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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. [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

  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. 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

  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. 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. ...

  5. 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 ...

  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 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

  19. 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

  20. 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

  1. 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

  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. 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

  1. 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

  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 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

  15. [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

  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

    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

  18. 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

  19. 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.

  20. 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

  1. 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

  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. 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

  8. [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

  9. 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.

  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. 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

  15. 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

  16. 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

  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. 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.

  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. [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

  3. '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

  4. 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

  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. 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

  9. 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

  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. 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

  8. 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

  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. 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

  19. 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

  20. 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

  1. 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

  2. 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

  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. 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.

  6. 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

  7. 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

  8. 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

  9. 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

  10. 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

  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. 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.

  15. 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

  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. [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

  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. 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

  4. 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

  5. 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

  6. 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

  7. 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

  8. [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

  9. 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

  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. 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.

  19. 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

  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 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

  4. 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

  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. 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

  7. 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

  8. 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

  9. 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

  10. 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

  11. 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

  12. 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

  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. 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

  16. [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

  17. 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

  18. 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.

  19. 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

  20. 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.

  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. 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

  3. 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

  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. 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

  6. 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

  7. 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

  8. 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

  9. 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

  10. 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

  11. 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

  12. 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

  13. 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

  14. 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.

  15. 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

  16. 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

  17. 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.

  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. 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

  20. 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

  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. 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.

  8. 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

  9. 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.

  10. 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

  11. 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.

  12. 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

  13. 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.

  14. 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

  15. 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

  16. [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

  17. 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.

  18. 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

  19. 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.

  20. 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

  1. 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

  2. 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

  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. 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.

  5. 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

  6. 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

  7. 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

  8. 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

  9. 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

  10. 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

  11. Comparison of minimally invasive parathyroidectomy under local anaesthesia and minimally invasive video-assisted parathyroidectomy for primary hyperparathyroidism: a cost analysis

    PubMed Central

    MELFA, G.I.; RASPANTI, C.; ATTARD, M.; COCORULLO, G.; ATTARD, A.; MAZZOLA, S.; SALAMONE, G.; GULOTTA, G.; SCERRINO, G.

    2016-01-01

    Background Primary hyperparathyroidism (PHPT) origins from a solitary adenoma in 70–95% of cases. Moreover, the advances in methods for localizing an abnormal parathyroid gland made minimally invasive techniques more prominent. This study presents a micro-cost analysis of two parathyroidectomy techniques. Patients and methods 72 consecutive patients who underwent minimally invasive parathyroidectomy, video-assisted (MIVAP, group A, 52 patients) or “open” under local anaesthesia (OMIP, group B, 20 patients) for PHPT were reviewed. Operating room, consumable, anaesthesia, maintenance costs, equipment depreciation and surgeons/anaesthesiologists fees were evaluated. The patient’s satisfaction and the rate of conversion to conventional parathyroidectomy were investigated. T-Student’s, Kolmogorov-Smirnov tests and Odds Ratio were used for statistical analysis. Results 1 patient of the group A and 2 of the group B were excluded from the cost analysis because of the conversion to the conventional technique. Concerning the remnant patients, the overall average costs were: for Operative Room, 1186,69 € for the MIVAP group (51 patients) and 836,11 € for the OMIP group (p<0,001); for the Team, 122,93 € (group A) and 90,02 € (group B) (p<0,001); the other operative costs were 1388,32 € (group A) and 928,23 € (group B) (p<0,001). The patient’s satisfaction was very strongly in favour of the group B (Odds Ratio 20,5 with a 95% confidence interval). Conclusions MIVAP is more expensive compared to the “open” parathyroidectomy under local anaesthesia due to the costs of general anaesthesia and the longer operative time. Moreover, the patients generally prefer the local anaesthesia. Nevertheless, the rate of conversion to the conventional parathyroidectomy was relevant in the group of the local anaesthesia compared to the MIVAP, since the latter allows a four-gland exploration. PMID:27381690

  12. Minimally invasive three-dimensional site characterization system. Final report

    SciTech Connect

    Steedman, D.; Seusy, F.E.; Gibbons, J.; Bratton, J.L.

    1993-09-01

    This paper presents an improved for hazardous site characterization. The major components of the systems are: (1) an enhanced cone penetrometer test, (2) surface geophysical surveys and (3) a field database and visualization code. The objective of the effort was to develop a method of combining geophysical data with cone penetrometer data in the field to produce a synergistic effect. Various aspects of the method were tested at three sites. The results from each site are discussed and the data compared. This method allows the data to be interpreted more fully with greater certainty, is faster, cheaper and leads to a more accurate site characterization. Utilizing the cone penetrometer test rather than the standard drilling, sampling and laboratory testing reduces the workers exposure to hazardous materials and minimizes the hazardous material disposal problems. The technologies employed in this effort are, for the most part, state-of-the-art procedures. The approach of using data from various measurement systems to develop a synergistic effect was a unique contribution to environmental site characterization. The use of the cone penetrometer for providing ``ground truth`` data and as a platform for subsurface sensors in environmental site characterization represents a significant advancement in environmental site characterization.

  13. Validation of a New Minimally Invasive Intracranial Pressure Monitoring Method by Direct Comparison with an Invasive Technique.

    PubMed

    Vilela, Gustavo Henrique Frigieri; Cabella, Brenno; Mascarenhas, Sérgio; Czosnyka, Marek; Smielewski, Peter; Dias, Celeste; Cardim, Danilo Augusto; Mascarenhas, Yvonne Maria; Wang, Charles Chenwei; Andrade, Rodrigo; Tanaka, Koji; Lopes, Luiza Silva; Colli, Benedicto Oscar

    2016-01-01

    In this chapter we present in vivo experiments with a new minimally invasive method of monitoring intracranial pressure (ICP). Strain gauge deformation sensors are externally glued onto the exposed skull. The signal from these sensors is amplified, filtered, and sent to a computer with appropriate software for analysis and data storage. Saline infusions into the spinal channel of rats were performed to produce ICP changes, and minimally invasive ICP and direct Codman intraparenchymal ICP were simultaneously acquired in six animals. The similarity between the invasive and minimally invasive methods in response to ICP increase was assessed using Pearson's correlation coefficient. It demonstrated good agreement between the two measures < r > = 0.8 ± 0.2, with a range of 0.31-0.99. PMID:27165885

  14. Microdiskectomy and Translaminar Approach: Minimal Invasiveness and Flavum Ligament Preservation

    PubMed Central

    Vanni, Daniele; Sirabella, Francesco S.; Guelfi, Matteo; Pantalone, Andrea; Galzio, Renato; Salini, Vincenzo; Magliani, Vincenzo

    2014-01-01

    surgery was performed. Conclusion The translaminar approach is the only tissue-sparing technique viable in case of cranially migrated LDH encroaching on the exiting nerve root in the preforaminal zones, for the levels above L2–L3, and in the preforaminal and foraminal zones, for the levels below L3–L4 (L5–S1 included, if a total microdiskectomy is not necessary). The possibility to spare the flavum ligament is one of the main advantages of this technique. According to our experience, the translaminar approach is an effective and safe alternative minimally invasive surgical option. PMID:25844280

  15. Systematic review of robotic minimally invasive mitral valve surgery

    PubMed Central

    Seco, Michael; Cao, Christopher; Modi, Paul; Bannon, Paul G.; Wilson, Michael K.; Vallely, Michael P.; Phan, Kevin; Misfeld, Martin; Mohr, Friedrich

    2013-01-01

    Background Robotic telemanipulators have evolved to assist the challenges of minimally invasive mitral valve surgery (MVS). A systematic review was performed to provide a synopsis of the literature, focusing on clinical outcomes and cost-effectiveness. Method Structured searches of MEDLINE, Embase, and Cochrane databases were performed in August 2013. All original studies except case-reports were included in qualitative review. Studies with ≥50 patients were presented quantitatively. Results After applying inclusion and exclusion criteria to the search results, 27 studies were included in qualitative review, 16 of which had ≥50 patients. All studies were observational in nature, and thus the quality of evidence was rated low to medium. Patients generally had good left ventricular performance, were relatively asymptomatic, and mean patient age ranged from 52.6-58.4 years. Rates of intraoperative outcomes ranged from: 0.0-9.1% for conversion to non-robotic surgery, 106±22 to 188.5±53.8 min for cardiopulmonary bypass (CPB) time and 79±16 to 140±40 min for cross-clamp (XC) time. Rates of short-term postoperative outcomes ranged from: 0.0-3.0% for mortality, 0.0-3.2% for myocardial infarction (MI), 0.0-3.0% for permanent stroke, 1.6-15% for pleural effusion, 0.0-5.0% for reoperations for bleeding, 0.0-0.3% for infection, and 1.1-6% for prolonged ventilation (>48 hours), 1.5-5.4% for early repair failure, 12.3±6.7 to 36.6±24.7 hours for intensive care length of stay, 3.1±0.3 to 6.3±3.9 days for hospital length of stay (HLOS) and 81.7-97.6% had no or trivial mitral regurgitation (MR) before discharge. Conclusions All subtypes of mitral valve prolapse are repairable with robotic techniques. CPB and XC times are long, and novel techniques such as the Cor-Knot, Nitinol clips or running sutures may reduce the time required. The overall rates of early postoperative mortality and morbidity are low. Improvements in postoperative quality of life (QoL) and expeditious

  16. Microdiskectomy and translaminar approach: minimal invasiveness and flavum ligament preservation.

    PubMed

    Vanni, Daniele; Sirabella, Francesco S; Guelfi, Matteo; Pantalone, Andrea; Galzio, Renato; Salini, Vincenzo; Magliani, Vincenzo

    2015-04-01

    was performed. Conclusion The translaminar approach is the only tissue-sparing technique viable in case of cranially migrated LDH encroaching on the exiting nerve root in the preforaminal zones, for the levels above L2-L3, and in the preforaminal and foraminal zones, for the levels below L3-L4 (L5-S1 included, if a total microdiskectomy is not necessary). The possibility to spare the flavum ligament is one of the main advantages of this technique. According to our experience, the translaminar approach is an effective and safe alternative minimally invasive surgical option. PMID:25844280

  17. Diminished dose minimally invasive radioguided parathyroidectomy: a case for radioguidance.

    PubMed

    You, Christopher J; Zapas, John L

    2007-07-01

    Minimally invasive radioguided parathyroidectomy (MIRP) has been established as an alternative to bilateral neck exploration (BNE) for primary hyperparathyroidism. We investigate whether a diminished dose of technetium-99m sestamibi gives similar results to the standard dose. One hundred one patients were offered MIRP or diminished-dose MIRP (ddMIRP). Patients received intravenous Tc-99m sestamibi at a dose of either 25 mCi 1.5 hours or 5 mCi 1 hour preoperatively. The procedure was terminated when the 20 per cent rule was satisfied. All tissue was confirmed to be parathyroid tissue by frozen section analysis. In addition, intraoperative parathyroid hormone levels were measured in a majority of patients. Patients who failed IOM underwent BNE. Frozen section analysis and intraoperative parathyroid hormone monitoring were also performed in the BNEs. Postoperatively, serum calcium levels were measured at 1 week and 6 months. Fifteen per cent of patients were male and 85 per cent were female. The median age was 63 years (range, 25-89 years). The first 58 patients had the standard dose of 25 mCi, whereas 43 patients had ddMIRP. Six patients (10%) failed intraoperative mapping in the MIRP group and were found to have single-gland disease. Five patients (12%) failed intraoperative mapping in the ddMIRP group. However, two patients were identified to have multigland disease making the true failure rate of intraoperative mapping 7 per cent (three patients). Median operative times for MIRP, ddMIRP, and BNE were 40 minutes, 46 minutes, and 105 minutes, respectively. The 20 per cent rule was satisfied in 96 per cent of patients undergoing MIRP and 98 per cent of patients undergoing ddMIRP. Frozen section analysis and intraoperative parathyroid hormone monitoring did not result in a change in management. Median follow up was 193 days and serum calcium levels at 6 months were normal. Diminished-dose MIRP is a feasible alternative to standard-dose MIRP without compromising

  18. Robust model-based 3d/3D fusion using sparse matching for minimally invasive surgery.

    PubMed

    Neumann, Dominik; Grbic, Sasa; John, Matthias; Navab, Nassir; Hornegger, Joachim; Ionasec, Razvan

    2013-01-01

    Classical surgery is being disrupted by minimally invasive and transcatheter procedures. As there is no direct view or access to the affected anatomy, advanced imaging techniques such as 3D C-arm CT and C-arm fluoroscopy are routinely used for intra-operative guidance. However, intra-operative modalities have limited image quality of the soft tissue and a reliable assessment of the cardiac anatomy can only be made by injecting contrast agent, which is harmful to the patient and requires complex acquisition protocols. We propose a novel sparse matching approach for fusing high quality pre-operative CT and non-contrasted, non-gated intra-operative C-arm CT by utilizing robust machine learning and numerical optimization techniques. Thus, high-quality patient-specific models can be extracted from the pre-operative CT and mapped to the intra-operative imaging environment to guide minimally invasive procedures. Extensive quantitative experiments demonstrate that our model-based fusion approach has an average execution time of 2.9 s, while the accuracy lies within expert user confidence intervals. PMID:24505663

  19. Outcomes of Minimally Invasive Myotomy for the Treatment of Achalasia in the Elderly

    PubMed Central

    Craft, Randall O.; Aguilar, Brenda E.; Flahive, Colleen; Merritt, Marianne V.; Chapital, Alyssa B.; Schlinkert, Richard T.; Harold, Kristi L.

    2010-01-01

    Background: An increasing number of elderly patients diagnosed with achalasia are being referred for minimally invasive myotomy. Little data are available about the operative outcomes in this population. The objective of this study was to review our experience with this procedure in an elderly population. Methods: A retrospective review was performed of 51 consecutive patients, 65 years of age or older, diagnosed with achalasia who underwent a minimally invasive myotomy at our institution. Prior therapies, perioperative outcomes, and postoperative interventions were also analyzed. Results: Of the 51 patients, 28 (55%) had undergone prior endoscopic therapy, and 2 patients (7%) had a prior myotomy. Mean duration of symptoms was 10.9 years (range, 0.5 to 50). No perioperative mortality occurred, and the median hospital stay was 3 days. Two patients (3.8%) had complications, including a gastric mucosal injury and one atelectasia. Eleven patients (21%) required additional therapy postoperatively. Symptom improvement was described in all patients. Conclusion: Laparoscopic Heller myotomy can safely be performed in elderly patients, providing significant symptom relief. No evidence suggests that surgery should not be considered a first-line treatment. Advanced age does not appear to adversely affect outcomes of laparoscopic Heller myotomy. PMID:21333185

  20. Minimally Invasive Holographic Surface Scanning for Soft-Tissue Image Registration

    PubMed Central

    Hackworth, Douglas M.; Webster, Robert J.

    2014-01-01

    Recent advances in registration have extended intra-surgical image guidance from its origins in bone-based procedures to new applications in soft tissues, thus enabling visualization of spatial relationships between surgical instruments and subsurface structures before incisions begin. Preoperative images are generally registered to soft tissues through aligning segmented volumetric image data with an intraoperatively sensed cloud of organ surface points. However, there is currently no viable noncontact minimally invasive scanning technology that can collect these points through a single laparoscopic port, which limits wider adoption of soft-tissue image guidance. In this paper, we describe a system based on conoscopic holography that is capable of minimally invasive surface scanning. We present the results of several validation experiments scanning ex vivo biological and phantom tissues with a system consisting of a tracked, off-the-shelf, relatively inexpensive conoscopic holography unit. These experiments indicate that conoscopic holography is suitable for use with biological tissues, and can provide surface scans of comparable quality to existing clinically used laser range scanning systems that require open surgery. We demonstrate experimentally that conoscopic holography can be used to guide a surgical needle to desired subsurface targets with an average tip error of less than 3 mm. PMID:20659823

  1. Lung cancer diagnosis and staging in the minimally invasive age with increasing demands for tissue analysis

    PubMed Central

    Costa, Daniel B.; Wright, Jeffrey; VanderLaan, Paul A.

    2015-01-01

    The diagnosis and staging of patients with lung cancer in recent decades has increasingly relied on minimally invasive tissue sampling techniques, such as endobronchial ultrasound (EBUS) or endoscopic ultrasound (EUS) needle aspiration, transbronchial biopsy, and transthoracic image guided core needle biopsy. These modalities have been shown to have low complication rates, and provide adequate cellular material for pathologic diagnosis and necessary ancillary molecular testing. As an important component to a multidisciplinary team approach in the care of patients with lung cancer, these minimally invasive modalities have proven invaluable for the rapid and safe acquisition of tissue used for the diagnosis, staging, and molecular testing of tumors to identify the best evidence-based treatment plan. The continuous evolution of the field of lung cancer staging and treatment has translated into improvements in survival and quality of life for patients. Although differences in clinical practice between academic and community hospital settings still exist, improvements in physician education and training as well as adoption of technological advancements should help narrow this gap going forward. PMID:26380180

  2. Minimally invasive pediatric surgery: Increasing implementation in daily practice and resident’s training

    PubMed Central

    Bax, N. M. A.; Tytgat, S. H. A. J.; de Jong, J. R.; Travassos, D. Vieira; Kramer, W. L. M.; van der Zee, D. C.

    2007-01-01

    Background In 1998, the one-year experience in minimally invasive abdominal surgery in children at a pediatric training center was assessed. Seven years later, we determined the current status of pediatric minimally invasive surgery in daily practice and surgical training. Methods A retrospective review was undertaken of all children with intra-abdominal operations performed between 1 January 2005 and 31 December 2005. Results The type of operations performed ranged from common interventions to demanding laparoscopic procedures. 81% of all abdominal procedures were performed laparoscopically, with a complication rate stable at 6.9%, and conversion rate decreasing from 10% to 7.4%, compared to 1998. There were six new advanced laparoscopic procedures performed in 2005 as compared to 1998. The children in the open operated group were significantly smaller and younger than in the laparoscopic group (p < 0.001 and p = 0.001, respectively). The majority (64.2%) of the laparoscopic procedures were performed by a trainee. There was no difference in the operating times of open versus laparoscopic surgery, or of procedures performed by trainees versus staff surgeons. Laparoscopy by trainees did not have a negative impact on complication or conversion rates. Conclusions Laparoscopy is an established approach in abdominal procedures in children, and does not hamper surgical training. PMID:17483990

  3. The impact of resident involvement in minimally-invasive urologic oncology procedures

    PubMed Central

    Ruhotina, Nedim; Dagenais, Julien; Gandaglia, Giorgio; Sood, Akshay; Abdollah, Firas; Chang, Steven L.; Leow, Jeffrey J.; Olugbade, Kola; Rai, Arun; Sammon, Jesse D.; Schmid, Marianne; Varda, Briony; Zorn, Kevin C.; Menon, Mani; Kibel, Adam S.; Trinh, Quoc-Dien

    2014-01-01

    Introduction: Robotic and laparoscopic surgical training is an integral part of resident education in urology, yet the effect of resident involvement on outcomes of minimally-invasive urologic procedures remains largely unknown. We assess the impact of resident participation on surgical outcomes using a large multi-institutional prospective database. Methods: Relying on the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) Participant User Files (2005–2011), we abstracted the 3 most frequently performed minimally-invasive urologic oncology procedures. These included radical prostatectomy, radical nephrectomy and partial nephrectomy. Multivariable logistic regression models were constructed to assess the impact of trainee involvement (PGY 1–2: junior, PGY 3–4: senior, PGY ≥5: chief) versus attending-only on operative time, length-of-stay, 30-day complication, reoperation and readmission rates. Results: A total of 5459 minimally-invasive radical prostatectomies, 1740 minimally-invasive radical nephrectomies and 786 minimally-invasive partial nephrectomies were performed during the study period, for which data on resident surgeon involvement was available. In multivariable analyses, resident involvement was not associated with increased odds of overall complications, reoperation, or readmission rates for minimally-invasive prostatectomy, radical and partial nephrectomy. However, operative time was prolonged when residents were involved irrespective of the type of procedure. Length-of-stay was decreased with senior resident involvement in minimally-invasive partial nephrectomies (odds ratio [OR] 0.49, p = 0.04) and prostatectomies (OR 0.68, p = 0.01). The major limitations of this study include its retrospective observational design, inability to adjust for the case complexity and surgeon/hospital characteristics, and the lack of information regarding the minimally-invasive approach utilized (whether robotic or laparoscopic

  4. From four-parathyroid gland exploration to a minimally invasive technique. Minimally invasive parathyroidectomy as a current approach in surgery for primary hyperparathyroidism.

    PubMed

    Kobiela, Jarek; Łaski, Dariusz; Stróżyk, Aneta; Proczko-Markuszewska, Monika; Stefaniak, Tomasz; Sworczak, Krzysztof; Łachiński, Andrzej J; Śledziński, Zbigniew

    2014-01-01

    Complete surgical resection of hyperfunctioning parathyriod tissue is essential for the treatment of primary hyperparathyroidism. During recent years, minimally invasive surgery has been successfully applied in neck exploration, because of significant developments of guidance by intraoperative scans, the use of quick, intraoperative PTH assay, and also preoperative imaging procedures such as high resolution ultrasonography and sestamibi scintigraphy. The results of operations which are performed with minimally invasive techniques are comparable to those of conventional surgery, and provide advantages with regard to cosmetic result, length of hospitalisation, and reduced post-operative pain. PMID:24971926

  5. Minimally invasive and alternative approaches for long-term LVAD placement: the Vanderbilt strategy

    PubMed Central

    Davis, Mary E.; Haglund, Nicholas

    2014-01-01

    Background Minimally invasive and alternative strategies for implantation have been anecdotally reported for contemporary continuous-flow left ventricular assist device (CF-LVAD) placement. Methods We reviewed our experience at a single center with alternative strategies for implantation of the HeartMate II and HeartWare CF-LVADs, in patients with advanced heart failure (HF). This featured article focuses on the associated surgical techniques and patient management pitfalls. Results For appropriately selected cases, our group believes that these alternative strategies allow for the development of novel and less traumatic surgical approaches for CF-LVAD implantation. With reproducible outcomes, these approaches also promise the possibility of increasing the number of high-risk surgical patients who could benefit from CF-LVAD therapies. Conclusions This work has detailed a variety of less invasive alternative strategies for implantation of long-term LVADs. These newer approaches have the potential for significant advancements in the field of cardiothoracic surgery. Large-scale collaborative studies will be needed to clarify the potential advantages and disadvantages of these novel techniques on patient outcomes. PMID:25512895

  6. Minimally invasive evacuation of spontaneous intracerebral hemorrhage using sonothrombolysis

    PubMed Central

    Newell, David W.; Shah, M. Mohsin; Wilcox, Robert; Hansmann, Douglas R.; Melnychuk, Erik; Muschelli, John; Hanley, Daniel F.

    2013-01-01

    treatment in 7 of 9 patients. The rate of hemorrhage lysis was compared between 8 patients who completed treatment, and patient cohorts treated for IVH and ICH using identical doses of rt-PA and catheter drainage but without the ultrasound (courtesy of the MISTIE [Minimally Invasive Surgery plus T-PA for Intracerebral Hemorrhage Evacuation] and CLEAR II [Clot Lysis Evaluating Accelerated Resolution of Intraventricular Hemorrhage II] studies). Compared with the MISTIE and CLEAR data, the authors observed a faster rate of lysis during treatment for IVH and ICH in the patients treated with sonolysis plus rt-PA versus rt-PA alone. Conclusions Lysis and drainage of spontaneous ICH and IVH with a reduction in mass effect can be accomplished rapidly and safely through sonothrombolysis using stereotactically delivered drainage and ultrasound catheters via a bur hole. A larger clinical trial with catheters specifically designed for brain blood clot removal is warranted. PMID:21663412

  7. Scope and limitations of minimal invasive surgery in practice of pediatric surgical oncology

    PubMed Central

    Bhatnagar, Sushmita; Sarin, Yogesh Kumar

    2010-01-01

    Management of Solid tumors in children needs a comprehensive multimodality protocol based treatment plan. Open surgical removal of the tumors occurring in any of the sites such as abdomen, thorax, chest wall, HFN (head, face, neck), brain and extremities, is the option which has been traditionally practiced even in the present era and in most of the centers. Nevertheless with the advances in science and technology and with ever increasing usage and expertise of laparoscopy in children, it’s application has extended to treatment of solid tumors in children. A review of the scope of such intervention as well as the limitations of minimal invasive surgery in this specialized field of pediatric surgery has been attempted in this article. PMID:21584219

  8. The past, present and future of minimally invasive endoscopy in gynecology: a review and speculative outlook.

    PubMed

    Mettler, Liselotte; Clevin, Lotte; Ternamian, Artin; Puntambekar, Shailesh; Schollmeyer, Thoralf; Alkatout, Ibrahim

    2013-08-01

    Over the last twenty-five years, minimally invasive surgery (MIS) has evolved in a relatively short period of time to overtake the centuries-old visionary and pioneering groundwork of our outstanding colleagues in all surgical disciplines. This overview on the development of gynecological endoscopy, at the invitation of SMIT, highlights past achievements and describes present challenges. It emphasizes future opportunities and possibilities to foster interdisciplinary collaboration and integrate emerging endoscopic, imaging and stereotactic surgical technologies to improve patient safety, enhance quality of care and advance surgical education. This article will introduce younger colleagues to the exciting world of contemporary gynecologic endoscopy and help them appreciate the immense technology-laden opportunities that the future holds for those who are prepared to follow in the footsteps and aspirations of our founding surgical colleagues. PMID:23964793

  9. Minimally Invasive Hip Surgery Isn't Always the Right Choice

    MedlinePlus

    ... Minimally Invasive Hip Surgery Isn't Always the Right Choice One-third of older patients may need ... hip arthroscopy for a labral tear in the right patient is an "excellent" surgery. It helps accommodate ...

  10. Minimally invasive is the future of left ventricular assist device implantation

    PubMed Central

    Makdisi, George

    2015-01-01

    There have been many factors that have allowed for progressive improvement in outcomes and lower complication rates. These include the improvement in left ventricular assist device (LVAD) technologies, combined with better understanding of patient management, all these. Nowadays the numbers of LVAD implantations exceed the number of annual heart transplants worldwide. Minimally invasive procedures are shown to improve the surgical outcome in both LVAD insertion and replacement. These minimally invasive techniques can be grouped grossly into shifting from on-pump to off-pump implantation, alternative access for implantation other than sternotomy, and a combination of both, which should be the ultimate aim of minimally invasive LVAD implantation. Here we describe the alternative techniques and configurations of minimally invasive and sites of implantation. PMID:26543617

  11. Minimally invasive is the future of left ventricular assist device implantation.

    PubMed

    Makdisi, George; Wang, I-Wen

    2015-09-01

    There have been many factors that have allowed for progressive improvement in outcomes and lower complication rates. These include the improvement in left ventricular assist device (LVAD) technologies, combined with better understanding of patient management, all these. Nowadays the numbers of LVAD implantations exceed the number of annual heart transplants worldwide. Minimally invasive procedures are shown to improve the surgical outcome in both LVAD insertion and replacement. These minimally invasive techniques can be grouped grossly into shifting from on-pump to off-pump implantation, alternative access for implantation other than sternotomy, and a combination of both, which should be the ultimate aim of minimally invasive LVAD implantation. Here we describe the alternative techniques and configurations of minimally invasive and sites of implantation. PMID:26543617

  12. Simple, minimally invasive surgical technique for treatment of type 2 fractures of the distal clavicle.

    PubMed

    Levy, Ofer

    2003-01-01

    Neer type 2 fractures of the distal clavicle have a high rate of nonunion and delayed union. A simple, minimally invasive surgical technique using suture fixation is introduced. In this series 12 patients were treated with suture fixation of this fracture with absorbable suture material, resulting in union of all fractures. There was a rapid return to function and no complications. This technique allows simple, minimally invasive fixation with good fracture healing and early return to work and sports. PMID:12610482

  13. A minimally invasive surgical technique to treat distal clavicle fractures.

    PubMed

    Swanson, Kyle E; Swanson, Britta L

    2009-07-01

    Treatment of distal clavicle fractures ranges from nonoperative to operative approaches. Various surgical procedures have been described in the literature, each with potential complications. For fractures treated operatively, the goal is to maximize stability and functionality while minimizing pain and deformity. This article describes a double-button suture system using a mini-open technique to repair a distal clavicle fracture providing stable fixation with minimal disruption of the surrounding anatomy. PMID:19634845

  14. From the Idea to Its Realization: The Evolution of Minimally Invasive Techniques in Neurosurgery

    PubMed Central

    Grunert, P.

