapo; Annecchiarico, Mario; Farsi, Marco; Bartolini, Ilenia; Mirasolo, Vita; Guerra, Francesco; Coratti, Andrea

    2015-01-01

    Pancreatic surgery for malignancy is recognized as challenging for the surgeons and risky for the patients due to consistent perioperative morbidity and mortality. Furthermore, the oncological long-term results are largely disappointing, even for those patients who experience an uneventfully hospital stay. Nevertheless, surgery still remains the cornerstone of a multidisciplinary treatment for pancreatic cancer. In order to maximize the benefits of surgery, the advent of both laparoscopy and robotics has led many surgeons to treat pancreatic cancers with these new methodologies. The reduction of postoperative complications, length of hospital stay and pain, together with a shorter interval between surgery and the beginning of adjuvant chemotherapy, represent the potential advantages over conventional surgery. Lastly, a better cosmetic result, although not crucial in any cancerous patient, could also play a role by improving overall well-being and patient self-perception. The laparoscopic approach to pancreatic surgery is, however, difficult in inexperienced hands and requires a dedicated training in both advanced laparoscopy and pancreatic surgery. The recent large diffusion of the da Vinci® robotic platform seems to facilitate many of the technical maneuvers, such as anastomotic biliary and pancreatic reconstructions, accurate lymphadenectomy, and vascular sutures. The two main pancreatic operations, distal pancreatectomy and pancreaticoduodenectomy, are approachable by a minimally invasive path, but more limited interventions such as enucleation are also feasible. Nevertheless, a word of caution should be taken into account when considering the increasing costs of these newest technologies because the main concerns regarding these are the maintenance of all oncological standards and the lack of long-term follow-up. The purpose of this review is to examine the evidence for the use of minimally invasive surgery in pancreatic cancer (and less aggressive tumors

  14. Minimally Invasive Techniques for the Management of Adult UPJ Obstruction.

    PubMed

    Strother, Marshall C; Mucksavage, Phillip

    2016-05-01

    Ureteropelvic junction obstruction (UPJO) is a common congenital abnormality that often presents in adulthood. Open dismembered pyeloplasty was considered the gold standard for the management of this condition; however, recent advancements in laparoscopic and robotic surgery have dramatically shifted the landscape to more minimally invasive techniques. A literature search of ureteropelvic junction obstruction, pyeloplasty, endopyelotomy, laparoscopic pyeloplasty, robotic pyeloplasty, and microlaparoscopic pyeloplasty was performed. A focus was placed on literature published since 2013. Minimally invasive laparoscopic and robotic techniques have become the gold standard for the management of UPJO. With the rise of robotic pyeloplasty, open repairs are becoming less frequent, while endoscopic treatments have remained stable. Minimally invasive (robotic) techniques have become the gold standard for the management of UPJO. Newer, even less-invasive techniques are also showing promise, but technical challenges still exist. PMID:26968419

  15. Superiority of minimally invasive parathyroidectomy.

    PubMed

    Kunstman, John W; Udelsman, Robert

    2012-01-01

    Because greater than 80% of spontaneous cases of primary hyperparathyroidism are caused by a single adenoma, BCE of the neck, which has long been the approach of choice, is being replaced. Focused parathyroidectomy has been made possible by advances in preoperative parathyroid localization and IOPTH monitoring, which allows confirmation of cure and confirmation of the absence of MGD without visualizing all 4 parathyroids. Several techniques for focused parathyroidectomy exist, but open MIP through an incision of 2 to 3 cm with surgeon-administered locoregional anesthesia seems to improve on the already high success rate and low morbidity associated withimproe on bilateral exploration. In addition, MIP is associated with numerous secondary benefits such as decreased hospital cost, improved patient satisfaction, decreased operative time, and same-day discharge. Bilateral exploration will remain the standard of care for most patients with multigland or syndromic disease. Most patients with sporadic PHPT are candidates for MIP. PMID:22873039

  16. Minimally invasive surgical training: challenges and solutions.

    PubMed

    Pierorazio, Phillip M; Allaf, Mohamad E

    2009-01-01

    Treatment options for urological malignancies continue to increase and include endoscopic, laparoscopic, robotic, and image-guided percutaneous techniques. This ever expanding array of technically demanding management options coupled with a static training paradigm introduces challenges to training the urological oncologist of the future. Minimally invasive learning opportunities continue to evolve, and include an intensive experience during residency, postgraduate short courses or mini-apprenticeships, and full time fellowship programs. Incorporation of large animal surgery and surgical simulators may help shorten the necessary learning curve. Ultimately, programs must provide an intense hands-on experience to trainees in all minimally invasive surgical aspects for optimal training. PMID:19285236

  17. Minimally invasive transforaminal lumbosacral interbody fusion.

    PubMed

    Chang, Peng-Yuan; Wang, Michael Y

    2016-07-01

    In minimally invasive spinal fusion surgery, transforaminal lumbar (sacral) interbody fusion (TLIF) is one of the most common procedures that provides both anterior and posterior column support without retraction or violation to the neural structure. Direct and indirect decompression can be done through this single approach. Preoperative plain radiographs and MR scan should be carefully evaluated. This video demonstrates a standard approach for how to perform a minimally invasive transforaminal lumbosacral interbody fusion. The video can be found here: https://youtu.be/bhEeafKJ370 . PMID:27364426

  18. Minimally invasive (robotic assisted thoracic surgery and video-assisted thoracic surgery) lobectomy for the treatment of locally advanced non-small cell lung cancer

    PubMed Central

    Yang, Hao-Xian; Woo, Kaitlin M.; Sima, Camelia S.

    2016-01-01

    Background Insufficient data exist on the results of minimally invasive surgery (MIS) for locally advanced non-small cell lung cancer (NSCLC) traditionally approached by thoracotomy. The use of telerobotic surgical systems may allow for greater utilization of MIS approaches to locally advanced disease. We will review the existing literature on MIS for locally advanced disease and briefly report on the results of a recent study conducted at our institution. Methods We performed a retrospective review of a prospective single institution database to identify patients with clinical stage II and IIIA NSCLC who underwent lobectomy following induction chemotherapy. The patients were classified into two groups (MIS and thoracotomy) and were compared for differences in outcomes and survival. Results From January 2002 to December 2013, 428 patients {397 thoracotomy, 31 MIS [17 robotic and 14 video-assisted thoracic surgery (VATS)]} underwent induction chemotherapy followed by lobectomy. The conversion rate in the MIS group was 26% (8/31) The R0 resection rate was similar between the groups (97% for MIS vs. 94% for thoracotomy; P=0.71), as was postoperative morbidity (32% for MIS vs. 33% for thoracotomy; P=0.99). The median length of hospital stay was shorter in the MIS group (4 vs. 5 days; P<0.001). The 3-year overall survival (OS) was 48.3% in the MIS group and 56.6% in the thoracotomy group (P=0.84); the corresponding 3-year DFS were 49.0% and 42.1% (P=0.19). Conclusions In appropriately selected patients with NSCLC, MIS approaches to lobectomy following induction therapy are feasible and associated with similar disease-free and OS to those following thoracotomy. PMID:27195138

  19. Minimally Invasive Osteotomies of the Calcaneus.

    PubMed

    Guyton, Gregory P

    2016-09-01

    Osteotomies of the calcaneus are powerful surgical tools, representing a critical component of the surgical reconstruction of pes planus and pes cavus deformity. Modern minimally invasive calcaneal osteotomies can be performed safely with a burr through a lateral incision. Although greater kerf is generated with the burr, the effect is modest, can be minimized, and is compatible with many fixation techniques. A hinged jig renders the procedure more reproducible and accessible. PMID:27524705

  20. Pancreatic cancer: Open or minimally invasive surgery?

    PubMed Central

    Zhang, Yu-Hua; Zhang, Cheng-Wu; Hu, Zhi-Ming; Hong, De-Fei

    2016-01-01

    Pancreatic duct adenocarcinoma is one of the most fatal malignancies, with R0 resection remaining the most important part of treatment of this malignancy. However, pancreatectomy is believed to be one of the most challenging procedures and R0 resection remains the only chance for patients with pancreatic cancer to have a good prognosis. Some surgeons have tried minimally invasive pancreatic surgery, but the short- and long-term outcomes of pancreatic malignancy remain controversial between open and minimally invasive procedures. We collected comparative data about minimally invasive and open pancreatic surgery. The available evidence suggests that minimally invasive pancreaticoduodenectomy (MIPD) is as safe and feasible as open PD (OPD), and shows some benefit, such as less intraoperative blood loss and shorter postoperative hospital stay. Despite the limited evidence for MIPD in pancreatic cancer, most of the available data show that the short-term oncological adequacy is similar between MIPD and OPD. Some surgical techniques, including superior mesenteric artery-first approach and laparoscopic pancreatoduodenectomy with major vein resection, are believed to improve the rate of R0 resection. Laparoscopic distal pancreatectomy is less technically demanding and is accepted in more pancreatic centers. It is technically safe and feasible and has similar short-term oncological prognosis compared with open distal pancreatectomy. PMID:27621576

  1. Minimally invasive pancreatic surgery – a review

    PubMed Central

    Damoli, Isacco; Ramera, Marco; Paiella, Salvatore; Marchegiani, Giovanni; Bassi, Claudio

    2015-01-01

    During the past 20 years the application of a minimally invasive approach to pancreatic surgery has progressively increased. Distal pancreatectomy is the most frequently performed procedure, because of the absence of a reconstructive phase. However, middle pancreatectomy and pancreatoduodenectomy have been demonstrated to be safe and feasible as well. Laparoscopic distal pancreatectomy is recognized as the gold standard treatment for small tumors of the pancreatic body-tail, with several advantages over the traditional open approach in terms of patient recovery. The surgical treatment of lesions of the pancreatic head via a minimally invasive approach is still limited to a few highly experienced surgeons, due to the very challenging resection and complex anastomoses. Middle pancreatectomy and enucleation are indicated for small and benign tumors and offer the maximum preservation of the parenchyma. The introduction of a robotic platform more than ten years ago increased the interest of many surgeons in minimally invasive treatment of pancreatic diseases. This new technology overcomes all the limitations of laparoscopic surgery, but actual benefits for the patients are still under investigation. The increased costs associated with robotic surgery are under debate too. This article presents the state of the art of minimally invasive pancreatic surgery. PMID:26240612

  2. Pancreatic cancer: Open or minimally invasive surgery?

    PubMed

    Zhang, Yu-Hua; Zhang, Cheng-Wu; Hu, Zhi-Ming; Hong, De-Fei

    2016-08-28

    Pancreatic duct adenocarcinoma is one of the most fatal malignancies, with R0 resection remaining the most important part of treatment of this malignancy. However, pancreatectomy is believed to be one of the most challenging procedures and R0 resection remains the only chance for patients with pancreatic cancer to have a good prognosis. Some surgeons have tried minimally invasive pancreatic surgery, but the short- and long-term outcomes of pancreatic malignancy remain controversial between open and minimally invasive procedures. We collected comparative data about minimally invasive and open pancreatic surgery. The available evidence suggests that minimally invasive pancreaticoduodenectomy (MIPD) is as safe and feasible as open PD (OPD), and shows some benefit, such as less intraoperative blood loss and shorter postoperative hospital stay. Despite the limited evidence for MIPD in pancreatic cancer, most of the available data show that the short-term oncological adequacy is similar between MIPD and OPD. Some surgical techniques, including superior mesenteric artery-first approach and laparoscopic pancreatoduodenectomy with major vein resection, are believed to improve the rate of R0 resection. Laparoscopic distal pancreatectomy is less technically demanding and is accepted in more pancreatic centers. It is technically safe and feasible and has similar short-term oncological prognosis compared with open distal pancreatectomy. PMID:27621576

  3. [Minimally Invasive Open Surgery for Lung Cancer].

    PubMed

    Nakagawa, Kazuo; Watanabe, Shunichi

    2016-07-01

    Significant efforts have been made to reduce the invasiveness of surgical procedures by surgeons for a long time. Surgeons always keep it in mind that the basic principle performing less invasive surgical procedures for malignant tumors is to decrease the invasiveness for patients without compromising oncological curability and surgical safety. Video-assisted thoracic surgery (VATS) has been used increasingly as a minimally invasive approach to lung cancer surgery. Whereas, whether VATS lobectomy is a less invasive procedure and has equivalent or better clinical effect compared with open lobectomy for patients with lung cancer remains controversial because of the absence of randomized prospective studies. The degree of difficulty for anatomical lung resection depends on the degree of the fissure development, mobility of hilar lymph nodes, and the degree of pleural adhesions. During pulmonary surgery, thoracic surgeons always have to deal with not only these difficulties but other unexpected events such as intraoperative bleeding. Recently, we perform pulmonary resection for lung cancer with minimally invasive open surgery (MIOS) approach. In this article, we introduce the surgical procedure of MIOS and demonstrate short-term results. Off course, the efficacy of MIOS needs to be further evaluated with long-term results. PMID:27440030

  4. Minimal invasive treatments for liver malignancies.

    PubMed

    Orsi, Franco; Varano, Gianluca

    2015-11-01

    Minimal invasive therapies have proved useful in the management of primary and secondary hepatic malignancies. The most relevant aspects of all these therapies are their minimal toxicity profiles and highly effective tumor responses without affecting the normal hepatic parenchyma. These unique characteristics coupled with their minimally invasive nature provide an attractive therapeutic option for patients who previously may have had few alternatives. Combination of these therapies might extend indications to bring curative treatment to a wider selected population. The results of various ongoing combination trials of intraarterial therapies with targeted therapies are awaited to further improve survival in this patient group. This review focuses on the application of ablative and intra-arterial therapies in the management of hepatocellular carcinoma and hepatic colorectal metastasis. PMID:26050603

  5. Minimally invasive thyroidectomy: a ten years experience

    PubMed Central

    Viani, Lorenzo; Montana, Chiara Montana; Cozzani, Federico; Sianesi, Mario

    2016-01-01

    Background The conventional thyroidectomy is the most frequent surgical procedure for thyroidal surgical disease. From several years were introduced minimally invasive approaches to thyroid surgery. These new procedures improved the incidence of postoperative pain, cosmetic results, patient’s quality of life, postoperative morbidity. The mini invasive video-assisted thyroidectomy (MIVAT) is a minimally invasive procedure that uses a minicervicotomy to treat thyroidal diseases. Methods We present our experience on 497 consecutively treated patients with MIVAT technique. We analyzed the mean age, sex, mean operative time, rate of bleeding, hypocalcemia, transitory and definitive nerve palsy (6 months after the procedure), postoperative pain scale from 0 to 10 at 1 hour and 24 hours after surgery, mean hospital stay. Results The indications to treat were related to preoperative diagnosis: 182 THYR 6, 184 THYR 3–4, 27 plummer, 24 basedow, 28 toxic goiter, 52 goiter. On 497 cases we have reported 1 case of bleeding (0,2%), 12 (2,4%) cases of transitory nerve palsy and 4 (0,8%) definitive nerve palsy. The rate of serologic hypocalcemia was 24.9% (124 cases) and clinical in 7.2% (36 cases); 1 case of hypoparathyroidism (0.2%). Conclusions The MIVAT is a safe approach to surgical thyroid disease, the cost are similar to CT as the adverse events. The minicervicotomy is really a minimally invasive tissue dissection. PMID:27294036

  6. Minimally invasive follicular thyroid carcinomas: prognostic factors.

    PubMed

    Stenson, Gustav; Nilsson, Inga-Lena; Mu, Ninni; Larsson, Catharina; Lundgren, Catharina Ihre; Juhlin, C Christofer; Höög, Anders; Zedenius, Jan

    2016-08-01

    Although minimally invasive follicular thyroid carcinoma (MI-FTC) is regarded as an indolent tumour, treatment strategies remain controversial. Our aim was to investigate the outcome for patients with MI-FTC and to identify prognostic parameters to facilitate adequate treatment and follow-up. This retrospective follow-up study involved all cases of MI-FTC operated at the Karolinska University Hospital between 1986 and 2009. Outcome was analysed using death from MI-FTC as endpoint. Fifty-eight patients (41 women and 17 men) with MI-FTC were identified. The median follow-up time was 140 (range 21-308) months. Vascular invasion was observed in 36 cases and was associated with larger tumour size [median 40 (20-76) compared with 24 (10-80) mm for patients with capsular invasion only (P = 0.001)] and older patients [54 (20-92) vs. 44 (11-77) years; P = 0.019]. Patients with vascular invasion were more often treated with thyroidectomy (21/36 compared to 7/22 with capsular invasion only; P = 0.045). Five patients died from metastatic disease of FTC after a median follow-up of 114 (range 41-193) months; all were older than 50 years (51-72) at the time of the initial surgery; vascular invasion was present in all tumours and all but one were treated with thyroidectomy. Univariate analysis identified combined capsular and vascular invasion (P = 0.034), age at surgery ≥50 years (P = 0.023) and male gender (P = 0.005) as related to risk of death from MI-FTC. MI-FTC should not be considered a purely indolent disease. Age at diagnosis and the existence of combined capsular and vascular invasion were identified as important prognostic factors. PMID:26858184

  7. Navigated minimally invasive unicompartmental knee arthroplasty.

    PubMed

    Jenny, Jean-Yves; Müller, Peter E; Weyer, R; John, Michael; Weber, Patrick; Ciobanu, Eugène; Schmitz, Andreas; Bacher, Thomas; Neumann, Wolfram; Jansson, Volkmar

    2006-10-01

    Unicompartmental knee arthroplasty (UKA) is an alternative procedure to high tibial osteotomy. This study assessed the procedure using computer navigation to improve implantation accuracy and presents early radiological results of a group of patients implanted with the univation UKA (B. Braun Aesculap, Tuttlingen, Germany) with navigation instrumentation and a minimally invasive approach. The authors concluded that navigated implantation of a UKA using a nonimage-based system improved radiologic accuracy implantation without significant inconvenience and minimal change in the conventional operating technique. PMID:17407935

  8. Minimally invasive approach to familial multiple lipomatosis.

    PubMed

    Ronan, S J; Broderick, T

    2000-09-01

    Thirty-five abdominal wall lipomas were removed from a patient with familial multiple lipomatosis using a minimally invasive approach in a cost-effective, reliable, and cosmetically pleasing manner. The surgical technique used is described in this case report. Clinical findings and prior excisions provided the preoperative diagnosis. The abdominal wall was dissected through two small, vertical midline incisions in the suprafascial plane with the aid of a lighted breast retractor. A complete excision of all palpable lipomas was achieved with this approach. The patient had excellent cosmetic results with minimal postoperative scarring. PMID:11007403

  9. Perfusion techniques for minimally invasive valve procedures.

    PubMed

    de Jong, A; Popa, B A; Stelian, E; Karazanishvili, L; Lanzillo, G; Simonini, S; Renzi, L; Diena, M; Tesler, U F

    2015-05-01

    In this paper, we present, in detail, the simplified perfusion technique that we have adopted since January 2009 and that we have utilized in 200 cases for cardiac minimally invasive valvular procedures that were performed through a right lateral mini-thoracotomy in the 3(rd)-4(th) intercostal space. Cardiopulmonary bypass was achieved by means of the direct cannulation of the ascending aorta and the insertion of a percutaneous venous cannula in the femoral vein. A flexible aortic cross-clamp was applied through the skin incision and cardioplegic arrest was obtained with the antegrade delivery of a crystalloid solution. Gravity drainage was enhanced by vacuum-assisted aspiration. There were no technical complications related to this perfusion technique that we have adopted in minimally invasive surgical procedures. PMID:25280878

  10. Intravital microscopy of the lung: minimizing invasiveness.

    PubMed

    Fiole, Daniel; Tournier, Jean-Nicolas

    2016-09-01

    In vivo microscopy has recently become a gold standard in lung immunology studies involving small animals, largely benefiting from the democratization of multiphoton microscopy allowing for deep tissue imaging. This technology represents currently our only way of exploring the lungs and inferring what happens in human respiratory medicine. The interest of lung in vivo microscopy essentially relies upon its relevance as a study model, fulfilling physiological requirements in comparison with in vitro and ex vivo experiments. However, strategies developed in order to overcome movements of the thorax caused by breathing and heartbeats remain the chief drawback of the technique and a major source of invasiveness. In this context, minimizing invasiveness is an unavoidable prerequisite for any improvement of lung in vivo microscopy. This review puts into perspective the main techniques enabling lung in vivo microscopy, providing pros and cons regarding invasiveness. PMID:26846880

  11. Combined thoracoscopic and laparoscopic minimally invasive esophagectomy

    PubMed Central

    Zeng, Fuchun; Wang, Youyu; Xue, Yang; Cong, Wei

    2014-01-01

    With the improvement in thoracoscopic and laparoscopic surgery, thoracoscopic and laparoscopic esophagectomy (TLE), a minimally invasive approach, has attracted increasing attention as an alternative to open three-field esophagectomy. From June 2012 to October 2013, 90 patients underwent laparoscopic and thoracoscopic resection of esophageal carcinoma in our department. The VATS esophagectomy technique described here is the approach currently employed in the department of thoracic surgery at Sichuan Provincial People’s Hospital of China. PMID:24605230

  12. Minimally invasive aesthetic procedures in young adults

    PubMed Central

    Wollina, Uwe; Goldman, Alberto

    2011-01-01

    Age is a significant factor in modifying specific needs when it comes to medical aesthetic procedures. In this review we will focus on young adults in their third decade of life and review minimally invasive aesthetic procedures other than cosmetics and cosmeceuticals. Correction of asymmetries, correction after body modifying procedures, and facial sculpturing are important issues for young adults. The implication of aesthetic medicine as part of preventive medicine is a major ethical challenge that differentiates aesthetic medicine from fashion. PMID:21673871

  13. Minimally invasive local therapies for liver cancer

    PubMed Central

    Li, David; Kang, Josephine; Golas, Benjamin J.; Yeung, Vincent W.; Madoff, David C.

    2014-01-01

    Primary and metastatic liver tumors are an increasing global health problem, with hepatocellular carcinoma (HCC) now being the third leading cause of cancer-related mortality worldwide. Systemic treatment options for HCC remain limited, with Sorafenib as the only prospectively validated agent shown to increase overall survival. Surgical resection and/or transplantation, locally ablative therapies and regional or locoregional therapies have filled the gap in liver tumor treatments, providing improved survival outcomes for both primary and metastatic tumors. Minimally invasive local therapies have an increasing role in the treatment of both primary and metastatic liver tumors. For patients with low volume disease, these therapies have now been established into consensus practice guidelines. This review highlights technical aspects and outcomes of commonly utilized, minimally invasive local therapies including laparoscopic liver resection (LLR), radiofrequency ablation (RFA), microwave ablation (MWA), high-intensity focused ultrasound (HIFU), irreversible electroporation (IRE), and stereotactic body radiation therapy (SBRT). In addition, the role of combination treatment strategies utilizing these minimally invasive techniques is reviewed. PMID:25610708

  14. [Minimally Invasive Treatment of Esophageal Benign Diseases].

    PubMed

    Inoue, Haruhiro

    2016-07-01

    As a minimally invasive treatment of esophageal achalasia per-oral endoscopic myotomy( POEM) was developed in 2008. More than 1,100 cases of achalasia-related diseases received POEM. Success rate of the procedure was more than 95%(Eckerdt score improvement 3 points and more). No serious( Clavian-Dindo classification III b and more) complication was experienced. These results suggest that POEM becomes a standard minimally invasive treatment for achalasia-related diseases. As an off-shoot of POEM submucosal tumor removal through submucosal tunnel (per-oral endoscopic tumor resection:POET) was developed and safely performed. Best indication of POET is less than 5 cm esophageal leiomyoma. A novel endoscopic treatment of gastroesophageal reflux disease (GERD) was developed. Anti-reflux mucosectomy( ARMS) is nearly circumferential mucosal reduction of gastric cardia mucosa. ARMS is performed in 56 consecutive cases of refractory GERD. No major complications were encountered and excellent clinical results. Best indication of ARMS is a refractory GERD without long sliding hernia. Longest follow-up case is more than 10 years. Minimally invasive treatments for esophageal benign diseases are currently performed by therapeutic endoscopy. PMID:27440038

  15. Minimally invasive local therapies for liver cancer.

    PubMed

    Li, David; Kang, Josephine; Golas, Benjamin J; Yeung, Vincent W; Madoff, David C

    2014-12-01

    Primary and metastatic liver tumors are an increasing global health problem, with hepatocellular carcinoma (HCC) now being the third leading cause of cancer-related mortality worldwide. Systemic treatment options for HCC remain limited, with Sorafenib as the only prospectively validated agent shown to increase overall survival. Surgical resection and/or transplantation, locally ablative therapies and regional or locoregional therapies have filled the gap in liver tumor treatments, providing improved survival outcomes for both primary and metastatic tumors. Minimally invasive local therapies have an increasing role in the treatment of both primary and metastatic liver tumors. For patients with low volume disease, these therapies have now been established into consensus practice guidelines. This review highlights technical aspects and outcomes of commonly utilized, minimally invasive local therapies including laparoscopic liver resection (LLR), radiofrequency ablation (RFA), microwave ablation (MWA), high-intensity focused ultrasound (HIFU), irreversible electroporation (IRE), and stereotactic body radiation therapy (SBRT). In addition, the role of combination treatment strategies utilizing these minimally invasive techniques is reviewed. PMID:25610708

  16. Role of minimally invasive surgery in ovarian cancer.

    PubMed

    Nezhat, Farr R; Pejovic, Tanja; Finger, Tamara N; Khalil, Susan S

    2013-01-01

    The standard treatment of ovarian cancer includes upfront surgery with intent to accurately diagnose and stage the disease and to perform maximal cytoreduction, followed by chemotherapy in most cases. Surgical staging of ovarian cancer traditionally has included exploratory laparotomy with peritoneal washings, hysterectomy, salpingo-oophorectomy, omentectomy, multiple peritoneal biopsies, and possible pelvic and para-aortic lymphadenectomy. In the early 1990s, pioneers in laparoscopic surgery used minimally invasive techniques to treat gynecologic cancers, including laparoscopic staging of early ovarian cancer and primary and secondary cytoreduction in advanced and recurrent disease in selected cases. Since then, the role of minimally invasive surgery in gynecologic oncology has been continually expanding, and today advanced laparoscopic and robotic-assisted laparoscopic techniques are used to evaluate and treat cervical and endometrial cancer. However, the important question about the place of the minimally invasive approach in surgical treatment of ovarian cancer remains to be evaluated and answered. Overall, the potential role of minimally invasive surgery in treatment of ovarian cancer is as follows: i) laparoscopic evaluation, diagnosis, and staging of apparent early ovarian cancer; ii) laparoscopic assessment of feasibility of upfront surgical cytoreduction to no visible disease; iii) laparoscopic debulking of advanced ovarian cancer; iv) laparoscopic reassessment in patients with complete remission after primary treatment; and v) laparoscopic assessment and cytoreduction of recurrent disease. The accurate diagnosis of suspect adnexal masses, the safety and feasibility of this surgical approach in early ovarian cancer, the promise of laparoscopy as the most accurate tool for triaging patients with advanced disease for surgery vs upfront chemotherapy or neoadjuvant chemotherapy, and its potential in treatment of advanced cancer have been documented and

  17. Minimally invasive surgery for atrial fibrillation

    PubMed Central

    Suwalski, Piotr

    2013-01-01

    Atrial fibrillation (AF) remains the most common cardiac arrhythmia, affecting nearly 2% of the general population worldwide. Minimally invasive surgical ablation remains one of the most dynamically evolving fields of modern cardiac surgery. While there are more than a dozen issues driving this development, two seem to play the most important role: first, there is lack of evidence supporting percutaneous catheter based approach to treat patients with persistent and long-standing persistent AF. Paucity of this data offers surgical community unparalleled opportunity to challenge guidelines and change indications for surgical intervention. Large, multicenter prospective clinical studies are therefore of utmost importance, as well as honest, clear data reporting. Second, a collaborative methodology started a long-awaited debate on a Heart Team approach to AF, similar to the debate on coronary artery disease and transcatheter valves. Appropriate patient selection and tailored treatment options will most certainly result in better outcomes and patient satisfaction, coupled with appropriate use of always-limited institutional resources. The aim of this review, unlike other reviews of minimally invasive surgical ablation, is to present medical professionals with two distinctly different, approaches. The first one is purely surgical, Standalone surgical isolation of the pulmonary veins using bipolar energy source with concomitant amputation of the left atrial appendage—a method of choice in one of the most important clinical trials on AF—The Atrial Fibrillation Catheter Ablation Versus Surgical Ablation Treatment (FAST) Trial. The second one represents the most complex approach to this problem: a multidisciplinary, combined effort of a cardiac surgeon and electrophysiologist. The Convergent Procedure, which includes both endocardial and epicardial unipolar ablation bonds together minimally invasive endoscopic surgery with electroanatomical mapping, to deliver best of

  18. Minimally invasive surgery for atrial fibrillation.

    PubMed

    Zembala, Michael O; Suwalski, Piotr

    2013-11-01

    Atrial fibrillation (AF) remains the most common cardiac arrhythmia, affecting nearly 2% of the general population worldwide. Minimally invasive surgical ablation remains one of the most dynamically evolving fields of modern cardiac surgery. While there are more than a dozen issues driving this development, two seem to play the most important role: first, there is lack of evidence supporting percutaneous catheter based approach to treat patients with persistent and long-standing persistent AF. Paucity of this data offers surgical community unparalleled opportunity to challenge guidelines and change indications for surgical intervention. Large, multicenter prospective clinical studies are therefore of utmost importance, as well as honest, clear data reporting. Second, a collaborative methodology started a long-awaited debate on a Heart Team approach to AF, similar to the debate on coronary artery disease and transcatheter valves. Appropriate patient selection and tailored treatment options will most certainly result in better outcomes and patient satisfaction, coupled with appropriate use of always-limited institutional resources. The aim of this review, unlike other reviews of minimally invasive surgical ablation, is to present medical professionals with two distinctly different, approaches. The first one is purely surgical, Standalone surgical isolation of the pulmonary veins using bipolar energy source with concomitant amputation of the left atrial appendage-a method of choice in one of the most important clinical trials on AF-The Atrial Fibrillation Catheter Ablation Versus Surgical Ablation Treatment (FAST) Trial. The second one represents the most complex approach to this problem: a multidisciplinary, combined effort of a cardiac surgeon and electrophysiologist. The Convergent Procedure, which includes both endocardial and epicardial unipolar ablation bonds together minimally invasive endoscopic surgery with electroanatomical mapping, to deliver best of the

  19. Minimally Invasive Surgery Osteotomy of the Hindfoot.

    PubMed

    Vernois, Joel; Redfern, David; Ferraz, Linda; Laborde, Julien

    2015-07-01

    A minimally invasive surgical approach has been developed for hindfoot as well as forefoot procedures. Percutaneous techniques have been evolving for more than 20 years. Many conventional surgical techniques can be performed percutaneously after training. Percutaneous surgical techniques require knowledge specific to each procedure (eg, percutaneous Zadek osteotomy or percutaneous medial heel shift). In the treatment and correction of the hindfoot pathology the surgeon now has percutaneous options including medial or lateral heel shift, Zadek osteotomy, and exostectomy with/without arthroscopy. PMID:26117576

  20. Minimally Invasive Atrial Fibrillation Surgery: Hybrid Approach

    PubMed Central

    Beller, Jared P.; Downs, Emily A.; Ailawadi, Gorav

    2016-01-01

    Atrial fibrillation is a challenging pathologic process. There continues to be a great need for the development of a reproducible, durable cure when medical management has failed. An effective, minimally invasive, sternal-sparing intervention without the need for cardiopulmonary bypass is a promising treatment approach. In this article, we describe a hybrid technique being refined at our center that combines a thoracoscopic epicardial surgical approach with an endocardial catheter-based procedure. We also discuss our results and review the literature describing this unique treatment approach. PMID:27127561

  1. Minimally Invasive Approach of a Retrocaval Ureter

    PubMed Central

    Pinheiro, Hugo; Ferronha, Frederico; Morales, Jorge; Campos Pinheiro, Luís

    2016-01-01

    The retrocaval ureter is a rare congenital entity, classically managed with open pyeloplasty techniques. The experience obtained with the laparoscopic approach of other more frequent causes of ureteropelvic junction (UPJ) obstruction has opened the method for the minimally invasive approach of the retrocaval ureter. In our paper, we describe a clinical case of a right retrocaval ureter managed successfully with laparoscopic dismembered pyeloplasty. The main standpoints of the procedure are described. Our results were similar to others published by other urologic centers, which demonstrates the safety and feasibility of the procedure for this condition.