    2013-01-01

    Minimally invasive techniques in neurosurgery evolved in two steps. Many minimally invasive concepts like neuronavigation, endoscopy, or frame based stereotaxy were developed by the pioneers of neurosurgery, but it took decades till further technical developments made the realization and broad clinical application of these early ideas safe and possible. This thesis will be demonstrated by giving examples of the evolution of four minimally invasive techiques: neuronavigation, transsphenoidal pituitary surgery, neuroendoscopy and stereotaxy. The reasons for their early failure and also the crucial steps for the rediscovery of these minimally invasive techniques will be analysed. In the 80th of the 20th century endoscopy became increasingly applied in different surgical fields. The abdominal surgeons coined as first for their endoscopic procedures the term minimally invasive surgery in contrast to open surgery. In neurrosurgery the term minimally invasive surgery stood not in opposiotion to open procedures but was understood as a general concept and philosophy using the modern technology such as neuronavigation, endoscopy and planing computer workstations with the aim to make the procedures less traumatic. PMID:24455231

  15. Development of Minimally-Invasive Aortic Pressure and Flow Instrumentation

    NASA Technical Reports Server (NTRS)

    Ewert, Dan

    1996-01-01

    To better understand the mechanisms underlying the effects of microgravity on the cardiovascular system, cardiovascular models have been developed. These computational models estimate changes in cardiovascular parameters such as total peripheral resistance and systemic arterial compliance, and require high quality aortic pressure and flow measurements as their input. Many of these measurements are obtained in experimental animals and therefore the invasiveness of the instrumentation must be as kept to a minimum. These considerations are the primary motivation behind this work.

  16. Minimally Invasive Periareolar Approach to Unroofed Coronary Sinus Atrial Septal Defect Repair.

    PubMed

    Bozso, Sabin J; Grant, Aaron; Iglesias, Ivan; Chu, Michael W A

    2016-09-01

    Less invasive techniques are commonly used to treat patients with anatomically suitable secundum atrial septal defects; however, repair of more complex atrial septal defects are still performed through sternotomy. Cosmetically appealing periareolar incisions have been used in breast reconstructive surgery and may provide an esthetically superior alternative to the anterolateral minithoracotomy incision used in minimally invasive cardiac surgery. We describe a patient with an unroofed coronary sinus atrial septal defect who underwent successful minimally invasive, endoscopic repair of this defect with autologous pericardial baffle reconstruction of the coronary sinus roof and closure of the interatrial communication through a periareolar approach. PMID:27549549

  17. The development of minimally invasive continuous Metabolic Monitoring Technologies in the U.S. Army TMM Research Program.

    PubMed

    Hover, Carl G; Stedeford, Todd; Vigneulle, Roy M

    2005-02-01

    The Technologies for Metabolic Monitoring and Julia Weaver Fund Research Program (TMM) promotes the development of minimally invasive, innovative technologies for the monitoring and assessment of metabolic changes that are important to the management of diabetes. This program also promotes the advancement of biological monitoring technologies for healthy individuals operating in extreme environments, such as soldiers and astronauts. These technologies have focused on measurements of analytes in interstitial fluids and functional outcomes related to glucose regulation. TMM investigators have advanced new sensing methods and are working to overcome technological barriers to long-term implants. This paper reviews the current goals, research areas, and future direction of the program. PMID:15738719

  18. Minimally invasive surgical procedures for the treatment of lumbar disc herniation

    PubMed Central

    Lühmann, Dagmar; Burkhardt-Hammer, Tatjana; Borowski, Cathleen; Raspe, Heiner

    2005-01-01

    Introduction In up to 30% of patients undergoing lumbar disc surgery for herniated or protruded discs outcomes are judged unfavourable. Over the last decades this problem has stimulated the development of a number of minimally-invasive operative procedures. The aim is to relieve pressure from compromised nerve roots by mechanically removing, dissolving or evaporating disc material while leaving bony structures and surrounding tissues as intact as possible. In Germany, there is hardly any utilisation data for these new procedures – data files from the statutory health insurances demonstrate that about 5% of all lumbar disc surgeries are performed using minimally-invasive techniques. Their real proportion is thought to be much higher because many procedures are offered by private hospitals and surgeries and are paid by private health insurers or patients themselves. So far no comprehensive assessment comparing efficacy, safety, effectiveness and cost-effectiveness of minimally-invasive lumbar disc surgery to standard procedures (microdiscectomy, open discectomy) which could serve as a basis for coverage decisions, has been published in Germany. Objective Against this background the aim of the following assessment is: Based on published scientific literature assess safety, efficacy and effectiveness of minimally-invasive lumbar disc surgery compared to standard procedures. To identify and critically appraise studies comparing costs and cost-effectiveness of minimally-invasive procedures to that of standard procedures. If necessary identify research and evaluation needs and point out regulative needs within the German health care system. The assessment focusses on procedures that are used in elective lumbar disc surgery as alternative treatment options to microdiscectomy or open discectomy. Chemonucleolysis, percutaneous manual discectomy, automated percutaneous lumbar discectomy, laserdiscectomy and endoscopic procedures accessing the disc by a posterolateral or

  19. Minimally invasive plate osteosynthesis using 3D printing for shaft fractures of clavicles: technical note.

    PubMed

    Jeong, Ho-Seung; Park, Kyoung-Jin; Kil, Kyung-Min; Chong, Suri; Eun, Hyeon-Jun; Lee, Tae-Soo; Lee, Jeong-Pyo

    2014-11-01

    This article describes a minimally invasive plate osteosynthesis technique for midshaft fractures of clavicles using intramedullary indirect reduction and prebent plates with 3D printing models. This technique allows for easy reduction of fractures with accurate prebent plates and minimal soft tissue injury around the fracture site. PMID:25164764

  20. Minimally Invasive Multivessel Coronary Surgery and Hybrid Coronary Revascularization: Can We Routinely Achieve Less Invasive Coronary Surgery?

    PubMed

    Rodriguez, Maria; Ruel, Marc

    2016-01-01

    Coronary artery bypass grafting (CABG) is the gold standard in managing severe coronary artery disease. However, it is associated with prolonged recovery and potential complications, in part due to the invasiveness of the procedure. Less invasive CABG techniques attempt to improve the quality and quantity of life in the same way as surgical revascularization but with fewer complications. Minimally invasive coronary surgery (MICS) through a small thoracotomy allows for complete revascularization with good results in graft patency. Perioperative mortality is low, and there is decreased need for blood transfusion, lower surgical site infection rates, and an earlier return to full physical function. Hybrid coronary revascularization (HCR) attempts to combine the advantages of coronary artery bypass grafting with those of percutaneous coronary intervention. Several studies have shown that HCR provides better short-term outcomes with regard to decreased ventilation and ICU time, reduced need for blood transfusion, and shortened hospital stay. However, the rates for major adverse cardiovascular events and mortality are comparable to conventional CABG, except for patients with a high SYNTAX score who displayed increased mortality rates. There is also strong evidence of a higher need for repeat revascularization with HCR compared to CABG. Overall, MICS and HCR appear to be viable alternatives to conventional CABG, offering a less invasive approach to coronary revascularization, which may be especially beneficial to high-risk patients. This article discusses approaches that deliver the advantages of minimally invasive surgical revascularization that can be adapted by surgeons with minimal investment with regards to training and infrastructure. PMID:27127557

  1. Probabilistic sparse matching for robust 3D/3D fusion in minimally invasive surgery.

    PubMed

    Neumann, Dominik; Grbic, Sasa; John, Matthias; Navab, Nassir; Hornegger, Joachim; Ionasec, Razvan

    2015-01-01

    Classical surgery is being overtaken by minimally invasive and transcatheter procedures. As there is no direct view or access to the affected anatomy, advanced imaging techniques such as 3D C-arm computed tomography (CT) and C-arm fluoroscopy are routinely used in clinical practice for intraoperative guidance. However, due to constraints regarding acquisition time and device configuration, intraoperative modalities have limited soft tissue image quality and reliable assessment of the cardiac anatomy typically requires contrast agent, which is harmful to the patient and requires complex acquisition protocols. We propose a probabilistic sparse matching approach to fuse high-quality preoperative CT images and nongated, noncontrast intraoperative C-arm CT images by utilizing robust machine learning and numerical optimization techniques. Thus, high-quality patient-specific models can be extracted from the preoperative CT and mapped to the intraoperative imaging environment to guide minimally invasive procedures. Extensive quantitative experiments on 95 clinical datasets demonstrate that our model-based fusion approach has an average execution time of 1.56 s, while the accuracy of 5.48 mm between the anchor anatomy in both images lies within expert user confidence intervals. In direct comparison with image-to-image registration based on an open-source state-of-the-art medical imaging library and a recently proposed quasi-global, knowledge-driven multi-modal fusion approach for thoracic-abdominal images, our model-based method exhibits superior performance in terms of registration accuracy and robustness with respect to both target anatomy and anchor anatomy alignment errors. PMID:25095250

  2. Forces and Trauma Associated with Minimally-Invasive, Image-Guided Cochlear Implantation

    PubMed Central

    Rohani, Pooyan; Pile, Jason; Kahrs, Lueder A; Balachandran, Ramya; Blachon, Grégoire S; Simaan, Nabil; Labadie, Robert F

    2015-01-01

    Objective Minimally-invasive, image-guided cochlear implantation (CI) utilizes a patient-customized microstereotactic frame to access the cochlea via a single drill-pass. We investigate the average force and trauma associated with the insertion of lateral wall CI electrodes using this technique. Study Design Assessment using cadaveric temporal bones Setting Laboratory setup Subjects and Methods Microstereotactic frames for six fresh cadaveric temporal bones were built using CT scans to determine an optimal drill path following which drilling was performed. CI electrodes were inserted using surgical forceps to manually advance the CI electrode array, via the drilled tunnel, into the cochlea. Forces were recorded using a six-axis load sensor placed under the temporal bone during the insertion of lateral wall electrode arrays (two each of Nucleus CI422, MED-EL standard, and modified MED-EL electrodes with stiffeners). Tissue histology was performed by microdissection of the otic capsule and apical photo-documentation of electrode position and intracochlear tissue. Results After drilling, CT scanning demonstrated successful access to cochlea in all six bones. Average insertion forces ranged from 0.009 to 0.078N. Peak forces were in the range of 0.056–0.469N. Tissue histology showed complete scala tympani insertion in five specimens and scala vestibuli insertion in the remaining specimen with depth of insertion ranging from 360–600°. No intracochlear trauma was identified. Conclusion The use of lateral wall electrodes with the minimally-invasive, image-guided CI approach was associated with insertion forces comparable to traditional CI surgery. Deep insertions were obtained without identifiable trauma. PMID:24468898

  3. Minimally invasive surgery for upper gastrointestinal cancer: Our experience and review of the literature

    PubMed Central

    Suda, Koichi; Nakauchi, Masaya; Inaba, Kazuki; Ishida, Yoshinori; Uyama, Ichiro

    2016-01-01

    Minimally invasive surgery (MIS) for upper gastrointestinal (GI) cancer, characterized by minimal access, has been increasingly performed worldwide. It not only results in better cosmetic outcomes, but also reduces intraoperative blood loss and postoperative pain, leading to faster recovery; however, endoscopically enhanced anatomy and improved hemostasis via positive intracorporeal pressure generated by CO2 insufflation have not contributed to reduction in early postoperative complications or improvement in long-term outcomes. Since 1995, we have been actively using MIS for operable patients with resectable upper GI cancer and have developed stable and robust methodology in conducting totally laparoscopic gastrectomy for advanced gastric cancer and prone thoracoscopic esophagectomy for esophageal cancer using novel technology including da Vinci Surgical System (DVSS). We have recently demonstrated that use of DVSS might reduce postoperative local complications including pancreatic fistula after gastrectomy and recurrent laryngeal nerve palsy after esophagectomy. In this article, we present the current status and future perspectives on MIS for gastric and esophageal cancer based on our experience and a review of the literature. PMID:27217695

  4. Minimally invasive surgical method to detect sound processing in the cochlear apex by optical coherence tomography

    NASA Astrophysics Data System (ADS)

    Ramamoorthy, Sripriya; Zhang, Yuan; Petrie, Tracy; Fridberger, Anders; Ren, Tianying; Wang, Ruikang; Jacques, Steven L.; Nuttall, Alfred L.

    2016-02-01

    Sound processing in the inner ear involves separation of the constituent frequencies along the length of the cochlea. Frequencies relevant to human speech (100 to 500 Hz) are processed in the apex region. Among mammals, the guinea pig cochlear apex processes similar frequencies and is thus relevant for the study of speech processing in the cochlea. However, the requirement for extensive surgery has challenged the optical accessibility of this area to investigate cochlear processing of signals without significant intrusion. A simple method is developed to provide optical access to the guinea pig cochlear apex in two directions with minimal surgery. Furthermore, all prior vibration measurements in the guinea pig apex involved opening an observation hole in the otic capsule, which has been questioned on the basis of the resulting changes to cochlear hydrodynamics. Here, this limitation is overcome by measuring the vibrations through the unopened otic capsule using phase-sensitive Fourier domain optical coherence tomography. The optically and surgically advanced method described here lays the foundation to perform minimally invasive investigation of speech-related signal processing in the cochlea.

  5. Minimally invasive surgical options for ureteropelvic junction obstruction: A significant step in the right direction

    PubMed Central

    Symons, Stephanie J.; Palit, Victor; Biyani, Chandra Shekhar; Cartledge, Jon J.; Browning, Anthony J.; Joyce, Adrian D.

    2009-01-01

    Open pyeloplasty is the gold standard treatment for adult ureteropelvic junction obstruction (UPJO) with published success rates consistently over 90%. In recent years, the management of UPJO has been revolutionized by the introduction of endoscopic procedures and laparoscopic techniques. We analyzed the long-term results of endoscopic and other minimal access approaches for the treatment of UPJO. Early results for endopyelotomy were promising but long-term results were not encouraging. Laparoscopic pyeloplasty technique is well defined and duplicates the surgical principles of conventional open pyeloplasty. With such a large variety of minimally invasive procedures for the treatment of UPJO available, the treatment choice for UPJO must be based on the success and morbidity of the procedures, the surgeon’s experience, the cost of the treatment, and the patient’s choice. We feel that with the technological advances in instrumentation coupled with a decrease in cost and improved training of urological surgeons, laparoscopic pyeloplasty may evolve to be the new “gold” standard for the treatment of UPJO. PMID:19468425

  6. Minimally invasive surgery for upper gastrointestinal cancer: Our experience and review of the literature.

    PubMed

    Suda, Koichi; Nakauchi, Masaya; Inaba, Kazuki; Ishida, Yoshinori; Uyama, Ichiro

    2016-05-21

    Minimally invasive surgery (MIS) for upper gastrointestinal (GI) cancer, characterized by minimal access, has been increasingly performed worldwide. It not only results in better cosmetic outcomes, but also reduces intraoperative blood loss and postoperative pain, leading to faster recovery; however, endoscopically enhanced anatomy and improved hemostasis via positive intracorporeal pressure generated by CO2 insufflation have not contributed to reduction in early postoperative complications or improvement in long-term outcomes. Since 1995, we have been actively using MIS for operable patients with resectable upper GI cancer and have developed stable and robust methodology in conducting totally laparoscopic gastrectomy for advanced gastric cancer and prone thoracoscopic esophagectomy for esophageal cancer using novel technology including da Vinci Surgical System (DVSS). We have recently demonstrated that use of DVSS might reduce postoperative local complications including pancreatic fistula after gastrectomy and recurrent laryngeal nerve palsy after esophagectomy. In this article, we present the current status and future perspectives on MIS for gastric and esophageal cancer based on our experience and a review of the literature. PMID:27217695

  7. Modular minimally invasive extracorporeal circulation systems; can they become the standard practice for performing cardiac surgery?

    PubMed

    Anastasiadis, K; Antonitsis, P; Argiriadou, H; Deliopoulos, A; Grosomanidis, V; Tossios, P

    2015-04-01

    Minimally invasive extracorporeal circulation (MiECC) has been developed in an attempt to integrate all advances in cardiopulmonary bypass technology in one closed circuit that shows improved biocompatibility and minimizes the systemic detrimental effects of CPB. Despite well-evidenced clinical advantages, penetration of MiECC technology into clinical practice is hampered by concerns raised by perfusionists and surgeons regarding air handling together with blood and volume management during CPB. We designed a modular MiECC circuit, bearing an accessory circuit for immediate transition to an open system that can be used in every adult cardiac surgical procedure, offering enhanced safety features. We challenged this modular circuit in a series of 50 consecutive patients. Our results showed that the modular AHEPA circuit design offers 100% technical success rate in a cohort of random, high-risk patients who underwent complex procedures, including reoperation and valve and aortic surgery, together with emergency cases. This pilot study applies to the real world and prompts for further evaluation of modular MiECC systems through multicentre trials. PMID:25564510

  8. Utility of Intraoperative Neuromonitoring during Minimally Invasive Fusion of the Sacroiliac Joint

    PubMed Central

    Woods, Michael; Birkholz, Denise; MacBarb, Regina; Capobianco, Robyn; Woods, Adam

    2014-01-01

    Study Design. Retrospective case series. Objective. To document the clinical utility of intraoperative neuromonitoring during minimally invasive surgical sacroiliac joint fusion for patients diagnosed with sacroiliac joint dysfunction (as a direct result of sacroiliac joint disruptions or degenerative sacroiliitis) and determine stimulated electromyography thresholds reflective of favorable implant position. Summary of Background Data. Intraoperative neuromonitoring is a well-accepted adjunct to minimally invasive pedicle screw placement. The utility of intraoperative neuromonitoring during minimally invasive surgical sacroiliac joint fusion using a series of triangular, titanium porous plasma coated implants has not been evaluated. Methods. A medical chart review of consecutive patients treated with minimally invasive surgical sacroiliac joint fusion was undertaken at a single center. Baseline patient demographics and medical history, intraoperative electromyography thresholds, and perioperative adverse events were collected after obtaining IRB approval. Results. 111 implants were placed in 37 patients. Sensitivity of EMG was 80% and specificity was 97%. Intraoperative neuromonitoring potentially avoided neurologic sequelae as a result of improper positioning in 7% of implants. Conclusions. The results of this study suggest that intraoperative neuromonitoring may be a useful adjunct to minimally invasive surgical sacroiliac joint fusion in avoiding nerve injury during implant placement. PMID:25544898

  9. Utility of Intraoperative Neuromonitoring during Minimally Invasive Fusion of the Sacroiliac Joint.

    PubMed

    Woods, Michael; Birkholz, Denise; MacBarb, Regina; Capobianco, Robyn; Woods, Adam

    2014-01-01

    Study Design. Retrospective case series. Objective. To document the clinical utility of intraoperative neuromonitoring during minimally invasive surgical sacroiliac joint fusion for patients diagnosed with sacroiliac joint dysfunction (as a direct result of sacroiliac joint disruptions or degenerative sacroiliitis) and determine stimulated electromyography thresholds reflective of favorable implant position. Summary of Background Data. Intraoperative neuromonitoring is a well-accepted adjunct to minimally invasive pedicle screw placement. The utility of intraoperative neuromonitoring during minimally invasive surgical sacroiliac joint fusion using a series of triangular, titanium porous plasma coated implants has not been evaluated. Methods. A medical chart review of consecutive patients treated with minimally invasive surgical sacroiliac joint fusion was undertaken at a single center. Baseline patient demographics and medical history, intraoperative electromyography thresholds, and perioperative adverse events were collected after obtaining IRB approval. Results. 111 implants were placed in 37 patients. Sensitivity of EMG was 80% and specificity was 97%. Intraoperative neuromonitoring potentially avoided neurologic sequelae as a result of improper positioning in 7% of implants. Conclusions. The results of this study suggest that intraoperative neuromonitoring may be a useful adjunct to minimally invasive surgical sacroiliac joint fusion in avoiding nerve injury during implant placement. PMID:25544898

  10. Minimally invasive surgery for live kidney donors: techniques and challenges.

    PubMed

    Brook, Nicholas R; Nicholson, Michael L

    2005-09-01

    Live kidney donation is assuming an increasingly prominent role in kidney transplantation programs. The traditional operative approach has been through an incision in the upper quadrant of the abdomen or in the loin, with the attendant potential postoperative complications associated with a large surgical wound. These problems may act as disincentives to prospective donors. The introduction of laparoscopic donor surgery in 1995 heralded a new era offering reduced post-operative pain and improved cosmetic result. It is hoped that these benefits may counter some disincentives and thereby increase donation rates. Three minimal-access approaches and their advantages and disadvantages are described: classical laparoscopic, hand-assisted laparoscopic, and retroperitoneoscopic surgery. Published reports indicate extensive experience with the first 2 of these approaches and less experience with the latter. All 3 approaches present technical, physiological, and anatomical challenges in the context of retrieving an organ that is fit for transplantation. For minimal-access surgery to be accepted as the procedure of choice for live kidney donors, it must be demonstrated that morbidity is not transferred from donor to recipient when these techniques are used. Some concerns about these procedures are addressed. High-level evidence in the form of randomized controlled trials is generally lacking, but experiences of surgeons and patients suggest that, with appropriate modifications, these techniques are safe for both donors and allografts and also benefit donors' recovery. PMID:16252632

  11. Detection and minimally invasive treatment of early squamous lung cancer

    PubMed Central

    Sutedja, Thomas G.

    2013-01-01

    Non-small cell lung cancer (NSCLC) is the most common cause of cancer deaths worldwide. The majority of patents presenting with NSCLC have advanced disease, which precludes curative treatment. Early detection and treatment might result in the identification of more patients with early central lung cancer and improve survival. In addition, the study of early lung cancer improves understanding of lung carcinogenesis and might also reveal new treatment targets for advanced lung cancer. Bronchoscopic investigation of the central airways can reveal both early central lung cancer in situ (stage 0) and other preinvasive lesions such as dysplasia. In the current review we discuss the detection of early squamous lung cancer, the natural history of preinvasive lesions and whether biomarkers can be used to predict progression to cancer. Finally we will review the staging and management of preinvasive lung cancer lesions and the different therapeutic modalities that are available. PMID:23858332

  12. The role of the robotic technique in minimally invasive surgery in rectal cancer

    PubMed Central

    Bianchi, Paolo Pietro; Luca, Fabrizio; Petz, Wanda; Valvo, Manuela; Cenciarelli, Sabine; Zuccaro, Massimiliano; Biffi, Roberto

    2013-01-01

    Laparoscopic rectal surgery is feasible, oncologically safe, and offers better short-term outcomes than traditional open procedures in terms of pain control, recovery of bowel function, length of hospital stay, and time until return to working activity. Nevertheless, laparoscopic techniques are not widely used in rectal surgery, mainly because they require a prolonged and demanding learning curve that is available only in high-volume and rectal cancer surgery centres experienced in minimally invasive surgery. Robotic surgery is a new technology that enables the surgeon to perform minimally invasive operations with better vision and more intuitive and precise control of the operating instruments, promising to overcome some of the technical difficulties associated with standard laparoscopy. The aim of this review is to summarise the current data on clinical and oncological outcomes of minimally invasive surgery in rectal cancer, focusing on robotic surgery, and providing original data from the authors’ centre. PMID:24101946

  13. [History and development trend of minimally invasive techniques for gastric cancer in China].

    PubMed

    Yu, Peiwu; Hao, Yingxue

    2016-08-25

    Laparoscopic gastrectomy is one of the main directions of minimally invasive surgery for gastric cancer. Since 1999, the first laparoscopic gastrectomy was reported, minimally invasive laparoscopic surgery for gastric cancer in China has undergone three stages: initial exploration period, rapid development period and gradual maturation period. The hospitals which performed laparoscopic gastrectomy and the reported cases have been increasing, at the same time the clinical efficacy is satisfied. However, there is still lack of standard and insufficient evidence in the treatment of gastric cancer by laparoscopic gastrectomy. The 3D laparoscopic and robotic gastrectomies still can not be performed in the most hospitals in China. So we should strengthen the standardization training of laparoscopic gastrectomy, develop the evidence-based medical research, promote the 3D laparoscopic and robotic gastrectomies to enhance the level of minimally invasive surgery for gastric cancer. PMID:27545459

  14. The Warden procedure can be successfully performed using minimally invasive cardiac surgery without aortic clamping.

    PubMed

    Zubritskiy, Alexey; Arkhipov, Alexey; Khapaev, Timur; Naberukhin, Yuriy; Omelchenko, Alexander; Gorbatykh, Yuriy; Bogachev-Prokophiev, Alexander; Karaskov, Alexander

    2016-02-01

    Currently, minimally invasive cardiac surgery has found widespread use even in congenital heart surgery. The number of defects, which can be corrected through a small incision or totally endoscopic, is on the rise. Nowadays, surgeons can repair atrial septal defect, ventricular septal defect, patent ductus arteriosus and other congenital heart defects using minimally invasive techniques. In this paper, we report 21 cases of successful repair of supracardiac partial anomalous right upper and middle pulmonary venous connection, using the Warden procedure. It was performed in children through the right-sided midaxillary thoracotomy with direct cardiopulmonary bypass cannulation and induction of ventricular fibrillation. There were no operative or early postoperative deaths or complications. All patients were in sinus rhythm at discharge. According to echocardiography, there were no cases of early SVC or pulmonary veins narrowing. The Warden procedure can be performed safely and efficiently using the minimally invasive cardiac surgery. PMID:26541958

  15. Distributed network imaging and electrical impedance tomography of minimally invasive surgery.

    PubMed

    Otten, David M; Onik, Gary; Rubinsky, Boris

    2004-04-01

    Minimally invasive surgery has become highly dependent on imaging. For instance, the effectiveness of cryosurgery in treating cancer is dependent on knowledge of freezing extent, and relies on real-time imaging techniques for monitoring. However, medical imaging is often very expensive and therefore not available to most of the world population. Here we propose the concept of distributed network imaging (DNI) which could make medical imaging and minimally invasive surgery available to all who need these advanced medical modalities. We demonstrate the concept through electrical impedance tomography (EIT) of cryosurgery. The central idea is to develop an inexpensive measurend (data collection hardware) at a remote site and then to connect the measurend apparatus to an advanced image reconstruction server, which can serve a large number of distributed measurends at remote sites, using existing communication conduits (Ethernet, telephone, satellite, etc.). These conduits transfer the raw data from the measurend to the server and the reconstructed image from the server to the measurend. Electrical impedance tomography (EIT) is an imaging modality which utilizes tissue impedance variation to construct an image. The EIT measurend which consists of electrodes, a power supply, and means to measure voltage is inexpensive, and therefore suitable for DNI. EIT is also very well-suited to imaging cryosurgery since frozen tissue impedance is much higher than that of unfrozen tissue. In this study, we first develop numerical models to illustrate the theoretical ability of EIT to image cryosurgery. We begin with a simplified two dimensional model, and then extend the study to the more appropriate three dimensional model. Our simulated finite element phantoms and pixel-based Newton-Raphson reconstruction algorithms were able to produce easily identifiable images of frozen regions within tissue. Then, we demonstrate the feasibility of the DNI concept though a case study using EIT to

  16. Minimally Invasive Management of Complex Recurrent Lymphangioma of the Thorax and Abdomen.

    PubMed

    Knight, Joshua K; Marshall, M Blair

    2016-06-01

    Lymphangioma is a rare benign proliferation of lymph vessels in the head and neck, axilla, and rarely the mediastinum. We report on the minimally invasive management of a complex recurrence of lymphangioma involving bilateral chest, mediastinum, and abdomen. Given the complexity, the patient underwent debulking of the lymphangioma, ligation of the cisterna chyli, and repeated percutaneous drainage and sclerosing procedures. This report suggests that the use of combined minimally invasive techniques including laparoscopy, thoracoscopy, percutaneous drainage, and sclerosis may be the optimal strategy to manage these complex situations. PMID:27211980

  17. Secondary abdominal compartment syndrome required decompression laparotomy during minimally invasive mitral valve repair.

    PubMed

    Nishi, Hiroyuki; Toda, Koichi; Miyagawa, Shigeru; Yoshikawa, Yasushi; Fukushima, Satsuki; Yoshioka, Daisuke; Saito, Tetsuya; Sawa, Yoshiki

    2016-12-01

    We treated a 77-year-old patient with secondary abdominal compartment syndrome that caused failure to maintain cardiopulmonary bypass while undergoing elective minimally invasive right mini-thoracotomy mitral valve and tricuspid valve repair procedures. During the operation, a decompression laparotomy was needed to relieve elevated intraabdominal pressure that caused instability of the cardiopulmonary bypass. Due to poor oxygenation and the long cardiopulmonary bypass time, the patient required peripheral extracorporeal membrane oxygenation before recovery. We alert surgeons to this rare complication that can occur even in patients undergoing minimally invasive surgery with a right mini-thoracotomy. PMID:26943679

  18. Use of Intraoperative Navigation for Minimally Invasive Retrieval of a Broken Dental Needle.

    PubMed

    Stein, Kyle M

    2015-10-01

    This report describes a case of needle breakage during an inferior alveolar nerve block to perform a restorative dental procedure on a 13-year-old patient. The needle was removed in a minimally invasive fashion using a Medtronic StealthStation S7 surgical navigation system and custom interocclusal splint to allow for stable, identically repeatable positioning of the mandible. This report adds another example of the utility of image-guided surgery for the removal of foreign bodies from the head and neck region in a minimally invasive fashion. PMID:25981862

  19. Single stage minimally invasive bilateral video assisted thoracoscopic surgery for simultaneous bilateral primary spontaneous pneumothorax.

    PubMed

    Sachithanandan, A; Nur Ezrin, I; Badmanaban, B

    2012-04-01

    Simultaneous bilateral spontaneous pneumothorax (SBSP) is a very rare life-threatening condition that requires rapid diagnosis and treatment. Most cases are secondary to various underlying lung pathology but a primary SBSP may occur due to rupture of subpleural blebs or bullae. Surgery via an open or minimally invasive approach provides definitive treatment and can be undertaken as a staged or simultaneous procedure. We report our experience with two such rare cases utilizing a single stage minimally invasive bilateral video assisted thoracoscopic (VATS) approach. The pathogenesis of this rare condition and intra-operative technical considerations for a successful outcome are discussed. PMID:22822653

  20. [Design of minimally invasive surgery wrist institution actuated by shape memory alloy].

    PubMed

    Zhang, Zhenhua; Cao, Tong; Chen, Hua; Liu, Da; Shi, Zhenyun; Ma, Chen

    2013-06-01

    The rapid development of minimally invasive surgery technology requires higher flexibility of surgical treatment and small volume of medical instrument. This paper proposed a new type of minimally invasive surgery wrist institution actuated by TiNi shape memory alloy (SMA) wire. The wrist institution has some advantages such as compact structure, flexible function, light weight, big movement space, and high output position precision. The paper briefly introduces the properties of TiNi SMA and describes the configuration of wrist institution. We also carried out mechanism simulation analysis to the mechanics model and set up kinematics equations, and finally presented the workspace of the institution. PMID:23865329

  1. Field analysis of electro-optic probes for minimally invasive microwave sampling.

    PubMed

    Lee, Dong-Joon; Kwon, Jae-Yong; Kang, No-Weon

    2014-02-10

    We numerically and experimentally investigate the field invasiveness of microwave signals using an electro-optic technique. The distortion of the standing wave voltage and pulse waveform probed by the electro-optic technique is explored through both minimally invasive external and non-invasive internal sensing configurations. First, we analyzed the continuous wave microwave field imaging on a millimeter- scale coaxial transmission line using a highly accurate and stable electro- optic scanning system. The electric field images from the microwave device are attained virtually non-invasively using a miniaturized fiber-coupled electro-optic probe. The accuracy of the field imaging associated with various probe styles is investigated by numerical analysis and experiment. Then, we analyzed the waveform of the coaxial transmission line up to 50 GHz using a pulsed electro-optic system with an external probe set. Finally, the invasive analysis was extended to the sub-millimeter-scale on-wafer coplanar waveguides, where the voltage waveforms are measured using a minimally invasive external probe as well as an internal wafer probe for non-invasive sampling. PMID:24663582

  2. [Adjustable electrohydraulic lithotripsy for minimally invasive ureteroscopic stone treatment].

    PubMed

    Vorreuther, R; Engelking, R

    1992-03-01

    We report on 82 ureteroscopies and electrohydraulic lithotripsies performed with small semirigid ureteroscopes with a minimum outer diameter of 6.5 F and probes of 2.4 F and 3.3 F. Prototypes of new lithotripters were employed, which incorporate infinitely variable energy within a range of 265-1382 mJ per pulse. Increased energy was provided by a rise in voltage, thus modifying the peak pressure and the initial slope of the shock wave. One third of the stones were situated in the upper ureter, 15% in the middle and 46% in the lower ureter. In 54% of these cases previous ESWL (Dornier MFL 5000) had been performed without success. Over 85% of the manipulations were performed under local anesthesia and i.v. sedation. Stone contact was achieved in 99%. Lithotripsy was fully successful in over 90%. The average energy per pulse was 450 mJ. In 7% partial disintegration was achieved and the residual stone was flushed back into the renal pelvis followed by further effective ESWL treatment. One stone had to be removed by open surgery. There were no major complications, such as perforations, due to the electrohydraulic lithotripsy itself. One perforation was caused when the endoscope was advanced into the ureter. No strictures were seen at the 6-month follow-up examination. An indwelling stent was placed in 48% of cases, as the stone burden or an inflamed stone bed suggested this was necessary. We conclude that electrohydraulic lithotripsy with adjustable energy resulting in various peak pressures of the shock wave is a safe and effective method of endoureteral stone treatment. PMID:1561730

  3. Shifting a Paradigm of Cardiac Surgery: From Minimally Invasive to Micro-Invasive.

    PubMed

    D'Onofrio, Augusto; Gerosa, Gino

    2015-09-01

    The development of new techniques for the treatment of almost all structural heart pathologies that do not require cardiopulmonary bypass and aortic cross-clamping, such as transcatheter aortic valve replacement and transapical mitral chordae implantation, define a new age of our specialty: the micro-invasive (microICS) cardiac surgery era. PMID:26897830

  4. Comparing open and minimally invasive surgical procedures for oesophagectomy in the treatment of cancer: the ROMIO (Randomised Oesophagectomy: Minimally Invasive or Open) feasibility study and pilot trial.

    PubMed Central

    Metcalfe, Chris; Avery, Kerry; Berrisford, Richard; Barham, Paul; Noble, Sian M; Fernandez, Aida Moure; Hanna, George; Goldin, Robert; Elliott, Jackie; Wheatley, Timothy; Sanders, Grant; Hollowood, Andrew; Falk, Stephen; Titcomb, Dan; Streets, Christopher; Donovan, Jenny L; Blazeby, Jane M

    2016-01-01

    BACKGROUND Localised oesophageal cancer can be curatively treated with surgery (oesophagectomy) but the procedure is complex with a risk of complications, negative effects on quality of life and a recovery period of 6-9 months. Minimal-access surgery may accelerate recovery. OBJECTIVES The ROMIO (Randomised Oesophagectomy: Minimally Invasive or Open) study aimed to establish the feasibility of, and methodology for, a definitive trial comparing minimally invasive and open surgery for oesophagectomy. Objectives were to quantify the number of eligible patients in a pilot trial; develop surgical manuals as the basis for quality assurance; standardise pathological processing; establish a method to blind patients to their allocation in the first week post surgery; identify measures of postsurgical outcome of importance to patients and clinicians; and establish the main cost differences between the surgical approaches. DESIGN Pilot parallel three-arm randomised controlled trial nested within feasibility work. SETTING Two UK NHS departments of upper gastrointestinal surgery. PARTICIPANTS Patients aged ≥ 18 years with histopathological evidence of oesophageal or oesophagogastric junctional adenocarcinoma, squamous cell cancer or high-grade dysplasia, referred for oesophagectomy or oesophagectomy following neoadjuvant chemo(radio)therapy. INTERVENTIONS Oesophagectomy, with patients randomised to open surgery, a hybrid open chest and minimally invasive abdomen or totally minimally invasive access. MAIN OUTCOME MEASURE The primary outcome measure for the pilot trial was the number of patients recruited per month, with the main trial considered feasible if at least 2.5 patients per month were recruited. RESULTS During 21 months of recruitment, 263 patients were assessed for eligibility; of these, 135 (51%) were found to be eligible and 104 (77%) agreed to participate, an average of five patients per month. In total, 41 patients were allocated to open surgery, 43 to the

  5. Transanal minimally invasive surgery (TAMIS) approach for large juxta-anal gastrointestinal stromal tumour

    PubMed Central

    Wachter, Nicolas; Wörns, Marcus-Alexander; dos Santos, Daniel Pinto; Lang, Hauke; Huber, Tobias; Kneist, Werner

    2016-01-01

    Gastrointestinal stromal tumours (GISTs) are rarely found in the rectum. Large rectal GISTs in the narrow pelvis sometimes require extended abdominal surgery to obtain free resection margins, and it is a challenge to preserve sufficient anal sphincter and urogenital function. Here we present a 56-year-old male with a locally advanced juxta-anal non-metastatic GIST of approximately 10 cm in diameter. Therapy with imatinib reduced the tumour size and allowed partial intersphincteric resection (pISR). The patient underwent an electrophysiology-controlled nerve-sparing hybrid of laparoscopic and transanal minimally invasive surgery (TAMIS) in a multimodal setting. The down-to-up approach provided sufficient dissection plane visualisation and allowed the confirmed nerve-sparing. Lateroterminal coloanal anastomosis was performed. Follow-up showed preserved urogenital function and good anorectal function, and the patient remains disease-free under adjuvant chemotherapy as of 12 months after surgery. This report suggests that the TAMIS approach enables extraluminal high-quality oncological and function-preserving excision of high-risk GISTs. PMID:27279406

  6. Single-port access laparoscopic hysterectomy: a new dimension of minimally invasive surgery.

    PubMed

    Liliana, Mereu; Alessandro, Pontis; Giada, Carri; Luca, Mencaglia

    2011-01-01

    The fundamental idea is to have all of the laparoscopic working ports entering the abdominal wall through the same incision. Single-incision laparoscopic surgery is an alternative to conventional multiport laparoscopy. Single-access laparoscopy using a transumbilical port affords maximum cosmetic benefits because the surgical incision is hidden in the umbilicus and reduces morbidity of minimally invasive surgery. The advantages of single-access laparoscopic surgery may include less bleeding, infection, and hernia formation and better cosmetic outcome and less pain. The disadvantages and limitations include longer surgery time, difficulty in learning the technique, and the need for specialized instruments. This review summarizes the history of SPAL hysterectomy (single-port access laparoscopy), and emphasizes nomenclature, surgical technique, instrumentation, and perioperative outcomes. Specific gynecological applications of single-port hysterectomy to date are summarized. Using the PubMed database, the English-language literature was reviewed for the past 40 years. Keyword searches included scarless, scar free, single-port/trocar/incision, single-port access laparoscopic hysterectomy. Within the bibliography of selected references, additional sources were retrieved. The purpose of the present article was to review the development and current status of SPAL hysterectomy and highlight important advances associated with this innovative approach. PMID:22442528

  7. A minimally invasive immunocytochemical approach to early detection of oral squamous cell carcinoma and dysplasia

    PubMed Central

    Scott, I S; Odell, E; Chatrath, P; Morris, L S; Davies, R J; Vowler, S L; Laskey, R A; Coleman, N

    2006-01-01

    Squamous dysplasia of the oral cavity indicates increased risk of progression to squamous cell carcinoma (SCC). An important advance would be the development of a minimally invasive assay for identification of oral SCC and dysplasia. We have investigated the suitability in this context of immunostaining oral smears for minichromosome maintainance proteins (MCMs), sensitive and specific biomarkers of cell cycle entry. Immunohistochemical examination of 66 oral tissue samples showed a greater frequency of Mcm-2 expression in surface layers of moderate/severe dysplasia and SCC compared to benign keratosis/mild dysplasia. Immunocytochemistry for Mcm-2/Mcm-5 was performed on 101 oral smears. Conventional smears included 23 from normal mucosa, benign proliferative disease and mild dysplasia, all of which were MCM negative. Of 52 conventional smears of SCC tissue samples, 18 were inadequate. However, MCM-positive cells were present in 33/34 adequate samples. Of 26 liquid-based cytology smears, 19 out of 20 smears from SCC were adequate and all were MCM positive. Six smears from benign lesions were adequate and MCM negative. We conclude that MCMs are promising markers for early detection of oral SCC and dysplasia, particularly in a liquid-based cytology platform. Detection of MCMs would be amenable to automation and potentially applicable in the developing world. Further studies are now warranted. PMID:16622441

  8. Major venous resection and reconstruction using a minimally invasive approach during laparoscopic pancreaticoduodenectomy: One step forward.

    PubMed

    Palanisamy, Senthilnathan; Deuri, Biswajit; Naidu, Subrahmaneswara Babu; Vaiyapurigoundar Palanisamy, Nalankilli; Natesan, Anand Vijay; Palanivelu, Praveen Raj; Parthasarathy, Ramakrishnan; Palanivelu, Chinnusamy

    2015-11-01

    In the current era of technological advancement, the feasibility of laparoscopic pancreaticoduodenectomy has been established. However, major venous resection and reconstruction along with laparoscopic pancreaticoduodenectomy is still considered a complex procedure. A 47-year-old woman presented with obstructive jaundice secondary to carcinoma in the pancreatic head. Triphasic abdominal CT revealed a 2.7 × 3.0-cm heterogenous mass in the pancreatic head with peripancreatic lymphadenopathy without vascular involvement. The patient was scheduled for laparoscopic pancreaticoduodenectomy. During mobilization, the tumor was found adherent to the superior mesenteric vein. Therefore, vascular resection and reconstruction was accomplished laparoscopically along with pancreaticoduodenectomy. The duration of superior mesenteric vein occlusion was 45 min. The patient had an uneventful recovery and was discharged on postoperative day 10. Major venous resection and reconstruction during laparoscopic pancreaticoduodenectomy using a minimally invasive approach is feasible in selected patients. Adequate experience in complex laparoscopic pancreatic surgery is required before attempting this procedure. PMID:26708588

  9. Anesthetic challenges in minimally invasive cardiac surgery: Are we moving in a right direction?

    PubMed Central

    Malik, Vishwas; Jha, Ajay Kumar; Kapoor, Poonam Malhotra

    2016-01-01

    Continuously growing patient's demand, technological innovation, and surgical expertise have led to the widespread popularity of minimally invasive cardiac surgery (MICS). Patient's demand is being driven by less surgical trauma, reduced scarring, lesser pain, substantially lesser duration of hospital stay, and early return to normal activity. In addition, MICS decreases the incidence of postoperative respiratory dysfunction, chronic pain, chest instability, deep sternal wound infection, bleeding, and atrial fibrillation. Widespread media coverage, competition among surgeons and hospitals, and their associated brand values have further contributed in raising awareness among patients. In this process, surgeons and anesthesiologist have moved from the comfort of traditional wide incision surgeries to more challenging and intensively skilled MICS. A wide variety of cardiac lesions, techniques, and approaches coupled with a significant learning curve have made the anesthesiologist's job a challenging one. Anesthesiologists facilitate in providing optimal surgical settings beginning with lung isolation, confirmation of diagnosis, cannula placement, and cardioplegia delivery. However, the concern remains and it mainly relates to patient safety, prolonged intraoperative duration, and reduced surgical exposure leading to suboptimal treatment. The risk of neurological complications, aortic injury, phrenic nerve palsy, and peripheral vascular thromboembolism can be reduced by proper preoperative evaluation and patient selection. Nevertheless, advancement in surgical instruments, perfusion practices, increasing use of transesophageal echocardiography, and accumulating experience of surgeons and anesthesiologist have somewhat helped in amelioration of these valid concerns. A patient-centric approach and clear communication between the surgeon, anesthesiologist, and perfusionist are vital for the success of MICS. PMID:27397454

  10. Minimally Invasive Approach to the Repair of Injured Skeletal Muscle With a Shape-memory Scaffold

    PubMed Central

    Wang, Lin; Cao, Lan; Shansky, Janet; Wang, Zheng; Mooney, David; Vandenburgh, Herman

    2014-01-01

    Repair of injured skeletal muscle by cell therapies has been limited by poor survival of injected cells. Use of a carrier scaffold delivering cells locally, may enhance in vivo cell survival, and promote skeletal muscle regeneration. Biomaterial scaffolds are often implanted into muscle tissue through invasive surgeries, which can result in trauma that delays healing. Minimally invasive approaches to scaffold implantation are thought to minimize these adverse effects. This hypothesis was addressed in the context of a severe mouse skeletal muscle injury model. A degradable, shape-memory alginate scaffold that was highly porous and compressible was delivered by minimally invasive surgical techniques to injured tibialis anterior muscle. The scaffold controlled was quickly rehydrated in situ with autologous myoblasts and growth factors (either insulin-like growth factor-1 (IGF-1) alone or IGF-1 with vascular endothelial growth factor (VEGF)). The implanted scaffolds delivering myoblasts and IGF-1 significantly reduced scar formation, enhanced cell engraftment, and improved muscle contractile function. The addition of VEGF to the scaffold further improved functional recovery likely through increased angiogenesis. Thus, the delivery of myoblasts and dual local release of VEGF and IGF-1 from degradable scaffolds implanted through a minimally invasive procedure effectively promoted the functional regeneration of injured skeletal muscle. PMID:24769909

  11. Traumatic Hallux Varus Treated by Minimally Invasive Extensor Hallucis Brevis Tenodesis

    PubMed Central

    Cheung, C. N.; Lui, T. H.

    2015-01-01

    A case of traumatic hallux varus due to avulsion fracture of the lateral side of the base of proximal phalanx was reported. The lateral instability of the first metatarsophalangeal joint was believed to be due to the disruption of adductor hallucis function. It was successfully managed by minimally invasive extensor hallucis brevis tenodesis. PMID:26793399

  12. Lung herniation secondary to minimally invasive direct coronary artery bypass grafting.

    PubMed

    Deeik, R K; Memon, M A; Sugimoto, J T

    1998-06-01

    Lung herniation after thoracotomy is rare. We report a 66-year-old man who presented with this complication after undergoing attempted minimally invasive direct coronary artery bypass grafting. The defect was repaired with a composite of Marlex mesh and methyl methacrylate. PMID:9647101

  13. Application of the Flexible CO2 Laser in Minimally Invasive Laminectomies: Technical Note

    PubMed Central

    Perez-Cruet, Mick

    2016-01-01

    Background Minimally invasive laminectomy is a very effective surgical method for treating lumbar stenosis. However, this technique can be technically difficult, especially in patients suffering from severe stenosis. The contralateral decompression from a unilateral approach can result in durotomy during removal of the hypertrophied ligamentum flavum. This complication can be difficult to treat through a small working channel. Objective To detail our group’s operative experience with the CO2 laser and discuss our results and previous studies in the literature reporting results.  Methods The CO2 laser (Omniguide, Boston, MA) was investigated in the surgical ablation of the contralateral ligamentum flavum during minimally invasive laminectomies. Forty levels have been investigated thus far. The amount of voltage needed to adequately desiccate and remove the ligamentum flavum safely as well as the effectiveness of this technique were investigated. Results The contralateral ligamentum flavum could be removed effectively using the 9 to 11 watt continuous wavelength (10,600 nanometer) power setting on the CO2 laser. Shrinkage of the contralateral ligamentum flavum facilitated its removal using a number 2 Kerrison Punch. No durotomies occurred, and the use of the laser did not significantly lengthen operative times.  Conclusions The CO2 laser appears to be a useful tool in the armamentarium of instruments available to the minimally invasive spine surgeon and may help to reduce the incidence of durotomies when performing minimally invasive laminectomies. PMID:27433407

  14. Minimally Invasive Mitral Valve Repair in a Marfan Patient with Severe Scoliokyphosis

    PubMed Central

    Noack, Thilo; Lehmkuhl, Lukas; Seeburger, Joerg; Mohr, Friedrich Wilhelm

    2014-01-01

    A 26-year-old female Marfan patient with extensive scoliokyphosis presented with severe mitral valve regurgitation. The patient was treated with minimally invasive mitral valve repair via a right lateral minithoracotomy. In this report, we discuss the operative procedure followed in this special case and the current literature. PMID:25798347

  15. Application of the Flexible CO2 Laser in Minimally Invasive Laminectomies: Technical Note.

    PubMed

    Hussain, Namath S; Perez-Cruet, Mick

    2016-01-01

    Background Minimally invasive laminectomy is a very effective surgical method for treating lumbar stenosis. However, this technique can be technically difficult, especially in patients suffering from severe stenosis. The contralateral decompression from a unilateral approach can result in durotomy during removal of the hypertrophied ligamentum flavum. This complication can be difficult to treat through a small working channel. Objective To detail our group's operative experience with the CO2 laser and discuss our results and previous studies in the literature reporting results.  Methods The CO2 laser (Omniguide, Boston, MA) was investigated in the surgical ablation of the contralateral ligamentum flavum during minimally invasive laminectomies. Forty levels have been investigated thus far. The amount of voltage needed to adequately desiccate and remove the ligamentum flavum safely as well as the effectiveness of this technique were investigated. Results The contralateral ligamentum flavum could be removed effectively using the 9 to 11 watt continuous wavelength (10,600 nanometer) power setting on the CO2 laser. Shrinkage of the contralateral ligamentum flavum facilitated its removal using a number 2 Kerrison Punch. No durotomies occurred, and the use of the laser did not significantly lengthen operative times.  Conclusions The CO2 laser appears to be a useful tool in the armamentarium of instruments available to the minimally invasive spine surgeon and may help to reduce the incidence of durotomies when performing minimally invasive laminectomies. PMID:27433407

  16. Degradable Magnetic Composites for Minimally Invasive Interventions: Device Fabrication, Targeted Drug Delivery, and Cytotoxicity Tests.

    PubMed

    Peters, Christian; Hoop, Marcus; Pané, Salvador; Nelson, Bradley J; Hierold, Christofer

    2016-01-20

    Superparamagnetic nanoparticles and a functional, degradable polymer matrix based on poly(ethylene glycol) are combined to enable fully degradable magnetic microdevices for minimally invasive biomedical applications. A bioinspired helical microrobot platform mimicking Escherichia coli bacteria is fabricated and actuated using weak rotating magnetic fields. Locomotion based on corkscrew propulsion, targeted drug delivery, and low-degradation-product cytotoxicity are demonstrated. PMID:26603856

  17. Morcellation and myomas: Balancing decisions around minimally invasive treatments for fibroids.

    PubMed

    Siedhoff, Matthew T; Kim, Kenneth H

    2015-12-01

    Minimally invasive surgery (MIS) is increasingly being used to treat uterine fibroids because of the significant patient and societal benefits of these techniques over traditional laparotomy. Morcellation affords the removal of large fibroids in MIS but carries the risk of disseminating occult malignant tissue. The benefits of MIS for treating fibroids must be carefully weighed against its risks of morcellation. PMID:26768314

  18. A comparison of the hospital costs of open vs. minimally invasive surgical management of necrotizing pancreatitis

    PubMed Central

    Beenen, Edwin; Brown, Lisa; Connor, Saxon

    2011-01-01

    Background Infected necrotizing pancreatitis is a major burden for both the patient and the health care system. Little is known about how hospital costs break down and how they may have shifted with the increasing use of minimally invasive techniques. The aim of this study was to analyse inpatient hospital costs associated with pancreatic necrosectomy. Methods A prospective database was used to identify all patients who underwent an intervention for necrotizing pancreatitis. Costs of treatment were calculated using detailed information from the Decision Support Department. Costs for open and minimally invasive surgical modalities were compared. Results Twelve open and 13 minimally invasive necrosectomies were performed in a cohort of 577 patients presenting over a 50-month period. One patient in each group died in hospital. Overall median stay was 3.8 days in the intensive care unit (ICU) and 44 days on the ward. The median overall treatment cost was US$56 674. The median largest contributors to this total were ward (26.3%), surgical personnel (22.3%) and ICU (17.0%) costs. These did not differ statistically between the two treatment modalities. Conclusions Pancreatic necrosectomy uses considerable health care resources. Minimally invasive techniques have not been shown to reduce costs. Any intervention that can reduce the length of hospital and, in particular, ICU stay by reducing the incidence of organ failure or by preventing secondary infection is likely to be cost-effective. PMID:21309935

  19. Effects of Camera Arrangement on Perceptual-Motor Performance in Minimally Invasive Surgery

    ERIC Educational Resources Information Center

    Delucia, Patricia R.; Griswold, John A.

    2011-01-01

    Minimally invasive surgery (MIS) is performed for a growing number of treatments. Whereas open surgery requires large incisions, MIS relies on small incisions through which instruments are inserted and tissues are visualized with a camera. MIS results in benefits for patients compared with open surgery, but degrades the surgeon's perceptual-motor…

  20. Minimally invasive management of intrahepatic type II gallbladder perforation: a case report

    PubMed Central

    Alshammari, Dheidan; Tzedakis, Stylianos; Hargat, Julie; Mutter, Didier; Marescaux, Jacques; Pessaux, Patrick

    2016-01-01

    Intrahepatic gallbladder perforation (GBP) is a rare medical entity, which creates a cholecystohepatic communication. We describe the case of a 70-year-old patient who presented with abdominal pain and a Niemeier type II GBP. This case report illustrates the minimally invasive management of a rare and life-threatening pathology. PMID:26904560

  1. Minimally Invasive Techniques to Accelerate the Orthodontic Tooth Movement: A Systematic Review of Animal Studies

    PubMed Central

    Qamruddin, Irfan; Alam, Mohammad Khursheed; Khamis, Mohd Fadhli; Husein, Adam

    2015-01-01

    Objective. To evaluate various noninvasive and minimally invasive procedures for the enhancement of orthodontic tooth movement in animals. Materials and Methods. Literature was searched using NCBI (PubMed, PubMed Central, and PubMed Health), MedPilot (Medline, Catalogue ZB MED, Catalogue Medicine Health, and Excerpta Medica Database (EMBASE)), and Google Scholar from January 2009 till 31 December 2014. We included original articles related to noninvasive and minimally invasive procedures to enhance orthodontic tooth movement in animals. Extraction of data and quality assessments were carried out by two observers independently. Results. The total number of hits was 9195 out of which just 11 fulfilled the inclusion criteria. Nine articles were good and 5 articles were moderate in quality. Low level laser therapy (LLLT) was among the most common noninvasive techniques whereas flapless corticision using various instruments was among the commonest minimally invasive procedures to enhance velocity of tooth movement. Conclusions. LLLT, low intensity pulsed ultrasound (LIPUS), mechanical vibration, and flapless corticision are emerging noninvasive and minimally invasive techniques which need further researches to establish protocols to use them clinically with conviction. PMID:26881201

  2. Comparison of minimally invasive transspinous and open approaches for thoracolumbar intradural-extramedullary spinal tumors.