  2. Minimally Invasive Transforaminal Lumbar Interbody Fusion.

    PubMed

    Ahn, Junyoung; Tabaraee, Ehsan; Singh, Kern

    2015-07-01

    Minimally invasive transforaminal lumbar interbody fusion (MIS TLIF) is performed via tubular dilators thereby preserving the integrity of the paraspinal musculature. The decreased soft tissue disruption in the MIS technique has been associated with significantly decreased blood loss, shorter length of hospitalization, and an expedited return to work while maintaining comparable arthrodesis rates when compared with the open technique particularly in the setting of spondylolisthesis (isthmic and degenerative), recurrent symptomatic disk herniation, spinal stenosis, pseudoarthrosis, iatrogenic instability, and spinal trauma. The purpose of this article and the accompanying video wass to demonstrate the techniques for a primary, single-level MIS TLIF. PMID:26079840

  3. Minimally invasive surgery for esophageal achalasia

    PubMed Central

    Chen, Huan-Wen

    2016-01-01

    Esophageal achalasia is due to the esophagus of neuromuscular dysfunction caused by esophageal functional disease. Its main feature is the lack of esophageal peristalsis, the lower esophageal sphincter pressure and to reduce the swallow’s relaxation response. Lower esophageal muscular dissection is one of the main ways to treat esophageal achalasia. At present, the period of muscular layer under the thoracoscope esophagus dissection is one of the treatment of esophageal achalasia. Combined with our experience in minimally invasive esophageal surgery, to improved incision and operation procedure, and adopts the model of the complete period of muscular layer under the thoracoscope esophagus dissection in the treatment of esophageal achalasia. PMID:27499977

  4. Cardiac Output Assessed by Invasive and Minimally Invasive Techniques

    PubMed Central

    Lee, Allison J.; Cohn, Jennifer Hochman; Ranasinghe, J. Sudharma

    2011-01-01

    Cardiac output (CO) measurement has long been considered essential to the assessment and guidance of therapeutic decisions in critically ill patients and for patients undergoing certain high-risk surgeries. Despite controversies, complications and inherent errors in measurement, pulmonary artery catheter (PAC) continuous and intermittent bolus techniques of CO measurement continue to be the gold standard. Newer techniques provide less invasive alternatives; however, currently available monitors are unable to provide central circulation pressures or true mixed venous saturations. Esophageal Doppler and pulse contour monitors can predict fluid responsiveness and have been shown to decrease postoperative morbidity. Many minimally invasive techniques continue to suffer from decreased accuracy and reliability under periods of hemodynamic instability, and so few have reached the level of interchangeability with the PAC. PMID:21776254

  5. Minimally invasive coronary artery bypass grafting: initial Connecticut experience.

    PubMed

    Tellides, G; Maragh, M R; Smith, J M; Kopf, G S; Ezekowitz, M; Remetz, M; Elefteriades, J A

    1997-03-01

    We report the initial Connecticut experience with minimally invasive coronary artery bypass grafting. This procedure allows bypass grafting to the left anterior descending coronary artery utilizing the internal mammary artery as the conduit. The procedure is minimally invasive because it is performed through a mini-thoracotomy incision in the fourth anterior intercostal space and it is conducted without the use of cardiopulmonary bypass. The procedure has been applied to 13 patients operated between February and October 1996. All but one patient selected were poor candidates for conventional coronary artery bypass surgery because of advanced age (6), chronic renal failure/dialysis/kidney transplant (4), redo status with vulnerable grafts (1), severe peripheral vascular disease (6), severe chronic obstructive pulmonary disease (4). All patients survived operation and were discharged in good condition. Mean postoperative intubation time was seven hours and mean hospital stay was 4.5 days despite the very high pre-existing comorbidity of these patients. All patients are alive at the current follow-up time. Two patients required a conventional bypass procedure for occlusion of the minimally invasive graft, the first because of diffuse disease in the target artery and the second attributable to the technical limitations of minimally invasive coronary artery bypass grafting; both tolerated the subsequent procedure well. All patients are now angina-free. All four grafts studied by routine postoperative angiography were widely patent. Routine post-operative exercise nuclear imaging was normal in an additional patient. This procedure of minimally invasive coronary artery bypass grafting offers significant advantages compared to the conventional bypass procedure (short hospital stay, quick recovery, and, especially, avoidance of cerebrovascular accidents caused by the heart-lung machine). This minimally invasive procedure is expected to apply to a growing percentage of

  6. [Comprehensive Treatment for Lung Cancer 
Based on Minimally Invasive Thoracic Surgery].

    PubMed

    He, Jianxing

    2016-06-20

    The treatment for resectable lung cancer has developed to the era of comprehensive treatment based on minimally invasive surgery (MIS). MIS is not only manifested by the "shrink" of incisions, but also by the individualization and meticulous of incisions. Meanwhile, the minimal invasiveness of other procedures in MIS, such as the minimally invasive anesthesia (tubeless anesthesia) and minimally invasive, meticulous and individualized surgical instruments represented by 3D thoracoscope with naked eye. Even advanced stage lung cancer patients could receive precision treatment based on molecular information of their cancer tissue obtained by surgery. Therefore, the treatment for lung cancer should be comprehensive treatment based on MIS. PMID:27335290

  7. MR imaging guidance for minimally invasive procedures

    NASA Astrophysics Data System (ADS)

    Wong, Terence Z.; Kettenbach, Joachim; Silverman, Stuart G.; Schwartz, Richard B.; Morrison, Paul R.; Kacher, Daniel F.; Jolesz, Ferenc A.

    1998-04-01

    Image guidance is one of the major challenges common to all minimally invasive procedures including biopsy, thermal ablation, endoscopy, and laparoscopy. This is essential for (1) identifying the target lesion, (2) planning the minimally invasive approach, and (3) monitoring the therapy as it progresses. MRI is an ideal imaging modality for this purpose, providing high soft tissue contrast and multiplanar imaging, capability with no ionizing radiation. An interventional/surgical MRI suite has been developed at Brigham and Women's Hospital which provides multiplanar imaging guidance during surgery, biopsy, and thermal ablation procedures. The 0.5T MRI system (General Electric Signa SP) features open vertical access, allowing intraoperative imaging to be performed. An integrated navigational system permits near real-time control of imaging planes, and provides interactive guidance for positioning various diagnostic and therapeutic probes. MR imaging can also be used to monitor cryotherapy as well as high temperature thermal ablation procedures sing RF, laser, microwave, or focused ultrasound. Design features of the interventional MRI system will be discussed, and techniques will be described for interactive image acquisition and tracking of interventional instruments. Applications for interactive and near-real-time imaging will be presented as well as examples of specific procedures performed using MRI guidance.

  8. Minimally invasive treatment options in fixed prosthodontics.

    PubMed

    Edelhoff, Daniel; Liebermann, Anja; Beuer, Florian; Stimmelmayr, Michael; Güth, Jan-Frederik

    2016-03-01

    Minimally invasive treatment options have become increasingly feasible in restorative dentistry, due to the introduction of the adhesive technique in combination with restorative materials featuring translucent properties similar to those of natural teeth. Mechanical anchoring of restorations via conventional cementation represents a predominantly subtractive treatment approach that is gradually being superseded by a primarily defect-oriented additive method in prosthodontics. Modifications of conventional treatment procedures have led to the development of an economical approach to the removal of healthy tooth structure. This is possible because the planned treatment outcome is defined in a wax-up before the treatment is commenced and this wax-up is subsequently used as a reference during tooth preparation. Similarly, resin- bonded FDPs and implants have made it possible to preserve the natural tooth structure of potential abutment teeth. This report describes a number of clinical cases to demonstrate the principles of modern prosthetic treatment strategies and discusses these approaches in the context of minimally invasive prosthetic dentistry. PMID:26925471

  9. [Theory and practice of minimally invasive endodontics].

    PubMed

    Jiang, H W

    2016-08-01

    The primary goal of modern endodontic therapy is to achieve the long-term retention of a functional tooth by preventing or treating pulpitis or apical periodontitis is. The long-term retention of endodontically treated tooth is correlated with the remaining amount of tooth tissue and the quality of the restoration after root canal filling. In recent years, there has been rapid progress and development in the basic research of endodontic biology, instrument and applied materials, making treatment procedures safer, more accurate, and more efficient. Thus, minimally invasive endodontics(MIE)has received increasing attention at present. MIE aims to preserve the maximum of tooth structure during root canal therapy, and the concept covers the whole process of diagnosis and treatment of teeth. This review article focuses on describing the minimally invasive concepts and operating essentials in endodontics, from diagnosis and treatment planning to the access opening, pulp cavity finishing, root canal cleaning and shaping, 3-dimensional root canal filling and restoration after root canal treatment. PMID:27511034

  10. Minimally Invasive Procedures for Nasal Aesthetics

    PubMed Central

    Redaelli, Alessio; Limardo, Pietro

    2012-01-01

    Nose has an important role in the aesthetics of face. It is easy to understand the reason of the major interest that has revolved around the correction of its imperfections for several centuries, or even from the ancient times. In the last decade, all the surgical or medical minimal-invasive techniques evolved exponentially. The techniques of rejuvenation and corrections of nasal imperfections did not escape this development that is much widespread in the medicine of the third millennium. In many cases, the techniques of surgical correction involve invasive procedure that necessitates, for the majority of cases, hospitalisation. The author, using a different approach, has developed mini-invasive techniques using botulinum toxin A (BTxA) and absorbable fillers for the correction of nasal imperfections. BTxA allows to reduce the imperfections due to hypertension of muscles, while the absorbable fillers allow to correct all the imperfections of the nasal profile from the root to the tip in total safety. The correction is based on the precise rules that allow avoiding the majority of side effects. Results are long lasting and well appreciated by patients. PMID:23060706

  11. Minimally invasive endoscopic surgery for treatment of spontaneous intracerebral haematomas.

    PubMed

    Beynon, Christopher; Schiebel, Patrick; Bösel, Julian; Unterberg, Andreas W; Orakcioglu, Berk

    2015-07-01

    Spontaneous intracerebral haemorrhage (ICH) is a devastating disease with a mortality rate of more than 40 % and a high morbidity rate with 10-15 % of survivors remaining fully dependent [11]. The role of surgical treatment of ICH remains a matter of controversy and ongoing investigation. Advances in neurosurgical techniques such as endoscopy and neuronavigation have been established in various fields of neurosurgery. Results of reported case series have suggested that some patients with ICH may benefit from haematoma evacuation through minimally invasive endoscopic procedures. In this article, we focus on the pathophysiologic rationales behind minimally invasive haematoma evacuation through endoscopic surgery and provide an overview of technical developments and reported patient series. In addition, the modalities of the surgical procedure at the authors' institution are described. Controlled clinical trials are needed to evaluate the full potential and limitations of this promising technique. PMID:25687253

  12. Minimally invasive radio-guided parathyroidectomy.

    PubMed

    Rubello, Domenico; Giannini, Sandro; Martini, Chiara; Piotto, Andrea; Rampin, Lucia; Fanti, Stefano; Armigliato, Michela; Nardi, Alfredo; Carpi, Angelo; Mariani, Giuliano; Gross, Milton D; Pelizzo, Maria Rosa

    2006-04-01

    We reported here the data on minimally invasive radio-guided parathyroidectomy (MIRP) in a large group of 253 patients enrolled from the whole series of 355 consecutive patients affected by primary hyperparathyroidism (P-HPT) referred to our center. On the basis of preoperative imaging including Sestamibi scintigraphy and neck ultrasound (US), 263 patients (74% of the whole series) with evidence of a solitary parathyroid adenoma (PA) and a normal thyroid gland were addressed to MIRP and in 253 (96%) of them this minimally invasive neck exploration was successfully performed. The MIRP protocol developed in our center consisted of a very low 1 mCi Sestamibi injection in the operating room a few minutes before the start of intervention, thus minimizing the radiation exposure dose to the patient and personnel. No major intraoperative complication was recorded in patients treated by MIRP and only a transient hypocalcemia in 8.5% of cases. The mean duration time for MIRP was 35 min and the mean hospital stay 1.2 days. Local anesthesia was also performed in 62 patients, 54 of whom were elderly patients with concomitant invalidating diseases contraindicating general anesthesia. No HPT relapse was observed during subsequent follow-up. The gamma probe was used also during bilateral neck exploration in the group of 92 patients excluded from MIRP. The most frequent cause of exclusion from MIRP in our series was the presence of concomitant Sestamibi avid thyroid nodules (68.5% of cases) that can give false positive results at radio-guided surgery. In conclusion, MIRP is an effective treatment in patients with a high likelihood of a solitary PA and a normal thyroid gland at scintigraphy and US so that an accurate preoperative localizing imaging is required for MIRP. A low 1 mCi Sestamibi dose appears sufficient to perform MIRP. Patients with concomitant Sestamibi avid thyroid nodules should be excluded from MIRP. PMID:16524690

  13. Comparison of laparoscopy-assisted and open radical gastrectomy for advanced gastric cancer: A retrospective study in a single minimally invasive surgery center.

    PubMed

    Hao, Yingxue; Yu, Peiwu; Qian, Feng; Zhao, Yongliang; Shi, Yan; Tang, Bo; Zeng, Dongzhu; Zhang, Chao

    2016-06-01

    Laparoscopy-assisted gastrectomy (LAG) has gained international acceptance for the treatment of early gastric cancer (EGC). However, the use of laparoscopic surgery in the management of advanced gastric cancer (AGC) has not attained widespread acceptance. This retrospective large-scale patient study in a single center for minimally invasive surgery assessed the feasibility and safety of LAG for T2 and T3 stage AGC. A total of 628 patients underwent LAG and 579 patients underwent open gastrectomy (OG) from Jan 2004 to Dec 2011. All cases underwent radical lymph node (LN) dissection from D1 to D2+. This study compared short- and long-term results between the 2 groups after stratifying by pTNM stages, including the mean operation time, volume of blood loss, number of harvested LNs, average days of postoperative hospital stay, mean gastrointestinal function recovery time, intra- and post-operative complications, recurrence rate, recurrence site, and 5-year survival curve. Thirty-five patients (5.57%) converted to open procedures in the LAG group. There were no significant differences in retrieved LN number (30.4 ± 13.4 vs 28.1 ± 17.2, P = 0.43), proximal resection margin (PRM) (6.15 ± 1.63 vs 6.09 ± 1.91, P = 0.56), or distal resection margin (DRM) (5.46 ± 1.74 vs 5.40 ± 1.95, P = 0.57) between the LAG and OG groups, respectively. The mean volume of blood loss (154.5 ± 102.6 vs 311.2 ± 118.9 mL, P < 0.001), mean postoperative hospital stay (7.6 ± 2.5 vs 10.7 ± 3.6 days, P < 0.001), mean time for gastrointestinal function recovery (3.3 ± 1.4 vs 3.9 ± 1.5 days, P < 0.001), and postoperative complications rate (6.4% vs 10.5%, P = 0.01) were clearly lower in the LAG group compared to the OG group. However, the recurrence pattern and site were not different between the 2 groups, even they were stratified by the TNM stage. The 5-year overall survival (OS) rates were 85.38%, 79.70%, 57

  14. Injectable biomaterials for minimally invasive orthopedic treatments.

    PubMed

    Jayabalan, M; Shalumon, K T; Mitha, M K

    2009-06-01

    Biodegradable and injectable hydroxy terminated-poly propylene fumarate (HT-PPF) bone cement was developed. The injectable formulation consisting HT-PPF and comonomer, n-vinyl pyrrolidone, calcium phosphate filler, free radical catalyst, accelerator and radiopaque agent sets rapidly to hard mass with low exothermic temperature. The candidate bone cement attains mechanical strength more than the required compressive strength of 5 MPa and compressive modulus 50 MPa. The candidate bone cement resin elicits cell adhesion and cytoplasmic spreading of osteoblast cells. The cured bone cement does not induce intracutaneous irritation and skin sensitization. The candidate bone cement is tissue compatible without eliciting any adverse tissue reactions. The candidate bone cement is osteoconductive and inductive and allow osteointegration and bone remodeling. HT-PPF bone cement is candidate bone cement for minimally invasive radiological procedures for the treatment of bone diseases and spinal compression fractures. PMID:19160023

  15. Endoscopic navigation for minimally invasive suturing.

    PubMed

    Wengert, Christian; Bossard, Lukas; Häberling, Armin; Baur, Charles; Székely, Gábor; Cattin, Philippe C

    2007-01-01

    Manipulating small objects such as needles, screws or plates inside the human body during minimally invasive surgery can be very difficult for less experienced surgeons, due to the loss of 3D depth perception. This paper presents an approach for tracking a suturing needle using a standard endoscope. The resulting pose information of the needle is then used to generate artificial 3D cues on the 2D screen to optimally support surgeons during tissue suturing. Additionally, if an external tracking device is provided to report the endoscope's position, the suturing needle can be tracked in a hybrid fashion with sub-millimeter accuracy. Finally, a visual navigation aid can be incorporated, if a 3D surface is intraoperatively reconstructed from video or registered from preoperative imaging. PMID:18044620

  16. Minimally invasive procedures for neuropathic pain.

    PubMed

    Sdrulla, Andrei; Chen, Grace

    2016-04-01

    Neuropathic pain is "pain arising as a direct consequence of a lesion or disease affecting the somatosensory system". The prevalence of neuropathic pain ranges from 7 to 11% of the population and minimally invasive procedures have been used to both diagnose and treat neuropathic pain. Diagnostic procedures consist of nerve blocks aimed to isolate the peripheral nerve implicated, whereas therapeutic interventions either modify or destroy nerve function. Procedures that modify how nerves function include epidural steroid injections, peripheral nerve blocks and sympathetic nerve blocks. Neuroablative procedures include radiofrequency ablation, cryoanalgesia and neurectomies. Currently, neuromodulation with peripheral nerve stimulators and spinal cord stimulators are the most evidence-based treatments of neuropathic pain. PMID:26988024

  17. Minimally invasive training in urologic oncology.

    PubMed

    Liu, Jen-Jane; Gonzalgo, Mark L

    2011-11-01

    Use of minimally invasive surgical (MIS) techniques continues to expand in the field of urologic oncology; however, proficiency in these techniques is subject to a learning curve. Current training paradigms have incorporated MIS, but in a non-standardized fashion. Residency work-hour restrictions and ethical concerns may influence efforts to deliver adequate training during a defined residency period. Post-residency fellowships or mini-courses may help urologists gain proficiency in these skills, but are time-consuming and may not provide adequate exposure. Surgical simulation with dry labs and augmentation with virtual reality are important adjuncts to operative training for MIS. The urologic oncologist must be familiar with open and MIS techniques to effectively treat cancer in the least morbid way possible and adapt to the ever-changing field of MIS with dynamic training paradigms. PMID:22155873

  18. Minimally invasive total hip arthroplasty: in opposition.

    PubMed

    Hungerford, David S

    2004-06-01

    At the Knee Society Winter Meeting in 2003, Seth Greenwald and I debated about whether there should be new standards (ie, regulations) applied to the release of information to the public on "new developments." I argued for the public's "right to know" prior to the publication of peer-reviewed literature. He argued for regulatory constraint or "proving by peer-reviewed publication" before alerting the public. It is not a contradiction for me to currently argue against the public advertising of minimally invasive (MIS) total hip arthroplasty as not yet being in the best interest of the public. It is hard to remember a concept that has so captured both the public's and the surgical community's fancy as MIS. Patients are "demanding" MIS without knowing why. Surgeons are offering it as the next best, greatest thing without having developed the skill and experience to avoid the surgery's risks. If you put "minimally invasive hip replacement" into the Google search engine (http://www.google.com), you get 5,170 matches. If you put the same words in PubMed (http://www.ncbi.nlm.nih.gov/entrez/query.fcgi), referencing the National Library of Medicine database, you get SEVENTEEN; none is really a peer-reviewed article. Most are 1 page papers in orthopedics from medical education meetings. On the other hand, there are over 6,000 peer-reviewed articles on total hip arthroplasty. Dr. Thomas Sculco, my couterpart in this debate, wrote an insightful editorial in the American Journal of Orthopedic Surgery in which he stated: "Although these procedures have generated incredible interest and enthusiasm, I am concerned that they may be performed to the detriment of our patients." I couldn't agree with him more. Smaller is not necessarily better and, when it is worse, it will be the "smaller" that is held accountable. PMID:15190556

  19. Innovations in minimally invasive mitral valve pair.

    PubMed

    Sündermann, Simon H; Seeburger, Joerg; Scherman, Jacques; Mohr, Friedrich Wilhelm; Falk, Volkmar

    2012-12-01

    Mitral valve (MV) insufficiency is the second most common heart valve disease represented in cardiac surgery. The gold standard therapy is surgical repair of the valve. Today, most centers prefer a minimally invasive approach through a right-sided mini-thoracotomy. Despite the small access, there is still the need to use cardiopulmonary bypass (CPB), and the operation has to be performed on the arrested heart. New devices have been developed to optimize the results of surgical repair by implementing mechanisms for post-implantation adjustment on the beating heart or the avoidance of CPB. Early attempts with adjustable mitral annuloplasty rings go back to the early 1990s. Only a few devices are available on the market. Recently, a mitral valve adjustable annuloplasty ring was CE-marked and is under further clinical investigation. In addition, a sutureless annuloplasty band to be implanted on the beating heart is under preclinical and initial clinical investigation for transatrial and transfemoral transcatheter implantation. Furthermore, new neochord systems are being developed, which allow for functional length adjustment on the beating heart after implantation. Some devices were developed for percutaneous MV repair implanted into the coronary sinus to reshape the posterior MV annulus. Other percutaneous devices are directly fixed to the posterior annulus to alter its shape. Several disadvantages have been observed preventing a broad clinical use of some of these devices. There is a continuous effort to develop innovative techniques to optimize MV repair and to decrease invasiveness. PMID:23315719

  20. [Minimally Invasive Thoracoscopic Surgery for Mediastinal Lesions].

    PubMed

    Maeda, Sumiko

    2016-07-01

    This review article describes minimally invasive thoracoscopic surgery for anterior mediastinal lesions. The operative procedures for anterior mediastinal lesions have been changed in a couple of decades from open surgery under median sternotomy to complete thoracoscopic mediastinal surgery with sternal lifting or carbon dioxide insufflation. Carbon dioxide insufflation of the thoracic cavity or the mediastinum is now prevailing to improve the surgical field and facilitate the operative procedures. Surgical indications for complete thoracoscopic mediastinal surgery include benign cystic lesions generally regardless of their size and non-invasive anterior mediastinal tumors usually less than 50~60 mm in the greatest dimension. There are currently three surgical approaches in the complete thoracoscopic surgery for the anterior mediastinal lesions. One is the unilateral or bilateral transthoracic approach. The second is the combination of the subxiphoid and the transthoracic approach. The last is the subxiphoid approach. The selection of the surgical approach depends on the surgeon's preference and experiences. When carbon dioxide insufflation is applied during the operation, following complications may occur;hypercapnia, gas embolism, subcutaneous emphysema, endotracheal tube dislocation due to the mediastinal sift, and hypotention. Special safety considerations are necessary during the complete thoracoscopic mediastinal surgery with carbon dioxide insufflation. PMID:27440034

  1. Minimally invasive knee arthroplasty: An overview

    PubMed Central

    Tria, Alfred J; Scuderi, Giles R

    2015-01-01

    Minimally invasive surgery (MIS) for arthroplasty of the knee began with surgery for unicondylar knee arthroplasty (UKA). Partial knee replacements were designed in the 1970s and were amenable to a more limited exposure. In the 1990s Repicci popularized the MIS for UKA. Surgeons began to apply his concepts to total knee arthroplasty. Four MIS surgical techniques were developed: quadriceps sparing, mini-mid vastus, mini-subvastus, and mini-medial parapatellar. The quadriceps sparing technique is the most limited one and is also the most difficult. However, it is the least invasive and allows rapid recovery. The mini-midvastus is the most common technique because it affords slightly better exposure and can be extended. The mini-subvastus technique entirely avoids incising the quadriceps extensor mechanism but is time consuming and difficult in the obese and in the muscular male patient. The mini-parapatellar technique is most familiar to surgeons and represents a good starting point for surgeons who are learning the techniques. The surgeries are easier with smaller instruments but can be performed with standard ones. The techniques are accurate and do lead to a more rapid recovery, with less pain, less blood loss, and greater motion if they are appropriately performed. PMID:26601062

  2. Transdermal Photopolymerization for Minimally Invasive Implantation

    NASA Astrophysics Data System (ADS)

    Elisseeff, J.; Anseth, K.; Sims, D.; McIntosh, W.; Randolph, M.; Langer, R.