    PubMed

    Raygor, Kunal P; Than, Khoi D; Chou, Dean; Mummaneni, Praveen V

    2015-08-01

    OBJECT Spinal tumor resection has historically been performed via open approaches, although minimally invasive approaches have recently been found to be effective in small cohort series. The authors compare surgical characteristics and clinical outcomes of surgery in patients undergoing mini-open and open approaches for intradural-extramedullary tumor resection. METHODS The authors retrospectively reviewed 65 consecutive intradural-extramedullary tumor resections performed at their institution from 2007 to 2014. Patients with cervical tumors or pathology demonstrating neurofibroma were excluded (n = 14). The nonparametric Mann-Whitney U-test and Pearson chi-square test were used to compare continuous and categorical variables, respectively. Statistical analyses were performed using SPSS, with significance set at p < 0.05. RESULTS Fifty-one thoracolumbar intradural-extramedullary tumor resections were included; 25 were performed via the minimally invasive transspinous approach. There were no statistically significant differences in age, sex, body mass index, preoperative American Spinal Injury Association (ASIA) score, preoperative symptom duration, American Society of Anesthesiologists (ASA) physical status class, tumor size, or tumor location. There was no statistically significant difference between groups with respect to the duration of the operation or extent of resection, but the mean estimated blood loss was significantly lower in the minimally invasive surgery (MIS) cohort (142 vs 320 ml, p < 0.05). In each group, the 2 most common tumor pathologies were schwannoma and meningioma. There were no statistically significant differences in length of hospitalization, ASIA score improvement, complication rate, or recurrence rate. The mean duration of follow-up was 2 years for the MIS group and 1.6 years for the open surgery group. CONCLUSIONS This is one of the largest comparisons of minimally invasive and open approaches to the resection of thoracolumbar

  3. [NEW SURGICAL APPROACH IN PRIMARY OPEN-ANGLE GLAUCOMA: XEN GEL STENT A MINIMALLY INVASIVE TECHNIQUE].

    PubMed

    Dupont, G; Collignon, N

    2016-02-01

    Primary open-angle glaucoma is a progressive ocular disease affecting adults and associated with visual field defect. The aim of its treatment is to lower the ocular pressure by means of ocular drops, laser or surgery. To date, traditional surgical techniques still remain quite invasive, but recent research efforts have been made with a view to develop minimally invasive techniques. The Xen Gel Stent is one of them. It allows a safe and efficient lowering of ocular pressure by creating a sub-conjunctival flow, following an ab interno procedure that highly preserves the architecture of the treated eye. PMID:27141652

  4. Complications of Minimally Invasive, Tubular Access Surgery for Cervical, Thoracic, and Lumbar Surgery

    PubMed Central

    Ross, Donald A.

    2014-01-01

    The object of the study was to review the author's large series of minimally invasive spine surgeries for complication rates. The author reviewed a personal operative database for minimally access spine surgeries done through nonexpandable tubular retractors for extradural, nonfusion procedures. Consecutive cases (n = 1231) were reviewed for complications. There were no wound infections. Durotomy occurred in 33 cases (2.7% overall or 3.4% of lumbar cases). There were no external or symptomatic internal cerebrospinal fluid leaks or pseudomeningoceles requiring additional treatment. The only motor injuries were 3 C5 root palsies, 2 of which resolved. Minimally invasive spine surgery performed through tubular retractors can result in a low wound infection rate when compared to open surgery. Durotomy is no more common than open procedures and does not often result in the need for secondary procedures. New neurologic deficits are uncommon, with most observed at the C5 root. Minimally invasive spine surgery, even without benefits such as less pain or shorter hospital stays, can result in considerably lower complication rates than open surgery. PMID:25097785

  5. Accidental Durotomy in Minimally Invasive Transforaminal Lumbar Interbody Fusion: Frequency, Risk Factors, and Management

    PubMed Central

    Volz, Florian; Krüger, Marie T.; Kogias, Evangelos; Rölz, Roland; Sircar, Ronen; Hubbe, Ulrich

    2015-01-01

    Purpose. To assess the frequency, risk factors, and management of accidental durotomy in minimally invasive transforaminal lumbar interbody fusion (MIS TLIF). Methods. This single-center study retrospectively investigates 372 patients who underwent MIS TLIF and were mobilized within 24 hours after surgery. The frequency of accidental durotomies, intraoperative closure technique, body mass index, and history of previous surgery was recorded. Results. We identified 32 accidental durotomies in 514 MIS TLIF levels (6.2%). Analysis showed a statistically significant relation of accidental durotomies to overweight patients (body mass index ≥25 kg/m2; P = 0.0493). Patient age older than 65 years tended to be a positive predictor for accidental durotomies (P = 0.0657). Mobilizing patients on the first postoperative day, we observed no durotomy-associated complications. Conclusions. The frequency of accidental durotomies in MIS TLIF is low, with overweight being a risk factor for accidental durotomies. The minimally invasive approach seems to minimize durotomy-associated complications (CSF leakage, pseudomeningocele) because of the limited dead space in the soft tissue. Patients with accidental durotomy can usually be mobilized within 24 hours after MIS TLIF without increased risk. The minimally invasive TLIF technique might thus be beneficial in the prevention of postoperative immobilization-associated complications such as venous thromboembolism. This trial is registered with DRKS00006135. PMID:26075294

  6. Simultaneous Minimally Invasive Treatment of Colorectal Neoplasm with Synchronous Liver Metastasis

    PubMed Central

    Garritano, Stefano; Selvaggi, Federico; Spampinato, Marcello Giuseppe

    2016-01-01

    Purpose. To analyse perioperative and oncological outcomes of minimally invasive simultaneous resection of primary colorectal neoplasm with synchronous liver metastases. Methods. A Medline revision of the current published literature on laparoscopic and robotic-assisted combined colectomy with hepatectomy for synchronous liver metastatic colorectal neoplasm was performed until February 2015. The specific search terms were “liver metastases”, “hepatic metastases”, “colorectal”, “colon”, “rectal”, “minimally invasive”, “laparoscopy”, “robotic-assisted”, “robotic colorectal and liver resection”, “synchronous”, and “simultaneous”. Results. 20 clinical reports including 150 patients who underwent minimally invasive one-stage procedure were retrospectively analysed. No randomized trials were found. The approach was laparoscopic in 139 patients (92.7%) and robotic in 11 cases (7.3%). The rectum was the most resected site of primary neoplasm (52.7%) and combined liver procedure was in 89% of cases a minor liver resection. One patient (0.7%) required conversion to open surgery. The overall morbidity and mortality rate were 18% and 1.3%, respectively. The most common complication was colorectal anastomotic leakage. Data concerning oncologic outcomes were too heterogeneous in order to gather definitive results. Conclusion. Although no prospective randomized trials are available, one-stage minimally invasive approach seems to show advantages over conventional surgery in terms of postoperative short-term course. On the contrary, more studies are required to define the oncologic values of the minimally invasive combined treatment. PMID:27294144

  7. Endoscopic-assisted minimally invasive resection of a papillary muscle blood cyst in an adult patient.

    PubMed

    Okamoto, Kazuma; Kudo, Mikihiko; Hayashi, Kanako; Shimizu, Hideyuki

    2016-02-01

    We describe endoscopic-assisted minimally invasive resection of a blood cyst originating from the papillary muscle that caused severe mitral regurgitation and necessitated mitral valve replacement in an active adult woman, as well as a review of the relevant literature. An endoscopic view increases the visibility of the surgical target and facilitates a precise observation of the tumour and dissection at the appropriate layer. The On-X mechanical valve was chosen for mitral valve repair to minimize thromboembolic risk. This patient additionally benefited from endoscopic-assisted right minithoracotomy in terms of both cosmetic and functional aspects. PMID:26586675

  8. Time-to-administration in postoperative chemotherapy for colorectal cancer: does minimally-invasive surgery help?

    PubMed

    Amore Bonapasta, Stefano; Checcacci, Paolo; Guerra, Francesco; Mirasolo, Vita M; Moraldi, Luca; Ferrara, Angelo; Annecchiarico, Mario; Coratti, Andrea

    2016-06-01

    The optimal delay in the start of chemotherapy following rectal cancer surgery has not yet been identified. However, postponed adjuvant therapy has been proven to be connected with a significant survival detriment. We aimed to investigate whether the time to initiation of adjuvant treatment can be influenced by the application of minimally invasive surgery rather than traditional open surgery. By comprehensively evaluating the available inherent literature, several factors appear to be associated with delayed postoperative chemotherapy. Some of them are strictly related to surgical short-term outcomes. Laparoscopy results in shortened length of hospital stay, reduced surgical morbidity and lower rate of wound infection compared to conventional surgery. Probably due to such advantages, the application of minimally-invasive surgery to treat rectal malignancies seems to impact favorably the possibility to start adjuvant chemotherapy within an adequate timeframe following surgical resection, with potential improvement in patient survival. PMID:26976732

  9. Esthetic rehabilitation of a worn dentition with a minimally invasive prosthetic procedure (MIPP).

    PubMed

    Fradeani, Mauro; Barducci, Giancarlo; Bacherini, Leonardo

    2016-01-01

    A minimally invasive prosthetic procedure (MIPP) for the esthetic rehabilitation of the complete arch advocates the preservation of enamel to optimize the adhesive bond of the luting agent to both the tooth surface and the etchable ceramic restoration. When esthetic rehabilitation of a worn dentition is required, a MIPP can be selected to reduce the biological cost of removing additional enamel tooth structure. The fundamental steps to achieve this goal are to: (1) increase the vertical dimension of occlusion (VDO); (2) reduce the thickness of the monolithic ceramic material; (3) preserve the enamel during tooth preparation; and (4) adhesively bond the etchable ceramic restorations. This article presents a comprehensive, minimally invasive prosthetic treatment approach for the esthetic rehabilitation of a severely worn dentition using a lithium disilicate all-ceramic material with partial and complete coverage restorations. PMID:26835522

  10. Minimally invasive percutaneous cystostomy with ureteroscopic pneumatic lithotripsy for calculus in bladder diverticula

    PubMed Central

    GU, SI-PING; YOU, ZHI-YUAN; HUANG, YUNTENG; LU, YI-JIN; HE, CAOHUI; CAI, XIAO-DONG; ZHOU, XIAO-MING

    2013-01-01

    The aim of this study was to investigate the effectiveness of minimally invasive percutaneous cystostomy with ureteroscopic pneumatic lithotripsy for treating calculus in bladder diverticula. Percutaneous cystostomy with ureteroscopic pneumatic lithotripsy was performed on six elderly male patients with calculi in bladder diverticula, who could not be treated with transurethral ureteroscopic lithotripsy. The stones were successfully removed from all patients, with no complications such as bladder perforation, rupture, urethritis or cystitis. The surgery time was 15–60 min, with an average time of 32 min. Postoperative ultrasound or X-ray examination showed no stone residues and the bladder stoma healed well. No recurrent stones were detected in the follow-up of 3–24 months (average, 16 months). Minimally invasive percutaneous cystostomy with ureteroscopic pneumatic lithotripsy is a safe, efficient and easy treatment for calculus in bladder diverticula. This method provides a new clinical approach for lithotripsy and we suggest that it is worthy of wider use. PMID:23837044

  11. Gastrointestinal Endoscopy-Assisted Minimally Invasive Surgery for Superficial Cancer of the Uvula

    PubMed Central

    Odagiri, Hiroyuki; Iizuka, Toshiro; Kikuchi, Daisuke; Kaise, Mitsuru; Takeda, Hidehiko; Ohashi, Kenichi; Yasunaga, Hideo

    2016-01-01

    Previous studies reported that endoscopic resection is effective for the treatment of superficial pharyngeal cancers, as for digestive tract cancers. However, the optimal treatment for superficial cancer of the uvula has not been established because of the rarity of this condition. We present two male patients in their 70s with superficial cancer of the uvula, detected with upper gastrointestinal endoscopy. Both patients underwent surgical resection of the uvula under general anesthesia. The extent of the lesions was determined by means of gastrointestinal endoscopy by using magnifying observation with narrow-band imaging, enabling the performance of minimally invasive surgery. Endoscopic submucosal dissection was performed to achieve en bloc resection of the intramucosal carcinoma that had infiltrated the area adjacent to the uvula. Gastrointestinal endoscopists should carefully examine the laryngopharynx to avoid missing superficial cancers. Our minimally invasive treatment for superficial cancer of the uvula had favorable postoperative outcomes, and prevented postoperative loss of breathing, swallowing, and articulation functions. PMID:27040382

  12. The evolution of minimally invasive thoracic surgery: implications for the practice of uniportal thoracoscopic surgery

    PubMed Central

    2014-01-01

    The history of Minimally Invasive Surgery in the thorax is one of evolution, not revolution. The concept of video-assisted thoracic surgery (VATS) to greatly reduce the trauma of chest operations was born over two decades ago. Since then, it has undergone a series of step-wise modifications and improvement. The original practice of three access ports in a ‘baseball diamond’ pattern was modified to suit operational needs, and gradually developed into ‘next generation’ approaches, including Needlescopic and 2-port VATS. The logical, incremental progression has culminated in the Uniportal VATS approach which has stirred considerable interest within the field of Thoracic Surgery in recent years. This measured, evolutionary process has significant implications on how the surgeon should approach, master and realize the full potential of the Uniportal technique. This article gives a précis of the evolutionary history of minimally invasive thoracic surgery, and highlights the lessons it provides about its future. PMID:25379198

  13. Virtual and augmented medical imaging environments: enabling technology for minimally invasive cardiac interventional guidance.

    PubMed

    Linte, Cristian A; White, James; Eagleson, Roy; Guiraudon, Gérard M; Peters, Terry M

    2010-01-01

    Virtual and augmented reality environments have been adopted in medicine as a means to enhance the clinician's view of the anatomy and facilitate the performance of minimally invasive procedures. Their value is truly appreciated during interventions where the surgeon cannot directly visualize the targets to be treated, such as during cardiac procedures performed on the beating heart. These environments must accurately represent the real surgical field and require seamless integration of pre- and intra-operative imaging, surgical tracking, and visualization technology in a common framework centered around the patient. This review begins with an overview of minimally invasive cardiac interventions, describes the architecture of a typical surgical guidance platform including imaging, tracking, registration and visualization, highlights both clinical and engineering accuracy limitations in cardiac image guidance, and discusses the translation of the work from the laboratory into the operating room together with typically encountered challenges. PMID:22275200

  14. Minimally Invasive Vacuum-Assisted Closure Therapy With Instillation (Mini-VAC-Instill) for Pleural Empyema.

    PubMed

    Hofmann, Hans-Stefan; Neu, Reiner; Potzger, Tobias; Schemm, Rudolf; Grosser, Christian; Szöke, Tamas; Sziklavari, Zsolt

    2015-06-01

    Enthusiasm for minimally invasive thoracic surgery is increasing. Thoracoscopy plays a significant therapeutic role in the fibrinopurulent stage (stage II) of empyema, in which loculated fluid cannot often be adequately drained by chest tube alone. For some debilitated and septic patients, further procedures such as open-window thoracostomy (OWT) with daily wound care or vacuum-assisted closure (VAC) therapy are necessary. In the present article, we propose a new option of minimally invasive VAC therapy including a topical solution of the empyema without open-window thoracostomy (Mini-VAC-instill). Three patients who underwent surgery using this technique are also presented. The discussion is focused on the advantages and disadvantages of the approach. PMID:25049317

  15. Nuclear Imaging and Minimally Invasive Surgery in the Management of Hyperparathyroidism*

    PubMed Central

    Judson, Benjamin L.; Shaha, Ashok R.

    2013-01-01

    Primary hyperparathyroidism is the most common cause of hypercalcemia, and the treatment is primarily surgical. Because of biochemical screening, more patients now present with asymptomatic primary hyperparathyroidism, and consensus guidelines have been developed for the treatment of these patients. There is now considerable interest in minimally invasive approaches to the treatment of hyperparathyroidism. Sestamibi scanning as a localizing study, used in combination with anatomic imaging and intraoperative rapid parathyroid hormone assays, has enabled focused surgical approaches. Patients with localizing studies that indicate a single parathyroid adenoma are candidates for such approaches, including unilateral neck exploration, minimally invasive single-gland exploration, or endoscopic exploration instead of the traditional approach of bilateral neck exploration. Nuclear imaging is also critical to the successful management of patients with persistent or recurrent hyperparathyroidism. PMID:18927330

  16. Laser radiation in tennis elbow treatment: a new minimally invasive alternative

    NASA Astrophysics Data System (ADS)

    Paganini, Stefan; Thal, Dietmar R.; Werkmann, Klaus

    1998-01-01

    The epicondylitis humeri radialis (EHR) (tennis elbow), is a common disease in elbow joint pain syndromes. We treated patients with chronic pain for at least one year and no improvement with conservative or operative therapies with a new minimal invasive method, the EHR-Laser radiation (EHR- LR). With this method periepicondylar coagulations were applied to the trigger points of the patients. For this the previously established technique of facet joint coagulation with the Nd:Yag-laser was modified. In a follow-up study of between 6 weeks and 2 years all patients reported either a significant pain reduction or were symptom free. EHR-LR is a new method situated between conservative and surgical treatments for minimal invasive therapy of EHR. Several therapeutic rationales were discussed for the resulting pain reduction.

  17. Novel Wireless-Communicating Textiles Made from Multi-Material and Minimally-Invasive Fibers

    PubMed Central

    Gorgutsa, Stepan; Bélanger-Garnier, Victor; Ung, Bora; Viens, Jeff; Gosselin, Benoit; LaRochelle, Sophie; Messaddeq, Younes

    2014-01-01

    The ability to integrate multiple materials into miniaturized fiber structures enables the realization of novel biomedical textile devices with higher-level functionalities and minimally-invasive attributes. In this work, we present novel textile fabrics integrating unobtrusive multi-material fibers that communicate through 2.4 GHz wireless networks with excellent signal quality. The conductor elements of the textiles are embedded within the fibers themselves, providing electrical and chemical shielding against the environment, while preserving the mechanical and cosmetic properties of the garments. These multi-material fibers combine insulating and conducting materials into a well-defined geometry, and represent a cost-effective and minimally-invasive approach to sensor fabrics and bio-sensing textiles connected in real time to mobile communications infrastructures, suitable for a variety of health and life science applications. PMID:25325335

  18. Transthoracic minimally invasive closure for the treatment of ruptured sinus of Valsalva Aneurysm: a case report

    PubMed Central

    2014-01-01

    Ruptured sinus of the valsalva aneurysm (RSVA ) is a rare cardiac anomaly. Nearly 80% of patients will have symptom when RSVA ruptures into one of the cardiac chambers. The conventional treatment of RSVA is surgical repair under cardio-pulmonary bypass (CPB) or percutaneous catheter closure. Here, we present one case of RSVA undergo transthoracic minimally invasive closure, which is a novel methods for the treatment of RSVA. We describe a thirty four-year-old Asian man with chest pain and palpitation for 3 days. Echocardiography showed that RSVA presented in the right coronary cusp. The sinus opened into the right atrium, and the diameter of the opening was 5 mm. The opening was successfully closed by transthoracic minimally invasive closure with a ventricular septal defect (VSD) occluder. PMID:24506848

  19. Minimally invasive single-site surgery for the digestive system: A technological review

    PubMed Central

    Dhumane, Parag W; Diana, Michele; Leroy, Joel; Marescaux, Jacques

    2011-01-01

    Minimally Invasive Single Site (MISS) surgery is a better terminology to explain the novel concept of scarless surgery, which is increasingly making its way into clinical practice. But, there are some difficulties. We review the existing technologies for MISS surgery with regards to single-port devices, endoscope and camera, instruments, retractors and also the future perspectives for the evolution of MISS surgery. While we need to move ahead cautiously and wait for the development of appropriate technology, we believe that the “Ultimate form of Minimally Invasive Surgery” will be a hybrid form of MISS surgery and Natural Orifice Transluminal Endoscopic Surgery, complimented by technological innovations from the fields of robotics and computer-assisted surgery. PMID:21197242

  20. Minimally invasive space shuttle laminotomy for degenerative lumbar spinal canal stenosis

    PubMed Central

    Asamoto, Shunji; Muto, Jun; Jimbo, Hiroyuki

    2016-01-01

    Study Design: Technical note. Objectives: To show microsurgical technique, considering the meticulous anatomy of the ligamentum flavum (LF). Background: Different methods are available for treating lumbar spinal canal stenosis (LSCS). A minimally invasive surgery, namely, space shuttle laminotomy, has recently been proposed. Here, we describe the surgical method for this novel technique. To conduct this surgery accurately, surgeons must have perfect knowledge of anatomy, especially regarding the LF. Materials and Methods and Results: We use this interlaminectomy technique for all cases of LSCS. All patients with LSCS recovered from their neurological deficits in shorter hoslital stays than regular laminectomy. Conclusion: Minimally invasive space shuttle laminotomy (MISSL), which involves a microsurgical technique, is a safe, complication-free procedure. PMID:27041887

  1. Minimally invasive arthrodesis for chronic sacroiliac joint dysfunction using the SImmetry SI Joint Fusion system.

    PubMed

    Miller, Larry E; Block, Jon E

    2014-01-01

    Chronic sacroiliac (SI) joint-related low back pain (LBP) is a common, yet under-diagnosed and undertreated condition due to difficulties in accurate diagnosis and highly variable treatment practices. In patients with debilitating SI-related LBP for at least 6 months duration who have failed conservative management, arthrodesis is a viable option. The SImmetry(®) SI Joint Fusion System is a novel therapy for SI joint fusion, not just fixation, which utilizes a minimally invasive surgical approach, instrumented fixation for immediate stability, and joint preparation with bone grafting for a secure construct in the long term. The purpose of this report is to describe the minimally invasive SI Joint Fusion System, including patient selection criteria, implant characteristics, surgical technique, postoperative recovery, and biomechanical testing results. Advantages and limitations of this system will be discussed. PMID:24851059

  2. Minimally invasive surgical techniques in the management of differentiated thyroid cancer

    PubMed Central

    Tucker, N.; Mitchem, J.; Gillanders, W.

    2015-01-01

    Thyroid cancer is the fifth most common cancer in women with approximately 60,220 expected new cases in the United States in 2013, and the incidence continues to increase each year. Fortunately, the majority are well-differentiated thyroid cancers with excellent overall prognosis. Controversy persists regarding the optimal surgical management of differentiated thyroid cancer in terms of the extent of thyroid resection (thyroid lobectomy vs total thyroidectomy) and the utility of prophylactic central neck dissection (pCND) in low-risk PTC, and papillary thyroid microcarcinoma (PTMC, defined as <10 mm). Thyroid surgical approaches have progressed from the Kocher open incision to minimally invasive techniques that include endoscopic and robotic thyroidectomy. Overall, these minimally invasive techniques have been shown to be safe, and appear to be associated with improved cosmesis and decreased pain compared to open thyroidectomy. PMID:26504264

  3. Rolled-up magnetic microdrillers: towards remotely controlled minimally invasive surgery.

    PubMed

    Xi, Wang; Solovev, Alexander A; Ananth, Adithya N; Gracias, David H; Sanchez, Samuel; Schmidt, Oliver G

    2013-02-21

    Self-folded magnetic microtools with sharp ends are directed at enabling drilling and related incision operations of tissues, ex vivo, in a fluid with a viscosity similar to that of blood. These microtools change their rotation from a horizontal to a vertical one when they are immersed into a rotational magnetic field. Novel self-assembly paradigms with magnetic materials can enable the creation of remotely controlled and mass-produced tools for potential applications in minimally invasive surgery. PMID:23154823

  4. Detrusor-External Sphincter Dyssynergia: Review of Minimally Invasive and Endoscopic Management.

    PubMed

    Barbalat, Yanina; Rutman, Matthew

    2016-04-01

    Detrusor-external sphincter dyssynergia (DSD) is a debilitating problem in patients with spinal cord injury. DSD carries a high risk of complications, and even life expectancy can be affected. Management of this condition includes the use of antimuscarinic agents in combination with intermittent catheterization, indwelling urethral catheterization, suprapubic catheterization, and a variety of surgical options, depending on patient and physician preference. This paper will review the current literature and data on minimally invasive and endoscopic management of DSD. PMID:26826587

  5. Minimally invasive treatment for esthetic enhancement of white spot lesion in adjacent tooth

    PubMed Central

    Lee, Ji-Hye; Kim, Dae-Gon; Park, Chan-Jin

    2013-01-01

    This article describes the treatment provided to a patient with the maxillary anterior teeth exhibiting severe secondary caries beneath the previous restoration and a white spot lesion on the adjacent incisor. Two implants were placed after extraction of hopeless teeth with the guided bone regeneration technique. A white spot lesion of the adjacent incisor was treated with minimally invasive treatment. This clinical report describes the multidisciplinary treatment for the white spot lesion and esthetic restoration of missing anterior teeth. PMID:24049579

  6. Lessons from aviation - the role of checklists in minimally invasive cardiac surgery.

    PubMed

    Hussain, S; Adams, C; Cleland, A; Jones, P M; Walsh, G; Kiaii, B

    2016-01-01

    We describe an adverse event during minimally invasive cardiac surgery that resulted in a multi-disciplinary review of intra-operative errors and the creation of a procedural checklist. This checklist aims to prevent errors of omission and communication failures that result in increased morbidity and mortality. We discuss the application of the aviation - led "threats and errors model" to medical practice and the role of checklists and other strategies aimed at reducing medical errors. PMID:25918039

  7. 3T MR-guided minimally-invasive penile fracture repair.

    PubMed

    Rosi, Giovanni; Fontanella, Paolo; Venzi, Giordano; Jermini, Fernando; Del Grande, Filippo

    2016-03-01

    We present the case of a 21 year old patient with an incomplete tear of the tunica albuginea occurred after violent masturbation. The diagnostic assessment was performed first clinically, then with ultrasound and with 3 Tesla MRI. 3 Tesla MRI, owing to its high resolution, allowed to exactly detect the tear location leading to precise preoperative planning. After adequate diagnosis through imaging and proper planning, we were able to perform a selective minimally invasive surgical approach to repair the lesion. PMID:27072182

  8. Minimally Invasive Techniques for the Treatment of Benign Salivary Gland Obstruction: A Review

    SciTech Connect

    Brown, Jackie E.

    2002-10-15

    This paper reviews the literature published on minimally invasive techniques developed to treat benign salivary gland obstruction. Techniques reported include extracorporeal and intracorporeal salivary gland lithotripsy, endoscopy and radiologically guided techniques for the extraction of calculi and dilatation of duct strictures. These techniques are described, their advantages and disadvantages discussed and their success rates compared. Recommendations are made on the most appropriate application of each technique.

  9. Inadvertent subclavian artery cannulation with a central venous catheter; successful retrieval using a minimally invasive technique.

    PubMed

    Redmond, C E; O'Donohoe, R; Breslin, D; Brophy, D P

    2014-10-01

    A 48-year-old lady was referred to our department as an emergency following an unsuccessful attempt at central venous catheter insertion, resulting in cannulation of the subclavian artery. She underwent angiography with removal of the catheter and closure of the arteriotomy using an Angio-Seal device. While the optimal management of this scenario has yet to be defined, the use of this minimally invasive technique warrants consideration. PMID:25507120

  10. Inadvertent subclavian artery cannulation with a central venous catheter; successful retrieval using a minimally invasive technique.

    PubMed

    Redmond, C E; O'Donohoe, R; Breslin, D; Brophy, D P

    2014-10-01

    A 48-year-old lady was referred to our department as an emergency following an unsuccessful attempt at central venous catheter insertion, resulting in cannulation of the subclavian artery. She underwent angiography with removal of the catheter and closure of the arteriotomy using an Angio-Seal device. While the optimal management of this scenario has yet to be defined, the use of this minimally invasive technique warrants consideration. PMID:25417392

  11. Challenging posterior mediastinal mass resection via a minimally invasive approach with neurological monitoring.

    PubMed

    Smail, Hassiba; Baste, Jean Marc; Melki, Jean; Peillon, Christophe

    2013-02-01

    We report a novel surgical strategy for the resection of a rare type of posterior mediastinal tumour in a young patient. A melanotic schwannoma arose from the left thoracic sympathetic chain, adjacent to the origin of the artery of Adamkiewicz. Successful excision of this tumour via a minimally invasive approach without arterial or spinal cord injury was possible with the aid of neurological monitoring using spinal-evoked potentials. PMID:23190618

  12. Rhabdomyolysis and acute renal failure following minimally invasive spine surgery: report of 5 cases.

    PubMed

    Dakwar, Elias; Rifkin, Stephen I; Volcan, Ildemaro J; Goodrich, J Allan; Uribe, Juan S

    2011-06-01

    Minimally invasive spine surgery is increasingly used to treat various spinal pathologies with the goal of minimizing destruction of the surrounding tissues. Rhabdomyolysis (RM) is a rare but known complication of spine surgery, and acute renal failure (ARF) is in turn a potential complication of severe RM. The authors report the first known case series of RM and ARF following minimally invasive lateral spine surgery. The authors retrospectively reviewed data in all consecutive patients who underwent a minimally invasive lateral transpsoas approach for interbody fusion with the subsequent development of RM and ARF at 2 institutions between 2006 and 2009. Demographic variables, patient home medications, preoperative laboratory values, and anesthetic used during the procedure were reviewed. All patient data were recorded including the operative procedure, patient positioning, postoperative hospital course, operative time, blood loss, creatine phosphokinase (CPK), creatinine, duration of hospital stay, and complications. Five of 315 consecutive patients were identified with RM and ARF after undergoing minimally invasive lateral transpsoas spine surgery. There were 4 men and 1 woman with a mean age of 66 years (range 60-71 years). The mean body mass index was 31 kg/m2 and ranged from 25 to 40 kg/m2. Nineteen interbody levels had been fused, with a range of 3-6 levels per patient. The mean operative time was 420 minutes and ranged from 315 to 600 minutes. The CPK ranged from 5000 to 56,000 U/L, with a mean of 25,861 U/L. Two of the 5 patients required temporary hemodialysis, while 3 required only aggressive fluid resuscitation. The mean duration of the hospital stay was 12 days, with a range of 3-25 days. Rhabdomyolysis is a rare but known potential complication of spine surgery. The authors describe the first case series associated with the minimally invasive lateral approach. Surgeons must be aware of the possibility of postoperative RM and ARF, particularly in

  13. Use of minimal invasive extracorporeal circulation in cardiac surgery: principles, definitions and potential benefits. A position paper from the Minimal invasive Extra-Corporeal Technologies international Society (MiECTiS).

    PubMed

    Anastasiadis, Kyriakos; Murkin, John; Antonitsis, Polychronis; Bauer, Adrian; Ranucci, Marco; Gygax, Erich; Schaarschmidt, Jan; Fromes, Yves; Philipp, Alois; Eberle, Balthasar; Punjabi, Prakash; Argiriadou, Helena; Kadner, Alexander; Jenni, Hansjoerg; Albrecht, Guenter; van Boven, Wim; Liebold, Andreas; de Somer, Fillip; Hausmann, Harald; Deliopoulos, Apostolos; El-Essawi, Aschraf; Mazzei, Valerio; Biancari, Fausto; Fernandez, Adam; Weerwind, Patrick; Puehler, Thomas; Serrick, Cyril; Waanders, Frans; Gunaydin, Serdar; Ohri, Sunil; Gummert, Jan; Angelini, Gianni; Falk, Volkmar; Carrel, Thierry

    2016-05-01

    Minimal invasive extracorporeal circulation (MiECC) systems have initiated important efforts within science and technology to further improve the biocompatibility of cardiopulmonary bypass components to minimize the adverse effects and improve end-organ protection. The Minimal invasive Extra-Corporeal Technologies international Society was founded to create an international forum for the exchange of ideas on clinical application and research of minimal invasive extracorporeal circulation technology. The present work is a consensus document developed to standardize the terminology and the definition of minimal invasive extracorporeal circulation technology as well as to provide recommendations for the clinical practice. The goal of this manuscript is to promote the use of MiECC systems into clinical practice as a multidisciplinary strategy involving cardiac surgeons, anaesthesiologists and perfusionists. PMID:26819269

  14. Minimally invasive surgical treatment for unstable fractures of the proximal phalanx: intramedullary screw☆

    PubMed Central

    Aita, Marcio Aurélio; Mos, Paulo Augusto Castro; de Paula Cardoso Marques Leite, Gisele; Alves, Rafael Saleme; Credídio, Marcos Vinicius; da Costa, Eduardo Fernandes

    2015-01-01

    Objective To analyze the clinical-functional parameters and quality of life of patients undergoing minimally invasive surgical treatment for extra-articular fractures of the proximal phalanx, using an intramedullary screw (Acutrak®). Methods Between January 2011 and September 2014, a prospective study was conducted on 41 patients (48 fingers) with unstable extra-articular fractures of the proximal phalanx, who underwent minimally invasive surgical treatment using an intramedullary screw (Acutrak®). These patients were evaluated 12 months after the surgery by means of the DASH quality-of-life questionnaire, VAS pain scale, measurement of range of motion (ROM, in degrees) and radiographic assessment. Results All the patients achieved adequate reduction and consolidation of their fractures. There were statistically significant improvements in quality of life on the DASH scale, pain on the VAS scale and range of motion. Conclusion The minimally invasive technique for treating unstable extra-articular fractures of the proximal phalanx using an intramedullary screw (Acutrak®) is effective and safe, and it presents satisfactory clinical-functional results. PMID:26962488

  15. Quality assurance of multiport image-guided minimally invasive surgery at the lateral skull base.

    PubMed

    Nau-Hermes, Maria; Schmitt, Robert; Becker, Meike; El-Hakimi, Wissam; Hansen, Stefan; Klenzner, Thomas; Schipper, Jörg

    2014-01-01

    For multiport image-guided minimally invasive surgery at the lateral skull base a quality management is necessary to avoid the damage of closely spaced critical neurovascular structures. So far there is no standardized method applicable independently from the surgery. Therefore, we adapt a quality management method, the quality gates (QG), which is well established in, for example, the automotive industry and apply it to multiport image-guided minimally invasive surgery. QG divide a process into different sections. Passing between sections can only be achieved if previously defined requirements are fulfilled which secures the process chain. An interdisciplinary team of otosurgeons, computer scientists, and engineers has worked together to define the quality gates and the corresponding criteria that need to be fulfilled before passing each quality gate. In order to evaluate the defined QG and their criteria, the new surgery method was applied with a first prototype at a human skull cadaver model. We show that the QG method can ensure a safe multiport minimally invasive surgical process at the lateral skull base. Therewith, we present an approach towards the standardization of quality assurance of surgical processes. PMID:25105146

  16. Lumbar Spinal Stenosis Minimally Invasive Treatment with Bilateral Transpedicular Facet Augmentation System

    SciTech Connect

    Masala, Salvatore; Tarantino, Umberto; Nano, Giovanni; Iundusi, Riccardo; Fiori, Roberto Da Ros, Valerio Simonetti, Giovanni

    2013-06-15

    Purpose. The purpose of this study was to evaluate the effectiveness of a new pedicle screw-based posterior dynamic stabilization device PDS Percudyn System Trade-Mark-Sign Anchor and Stabilizer (Interventional Spine Inc., Irvine, CA) as alternative minimally invasive treatment for patients with lumbar spine stenosis. Methods. Twenty-four consecutive patients (8 women, 16 men; mean age 61.8 yr) with lumbar spinal stenosis underwent implantation of the minimally invasive pedicle screw-based device for posterior dynamic stabilization. Inclusion criteria were lumbar stenosis without signs of instability, resistant to conservative treatment, and eligible to traditional surgical posterior decompression. Results. Twenty patients (83 %) progressively improved during the 1-year follow-up. Four (17 %) patients did not show any improvement and opted for surgical posterior decompression. For both responder and nonresponder patients, no device-related complications were reported. Conclusions. Minimally invasive PDS Percudyn System Trade-Mark-Sign has effectively improved the clinical setting of 83 % of highly selected patients treated, delaying the need for traditional surgical therapy.

  17. Quality Assurance of Multiport Image-Guided Minimally Invasive Surgery at the Lateral Skull Base

    PubMed Central

    Nau-Hermes, Maria; Schmitt, Robert; Becker, Meike; El-Hakimi, Wissam; Hansen, Stefan; Klenzner, Thomas; Schipper, Jörg

    2014-01-01

    For multiport image-guided minimally invasive surgery at the lateral skull base a quality management is necessary to avoid the damage of closely spaced critical neurovascular structures. So far there is no standardized method applicable independently from the surgery. Therefore, we adapt a quality management method, the quality gates (QG), which is well established in, for example, the automotive industry and apply it to multiport image-guided minimally invasive surgery. QG divide a process into different sections. Passing between sections can only be achieved if previously defined requirements are fulfilled which secures the process chain. An interdisciplinary team of otosurgeons, computer scientists, and engineers has worked together to define the quality gates and the corresponding criteria that need to be fulfilled before passing each quality gate. In order to evaluate the defined QG and their criteria, the new surgery method was applied with a first prototype at a human skull cadaver model. We show that the QG method can ensure a safe multiport minimally invasive surgical process at the lateral skull base. Therewith, we present an approach towards the standardization of quality assurance of surgical processes. PMID:25105146

  18. Effect of Anti-Sticking Nanostructured Surface Coating on Minimally Invasive Electrosurgical Device in Brain.

    PubMed

    Cheng, Han-Yi; Ou, Keng-Liang; Chiang, Hsi-Jen; Lin, Li-Hsiang

    2015-10-01

    The purpose of the present study was to examine the extent of thermal injury in the brain after the use of a minimally invasive electrosurgical device with a nanostructured copper-doped diamond-like carbon (DLC-Cu) surface coating. To effectively utilize an electrosurgical device in clinical surgery, it is important to decrease the thermal injury to the adjacent tissues. The surface characteristics and morphology of DLC-Cu thin film was evaluated using a contact angle goniometer, scanning electron microscopy, and atomic force microscopy. Three-dimensional biomedical brain models were reconstructed using magnetic resonance images to simulate the electrosurgical procedure. Results indicated that the temperature was reduced significantly when a minimally invasive electrosurgical device with a DLC-Cu thin film coating (DLC-Cu-SS) was used. Temperatures decreased with the use of devices with increasing film thickness. Thermographic data revealed that surgical temperatures in an animal model were significantly lower with the DLC-Cu-SS electrosurgical device compared to an untreated device. Furthermore, the DLC-Cu-SS device created a relatively small region of injury and lateral thermal range. As described above, the biomedical nanostructured film reduced excessive thermal injury with the use of a minimally invasive electrosurgical device in the brain. PMID:25851468

  19. [Perioperative Pain Management of Minimally Invasive Esophagectomy with Bilateral Continuous Thoracic Paravertebral Block].

    PubMed

    Hida, Kumiko; Murata, Hiroaki; Sakai, Akiko; Ogami, Keiko; Maekawa, Takuji; Hara, Tetsuya

    2016-02-01

    Minimally invasive esophagectomy has become popular as a surgical procedure for esophageal cancer. We describe bilateral continuous thoracic paravertebral blocks for perioperative pain management in 3 patients who underwent minimally invasive esophagectomy. After anesthesia induction, bilateral thoracic paravertebral catheters were placed under ultrasound guidance with the patients in left lateral decubitus position at the sixth or seventh right intercostal space and eighth or ninth left intercostal space, respectively. Multiple ports for thoracoscopic procedures were located between the right third and ninth intercostal spaces. Laparoscopy-assisted gastric tube reconstruction was performed with skin incisions at bilateral T7-10 dermatomes. Intraoperative intermittent bolus injections of ropivacaine through the thoracic paravertebral catheters were used in combination with sevoflurane-remifentanil anesthesia, followed by continuous thoracic paravertebral infusion of ropivacaine for postoperative analgesia with continuous intravenous fentanyl infusion and periodical intravenous acetaminophen administration. Numerical rating scales of postoperative pain at rest and when coughing were 4 or less for 48 hr after surgery. No complications related to thoracic paravertebral catheterization were observed. Bilateral continuous thoracic paravertebral blocks at different intercostal levels can provide good perioperative analgesia for minimally invasive esophagectomy. PMID:27017762

  20. Spontaneous spinal epidural hematoma management with minimally invasive surgery through tubular retractors

    PubMed Central

    Fu, Chao-Feng; Zhuang, Yuan-Dong; Chen, Chun-Mei; Cai, Gang-Feng; Zhang, Hua-Bin; Zhao, Wei; Ahmada, Said Idrissa; Devi, Ramparsad Doorga; Kibria, Md Golam

    2016-01-01

    Abstract To report a minimally invasive paraspinal approach in the treatment of a case of spontaneous spinal epidural hematoma (SSEH). We additionally aim to review the relevant literature to enhance our knowledge of this disease. SSEH is an uncommon but potentially catastrophic disease. Currently, most appropriate management is emergence decompression laminectomy and hematoma evacuation. An 81-year-old woman was admitted to the neurology department with a chief complaint of bilateral numbness and weakness of the lower limbs and difficulty walking for 4 days with progressive weakness developed over the following 3 days accompanied with pain in the lower limbs and lower back. No history of trauma was reported. Magnetic resonance imaging of the thoracolumbar spine demonstrated an epidural hematoma extending from T-12 to L-5 with thecal sac and cauda equina displacement anterior. The patient was treated in our department with a minimally invasive approach. This operation method had been approved by Chinese Independent Ethics Committee. Three months following the operation, the patient had regained the ability to walk with the aid of a cane and myodynamia tests revealed normal results for the left lower limb and a 4/5 grade for the right limb. Importantly, no complications were exhibited from the surgical operation. The minimally invasive paraspinal approach through tubular retractors is demonstrated here as an effective alternative method for the treatment of SSEH. PMID:27367986

  1. Minimally Invasive Repair of Pectus Carinatum in Patients Unsuited to Bracing Therapy

    PubMed Central

    Suh, Jee-Won; Joo, Seok; Lee, Geun Dong; Haam, Seok Jin; Lee, Sungsoo

    2016-01-01

    Background We used an Abramson technique for minimally invasive repair of pectus carinatum in patients who preferred surgery to brace therapy, had been unsuccessfully treated via brace therapy, or were unsuitable for brace therapy because of a rigid chest wall. Methods Between July 2011 and May 2015, 16 patients with pectus carinatum underwent minimally invasive surgery. Results The mean age of the patients was 24.35±13.20 years (range, 14–57 years), and all patients were male. The percentage of excellent aesthetic results, as rated by the patients, was 37.5%, and the percentage of good results was 56.25%. The preoperative and postoperative Haller Index values were 2.01±0.19 (range, 1.60–2.31), and 2.22±0.19 (range, 1.87–2.50), respectively (p-value=0.01), and the median hospital stay was 7.09±2.91 days (range, 5–15 days). Only one patient experienced postoperative complications. Conclusion Minimally invasive repair is effective for the treatment of pectus carinatum, even in adult patients. PMID:27066432

  2. [Use of minimally invasive approaches for stage I non-small cell lung cancer: A surgeon's point of view].

    PubMed

    Thomas, P-A

    2015-10-01

    Lobectomy with lymphadenectomy is the standard of care of patients with early stage non-small cell lung cancer, and the use of minimally invasive approaches is associated with reduced morbidity when compared with thoracotomy. Segmentectomy with lymphadenectomy seems to provide a curative effect equivalent to that of lobectomy for stage IA tumours of 2 cm or smaller, and for pure or predominant ground glass opacities. The combination of lung-sparing resections with minimally invasive approaches results in preserved pulmonary function, improved quality of life and very low morbidity. This benefit persists in so-called high-risk patients. Among patients with clinical stage IA managed with sublobar resections, more than 25% are proved to have a more advanced pathologic stage at surgery, suggesting that alternative ablative therapies would result in an incomplete resection in a similar proportion. Moreover, resection samples tumour tissue that is adequate in quantity and quality, and provides material for "research biopsies" to consolidate tissue availability for clinical trials, translational research, and in biobanks. PMID:26344441

  3. Minimally Invasive Thumb-sized Pterional Craniotomy for Surgical Clip Ligation of Unruptured Anterior Circulation Aneurysms.

    PubMed

    Deshaies, Eric M; Villwock, Mark R; Singla, Amit; Toshkezi, Gentian; Padalino, David J

    2015-01-01

    Less invasive surgical approaches for intracranial aneurysm clipping may reduce length of hospital stay, surgical morbidity, treatment cost, and improve patient outcomes. We present our experience with a minimally invasive pterional approach for anterior circulation aneurysms performed in a major tertiary cerebrovascular center and compare the results with an aged matched dataset from the Nationwide Inpatient Sample (NIS). From August 2008 to December 2012, 22 elective aneurysm clippings on patients ≤55 years of age were performed by the same dual fellowship-trained cerebrovascular/endovascular neurosurgeon. One patient (4.5%) experienced transient post-operative complications. 18 of 22 patients returned for follow-up imaging and there were no recurrences through an average duration of 22 months. A search in the NIS database from 2008 to 2010, also for patients aged ≤55 years of age, yielded 1,341 hospitalizations for surgical clip ligation of unruptured cerebral aneurysms. Inpatient length of stay and hospital charges at our institution using the minimally invasive thumb-sized pterional technique were nearly half that of NIS (length of stay: 3.2 vs 5.7 days; hospital charges: $52,779 vs. $101,882). The minimally invasive thumb-sized pterional craniotomy allows good exposure of unruptured small and medium-sized supraclinoid anterior circulation aneurysms. Cerebrospinal fluid drainage from key subarachnoid cisterns and constant bimanual microsurgical techniques avoid the need for retractors which can cause contusions, localized venous infarctions, and post-operative cerebral edema at the retractor sites. Utilizing this set of techniques has afforded our patients with a shorter hospital stay at a lower cost compared to the national average. PMID:26325337

  4. Minimally invasive evacuation of intraventricular hemorrhage with the Apollo vibration/suction device.

    PubMed

    Tan, Lee A; Lopes, Demetrius K; Munoz, Lorenzo F; Shah, Yojan; Bhabad, Sudeep; Jhaveri, Miral; Moftakhar, Roham

    2016-05-01

    Intraventricular hemorrhages (IVH) can occur as a consequence of spontaneous intracerebral hemorrhage, aneurysm rupture, arteriovenous malformation hemorrhage, trauma, or coagulopathy. IVH is a known risk factor for poor clinical outcome with up to 80% mortality. The current standard treatment strategy for IVH consists of the placement of an external ventricular drain. We report our early experience with using the Apollo suction/vibration aspiration system (Penumbra, Alameda, CA, USA) for minimally invasive evacuation of IVH with a review of the pertinent literature. Medical records of patients with IVH who were admitted to Rush University Medical Center, USA, from July to November 2014 were queried from the electronic database. Patients with Graeb Scores (GS) >6 were selected for minimally invasive IVH evacuation with the Apollo aspiration system. Patient demographics, pre- and post-operative GS, pre- and post-operative modified Graeb Score (mGS), as well procedure related complications were analyzed and recorded. A total of eight patients (five men) were identified during the study period. The average age was 55.5years. The mean GS was 9.6 pre-operatively and decreased to 4.9 post-operatively (p=0.0002). The mean mGS was 22.9 pre-operatively and decreased to 11.4 post-operatively (p=0.0001). Most of the IVH reduction occurred in the frontal horn and atrium of the lateral ventricle, as well the third ventricle. One (1/8) procedure-related complication occurred consisted of a tract hemorrhage. The Apollo system can be used for minimally invasive IVH evacuation to achieve significant blood clot volume reduction with minimal procedure-related complication. PMID:26778051

  5. Minimally Invasive Total Knee Arthroplasty: A Comparative Study to the Standard Approach

    PubMed Central

    Dabboussi, Naji; Sakr, Mazen; Girard, Julien; Fakih, Riad

    2012-01-01

    Background: Minimally invasive surgery has gained popularity over the past several years. Early results have shown better functional outcome with early recovery and rapid rehabilitation. Aim: Evaluation of the short-term clinical and functional outcome of minimally invasive surgery total knee arthroplasty (MIS-TKA) compared with the traditional total knee arthroplasty (TKA). Materials and Methods: During 2009, all cases scheduled for primary TKA through the modified mini-mid-vastus approach (MIS group) were studied. This group included 40 knees and was compared to a cohort control group of similar number of patients (40 knees) that underwent the procedure through the standard conventional technique (standard group). Results: Patients in the MIS group showed significant decrease in postoperative pain, blood loss in first 24 hours, and in hospital stay. Furthermore, they achieved motion considerably faster than the standard group with earlier return of quadriceps function and greater early flexion. Conclusion: This study proved that MIS-TPA has the ability to couple the benefits of less invasive surgical approach. PMID:22408753

  6. Anterior Spinal Artery Syndrome: Reversible Paraplegia after Minimally Invasive Spine Surgery

    PubMed Central

    Bredow, J.; Oppermann, J.; Keller, K.; Beyer, F.; Boese, C. K.; Zarghooni, K.; Sobottke, R.; Eysel, P.; Siewe, J.

    2014-01-01

    Background Context. Percutaneous balloon kyphoplasty is an established minimally invasive technique to treat painful vertebral compression fractures, especially in the context of osteoporosis with a minor complication rate. Purpose. To describe the heparin anticoagulation treatment of paraplegia following balloon kyphoplasty. Study Design. We report the first case of an anterior spinal artery syndrome with a postoperative reversible paraplegia following a minimally invasive spine surgery (balloon kyphoplasty) without cement leakage. Methods. A 75-year-old female patient underwent balloon kyphoplasty for a fresh fracture of the first vertebra. Results. Postoperatively, the patient developed an acute anterior spinal artery syndrome with motor paraplegia of the lower extremities as well as loss of pain and temperature sensation with retained proprioception and vibratory sensation. Complete recovery occurred six hours after bolus therapy with 15.000 IU low-molecular heparin. Conclusion. Spine surgeons should consider vascular complications in patients with incomplete spinal cord syndromes after balloon kyphoplasty, not only after more invasive spine surgery. High-dose low-molecular heparin might help to reperfuse the Adamkiewicz artery. PMID:25210639

  7. Anterior spinal artery syndrome: reversible paraplegia after minimally invasive spine surgery.

    PubMed

    Bredow, J; Oppermann, J; Keller, K; Beyer, F; Boese, C K; Zarghooni, K; Sobottke, R; Eysel, P; Siewe, J

    2014-01-01

    Background Context. Percutaneous balloon kyphoplasty is an established minimally invasive technique to treat painful vertebral compression fractures, especially in the context of osteoporosis with a minor complication rate. Purpose. To describe the heparin anticoagulation treatment of paraplegia following balloon kyphoplasty. Study Design. We report the first case of an anterior spinal artery syndrome with a postoperative reversible paraplegia following a minimally invasive spine surgery (balloon kyphoplasty) without cement leakage. Methods. A 75-year-old female patient underwent balloon kyphoplasty for a fresh fracture of the first vertebra. Results. Postoperatively, the patient developed an acute anterior spinal artery syndrome with motor paraplegia of the lower extremities as well as loss of pain and temperature sensation with retained proprioception and vibratory sensation. Complete recovery occurred six hours after bolus therapy with 15.000 IU low-molecular heparin. Conclusion. Spine surgeons should consider vascular complications in patients with incomplete spinal cord syndromes after balloon kyphoplasty, not only after more invasive spine surgery. High-dose low-molecular heparin might help to reperfuse the Adamkiewicz artery. PMID:25210639

  8. Risk Factors for Distant Metastasis in Patients with Minimally Invasive Follicular Thyroid Carcinoma

    PubMed Central

    Kim, Tae Yong; Sung, Tae-Yon; Yoon, Jong Ho; Chung, Ki-Wook; Hong, Suck Joon

    2016-01-01

    Background Although patients with minimally invasive follicular thyroid carcinoma (MIFTC) generally have an excellent prognosis, distant metastasis occurs in some patients. Risk factors for distant metastasis have been reported, none has been found to be conclusive. This study evaluated risk factors for distant metastasis, including protein markers, in patients with MIFTC. Methods A review of patient records identified 259 patients who underwent surgery at Asan Medical Center from 1996 to 2010 and were subsequently diagnosed with MIFTC. After review of pathological slides, 120 patients with paraffin blocks suited for tissue microarrays (TMA) were included in this study. Immunohistochemical stain of TMA slides was performed by protein markers; β-catenin, C-MET, CK19, estrogen receptor (ER) α, ER β, HBME-1, MMP2, PPAR γ and progesterone receptor. Results 120 patients included 28 males (23.3%) and 92 females (76.7%), of mean age 41.5±10.8 years (range, 13–74 years). Eight patients (6.7%) had distant metastases during follow-up. Univariate analysis showed that age (≥45 years), male sex, and extensive vascular invasion (≥4 foci) were associated with distant metastasis. Multivariate regression analysis showed that extensive vascular invasion was the only independent risk factor for distant metastasis (p = 0.012). Although no protein markers on TMA analysis were directly related to distant metastasis of MIFTC, CK19 expression was more frequent in patients with than without extensive vascular invasion (p = 0.036). Conclusion Extensive vascular invasion was the only independent risk factor for distant metastasis of MIFTC. No proteins markers were directly related to distant metastasis, but CK19 was associated with extensive vascular invasion. PMID:27171147

  9. Minimally invasive endovascular stent-electrode array for high-fidelity, chronic recordings of cortical neural activity.