    1999-03-01

    Photopolymerizations are widely used in medicine to create polymer networks for use in applications such as bone restorations and coatings for artificial implants. These photopolymerizations occur by directly exposing materials to light in "open" environments such as the oral cavity or during invasive procedures such as surgery. We hypothesized that light, which penetrates tissue including skin, could cause a photopolymerization indirectly. Liquid materials then could be injected s.c. and solidified by exposing the exterior surface of the skin to light. To test this hypothesis, the penetration of UVA and visible light through skin was studied. Modeling predicted the feasibility of transdermal polymerization with only 2 min of light exposure required to photopolymerize an implant underneath human skin. To establish the validity of these modeling studies, transdermal photopolymerization first was applied to tissue engineering by using "injectable" cartilage as a model system. Polymer/chondrocyte constructs were injected s.c. and transdermally photopolymerized. Implants harvested at 2, 4, and 7 weeks demonstrated collagen and proteoglycan production and histology with tissue structure comparable to native neocartilage. To further examine this phenomenon and test the applicability of transdermal photopolymerization for drug release devices, albumin, a model protein, was released for 1 week from photopolymerized hydrogels. With further study, transdermal photpolymerization potentially could be used to create a variety of new, minimally invasive surgical procedures in applications ranging from plastic and orthopedic surgery to tissue engineering and drug delivery.

  3. Prevailing Trends in Haptic Feedback Simulation for Minimally Invasive Surgery.

    PubMed

    Pinzon, David; Byrns, Simon; Zheng, Bin

    2016-08-01

    Background The amount of direct hand-tool-tissue interaction and feedback in minimally invasive surgery varies from being attenuated in laparoscopy to being completely absent in robotic minimally invasive surgery. The role of haptic feedback during surgical skill acquisition and its emphasis in training have been a constant source of controversy. This review discusses the major developments in haptic simulation as they relate to surgical performance and the current research questions that remain unanswered. Search Strategy An in-depth review of the literature was performed using PubMed. Results A total of 198 abstracts were returned based on our search criteria. Three major areas of research were identified, including advancements in 1 of the 4 components of haptic systems, evaluating the effectiveness of haptic integration in simulators, and improvements to haptic feedback in robotic surgery. Conclusions Force feedback is the best method for tissue identification in minimally invasive surgery and haptic feedback provides the greatest benefit to surgical novices in the early stages of their training. New technology has improved our ability to capture, playback and enhance to utility of haptic cues in simulated surgery. Future research should focus on deciphering how haptic training in surgical education can increase performance, safety, and improve training efficiency. PMID:26839212

  4. 'Mini, ultra, micro' - nomenclature and cost of these new minimally invasive percutaneous nephrolithotomy (PCNL) techniques.

    PubMed

    Wright, Anna; Rukin, Nick; Smith, Daron; De la Rosette, Jean; Somani, Bhaskar K

    2016-04-01

    New minimally invasive percutaneous nephrolithotomy (PCNL) techniques have changed the management of renal stones. We discuss the technological advances in PCNL and explain the meaning, requirements and set up costs for each of these 'newer' techniques. PMID:27034726

  5. Surgical efficacy of minimally invasive thoracic discectomy.

    PubMed

    Elhadi, Ali M; Zehri, Aqib H; Zaidi, Hasan A; Almefty, Kaith K; Preul, Mark C; Theodore, Nicholas; Dickman, Curtis A

    2015-11-01

    We aimed to determine the clinical indications and surgical outcomes for thoracoscopic discectomy. Thoracic disc disease is a rare degenerative process. Thoracoscopic approaches serve to minimize tissue injury during the approach, but critics argue that this comes at the cost of surgical efficacy. Current reports in the literature are limited to small institutional patient series. We systematically identified all English language articles on thoracoscopic discectomy with at least two patients, published from 1994 to 2013 on MEDLINE, Science Direct, and Google Scholar. We analyzed 12 articles that met the inclusion criteria, five prospective and seven retrospective studies comprising 545 surgical patients. The overall complication rate was 24% (n=129), with reported complications ranging from intercostal neuralgia (6.1%), atelectasis (2.8%), and pleural effusion (2.6%), to more severe complications such as pneumonia (0.8%), pneumothorax (1.3%), and venous thrombosis (0.2%). The average reported postoperative follow-up was 20.5 months. Complete resolution of symptoms was reported in 79% of patients, improvement with residual symptoms in 10.2%, no change in 9.6%, and worsening in 1.2%. The minimally invasive endoscopic approaches to the thoracic spine among selected patients demonstrate excellent clinical efficacy and acceptable complication rates, comparable to the open approaches. Disc herniations confined to a single level, with small or no calcifications, are ideal for such an approach, whereas patients with calcified discs adherent to the dura would benefit from an open approach. PMID:26206758

  6. The theoretical basis of minimally-invasive and non-invasive medicine: Treatments--Minimize harm to patients.

    PubMed

    Wang, Zhibiao

    2015-11-01

    This perspective, for the first time, proposed the theoretical basis for the minimally-invasive and non-invasive medicine. It sets the goal of medical treatment that is to minimize harm to patients and to maximize the natural self-healing power for fighting against the disease. It took a historical review on the technological developments shaped by the minimally-invasive and non-invasive ideology with a focus on the course of research, development and clinical deployment of the high-intensity focused ultrasound (HIFU) ablation therapy by the Chinese research team. It also summarized the highlights of the "1st Yangtze International Summit of Minimally-invasive and Non-invasive Medicine 2013" and the mandate of the newly inaugurated International Society of the Minimally-invasive and Noninvasive Medicine (ISMINIM). It provides a perspective on the future development of this emerging field and its impact on human civilization. PMID:26074209

  7. Minimally Invasive Versus Conventional Aortic Valve Replacement

    PubMed Central

    Attia, Rizwan Q.; Hickey, Graeme L.; Grant, Stuart W.; Bridgewater, Ben; Roxburgh, James C.; Kumar, Pankaj; Ridley, Paul; Bhabra, Moninder; Millner, Russell W. J.; Athanasiou, Thanos; Casula, Roberto; Chukwuemka, Andrew; Pillay, Thasee; Young, Christopher P.

    2016-01-01

    Objective Minimally invasive aortic valve replacement (MIAVR) has been demonstrated as a safe and effective option but remains underused. We aimed to evaluate outcomes of isolated MIAVR compared with conventional aortic valve replacement (CAVR). Methods Data from The National Institute for Cardiovascular Outcomes Research (NICOR) were analyzed at seven volunteer centers (2006–2012). Primary outcomes were in-hospital mortality and midterm survival. Secondary outcomes were postoperative length of stay as well as cumulative bypass and cross-clamp times. Propensity modeling with matched cohort analysis was used. Results Of 307 consecutive MIAVR patients, 151 (49%) were performed during the last 2 years of study with a continued increase in numbers. The 307 MIAVR patients were matched on a 1:1 ratio. In the matched CAVR group, there was no statistically significant difference in in-hospital mortality [MIAVR, 4/307,(1.3%); 95% confidence interval (CI), 0.4%–3.4% vs CAVR, 6/307 (2.0%); 95% CI, 0.8%–4.3%; P = 0.752]. One-year survival rates in the MIAVR and CAVR groups were 94.4% and 94.6%, respectively. There was no statistically significant difference in midterm survival (P = 0.677; hazard ratio, 0.90; 95% CI, 0.56–1.46). Median postoperative length of stay was lower in the MIAVR patients by 1 day (P = 0.009). The mean cumulative bypass time (94.8 vs 91.3 minutes; P = 0.333) and cross-clamp time (74.6 vs 68.4 minutes; P = 0.006) were longer in the MIAVR group; however, this was significant only in the cross-clamp time comparison. Conclusions Minimally invasive aortic valve replacement is a safe alternative to CAVR with respect to operative and 1-year mortality and is associated with a shorter postoperative stay. Further studies are required in high-risk (logistic EuroSCORE > 10) patients to define the role of MIAVR. PMID:26926521

  8. Minimally Invasive Approach to Achilles Tendon Pathology.

    PubMed

    Hegewald, Kenneth W; Doyle, Matthew D; Todd, Nicholas W; Rush, Shannon M

    2016-01-01

    Many surgical procedures have been described for Achilles tendon pathology; however, no overwhelming consensus has been reached for surgical treatment. Open repair using a central or paramedian incision allows excellent visualization for end-to-end anastomosis in the case of a complete rupture and detachment and reattachment for insertional pathologies. Postoperative wound dehiscence and infection in the Achilles tendon have considerable deleterious effects on overall functional recovery and outcome and sometimes require plastic surgery techniques to achieve coverage. With the aim of avoiding such complications, foot and ankle surgeons have studied less invasive techniques for repair. We describe a percutaneous approach to Achilles tendinopathy using a modification of the Bunnell suture weave technique combined with the use of interference screws. No direct end-to-end repair of the tendon is performed, rather, the proximal stump is brought in direct proximity of the distal stump, preventing overlengthening and proximal stump retraction. This technique also reduces the suture creep often seen with end-to-end tendon repair by providing a direct, rigid suture to bone interface. We have used the new technique to minimize dissection and exposure while restoring function and accelerating recovery postoperatively. PMID:26385574

  9. Advances in Bio-Tactile Sensors for Minimally Invasive Surgery Using the Fibre Bragg Grating Force Sensor Technique:A Survey

    PubMed Central

    Abushagur, Abdulfatah A.G.; Arsad, Norhana; Ibne Reaz, Mamun; Ashrif, A.; Bakar, A.

    2014-01-01

    The large interest in utilising fibre Bragg grating (FBG) strain sensors for minimally invasive surgery (MIS) applications to replace conventional electrical tactile sensors has grown in the past few years. FBG strain sensors offer the advantages of optical fibre sensors, such as high sensitivity, immunity to electromagnetic noise, electrical passivity and chemical inertness, but are not limited by phase discontinuity or intensity fluctuations. FBG sensors feature a wavelength-encoding sensing signal that enables distributed sensing that utilises fewer connections. In addition, their flexibility and lightness allow easy insertion into needles and catheters, thus enabling localised measurements inside tissues and blood. Two types of FBG tactile sensors have been emphasised in the literature: single-point and array FBG tactile sensors. This paper describes the current design, development and research of the optical fibre tactile techniques that are based on FBGs to enhance the performance of MIS procedures in general. Providing MIS or microsurgery surgeons with accurate and precise measurements and control of the contact forces during tissues manipulation will benefit both surgeons and patients. PMID:24721774

  10. Training minimal invasive approaches in hepatopancreatobilliary fellowship: the current status

    PubMed Central

    Subhas, Gokulakkrishna; Mittal, Vijay K

    2011-01-01

    Background There has been an increasing role of advanced minimally invasive procedures in hepatopancreatobilliary (HPB) surgery. However, there are no set minimum laparoscopic case requirements. Methods A 14-question electronic survey was sent to 82 worldwide HPB fellowship programme directors. Results Forty-nine per cent (n = 40) of the programme directors responded. The programmes were predominantly university based (83%). Programmes had either one (55%) or two fellows (40%) each year. Programmes (35–48%) had average annual volumes of 51–100 hepatic, 51–100 pancreatic and 25–50 biliary cases. For many programmes, <10% of hepatic (48%), pancreatic (40%) and biliary (70%) cases were done laparoscopically. The average annual fellow case volumes for hepatic, pancreatic and biliary surgeries were 25–50 (62%), 25–50 (47%) and <25 (50%), respectively. The average annual number of hepatic, pancreatic and biliary cases done laparoscopically by a fellow was 9, 9 and 4, which constitutes 36%, 36% and 16%, respectively, of the International Hepato-Pancreato-Billiary Association (IHPBA) requirement. Conclusion We surmise that the low average number of surgeries performed by minimally-invasive techniques by HPB fellows is not sufficient in today's practice. Should there be an increase in the minimal number of hepatic, pancreatic and complex biliary cases to 50, 50, and 25, with at least 50% of these performed laparoscopically? PMID:21309929

  11. Endoscopic cystogastrostomy: minimally invasive approach for pancreatic pseudocyst.

    PubMed

    Sial, Gull-Zareen Khan; Qazi, Abid Quddus; Yusuf, Mohammed Aasim

    2015-01-01

    Pancreatic pseudocysts in children are not uncommon. Non-resolving pseudocysts often require surgical intervention. Endoscopic cystogastrostomy is a minimally invasive procedure which is recommended for this condition. We report a large pancreatic pseudocyst in a 4-year old child, which developed following therapy with PEG-Asparaginase for acute lymphoblastic leukemia. It was managed with minimally invasive procedure. PMID:25628993

  12. Endoscopic Cystogastrostomy: Minimally Invasive Approach for Pancreatic Pseudocyst

    PubMed Central

    Sial, Gull-Zareen Khan; Yusuf, Mohammed Aasim

    2015-01-01

    Pancreatic pseudocysts in children are not uncommon. Non-resolving pseudocysts often require surgical intervention. Endoscopic cystogastrostomy is a minimally invasive procedure which is recommended for this condition. We report a large pancreatic pseudocyst in a 4-year old child, which developed following therapy with PEG-Asparaginase for acute lymphoblastic leukemia. It was managed with minimally invasive procedure. PMID:25628993

  13. Minimally Invasive Treatment of Liver Hydatidosis

    PubMed Central

    Pantea, Stelian; Lazar, Caius; Salim, Abdullah; Barjica, Daniela

    2016-01-01

    Background and Objectives: Open surgery has been the mainstay treatment for liver hydatidosis in the past. Today, for treatment of simple and uncomplicated cysts, we have a variety of choices: antihelmintic therapy, the PAIR (puncture, aspiration, injection, and respiration) technique, and the laparoscopic approach. We reviewed our series of 267 cases of hepatic hydatidosis submitted to surgery over a period of 20 years, from 1995 through 2014, comparing the results of these minimally invasive treatments. Methods: In 92 patients (25.7% of cases) who presented with complicated liver hydatid cysts, we performed open surgery. In 16.4% of cases (59 patients), we used a laparoscopic approach, and in 208 patients (57.9% of cases), we used the PAIR technique. All patients were monitored after surgery for a mean of 61.7 months (range, 16–127). Postoperative follow-up consisted of clinical examination, laboratory investigation, abdominal ultrasound, and magnetic resonance imaging. Results: Almost all patients (198, 95.2%) treated with the PAIR technique and 55 patients (93.2%) treated with the laparoscopic approach were cured. Six patients (2.8%) from the echo-guided puncture group had to undergo a repeat of the procedure because the cavity did not disappear after 2 years. In 4 patients (2%), we performed open surgery for 2 biliary fistulas and 2 hepatic abscesses. Four patients from the laparoscopic group needed additional procedures. Open surgery was necessary in 2 patients for a recurrence after 2 years; 1 patient had developed a liver abscess and the other had a biliary fistula. Conclusions: In conclusion, open surgery remains the viable option for complicated cysts, with biliary communication, with multiple daughter vesicles, or with calcified walls. For simple, uncomplicated hydatid cysts, both methods (the PAIR technique and laparoscopic procedure) are safe and efficient, with very good results and low morbidity rates. PMID:27019575

  14. Noninvasive and minimally invasive techniques in body contouring.

    PubMed

    Afrooz, Paul N; Pozner, Jason N; DiBernardo, Barry E

    2014-10-01

    Major surgical body contouring procedures have several inherent drawbacks, including hospitalization, anesthetic use, pain, swelling, and prolonged recovery. It is for these reasons that body contouring through noninvasive and minimally invasive methods has become one of the most alluring areas in aesthetic surgery. Patient expectations and demands have driven the field toward safer, less-invasive procedures with less discomfort, fewer complications, and a shorter recovery. In this article, the current minimally invasive and noninvasive modalities for body contouring are reviewed. PMID:25283463

  15. The Technological Development of Minimally Invasive Spine Surgery

    PubMed Central

    Snyder, Laura A.; O'Toole, John; Eichholz, Kurt M.; Perez-Cruet, Mick J.; Fessler, Richard

    2014-01-01

    Minimally invasive spine surgery has its roots in the mid-twentieth century with a few surgeons and a few techniques, but it has now developed into a large field of progressive spinal surgery. A wide range of techniques are now called “minimally invasive,” and case reports are submitted constantly with new “minimally invasive” approaches to spinal pathology. As minimally invasive spine surgery has become more mainstream over the past ten years, in this paper we discuss its history and development. PMID:24967347

  16. The Body Image Dissatisfaction and Psychological Symptoms among Invasive and Minimally Invasive Aesthetic Surgery Patients

    PubMed Central

    Y. Yazdandoost, Rokhsareh; Hayatbini, Niki; Asgharnejad Farid, Ali Asghar; Gharaee, Banafsheh; Latifi, Noor Ahmad

    2016-01-01

    BACKGROUND Elective aesthetic surgeries are increasing in the Iranian population with reasons linked to body image dissatisfaction and psychological symptoms. This study compared the body image dissatisfaction and psychological symptoms among invasive and minimally invasive aesthetic surgery patients and a control group. METHODS Data from 90 participants (invasive aesthetic surgery=30 Ss, minimally invasive aesthetic surgery=30 Ss, and control group=30 Ss) were included. Subjects were assessed on body image dissatisfaction and psychological symptoms to provide an evidence for a continuum of body image dissatisfaction, anxiety, depression and interpersonal sensitivity in invasive and minimally invasive aesthetic surgery clients. RESULTS Between the three groups of invasive, minimally invasive aesthetic surgeries and control on body image dissatisfaction and psychological symptoms (anxiety, depression and interpersonal sensitivity), there was a significant difference. CONCLUSION These findings have implications for pre-surgical assessment as well as psychological interventions rather than invasive medical interventions at first step.

  17. Rapidly advancing invasive endomyocardial aspergillosis.

    PubMed

    Davutoglu, Vedat; Soydinc, Serdar; Aydin, Abdullah; Karakok, Metin

    2005-02-01

    The exposure to Aspergillus organisms/spores is likely common, but disease caused by tissue invasion with these fungi is uncommon and occurs primarily in the setting of immunosuppression. We report a case of rapidly advancing invasive endomyocardial aspergillosis secondary to prolonged usage of multiple broad-spectrum antibiotics in a nonimmunocompromised host. A 36-year-old cotton textile worker presented to our institution with a 3-month history of weight loss and fatigue. He reported receiving prolonged use of multiple broad-spectrum antibiotic treatment. The echocardiogram demonstrated multiple endomyocardial vegetations and a mass in the left atrium. Myocardial biopsy specimen revealed an invasive endomyocardial aspergillosis. The patient was investigated for immune deficiency including HIV, and this workup was negative. Treatment was started with amphotericin B and heparin for presumed left atrial thrombus. The patient died because of a rupture of mycotic aneurysm that resulted in cerebral hemorrhage. This case illustrates the risk of an invasive fungal infection in a nonimmunocompromised host who is a prolonged user of antibiotics in the setting of environmental exposure of opportunistic invasive fungal infections. PMID:15682058

  18. Minimally invasive thymectomy: the Mayo Clinic experience

    PubMed Central

    Rowse, Phillip G.; Roden, Anja C.; Corl, Frank M.; Allen, Mark S.; Cassivi, Stephen D.; Nichols, Francis C.; Shen, K. Robert; Wigle, Dennis A.

    2015-01-01

    Background The prevalence of minimally invasive thymectomy (MIT) is increasing and may have significant benefit to patients in terms of morbidity and post-operative recovery. Our aim was to review the Mayo Clinic experience of MIT. Methods We reviewed data from all MIT cases collected in a prospectively maintained database from January 1995 to February 2015. Data were collected regarding patient demographics, perioperative management and patient outcomes. Results A total of 510 thymectomies were performed in 20 years. Fifty-six patients underwent MIT (45 video-assisted thoracoscopy, 11 robotic-assisted). The median age was 55 years (range, 23-87 years) with male to female ratio of 25:31. Thymoma was the main pathologic diagnosis in 27/56 patients (48%), with 11/27 (41%) associated with myasthenia gravis (MG), and 16/27 (59%) non-MG. Other pathologies included 1/56 (2%) of each teratoma, lymphoma, lymphangioma, carcinoma and thymolipoma. There were 3/56 (5%) atrophic glands, 4/56 (7%) cysts, 6/56 (11%) benign glands and 11/56 (20%) hyperplastic. Mean blood loss (mL) and operative time (min) were significantly lower in the video-assisted thoracoscopic surgery (VATS) group compared to robotic (65±41 vs. 160±205 mL, P=0.04 and 102±39 vs. 178±53 min, P=0.001, respectively). There was no 30-day mortality. Post-operative morbidity occurred in 7/45 (16%) VATS patients (phrenic nerve palsy 7%, pericarditis 4%, atrial fibrillation 2%, pleural effusion 2%) and 1/11 (9%) robotic (urinary retention requiring self-catheterization). Reoperation was required in 1/3 of VATS patients with phrenic nerve palsy. There was no significant difference in length of hospital stay [VATS 1.5 days (range, 1-4 days) and robotic 2 days (range, 1-5 days) VATS; P=0.05]. Mean follow-up was 18.4 months (range, 1-50.4 months) with no tumor recurrences. Conclusions MIT can be performed with low morbidity and mortality. VATS is associated with reduced blood loss, operative times and earlier hospital

  19. Minimally Invasive Colorectal Cancer Surgery in Europe

    PubMed Central

    Babaei, Masoud; Balavarca, Yesilda; Jansen, Lina; Gondos, Adam; Lemmens, Valery; Sjövall, Annika; B⊘rge Johannesen, Tom; Moreau, Michel; Gabriel, Liberale; Gonçalves, Ana Filipa; Bento, Maria José; van de Velde, Tony; Kempfer, Lana Raffaela; Becker, Nikolaus; Ulrich, Alexis; Ulrich, Cornelia M.; Schrotz-King, Petra; Brenner, Hermann

    2016-01-01

    Abstract Minimally invasive surgery (MIS) of colorectal cancer (CRC) was first introduced over 20 years ago and recently has gained increasing acceptance and usage beyond clinical trials. However, data on dissemination of the method across countries and on long-term outcomes are still sparse. In the context of a European collaborative study, a total of 112,023 CRC cases from 3 population-based (N = 109,695) and 4 institute-based clinical cancer registries (N = 2328) were studied and compared on the utilization of MIS versus open surgery. Cox regression models were applied to study associations between surgery type and survival of patients from the population-based registries. The study considered adjustment for potential confounders. The percentage of CRC patients undergoing MIS differed substantially between centers and generally increased over time. MIS was significantly less often used in stage II to IV colon cancer compared with stage I in most centers. MIS tended to be less often used in older (70+) than in younger colon cancer patients. MIS tended to be more often used in women than in men with rectal cancer. MIS was associated with significantly reduced mortality among colon cancer patients in the Netherlands (hazard ratio [HR] 0.66, 95% confidence interval [CI] (0.63–0.69), Sweden (HR 0.68, 95% CI 0.60–0.76), and Norway (HR 0.73, 95% CI 0.67–0.79). Likewise, MIS was associated with reduced mortality of rectal cancer patients in the Netherlands (HR 0.74, 95% CI 0.68–0.80) and Sweden (HR 0.77, 95% CI 0.66–0.90). Utilization of MIS in CRC resection is increasing, but large variation between European countries and clinical centers prevails. Our results support association of MIS with substantially enhanced survival among colon cancer patients. Further studies controlling for selection bias and residual confounding are needed to establish role of MIS in survival of patients. PMID:27258522

  20. Minimally invasive surgery for the treatment of ureteral stump syndrome

    PubMed Central

    Alenezi, Husain; Eltiraifi, Abdelmoniem E.; Alomar, Mohammad

    2015-01-01

    Objective: The aim was to highlight the advantages and the feasibility of treating ureteral stump syndrome (USS) by different minimally invasive procedures. Materials and Methods: Four patients with USS who were treated by different minimally invasive surgery approaches depending on their presentation and findings on radiologic investigations. Results: Three patients had complete resolution of their symptoms, whereas the fourth patient had persistence of urinary tract infection. Conclusion: Minimally invasive surgery is a valid treatment option for patients with USS with possible less morbidity than conventional open surgical excision. PMID:26692664

  1. Minimally Invasive Suturectomy and Postoperative Helmet Therapy : Advantages and Limitations

    PubMed Central

    Chong, Sangjoon; Wang, Kyu-Chang; Phi, Ji Hoon; Lee, Ji Yeoun

    2016-01-01

    Various operative techniques are available for the treatment of craniosynostosis. The patient's age at presentation is one of the most important factors in the determination of the surgical modality. Minimally invasive suturectomy and postoperative helmet therapy may be performed for relatively young infants, whose age is younger than 6 months. It relies upon the potential for rapid brain growth in this age group. Its minimal invasiveness is also advantageous. In this article, we review the advantages and limitations of minimally invasive suturectomy followed by helmet therapy for the treatment of craniosynostosis. PMID:27226853

  2. Fluidic lens laparoscopic zoom camera for minimally invasive surgery

    NASA Astrophysics Data System (ADS)

    Tsai, Frank S.; Johnson, Daniel; Francis, Cameron S.; Cho, Sung Hwan; Qiao, Wen; Arianpour, Ashkan; Mintz, Yoav; Horgan, Santiago; Talamini, Mark; Lo, Yu-Hwa

    2010-05-01

    This work reports a miniaturized laparoscopic zoom camera that can significantly improve vision for minimally invasive surgery (MIS), also known as laparoscopic surgery. The laparoscopic zoom camera contains bioinspired fluidic lenses that can change curvature and focal length in a manner similar to the crystalline lenses in human eyes. The traditional laparoscope is long, rigid, and made of fixed glass lenses with a fixed field of view. The constricted vision of a laparoscope is often an inconvenience and plays a role in many surgical injuries. To further advance MIS technology, we developed a new type of laparoscopic camera that has a total length of less than 17 mm, greater than 4× optical zoom, and 100 times higher sensitivity than today's laparoscope allowing it to work under illumination as low as 300 lux. All these unique features are enabled by the technology of bioinspired fluidic lenses having a dynamic range over 100 diopters and being convertible between a convex and concave shape.

  3. Minimally invasive lumbar decompression-the surgical learning curve.

    PubMed

    Kim, Choll W

    2016-08-01

    Commentary On: Ahn J, Iqbal A, Manning BT, Leblang S, Bohl DD, Mayo BC, et al. Minimally invasive lumbar decompression-the surgical learning curve. Spine J 2016:16:909-16. (in this issue). PMID:27545398

  4. Minimally Invasive, Nonsurgical Approach to Repairing Mitral Valve Leaks

    MedlinePlus Videos and Cool Tools

    Minimally Invasive, Nonsurgical Approach to Repairing Mitral Valve Leaks - David X. Zhao, MD Click Here to view the BroadcastMed, Inc. Privacy Policy and Legal Notice © 2016 BroadcastMed, Inc. All rights reserved.