    PubMed

    Oxley, Thomas J; Opie, Nicholas L; John, Sam E; Rind, Gil S; Ronayne, Stephen M; Wheeler, Tracey L; Judy, Jack W; McDonald, Alan J; Dornom, Anthony; Lovell, Timothy J H; Steward, Christopher; Garrett, David J; Moffat, Bradford A; Lui, Elaine H; Yassi, Nawaf; Campbell, Bruce C V; Wong, Yan T; Fox, Kate E; Nurse, Ewan S; Bennett, Iwan E; Bauquier, Sébastien H; Liyanage, Kishan A; van der Nagel, Nicole R; Perucca, Piero; Ahnood, Arman; Gill, Katherine P; Yan, Bernard; Churilov, Leonid; French, Christopher R; Desmond, Patricia M; Horne, Malcolm K; Kiers, Lynette; Prawer, Steven; Davis, Stephen M; Burkitt, Anthony N; Mitchell, Peter J; Grayden, David B; May, Clive N; O'Brien, Terence J

    2016-03-01

    High-fidelity intracranial electrode arrays for recording and stimulating brain activity have facilitated major advances in the treatment of neurological conditions over the past decade. Traditional arrays require direct implantation into the brain via open craniotomy, which can lead to inflammatory tissue responses, necessitating development of minimally invasive approaches that avoid brain trauma. Here we demonstrate the feasibility of chronically recording brain activity from within a vein using a passive stent-electrode recording array (stentrode). We achieved implantation into a superficial cortical vein overlying the motor cortex via catheter angiography and demonstrate neural recordings in freely moving sheep for up to 190 d. Spectral content and bandwidth of vascular electrocorticography were comparable to those of recordings from epidural surface arrays. Venous internal lumen patency was maintained for the duration of implantation. Stentrodes may have wide ranging applications as a neural interface for treatment of a range of neurological conditions. PMID:26854476

  10. Minimally Invasive Medial Plating of Low-Energy Lisfranc Injuries: Preliminary Experience with Five Cases

    PubMed Central

    del Vecchio, Jorge Javier; Ghioldi, Mauricio; Raimondi, Nicolás; De Elias, Manuel

    2016-01-01

    Fracture dislocations involving the Lisfranc joint are rare; they represent only 0.2% of all the fractures. There is no consensus about the surgical management of these lesions in the medical literature. However, both anatomical reduction and tarsometatarsal stabilization are essential for a good outcome. In this clinical study, five consecutive patients with a diagnosis of Lisfranc low-energy lesion were treated with a novel surgical technique characterized by minimal osteosynthesis performed through a minimally invasive approach. According to the radiological criteria established, the joint reduction was anatomical in four patients, almost anatomical in one patient (#4), and nonanatomical in none of the patients. At the final follow-up, the AOFAS score for the midfoot was 96 points (range, 95–100). The mean score according to the VAS (Visual Analog Scale) at the end of the follow-up period was 1.4 points over 10 (range, 0–3). The surgical technique described in this clinical study is characterized by the use of implants with the utilization of a novel approach to reduce joint and soft tissue damage. We performed a closed reduction and minimally invasive stabilization with a bridge plate and a screw after achieving a closed anatomical reduction. PMID:27340569

  11. Current role of the minimally invasive direct aortic surgery for 3-A repair (MIDAS-3A).

    PubMed

    de Donato, Gaetano; Sarradon, Pierre; Weber, George; de Donato, Gianmarco

    2003-01-01

    Open aneurysmectomy and aortic graft is still associated with a relatively high morbidity and mortality. To decrease this surgical stress, less invasive procedure, MIDAS-3A technique (Minimally Invasive Direct Aortic Surgery for AAA) was developed, utilizing a 5 cm abdominal incision and a video-laparoscopic assistance (gas-less) to reach the AAA retroperitoneally. From Nov. 1999 to Dec. 2002, 80 patients underwent surgery. This technique provides all the benefits of an open surgical approach, to be combined with the advantages derived from minimized tissue trauma. A comparison between MIDAS-3A and CL (Conventional Laparotomy) was performed, monitorizing-nasogastric drainage;--initial feeding;--pulmonary functions (Vital Capacity, and Forced Expiration Volume);--Intensive Care Unit recovery (long stay);--length of hospital stay;--operative time;--blood loss. The perioperative (30 days) mortality (2.5%), and the morbidity (7.5%) was equal in both groups. No conversion to conventional laparotomy occurred. MIDAS-3A has significantly reduced length of hospital stay (3.5 days), and pulmonary dysfunctions. This technique provides all the benefits of open surgical approach, to be combined with the advantages derived from minimized tissue trauma. MIDAS-3A reduced trauma and pain, which resulted in a shorter hospital stay, and so lower expense and better financial consequences. PMID:14587105

  12. Minimally Invasive Plate Osteosynthesis of Distal Tibia and Fibular Fractures Through a Single Distal Anterolateral Incision.

    PubMed

    Unlu, Serhan; Catma, Mehmet F; Bilgetekin, Yenel G; Altay, Murat; Ates, Yalim; Bozkurt, Murat; Kapicioglu, Mehmet I Safa

    2015-01-01

    Treating distal tibia fractures is often challenging given the extent of soft tissue damage around the fracture and the risk of infection and other complications with internal fixation and the accompanying incisions. Minimally invasive plate osteosynthesis minimizes these complications and can be performed through a single incision. From April 2009 to January 2011, we treated 20 patients who had both tibial and fibular distal fractures through a distal anterolateral approach with this technique. The mean follow-up period was 15.5 (range 12 to 26) months. The mean interval to bony union was 21 (range 18 to 25) weeks. A 5° varus deformity was found in 1 patient. Another patient, who had a history of alcohol consumption and smoking, developed wound necrosis that was treated successfully with debridement and without skin grafting. The mean American Orthopaedic Foot and Ankle Society score for all patients was 91.8 (range 84 to 97). The anterolateral, minimally invasive plate osteosynthesis technique is a useful method for treating distal tibial and fibular fractures at the same level, with a low complication rate. PMID:26190782

  13. Combined ablation of atrial fibrillation and minimally invasive mitral valve surgery: a case report

    PubMed Central

    2010-01-01

    A partial lower inverted J sternotomy and an extended transseptal incision provide excellent exposure for minimally invasive mitral valve surgery. However, the extended trasnsseptal incision causes dividing the sinus node artery, which may result in conduction system disturbance and need for permanent pacemaker implantation. Therefore, there is a challenge in the patient who requires concomitant ablation for atrial fibrillation because of possible conduction system disturbance caused by extended transseptal incision. We describe a new strategy for combined ablation of atrial fibrillation with minimally invasive cardiac surgery by a transseptal approach to the mitral valve through a partial lower sternotomy incision. Cryoablation was performed using a T-shaped cryoprobe with a lesion set of pulmonary vein isolation and ablation of the left and right isthmus in performing mitral annuloplasty, tricuspid annuloplasty, and atrial septal defect closure through a limited sternotomy incision. This technique might minimize possible conduction system disturbance and provide good surgical result for the patients who undergo mitral valve surgery and ablation of atrial fibrillation. PMID:20937138

  14. Prostatic urethral lift: A minimally invasive treatment for benign prostatic hyperplasia

    PubMed Central

    Garcia, Cindy; Chin, Peter; Rashid, Prem; Woo, Henry H.

    2015-01-01

    Prostatic urethral lift (PUL) is a minimally invasive procedure for the treatment of lower urinary tract symptoms (LUTS) secondary to benign prostatic hyperplasia. The procedure may be performed under local, spinal, or general anesthesia. The PUL procedure involves the delivery of implants that retract obstructing prostate lobes. Unlike other benign prostatic hyperplasia treatment options including pharmacological therapy, and the current invasive gold-standard transurethral resection of the prostate, the PUL procedure achieves quantifiable improvements in functional outcomes and quality of life, in the absence of major adverse events. Furthermore, improvement in LUTS may be attained while preserving erectile and ejaculatory function. Adverse effects associated with the PUL procedure are mild to moderate, and are transient in nature. The PUL procedure provides an alternative for men seeking treatment for bothersome LUTS, with fewer side-effects. PMID:26157759

  15. Minimally-invasive posterior lumbar stabilization for degenerative low back pain and sciatica. A review.

    PubMed

    Bonaldi, G; Brembilla, C; Cianfoni, A

    2015-05-01

    The most diffused surgical techniques for stabilization of the painful degenerated and instable lumbar spine, represented by transpedicular screws and rods instrumentation with or without interbody cages or disk replacements, require widely open and/or difficult and poorly anatomical accesses. However, such surgical techniques and approaches, although still considered "standard of care", are burdened by high costs, long recovery times and several potential complications. Hence the effort to open new minimally-invasive surgical approaches to eliminate painful abnormal motion. The surgical and radiological communities are exploring, since more than a decade, alternative, minimally-invasive or even percutaneous techniques to fuse and lock an instable lumbar segment. Another promising line of research is represented by the so-called dynamic stabilization (non-fusion or motion preservation back surgery), which aims to provide stabilization to the lumbar spinal units (SUs), while maintaining their mobility and function. Risk of potential complications of traditional fusion methods (infection, CSF leaks, harvest site pain, instrumentation failure) are reduced, particularly transitional disease (i.e., the biomechanical stresses imposed on the adjacent segments, resulting in delayed degenerative changes in adjacent facet joints and discs). Dynamic stabilization modifies the distribution of loads within the SU, moving them away from sensitive (painful) areas of the SU. Basic biomechanics of the SU will be discussed, to clarify the mode of action of the different posterior stabilization devices. Most devices are minimally invasive or percutaneous, thus accessible to radiologists' interventional practice. Devices will be described, together with indications for patient selection, surgical approaches and possible complications. PMID:24906245

  16. Percutaneous, Minimally Invasive Repair of Traumatic and Simultaneous Rupture of Both Achilles Tendons: A Case Report.

    PubMed

    Zietek, Pawel; Karaczun, Maciej; Kruk, Bartosz; Szczypior, Karina

    2016-01-01

    Achilles injury is a common musculoskeletal disorder. Bilateral rupture of the Achilles tendon, however, is much less common and usually occurs spontaneously. Complete, traumatic, and bilateral ruptures are rare and typically require long periods of immobilization before the patient can return to full weightbearing. A 52-year-old male was hospitalized for bilateral traumatic rupture to both Achilles tendons. No risk factors for tendon rupture were found. Blood samples revealed no peripheral blood pathologic features. Both tendons were repaired with percutaneous, minimally invasive surgery using the Achillon(®) tendon suture system. Rehabilitation was begun 4 weeks later. An ankle-foot orthosis was prescribed to provide ankle support with an adjustable range of movement, and active plantar flexion was set at 0° to 30°. The patient remained non-weightbearing with the ankle-foot orthosis device and performed active range-of-motion exercises. At 8 weeks after surgery, we recommended that he begin walking with partial weightbearing using a foot-tibial orthosis with the range of motion set to 45° plantar flexion and 15° dorsiflexion. At 10 weeks postoperatively, he was encouraged to return to full weightbearing on both feet. Beginning rehabilitation as soon as possible after minimally invasive surgery, compared with 6 weeks of immobilization after surgery, provided a rapid resumption to full weightbearing. We emphasize the clinical importance of a safe, simple treatment program that can be followed for a patient with damage to the Achilles tendons. To our knowledge, ours is the first report of minimally invasive repair of bilateral simultaneous traumatic rupture of the Achilles tendon. PMID:26002678

  17. Clinical and functional results after the rehabilitation period in minimally-invasive unicondylar knee arthroplasty patients.

    PubMed

    Fuchs, Susanne; Rolauffs, Bernd; Plaumann, Thorsten; Tibesku, Carsten O; Rosenbaum, Dieter

    2005-04-01

    The objective of the present study was to analyze the clinical and functional outcome after minimally-invasive implantation of a Repicci-type unicompartmental sledge prosthesis . In 29 patients with primary unicompartmental knee osteoarthritis, 29 replacements of the medial compartment and four of the lateral compartment were performed using the minimally-invasive technique with the metal-backed and the all-polyethylene versions of the Repicci sledge prosthesis. Electromyography (EMG) of standardized locations was measured with the MyoSystem 2000 and analyzed with Myoresearch software. Gait analysis was performed with a six-camera motion analysis system and force platforms. Established clinical and quality of life (SF-36) scores were used to compare patients with 11 healthy age-matched individuals. The Repicci sledge prosthesis led postoperatively to functional results that were in the range of healthy joints, and superior to sledge prostheses of a different design. Gait and balance parameters were comparable to the control group, whilst electromyographically lower amplitudes were found in the patients than the controls and in the operated legs as compared to the non-operated legs. Many parameters of quality of life and activity were comparable to age-matched healthy individuals, and quality of life was superior to total knee replacement. When implanted using a minimally-invasive technique and with suitable patient selection, the Repicci sledge led to functional results comparable to those of healthy joints and gait parameters comparable to those of healthy individuals. The level of evidence is Level III, retrospective cohort study. PMID:15175850

  18. Triangular Titanium Implants for Minimally Invasive Sacroiliac Joint Fusion: A Prospective Study

    PubMed Central

    Duhon, Bradley S.; Cher, Daniel J.; Wine, Kathryn D.; Kovalsky, Don A.; Lockstadt, Harry

    2015-01-01

    Study Design Prospective multicenter single-arm interventional clinical trial. Objective To determine the degree of improvement in sacroiliac (SI) joint pain, disability related to SI joint pain, and quality of life in patients with SI joint dysfunction who undergo minimally invasive SI joint fusion using triangular-shaped titanium implants. Methods Subjects (n = 172) underwent minimally invasive SI joint fusion between August 2012 and January 2014 and completed structured assessments preoperatively and at 1, 3, 6, and 12 months postoperatively, including a 100-mm SI joint and back pain visual analog scale (VAS), Oswestry Disability Index (ODI), Short Form-36 (SF-36), and EuroQOL-5D. Patient satisfaction with surgery was assessed at 6 and 12 months. Results Mean SI joint pain improved from 79.8 at baseline to 30.0 and 30.4 at 6 and 12 months, respectively (mean improvements of 49.9 and 49.1 points, p < 0.0001 each). Mean ODI improved from 55.2 at baseline to 32.5 and 31.4 at 6 and 12 months (improvements of 22.7 and 23.9 points, p < 0.0001 each). SF-36 physical component summary improved from 31.7 at baseline to 40.2 and 40.3 at 6 and 12 months (p < 0.0001). At 6 and 12 months, 93 and 87% of subjects, respectively, were somewhat or very satisfied and 92 and 91%, respectively, would have the procedure again. Conclusions Minimally invasive SI joint fusion resulted in improvement of pain, disability, and quality of life in patients with SI joint dysfunction due to degenerative sacroiliitis and SI joint disruption. PMID:27099817

  19. Fiber optic photoacoustic probe with ultrasonic tracking for guiding minimally invasive procedures

    NASA Astrophysics Data System (ADS)

    Xia, Wenfeng; Mosse, Charles A.; Colchester, Richard J.; Mari, Jean Martial; Nikitichev, Daniil I.; West, Simeon J.; Ourselin, Sebastien; Beard, Paul C.; Desjardins, Adrien E.

    2015-07-01

    In a wide range of clinical procedures, accurate placement of medical devices such as needles and catheters is critical to optimize patient outcomes. Ultrasound imaging is often used to guide minimally invasive procedures, as it can provide real-time visualization of patient anatomy and medical devices. However, this modality can provide low image contrast for soft tissues, and poor visualization of medical devices that are steeply angled with respect to the incoming ultrasound beams. Photoacoustic sensors can provide information about the spatial distributions of tissue chromophores that could be valuable for guiding minimally invasive procedures. In this study, a system for guiding minimally invasive procedures using photoacoustic sensing was developed. This system included a miniature photoacoustic probe with three optical fibers: one with a bare end for photoacoustic excitation of tissue, a second for photoacoustic excitation of an optically absorbing coating at the distal end to transmit ultrasound, and a third with a Fabry-Perot cavity at the distal end for receiving ultrasound. The position of the photoacoustic probe was determined with ultrasonic tracking, which involved transmitting pulses from a linear-array ultrasound imaging probe at the tissue surface, and receiving them with the fiber-optic ultrasound receiver in the photoacoustic probe. The axial resolution of photoacoustic sensing was better than 70 μm, and the tracking accuracy was better than 1 mm in both axial and lateral dimensions. By translating the photoacoustic probe, depth scans were obtained from different spatial positions, and two-dimensional images were reconstructed using a frequency-domain algorithm.

  20. Experimental femtosecond laser photodisruption of rabbit sclera for minimally invasive laser sclerostomy: An in vitro study

    NASA Astrophysics Data System (ADS)

    Yang, Xiaobo; Dai, Nengli; Long, Hua; Lu, Peixiang; Li, Wan; Jiang, Fagang

    2010-07-01

    Femtosecond laser technology, used as a minimally invasive tool in intrastromal refractive surgery, may also have potential as a useful instrument for glaucoma filtration surgery. The purpose of the present study was to evaluate the feasibility of minimally invasive laser sclerostomy by femtosecond laser photodisruption and seek the appropriate patterns of laser ablation and relevant laser parameters. A femtosecond laser (800 nm/50 fs/1 kHz), focused by a 0.1 numerical aperture (NA) objective lens, with different pulse energies and exposure times was applied to ablate hydrated rabbit sclera in vitro. The irradiated samples were examined by scanning electron microscopy (SEM). By moving a three-dimensional, computer-controlled translation stage to which the sample was attached, the femtosecond laser could produce three types of ablation patterns, including linear ablation, cylindrical aperture and rectangular cavity. With pulse energies ranging from 37.5 to 150 μJ, the linear lesions were consistently observed at the inner surface of sclera, whereas it failed to make any photodisruption if pulse energy was below the threshold value of 31.25 μJ, with the corresponding threshold intensity of 4.06×10 14 W/cm 2. The depths of the linear lesions increased linearly with both pulse energy (37.5-150 μJ) and exposure time (0.1-0.4 s). Histological examination showed the incisions produced by femtosecond laser photodisruption had precise geometry and the edges were sharp and smooth, with no evidence of collateral damage to the surrounding tissue. Our results predict the potential application of femtosecond laser pulses in minimally invasive laser sclerostomy for glaucoma treatment.

  1. Triangular Titanium Implants for Minimally Invasive Sacroiliac Joint Fusion: A Prospective Study.

    PubMed

    Duhon, Bradley S; Cher, Daniel J; Wine, Kathryn D; Kovalsky, Don A; Lockstadt, Harry

    2016-05-01

    Study Design Prospective multicenter single-arm interventional clinical trial. Objective To determine the degree of improvement in sacroiliac (SI) joint pain, disability related to SI joint pain, and quality of life in patients with SI joint dysfunction who undergo minimally invasive SI joint fusion using triangular-shaped titanium implants. Methods Subjects (n = 172) underwent minimally invasive SI joint fusion between August 2012 and January 2014 and completed structured assessments preoperatively and at 1, 3, 6, and 12 months postoperatively, including a 100-mm SI joint and back pain visual analog scale (VAS), Oswestry Disability Index (ODI), Short Form-36 (SF-36), and EuroQOL-5D. Patient satisfaction with surgery was assessed at 6 and 12 months. Results Mean SI joint pain improved from 79.8 at baseline to 30.0 and 30.4 at 6 and 12 months, respectively (mean improvements of 49.9 and 49.1 points, p < 0.0001 each). Mean ODI improved from 55.2 at baseline to 32.5 and 31.4 at 6 and 12 months (improvements of 22.7 and 23.9 points, p < 0.0001 each). SF-36 physical component summary improved from 31.7 at baseline to 40.2 and 40.3 at 6 and 12 months (p < 0.0001). At 6 and 12 months, 93 and 87% of subjects, respectively, were somewhat or very satisfied and 92 and 91%, respectively, would have the procedure again. Conclusions Minimally invasive SI joint fusion resulted in improvement of pain, disability, and quality of life in patients with SI joint dysfunction due to degenerative sacroiliitis and SI joint disruption. PMID:27099817

  2. Incorporating Minimally Invasive Procedures into an Aesthetic Surgery Practice.

    PubMed

    Matarasso, Alan; Nikfarjam, Jeremy; Abramowitz, Lauren

    2016-07-01

    Minimally invasive procedures in an aesthetic practice have grown over the past decade. Plastic surgery practices are embracing the incorporation of injectables and lasers as adjuncts to their surgical procedures. The use of botulinum toxin, hyaluronic acid fillers, and lasers has made a significant impact on the authors' practice. The authors describe the important considerations, consultation goals, and procedural steps with injectables and fillers. The novel use of deoxycholic acid injections is also described. The authors strongly think that as options continue to expand, plastic surgeons will benefit from taking an active role in adopting these new innovations. PMID:27363759

  3. A Proposed Staging Classification for Minimally Invasive Management of Haglund's Syndrome with Percutaneous and Endoscopic Surgery.

    PubMed

    Syed, Turab Arshad; Perera, Anthony

    2016-09-01

    Haglund's syndrome encompasses several different pathologies, including Haglund's deformity, insertional Achilles tendonopathy, retrocalcaneal bursitis, and superficial bursitis. Traditionally treated with open surgery, there is increasing interest in a more minimally invasive approach to this difficult region to reduce complications and improve the rate and ease of recovery. We review the evidence available for 2 of these techniques: the endoscopic calcaneoplasty and percutaneous Zadek's calcaneal osteotomy (also known as Keck and Kelly's osteotomy). The senior author's classification for management of the condition is presented as well as describing his operative technique for these procedures. PMID:27524710

  4. [History and development trend of minimally invasive surgery for colorectal cancer in China].

    PubMed

    Zheng, Minhua; Ma, Junjun

    2016-08-25

    With the development in past 20 years, the utilization of the laparoscopic surgery, which is the main trend in minimally invasive surgery for colorectal cancer, has tremendously changed. Minimally invasive surgery for colorectal cancer is now at a high level platform after going through the exploration at the very beginning and rapid development in the period of standardizing and promoting the regulations. Nowadays, the unique advantage that the laparoscopy owns is high definition and enlargement of the image, along with the establishment of the key note in series of laparoscopic complete mesocolic excision and the improvement of surgical instruments and methods make the operation skills accurate and normative in exploration of correct plane, high ligation of vessels and protection of nerve during the lymph node dissection of colorectal surgery. Currently, the most common procedure widely used in reconstruction of gastrointestinal(GI) tract is still laparoscopy-assisted approach. The frequent reconstruction of GI tract in rectal cancer surgery is double stapling technique, coloanal anastomosis by hand-sewn technique and the laparoscopic reconstruction of GI tract based on NOSE. At present, the most reconstructions of GI tract, including reconstruction by instrument and by hand-sewn are operated extracorporeally by pulling out the colon through the small incision, which is used to extract specimen. Although compared with the traditional reconstruction of GI tract, the complete laparoscopic excision has the advantage that the incision is smaller, it is more expensive. The preference approach of laparoscopic surgery is mainly medial approach, but with further understanding of CME, TME and the basic of medial approach, the new approaches like total medial approach, hybrid medial approach and caudal approach applied in right hemicolectomy and cephalad medial approach applied in rectal cancer have derived. As the introduction of NOTES, transanal TME and transanal

  5. Minimally invasive transforaminal lumbar interbody fusion with percutaneous navigated guidewireless lumbosacral pedicle screw fixation.

    PubMed

    Chen, Kevin S; Park, Paul

    2016-07-01

    This video details the minimally invasive approach for treatment of a symptomatic Grade II lytic spondylolisthesis with high-grade foraminal stenosis. In this procedure, the use of a navigated, guidewireless technique for percutaneous pedicle screw placement at the lumbosacral junction is highlighted following initial decompression and transforaminal interbody fusion. Key steps of the procedure are delineated that include positioning, exposure, technique for interbody fusion, intraoperative image acquisition, and use of a concise 2-step process for navigated screw placement without using guidewires. The video can be found here: https://youtu.be/2u6H4Pc_8To . PMID:27364422

  6. Bivalirudin anticoagulation for minimal invasive transapical transcatheter aortic valve replacement in a patient with antiphospholipid antibodies.

    PubMed

    Koster, Andreas; Ensminger, Stephan; Vlachojannis, Marios; Birschmann, Ingvild

    2016-09-01

    The occurrence of lupus anticoagulant is associated with the hazard of developing an antiphospholipid syndrome, a severe prothrombotic condition which may particularly occur after major surgical trauma. This disease requires certain considerations regarding surgical strategy and anticoagulation management. We describe the perioperative management of a patient scheduled for elective aortic valve replacement and diagnosed for having antiphospholipid antibodies. The procedure was successfully performed using a minimally invasive approach via transapical aortic valve replacement and anticoagulation with the nonreversible short-acting direct thrombin Inhibitor bivalirudin. PMID:27555195

  7. Minimally invasive valve sparing aortic root replacement (David procedure) is safe

    PubMed Central

    Krueger, Heike; Umminger, Julia; Koigeldiyev, Nurbol; Beckmann, Erik; Haverich, Axel; Martens, Andreas

    2015-01-01

    Objective Even though minimally invasive cardiac surgery may reduce morbidity, this approach is not routinely performed for aortic root replacements. The purpose of this pilot study was to assess the safety and feasibility of valve sparing aortic root replacement via an upper mini-sternotomy up to the 3rd intercostal space. Methods Between April 2011 and March 2014, 26 patients (22 males, age 47.6±13 years) underwent elective minimally invasive aortic valve sparing root replacement (David procedure, group A). Twelve patients underwent additional leaflet repair. Concomitant procedures were: four proximal aortic arch replacements and one coronary artery bypass grafting (CABG) to the proximal right coronary artery (RCA). During the same time period, 14 patients (ten males, age 64.2±9.5 years) underwent elective David procedure via median full sternotomy (group B). Concomitant procedures included six proximal aortic arch replacements. Although the patient cohorts were small, the results of these two groups were compared. Results In group A, there were no intra-operative conversions to full sternotomy. The aortic cross-clamp and cardiopulmonary bypass (CPB) times were 115.6±30.3 and 175.8±41.9 min, respectively. One patient was re-opened (via same access) due to post-operative bleeding. The post-operative ventilation time and hospital stay were 0.5±0.3 and 10.4±6.8 days, respectively. There was no 30-day mortality. The patient questionnaire showed that the convalescence time was approximately two weeks. In group B: the cross-clamp and CPB times were 114.1±19.9 and 163.0±24.5 min, respectively. One patient was re-opened (7.1%) due to post-operative bleeding. The post-operative ventilation time and hospital stay were 0.6±0.7 and 14.2±16.7 days, respectively. There was no 30-day mortality. Conclusions Minimally invasive valve sparing aortic root replacement can be safely performed in selected patients. The results are comparable to those operated via a full

  8. Role of minimally invasive surgery for adult spinal deformity in preventing complications.

    PubMed

    Yen, Chun-Po; Mosley, Yusef I; Uribe, Juan S

    2016-09-01

    With the aging population, there is a rising prevalence of degenerative spinal deformity and need of surgical care for these patients. Surgical treatment for adult spinal deformity (ASD) is often fraught with a high rate of complications. Minimally invasive surgery (MIS) has for the past decade been adopted by spine surgeons to treat ASD in the hopes of reducing access-related morbidity and perioperative complications. The benefits of MIS approach in general and recent development of MIS techniques to avoid long-term complications such as pseudoarthrosis or proximal junctional kyphosis are reviewed. PMID:27411527

  9. Minimally invasive keyhole approaches in spinal intradural tumor surgery: report of two cases and conceptual considerations.