  5. Minimally invasive dynamic hip screw for fixation of hip fractures

    PubMed Central

    Ho, Michael; Garau, Giorgio; Walley, Gayle; Oliva, Francesco; Panni, Alfredo Schiavone; Longo, Umile Giuseppe

    2008-01-01

    We compared a minimally invasive surgical technique to the conventional (open approach) surgical technique used in fixation of hip fractures with the dynamic hip screw (DHS) device. Using a case-control design (44 cases and 44 controls), we tested the null hypothesis that there is no difference between the two techniques in the following outcome measures: duration of surgery, time to mobilisation and weight bearing postoperatively, length of hospital stay, mean difference of pre- and postoperative haemoglobin levels, position of the lag screw of the DHS device in the femoral head, and the tip–apex distance. The minimally invasive DHS technique had significantly shorter duration of surgery and length of hospital stay. There was also less blood loss in the minimally invasive DHS technique. The minimally invasive DHS technique produces better outcome measures in the operating time, length of hospital stay, and blood loss compared to the conventional approach while maintaining equal fixation stability. PMID:18478227

  6. Complications of Minimally Invasive Surgery and Their Management.

    PubMed

    Kaplan, Joshua R; Lee, Ziho; Eun, Daniel D; Reese, Adam C

    2016-06-01

    Minimally invasive surgery, including both traditional laparoscopic and robot-assisted laparoscopic approaches, has increasingly become the standard of care for urologic abdominal and pelvic surgery. This is a comprehensive review of the contemporary literature regarding complications of laparoscopic and robotic urologic surgery. The review highlights pertinent studies with the goal of providing the minimally invasive urologic surgeon with an up-to-date overview of general and procedure-specific complications and their management. PMID:27075019

  7. A Videoscope for use in Minimally Invasive Periodontal Surgery

    PubMed Central

    Harrel, Stephen K.; Wilson, Thomas G.; Rivera-Hidalgo, Francisco

    2013-01-01

    Introduction Minimally invasive periodontal procedures have been reported to produce excellent clinical results. Visualization during minimally invasive procedures has traditionally been obtained by the use of surgical telescopes, surgical microscopes, glass fiber endoscopes, or a combination of these devices. All of these methods for visualization are less than fully satisfactory due to problems with access, magnification, and blurred imaging. Clinical Innovation A videoscope for use with minimally invasive periodontal procedures has been developed to overcome some of the difficulties that exist with current visualization approaches. This videoscope incorporates a gas shielding technology that eliminates the problems of fogging and fouling of the optics of the videoscope that has previously prevented the successful application of endoscopic visualization to periodontal surgery. Additionally, as part of the gas shielding technology the videoscope also includes a moveable retractor specifically adapted for minimally invasive surgery. Discussion The clinical use of the videoscope during minimally invasive periodontal surgery is demonstrated and discussed. Conclusion The videoscope with gas shielding alleviates many of the difficulties associated with visualization during minimally invasive periodontal surgery PMID:23782239

  8. Total minimally invasive esophagectomy for esophageal cancer: approaches and outcomes.

    PubMed

    Giugliano, Danica N; Berger, Adam C; Rosato, Ernest L; Palazzo, Francesco

    2016-09-01

    Since the introduction of minimally invasive esophagectomy 25 years ago, its use has been reported in several high volume centers. With only one published randomized control trial and five meta-analyses comparing its outcomes to open esophagectomy, available level I evidence is very limited. Available technical approaches include total minimally invasive transthoracic (Ivor Lewis or McKeown) or transhiatal esophagectomy; several hybrid options are available with one portion of the procedure completed via an open approach. A review of available level I evidence with focus on total minimally invasive esophagectomy is presented. The old debate regarding the superiority of a transthoracic versus transhiatal approach to esophagectomy may have been settled by minimally invasive esophagectomy as only few centers are reporting on the latter being utilized. The studies with the highest level of evidence available currently show that minimally invasive techniques via a transthoracic approach are associated with less overall morbidity, fewer pulmonary complications, and shorter hospital stays than open esophagectomy. There appears to be no detrimental effect on oncologic outcomes and possibly an added benefit derived by improved lymph node retrieval. Quality of life improvements may also translate into improved survival, but no conclusive evidence exists to support this claim. Robotic and hybrid techniques have also been implemented, but there currently is no evidence showing that these are superior to other minimally invasive techniques. PMID:27401326

  9. Minimally invasive, maximal outcomes in breast surgery.

    PubMed

    Kell, Malcolm R; Sharma, Shiva

    2016-06-01

    The contemporary treatment of breast cancer has evolved in response to numerous randomised control trials which have aided in the development of guidelines for effective treatment. Breast cancer surgery has progressed thanks in part to the advances made in chemotherapy, radiation therapy and early detection. As these advances continue the field of surgery needs to progress in tandem to maximise survival outcomes but to also minimise morbidity. PMID:26201516

  10. Minimally Invasive Surgical Treatment of Acute Epidural Hematoma: Case Series

    PubMed Central

    2016-01-01

    Background and Objective. Although minimally invasive surgical treatment of acute epidural hematoma attracts increasing attention, no generalized indications for the surgery have been adopted. This study aimed to evaluate the effects of minimally invasive surgery in acute epidural hematoma with various hematoma volumes. Methods. Minimally invasive puncture and aspiration surgery were performed in 59 cases of acute epidural hematoma with various hematoma volumes (13–145 mL); postoperative follow-up was 3 months. Clinical data, including surgical trauma, surgery time, complications, and outcome of hematoma drainage, recovery, and Barthel index scores, were assessed, as well as treatment outcome. Results. Surgical trauma was minimal and surgery time was short (10–20 minutes); no anesthesia accidents or surgical complications occurred. Two patients died. Drainage was completed within 7 days in the remaining 57 cases. Barthel index scores of ADL were ≤40 (n = 1), 41–60 (n = 1), and >60 (n = 55); scores of 100 were obtained in 48 cases, with no dysfunctions. Conclusion. Satisfactory results can be achieved with minimally invasive surgery in treating acute epidural hematoma with hematoma volumes ranging from 13 to 145 mL. For patients with hematoma volume >50 mL and even cerebral herniation, flexible application of minimally invasive surgery would help improve treatment efficacy. PMID:27144170

  11. The economic impact of minimally invasive total knee arthroplasty.

    PubMed

    Coon, Thomas M

    2006-07-01

    The goals of minimally invasive surgery (MIS) total knee arthroplasty (TKA) are to minimize surgical trauma, minimize blood loss, and maximize the effect of analgesia. Assuming these surgical procedures are successful and rigid fixation is achieved, the result, in theory, should be shorter hospital stays and successful, early, aggressive rehabilitation at reduced cost relative to standard TKA surgical techniques. In this article, I address the economic benefits of applying MIS TKA surgical techniques compared with standard TKA surgical techniques. PMID:16927653

  12. Coronary optical coherence tomography: minimally invasive virtual histology as part of targeted post-mortem computed tomography angiography.

    PubMed

    Adlam, David; Joseph, Shiju; Robinson, Claire; Rousseau, Clement; Barber, Jade; Biggs, Mike; Morgan, Bruno; Rutty, Guy

    2013-09-01

    Social, cultural and practical barriers to conventional invasive autopsy have led to considerable interest in the development of minimally invasive radiological techniques as an alternative to the invasive autopsy for determining the cause of death. Critical to accurate diagnosis in this context is detailed examination of coronary anatomy and pathology. Current computed tomography and magnetic resonance imaging approaches have significantly advanced minimally invasive autopsy practice but have limited spatial resolution. This prohibits assessment at a microscopic level, meaning that histological assessment is still required for detailed analysis of, for example, coronary plaque rupture or dissection. Coronary optical coherence tomography (OCT) is used in the living during percutaneous coronary interventions to provide high-resolution coronary imaging, but this technique for obtaining virtual histology has not, to date, been translated into minimally invasive autopsy practice. We present a first description of minimally invasive post-mortem coronary OCT and discuss the potential for this technique to advance current practice. PMID:23455719

  13. Cannulation Strategies and Pitfalls in Minimally Invasive Cardiac Surgery

    PubMed Central

    Ramchandani, Mahesh; Al Jabbari, Odeaa; Abu Saleh, Walid K.; Ramlawi, Basel

    2016-01-01

    For any given cardiac surgery, there are two invasive components: the surgical approach and the cardiopulmonary bypass circuit. The standard approach for cardiac surgery is the median sternotomy, which offers unrestricted access to the thoracic organs—the heart, lung, and major vessels. However, it carries a long list of potential complications such as wound infection, brachial plexus palsies, respiratory dysfunction, and an unpleasant-looking scar. The cardiopulmonary bypass component also carries potential complications such as end-organ dysfunction, coagulopathy, hemodilution, bleeding, and blood transfusion requirement. Furthermore, the aortic manipulation during cannulation and cross clamping increases the risk of dissection, arterial embolization, and stroke. Minimally invasive cardiac surgery is an iconic event in the history of cardiothoracic medicine and has become a widely adapted approach as it minimizes many of the inconvenient side effects associated with the median sternotomy and bypass circuit placement. This type of surgery requires the use of novel perfusion strategies, especially in patients who hold the highest potential for postoperative morbidity. Cannulation techniques are a fundamental element in minimally invasive cardiac surgery, and there are numerous cannulation procedures for each type of minimally invasive operation. In this review, we will highlight the strategies and pitfalls associated with a minimally invasive cannulation. PMID:27127556

  14. Minimally invasive aortic valve replacement: the “Miami Method”

    PubMed Central

    2015-01-01

    For patients undergoing aortic valve replacement (AVR), a minimally invasive approach performed via a right anterior thoracotomy is the preferred method at our institution. This method has evolved over a 10-year span, being applied to over 1,500 patients with the commitment of one surgeon seeking to offer a simplistic and reproducible minimally invasive alternative. We believe that this is truly the least invasive approach to the aortic valve since it avoids sternal invasion. By virtue of being less traumatic, the morbidity is diminished and therefore the recovery is enhanced. We believe that this approach is most beneficial in the high risk patient such as the elderly, the obese, those with chronic obstructive pulmonary, chronic kidney disease and those requiring re-operative surgery. This method has proven to be safe and effective in all patients requiring isolated AVR surgery. The only relative exclusion criteria would be a porcelain aorta with the inability to cannulate the patient. PMID:25694981

  15. In vivo minimally invasive interstitial multi-functional microendoscopy

    PubMed Central

    Shahmoon, Asaf; Aharon, Shiran; Kruchik, Oded; Hohmann, Martin; Slovin, Hamutal; Douplik, Alexandre; Zalevsky, Zeev

    2013-01-01

    Developing minimally invasive methodologies for imaging of internal organs is an emerging field in the biomedical examination research. This paper introduces a new multi-functional microendoscope device capable of imaging of internal organs with a minimal invasive intervention. In addition, the developed microendoscope can also be employed as a monitoring device for measuring local hemoglobin concentration in blood stream when administrated into a blood artery. The microendoscope device has a total external diameter of only 200 μm and can provide high imaging resolution capability of more than 5,000 pixels. The device can detect features with a spatial resolution of less than 1 μm. The microendoscope has been tested both in-vitro as well as in-vivo in rats presenting a promising and powerful tool as a high resolution and minimally invasive imaging facility suitable for previously unreachable clinical modalities. PMID:23712369

  16. Minimally Invasive Cardiac Surgery: Transapical Aortic Valve Replacement

    PubMed Central

    Li, Ming; Mazilu, Dumitru; Horvath, Keith A.

    2012-01-01

    Minimally invasive cardiac surgery is less traumatic and therefore leads to quicker recovery. With the assistance of engineering technologies on devices, imaging, and robotics, in conjunction with surgical technique, minimally invasive cardiac surgery will improve clinical outcomes and expand the cohort of patients that can be treated. We used transapical aortic valve implantation as an example to demonstrate that minimally invasive cardiac surgery can be implemented with the integration of surgical techniques and engineering technologies. Feasibility studies and long-term evaluation results prove that transapical aortic valve implantation under MRI guidance is feasible and practical. We are investigating an MRI compatible robotic surgical system to further assist the surgeon to precisely deliver aortic valve prostheses via a transapical approach. Ex vivo experimentation results indicate that a robotic system can also be employed in in vivo models. PMID:23125924

  17. ‘Mini, ultra, micro’ – nomenclature and cost of these new minimally invasive percutaneous nephrolithotomy (PCNL) techniques

    PubMed Central

    Wright, Anna; Rukin, Nick; Smith, Daron; De la Rosette, Jean; Somani, Bhaskar K.

    2015-01-01

    New minimally invasive percutaneous nephrolithotomy (PCNL) techniques have changed the management of renal stones. We discuss the technological advances in PCNL and explain the meaning, requirements and set up costs for each of these ‘newer’ techniques. PMID:27034726

  18. Minimally Invasive Spinal Surgery with Intraoperative Image-Guided Navigation

    PubMed Central

    Kim, Terrence T.; Johnson, J. Patrick; Pashman, Robert; Drazin, Doniel

    2016-01-01

    We present our perioperative minimally invasive spine surgery technique using intraoperative computed tomography image-guided navigation for the treatment of various lumbar spine pathologies. We present an illustrative case of a patient undergoing minimally invasive percutaneous posterior spinal fusion assisted by the O-arm system with navigation. We discuss the literature and the advantages of the technique over fluoroscopic imaging methods: lower occupational radiation exposure for operative room personnel, reduced need for postoperative imaging, and decreased revision rates. Most importantly, we demonstrate that use of intraoperative cone beam CT image-guided navigation has been reported to increase accuracy. PMID:27213152

  19. Pins and needles: minimally invasive office techniques for facial rejuvenation.

    PubMed

    Maas, Corey S; Bapna, Sumit

    2009-11-01

    The desire for minimally invasive facial rejuvenation has continued to increase from the perspective of both the patients and injectors. For successful rejuvenation, it is important to understand the anatomic changes of the aging face as well as the properties of available neuromodulators and soft tissue fillers. The injector should be knowledgeable of the advantages and disadvantages of each product. Patient selection, perhaps, plays the largest role in success, choosing patients that would truly benefit from and have reasonable expectations for minimally invasive techniques. Unsatisfactory outcomes can be limited by meticulous injection technique and well thought out treatment plans. PMID:19924599

  20. Minimally Invasive Spinal Surgery with Intraoperative Image-Guided Navigation.

    PubMed

    Kim, Terrence T; Johnson, J Patrick; Pashman, Robert; Drazin, Doniel

    2016-01-01

    We present our perioperative minimally invasive spine surgery technique using intraoperative computed tomography image-guided navigation for the treatment of various lumbar spine pathologies. We present an illustrative case of a patient undergoing minimally invasive percutaneous posterior spinal fusion assisted by the O-arm system with navigation. We discuss the literature and the advantages of the technique over fluoroscopic imaging methods: lower occupational radiation exposure for operative room personnel, reduced need for postoperative imaging, and decreased revision rates. Most importantly, we demonstrate that use of intraoperative cone beam CT image-guided navigation has been reported to increase accuracy. PMID:27213152

  1. Emergency Pulmonary Embolectomy Using Minimally Invasive Cardiac Surgery.

    PubMed

    Kodani, Noriko; Ohashi, Takeki; Iida, Hiroshi; Kageyama, Souichirou; Furui, Masato; Uchino, Gaku

    2016-04-01

    A 78-year-old man who had undergone operation for acute type A aortic dissection presented with dyspnea and shock. Chest computed tomography revealed pulmonary embolism. Minimally invasive cardiac surgery was performed through a right fourth intercostal skin incision using cardiopulmonary bypass through the right femoral artery and vein. The right pulmonary artery below the superior vena cava was incised vertically, and the thrombus was extracted directly by balloon catheter. The patient was weaned off cardiopulmonary bypass uneventfully. The postoperative course was also uneventful. In redo cardiac surgery, pulmonary embolectomy through minimally invasive right thoracotomy can be easily performed, with quick recovery. PMID:27000575

  2. Minimally invasive approaches for gastric cancer-Korean experience.

    PubMed

    Yang, Han-Kwang; Suh, Yun-Suhk; Lee, Hyuk-Joon

    2013-03-01

    Laparoscopic surgery in Korea increased rapidly because of the early detection of gastric cancer by the development of diagnostic tools and nationwide screening. The Korean Laparoscopic Gastrointestinal Surgery Study Group (KLASS group) played a leading role in various projects related with minimally invasive surgery. The justification of minimally invasive procedures including robotic surgery, sentinel-node biopsy, or single-port surgery/Natural Orifice Transluminal Endoscopic Surgery (NOTES) must be predetermined by the clinical trial before a wide application, and the medical industry as well as surgeons should have great responsibility. PMID:22806494

  3. [Robot-assisted minimally invasive esophagectomy. German version].

    PubMed

    van Hillegersberg, R; Seesing, M F J; Brenkman, H J F; Ruurda, J P

    2016-08-01

    Esophagolymphadenectomy is the cornerstone of multimodality treatment for resectable esophageal cancer. The preferred surgical approach is transthoracic, with a two-field lymph node dissection and gastric conduit reconstruction. A minimally invasive approach has been shown to reduce postoperative complications and increase quality of life. Robot-assisted minimally invasive esophagectomy (RAMIE) was developed to facilitate this complex thoracoscopic procedure. RAMIE has been shown to be safe with good oncologic results and reduced morbidity. The use of RAMIE opens new indications for curative surgery in patients with T4b tumors, high mediastinal tumors, and lymph node metastases after neoadjuvant treatment. PMID:27484825

  4. Minimally invasive retroperitoneal pancreatic necrosectomy in necrotising pancreatitis.

    PubMed

    Shelat, V G; Diddapur, R K

    2007-08-01

    With the marriage of surgery and technology, applications of minimal access surgery are increasing exponentially. Pancreatic diseases are no exception. Minimally invasive retroperitoneal pancreatic necrosectomy (MIRP), or percutaneous video-assisted necrosectomy, is a new technique to debride the necrotic pancreas. We report a 51- year-old male patient who successfully underwent MIRP for infected pancreatic necrosis, and briefly review of literature. PMID:17657370

  5. Minimally invasive surgery for diaphragmatic diseases in neonates and infants.

    PubMed

    Fujishiro, Jun; Ishimaru, Tetsuya; Sugiyama, Masahiko; Arai, Mari; Suzuki, Keisuke; Kawashima, Hiroshi; Iwanaka, Tadashi

    2016-07-01

    Owing to recent advances in minimally invasive surgery (MIS), laparoscopic and thoracoscopic surgery have been gradually introduced for use in neonates and infants. This review focuses on two popular MIS procedures for diaphragmatic diseases in neonates and infants: congenital diaphragmatic hernia (CHD) repair and plication for diaphragmatic eventration. While several advantages of MIS are proposed for CDH repair in neonates, there are also some concerns, namely intraoperative hypercapnia and acidosis and a higher recurrence rate than open techniques. Thus, neonates with severe CDH, along with an unstable circulatory and respiratory status, may be unsuitable for MIS repair, and the use of selection criteria is, therefore, important in these patients. It is generally believed that a learning curve is associated with the higher recurrence rate. Contrary to CDH repair, no major disadvantages associated with the use of MIS for diaphragmatic eventration have been reported in the literature, other than technical difficulty. Thus, if technically feasible, all pediatric patients with diaphragmatic eventration requiring surgical treatment are potential candidates for MIS. Due to a shortage of studies on this procedure, the potential advantages of MIS compared to open techniques for diaphragmatic eventration, such as early recovery and more rapid extubation, need to be confirmed by further studies. PMID:27246508

  6. Non-photorealistic rendering for minimally invasive procedures

    NASA Astrophysics Data System (ADS)

    Raab, Jens; Schäfer, Henry; Brost, Alexander; Stamminger, Marc; Pfister, Marcus

    2013-03-01

    Abdominal aortic aneurysms are a common disease of the aorta which are treated minimally invasive in about 33 % of the cases. Treatment is done by placing a stent graft in the aorta to prevent the aneurysm from growing. Guidance during the procedure is facilitated by fluoroscopic imaging. Unfortunately, due to low soft tissue contrast in X-ray images, the aorta itself is not visible without the application of contrast agent. To overcome this issue, advanced techniques allow to segment the aorta from pre-operative data, such as CT or MRI. Overlay images are then subsequently rendered from a mesh representation of the segmentation and fused to the live fluoroscopic images with the aim of improving the visibility of the aorta during the procedure. The current overlay images typically use forward projections of the mesh representation. This fusion technique shows deficiencies in both the 3-D information of the overlay and the visibility of the fluoroscopic image underneath. We present a novel approach to improve the visualization of the overlay images using non-photorealistic rendering techniques. Our method preserves the visibility of the devices in the fluoroscopic images while, at the same time, providing 3-D information of the fused volume. The evaluation by clinical experts shows that our method is preferred over current state-of-the-art overlay techniques. We compared three visualization techniques to the standard visualization. Our silhouette approach was chosen by clinical experts with 67 %, clearly showing the superiority of our new approach.

  7. Exciting times: towards a totally minimally invasive paediatric urology service.

    PubMed

    Lazarus, John

    2011-02-01

    Following on from the first paediatric laparoscopic nephrectomy in 1992, the growth of minimally invasive ablative and reconstructive procedures in paediatric urology has been dramatic. This article reviews the literature related to laparoscopic dismembered pyeloplasty, optimising posterior urethral valve ablation and intravesical laparoscopic ureteric reimplantation. PMID:21933475

  8. Minimally invasive redo discectomy for recurrent lumbar disc herniations.

    PubMed

    Kogias, Evangelos; Franco Jimenez, Pamela; Klingler, Jan-Helge; Hubbe, Ulrich

    2015-09-01

    The purpose of this systematic review is to investigate which minimally invasive techniques have been used for discectomy in recurrent lumbar disc herniation (LDH), to present the success and complication rates and to evaluate the advantages and limitations of each technique. Discectomy for recurrent LDH is accompanied by a higher morbidity rate compared with primary LDH. Because of the limited operating field, the majority of surgeons have been discouraged from utilising a minimally invasive approach for revision surgery. Minimally invasive techniques have gained ground in the treatment of primary LDH and an increasing number of patients are expressing interest in such techniques for the treatment of recurrent LDH. Microendoscopic discectomy (MED), endoscopic transforaminal and interlaminar discectomy (ETD and EID) have been used for treatment of recurrent LDH. The reported success rate is 60-95%. Full endoscopic techniques, especially ETD, showed favourable results concerning dural tear rates but have a demanding learning curve. The limitations of ETD include dislocated disc fragments or concomitant lateral recess stenosis, and MED is more effective in these instances. All three techniques have a low delayed instability rate. MED, ETD and EID are safe and efficient treatment options for surgical management of recurrent LDH with good success and low complication rates. At the same time, they offer the advantages of minimally invasive access. PMID:26122379

  9. Paradigm changes in spine surgery: evolution of minimally invasive techniques.

    PubMed

    Smith, Zachary A; Fessler, Richard G

    2012-08-01

    Minimally invasive spine surgery (MISS) techniques were developed to address morbidities associated with open spinal surgery approaches. MISS was initially applied for indications such as the microendoscopic decompression of stenosis (MEDS)-an operation that has become widely implemented in modern spine surgery practice. Minimally invasive surgery for MEDS is an excellent example of how an MISS technique has improved outcomes compared with the use of traditional open surgical procedures. In parallel with reports of surgeon experience, accumulating clinical evidence suggests that MISS is favoured over open surgery, and one could argue that the role of MISS techniques will continue to expand. As the field of minimally invasive surgery has developed, MISS has been implemented for the treatment of increasingly difficult and complex pathologies, including trauma, spinal malignancies and spinal deformity in adults. In this Review, we present the accumulating evidence in support of minimally invasive techniques for established MISS indications, such as lumbar stenosis, and discuss the need for additional level I and level II data to demonstrate the benefit of MISS over traditional open surgery. The expanding utility of MISS techniques to address an increasingly broad range of spinal pathologies is also highlighted. PMID:22710631

  10. Rate of repair in minimally invasive mitral valve surgery

    PubMed Central

    Hohenberger, Wolfgang; Lakew, Fitsum; Batz, Gerhard; Diegeler, Anno

    2013-01-01

    Background Valve repair has been shown to be the method of choice in the treatment of patients with severe mitral valve regurgitation. Minimally invasive surgery has raised skepticism regarding the rate of repair especially for supposedly complex lesions, when anterior leaflet involvement or bileaflet prolapse is present. We sought to review our experience of all our patients presenting with degenerative mitral valve regurgitation and operated on minimally invasively. Method From September 2006 to December 2012, 842 patients (mean age 56.12±11.62 years old) with degenerative mitral valve regurgitation and anterior leaflet (n=82, 9.7%), posterior leaflet (n=688, 81.7%) and bileaflet (n=72, 8.6%) prolapses were operated on using a minimally invasive approach. Results 836 patients had a valve repair (99.3%) and received a concomitant ring annuloplasty (mean size, 33.7; range, 28-40). Six patients (0.7%) underwent valve replacement. Two patients had a re-repair due to MR progression or infective endocarditis. Thirty-day mortality was 0.2% (two patients). There were 60 major adverse events (MAE) (7.1%). Conclusions A minimally invasive approach allows repair of almost all degenerative valves with good short-term outcomes in a tertiary referral center, when using proven and efficient surgical techniques. PMID:24349977

  11. Minimally Invasive Technique for PMMA Augmentation of Fenestrated Screws

    PubMed Central

    Kogias, Evangelos; Sircar, Ronen; Krüger, Marie T.; Volz, Florian; Scheiwe, Christian; Hubbe, Ulrich

    2015-01-01

    Purpose. To describe the minimally invasive technique for cement augmentation of cannulated and fenestrated screws using an injection cannula as well as to report its safety and efficacy. Methods. A total of 157 cannulated and fenestrated pedicle screws had been cement-augmented during minimally invasive posterior screw-rod spondylodesis in 35 patients from January to December 2012. Retrospective evaluation of cement extravasation and screw loosening was carried out in postoperative plain radiographs and thin-sliced triplanar computed tomography scans. Results. Twenty-seven, largely prevertebral cement extravasations were detected in 157 screws (17.2%). None of the cement extravasations was causing a clinical sequela like a new neurological deficit. One screw loosening was noted (0.6%) after a mean follow-up of 12.8 months. We observed no cementation-associated complication like pulmonary embolism or hemodynamic insufficiency. Conclusions. The presented minimally invasive cement augmentation technique using an injection cannula facilitates convenient and safe cement delivery through polyaxial cannulated and fenestrated screws during minimally invasive screw-rod spondylodesis. Nevertheless, the optimal injection technique and design of fenestrated screws have yet to be identified. This trial is registered with German Clinical Trials DRKS00006726. PMID:26075297

  12. Transanal Minimally Invasive Surgery: State of the Art.

    PubMed

    Keller, D S; Haas, E M

    2016-02-01

    The treatment for rectal cancer and benign rectal lesions continues to progress in the arena of minimally invasive surgery. While surgical excision of the primary mass remains essential for eradication of disease, there has been a paradigm shift towards less invasive resection methods. Local excision is increasing in popularity for its low morbidity and excellent functional results in select patients. Transanal minimally invasive surgery (TAMIS) is a new technology developed to elevate the practice of local excision to state-of-the-art resection. The goal of this article is to evaluate the history, short-term outcomes, and evolution of the TAMIS technique for excision of benign and malignant rectal neoplasia. PMID:26608195

  13. Minimally invasive aortic valve replacement: the Leipzig experience

    PubMed Central

    Merk, Denis R.; Etz, Christian D.; Seeburger, Joerg; Schroeter, Thomas; Oberbach, Andreas; Uhlemann, Madlen; Hoellriegel, Robert; Haensig, Martin; Leontyev, Sergey; Garbade, Jens; Misfeld, Martin; Mohr, Friedrich W.

    2015-01-01

    Background Minimally invasive techniques are progressively challenging traditional approaches in cardiothoracic surgery. Minimally invasive aortic valve replacement (AVR) has become a routine procedure at our institution. Methods We retrospectively analyzed all patients undergoing minimally invasive isolated AVR between January 2003 and March 2014, at our institution. Mean follow-up was 4.7±4.3 years (range: 0-18 years) and was 99.8% complete. Results There were 1,714 patients who received an isolated minimally invasive AVR. The mean (± SD) patient age was 65±12.8 years, ejection fraction 60%±12% and log EuroSCORE 5.3%±5.1%. Mean cross-clamp time was 58±18 minutes and mean cardiopulmonary bypass (CPB) time was 82.9±26.7 minutes. Thirty-day survival was 97.8%±0.4%, and 69.4%±1.7% at 10-years. The multivariate analysis revealed age at surgery [P=0.016; odds ratio (OR), 1.1], length of surgery time (P=0.002; OR, 1.01), female gender (P=0.023; OR, 3.54), preoperative myocardial infarction (MI) (P=0.006; OR, 7.87), preoperative stroke (P=0.001; OR, 13.76) and preoperative liver failure (P=0.015; OR, 10.28) as independent risk factors for mortality. Cox-regression analysis revealed the following predictors for long term mortality: age over 75 years (P<0.001; OR, 3.5), preoperative dialysis (P<0.01; OR, 2.14), ejection fraction less than 30% (P=0.003; OR, 3.28) and urgent or emergency operation (P<0.001; OR, 2.3). Conclusions Minimally invasive AVR can be performed safely and effectively with very few perioperative complications. The early and long-term outcomes in these patients are acceptable. PMID:25694976

  14. MINIMALLY INVASIVE SURGERY FOR GASTRIC CANCER: TIME TO CHANGE THE PARADIGM

    PubMed Central

    BARCHI, Leandro Cardoso; JACOB, Carlos Eduardos; BRESCIANI, Cláudio José Caldas; YAGI, Osmar Kenji; MUCERINO, Donato Roberto; LOPASSO, Fábio Pinatel; MESTER, Marcelo; RIBEIRO-JÚNIOR, Ulysses; DIAS, André Roncon; RAMOS, Marcus Fernando Kodama Pertille; CECCONELLO, Ivan; ZILBERSTEIN, Bruno

    2016-01-01

    ABSTRACT Introduction: Minimally invasive surgery widely used to treat benign disorders of the digestive system, has become the focus of intense study in recent years in the field of surgical oncology. Since then, the experience with this kind of approach has grown, aiming to provide the same oncological outcomes and survival to conventional surgery. Regarding gastric cancer, surgery is still considered the only curative treatment, considering the extent of resection and lymphadenectomy performed. Conventional surgery remains the main modality performed worldwide. Notwithstanding, the role of the minimally invasive access is yet to be clarified. Objective: To evaluate and summarize the current status of minimally invasive resection of gastric cancer. Methods: A literature review was performed using Medline/PubMed, Cochrane Library and SciELO with the following headings: gastric cancer, minimally invasive surgery, robotic gastrectomy, laparoscopic gastrectomy, stomach cancer. The language used for the research was English. Results: 28 articles were considered, including randomized controlled trials, meta-analyzes, prospective and retrospective cohort studies. Conclusion: Minimally invasive gastrectomy may be considered as a technical option in the treatment of early gastric cancer. As for advanced cancer, recent studies have demonstrated the safety and feasibility of the laparoscopic approach. Robotic gastrectomy will probably improve outcomes obtained with laparoscopy. However, high cost is still a barrier to its use on a large scale. PMID:27438040

  15. [Minimally invasive surgery in treatment of lumbar intervertebral disc herniation].