    PubMed

    Reisch, Robert; Koechlin, Nicolas O; Marcus, Hani J

    2016-09-01

    Despite their predominantly histologically benign nature, intradural tumors may become symptomatic by virtue of their space-occupying effect, causing severe neurological deficits. The gold standard treatment is total excision of the lesion; however, extended dorsal and dorsolateral approaches may cause late complications due to iatrogenic destruction of the posterolateral elements of the spine. In this article, we describe our concept of minimally invasive spinal tumor surgery. Two illustrative cases demonstrate the feasibility and safety of keyhole fenestrations exposing the spinal canal. PMID:25336048

  10. MIS-behavior: practical heuristics for precise pediatric minimally invasive surgery.

    PubMed

    Blinman, Thane A

    2015-02-01

    Minimally invasive surgery (MIS) has changed pediatric urology and general surgery, offering less morbidity and new surgical options for many procedures. This promise goes unrealized when technical methods lag. Application of MIS in children is uneven after more than 2 decades of application. Principles of versatile and proficient technique may remain unstated and implicit in surgical training, often leaving surgical training an exercise in inference and imitation. This article describes some essential practical principles of precision MIS applied to patients of any size. PMID:25455179

  11. Real-time stereo generation for surgical vision during minimal invasive robotic surgery

    NASA Astrophysics Data System (ADS)

    Laddi, Amit; Bhardwaj, Vijay; Mahapatra, Prasant; Pankaj, Dinesh; Kumar, Amod

    2016-03-01

    This paper proposes a framework for 3D surgical vision for minimal invasive robotic surgery. It presents an approach for generating the three dimensional view of the in-vivo live surgical procedures from two images captured by very small sized, full resolution camera sensor rig. A pre-processing scheme is employed to enhance the image quality and equalizing the color profile of two images. Polarized Projection using interlacing two images give a smooth and strain free three dimensional view. The algorithm runs in real time with good speed at full HD resolution.

  12. Minimally invasive L5-S1 oblique lumbar interbody fusion with anterior plate.

    PubMed

    Pham, Martin H; Jakoi, Andre M; Hsieh, Patrick C

    2016-07-01

    Lumbar interbody fusion is an important technique for the treatment of degenerative disc disease and degenerative scoliosis. The oblique lumbar interbody fusion (OLIF) establishes a minimally invasive retroperitoneal exposure anterior to the psoas and lumbar plexus. In this video case presentation, the authors demonstrate the techniques of the OLIF at L5-S1 performed on a 69-year-old female with degenerative scoliosis as one component of an overall strategy for her deformity correction. The video can be found here: https://youtu.be/VMUYWKLAl0g . PMID:27364428

  13. Minimally invasive microendoscopy system for in vivo functional imaging of deep nuclei in the mouse brain

    PubMed Central

    Bocarsly, Miriam E.; Jiang, Wan-chen; Wang, Chen; Dudman, Joshua T.; Ji, Na; Aponte, Yeka

    2015-01-01

    The ability to image neurons anywhere in the mammalian brain is a major goal of optical microscopy. Here we describe a minimally invasive microendoscopy system for studying the morphology and function of neurons at depth. Utilizing a guide cannula with an ultrathin wall, we demonstrated in vivo two-photon fluorescence imaging of deeply buried nuclei such as the striatum (2.5 mm depth), substantia nigra (4.4 mm depth) and lateral hypothalamus (5.0 mm depth) in mouse brain. We reported, for the first time, the observation of neuronal activity with subcellular resolution in the lateral hypothalamus and substantia nigra of head-fixed awake mice. PMID:26601017

  14. Minimally Invasive Surgical Technique in Periodontal Regeneration: A Randomized Controlled Clinical Trial Pilot Study.

    PubMed

    Ghezzi, Carlo; Ferrantino, Luca; Bernardini, Luigi; Lencioni, Margherita; Masiero, Silvia

    2016-01-01

    The purpose of this study was to compare two minimally invasive surgical techniques (MISTs) for the treatment of periodontal defects: (1) guided tissue regeneration (GTR) using resorbable minimembrane and particulate xenograft (DBBM); and (2) inductive periodontal regeneration (IPR) using enamel matrix derivatives and DBBM. A sample of 20 infrabony periodontal defects in 20 patients were randomly assigned to either the GTR or the IPR group. A follow-up was performed at 12 months postoperative. Significant improvement in clinical parameters was observed in both groups, although no intergroup differences were found. MIST with GTR or IPR demonstrated very good outcomes 1 year after surgery, with no differences between treatment groups. PMID:27333004

  15. Neuropathic Minimally Invasive Surgeries (NEMESIS):: Percutaneous Diabetic Foot Surgery and Reconstruction.

    PubMed

    Miller, Roslyn J

    2016-09-01

    Patients with peripheral neuropathy associated with ulceration are the nemesis of the orthopedic foot and ankle surgeon. Diabetic foot syndrome is the leading cause of peripheral neuropathy, and its prevalence continues to increase at an alarming rate. Poor wound healing, nonunion, infection, and risk of amputation contribute to the understandable caution toward this patient group. Significant metalwork is required to hold these technically challenging deformities. Neuropathic Minimally Invasive Surgeries is an addition to the toolbox of management of the diabetic foot. It may potentially reduce the risk associated with large wounds and bony correction in this patient group. PMID:27524708

  16. Urolift: a New Face of Minimally Invasive Surgical Technique for Benign Prostatic Hyperplasia?

    PubMed

    Tsui, Johnson F; Dixon, Christopher M

    2016-09-01

    The management of clinical benign prostatic hyperplasia (BPH) remains a common problem in daily urologic practice. Recently, a new minimally invasive procedure for BPH, the Urolift System, has been introduced. This article reviews the current literature discussing the technique, efficacy, adverse events, limitations, and possible concerns. The existing data which includes a 3-month, sham-controlled multicenter trial with a subsequent 3-year follow-up indicates significant improvements in the outcome measures in particular urinary symptoms. The adverse event profile and reoperation rates are acceptable. A particular benefit includes the lack of negative effects on erectile or ejaculatory function. The procedure can be performed with minimal anesthesia, but is limited to lateral lobe enlargement as it is unsuitable for median lobe or central zone obstruction. Another potential drawback is the placement of permanent implants into the prostatic urethra. The adoption of this procedure will ultimately be determined by multiple factors including ease of use, patient satisfaction, durability, and reimbursement. PMID:27432380

  17. Current Evidence of Minimally Invasive Spine Surgery in the Treatment of Lumbar Disc Herniations.

    PubMed

    Quirno, Martin; Vira, Shaleen; Errico, Thomas J

    2016-03-01

    With the advent of new instrumentation and better imaging techniques that allowed less tissue trauma compared with traditional open procedures, while providing adequate or enhanced visualization of the pathologic site and based upon the successful experience of outpatient spine surgery to assist early ambulation, the trend and evolution toward ''minimal access'' or minimally invasive spine surgery began to develop with greater intensity. Many surgical techniques have flourished with the promise of delivering a safe and efficient alternative, including chemonucleolysis, manual percutaneous discectomy (MPD), automated percutaneous lumbar discectomy (APLD), and percutaneous lumbar laser discectomy (PLLD). Unfortunately, most of these techniques have been demonstrated to be inefficient with high complication rates. Only modifications of the original open discectomy in which direct visualization of the disc is obtained through either microscopic or endoscopic techniques have proven to be successful. This review outlines the historical journey that has inspired the development of these techniques and delineates the progressive clinical experience gained from their advent. PMID:26977554

  18. A bounded iterative closest point method for minimally invasive registration of the femur.

    PubMed

    Rodriguez y Baena, Ferdinando; Hawke, Trevor; Jakopec, Matjaz

    2013-10-01

    This article describes a novel method for image-based, minimally invasive registration of the femur, for application to computer-assisted unicompartmental knee arthroplasty. The method is adapted from the well-known iterative closest point algorithm. By utilising an estimate of the hip centre on both the preoperative model and intraoperative patient anatomy, the proposed 'bounded' iterative closest point algorithm robustly produces accurate varus-valgus and anterior-posterior femoral alignment with minimal distal access requirements. Similar to the original iterative closest point implementation, the bounded iterative closest point algorithm converges monotonically to the closest minimum, and the presented case includes a common method for global minimum identification. The bounded iterative closest point method has shown to have exceptional resistance to noise during feature acquisition through simulations and in vitro plastic bone trials, where its performance is compared to a standard form of the iterative closest point algorithm. PMID:23959859

  19. Optimal Needle Grasp Selection for Automatic Execution of Suturing Tasks in Robotic Minimally Invasive Surgery

    PubMed Central

    Liu, Taoming; Çavuşoğlu, M. Cenk

    2015-01-01

    This paper presents algorithms for optimal selection of needle grasp, for autonomous robotic execution of the minimally invasive surgical suturing task. In order to minimize the tissue trauma during the suturing motion, the best practices of needle path planning that are used by surgeons are applied for autonomous robotic surgical suturing tasks. Once an optimal needle trajectory in a well-defined suturing scenario is chosen, another critical issue for suturing is the choice of needle grasp for the robotic system. Inappropriate needle grasp increases operating time requiring multiple re-grasps to complete the desired task. The proposed methods use manipulability, dexterity and torque metrics for needle grasp selection. A simulation demonstrates the proposed methods and recommends a variety of grasps. Then a realistic demonstration compares the performances of the manipulator using different grasps. PMID:26413382

  20. Minimally Invasive Insulin Delivery in Subjects with Type 1 Diabetes Using Hollow Microneedles

    PubMed Central

    Gupta, Jyoti

    2009-01-01

    Abstract Background Microneedles have previously been used to deliver insulin to animal models, but not in human subjects. This study tested the hypothesis that hollow microneedles can deliver insulin to modulate blood glucose levels in subjects with type 1 diabetes in a minimally invasive manner. Methods This study was carried out in two adults with type 1 diabetes and evaluated bolus delivery of lispro insulin using a hollow microneedle compared to a catheter infusion set (9 mm). The study first determined the minimum insulin delivery depth by administering insulin from microneedles inserted 1, 3.5, and 5 mm into the skin of fasting subjects and then assessed the efficacy of insulin delivery from microneedles inserted 1 mm into the skin to reduce postprandial glucose levels. Blood samples were periodically assayed for plasma free insulin and plasma glucose levels for up to 3.5 h. Results The first phase of the study indicated that microneedles inserted at the shallowest depth of 1 mm within the skin led to rapid insulin absorption and reduction in glucose levels. Bolus insulin delivery followed by consumption of a standardized meal in the second phase revealed that microneedles were effective in reducing postprandial glucose levels. Subjects reported no pain from microneedle treatments, and there were no adverse events. Conclusions This study provides the first proof of concept that hollow microneedles can effectively deliver bolus insulin to type 1 diabetes subjects in a minimally invasive manner. PMID:19459760

  1. Comparison of pain perception between open and minimally invasive surgery in total knee arthroplasty

    PubMed Central

    Moretti, Biagio; Vitale, Elsa; Esposito, Antonio; Colella, Antonio; Cassano, Maria; Notarnicola, Angela

    2010-01-01

    Total knee arthroplasty (TKA) was a well-established procedure that had shown excellent long-term results in terms of reduced pain and increased mobility. Pain was one of the most important outcome measures that contributed to patient dissatisfaction after TKA. After a computerized search of the Medline and Embase databases, we considered articles from January 1st, 1997 to October 31st, 2009 that underlined the impact on patient pain perception of either standard open total knee arthroplasty or minimally invasive total knee arthroplasty. We included articles that used the visual analog scale (VAS), Western Ontario and McMasters Universities Osteoarthritis Index (WOMAC), Knee Score, Hospital for Special Surgery Score (HSS), Oxford Knee Score (OKS) as postoperative pain indicators, and we included studies with a minimum follow-up period of two months. We excluded studies that monitored only functional postoperative knee activities. It was shown that TKA with the open technique was a better treatment for knees with a positive effect on pain and function than the minimally invasive technique. PMID:21042568

  2. Transanal Minimally Invasive Surgery (TAMIS) to Treat Vesicorectal Fistula: A New Approach

    PubMed Central

    Tobias-Machado, Marcos; Mattos, Pablo Aloisio Lima; Reis, Leonardo Oliveira; Juliano, César Augusto Braz; Pompeo, Antonio Carlos Lima

    2015-01-01

    ABSTRACT Purpose: Vesicorectal fistula is one of the most devastating postoperative complications after radical prostatectomy. Definitive treatment is difficult due to morbidity and recurrence. Despite many options, there is not an unanimous accepted approach. This article aimed to report a new minimally invasive approach as an option to reconstructive surgery. Materials and Methods: We report on Transanal Minimally Invasive Surgery (TAMIS) with miniLap devices for instrumentation in a 65 year old patient presenting with vesicorectal fistula after radical prostatectomy. We used Alexis® device for transanal access and 3, 5 and 11 mm triangulated ports for the procedure. The surgical steps were as follows: cystoscopy and implant of guide wire through fistula; patient at jack-knife position; transanal access; Identification of the fistula; dissection; vesical wall closure; injection of fibrin glue in defect; rectal wall closure. Results: The operative time was 240 minutes, with 120 minutes for reconstruction. No perioperative complications or conversion were observed. Hospital stay was two days and catheters were removed at four weeks. No recurrence was observed. Conclusions: This approach has low morbidity and is feasible. The main difficulties consisted in maintaining luminal dilation, instrumental manipulation and suturing. PMID:26689530

  3. Development of Minimally Invasive Medical Tools Using Laser Processing on Cylindrical Substrates

    NASA Astrophysics Data System (ADS)

    Haga, Yoichi; Muyari, Yuta; Goto, Shoji; Matsunaga, Tadao; Esashi, Masayoshi

    This paper reports micro-fabrication techniques using laser processing on cylindrical substrates for the realization of high-performance multifunctional minimally invasive medical tools with small sizes. A spring-shaped shape memory alloy (SMA) micro-coil with a square cross section has been fabricated by spiral cutting of a Ti-Ni SMA tube with a femtosecond laser. Small diameter active bending catheter which is actuated by hydraulic suction mechanism for intravascular minimally invasive diagnostics and therapy has also been developed. The catheter is made of a Ti-Ni super elastic alloy (SEA) tube which is processed by laser micromachining and a silicone rubber tube which covers the outside of the SEA tube. The active catheter is effective for insertion in branch of blood vessel which diverse in acute angle which is difficult to proceed. Multilayer metallization and patterning have been performed on glass tubes with 2 and 3 mm external diameters using maskless lithography techniques using a laser exposure system. Using laser soldering technique, a integrated circuit parts have been mounted on a multilayer circuit patterned on a glass tube. These fabrication techniques will effective for realization of high-performance multifunctional catheters, endoscopic tools, and implanted small capsules.

  4. TOPICAL REVIEW: Capacitive micromachined ultrasonic transducer arrays for minimally invasive medical ultrasound

    NASA Astrophysics Data System (ADS)

    Chen, Jingkuang

    2010-02-01

    This paper reviews the minimally invasive capacitive micromachined ultrasonic transducer (CMUT) arrays for medical diagnosis and therapy. While piezoelectric transducers dominate today's medical ultrasound market, the capacitive micromachined ultrasonic transducer has recently emerged as a promising alternative which delivers a comparable device performance to its piezoelectric counterparts, is compatible with front-end circuit integration, allows high-density imager integration and is relative easy in miniaturization. Utilizing MEMS technology, the substrate of CMUT arrays can be micromachined into miniature platforms with various geometrical shapes, which include needles, three-dimensional prisms, as well as other flexible-substrate configurations. These arrays are useful for reaching deep inside the tissue or an organ with a minimally invasive approach. Due to the close proximity of the transducers to the target organ/tissue, a higher resolution/accuracy of diagnostic information can be achieved. In addition to pulse-echo and photoacoustic imaging, high-power CMUT devices capable of delivering ultrasounds with a pressure greater than 1.0 MPa have been monolithically integrated with imager CMUTs for image-guided therapy (IGT). Such miniature devices would facilitate diagnostic and therapy interventions not possible with conventional piezoelectric transducers.

  5. Impact insertion of transfer-molded microneedle for localized and minimally invasive ocular drug delivery.

    PubMed

    Song, Hyun Beom; Lee, Kang Ju; Seo, Il Ho; Lee, Ji Yong; Lee, Sang-Mok; Kim, Jin Hyoung; Kim, Jeong Hun; Ryu, WonHyoung

    2015-07-10

    It has been challenging for microneedles to deliver drugs effectively to thin tissues with little background support such as the cornea. Herein, we designed a microneedle pen system, a single microneedle with a spring-loaded microneedle applicator to provide impact insertion. To firmly attach solid microneedles with 140 μm in height at the end of macro-scale applicators, a transfer molding process was employed. The fabricated microneedle pens were then applied to mouse corneas. The microneedle pens successfully delivered rhodamine dye deep enough to reach the stromal layer of the cornea with small entry only about 1000 μm(2). When compared with syringes or 30 G needle tips, microneedle pens could achieve more localized and minimally invasive delivery without any chances of perforation. To investigate the efficacy of microneedle pens as a way of drug delivery, sunitinib malate proven to inhibit in vitro angiogenesis, was delivered to suture-induced angiogenesis model. When compared with delivery by a 30 G needle tip dipped with sunitinib malate, only delivery by microneedle pens could effectively inhibit corneal neovascularization in vivo. Microneedle pens could effectively deliver drugs to thin tissues without impairing merits of using microneedles: localized and minimally invasive delivery. PMID:25937320

  6. Portable minimally invasive human glucose detection instrument by surface plasmon resonance

    NASA Astrophysics Data System (ADS)

    Li, Dachao; Wu, Peng; Zhang, Jingxin; Liang, Wenshuai; Xu, Kexin

    2010-08-01

    With the improvement of living standard, the incidence of diabetes increases year by year. Minimally invasive blood glucose monitoring is an effectively way to control diabetes, and it is achieved by measuring the glucose concentration of interstitial fluid in human body. This paper presents a portable minimally-invasive human glucose detection instrument which is based on a miniature integrated surface plasmon resonance (SPR) sensor. D-galactose/D-glucose Binding Protein (GGBP) which can specifically absorb glucose moleculars is used to modify the gold surface of SPR sensor for higher sensitivity and stability. The instrument includes an interstitial fluid extraction unit, a liquid flow unit, a SPR sensor unit and a circuit control unit. Interstitial fluid is extracted from human body using the interstitial fluid extraction unit, and it is then transported to the SPR sensor by the liquid flow unit, and the SPR sensor can detect the glucose concentration in the interstitial fluid. The acquisition and process of data is controlled by the circuit control unit, which controls the operation of the whole system as well. The glucose detection resolution could reach 6.25mg/L, and the experiment result has good linearity when the glucose concentration ranges from 6.25mg/L to 50mg/L.

  7. Novel hydrogel application in minimally invasive surgical approaches to spontaneous intracranial hypotension. Report of 2 cases.

    PubMed

    Chai, Casey M; Banu, Matei A; Cobb, William; Mehta, Neel; Heier, Linda; Boockvar, John A

    2014-10-01

    The authors report 2 cases of orthostatic headaches associated with spontaneous intracranial hypotension (SIH) secondary to CSF leaks that were successfully treated with an alternative dural repair technique in which a tubular retractor system and a hydrogel dural sealant were used. The 2 patients, a 63-year-old man and a 45-year-old woman, presented with orthostatic headache associated with SIH secondary to suspected lumbar and lower cervical CSF leaks, respectively, as indicated by bony defects or epidural fluid collection. Epidural blood patch repair failed in both cases, but both were successfully treated with the minimally invasive application of a hydrogel dural sealant as a novel adjunct to traditional dural repair techniques. Both patients tolerated the procedure well. Moreover, SIH symptoms and MRI signs were completely resolved at 1-month follow-up in both patients. The minimally invasive dural repair procedure with hydrogel dural sealant described here offers a viable alternative in patients in whom epidural blood patches have failed, with obscure recalcitrant CSF leaks at the cervical as well as lumbar spinal level. The authors demonstrate that the adjuvant use of sealant is a safe and efficient repair method regardless of dural defect location. PMID:25084466

  8. A Novel Technique for Transvaginal Retrieval of Enlarged Pelvic Viscera during Minimally Invasive Surgery.

    PubMed

    Wyman, Allison; Fuhrig, Lauren; Bedaiwy, Mohamed A; Debernardo, Robert; Coffey, Gary

    2012-01-01

    Introduction. With the widespread adoption of laparoscopic and robotic surgery, more and more women are undergoing minimally invasive surgery for complex gynecological procedures. The rate-limiting step is often the delivery of an intact uterus or an unruptured adnexal mass. To avoid conversion to a minilaparotomy for specimen retrieval, we describe a novel technique using an Anchor Tissue Retrieval System bag in conjunction with a pneumo-occluder to easily retrieve large specimens through a colpotomy incision. Surgical Technique. After completion of the robotic-assisted hysterectomy, the uterus, fallopian tubes, and ovaries were too large to be retrieved intact despite multiple attempts of delivery through the colpotomy incision. Prior to resorting to a minilaparotomy or morcellation of the specimen, a 15 mm anchor retrieval bag with a pneumo-occluder was placed through the vagina and the intact specimen was easily placed inside the bag under direct visualization and removed through the colpotomy incision intact. Conclusion. We routinely utilize this technique to retrieve hysterectomy specimens that are not readily delivered through the colpotomy incision and find this technique to be safe, highly efficient, and cost effective when there is a need to remove large intact specimens during minimally invasive surgery. PMID:22811899

  9. Ergonomic interface concepts for minimally invasive, remote, and virtual surgical systems.

    PubMed

    Noakes, Mark W; Dixon, Warren E

    2004-01-01

    Traditional open surgical techniques require a surgeon to assume a posture of leaning over the patient with a direct eye-to-hand perspective. As new minimally invasive and remote surgical procedures evolve, the surgeon is not required to maintain the same posture as in open techniques. While more ergonomic postures may be facilitated, some current remote systems have maintained surgeon configurations that are small variants of legacy postures (e.g., maintaining the eye to hand perspective). While the legacy configuration may be more familiar with some surgeons, studies have indicated that it can result in excessive fatigue. Robotics and human factors researchers have determined that fatigue due to inefficiencies in operator interfaces lead to longer completion times and increased task execution errors. This paper discusses operator interface design issues and guidelines that are relevant to remote and minimally invasive surgery, and presents one possible operator interface solution based on the compact remote console deployed for environmental restoration and remote handling of hazardous nuclear waste. PMID:15544288

  10. Minimally invasive aortic banding in mice: effects of altered cardiomyocyte insulin signaling during pressure overload.

    PubMed

    Hu, Ping; Zhang, Dongfang; Swenson, LeAnne; Chakrabarti, Gopa; Abel, E Dale; Litwin, Sheldon E

    2003-09-01

    We developed a minimally invasive method for producing left ventricular (LV) pressure overload in mice. With the use of this technique, we quickly and reproducibly banded the transverse aorta with low surgical morbidity and mortality. Minimally invasive transverse aortic banding (MTAB) acutely and chronically increased LV systolic pressure, increased heart weight-to-body weight ratio, and induced myocardial fibrosis. We used this technique to determine whether reduced insulin signaling in the heart altered the cardiac response to pressure overload. Mice with cardiac myocyte-restricted knockout of the insulin receptor (CIRKO) have smaller hearts than wild-type (WT) controls. Four weeks after MTAB, WT and CIRKO mice had comparably increased LV systolic pressure, increased cardiac mass, and induction of mRNA for beta-myosin heavy chain and atrial natriuretic factor. However, CIRKO hearts were more dilated, had depressed LV systolic function by echocardiography, and had greater interstitial fibrosis than WT mice. Expression of connective tissue growth factor was increased in banded CIRKO hearts compared with WT hearts. Thus lack of insulin signaling in the heart accelerates the transition to a more decompensated state during cardiac pressure overload. The use of the MTAB approach should facilitate the study of the pathophysiology and treatment of pressure-overload hypertrophy. PMID:12738623

  11. Lactate and glucose measurement in subepidermal tissue using minimally invasive microperfusion needle.

    PubMed

    Tsuruoka, Noriko; Ishii, Kenji; Matsunaga, Tadao; Nagatomi, Ryoichi; Haga, Yoichi

    2016-02-01

    Knowing the concentrations of biological substances can help ascertain physiological and pathological states. In the present study, a minimally invasive microperfusion needle was developed for measuring the concentrations of biological substances in subepidermal tissue. The microperfusion needle has a flow channel with a perforated membrane through which biological substances from subepidermal tissue are extracted. Since this device uses a thin steel acupuncture needle as the base substrate, it has sufficient rigidity for insertion through the skin. The efficacy of the needle was examined by measuring lactate and glucose concentrations in mice. Lactate was injected intraperitoneally, and changes in lactate concentrations in subepidermal tissue over time were measured using the device. Lactate concentrations of blood were also measured as a reference. Lactate was successfully collected using the microperfusion needle, and the lactate concentration of perfused saline was significantly correlated with blood lactate concentration. Glucose solution was administered orally, and the glucose concentration of perfused saline was also correlated with blood glucose concentration. The newly developed microperfusion needle can be used for minimally invasive monitoring of the concentrations of biological substances. PMID:26860415

  12. Hydrogel-forming microneedle arrays: Potential for use in minimally-invasive lithium monitoring.

    PubMed

    Eltayib, Eyman; Brady, Aaron J; Caffarel-Salvador, Ester; Gonzalez-Vazquez, Patricia; Zaid Alkilani, Ahlam; McCarthy, Helen O; McElnay, James C; Donnelly, Ryan F

    2016-05-01

    We describe, for the first time, hydrogel-forming microneedle (s) (MN) arrays for minimally-invasive extraction and quantification of lithium in vitro and in vivo. MN arrays, prepared from aqueous blends of hydrolysed poly(methyl-vinylether-co-maleic anhydride) and crosslinked by poly(ethyleneglycol), imbibed interstitial fluid (ISF) upon skin insertion. Such MN were always removed intact. In vitro, mean detected lithium concentrations showed no significant difference following 30min MN application to excised neonatal porcine skin for lithium citrate concentrations of 0.9 and 2mmol/l. However, after 1h application, the mean lithium concentrations extracted were significantly different, being appropriately concentration-dependent. In vivo, rats were orally dosed with lithium citrate equivalent to 15mg/kg and 30mg/kg lithium carbonate, respectively. MN arrays were applied 1h after dosing and removed 1h later. The two groups, having received different doses, showed no significant difference between lithium concentrations in serum or MN. However, the higher dosed rats demonstrated a lithium concentration extracted from MN arrays equivalent to a mean increase of 22.5% compared to rats which received the lower dose. Hydrogel-forming MN clearly have potential as a minimally-invasive tool for lithium monitoring in outpatient settings. We will now focus on correlation between serum and MN lithium concentrations. PMID:26969262

  13. Minimally invasive treatment for female stress urinary incontinence – Romanian highlights

    PubMed Central

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

    2011-01-01

    Rationale: Stress urinary incontinence is still a "battlefield" for many minimally invasive therapies, but, unfortunately, few can restore the anatomical and functional background of this disorder. Objective: Assessing the latest minimally invasive procedures of intra and perisphincterian injection of autologous stem cells. Method and Result: The first stem cell implantation (myoblasts and /or mature fibroblasts grown and multiplied in the laboratory from biopsy samples taken from the pectoralis muscle) in the urethral sphincter was performed on October 18, 2010, in “Fundeni” Clinic of Urology and Renal Transplantation, in Romania. Discussion: The follow-up at six weeks with the quality of life questionnaires, micturition diary and clinical examination revealed a decrease of urine loss from six pads/ day at one per day, which significantly improved the patient’s quality of life according to visual analogue scale. Clinical and urodynamic evaluations will continue and will be future scientific topics. Abbreviations: SUI = stress urinary incontinence; TVT = tension free vaginal tape; TVT-O = tension free vaginal tape obturator; QoL = quality of life PMID:22514562

  14. Productivity benefits of minimally invasive surgery in patients with chronic sacroiliac joint dysfunction

    PubMed Central

    Saavoss, Josh D; Koenig, Lane; Cher, Daniel J

    2016-01-01

    Introduction Sacroiliac joint (SIJ) dysfunction is associated with a marked decrease in quality of life. Increasing evidence supports minimally invasive SIJ fusion as a safe and effective procedure for the treatment of chronic SIJ dysfunction. The impact of SIJ fusion on worker productivity is not known. Methods Regression modeling using data from the National Health Interview Survey was applied to determine the relationship between responses to selected interview questions related to function and economic outcomes. Regression coefficients were then applied to prospectively collected, individual patient data in a randomized trial of SIJ fusion (INSITE, NCT01681004) to estimate expected differences in economic outcomes across treatments. Results Patients who receive SIJ fusion using iFuse Implant System® have an expected increase in the probability of working of 16% (95% confidence interval [CI] 11%–21%) relative to nonsurgical patients. The expected change in earnings across groups was US $3,128 (not statistically significant). Combining the two metrics, the annual increase in worker productivity given surgical vs nonsurgical care was $6,924 (95% CI $1,890–$11,945). Conclusion For employees with chronic, severe SIJ dysfunction, minimally invasive SIJ fusion may improve worker productivity compared to nonsurgical treatment. PMID:27114712

  15. Minimally Invasive Radiologically Guided Intervention for the Treatment of Salivary Calculi

    SciTech Connect

    Brown, Jackie E.; Drage, Nicholas A.; Escudier, Michael P.; Wilson, Ron F.; McGurk, Mark

    2002-10-15

    Purpose: To describe the technique and examine the value of salivary stone extraction using a minimally invasive, radiologically guided approach as an alternative to salivary gland surgery for the treatment of benign salivary gland obstruction. Methods: Eighty-six cases of sialolithiasis (83 patients) were treated by stone removal using a Dormia basket under local anesthesia and fluoroscopic guidance. Postoperative assessment was made clinically at review, by sialogram and by questionnaire. Results: Of 86 cases of sialolithiasis treated, in 55 (64%)it was possible to remove all stones. In 12 cases (14%) part of a stone or some of a number of calculi were removed and in 19 cases (22%) the procedure failed. The commonest reason for failure was fixation of the stone within the duct. Symptoms at review (range 1-49 months, mean 17 months) were relieved in 55 of 67 (82%) of cases where a stone or portion of stone was removed. Conclusions:Stone removal from the salivary duct system by radiologically guided,minimally invasive approach is a simple procedure with low morbidity and high patient acceptance when appropriate selection criteria are applied. These criteria are considered and recommendations made.