    PubMed

    Rotim, Krešimir; Sajko, Tomislav; Borić, Marta; Subašić, Ante

    2015-01-01

    Surgical treatment of lumbar intervertebral disc herniation is one of the most common neurosurgical procedures. Besides conventional surgical techniques, in the last more than 30 years, different methods with minimal damage to neuromuscular spine structures are being developed and introduced, all having the purpose of reducing postoperative back pain. The advantages of the minimally invasive spine surgery include: possibility of performing procedures under local anaesthesia, reduced hospital stay, limited blood loss with consecutively reduced fibrous tissue development. Patients are capable of return to work and everyday activities early after surgery. From the economical point of view, this kind of treatment is considered to be a cost-effective intervention. Three methods that are being used for treatment of lumbar intervertebral disc herniation are: percutaneous laser disc decompression (PLDD), microdiscectomy using tubular retractor system and selective endoscopic discectomy (SED). Conducted prospective studies have shown that minimally invasive methods are adequate alternative to classic surgical procedures. PMID:26065287

  16. Minimally invasive surgery of the anterior skull base: transorbital approaches

    PubMed Central

    Gassner, Holger G.; Schwan, Franziska; Schebesch, Karl-Michael

    2016-01-01

    Minimally invasive approaches are becoming increasingly popular to access the anterior skull base. With interdisciplinary cooperation, in particular endonasal endoscopic approaches have seen an impressive expansion of indications over the past decades. The more recently described transorbital approaches represent minimally invasive alternatives with a differing spectrum of access corridors. The purpose of the present paper is to discuss transorbital approaches to the anterior skull base in the light of the current literature. The transorbital approaches allow excellent exposure of areas that are difficult to reach like the anterior and posterior wall of the frontal sinus; working angles may be more favorable and the paranasal sinus system can be preserved while exposing the skull base. Because of their minimal morbidity and the cosmetically excellent results, the transorbital approaches represent an important addition to established endonasal endoscopic and open approaches to the anterior skull base. Their execution requires an interdisciplinary team approach. PMID:27453759

  17. Advanced pyrochemical technologies for minimizing nuclear waste

    SciTech Connect

    Bronson, M.C.; Dodson, K.E.; Riley, D.C.

    1994-06-01

    The Department of Energy (DOE) is seeking to reduce the size of the current nuclear weapons complex and consequently minimize operating costs. To meet this DOE objective, the national laboratories have been asked to develop advanced technologies that take uranium and plutonium, from retired weapons and prepare it for new weapons, long-term storage, and/or final disposition. Current pyrochemical processes generate residue salts and ceramic wastes that require aqueous processing to remove and recover the actinides. However, the aqueous treatment of these residues generates an estimated 100 liters of acidic transuranic (TRU) waste per kilogram of plutonium in the residue. Lawrence Livermore National Laboratory (LLNL) is developing pyrochemical techniques to eliminate, minimize, or more efficiently treat these residue streams. This paper will present technologies being developed at LLNL on advanced materials for actinide containment, reactors that minimize residues, and pyrochemical processes that remove actinides from waste salts.

  18. Minimally invasive surgery for inflammatory bowel disease: Review of current developments and future perspectives

    PubMed Central

    Neumann, Philipp-Alexander; Rijcken, Emile

    2016-01-01

    Patients with inflammatory bowel disease (IBD) comprise a population of patients that have a high likelihood of both surgical treatment at a young age and repetitive operative interventions. Therefore surgical procedures need to aim at minimizing operative trauma with best postoperative recovery. Minimally invasive techniques have been one of the major advancements in surgery in the last decades and are nowadays almost routinely performed in colorectal resections irrespective of underlying disease. However due to special disease related characteristics such as bowel stenosis, interenteric fistula, abscesses, malnutrition, repetitive surgeries, or immunosuppressive medications, patients with IBD represent a special cohort with specific needs for surgery. This review summarizes current evidence of minimally invasive surgery for patients with Crohn’s disease or ulcerative colitis and gives an outlook on the future perspective of technical advances in this highly moving field with its latest developments in single port surgery, robotics and trans-anal techniques. PMID:27158537

  19. Minimally invasive surgery for inflammatory bowel disease: Review of current developments and future perspectives.

    PubMed

    Neumann, Philipp-Alexander; Rijcken, Emile

    2016-05-01

    Patients with inflammatory bowel disease (IBD) comprise a population of patients that have a high likelihood of both surgical treatment at a young age and repetitive operative interventions. Therefore surgical procedures need to aim at minimizing operative trauma with best postoperative recovery. Minimally invasive techniques have been one of the major advancements in surgery in the last decades and are nowadays almost routinely performed in colorectal resections irrespective of underlying disease. However due to special disease related characteristics such as bowel stenosis, interenteric fistula, abscesses, malnutrition, repetitive surgeries, or immunosuppressive medications, patients with IBD represent a special cohort with specific needs for surgery. This review summarizes current evidence of minimally invasive surgery for patients with Crohn's disease or ulcerative colitis and gives an outlook on the future perspective of technical advances in this highly moving field with its latest developments in single port surgery, robotics and trans-anal techniques. PMID:27158537

  20. Improving the minimally invasive approach to mandible angle repair.

    PubMed

    Cole, Patrick; Rottgers, Stephen A; Cameron, Hunter; Hollier, Larry H

    2008-03-01

    Mandible angle fractures can be exceedingly difficult to manage and are associated with the highest complication rate of all mandible fractures. Although technically demanding, minimally invasive plate repair of angle fractures offers minimal morbidity and effective fragment stabilization while providing optimal aesthetic outcome. Although minimally invasive fixation provides attractive results, full mobilization of the operative site is often substantially limited by the inherent nature of local masseteric and deeper tissues. Although access limitations often prompt creation of an additional facial incision, trocar withdrawal into subcutaneous tissue followed by repositioning and deep tissue penetration greatly enhances operative mobility. Although this modification may seem simple, the senior author's experience at several outside institutions demonstrates that surgeons will all-too-often resort to additional facial incisions when access is severely limited. In review of our 5-year experience with minimally invasive angle repair, this straightforward innovation significantly decreased operative challenge, improved instrument range-of-motion, and eased the steep learning curve of these often-difficult procedures. PMID:18362737

  1. Recent advancement or less invasive treatment of percutaneous nephrolithotomy.

    PubMed

    Kim, Bum Soo

    2015-09-01

    Since its initial introduction in 1976, percutaneous nephrolithotomy (PCNL) has been widely performed for the management of large renal stones and currently is recommended for staghorn calculi, kidney stones larger than 2 cm, and shock wave lithotripsy-resistant lower pole stones greater than 1 cm. However, except for open and laparoscopic surgery, PCNL is the most invasive of the minimally invasive stone surgery techniques. Over the years, technical and instrumental advances have been made in PCNL to reduce morbidity and improve effectiveness. A thorough review of the recent literature identified five major areas of progress for the advancement of PCNL: patient positioning, method of percutaneous access, development of lithotriptors, miniaturized access tracts, and postoperative nephrostomy tube management. This review provides an overview of recent advancements in PCNL and the outcomes of each area of progress and notes how much we achieve with less invasive PCNL. This information may allow us to consider the future role and future developments of PCNL. PMID:26366273

  2. Recent advancement or less invasive treatment of percutaneous nephrolithotomy

    PubMed Central

    2015-01-01

    Since its initial introduction in 1976, percutaneous nephrolithotomy (PCNL) has been widely performed for the management of large renal stones and currently is recommended for staghorn calculi, kidney stones larger than 2 cm, and shock wave lithotripsy-resistant lower pole stones greater than 1 cm. However, except for open and laparoscopic surgery, PCNL is the most invasive of the minimally invasive stone surgery techniques. Over the years, technical and instrumental advances have been made in PCNL to reduce morbidity and improve effectiveness. A thorough review of the recent literature identified five major areas of progress for the advancement of PCNL: patient positioning, method of percutaneous access, development of lithotriptors, miniaturized access tracts, and postoperative nephrostomy tube management. This review provides an overview of recent advancements in PCNL and the outcomes of each area of progress and notes how much we achieve with less invasive PCNL. This information may allow us to consider the future role and future developments of PCNL. PMID:26366273

  3. Super resolution in robotic-assisted minimally invasive surgery.

    PubMed

    Lerotic, Mirna; Yang, Guang-Zhong

    2007-11-01

    In minimally invasive surgery, a small field of view is often required to achieve a large magnification factor during micro-scale tasks such as coronary anastomosis. However, constantly changing the orientation and focal length of the laparoscope camera is cumbersome, and can impose extra visual and cognitive load on the operating surgeon in terms of realigning the visual pathways and anatomical landmarks. The purpose of this paper is to investigate the use of fixational movements in robotic-assisted minimally invasive surgery, such that the perceived resolution of the foveal field of view is greater than the intrinsic resolution of the laparoscope camera. The proposed technique is based on super resolution imaging using projection onto convex sets for monochrome images, and a maximum a posteriori method with a novel YIQ space-based prior for color images. Validation with both phantom and in vivo data from totally endoscopic coronary artery bypass surgery is provided. PMID:18066950

  4. Minimally-invasive LVAD Implantation: State of the Art

    PubMed Central

    Hanke, Jasmin S.; Rojas, Sebastian V.; Avsar, Murat; Haverich, Axel; Schmitto, Jan D.

    2015-01-01

    Nowadays, the worldwide number of left ventricular assist devices (LVADs) being implanted per year is higher than the number of cardiac transplantations. The rapid developments in the field of mechanical support are characterized by continuous miniaturization and enhanced performance of the pumps, providing increased device durability and a prolonged survival of the patients. The miniaturization process enabled minimally-invasive implantation methods, which are associated with generally benefitting the overall outcome of patients. Therefore, these new implantation strategies are considered the novel state of the art in LVAD surgery. In this paper we provide a comprehensive review on the existing literature on minimally-invasive techniques with an emphasis on the different implantation approaches and their individual surgical challenges. PMID:25981314

  5. Minimally invasive surgery in orthopaedics. Small is beautiful?

    PubMed

    Yeung, S H

    2008-08-01

    With the blooming of minimally invasive procedures in surgical specialties, many orthopaedic subspecialties have been evolving along such lines. Despite the apparent paradox that many orthopaedic implants are quite bulky to start off with, different methods have been adopted to insert them safely with the least possible trauma. Altering time-honoured incisions and surgical techniques has often been helpful. The industry is also very keen to re-design implants for this purpose and has contributed substantial momentum in this direction. Coupled with the use of operating microscopes, endoscopes, and imaging modalities, operations can be performed with greater precision and lesser trauma. The advent of computer-assisted technology is another step forward. It is through constant attention to minimising tissue trauma and a combination of different methods available, that surgeons can achieve the ultimate goals of minimally invasive surgery. PMID:18685164

  6. Minimally Invasive ("Mini") Percutaneous Nephrolithotomy: Classification, Indications, and Outcomes.

    PubMed

    Druskin, Sasha C; Ziemba, Justin B

    2016-04-01

    Minimally invasive endoscopic procedures are often employed for the surgical removal of kidney stones. Traditionally, large stones are removed by (standard) percutaneous nephrolithotomy (SPCNL). Although effective for the clearance of large stone burdens, SPCNL is associated with significant morbidity. Therefore, in an effort to reduce this morbidity, while preserving efficacy, mini-PCNL (MPCNL) with a smaller tract size (<20 French) was developed. Several studies suggest that MPCNL has a comparable stone-free rate to SPCNL. However, the question of lower morbidity with MPCNL remains unanswered. In this review, we describe the equipment, indications, and efficacy of MPCNL with particular attention to its value over traditional minimally invasive stone removal techniques. PMID:26902624

  7. Minimally invasive harvesting of nonvascularized fibular graft in children.

    PubMed

    Lucas, G; Lopez, J; Fraisse, B; Marleix, S; Violas, P

    2015-06-01

    Using a nonvascularized fibular graft is part of the therapeutic arsenal for filling bone loss defects. It is conventionally performed by open surgery. The authors propose a minimally invasive technique for harvesting a free fibular graft. The fibula was removed subperiosteally by two or three small incisions in five patients with a mean age of nine years and nine months. The mean surgical time was 21 min and 40.5% of the length of the fibula was harvested. At the donor site, we found no removal-related complications, regeneration of the fibula was observed in 80% of cases, and the cosmetic result was considered excellent by all patients with a mean 4.3 years follow-up. This minimally invasive technique is simple and fast, with very low morbidity in our experience. PMID:25890811

  8. Minimally Invasive Thoracic Surgery in Pediatric Patients: The Taiwan Experience

    PubMed Central

    Huang, Yu-Kai; Chou, Chieh; Li, Chung-Liang; Chiu, Hui-Gin; Chang, Yu-Tang

    2013-01-01

    Minimally invasive technology or laparoscopic surgery underwent a major breakthrough over the past two decades. The first experience of thoracoscopy in children was reported around 1980 for diagnosis of intrathoracic pathology and neoplasia. Up until the middle of the 1990s, the surgical community in Taiwan was still not well prepared to accept the coming era of minimally invasive surgery. In the beginning, laparoscopy was performed in only a few specialties and only relatively short or simple surgeries were considered. But now, the Taiwan's experiences over the several different clinical scenarios were dramatically increased. Therefore, we elaborated on the experience about pectus excavatum: Nuss procedure, primary spontaneous hemopneumothorax, thoracoscopic thymectomy, and empyema in Taiwan. PMID:23819123

  9. [Prospect of transanal minimally invasive surgery for rectal neoplasm].

    PubMed

    Shen, Zhanlong; Ye, Yingjiang; Xie, Qiwei; Jiang, Kewei; Wang, Shan

    2015-05-01

    Transanal minimally invasive surgery (TAMIS) is a kind of minimally invasive surgery that local resection or total mesorectal excision for rectal neoplasm is performed through the use of multichannel port(single port) transanally. Compared to transanal endoscopic microsurgery(TEM) approach, TAMIS offers an alternative to TEM for rectal neoplasm, and shows the advantage of lower cost and shorter learning curve. TAMIS approach has been used not only in the local resection of rectal neoplasm but also in transanal total mesorectal excision (transanal TME), which is also called TAMIS-TME, in recent four years. The safety and efficacy of TAMIS approach has been shown in the currently published literatures. However, TAMIS approach has to wait for more evidence-based data with larger-scale and longer follow-up to get its validation. PMID:26013854

  10. Minimally invasive prostate cancer detection test using FISH probes

    PubMed Central

    Tinawi-Aljundi, Rima; Knuth, Shannon T; Gildea, Michael; Khal, Joshua; Hafron, Jason; Kernen, Kenneth; Di Loreto, Robert; Aurich-Costa, Joan

    2016-01-01

    Purpose The ability to test for and detect prostate cancer with minimal invasiveness has the potential to reduce unnecessary prostate biopsies. This study was conducted as part of a clinical investigation for the development of an OligoFISH® probe panel for more accurate detection of prostate cancer. Materials and methods One hundred eligible male patients undergoing transrectal ultrasound biopsies were enrolled in the study. After undergoing digital rectal examination with pressure, voided urine was collected in sufficient volume to prepare at least two slides using ThinPrep. Probe panels were tested on the slides, and 500 cells were scored when possible. From the 100 patients recruited, 85 had more than 300 cells scored and were included in the clinical performance calculations. Results Chromosomes Y, 7, 10, 20, 6, 8, 16, and 18 were polysomic in most prostate carcinoma cases. Of these eight chromosomes, chromosomes 7, 16, 18, and 20 were identified as having the highest clinical performance as a fluorescence in situ hybridization test and used to manufacture the fluorescence in situ hybridization probe panels. The OligoFISH® probes performed with 100% analytical specificity. When the OligoFISH® probes were compared with the biopsy results for each individual, the test results highly correlated with positive and negative prostate biopsy pathology findings, supporting their high specificity and accuracy. Probes for chromosomes 7, 16, 18, and 20 showed in the receiver operator characteristics analysis an area under the curve of 0.83, with an accuracy of 81% in predicting the biopsy result. Conclusion This investigation demonstrates the ease of use with high specificity, high predictive value, and accuracy in identifying prostate cancer in voided urine after digital rectal examination with pressure. The test is likely to have positive impact on clinical practice and advance approaches to the detection of prostate cancer. Further evaluation is warranted. PMID

  11. Standardized definitions and policies of minimally invasive thymoma resection

    PubMed Central

    2015-01-01

    A wide range of technical approaches for the minimally invasive resection of thymus have been described. Most of the time, the benefits are superior cosmetic outcome and shorter duration of postoperative stay. Other demonstrable differences that have been reported include shorter duration of surgery, less intraoperative blood loss and less postoperative pleural drainage. Robotic surgery and video-assisted surgery (VATS) may become routinely used procedures in the treatment of stage I and II thymomas. PMID:26693149

  12. [Minimally invasive hemodynamic monitoring with esophageal echoDoppler].

    PubMed

    Monge, M I; Estella, A; Díaz, J C; Gil, A

    2008-01-01

    Hemodynamic monitoring is a key element in the care of the critical patients, providing an unquestionable aid in the attendance to diagnosis and the choice of the adequate treatment. Minimally invasive devices have been emerging over the past few years as an effective alternative to classic monitoring tools. The esophageal echoDoppler is among these. It makes it possible to obtain continuous and minimally invasive monitoring of the cardiac output in addition to other useful parameters by measuring the blood flow rate and the diameter of the thoracic descending aorta, which provides a sufficiently extensive view of the hemodynamic state of the patient and facilitates early detection of the changes produced by a sudden clinical derangement. Although several studies have demonstrated the usefulness of the esophageal Doppler in the surgical scene, there is scarce and dispersed evidence in the literature on its benefits in critical patients. Nevertheless, its advantages make it an attractive element to take into account within the diagnostic arsenal in the intensive care. The purpose of the following article is to describe how it works, its degree of validation with other monitoring methods and the role of esophageal echoDoppler as a minimally invasive monitoring tool for measuring cardiac output in the daily clinical practice, contributing with our own experience in the critical patient. PMID:18221711

  13. Lasers in minimally invasive periodontal and peri-implant therapy.

    PubMed

    Mizutani, Koji; Aoki, Akira; Coluzzi, Donald; Yukna, Raymond; Wang, Chen-Ying; Pavlic, Verica; Izumi, Yuichi

    2016-06-01

    Laser therapy has the potential to be an effective, minimally invasive procedure in periodontal therapy. The aim of the present review was to survey the relevant literature on the clinical application of lasers as a minimally invasive treatment for periodontitis and peri-implant disease. Currently, there are a large number of published clinical studies and case reports that evaluate the adjunctive use of diode, carbon dioxide, neodymium-doped yttrium aluminium garnet (Nd:YAG), erbium-doped yttrium aluminium garnet (Er:YAG) and erbium, chromium-doped: yttrium, scandium, gallium, garnet (Er,Cr:YSGG) lasers or antimicrobial photodynamic therapy for nonsurgical and minimally invasive surgical treatment of periodontal pockets. These procedures are expected not only to control inflammation but also to provide biostimulation effects with photonic energy. Recent meta-analyses did not show statistically significant differences in pocket reduction and clinical attachment gain compared with mechanical debridement alone, although limited positive effects of adjunctive laser therapy were reported. At present, systematic literature approaches suggest that more evidence-based studies need to be performed to support the integration of various laser therapies into the treatment of periodontal and peri-implant diseases. The disparity between previous statistical analyses and individual successful clinical outcomes of laser applications might reveal the necessity of developing optimal laser-treatment modalities of different wavelengths and better-defined indications for each protocol. PMID:27045437

  14. Minimally invasive approaches for the treatment of inflammatory bowel disease

    PubMed Central

    Zoccali, Marco; Fichera, Alessandro

    2012-01-01

    Despite significant improvements in medical management of inflammatory bowel disease, many of these patients still require surgery at some point in the course of their disease. Their young age and poor general conditions, worsened by the aggressive medical treatments, make minimally invasive approaches particularly enticing to this patient population. However, the typical inflammatory changes that characterize these diseases have hindered wide diffusion of laparoscopy in this setting, currently mostly pursued in high-volume referral centers, despite accumulating evidences in the literature supporting the benefits of minimally invasive surgery. The largest body of evidence currently available for terminal ileal Crohn’s disease shows improved short term outcomes after laparoscopic surgery, with prolonged operative times. For Crohn’s colitis, high quality evidence supporting laparoscopic surgery is lacking. Encouraging preliminary results have been obtained with the adoption of laparoscopic restorative total proctocolectomy for the treatment of ulcerative colitis. A consensus about patients’ selection and the need for staging has not been reached yet. Despite the lack of conclusive evidence, a wave of enthusiasm is pushing towards less invasive strategies, to further minimize surgical trauma, with single incision laparoscopic surgery being the most realistic future development. PMID:23239913

  15. Complications of Minimally Invasive Cosmetic Procedures: Prevention and Management

    PubMed Central

    Levy, Lauren L; Emer, Jason J

    2012-01-01

    Over the past decade, facial rejuvenation procedures to circumvent traditional surgery have become increasingly popular. Office-based, minimally invasive procedures can promote a youthful appearance with minimal downtime and low risk of complications. Injectable botulinum toxin (BoNT), soft-tissue fillers, and chemical peels are among the most popular non-invasive rejuvenation procedures, and each has unique applications for improving facial aesthetics. Despite the simplicity and reliability of office-based procedures, complications can occur even with an astute and experienced injector. The goal of any procedure is to perform it properly and safely; thus, early recognition of complications when they do occur is paramount in dictating prevention of long-term sequelae. The most common complications from BoNT and soft-tissue filler injection are bruising, erythema and pain. With chemical peels, it is not uncommon to have erythema, irritation and burning. Fortunately, these side effects are normally transient and have simple remedies. More serious complications include muscle paralysis from BoNT, granuloma formation from soft-tissue filler placement and scarring from chemical peels. Thankfully, these complications are rare and can be avoided with excellent procedure technique, knowledge of facial anatomy, proper patient selection, and appropriate pre- and post-skin care. This article reviews complications of office-based, minimally invasive procedures, with emphasis on prevention and management. Practitioners providing these treatments should be well versed in this subject matter in order to deliver the highest quality care. PMID:23060707

  16. Evolution of Minimally Invasive Approaches to the Sella and Parasellar Region

    PubMed Central

    Louis, Robert G.; Eisenberg, Amy; Barkhoudarian, Garni; Griffiths, Chester; Kelly, Daniel F.

    2014-01-01

    Introduction Given advancements in endoscopic image quality, instrumentation, surgical navigation, skull base closure techniques, and anatomical understanding, the endonasal endoscopic approach has rapidly evolved into a widely utilized technique for removal of sellar and parasellar tumors. Although pituitary adenomas and Rathke cleft cysts constitute the majority of lesions removed via this route, craniopharyngiomas, clival chordomas, parasellar meningiomas, and other lesions are increasingly removed using this approach. Paralleling the evolution of the endonasal route to the parasellar region, the supraorbital eyebrow craniotomy has also been increasingly used as an alternative minimally invasive approach to reach this skull base region. Similar to the endonasal route, the supraorbital route has been greatly facilitated by advances in endoscopy, along with development of more refined, low-profile instrumentation and surgical navigation technology. Objectives This review, encompassing both transcranial and transsphenoidal routes, will recount the high points and advances that have made minimally invasive approaches to the sellar region possible, the evolution of these approaches, and their relative indications and technical nuances. Data Synthesis The literature is reviewed regarding the evolution of surgical approaches to the sellar region beginning with the earliest attempts and emphasizing technological advances, which have allowed the evolution of the modern technique. The surgical techniques for both endoscopic transsphenoidal and supraorbital approaches are described in detail. The relative indications for each approach are highlighted using case illustrations. Conclusions Although tremendous advances have been made in transitioning toward minimally invasive transcranial and transsphenoidal approaches to the sella, further work remains to be done. Together, the endonasal endoscopic and the supraorbital endoscope-assisted approaches are complementary

  17. Efficacy of minimally invasive techniques for enhancement of fracture healing: evidence today

    PubMed Central

    Pountos, Ippokratis; Georgouli, Theodora; Kontakis, George

    2009-01-01

    The successful treatment of nonunions represents a major challenge for orthopaedic surgeons. Lately, ongoing advances made in the field of molecular medicine and molecular biology have increased our understanding of the pathways and involvement of mediators surrounding the bone healing process. As a result, the surgeon’s armamentarium has been increased in terms of options for intervention. This article aims to provide an overview of minimally invasive techniques applicable in the treatment of nonunions of fractures. PMID:19844709

  18. Highlights in the minimally invasive treatment of SUI in women

    PubMed Central

    Chibelean, C; Iordache, A; Mirvald, C; Gîngu, C; Margaritis, S; Stoica, R; Codoiu, C; Savu, C; Marksteiner, R; Sinescu, I

    2011-01-01

    Objective: Treatment of stress urinary incontinence consists of a wide range of options, from conservative therapies like lifestyle changes, medication, pelvic floor muscles exercises, electro-stimulation, to minimally invasive procedures- injection of collagen, suburethral slings TVT / TOT and last but not least, invasive surgical treatment reserved for recurrent and complex cases. Among the latest minimally invasive procedures reported in literature, the injection of intra-and perisphincterian of autologous stem cell (mioblasts and /or mature fibroblasts grown and multiplied in the laboratory from biopsy samples taken from the pectoralis muscles). Material and method: On October 18, 2010, in ‘Fundeni’ Clinical Institute of Uronephrology and Renal Transplantation was performed the first stem cell implantation procedure in the urethral sphincter, in Romania. Results: Assessment at 6 weeks, the quality of life questionnaires, micturition diary and clinical examination revealed a stunning decrease of urine loss from 6 pads / day at one per day, which significantly improved the patient's quality of life. Conclusions: Stem–cell–mioblasts therapy may represent in the future an every–day intervention in the urologist's armamentarium. The effectiveness of this treatment can change the course of therapy and last but not least, the accessibility to urological evaluation of patients with stress urinary incontinence. Clinical and urodynamic evaluations will continue and will be future scientific topics PMID:22567051

  19. Minimally invasive scoliosis treatment with a Ho:YAG laser

    NASA Astrophysics Data System (ADS)

    Rumpf, Christian G.; Lang, Robert D.; Goetz, Marcus H.

    2000-11-01

    Today most surgical treatment of spinal deformations is concentrated on invasive mechanical techniques with long operation times and major effects on the patient's mobility. The proposed minimally invasive technique using laser light for tissue ablation offers a possibility of gentle scoliosis treatment. It is thought that an early removal of the epiphysial growth zone on the convex side over several vertebrae results in a straightening of the spine. In a first evaluation, four different laser systems including argon ion, Nd:YAG (Q-switched), Nd:YAG (cw), and Ho:YAG laser were compared with respect to thermal damage to adjacent tissue, ablation rates, efficiency and laser handling. For in-vivo investigation, fresh lamb spine was used. Comparison showed that the Ho:YAG laser is the most appropriate laser for the given goal, providing efficient photoablation with moderate thermal effects on the adjacent tissue. In a second step the proposed minimally invasive operation technique was performed in in-vivo experiments on young foxhounds using 3D- thoracoscopic operation techniques. During these operations temperature mapping was done using fiber-optic fluorescent probes. After 12 months of normal growth the animals were sacrificed and x-ray as well as MRI was performed on the spine. First results show a positive effect of scoliotic growth in two cases. Being able to produce a scoliosis by hemiepiphysiodesis on the vertebra, It is thought that this technique is successful for a straightening of the spine on patients with scoliosis.

  20. Endoscopic evaluation of gastric conduit perfusion in minimally invasive Ivor Lewis esophagectomy

    PubMed Central

    Fikfak, Vid; Gaur, Puja; Kim, Min P.

    2015-01-01

    Introduction Laser-assisted indocyanine green (ICG) fluorescent dye angiography has been used in esophageal reconstructive surgery where it has been shown to significantly decrease the anastomotic leak rate. Recent advances in technology have made this possible in minimally invasive esophagectomy. Presentation of case We present a 69-year-old male with a cuT2N0M0 adenocarcinoma of the esophagus at the gastroesophageal junction who presented to our clinic after chemoradiation and underwent a minimally invasive Ivor Lewis esophagectomy. The perfusion of the gastric conduit was assessed intraoperatively using endoscopic ICG fluorescent imaging system. The anastomosis was created at the well-perfused site identified on the fluorescent imaging. The patient tolerated the procedure well, had an uneventful recovery going home on postoperative day 6 and tolerating a regular diet 2 weeks after the surgery. Discussion Combination of minimally invasive surgery and endoscopic evaluation of perfusion of gastric conduit provide improved outcomes for surgical treatment for patients with esophageal cancer. Conclusion The gastric conduit during minimally invasive Ivor Lewis esophagectomy can be evaluated using endoscopic ICG fluorescent imaging. PMID:26745315

  1. Tuberoplasty: minimally invasive osteosynthesis technique for tibial plateau fractures.

    PubMed

    Vendeuvre, T; Babusiaux, D; Brèque, C; Khiami, F; Steiger, V; Merienne, J-F; Scepi, M; Gayet, L E

    2013-06-01

    Fractures of the tibial plateau are in constant progression. They affect an elderly population suffering from a number of comorbidities, but also a young population increasingly practicing high-risk sports and using two-wheeled vehicles. The objective of this study was therefore to propose a new technique for the treatment of this type of fracture. There are a variety of classical pitfalls of conservative treatment such as defective reduction resulting in early osteoarthritis and alignment defects. Conventional treatments lead to joint stiffness and amyotrophy of the quadriceps, caused by the open technique and late loading. We propose an osteosynthesis technique for tibial plateau fractures with minimally invasive surgery. A minimally invasive technique would be more appropriate to remedy all of the surgical drawbacks resulting from current practices. The surgical technique that we propose uses a balloon allowing progressive and total reduction, associated with percutaneous screw fixation and filling with polymethylmethacrylate (PMMA) cement. The advantages are optimal reduction, minimal devascularization, soft tissues kept intact, as well as early loading and mobilization. This simple technique seems to be a good alternative to conventional treatment. The most comminuted fractures as well as the most posterior compressions can be treated, while causing the least impairment possible. Arthroscopy can be used to verify fracture reduction and cement leakage. At the same time, it can be used to assess the associated meniscal lesions and to repair them if necessary. PMID:23622864

  2. Percutaneous radiofrequency ablation: minimally invasive therapy for renal tumors.

    PubMed

    Ahrar, Kamran; Wallace, Michael J; Matin, Surena F

    2006-12-01

    Currently, up to 60% of renal tumors are detected incidentally by abdominal imaging. Most of these tumors are small and localized to the kidney. Owing to the shift to lower stage at diagnosis, radical nephrectomy has fallen out of favor and has been replaced by nephron-sparing surgery. Currently, partial nephrectomy is the treatment of choice for patients with small renal tumors. As the trend towards less invasive therapy continues, laparoscopic and percutaneous ablation techniques have gained popularity for the treatment of renal tumors in patients who are high-risk surgical candidates, or have a solitary kidney, limited renal function or multifocal disease. Percutaneous radiofrequency ablation is a safe, minimally invasive treatment option for those patients. PMID:17181487

  3. Past, Present, and Future of Minimally Invasive Abdominal Surgery.

    PubMed

    Antoniou, Stavros A; Antoniou, George A; Antoniou, Athanasios I; Granderath, Frank-Alexander

    2015-01-01

    Laparoscopic surgery has generated a revolution in operative medicine during the past few decades. Although strongly criticized during its early years, minimization of surgical trauma and the benefits of minimization to the patient have been brought to our attention through the efforts and vision of a few pioneers in the recent history of medicine. The German gynecologist Kurt Semm (1927-2003) transformed the use of laparoscopy for diagnostic purposes into a modern therapeutic surgical concept, having performed the first laparoscopic appendectomy, inspiring Erich Mühe and many other surgeons around the world to perform a wide spectrum of procedures by minimally invasive means. Laparoscopic cholecystectomy soon became the gold standard, and various laparoscopic procedures are now preferred over open approaches, in the light of emerging evidence that demonstrates less operative stress, reduced pain, and shorter convalescence. Natural orifice transluminal endoscopic surgery (NOTES) and single-incision laparoscopic surgery (SILS) may be considered further steps toward minimization of surgical trauma, although these methods have not yet been standardized. Laparoscopic surgery with the use of a robotic platform constitutes a promising field of investigation. New technologies are to be considered under the prism of the history of surgery; they seem to be a step toward further minimization of surgical trauma, but not definite therapeutic modalities. Patient safety and medical ethics must be the cornerstone of future investigation and implementation of new techniques. PMID:26508823

  4. Past, Present, and Future of Minimally Invasive Abdominal Surgery

    PubMed Central

    Antoniou, George A.; Antoniou, Athanasios I.; Granderath, Frank-Alexander

    2015-01-01

    Laparoscopic surgery has generated a revolution in operative medicine during the past few decades. Although strongly criticized during its early years, minimization of surgical trauma and the benefits of minimization to the patient have been brought to our attention through the efforts and vision of a few pioneers in the recent history of medicine. The German gynecologist Kurt Semm (1927–2003) transformed the use of laparoscopy for diagnostic purposes into a modern therapeutic surgical concept, having performed the first laparoscopic appendectomy, inspiring Erich Mühe and many other surgeons around the world to perform a wide spectrum of procedures by minimally invasive means. Laparoscopic cholecystectomy soon became the gold standard, and various laparoscopic procedures are now preferred over open approaches, in the light of emerging evidence that demonstrates less operative stress, reduced pain, and shorter convalescence. Natural orifice transluminal endoscopic surgery (NOTES) and single-incision laparoscopic surgery (SILS) may be considered further steps toward minimization of surgical trauma, although these methods have not yet been standardized. Laparoscopic surgery with the use of a robotic platform constitutes a promising field of investigation. New technologies are to be considered under the prism of the history of surgery; they seem to be a step toward further minimization of surgical trauma, but not definite therapeutic modalities. Patient safety and medical ethics must be the cornerstone of future investigation and implementation of new techniques. PMID:26508823

  5. Cost-effectiveness of minimally invasive sacroiliac joint fusion

    PubMed Central

    Cher, Daniel J; Frasco, Melissa A; Arnold, Renée JG; Polly, David W

    2016-01-01

    Background Sacroiliac joint (SIJ) disorders are common in patients with chronic lower back pain. Minimally invasive surgical options have been shown to be effective for the treatment of chronic SIJ dysfunction. Objective To determine the cost-effectiveness of minimally invasive SIJ fusion. Methods Data from two prospective, multicenter, clinical trials were used to inform a Markov process cost-utility model to evaluate cumulative 5-year health quality and costs after minimally invasive SIJ fusion using triangular titanium implants or non-surgical treatment. The analysis was performed from a third-party perspective. The model specifically incorporated variation in resource utilization observed in the randomized trial. Multiple one-way and probabilistic sensitivity analyses were performed. Results SIJ fusion was associated with a gain of approximately 0.74 quality-adjusted life years (QALYs) at a cost of US$13,313 per QALY gained. In multiple one-way sensitivity analyses all scenarios resulted in an incremental cost-effectiveness ratio (ICER) <$26,000/QALY. Probabilistic analyses showed a high degree of certainty that the maximum ICER for SIJ fusion was less than commonly selected thresholds for acceptability (mean ICER =$13,687, 95% confidence interval $5,162–$28,085). SIJ fusion provided potential cost savings per QALY gained compared to non-surgical treatment after a treatment horizon of greater than 13 years. Conclusion Compared to traditional non-surgical treatments, SIJ fusion is a cost-effective, and, in the long term, cost-saving strategy for the treatment of SIJ dysfunction due to degenerative sacroiliitis or SIJ disruption. PMID:26719717

  6. Minimally invasive surgery for rectal cancer: Are we there yet?

    PubMed Central

    Champagne, Bradley J; Makhija, Rohit

    2011-01-01

    Laparoscopic colon surgery for select cancers is slowly evolving as the standard of care but minimally invasive approaches for rectal cancer have been viewed with significant skepticism. This procedure has been performed by select surgeons at specialized centers and concerns over local recurrence, sexual dysfunction and appropriate training measures have further hindered widespread acceptance. Data for laparoscopic rectal resection now supports its continued implementation and widespread usage by expeienced surgeons for select patients. The current controversies regarding technical approaches have created ambiguity amongst opinion leaders and are also addressed in this review. PMID:21412496

  7. Right infraaxillary thoracotomy for minimally invasive aortic valve replacement.

    PubMed

    Ito, Toshiaki; Maekawa, Atsuo; Hoshino, Satoshi; Hayashi, Yasunari

    2013-08-01

    Minimally invasive aortic valve replacement has been performed via partial sternotomy, the parasternal approach, and anterior intercostal approaches. We successfully performed aortic valve replacement through a small right infraaxillary thoracotomy in 25 patients, with the aid of a thoracoscope and a knot-pusher. The patients were 9 men and 16 women with a mean age of 72.6 years. Our approach had better cosmetic results than traditional approaches through the anterior chest wall. This method did not require rib transection or sacrifice of the internal thoracic artery. PMID:23910127

  8. Minimally invasive radioguided parathyroidectomy using intraoperative sestamibi localization.

    PubMed

    Lee, Wha-Joon; Ruda, James; Stack, Brendan C

    2004-08-01

    This article presents the authors' technique of minimally invasive radio guided parathyroidectomy (MIRP) with intra-operative use of the hand-held gamma probe for primary HPT caused by a solitary adenoma. It points out how this approach varies from that of others who perform MIRP. It also illustrates ways to troubleshoot common problems with the technique in inexperienced hands. The goal is to present an understandable and systematic approach to MIRP for surgeons who do not currently use this technique. This article is not intended to replace formalized training, which is essential to master the technique. PMID:15262516

  9. Ergonomic T-Handle for Minimally Invasive Surgical Instruments

    PubMed Central

    Parekh, J; Shepherd, DET; Hukins, DWL; Maffulli, N

    2016-01-01

    A T-handle has been designed to be used for minimally invasive implantation of a dynamic hip screw to repair fractures of the proximal femur. It is capable of being used in two actions: (i) push and hold (while using an angle guide) and (ii) application of torque when using the insertion wrench and lag screw tap. The T-handle can be held in a power or precision grip. It is suitable for either single (sterilised by γ-irradiation) or multiple (sterilised by autoclaving) use. The principles developed here are applicable to handles for a wide range of surgical instruments. PMID:27326394

  10. Minimally invasive approach to eliminate pyogenic granuloma: a case report.

    PubMed

    Chandrashekar, B

    2012-01-01

    Pyogenic granuloma is one of the inflammatory hyperplasia seen in the oral cavity. The term is a misnomer because it is not related to infection and arises in response to various stimuli such as low-grade local irritation, traumatic injury, or hormonal factors. It is most commonly seen in females in their second decade of life due to vascular effects of hormones. Although excisional surgery is the treatment of choice for it, this paper presents the safest and most minimally invasive procedure for the regression of pyogenic granuloma. PMID:22567459

  11. Minimally invasive glaucoma surgery: current status and future prospects

    PubMed Central

    Richter, Grace M; Coleman, Anne L

    2016-01-01

    Minimally invasive glaucoma surgery aims to provide a medication-sparing, conjunctival-sparing, ab interno approach to intraocular pressure reduction for patients with mild-to-moderate glaucoma that is safer than traditional incisional glaucoma surgery. The current approaches include: increasing trabecular outflow (Trabectome, iStent, Hydrus stent, gonioscopy-assisted transluminal trabeculotomy, excimer laser trabeculotomy); suprachoroidal shunts (Cypass micro-stent); reducing aqueous production (endocyclophotocoagulation); and subconjunctival filtration (XEN gel stent). The data on each surgical procedure for each of these approaches are reviewed in this article, patient selection pearls learned to date are discussed, and expectations for the future are examined. PMID:26869753

  12. Ergonomic T-Handle for Minimally Invasive Surgical Instruments.

    PubMed

    Parekh, J; Shepherd, Det; Hukins, Dwl; Maffulli, N

    2016-05-01

    A T-handle has been designed to be used for minimally invasive implantation of a dynamic hip screw to repair fractures of the proximal femur. It is capable of being used in two actions: (i) push and hold (while using an angle guide) and (ii) application of torque when using the insertion wrench and lag screw tap. The T-handle can be held in a power or precision grip. It is suitable for either single (sterilised by γ-irradiation) or multiple (sterilised by autoclaving) use. The principles developed here are applicable to handles for a wide range of surgical instruments. PMID:27326394

  13. Minimally invasive intraoral condylectomy: proof of concept report.

    PubMed

    Hernández-Alfaro, F; Méndez-Manjón, I; Valls-Ontañón, A; Guijarro-Martínez, R

    2016-09-01

    A significant proportion of facial asymmetry cases are caused by abnormal growth of the mandibular condyles. Surgical management is generally based on a condylectomy performed through a pre-auricular transcutaneous access. However, this approach entails potential neurovascular, salivary, and aesthetic complications. In this study, a proof-of-concept evaluation was performed of a novel minimally invasive technique for condylectomy performed through an intraoral approach. Based on precise three-dimensional virtual planning to define intraoperative references, this technique provides an excellent access for total or partial condylectomy through a limited intraoral incision. Piezoelectric surgery with customized attachments enables the safe, accurate execution of the condylectomy. In addition, experience gained in seven consecutive cases suggests that the need for coronoidectomy can be obviated, surgical time is reduced to an average of 16.9min, and postoperative morbidity is minimal. This alternative intraoral approach could become the treatment of choice for most condylar hyperplastic conditions. PMID:27134047

  14. Minimally Invasive Surgical Approach to Complicated Recurrent Pilonidal Sinus

    PubMed Central

    Gul, Vahit Onur; Destek, Sebahattin; Ozer, Serhat; Etkin, Ergin; Ahioglu, Serkan; Ince, Mehmet; Cimin, Vedat; Sen, Deniz; Erbil, Yesim

    2015-01-01

    Pilonidal sinus is considered as a simple and frequently occurring disease localized at the sacrococcygeal area. However, at the intergluteal region, it can often turn into a chronic and complicated disease. In some cases, it can fistulize up to the gluteal region and appear at the secondary orifices. Minimally invasive surgical techniques are becoming widespread in recent years due to the increased experience and development of new instruments. Limited excision of the pilonidal sinus tract can be a better treatment option compared with large excisions in terms of recovery time and patient's comfort. This case study reports the single-phase surgical treatment of complicated and recurrent pilonidal sinus localized at the gluteal area, with minimal tissue loss and inflammation. PMID:26576314

  15. A robust motion estimation system for minimal invasive laparoscopy

    NASA Astrophysics Data System (ADS)

    Marcinczak, Jan Marek; von Öhsen, Udo; Grigat, Rolf-Rainer

    2012-02-01

    Laparoscopy is a reliable imaging method to examine the liver. However, due to the limited field of view, a lot of experience is required from the surgeon to interpret the observed anatomy. Reconstruction of organ surfaces provide valuable additional information to the surgeon for a reliable diagnosis. Without an additional external tracking system the structure can be recovered from feature correspondences between different frames. In laparoscopic images blurred frames, specular reflections and inhomogeneous illumination make feature tracking a challenging task. We propose an ego-motion estimation system for minimal invasive laparoscopy that can cope with specular reflection, inhomogeneous illumination and blurred frames. To obtain robust feature correspondence, the approach combines SIFT and specular reflection segmentation with a multi-frame tracking scheme. The calibrated five-point algorithm is used with the MSAC robust estimator to compute the motion of the endoscope from multi-frame correspondence. The algorithm is evaluated using endoscopic videos of a phantom. The small incisions and the rigid endoscope limit the motion in minimal invasive laparoscopy. These limitations are considered in our evaluation and are used to analyze the accuracy of pose estimation that can be achieved by our approach. The endoscope is moved by a robotic system and the ground truth motion is recorded. The evaluation on typical endoscopic motion gives precise results and demonstrates the practicability of the proposed pose estimation system.

  16. Emerging Techniques in Minimally Invasive Surgery. Pros and Cons.

    PubMed

    Fisichella, P Marco; DeMeester, Steven R; Hungness, Eric; Perretta, Silvana; Soper, Nathaniel J; Rosemurgy, Alexander; Torquati, Alfonso; Sachdeva, Ajit K; Patti, Marco G

    2015-07-01

    New trends have emerged regarding the best minimally invasive access approaches to perform gastrointestinal surgery. However, these newer approaches are seen critically by those who demand a more strict assessment of outcomes and safety. An international panel of expert gathered at the 2014 American College of Surgeons Meeting with the goal of providing an evidence-based understanding of the real value of these approaches in gastrointestinal surgery. The panel has compared the efficacy and safety of most established approaches to gastrointestinal diseases to those of new treatment modalities: peroral esophageal myotomy vs. laparoscopic myotomy for achalasia, transgastric vs. transvaginal approach, and single-incision vs. multi-port access minimally invasive surgery. The panel found that (1) the outcome of these new approaches was not superior to that of established surgical procedures; (2) the new approaches are generally performed in few highly specialized centers; and (3) transgastric and transvaginal approaches might be safe and feasible in very experienced hands, but cost, training, operative time, and tools seem to limit their application for the treatment of common procedures such as cholecystectomy and appendectomy. Because the expected advantages of new approaches have yet to be proven in controlled trials, new approaches should be considered for adoption into practice only after thorough analyses of their efficacy and effectiveness and appropriate training. PMID:25678255

  17. [TECHNIQUES IN MITRAL VALVE REPAIR VIA A MINIMALLY INVASIVE APPROACH].

    PubMed

    Ito, Toshiaki

    2016-03-01

    In mitral valve repair via a minimally invasive approach, resection of the leaflet is technically demanding compared with that in the standard approach. For resection and suture repair of the posterior leaflet, premarking of incision lines is recommended for precise resection. As an alternative to resection and suture, the leaflet-folding technique is also recommended. For correction of prolapse of the anterior leaflet, neochordae placement with the loop technique is easy to perform. Premeasurement with transesophageal echocardiography or intraoperative measurement using a replica of artificial chordae is useful to determine the appropriate length of the loops. Fine-tuning of the length of neochordae is possible by adding a secondary fixation point on the leaflet if the loop is too long. If the loop is too short, a CV5 Gore-Tex suture can be passed through the loop and loosely tied several times to stack the knots, with subsequent fixation to the edge of the leaflet. Finally, skill in the mitral valve replacement technique is necessary as a back-up for surgeons who perform minimally invasive mitral valve repair. PMID:27295773

  18. Current Status of Minimally Invasive Surgery for Renal Cell Carcinoma.

    PubMed

    Smith, Zachary L

    2016-06-01

    Over the last three decades, the incidence of renal cell carcinoma (RCC) has continuously risen, generally attributed to the increased use of cross-sectional imaging across all medical disciplines. Fortunately, despite this rising incidence, the estimated 5-year relative survival rate has improved. This survival improvement likely parallels the stage migration of the last two decades toward an increased incidence of small renal masses (SRMs). However, this survival improvement may be secondary to improved surgical techniques and medical therapies for these malignancies. The increased incidence of SRMs has led to an expected evolution in the treatment of RCC. Minimally invasive surgical applications for the treatment of RCC have gained widespread popularity, and now these approaches to renal malignancies have surpassed open techniques in frequency of utilization. Laparoscopic and robotic-assisted techniques have now been applied to both radical and partial nephrectomy procedures of varying complexity. Additionally, percutaneous ablative procedures have been applied to the treatment of some SRMs, increasing the urologist's armamentarium further. Below, we provide a review of these minimally invasive surgical (MIS) procedures for the treatment of RCC. PMID:27021911

  19. Thermotolerance of human myometrium: implications for minimally invasive uterine therapies

    NASA Astrophysics Data System (ADS)

    Thomas, Aaron C.; Grisez, Brian T.; McMillan, Kathleen; Chill, Nicholas; Harclerode, Tyler P.; Radabaugh, Rebecca; Jones, Ryan M.; Coad, James E.

    2013-02-01

    Endometrial ablation has gained significant clinical acceptance over the last decade as a minimally invasive treatment for abnormal uterine bleeding. To improve upon current thermal injury modeling, it is important to better characterize the myometrium's thermotolerance. The extent of myometrial thermal injury was determined across a spectrum of thermal histories/doses (time-temperature combinations). Fresh extirpated human myometrium was obtained from 13 subjects who underwent a previous scheduled benign hysterectomy. Within two hours of hysterectomy, the unfixed myometrium was treated in a stabilized saline bath with temperatures ranging from 45-70 °C and time intervals from 30- 150 seconds. The time-temperature combinations were selected to simulate treatment times under 2.5 minutes. A total of six such thermal matrices, each comprised of 45 time-temperature combinations, were prepared for evaluation. The treated myometrium was cryosectioned for nitro blue tetrazolium (NBT) staining to assess for thermal respiratory enzyme inactivation. Image analysis was subsequently used to quantitatively assess the stained myometrium's capacity to metabolize the tetrazolium at each time-temperature combination. This colorimetric data was then used as marker of cellular viability and determine survival parameters with implications for developing minimally invasive uterine therapies.

  20. Mitral Valve Surgery: Current Minimally Invasive and Transcatheter Options

    PubMed Central

    Ramlawi, Basel; Gammie, James S.

    2016-01-01

    The mitral valve is a highly complex structure, the competency and function of which relies on the harmonious action of its component parts. Minimally invasive cardiac surgery (MICS) for mitral valve repair or replacement (MVR/r) has been performed successfully with incremental improvements in techniques over the past decade. These minimally invasive procedures, while attractive to patients and referring physicians, should meet the same high bar for optimal clinical outcomes and long-term durability of valve repair as traditional sternotomy procedures. The majority of MICS MVR/r procedures are performed via a right minithoracotomy approach with direct or camera-assisted visualization, with a minority of centers performing robotic MVR/r. Outcomes with MICS MVR/r have been shown to have similar morbidity and mortality rates as traditional sternotomy MV procedures but with the advantage of reduced transfusions, postoperative atrial fibrillation, and time to recovery. More recently, transcatheter mitral valve repair and replacement (TMVR/r) has become a reality. Percutaneous MV repair technology is currently FDA approved for patients with nonsurgical high-risk degenerative mitral regurgitation. Other TMVR/r technology is at various levels of preclinical and clinical investigation, although these devices are proving to be more challenging compared to transcatheter aortic valve replacement (TAVR) due to the significantly more complex mitral anatomy and the greater heterogeneity of mitral disease requiring treatment. In this article, we review current techniques for MICS MVR/r and upcoming catheter-based therapies for the mitral valve. PMID:27127558

  1. Imaging Live Bee Brains using Minimally-Invasive Diagnostic Radioentomology

    PubMed Central

    Greco, Mark K; Tong, Jenna; Soleimani, Manucher; Bell, Duncan; Schäfer, Marc O

    2012-01-01

    The sensitivity of the honey bee, Apis mellifera L. (Hymeonoptera: Apidae), brain volume and density to behavior (plasticity) makes it a great model for exploring the interactions between experience, behavior, and brain structure. Plasticity in the adult bee brain has been demonstrated in previous experiments. This experiment was conducted to identify the potentials and limitations of MicroCT (micro computed tomograpy) scanning “live” bees as a more comprehensive, non-invasive method for brain morphology and physiology. Bench-top and synchrotron MicroCT were used to scan live bees. For improved tissue differentiation, bees were fed and injected with radiographic contrast. Images of optic lobes, ocelli, antennal lobes, and mushroom bodies were visualized in 2D and 3D rendering modes. Scanning of live bees (for the first time) enabled minimally-invasive imaging of physiological processes such as passage of contrast from gut to haemolymph, and preliminary brain perfusion studies. The use of microCT scanning for studying insects (collectively termed ‘diagnostic radioentomology’, or DR) is increasing. Our results indicate that it is feasible to observe plasticity of the honey bee brain in vivo using diagnostic radioentomology, and that progressive, real-time observations of these changes can be followed in individual live bees. Limitations of live bee scanning, such as movement errors and poor tissue differentiation, were identified; however, there is great potential for in-vivo, non-invasive diagnostic radioentomology imaging of the honey bee for brain morphology and physiology. PMID:23421752

  2. Living Cell Factories - Electrosprayed Microcapsules and Microcarriers for Minimally Invasive Delivery.

    PubMed

    Naqvi, Syeda M; Vedicherla, Srujana; Gansau, Jennifer; McIntyre, Tom; Doherty, Michelle; Buckley, Conor T

    2016-07-01

    Minimally invasive delivery of "living cell factories" consisting of cells and therapeutic agents has gained wide attention for next generation biomaterial device systems for multiple applications including musculoskeletal tissue regeneration, diabetes and cancer. Cellular-based microcapsules and microcarrier systems offer several attractive features for this particular purpose. One such technology capable of generating these types of systems is electrohydrodynamic (EHD) spraying. Depending on various parameters, including applied voltage, biomaterial properties (viscosity, conductivity) and needle geometry, complex structures and arrangements can be fabricated for therapeutic strategies. The advances in the use of EHD technology are outlined, specifically in the manipulation of bioactive and dynamic material systems to control size, composition and configuration in the development of minimally invasive micro-scaled biopolymeric systems. The exciting therapeutic applications of this technology, future perspectives and associated challenges are also presented. PMID:26695531

  3. Minimally invasive techniques for head and neck malignancies: current indications, outcomes and future directions.

    PubMed

    Hartl, Dana M; Ferlito, Alfio; Silver, Carl E; Takes, Robert P; Stoeckli, Sandro J; Suárez, Carlos; Rodrigo, Juan P; Sesterhenn, Andreas M; Snyderman, Carl H; Terris, David J; Genden, Eric M; Rinaldo, Alessandra

    2011-09-01

    The trend toward minimally invasive surgery, appropriately applied, has evolved over the past three decades to encompass all fields of surgery, including curative intent cancer surgery of the head and neck. Proper patient and tumor selection are fundamental to optimizing oncological and functional outcomes in such a personalized approach to cancer treatment. Training, experience, and appropriate technological equipment are prerequisites for any type of minimally invasive surgery. The aim of this review was to provide an overview of currently available techniques and the evidence justifying their use. Much evidence is in favor of routine use of transoral laser resection, transoral robot-assisted surgery, transnasal endoscopic resection, sentinel node biopsy, and endoscopic neck surgery for selected malignant tumors, by experienced surgical teams. Technological advances will enhance the scope of this type of surgery in the future and physicians need to be aware of the current applications and trends. PMID:21562814

  4. [Minimally invasive interventional techniques involving the urogenital tract in dogs and cats].

    PubMed

    Heilmann, R M

    2016-04-18

    Minimally invasive interventional techniques are advancing fast in small animal medicine. These techniques utilize state-of-the-art diagnostic methods, including fluoroscopy, ultrasonography, endoscopy, and laparoscopy. Minimally invasive procedures are particularly attractive in the field of small animal urology because, in the past, treatment options for diseases of the urogenital tract were rather limited or associated with a high rate of complications. Most endourological interventions have a steep learning curve. With the appropriate equipment and practical training some of these procedures can be performed in most veterinary practices. However, most interventions require referral to a specialty clinic. This article summarizes the standard endourological equipment and materials as well as the different endourological interventions performed in dogs and cats with diseases of the kidneys/renal pelves, ureters, or lower urinary tract (urinary bladder and urethra). PMID:26998909

  5. Endoskopie, minimal invasive chirurgische und navigierte Verfahren in der Urologie

    NASA Astrophysics Data System (ADS)

    Grosse, Joachim; von Walter, Matthias; Jakse, Gerhard

    Betrachtet man die letzten 100 Jahre der Urologie in Deutschland seit Gründung ihrer Fachgesellschaft 1906 in Stuttgart, so sind sicherlich die letzten 25 Jahre von umfassenden Entwicklungen mit z. T. vollständigen Umwälzungen bisheriger Therapien und Methoden auf urologischen Fachgebiet gekennzeichnet. In erster Linie handelte es sich dabei um minimal invasive endoskopische Techniken wie perkutane Nierenchirurgie, Ureterorenoskopie, videoendoskopisch unterstütze transurethrale Elektroresektionen der Prostata und von Blasentumore sowie die Laparoskopie. Sie führten zu besseren operativen Ergebnissen und einer deutlichen Senkung der Morbidität der entsprechenden Behandlung urologischer Krankheitsbilder, mit der Konsequenz, dass einige bisher als Standard gültige offene Operationsverfahren abgelöst wurden.

  6. Achieving zero ischemia in minimally invasive partial nephrectomy surgery.

    PubMed

    Hou, Weibin; Ji, Zhigang

    2015-06-01

    Widespread application of the minimally invasive partial nephrectomy (MIPN) techniques like laparoscopic and robotic partial nephrectomy, has been limited by concerns about prolonged warm ischemia. So techniques aiming at performing have been actively explored. A systemic review of literatures on the MIPN without hilar clamping was performed and related methods were summarized. There are mainly seven methods including selective/segmental renal artery clamping technique, selective renal parenchymal clamping technique, targeted renal blood flow interruption technique, laser supported MIPN, radio frequency assisted MIPN, hydro-jet assisted MIPN, and sequential preplaced suture renorrhaphy technique that have been undergoing enthusiastic investigation for achieving MINP without hilar clamping. All of these emerging techniques represent the exploring work to achieve a zero ischemia MIPN for small renal tumors of different characteristics. Though not perfect for any of the technique, they deserve a further assessment during their future experimental and clinical applications. PMID:25895732

  7. Minimally invasive surgery for inflammatory bowel disease: Current perspectives.

    PubMed

    Shrestha, Badri

    2016-05-01

    The surgical management of complicated and recurrent inflammatory bowel disease (IBD), has remained a challenge. Minimally invasive surgery (MIS), in the form of laparoscopic resections, single port approach and robotic-assisted dissections in the management of IBD, have been examined in several prospective studies. All of them have shown advantages over open surgery in terms of reduction of physical trauma of surgery, recovery time, better cosmetic outcomes and shorter hospitalization. However, it is important to appreciate that not all patients with IBD are suitable for MIS, so a combination of both open and MIS should be adopted to achieve optimum outcomes. A review on this subject performed by Neumann et al in this issue of World Journal of Gastrointestinal Pharmacology and Therapeutics have provided evidence in support of the contemporary practice of MIS in the management of IBD and the accompanying commentary further critically evaluates their application in clinical practice. PMID:27158536

  8. Minimally invasive surgery for inflammatory bowel disease: Current perspectives

    PubMed Central

    Shrestha, Badri

    2016-01-01

    The surgical management of complicated and recurrent inflammatory bowel disease (IBD), has remained a challenge. Minimally invasive surgery (MIS), in the form of laparoscopic resections, single port approach and robotic-assisted dissections in the management of IBD, have been examined in several prospective studies. All of them have shown advantages over open surgery in terms of reduction of physical trauma of surgery, recovery time, better cosmetic outcomes and shorter hospitalization. However, it is important to appreciate that not all patients with IBD are suitable for MIS, so a combination of both open and MIS should be adopted to achieve optimum outcomes. A review on this subject performed by Neumann et al in this issue of World Journal of Gastrointestinal Pharmacology and Therapeutics have provided evidence in support of the contemporary practice of MIS in the management of IBD and the accompanying commentary further critically evaluates their application in clinical practice. PMID:27158536

  9. Partial prolapsectomy and fixation proctomucopexy: a novel minimally invasive procedure.

    PubMed

    Pescatori, L C; Busuito, G; Pescatori, M

    2014-09-01

    A novel minimally invasive procedure for the management of anterior external and posterior internal mucosal prolapse is described. The operation, carried out via a transanal route, consists of a partial prolapsectomy and a mucosal proctopexy. Out of six patients, one had severe postoperative bleeding and one had a recurrence of internal prolapse and obstructed defecation. Three patients had pelvic floor rehabilitation for associated dysfunctions. The advantage of the operation is that a circumferential anastomosis is avoided, thus decreasing the risk of dehiscence, and only a short sphincter dilation is required. Moreover, the procedure has very little effect on the rectal reservoir, thus preventing fecal urgency. No reintervention was needed, and almost all patients were cured after 2 years. PMID:24848527

  10. Minimally Invasive Techniques for Total Aortic Arch Reconstruction

    PubMed Central

    Faulds, Jason; Sandhu, Harleen K.; Estrera, Anthony L.; Safi, Hazim J.

    2016-01-01

    The cumulative experience with endovascular aortic repair in the descending thoracic and infrarenal aorta has led to increased interest in endovascular aortic arch reconstruction. Open total arch replacement is a robust operation that can be performed with excellent results. However, it requires cardiopulmonary bypass and circulatory arrest and, therefore, may not be tolerated by all patients. Minimally invasive techniques have been considered as an alternative and include hybrid arch debranching, parallel stent graft deployment in the chimney and snorkel configurations, and complete endovascular branched reconstruction with multi-branched devices. This review discusses the evolving use of endovascular techniques in the management of aortic arch pathology and considers their relevance in an era of safe and durable open aortic arch reconstruction. PMID:27127562

  11. Minimally Invasive Techniques for Total Aortic Arch Reconstruction.

    PubMed

    Faulds, Jason; Sandhu, Harleen K; Estrera, Anthony L; Safi, Hazim J

    2016-01-01

    The cumulative experience with endovascular aortic repair in the descending thoracic and infrarenal aorta has led to increased interest in endovascular aortic arch reconstruction. Open total arch replacement is a robust operation that can be performed with excellent results. However, it requires cardiopulmonary bypass and circulatory arrest and, therefore, may not be tolerated by all patients. Minimally invasive techniques have been considered as an alternative and include hybrid arch debranching, parallel stent graft deployment in the chimney and snorkel configurations, and complete endovascular branched reconstruction with multi-branched devices. This review discusses the evolving use of endovascular techniques in the management of aortic arch pathology and considers their relevance in an era of safe and durable open aortic arch reconstruction. PMID:27127562

  12. Fast and stable guidewire simulator for minimally invasive vascular surgery.

    PubMed

    Zhan-Jie Gao; Xiao-Liang Xie; Gui-Bin Bian; Jian-Long Hao; Zhen-Qiu Feng; Zeng-Guang Hou

    2015-08-01

    In recent years, minimally invasive vascular surgery is widely applied in treatment of cardiovascular diseases, and the manipulation of the guidewire is the essential skill for this surgery. Lots of time and money have to be taken to achieve the skill. In this paper, we present a multithreading guidewire simulator which can help the apprentice to gain the skill and modeling the guidewire is the core technique of the simulator. The guidewire is modeled by a fast and stable method based on the Cosserat theory of elastic rods. The method describes the behavior of the guidewire with the Lagrange equations of motion and it uses the penalty method to maintain constraints. We further propose a simplified solving procedure for the guidewire model. Finally, some experiments are conducted to evaluate the effectiveness of this model. PMID:26737612

  13. Minimally invasive pars approach for foraminal disc herniation.

    PubMed

    Hitchon, Patrick W; Awe, Olatilewa O; Close, Liesl; Sukkarieh, Hamdi G

    2015-07-01

    We present a retrospective cohort study on the outcome of patients with foraminal disc herniations (FDH) treated with partial pars resections using minimally invasive surgery (MIS) through a tube. FDH present a challenge due to the more lateral trajectory needed for their excision and thereby more muscle dissection and possibly facet resection. Forty patients, 19 women and 21 men with a mean age ± standard deviation of 58 ± 12 years, underwent MIS for FDH. Data on length of hospital stay, body mass index and outcomes were collected prospectively and reviewed retrospectively. Average length of stay following surgery was 1 ± 1 days. There was one wound infection and four unsatisfactory results. Using the Macnab score, good to excellent results were achieved in 89% of the patients. Based on these results, MIS surgery with partial pars resection is an attractive option in the treatment of FDH with low morbidity and short hospital stays. PMID:25882259

  14. First Robotic SPECT for Minimally Invasive Sentinel Lymph Node Mapping.

    PubMed

    Fuerst, Bernhard; Sprung, Julian; Pinto, Francisco; Frisch, Benjamin; Wendler, Thomas; Simon, Hervé; Mengus, Laurent; van den Berg, Nynke S; van der Poel, Henk G; van Leeuwen, Fijs W B; Navab, Nassir

    2016-03-01

    In this paper we present the usage of a drop-in gamma probe for intra-operative Single-Photon Emission Computed Tomography (SPECT) imaging in the scope of minimally invasive robot-assisted interventions. The probe is designed to be inserted and reside inside the abdominal cavity during the intervention. It is grasped during the procedure using a robotic laparoscopic gripper enabling full six degrees of freedom handling by the surgeon. We demonstrate the first deployment of the tracked probe for intra-operative in-patient robotic SPECT enabling augmented-reality image guidance. The hybrid mechanical- and image-based in-patient probe tracking is shown to have an accuracy of 0.2 mm. The overall system performance is evaluated and tested with a phantom for gynecological sentinel lymph node interventions and compared to ground-truth data yielding a mean reconstruction accuracy of 0.67 mm. PMID:26561283

  15. Acute Lumbar Burst Fracture Treated by Minimally Invasive Lateral Corpectomy

    PubMed Central

    Amaral, Rodrigo; Marchi, Luis; Oliveira, Leonardo; Coutinho, Thiago

    2013-01-01

    Burst fractures in acute spinal traumas are a difficult problem to solve. Different approaches and techniques have been utilized, but with high incidence of morbidity and mortality, besides unsatisfactory clinical and radiological results. Mini-open approaches recently emerged and have been shown to be safe and effective in the treatment of several spinal conditions. Here we report a case of acute lumbar burst fracture at L2 treated by minimally invasive true lateral approach posteriorly instrumented with percutaneous pedicle screws. The minimum disruptive access in addition to a rigid construction allowed a lumbar corpectomy without the morbidity of standard open approaches, lowering surgery costs and accelerating the patient recovery with successfully clinical and radiological results. PMID:23634314

  16. Evaluation of Network-Based Minimally Invasive VR Surgery Simulator.

    PubMed

    Tagawa, Kazuyoshi; Tanaka, Hiromi T; Kurumi, Yoshimasa; Komori, Masaru; Morikawa, Shigehiro

    2016-01-01

    In this paper, we report a result of an experiment of a field trial of our network-based minimally invasive surgery simulator. In our previous paper, we proposed a network-based visuohaptic surgery training system for laparoscopic surgery. In addition, we proposed a volume-based haptic communication approach, which allows participants at remote sites on the network to simultaneously interact with the same target object in virtual environments presented by multi-level computer performance systems, by only exchanging a small set of manipulation parameters for the target object and additional packet for synchronization of status of binary tree and deformation of shared volume model. We implemented the approach into our network-based surgery simulator, and field trial of the simulator at three locations was performed. PMID:27046613

  17. A Minimally Invasive Approach for Postoperative Pancreatic Fistula

    SciTech Connect

    Yamazaki, Shintaro Kuramoto, Kenmei; Itoh, Yutaka; Watanabe, Yoshika; Ueda, Toshisada

    2003-11-15

    Pancreas fistula is a well-known and severe complication of pancreaticoduodenectomy. It is difficult to control with conservative therapy, inducing further complications and severe morbidity. Until now, re-operation has been the only way to resolve pancreatic fistula causing complete dehiscence of the pancreatic-enteric anastomosis (complete pancreatic fistula). Percutaneous transgastric fistula drainage is one of the treatments for pancreatic fistula. This procedure allows both pancreas juice drainage and anastomosis re-construction at the same time. This is effective and minimally invasive but difficult to adapt to a long or complicated fistula. In particular, dilatation of the main pancreatic duct is indispensable. This paper reports the successful resolution of a postoperative pancreatic fistula by a two-way-approach percutaneous transgastric fistula drainage procedure. Using a snare catheter from the fistula and a flexible guidewire from the transgastric puncture needle, it can be performed either with or without main pancreatic duct dilatation.

  18. Minimally Invasive Surgery in Gastrointestinal Cancer: Benefits, Challenges, and Solutions for Underutilization

    PubMed Central

    Gusani, Niraj J.; Kimchi, Eric T.; Kavic, Stephen M.

    2014-01-01

    Background and Objectives: After the widespread application of minimally invasive surgery for benign diseases and given its proven safety and efficacy, minimally invasive surgery for gastrointestinal cancer has gained substantial attention in the past several years. Despite the large number of publications on the topic and level I evidence to support its use in colon cancer, minimally invasive surgery for most gastrointestinal malignancies is still underused. Methods: We explore some of the challenges that face the fusion of minimally invasive surgery technology in the management of gastrointestinal malignancies and propose solutions that may help increase the utilization in the future. These solutions are based on extensive literature review, observation of current trends and practices in this field, and discussion made with experts in the field. Results: We propose 4 different solutions to increase the use of minimally invasive surgery in the treatment of gastrointestinal malignancies: collaboration between surgical oncologists/hepatopancreatobiliary surgeons and minimally invasive surgeons at the same institution; a single surgeon performing 2 fellowships in surgical oncology/hepatopancreatobiliary surgery and minimally invasive surgery; establishing centers of excellence in minimally invasive gastrointestinal cancer management; and finally, using robotic technology to help with complex laparoscopic skills. Conclusions: Multiple studies have confirmed the utility of minimally invasive surgery techniques in dealing with patients with gastrointestinal malignancies. However, training continues to be the most important challenge that faces the use of minimally invasive surgery in the management of gastrointestinal malignancy; implementation of our proposed solutions may help increase the rate of adoption in the future. PMID:25489209

  19. Brow suspension, a minimally invasive technique in facial rejuvenation.

    PubMed

    Erol, O Onur; Sozer, S Ozan; Velidedeoglu, Hifzi V

    2002-06-01

    People tend to prefer noninvasive or minimally invasive methods of facial rejuvenation, especially when it involves their face, which is the hallmark of a person's identity and impossible to hide. It is widely known that brow ptosis gives the face a "tired look" and also accentuates deformities of the upper eyelid. Most people who are interested in facial rejuvenation may not accept even a minor surgery, such as an endoscopic surgery. The senior author has developed a minimally invasive method of suspending the brow at a higher position. In this technique, there is neither surgical dissection nor a surgical incision except for four stab incisions and suture insertion, which is why we refer to it as a nonsurgical brow suspension. It is done under local anesthesia, and the brows are fixed in the position that they assume when the patient is supine. In the past 6 years, we performed 387 brow suspensions on 324 female and 63 male patients. The youngest patient was 19 years old, and the oldest was 74 years old. A retrospective chart review was done. These 387 cases were reviewed by comparison of preoperative and postoperative photographs. This approach was not only used for patients who were not interested in surgical rejuvenation but was also combined with lipofilling, laser resurfacing, and/or upper blepharoplasty. This technique is useful for correcting postsurgical brow asymmetry. We present this technique as an adjunct to the established techniques of facial rejuvenation. Despite the high patient acceptance and technical ease, it is not a replacement for the established techniques of facial rejuvenation. PMID:12045586

  20. Impact of minimally invasive surgery on the pediatric surgical profession.

    PubMed

    Jones, Vinci S; Biesheuvel, Cornelis J; Cohen, Ralph C

    2008-12-01

    We conducted a survey among pediatric surgeons to examine the impact of the advent of minimally invasive surgery (MIS) on the pediatric surgical profession with respect to job satisfaction and training challenges. An invitation to participate in a web-based questionnaire was sent out to 306 pediatric surgeons. Apart from demographic details and training recommendations, parameters relevant to job satisfaction, including patient interaction, peer pressure, ethical considerations, academic progress, ability to train residents, and financial remuneration, were studied. The response rate was 38.2%. Working in a unit performing MIS was identified by 71% of respondents as the most effective and feasible modality of training in MIS. Inability to get away from a busy practice was the most common reason cited for inability to acquire MIS training. The overall responses to the job satisfaction parameters showed a positive trend in the current MIS era for patient interaction, ethical considerations, academic progress, and training residents, with a negative trend for peer pressure and financial remuneration. The enthusiastic minimally invasive surgeons (EMIS) were defined as those having more than 5 years of MIS experience and also performing more than 10% of their work using MIS. Of the 113 responses analyzed, 67 belonged to the EMIS category. Those belonging to the EMIS group were less likely to feel inadequate in training their residents, in meeting the felt needs of the patients, or to complain about peer pressure. They were more likely to consider MIS to be as relevant and beneficial in children as in adults. Embracing MIS, as represented by the EMIS group, correlated with an overall greater job satisfaction. PMID:19105675

  1. Sialolithiasis. Proposal for a new minimally invasive procedure: Piezoelectric surgery

    PubMed Central

    Cuervo-Díaz, Alfonso; Aracil-Kessler, Luis

    2014-01-01

    Sialolithiasis is the presence of stones in the ducts of the salivary glands. Most episodes are unique, and 60-80% are located exclusively in the main excretory duct. The main clinical manifestations are swelling and pain typically before, during or after meals that decreases if the obstruction is not complete. The highest prevalence of lithiasis is in the submandibular gland -87%-, whose secretion is more viscous, followed by the parotid gland -10%- and finally the sublingual gland -3%-. The most significant consequences are caused by the prolonged blockage of the duct by a stone, which can produce a persistent ductal dilatation with a swelling that does not subside, and could lead to the complete degeneration of the parenchyma, becoming a hot spot where secondary infections may occur, leading to acute bacterial sialadenitis or glandular abscesses. Treatment options range from a single probing extraction, extraction with sialographic control using the sialoendoscope, LASER intraductal lithotripsy, lithotripsy extracorporeal shock wave (ESWL), to the surgical techniques combining open duct with endoscopic or glandular removal. We propose, with regard to a case, the use of a simple piezoelectric device which, tunnelling through the glandular channel by the ostium, allows stone fragmentation, without damaging the surrounding soft tissue. Stone removal by this less invasive method reduces the need for more complex and expensive techniques. The postoperative course without retraction of the ostium, and the regaining of functionality is favourable. Key words:Calculus, lithotripsy, minimally invasive therapy, piezoelectric surgery, salivary glands, soft tissues. PMID:25136434

  2. The golden age of minimally invasive cardiothoracic surgery: current and future perspectives

    PubMed Central

    Iribarne, Alexander; Easterwood, Rachel; Chan, Edward YH; Yang, Jonathan; Soni, Lori; Russo, Mark J; Smith, Craig R; Argenziano, Michael

    2011-01-01

    Over the past decade, minimally invasive cardiothoracic surgery (MICS) has grown in popularity. This growth has been driven, in part, by a desire to translate many of the observed benefits of minimal access surgery, such as decreased pain and reduced surgical trauma, to the cardiac surgical arena. Initial enthusiasm for MICS was tempered by concerns over reduced surgical exposure in highly complex operations and the potential for prolonged operative times and patient safety. With innovations in perfusion techniques, refinement of transthoracic echocardiography and the development of specialized surgical instruments and robotic technology, cardiac surgery was provided with the necessary tools to progress to less invasive approaches. However, much of the early literature on MICS focused on technical reports or small case series. The safety and feasibility of MICS have been demonstrated, yet questions remain regarding the relative efficacy of MICS over traditional sternotomy approaches. Recently, there has been a growth in the body of published literature on MICS long-term outcomes, with most reports suggesting that major cardiac operations that have traditionally been performed through a median sternotomy can be performed through a variety of minimally invasive approaches with equivalent safety and durability. In this article, we examine the technological advancements that have made MICS possible and provide an update on the major areas of cardiac surgery where MICS has demonstrated the most growth, with consideration of current and future directions. PMID:21627475

  3. Haptic Feedback in Robot-Assisted Minimally Invasive Surgery

    PubMed Central

    Okamura, Allison M.

    2009-01-01

    Purpose of Review Robot-assisted minimally invasive surgery (RMIS) holds great promise for improving the accuracy and dexterity of a surgeon while minimizing trauma to the patient. However, widespread clinical success with RMIS has been marginal. It is hypothesized that the lack of haptic (force and tactile) feedback presented to the surgeon is a limiting factor. This review explains the technical challenges of creating haptic feedback for robot-assisted surgery and provides recent results that evaluate the effectiveness of haptic feedback in mock surgical tasks. Recent Findings Haptic feedback systems for RMIS are still under development and evaluation. Most provide only force feedback, with limited fidelity. The major challenge at this time is sensing forces applied to the patient. A few tactile feedback systems for RMIS have been created, but their practicality for clinical implementation needs to be shown. It is particularly difficult to sense and display spatially distributed tactile information. The cost-benefit ratio for haptic feedback in RMIS has not been established. Summary The designs of existing commercial RMIS systems are not conducive for force feedback, and creative solutions are needed to create compelling tactile feedback systems. Surgeons, engineers, and neuroscientists should work together to develop effective solutions for haptic feedback in RMIS. PMID:19057225

  4. Primary Hyperparathyroidism in Older People: Surgical Treatment with Minimally Invasive Approaches and Outcome

    PubMed Central

    Dobrinja, Chiara; Silvestri, Marta; de Manzini, Nicolò

    2012-01-01

    Introduction. Elderly patients with primary hyperparathyroidism (pHPT) are often not referred to surgery because of their associated comorbidities that may increase surgical risk. The aim of the study was to review indications and results of minimally invasive approach parathyroidectomy in elderly patients to evaluate its impact on outcome. Materials and Methods. All patients of 70 years of age or older undergoing minimally approach parathyroidectomy at our Department from May 2005 to May 2011 were reviewed. Data collected included patients demographic information, biochemical pathology, time elapsed from pHPT diagnosis to surgical intervention, operative findings, complications, and results of postoperative biochemical studies. Results and Discussion. 37 patients were analysed. The average length of stay was 2.8 days. 11 patients were discharged within 24 hours after their operation. Morbidity included 6 transient symptomatic postoperative hypocalcemias while one patient developed a transient laryngeal nerve palsy. Time elapsed from pHPT diagnosis to first surgical visit evidences that the elderly patients were referred after their disease had progressed. Conclusions. Our data show that minimally invasive approach to parathyroid surgery seems to be safe and curative also in elderly patients with few associated risks because of combination of modern preoperative imaging, advances in surgical technique, and advances in anesthesia care. PMID:22737167

  5. Minimally invasive strabismus surgery versus paralimbal approach: A randomized, parallel design study is minimally invasive strabismus surgery worth the effort?

    PubMed Central

    Sharma, Richa; Amitava, Abadan K; Bani, Sadat AO

    2014-01-01

    Introduction: Minimal access surgery is common in all fields of medicine. We compared a new minimally invasive strabismus surgery (MISS) approach with a standard paralimbal strabismus surgery (SPSS) approach in terms of post-operative course. Materials and Methods: This parallel design study was done on 28 eyes of 14 patients, in which one eye was randomized to MISS and the other to SPSS. MISS was performed by giving two conjunctival incisions parallel to the horizontal rectus muscles; performing recession or resection below the conjunctival strip so obtained. We compared post-operative redness, congestion, chemosis, foreign body sensation (FBS), and drop intolerance (DI) on a graded scale of 0 to 3 on post-operative day 1, at 2-3 weeks, and 6 weeks. In addition, all scores were added to obtain a total inflammatory score (TIS). Statistical Analysis: Inflammatory scores were analyzed using Wilcoxon's signed rank test. Results: On the first post-operative day, only FBS (P =0.01) and TIS (P =0.04) showed significant difference favoring MISS. At 2-3 weeks, redness (P =0.04), congestion (P =0.04), FBS (P =0.02), and TIS (P =0.04) were significantly less in MISS eye. At 6 weeks, only redness (P =0.04) and TIS (P =0.05) were significantly less. Conclusion: MISS is more comfortable in the immediate post-operative period and provides better cosmesis in the intermediate period. PMID:24088635

  6. Minimally invasive surgical approaches for temporal lobe epilepsy

    PubMed Central

    Chang, Edward F.; Englot, Dario J.; Vadera, Sumeet

    2016-01-01

    Surgery can be a highly effective treatment for medically refractory temporal lobe epilepsy (TLE). The emergence of minimally invasive resective and nonresective treatment options has led to interest in epilepsy surgery among patients and providers. Nevertheless, not all procedures are appropriate for all patients, and it is critical to consider seizure outcomes with each of these approaches, as seizure freedom is the greatest predictor of patient quality of life. Standard anterior temporal lobectomy (ATL) remains the gold standard in the treatment of TLE, with seizure freedom resulting in 60–80% of patients. It is currently the only resective epilepsy surgery supported by randomized controlled trials and offers the best protection against lateral temporal seizure onset. Selective amygdalohippocampectomy techniques preserve the lateral cortex and temporal stem to varying degrees and can result in favorable rates of seizure freedom but the risk of recurrent seizures appears slightly greater than with ATL, and it is not clear whether neuropsychological outcomes are improved with selective approaches. Stereotactic radiosurgery presents an opportunity to avoid surgery altogether, with seizure outcomes now under investigation. Stereotactic laser thermo-ablation allows destruction of the mesial temporal structures with low complication rates and minimal recovery time, and outcomes are also under study. Finally, while neuromodulatory devices such as responsive neurostimulation, vagus nerve stimulation, and deep brain stimulation have a role in the treatment of certain patients, these remain palliative procedures for those who are not candidates for resection or ablation, as complete seizure freedom rates are low. Further development and investigation of both established and novel strategies for the surgical treatment of TLE will be critical moving forward, given the significant burden of this disease. PMID:26017774

  7. Practical pathology perspectives for minimally invasive hyperthermic medical devices

    NASA Astrophysics Data System (ADS)

    Coad, James E.

    2011-03-01

    Currently, hyperthermic-based minimally invasive medical devices are available for the treatment of dysfunctional and neoplastic tissues in a variety of organ systems. These therapies employ a spectrum of modalities for delivering heat energy to the targeted tissue, including radiofrequency/microwave, high intensity focused ultrasound, conductive/convective sources and others. While differences in energy transfer and organ systems exist, hyperthermic treatment sites show a spectrum of changes that intimately correlate with the thermal history generated in the tissue (temperature-time dependence). As a result, these hyperthermic medical technologies can be viewed using a "gradient" approach. First, the thermal applications themselves can be globally categorized along a high-dose ablation to low-dose ablation to lowdose non-ablative rejuvenating slope. Second, the resultant tissue changes can be viewed along a decreasing thermal dose gradient from thermally/heat-fixed tissue necrosis to coagulative tissue necrosis to partial tissue necrosis (transition zone) to subtle non-necrotizing tissue changes. Finally, a gradient of cellular and structural protein denaturation is present, especially within the transition zone and adjacent viable tissue region. A hyperthermic treatment's location along these gradients depends more on the overall thermal history it generates than the amount of energy it deposits into the tissue. The features of these gradients are highlighted to provide a better understanding of hyperthermic device associated tissue changes and their associated healing responses.

  8. Chin augmentation using minimally invasive technique and bioplastique.

    PubMed

    Ersek, R A; Stovall, R B; Vazquez-Salisbury, A

    1995-05-01

    The plethora of problematic techniques for improving minor chin recessions has left the plastic surgeon inevitably uncertain of the most effective remedy. Research we began in 1968 has led us to the development of a new biphasic polymer and minimally invasive implantation techniques aimed at solving the soft-tissue deficiency dilemma. Bioplastique consists of inert, textured particles of critical dimension dispersed within a bioexcretable gel vehicle. Previous experimentation in rabbit ears has shown that the gel component is rapidly phagocytosed, excreted, and replaced by a fibrin matrix within 3 days. The matrix is then replaced by host collagen, gradually forming a stable encasement around each microparticle. Further evaluation has revealed that the implant resists migration and absorption. Based on these encouraging results, a clinical phase was initiated. Thirteen patients lacking chin prominence have subsequently been improved with Bioplastique implants. The infection rate was 0 percent, and other complications were minor. At 26 months, no evidence of migration or absorption has been observed, and the aesthetic results remain. PMID:7732146

  9. Evaluation of robotic minimally invasive surgical skills using motion studies.

    PubMed

    Jun, Seung-Kook; Sathia Narayanan, Madusudanan; Singhal, Pankaj; Garimella, Sudha; Krovi, Venkat

    2013-09-01

    Robotic Minimally Invasive Surgery, and the engendered computer-integration, offers unique opportunities for quantitative computer-based surgical-performance evaluation. In this work, we examine extension of traditional manipulative skill assessment, having deep roots in performance evaluation in manufacturing industries, for applicability to robotic surgical skill evaluation. This method relies on: defining task-level segmentation of modular sub-tasks/micro-motions called 'Therbligs' that can be combined to perform a given task; and analyzing intra- and inter-user performance variance by studying surgeons' performance over each 'Therbligs'. Any of the performance metrics of macro-motions-from motion-economy, tool motion measurements to handed-symmetry-can now be extended over the micro-motion temporal segments. Evaluation studies were based on video recordings of surgical tasks in two settings: first, we examined performance of two representative manipulation exercises (peg board and pick-and-place) on a da Vinci surgical SKILLS simulator. This affords a relatively-controlled and standardized test-scenarios for surgeons with varied experience-levels. Second, task-sequences from real surgical videos were analyzed with a list of predefined 'Therbligs' in order to investigate its overall usefulness. PMID:27000920

  10. Percutaneous iliac screws for minimally invasive spinal deformity surgery.

    PubMed

    Wang, Michael Y

    2012-01-01

    Introduction. Adult spinal deformity (ASD) surgeries carry significant morbidity, and this has led many surgeons to apply minimally invasive surgery (MIS) techniques to reduce the blood loss, infections, and other peri-operative complications. A spectrum of techniques for MIS correction of ASD has thus evolved, most recently the application of percutaneous iliac screws. Methods. Over an 18 months 10 patients with thoracolumbar scoliosis underwent MIS surgery. The mean age was 73 years (70% females). Patients were treated with multi-level facet osteotomies and interbody fusion using expandable cages followed by percutaneous screw fixation. Percutaneous iliac screws were placed bilaterally using the obturator outlet view to target the ischial body. Results. All patients were successfully instrumented without conversion to an open technique. Mean operative time was 302 minutes and the mean blood loss was 480 cc, with no intraoperative complications. A total of 20 screws were placed successfully as judged by CT scanning to confirm no bony violations. Complications included: two asymptomatic medial breaches at T10 and L5, and one patient requiring delayed epidural hematoma evacuation. Conclusions. Percutaneous iliac screws can be placed safely in patients with ASD. This MIS technique allows for successful caudal anchoring to stress-shield the sacrum and L5-S1 fusion site in long-segment constructs. PMID:22900162

  11. Multiple video sequences synchronization during minimally invasive surgery

    NASA Astrophysics Data System (ADS)

    Belhaoua, Abdelkrim; Moreau, Johan; Krebs, Alexandre; Waechter, Julien; Radoux, Jean-Pierre; Marescaux, Jacques

    2016-03-01

    Hybrid operating rooms are an important development in the medical ecosystem. They allow integrating, in the same procedure, the advantages of radiological imaging and surgical tools. However, one of the challenges faced by clinical engineers is to support the connectivity and interoperability of medical-electrical point-of-care devices. A system that could enable plug-and-play connectivity and interoperability for medical devices would improve patient safety, save hospitals time and money, and provide data for electronic medical records. In this paper, we propose a hardware platform dedicated to collect and synchronize multiple videos captured from medical equipment in real-time. The final objective is to integrate augmented reality technology into an operation room (OR) in order to assist the surgeon during a minimally invasive operation. To the best of our knowledge, there is no prior work dealing with hardware based video synchronization for augmented reality applications on OR. Whilst hardware synchronization methods can embed temporal value, so called timestamp, into each sequence on-the-y and require no post-processing, they require specialized hardware. However the design of our hardware is simple and generic. This approach was adopted and implemented in this work and its performance is evaluated by comparison to the start-of-the-art methods.

  12. Peroral endoscopic myotomy: An emerging minimally invasive procedure for achalasia

    PubMed Central

    Vigneswaran, Yalini; Ujiki, Michael B

    2015-01-01

    Peroral endoscopic myotomy (POEM) is an emerging minimally invasive procedure for the treatment of achalasia. Due to the improvements in endoscopic technology and techniques, this procedure allows for submucosal tunneling to safely endoscopically create a myotomy across the hypertensive lower esophageal sphincter. In the hands of skilled operators and experienced centers, the most common complications of this procedure are related to insufflation and accumulation of gas in the chest and abdominal cavities with relatively low risks of devastating complications such as perforation or delayed bleeding. Several centers worldwide have demonstrated the feasibility of this procedure in not only early achalasia but also other indications such as redo myotomy, sigmoid esophagus and spastic esophagus. Short-term outcomes have showed great clinical efficacy comparable to laparoscopic Heller myotomy (LHM). Concerns related to postoperative gastroesophageal reflux remain, however several groups have demonstrated comparable clinical and objective measures of reflux to LHM. Although long-term outcomes are necessary to better understand durability of the procedure, POEM appears to be a promising new procedure. PMID:26468336

  13. Peroral endoscopic myotomy: An emerging minimally invasive procedure for achalasia.

    PubMed

    Vigneswaran, Yalini; Ujiki, Michael B

    2015-10-10

    Peroral endoscopic myotomy (POEM) is an emerging minimally invasive procedure for the treatment of achalasia. Due to the improvements in endoscopic technology and techniques, this procedure allows for submucosal tunneling to safely endoscopically create a myotomy across the hypertensive lower esophageal sphincter. In the hands of skilled operators and experienced centers, the most common complications of this procedure are related to insufflation and accumulation of gas in the chest and abdominal cavities with relatively low risks of devastating complications such as perforation or delayed bleeding. Several centers worldwide have demonstrated the feasibility of this procedure in not only early achalasia but also other indications such as redo myotomy, sigmoid esophagus and spastic esophagus. Short-term outcomes have showed great clinical efficacy comparable to laparoscopic Heller myotomy (LHM). Concerns related to postoperative gastroesophageal reflux remain, however several groups have demonstrated comparable clinical and objective measures of reflux to LHM. Although long-term outcomes are necessary to better understand durability of the procedure, POEM appears to be a promising new procedure. PMID:26468336

  14. Miniature fibre optic probe for minimally invasive photoacoustic sensing

    NASA Astrophysics Data System (ADS)

    Mathews, Sunish J.; Zhang, Edward Z.; Desjardins, Adrien E.; Beard, Paul C.

    2016-03-01

    A miniature (175 μm) all-optical photoacoustic probe has been developed for minimally invasive sensing and imaging applications. The probe comprises a single optical fibre which delivers the excitation light and a broadband 50 MHz Fabry-Pérot (F-P) ultrasound sensor at the distal end for detecting the photoacoustic waves. A graded index lens proximal to the F-P sensor is used to reduce beam walk-off and thus increase sensitivity as well as confine the excitation beam in order to increase lateral spatial resolution. The probe was evaluated in non-scattering media and found to provide lateral and axial resolutions of < 100 μm and < 150 μm respectively for distances up to 1 cm from the tip of the probe. The ability of the probe to detect a blood vessel mimicking phantom at distances up to 7 mm from the tip was demonstrated in order to illustrate its potential suitability for needle guidance applications.

  15. A bioinspired soft manipulator for minimally invasive surgery.

    PubMed

    Ranzani, T; Gerboni, G; Cianchetti, M; Menciassi, A

    2015-06-01

    This paper introduces a novel, bioinspired manipulator for minimally invasive surgery (MIS). The manipulator is entirely composed of soft materials, and it has been designed to provide similar motion capabilities as the octopus's arm in order to reach the surgical target while exploiting its whole length to actively interact with the biological structures. The manipulator is composed of two identical modules (each of them can be controlled independently) with multi-directional bending and stiffening capabilities, like an octopus arm. In the authors' previous works, the design of the single module has been addressed. Here a two-module manipulator is presented, with the final aim of demonstrating the enhanced capabilities that such a structure can have in comparison with rigid surgical tools currently employed in MIS. The performances in terms of workspace, stiffening capabilities, and generated forces are characterized through experimental tests. The combination of stiffening capabilities and manipulation tasks is also addressed to confirm the manipulator potential employment in a real surgical scenario. PMID:25970550

  16. A new approach towards a minimal invasive retina implant

    NASA Astrophysics Data System (ADS)

    Gerding, H.

    2007-03-01

    The possibility of using retina implants ('retinal prostheses') for the restoration of basic orientation in blind patients suffering from distal retinal diseases is presently under investigation by at least 18 independent project groups worldwide. It is a common feature of all implants to bypass degenerated retinal layers and to transfer visual information into the retinal network either by direct electrical stimulation or by neurotransmitter release. Contemporary implant designs are differing in the position of stimulating electrodes (epiretinal, subretinal, external) and the anatomical arrangement of implant components (intraocular, extraocular). The latter is of high relevance with regard to possible implant-tissue interactions and biological reactions. During the last few years new types of implants appeared that reduce intraocular components which are now deposited on the outer scleral surface or even in extraorbital position. The extreme of this trend are completely extraocular implants with transchoroidal or extraocular stimulation of the retina. The new type of implant presented in this paper combines the principle of direct retinal stimulation and minimal invasive implantation in a way that stimulating electrodes are the only implant component penetrating the eye via sclera, choroid and retinal pigment epithelium. All other device elements are positioned in extraocular position. The new concept necessitates a paradigmatic change about surgical handling of the choroid and multiple penetrations of the eye. Successful data about this type of retinal prosthesis are already available from long-term observation in non-human primates.

  17. Population perception of surgical approach in minimally invasive surgery

    PubMed Central

    Inoue, Shogo; Kajiwara, Mitsuru; Teishima, Jun; Matsubara, Akio

    2015-01-01

    Introduction: The aim of this study was to better understand the impact that public opinion might have on surgical approaches in urologic minimally invasive surgery (MIS). Methods: We collected surveys from 400 participants, including the general population (n = 220) and paramedical staff (n = 180). Participants were anonymous. The survey included 16 questions on the characteristics and preference for the surgical approach if a urologic MIS were performed on them. Results: The responders preferred the transumbilical approach (57.0%) to the subcostal approach (43.0%). In particular, the preference for a transumbilical approach was significantly higher in females (65.1% vs. 49.3%, p = 0.0014). Similarly, when participants were divided into two groups (<50 years and ≥50 years), the preference for the transumbilical approach was significantly higher in the younger group (60.8% vs. 48.0%, p = 0.0187). Logistic regression analysis revealed that preference for this approach was about 2 times more likely to rise in the females (p = 0.032). Conclusions: Preference for the transumbilical approach was significantly higher young female respondents. This patient subset most values the cosmetic benefits of transumbilical approach in urologic MIS. PMID:25624959

  18. Minimally invasive photopolymerization in intervertebral disc tissue cavities

    NASA Astrophysics Data System (ADS)

    Schmocker, Andreas M.; Khoushabi, Azadeh; Gantenbein-Ritter, Benjamin; Chan, Samantha; Bonél, Harald Marcel; Bourban, Pierre-Etienne; Mânson, Jan Anders; Schizas, Constantin; Pioletti, Dominique; Moser, Christophe

    2014-03-01

    Photopolymerized hydrogels are commonly used for a broad range of biomedical applications. As long as the polymer volume is accessible, gels can easily be hardened using light illumination. However, in clinics, especially for minimally invasive surgery, it becomes highly challenging to control photopolymerization. The ratios between polymerizationvolume and radiating-surface-area are several orders of magnitude higher than for ex-vivo settings. Also tissue scattering occurs and influences the reaction. We developed a Monte Carlo model for photopolymerization, which takes into account the solid/liquid phase changes, moving solid/liquid-boundaries and refraction on these boundaries as well as tissue scattering in arbitrarily designable tissue cavities. The model provides a tool to tailor both the light probe and the scattering/absorption properties of the photopolymer for applications such as medical implants or tissue replacements. Based on the simulations, we have previously shown that by adding scattering additives to the liquid monomer, the photopolymerized volume was considerably increased. In this study, we have used bovine intervertebral disc cavities, as a model for spinal degeneration, to study photopolymerization in-vitro. The cavity is created by enzyme digestion. Using a custom designed probe, hydrogels were injected and photopolymerized. Magnetic resonance imaging (MRI) and visual inspection tools were employed to investigate the successful photopolymerization outcomes. The results provide insights for the development of novel endoscopic light-scattering polymerization probes paving the way for a new generation of implantable hydrogels.

  19. Update on Minimally Invasive Glaucoma Surgery (MIGS) and New Implants

    PubMed Central

    Brandão, Lívia M.; Grieshaber, Matthias C.

    2013-01-01

    Traditional glaucoma surgery has been challenged by the advent of innovative techniques and new implants in the past few years. There is an increasing demand for safer glaucoma surgery offering patients a timely surgical solution in reducing intraocular pressure (IOP) and improving their quality of life. The new procedures and devices aim to lower IOP with a higher safety profile than fistulating surgery (trabeculectomy/drainage tubes) and are collectively termed “minimally invasive glaucoma surgery (MIGS).” The main advantage of MIGS is that they are nonpenetrating and/or bleb-independent procedures, thus avoiding the major complications of fistulating surgery related to blebs and hypotony. In this review, the clinical results of the latest techniques and devices are presented by their approach, ab interno (trabeculotomy, excimer laser trabeculotomy, trabecular microbypass, suprachoroidal shunt, and intracanalicular scaffold) and ab externo (canaloplasty, Stegmann Canal Expander, suprachoroidal Gold microshunt). The drawback of MIGS is that some of these procedures produce a limited IOP reduction compared to trabeculectomy. Currently, MIGS is performed in glaucoma patients with early to moderate disease and preferably in combination with cataract surgery. PMID:24369494

  20. Minimally-invasive transepidermal potentiometry with microneedle salt bridge.

    PubMed

    Abe, Yuina; Nagamine, Kuniaki; Nakabayashi, Mayu; Kai, Hiroyuki; Kaji, Hirokazu; Yamauchi, Takeshi; Yamasaki, Kenshi; Nishizawa, Matsuhiko

    2016-08-01

    A commercial painless microneedle was filled with physiological saline agar, and this needle-based salt bridge was inserted into the skin (a piece of porcine skin and a flank skin of a live mouse) to make an electrical contact with its subepidermal region. The transepidermal potential (TEP), the potential difference between the skin surface and the subepidermal region, was measured using this inner electrode and a conventional agar electrode on the surface of the skin. Control of penetration depth of the inner electrode with a spacer and hydrophilic pretreatment with ozone plasma were found to be necessary for stable measurement. The TEP was reduced upon damages on the skin surface by tape stripping and acetone defatting, which indicated the fabricated needle electrode is useful for the minimally-invasive measurement of TEP and evaluation of skin barrier functions. Furthermore, we showed that the device integrating two electrodes into a single compact probe was useful to evaluate the local barrier functions and their mapping on a skin. This device could be a personal diagnostic tool in the fields of medicine and cosmetics in future. PMID:27294487

  1. Augmented Reality Image Guidance in Minimally Invasive Prostatectomy

    NASA Astrophysics Data System (ADS)

    Cohen, Daniel; Mayer, Erik; Chen, Dongbin; Anstee, Ann; Vale, Justin; Yang, Guang-Zhong; Darzi, Ara; Edwards, Philip'eddie'

    This paper presents our work aimed at providing augmented reality (AR) guidance of robot-assisted laparoscopic surgery (RALP) using the da Vinci system. There is a good clinical case for guidance due to the significant rate of complications and steep learning curve for this procedure. Patients who were due to undergo robotic prostatectomy for organ-confined prostate cancer underwent preoperative 3T MRI scans of the pelvis. These were segmented and reconstructed to form 3D images of pelvic anatomy. The reconstructed image was successfully overlaid onto screenshots of the recorded surgery post-procedure. Surgeons who perform minimally-invasive prostatectomy took part in a user-needs analysis to determine the potential benefits of an image guidance system after viewing the overlaid images. All surgeons stated that the development would be useful at key stages of the surgery and could help to improve the learning curve of the procedure and improve functional and oncological outcomes. Establishing the clinical need in this way is a vital early step in development of an AR guidance system. We have also identified relevant anatomy from preoperative MRI. Further work will be aimed at automated registration to account for tissue deformation during the procedure, using a combination of transrectal ultrasound and stereoendoscopic video.

  2. [Minimally Invasive Aortic Valve Replacement Via Right Mini-thoracotomy].

    PubMed

    Totsugawa, Toshinori

    2016-07-01

    Here we demonstrate our surgical procedure of minimally invasive aortic valve replacement through right anterolateral mini-thoracotomy. Preoperative evaluation of the whole aorta by contrast-enhanced computed tomography scan is important to prevent cerebrovascular complications. The patient is set in a mild left lateral decubitus position. A skin incision is made along the anterior axillary line to the inframammary fold and the chest is opened at the 3rd or 4th intercostal space. Cardiopulmonary bypass is usually established by femoro-femoral bypass. The ascending aorta is clamped with a Chitwood clamp and antegrade or selective cardioplegia is administered. Four traction sutures placed at the aortotomy widely open the aortotomy and offer fine surgical view of the aortic valve. The annular calcifications are excised using a cavitron ultrasonic surgical aspirator. Double-needle braided sutures with pledgets are placed in a non-everting mattress manner. Then the prosthetic valve is sewn onto the aortic annulus. Finger knot tying through anterolateral mini-thoracotomy is usually challenging;therefore, all sutures are tied using a knot pusher. The aortotomy is closed and the aorta is de-clamped. The pericardium is loosely closed;chest tubes are placed;and the thoracotomy is closed in a usual manner. PMID:27440021

  3. Development of minimally invasive techniques for management of medically-complicated obesity

    PubMed Central

    Rashti, Farzin; Gupta, Ekta; Ebrahimi, Suzan; Shope, Timothy R; Koch, Timothy R; Gostout, Christopher J

    2014-01-01

    The field of bariatric surgery has been rapidly growing and evolving over the past several decades. During the period that obesity has become a worldwide epidemic, new interventions have been developed to combat this complex disorder. The development of new laparoscopic and minimally invasive treatments for medically-complicated obesity has made it essential that gastrointestinal physicians obtain a thorough understanding of past developments and possible future directions in bariatrics. New laparoscopic advancements provide patients and practitioners with a variety of options that have an improved safety profile and better efficacy without open, invasive surgery. The mechanisms of weight loss after bariatric surgery are complex and may in part be related to altered release of regulatory peptide hormones from the gut. Endoscopic techniques designed to mimic the effects of bariatric surgery and endolumenal interventions performed entirely through the gastrointestinal tract offer potential advantages. Several of these new techniques have demonstrated promising, preliminary results. We outline herein historical and current trends in the development of bariatric surgery and its transition to safer and more minimally invasive procedures designed to induce weight loss. PMID:25309074

  4. A minimally invasive microchip for transdermal injection/sampling applications.

    PubMed

    Strambini, Lucanos M; Longo, Angela; Diligenti, Alessandro; Barillaro, Giuseppe

    2012-09-21

    The design, fabrication, and characterization of a minimally invasive silicon microchip for transdermal injection/sampling applications are reported and discussed. The microchip exploits an array of silicon-dioxide hollow microneedles with density of one million needles cm(-2) and lateral size of a few micrometers, protruding from the front-side chip surface for one hundred micrometers, to inject/draw fluids into/from the skin. The microneedles are in connection with independent reservoirs grooved on the back-side of the chip. Insertion experiments of the microchip in skin-like polymers (agarose hydrogels with concentrations of 2% and 4% wt) demonstrate that the microneedles successfully withstand penetration without breaking, despite their high density and small size, according to theoretical predictions. Operation of the microchip with different liquids of biomedical interest (deionized water, NaCl solution, and d-glucose solution) at different differential pressures, in the range 10-100 kPa, highlights that the flow-rate through the microneedles is linearly dependent on the pressure-drop, despite the small section area (about 13 μm(2)) of the microneedle bore, and can be finely controlled from a few ml min(-1) up to tens of ml min(-1). Evaporation (at room temperature) and acceleration (up to 80 g) losses through the microneedles are also investigated to quantify the ability of the chip in storing liquids (drug to be delivered or collected fluid) in the reservoir, and result to be of the order of 70 nl min(-1) and 1300 nl min(-1), respectively, at atmospheric pressure and room temperature. PMID:22773092

  5. Endoscopic-approach development for minimally invasive orbital surgery

    NASA Astrophysics Data System (ADS)

    Joos, Karen; Shah, Rohan; Shen, Jin

    2007-02-01

    Purpose: Orbital tumors and pseudotumor cerebri are sometimes treated with surgical approaches. Our previous studies suggest that potentially endoscopy may be useful for minimally invasive orbital surgery. This study proposed to improve the approach technique for accessing the posterior orbital space via endoscopy, as well as assess visibility improvements with CO II insufflation to posterior orbital tissues. Methods: An inferior transconjunctival approach accessed the posterior orbital space in non-survival pigs. Various guidance tubes were compared to assess ability to guide the endoscope to the posterior orbit with the greatest ease and visibility. FEL energy application (6.1 μm, 2.7 +/- 0.5 mJ, 30 Hz, delivered via glass-hollow waveguide) was attempted via endoscopy. The effect of CO II gas insufflation was assessed by analyzing visibility of the stuctures before and after CO II application. Results: The posterior orbit was accessed via endoscopy in all except the first attempted eye. A beveled transparent butyrate tube provided the best guidance for the endoscope and an opaque metal tube provided the worst guidance. The optic nerve was encountered and FEL energy was applied with the butyrate tube in 8 orbits. Visibility was adequate without CO II insufflation, and did not improve with CO II. Conclusions: The posterior orbit was successfully accessed using endoscopy. The optic nerve was exposed and treated with FEL energy. CO II insufflation did not further enhance visibility in this study. Application of endoscopy for posterior orbital procedures is feasible, but extreme surgical care is required and further study with human cadaveric eyes is needed.

  6. PARASURG hybrid parallel robot for minimally invasive surgery.

    PubMed

    Pisla, D; Gherman, B; Plitea, N; Gyurka, B; Vaida, C; Vlad, L; Graur, F; Radu, C; Suciu, M; Szilaghi, A; Stoica, A

    2011-01-01

    This paper presents the parallel hybrid robot, PARASURG 9M, for robotically assisted surgery, a robot which was entirely designed and produced in Romania. It is a versatile robot, being composed of a positioning and orientation module, PARASURG 5M with five degrees of freedom, having the possibility of attaching at its end either a laparoscope or an active surgical instrument for cutting/grasping, PARASIM, with four degrees of freedom. Based on its mathematical modelling, the first low-cost experimental model of the surgical robot has been built. The robot is part of the surgical robotic system, PARAMIS, with three arms, one used as a laparoscope holder, and other two for manipulating active instruments. When it is used as a manipulator of the camera, the user has the possibility to give commands in a large area for the positioning of the laparoscope using different interfaces: joystick, microphone, keyboard & mouse and haptic device. If the active surgical instrument, PARASIM, is attached, the robot commands are given through a haptic device. The main features that make the PARASURG 9M surgical robot suited for minimally invasive surgery are: precision, the elimination of the natural tremor of the surgeon, direct control over a smooth, precise, stable view of the internal surgical field for the surgeon. It also eliminates the need of a second surgeon to be present for the entire procedure (in the case of using the robot as a camera holder). In addition, there is improvement of surgeon dexterity in the case of using the PARASIM active instrument and better ergonomics in using the robot (in the case of the classic laparoscopy, the surgeon must adopt a difficult position for a long period of time, while the robot never gets tired). Having a relatively easy to understand, intuitive commanding system, the surgeons can rapidly adapt to the use of the PARASURG 9M robot in surgical procedures. PMID:22165061

  7. A Comprehensive Evaluation of Perioperative Adjuncts During Minimally Invasive Parathyroidectomy

    PubMed Central

    Chen, Herbert; Mack, Eberhard; Starling, James R.

    2005-01-01

    Objective: To determine the utility of several perioperative adjuncts for parathyroid localization during parathyroid surgery, we prospectively compared the accuracy of sestamibi–single photon emission computed tomography (SPECT) scanning, radioguided surgery, and intraoperative parathyroid hormone (ioPTH) testing. Summary and Background Data: Minimally invasive parathyroidectomy (MIP) is rapidly becoming the procedure of choice in patients with primary hyperparathyroidism (HPT). Several perioperative adjuncts can be used to localize parathyroid adenomas, including sestamibi-SPECT scanning, radioguided surgery, and ioPTH testing. However, the relative value of each of these technologies is unclear. Methods: Between March 2001 through September 2004, 254 patients with primary HPT underwent parathyroidectomy. All patients had preoperative imaging studies and underwent radioguided surgery with a gamma probe and ioPTH testing. The use of each perioperative adjunct was determined based on the intraoperative findings. Results: The mean age of patients was 61 ± 1 year. The mean calcium and parathyroid hormone levels were 11.4 ± 0.1 mg/dL and 136 ± 6 pg/mL, respectively. Of the 254 patients, 206 (81%) had a single parathyroid adenoma, 28 (11%) had double adenomas, 19 (8%) had hyperplasia, and one had parathyroid cancer. All resected parathyroid glands were hypercellular (mean weight = 895 ± 86 mg). The cure rate after parathyroidectomy was 98%. The positive predictive values for sestamibi scanning, radioguided surgery, and ioPTH testing were 81%, 88%, and 99.5%, respectively. Conclusions: This series is one of the largest to date that prospectively compares the use of sestamibi scanning, radioguided surgery, and ioPTH testing. Of all the perioperative adjuncts used during parathyroid surgery, ioPTH testing has the highest sensitivity, positive predictive value, and accuracy. Thus, the inherent variability of sestamibi scanning and radioguided techniques emphasizes

  8. Minimally invasive or noninvasive cardiac output measurement: an update.

    PubMed

    Sangkum, Lisa; Liu, Geoffrey L; Yu, Ling; Yan, Hong; Kaye, Alan D; Liu, Henry

    2016-06-01

    Although cardiac output (CO) by pulmonary artery catheterization (PAC) has been an important guideline in clinical management for more than four decades, some studies have questioned the clinical efficacy of CO in certain patient populations. Further, the use of CO by PAC has been linked to numerous complications including dysrhythmia, infection, rupture of pulmonary artery, injury to adjacent arteries, embolization, pulmonary infarction, cardiac valvular damage, pericardial effusion, and intracardiac catheter knotting. The use of PAC has been steadily declining over the past two decades. Minimally invasive and noninvasive CO monitoring have been studied in the past two decades with some evidence of efficacy. Several different devices based on pulse contour analysis are available currently, including the uncalibrated FloTrac/Vigileo system and the calibrated PiCCO and LiDCO systems. The pressure-recording analytical method (PRAM) system requires only an arterial line and is commercially available as the MostCare system. Transesophageal echocardiography (TEE) can measure CO by non-Doppler- or Doppler-based methods. The partial CO2 rebreathing technique, another method to measure CO, is marketed by Novametrix Medical Systems as the NICO system. Thoracic electrical bioimpedance (TEB) and electric bioreactance (EB) are totally noninvasive CO monitoring. Nexfin HD and the newer ClearSight systems are examples of noninvasive CO monitoring devices currently being marketed by Edwards Lifesciences. The developing focus in CO monitoring devices appears to be shifting to tissue perfusion and microcirculatory flow and aimed more at markers that indicate the effectiveness of circulatory and microcirculatory resuscitations. PMID:26961819

  9. Medicolegal Corner: When minimally invasive thoracic surgery leads to paraplegia.

    PubMed

    Epstein, Nancy E

    2014-01-01

    A patient with mild cervical myelopathy due to multilevel ossification of the posterior longitudinal ligament (OPLL) initially underwent a cervical C3-T1 laminectomy with C2-T2 fusion utilizing lateral mass screws. The patient's new postoperative right upper extremity paresis largely resolved within several postoperative months. However, approximately 6 months later, the patient developed increased paraparesis attributed to thoracic OPLL and Ossification of the yellow ligament (OYL) at the T2-T5 and T10-T11 levels. The patient underwent simultaneous minimally invasive (MIS) unilateral MetRx approaches to both regions. Postoperatively, the patient was paraplegic and never recovered function. Multiple mistakes led to permanent paraplegia due to MIS MetRx decompressions for T2-T5 and T10-11 OPLL/OYL in this patient. First, both thoracic procedures should have been performed "open" utilizing a full laminectomy rather than MIS; adequate visualization would have likely averted inadvertent cord injury, and the resultant CSF leak. Second, the surgeon should have used an operating microscope. Third, the operation should have been monitored with somatosensory evoked potentials (SEP), motor evoked potentials (MEP), and EMG (electromyography). Fourth, preoperatively the patient should have received a 1-gram dose of Solumedrol for cord "protection". Fifth, applying Gelfoam as part of the CSF leak repair is contraindicated (e.g. due to swelling in confined spaces- see insert). Sixth, if the patient had not stopped Excedrin prior to the surgery, the surgery should have been delayed to avoid the increased perioperative risk of bleeding/hematoma. PMID:24843811

  10. Physician pain and discomfort during minimally invasive gynecologic cancer surgery

    PubMed Central

    McDonald, Megan E.; Ramirez, Pedro T.; Munsell, Mark F.; Greer, Marilyn; Burke, William M.; Naumann, Wendell T.; Frumovitz, Michael

    2014-01-01

    Objective Despite increasing awareness of physical strain to surgeons associated with minimally invasive surgery (MIS), its use continues to expand. We sought to gather information from gynecologic oncologists regarding physical discomfort due to MIS. Methods Anonymous surveys were e-mailed to 1,279 Society of Gynecologic Oncology (SGO) members. Physical symptoms (numbness, pain, stiffness, and fatigue) and surgical and demographic factors were assessed. Univariate and multivariate analyses were performed to determine risk factors for physical symptoms. Results We analyzed responses of 350 SGO members who completed the survey and currently performed >50% of procedures robotically (n=122), laparoscopically (n=67), or abdominally (n=61). Sixty-one percent of members reported physical symptoms related to MIS. The rate of symptoms was higher in the robotic group (72%) than the laparoscopic (57%) or abdominal group (49%) (p=0.0052). Stiffness (p=0.0373) and fatigue (p=0.0125) were more common in the robotic group. Female sex (p<0.0001), higher caseload, (p=0.0007) and academic practice (p=0.0186) were associated with increased symptoms. On multivariate analysis, robotic surgery (odds ratio [OR] 2.38, 95% CI 1.20-4.69) and female sex (OR 4.20, 95% CI 2.13-8.29) were significant predictors of symptoms. There was no correlation between seeking treatment and surgical modality (laparotomy 11%, robotic 20%, laparoscopy 25%, p= 0.12). Conclusions Gynecologic oncologists report physical symptoms due to MIS at an alarming rate. Robotic surgery and female sex appear to be risk factors for physical discomfort. As we strive to improve patient outcomes and decrease patient morbidity with MIS, we must also work to improve the ergonomics of MIS for surgeons. PMID:24887354