  16. Minimally invasive plate osteosythesis of fractures of the radius and ulna in a primate.

    PubMed

    Tong, K; Guiot, L P

    2013-01-01

    A 25-year-old female mandrill (Mandrillus sphinx - a primate and part of the Old World monkey group) was presented with a mildly comminuted, diaphyseal, radial fracture associated with a transverse ulnar fracture. Minimally invasive plate osteosynthesis techniques were used to achieve fixation of both the radial and the ulnar fractures. First, closed fracture reduction was achieved with a distraction frame consisting of a motorized circular external skeletal fixator. Next, dual percutaneous radio-ulnar plating was performed using a 2.7 limited-contact dynamic compression plate on the cranial aspect of the radius and two stacked 2.0/2.7 veterinary cut-to-length plates on the lateral aspect of the ulna. Uncomplicated recovery was observed with a complete return to normal activity three months postoperatively. Fracture healing was documented at four weeks, clinical union at 14 weeks, and callus remodelling at 24 weeks postoperatively. This report demonstrates the feasibility of minimally invasive plate osteosynthesis in a primate and shows the adaptability of this technique across mammalian species. PMID:23708981

  17. Active self-calibration of thoracoscopic images for assisted minimally invasive spinal surgery

    NASA Astrophysics Data System (ADS)

    Girard, Fantin; Benboujja, Fouzi; Parent, Stefan; Cheriet, Farida

    2010-02-01

    Registration of thoracoscopic images to a preoperative 3D model of the spine is a prerequisite for minimally invasive surgical guidance. We propose an active self-calibration method of thoracoscopic image sequences acquired by an angled monocular endoscope with varying focal length during minimally invasive surgery of the spine. The extrinsic parameters are updated in real time by a motion tracking system while the intrinsic parameters are determined from a set of geometrical primitives extracted from the image of the surgical instrument tracked throughout the thoracoscopic sequence. A particle filter was used for the tracking of the instrument on the image sequence that was preprocessed to detect and correct reflexions due to the light source. The proposed method requires undertaking a pure rotation of the endoscope to update the focal length and exploits the inherent temporal rigid motion of the instrument through consecutive frames. A pure rotation is achievable by undertaking a rotation of the scope cylinder with respect to the head of the camera. Therefore, the surgeon may take full advantage of an angled endoscope by adjusting focus and zoom during surgery. Simulation experiments have assessed the accuracy of the obtained parameters and the optimal number of geometrical primitives required for an active self-calibration of the angled monocular endoscope. Finally, an in vitro experiment demonstrated that 3D reconstruction of rigid structures tracked throughout a monocular thoracoscopic image sequence is feasible and its accuracy is adequate for the registration of thoracoscopic images to a preoperative MRI 3D model of the spine.

  18. An interventional multispectral photoacoustic imaging platform for the guidance of minimally invasive procedures

    NASA Astrophysics Data System (ADS)

    Xia, Wenfeng; Nikitichev, Daniil I.; Mari, Jean Martial; West, Simeon J.; Ourselin, Sebastien; Beard, Paul C.; Desjardins, Adrien E.

    2015-07-01

    Precise and efficient guidance of medical devices is of paramount importance for many minimally invasive procedures. These procedures include fetal interventions, tumor biopsies and treatments, central venous catheterisations and peripheral nerve blocks. Ultrasound imaging is commonly used for guidance, but it often provides insufficient contrast with which to identify soft tissue structures such as vessels, tumors, and nerves. In this study, a hybrid interventional imaging system that combines ultrasound imaging and multispectral photoacoustic imaging for guiding minimally invasive procedures was developed and characterized. The system provides both structural information from ultrasound imaging and molecular information from multispectral photoacoustic imaging. It uses a commercial linear-array ultrasound imaging probe as the ultrasound receiver, with a multimode optical fiber embedded in a needle to deliver pulsed excitation light to tissue. Co-registration of ultrasound and photoacoustic images is achieved with the use of the same ultrasound receiver for both modalities. Using tissue ex vivo, the system successfully discriminated deep-located fat tissue from the surrounding muscle tissue. The measured photoacoustic spectrum of the fat tissue had good agreement with the lipid spectrum in literature.

  19. [Ingenuity of Lymph Node Dissection Reduction for Minimally Invasive Lung Cancer Surgery].

    PubMed

    Konno, Hayato; Minamiya, Yoshihiro

    2016-07-01

    Systematic lymph node dissection in radical operation for lung cancer is recognized as an operative procedure which is accurate staging. In clinical early-stage non-small cell lung cancer (NSCLC), if the nodes are negative, complete mediastinal lymph node dissection might be omitted. Selective mediastinal dissection for clinico-surgical stage I NSCLC proved to be as effective as complete dissection. When lymph node metastasis was observed, segmentectomy was converted to lobectomy. Sentinel node( SN) identification is useful to determine the final indication of minimally invasive surgery by targeting the lymph nodes needed for intraoperative frozen section diagnosis. Many evidences suggest that prognosis of NSCLC with lymph node micrometastases (LNMM) is poor compared with those without LNMM. Evaluation of micrometastases of all dissected lymph nodes may be substituted by evaluating micrometastases of SNs. SN identification is important to the efficiency of micrometastases detection of intraoperative diagnosis. To perform a minimally invasive surgery, evaluation of lymph nodes micrometastases in SN is required. PMID:27440033

  20. Minimally Invasive Surgery for Intracochlear Schwannoma Removal and Simultaneous Cochlear Implantation

    PubMed Central

    Bento, Ricardo Ferreira; Gebrim, Eloisa Maria Mello Santiago; Magalhães, Ana Tereza de Matos; Pereira, Larissa Vilela; Fonseca, Anna Carolina de Oliveira

    2016-01-01

    Introduction  Hearing preservation has not yet been reported in patients undergoing resection of intracochlear schwannomas. This study describes a minimally invasive procedure for intracochlear schwannoma resection with simultaneous cochlear implantation that resulted in good hearing. Objective  This study aims to describe a minimally invasive procedure for intracochlear schwannoma resection with simultaneous cochlear implantation. Data Synthesis  The technique described in this study was developed for a 55-year-old male with a 20-year history of bilateral progressive hearing loss and tinnitus that had a mass in the left apical turn of the cochlea measuring 0.3 cm. Surgery accessed the apical turn of the cochlea. We performed mastoidectomy and posterior tympanotomy and removed incus and tensor tympani muscle to expose the cochlear apex. The tumor was identified and completely resected. After the cochlea was anatomically preserved, it was implanted with a straight electrode via round window insertion. The histopathological examination confirmed intracochlear schwannoma. Speech perception test revealed 100% speech recognition with closed sentences and the average audiometric threshold (500 to 2000 Hz) was 23 dB. Conclusion  Our technique led to rehabilitation of the patient and improved hearing without damaging the intracochlear structure, making it possible to perform CI in the same procedure with good results. PMID:27413411

  1. Minimal invasive ostheosintesis for treatment of diaphiseal transverse humeral shaft fractures

    PubMed Central

    Zogaib, Rodrigo Kallás; Morgan, Steven; Belangero, Paulo Santoro; Fernandes, Hélio Jorge Alvachian; Belangero, William Dias; Livani, Bruno

    2014-01-01

    OBJECTIVE: To evaluate patients with transverse fractures of the shaft of the humerus treated with indirect reduction and internal fixation with plate and screws through minimally invasive technique. METHODS: Inclusion criteria were adult patients with transverse diaphyseal fractures of the humerus closed, isolated or not occurring within 15 days of the initial trauma. Exclusion criteria were patients with compound fractures. RESULTS: In two patients, proximal screw loosening occurred, however, the fractures consolidated in the same mean time as the rest of the series. Consolidation with up to 5 degrees of varus occurred in five cases and extension deficit was observed in the patient with olecranon fracture treated with tension band, which was not considered as a complication. There was no recurrence of infection or iatrogenic radial nerve injury. CONCLUSION: It can be concluded that minimally invasive osteosynthesis with bridge plate can be considered a safe and effective option for the treatment of transverse fractures of the humeral shaft. Level of Evidence III, Therapeutic Study. PMID:24868188

  2. Monitoring and guidance of minimally-invasive thermal therapy using diagnostic ultrasound.

    PubMed

    Ebbini, Emad S; Bischof, John C

    2009-01-01

    We present specialized ultrasound imaging modes for monitoring and guidance of noninvasive and minimally-invasive thermal therapy. One mode is based on two-dimensional imaging of temperature change using diagnostic ultrasound. We have validated this method both in vivo and in vitro in monitoring the heating patterns produced by noninvasive HIFU source and minimally-invasive RF ablation device, respectively. In addition, a nonlinear method for imaging the quadratic echo components from HIFU-induced lesions has also been developed and tested in vivo. Illustrative results from both modes of imaging are presented. These results demonstrate the unique advantages of ultrasound as an image-guidance modality. Specifically, the high spatial and temporal resolutions that allow for imaging highly-localized short-duration therapeutic and sub-therapeutic HIFU beams. With the advent of highperformance computing hardware, these imaging modes are now implementable in real-time. This will lead to active realtime monitoring and control of a range of thermal therapies in the very near future. PMID:19963819

  3. Temperature and pressure fiber-optic sensors applied to minimally invasive diagnostics and therapies

    NASA Astrophysics Data System (ADS)

    Hamel, Caroline; Pinet, Éric

    2006-02-01

    We present how fiber-optic temperature or pressure sensors could be applied to minimally invasive diagnostics and therapies. For instance a miniature pressure sensor based on micro-optical mechanical systems (MOMS) could solve most of the problems associated with fluidic pressure transduction presently used for triggering purposes. These include intra-aortic balloon pumping (IABP) therapy and other applications requiring detection of fast and/or subtle fluid pressure variations such as for intracranial pressure monitoring or for urology diagnostics. As well, miniature temperature sensors permit minimally invasive direct temperature measurement in diagnostics or therapies requiring energy transfer to living tissues. The extremely small size of fiber-optic sensors that we have developed allows quick and precise in situ measurements exactly where the physical parameters need to be known. Furthermore, their intrinsic immunity to electromagnetic interference (EMI) allows for the safe use of EMI-generating therapeutic or diagnostic equipments without compromising the signal quality. With the trend of ambulatory health care and the increasing EMI noise found in modern hospitals, the use of multi-parameter fiber-optic sensors will improve constant patient monitoring without any concern about the effects of EMI disturbances. The advantages of miniature fiberoptic sensors will offer clinicians new monitoring tools that open the way for improved diagnostic accuracy and new therapeutic technologies.

  4. Effectiveness of treatment of transtrochanteric fractures with Dynamic Hip Screws using minimally invasive access☆

    PubMed Central

    de Abreu, Eduardo Lima; Sena, Caroline Brum; Saldanha Rodrigues Filho, Sergio Antonio

    2016-01-01

    Objective To analyze the short-term results from treating unstable intertrochanteric fractures with Dynamic Hip Screws (DHS), using a minimally invasive route, focusing on the functional aspects and complication and mortality rates of the method. Methods This was a prospective longitudinal study on 140 patients who underwent fixation of transtrochanteric fractures with the DHS system with a lateral minimally invasive access in the hip, between January and December 2013. The patients were evaluated pre and postoperatively (after six months of follow-up) by means of the Parker and Palmer mobility score. Women comprised 65.7% of the sample, and 54.3% of the fractures were on the right side. The patients’ mean age was 80 years, ranging from 60 to 93 years. Results We observed an overall decrease in the mobility score and an increase in the degree of dependence over the short term. However, we encountered only two deaths in the study sample and there were no cases of infection or nonunion. Conclusion Despite the efficacy of the treatment with DHS, with high rates of fracture consolidation and a low mortality rate, we noted that the patients still showed significant functional limitation at the follow-up six months after the operation. PMID:27069880

  5. Minimally invasive poly-axial screw plating for three-part fractures of the proximal humerus.

    PubMed

    Barco, R; Barrientos, I; Encinas, C; Antuña, S A

    2012-12-01

    The purpose of this study was to evaluate the poly-axial locked plating system inserted through a minimally invasive approach for the treatment of three-part fractures of the proximal humerus. Twenty-three patients with a three-part fracture of the proximal humerus treated with a poly-axial locking plate through a percutaneous approach were available for clinical and radiological analysis at a minimum of 2 years follow up (average 36 months; range, 24-54 months). To assess objective and subjective outcomes the Constant Score (CS) and the Disabilities of the Arm, Shoulder, and Hand (DASH) score were obtained. All complications were recorded. There were 17 women and 6 men, with a mean age of 62 years (range, 18-86). All fractures healed. At final follow up, the mean forward flexion, external rotation and internal rotation were 126°, 44° and L1, respectively; the mean CS was 64 and the mean DASH score was 23. Twelve patients (52%) had a postoperative complication, which included screw cut-out, stiffness and infection. The poly-axial locked plating system through a minimally-invasive approach may be an appropriate treatment for three-part fractures of the proximal humerus and may reduce the biological aggression of conventional plate fixation. PMID:23622997

  6. Clinical observation of different minimally invasive surgeries for the treatment of impacted upper ureteral calculi

    PubMed Central

    Liu, Yuanhua; Zhou, Zhangyan; Xia, An; Dai, Haitao; Guo, Linjie; Zheng, Jiang

    2013-01-01

    Objective: To compare the clinical effects of three minimally invasive surgeries on the treatment of impacted upper ureteral calculi. Methods: 135 patients with impacted upper ureteral calculi were selected and randomly divided into three groups (Group A-C) (n=45), which were treated with transurethral ureteroscopic lithotripsy, minimally invasive percutaneous nephrolithotomy, and retroperitoneal laparoscopic ureterolithotomy respectively. Relevant results of the three groups were compared. Results: The surgery time of Group C was significantly longer than those of Group A and Group B (P < 0.05). The postoperative hospitalization time of Group B was significantly longer than those of Group A and Group C (P < 0.05). 37.78% (17/45) of Group A patients required extracorporeal shock wave lithotripsy, being significantly more than those in Group B (6.67%, 3/45) and Group C (0, 0/45) (P < 0.05). The postoperative calculus clearance rate of Group A (51.11%, 82.22%) was significantly lower than those of Group B (91.11%, 97.78%) and Group C (93.33%, 100%) (P < 0.05). The incidence rates of postoperative complications in Group A-C were 11.11% (5/45), 8.89% (4/45) and 6.67% (3/45) respectively without significant differences (P > 0.05). Conclusion: The three surgical methods for impacted upper ureteral calculi should be selected according to practical conditions to improve therapeutic effects and to ensure safe surgery. PMID:24550953

  7. Design method of a foldable ventricular assist device for minimally invasive implantation.

    PubMed

    Hsu, Po-Lin; Wang, Yaxin; Amaral, Felipe; Parker, Jack; Schmitz-Rode, Thomas; Autschbach, Rüdiger; Steinseifer, Ulrich

    2014-04-01

    To date, ventricular assist devices (VADs) have become accepted as a therapeutic solution for end-stage heart failure patients when a donor heart is not available. Newer generation VADs allow for a significant reduction in size and an improvement in reliability. However, the invasive implantation still limits this technology to critically ill patients. Recently, expandable/deployable devices have been investigated as a potential solution for minimally invasive insertion. Such a device can be inserted percutaneously via peripheral vessels in a collapsed form and operated in an expanded form at the desired location. A common structure of such foldable pumps comprises a memory alloy skeleton covered by flexible polyurethane material. The material properties allow elastic deformation to achieve the folded position and withstand the hydrodynamic forces during operation; however, determining the optimal geometry for such a structure is a complex challenge. The numerical finite element method (FEM) is widely used and provides accurate structural analysis, but computation time is considerably high during the initial design stage where various geometries need to be examined. This article details a simplified two-dimensional analytical method to estimate the mechanical stress and deformation of memory alloy skeletons. The method was applied in design examples including two popular types of blade skeletons of a foldable VAD. Furthermore, three force distributions were simulated to evaluate the strength of the structures under different loading conditions experienced during pump operation. The results were verified with FEM simulations. The proposed two-dimensional method gives a close stress and deformation estimation compared with three-dimensional FEM simulations. The results confirm the feasibility of such a simplified analytical approach to reveal priorities for structural optimization before time-consuming FEM simulations, providing an effective tool in the initial

  8. MR Monitoring of Minimally Invasive Delivery of Mesenchymal Stem Cells into the Porcine Intervertebral Disc

    PubMed Central

    Barczewska, Monika; Wojtkiewicz, Joanna; Habich, Aleksandra; Janowski, Miroslaw; Adamiak, Zbigniew; Holak, Piotr; Matyjasik, Hubert; Bulte, Jeff W. M.; Maksymowicz, Wojciech; Walczak, Piotr

    2013-01-01

    Purpose Bone marrow stem cell therapy is a new, attractive therapeutic approach for treatment of intervertebral disc (IVD) degeneration; however, leakage and backflow of transplanted cells into the structures surrounding the disc may lead to the formation of undesirable osteophytes. The purpose of this study was to develop a technique for minimally invasive and accurate delivery of stem cells. Methods Porcine mesenchymal stem cells (MSCs) were labeled with superparamagnetic iron oxide nanoparticles (SPIO, Molday ION rhodamine) and first injected into the explanted swine lumbar IVD, followed by ex vivo 3T MRI. After having determined sufficient sensitivity, IVD degeneration was then induced in swine (n=3) by laser-evaporation. 3 x 106 SPIO-labeled cells embedded within hydrogel were injected in 2 doses using a transcutaneous cannula and an epidural anesthesia catheter. T2-weighted MR images were obtained at 3T before and immediately after cell infusion. Two weeks after injection, histological examination was performed for detection of transplanted cells. Results MSCs were efficiently labeled with Molday ION rhodamine. Cells could be readily detected in the injected vertebral tissue explants as distinct hypointensities with sufficient sensitivity. MR monitoring indicated that the MSCs were successfully delivered into the IVD in vivo, which was confirmed by iron-positive Prussian Blue staining of the tissue within the IVD. Conclusion We have developed a technique for non-invasive monitoring of minimally invasive stem delivery into the IVD at 3T. By using a large animal model mimicking the anatomy of IVD in humans, the present results indicate that this procedure may be clinically feasible. PMID:24058619

  9. Minimally Invasive Spine Metastatic Tumor Resection and Stabilization: New Technology Yield Improved Outcome.

    PubMed

    Harel, Ran; Doron, Omer; Knoller, Nachshon

    2015-01-01

    Spinal metastases compressing the spinal cord are a medical emergency and should be operated on if possible; however, patients' medical condition is often poor and surgical complications are common. Minimizing surgical extant, operative time, and blood loss can potentially reduce postoperative complications. This is a retrospective study describing the patients operated on in our department utilizing a minimally invasive surgery (MIS) approach to decompress and instrument the spine from November 2013 to November 2014. Five patients were operated on for thoracic or lumbar metastases. In all cases a unilateral decompression with expandable tubular retractor was followed by instrumentation of one level above and below the index level and additional screw at the index level contralateral to the decompression side. Cannulated fenestrated screws were used (Longitude FNS) and cement was injected to increase pullout resistance. Mean operative time was 134 minutes and estimated blood loss was minimal in all cases. Improvement was noticeable in neurological status, function, and pain scores. No complications were observed. Technological improvements in spinal instruments facilitate shorter and safer surgeries in oncologic patient population and thus reduce the complication rate. These technologies improve patients' quality of life and enable the treatment of patients with comorbidities. PMID:26146637

  10. Minimally Invasive Spine Metastatic Tumor Resection and Stabilization: New Technology Yield Improved Outcome

    PubMed Central

    Harel, Ran; Doron, Omer; Knoller, Nachshon

    2015-01-01

    Spinal metastases compressing the spinal cord are a medical emergency and should be operated on if possible; however, patients' medical condition is often poor and surgical complications are common. Minimizing surgical extant, operative time, and blood loss can potentially reduce postoperative complications. This is a retrospective study describing the patients operated on in our department utilizing a minimally invasive surgery (MIS) approach to decompress and instrument the spine from November 2013 to November 2014. Five patients were operated on for thoracic or lumbar metastases. In all cases a unilateral decompression with expandable tubular retractor was followed by instrumentation of one level above and below the index level and additional screw at the index level contralateral to the decompression side. Cannulated fenestrated screws were used (Longitude FNS) and cement was injected to increase pullout resistance. Mean operative time was 134 minutes and estimated blood loss was minimal in all cases. Improvement was noticeable in neurological status, function, and pain scores. No complications were observed. Technological improvements in spinal instruments facilitate shorter and safer surgeries in oncologic patient population and thus reduce the complication rate. These technologies improve patients' quality of life and enable the treatment of patients with comorbidities. PMID:26146637

  11. An Automated and Minimally Invasive Tool for Generating Autologous Viable Epidermal Micrografts

    PubMed Central

    Osborne, Sandra N.; Schmidt, Marisa A.; Harper, John R.

    2016-01-01

    ABSTRACT OBJECTIVE: A new epidermal harvesting tool (CelluTome; Kinetic Concepts, Inc, San Antonio, Texas) created epidermal micrografts with minimal donor site damage, increased expansion ratios, and did not require the use of an operating room. The tool, which applies both heat and suction concurrently to normal skin, was used to produce epidermal micrografts that were assessed for uniform viability, donor-site healing, and discomfort during and after the epidermal harvesting procedure. DESIGN: This study was a prospective, noncomparative institutional review board–approved healthy human study to assess epidermal graft viability, donor-site morbidity, and patient experience. SETTING: These studies were conducted at the multispecialty research facility, Clinical Trials of Texas, Inc, San Antonio. PATIENTS: The participants were 15 healthy human volunteers. RESULTS: The average viability of epidermal micrografts was 99.5%. Skin assessment determined that 76% to 100% of the area of all donor sites was the same in appearance as the surrounding skin within 14 days after epidermal harvest. A mean pain of 1.3 (on a scale of 1 to 5) was reported throughout the harvesting process. CONCLUSIONS: Use of this automated, minimally invasive harvesting system provided a simple, low-cost method of producing uniformly viable autologous epidermal micrografts with minimal patient discomfort and superficial donor-site wound healing within 2 weeks. PMID:26765157

  12. Minimally invasive removal of lumbar intradural extramedullary lesions using the interlaminar approach.

    PubMed

    Zhu, Yong-Jian; Ying, Guang-Yu; Chen, Ai-Qin; Wang, Lin-Lin; Yu, Dan-Feng; Zhu, Liang-Liang; Ren, Yu-Cheng; Wang, Chen; Wu, Peng-Cheng; Yao, Ying; Shen, Fang; Zhang, Jian-Min

    2015-08-01

    OBJECT Posterior midline laminectomy or hemilaminectomy has been successfully applied as the standard microsurgical technique for the treatment of spinal intradural pathologies. However, the associated risks of postoperative spinal instability increase the need for subsequent fusion surgery to prevent potential long-term spinal deformity. Continuous efforts have been made to minimize injuries to the surrounding tissue resulting from surgical manipulations. The authors report here their experiences with a novel minimally invasive surgical approach, namely the interlaminar approach, for the treatment of lumbar intraspinal tumors. METHODS A retrospective review was conducted of patients at the Second Affiliated Hospital of Zhejiang University School of Medicine who underwent minimally invasive resection of lumbar intradural-extramedullary tumors. By using an operative microscope, in addition to an endoscope when necessary, the authors were able to treat all patients with a unilateral, paramedian, bone-sparing interlaminar technique. Data including preoperative neurological status, tumor location, size, pathological diagnosis, extension of resections, intraoperative blood loss, length of hospital stay, and clinical outcomes were obtained through clinical and radiological examinations. RESULTS Eighteen patients diagnosed with lumbar intradural-extramedullary tumors were treated from October 2013 to March 2015 by this interlaminar technique. A microscope was used in 15 cases, and the remaining 3 cases were treated using a microscope as well as an endoscope. There were 14 schwannomas, 2 ependymomas, 1 epidermoid cyst, and 1 enterogenous cyst. Postoperative radiological follow-up revealed complete removal of all the lesions and no signs of bone defects in the lamina. At clinical follow-up, 14 of the 18 patients had less pain, and patients' motor/sensory functions improved or remained normal in all cases except 1. CONClUSIONS When meeting certain selection criteria

  13. Minimally Invasive Direct Thoracic Interbody Fusion (MIS-DTIF): Technical Notes of a Single Surgeon Study

    PubMed Central

    Abbasi, Hamid

    2016-01-01

    Background Minimally invasive direct thoracic interbody fusion (MIS-DTIF) is a new single surgeon procedure for fusion of the thoracic vertebrae below the scapula (T6/7) to the thoracolumbar junction. In this proof of concept study, we describe the surgical technique for MIS-DTIF and report our experience and the perioperative outcomes of the first four patients who underwent this procedure. Study design/setting In this study we attempt to establish the safety and efficacy of MIS-DTIF. We have performed MIS-DTIF on six spinal levels in four patients with degenerative disk disease or disk herniation. We recorded surgery time, blood loss, fluoroscopy time, complications, and patient-reported pain. Methods Throughout the MIS-DTIF procedure, the surgeon is aided by biplanar fluoroscopic imaging and electrophysiological monitoring. The surgeon approaches the spine with a series of gentle tissue dilations and inserts a working tube that establishes a direct connection from the outside of the skin to the disk space. Through this working tube, the surgeon performs a discectomy and inserts an interbody graft or cage. The procedure is completed with minimally invasive (MI) posterior pedicle screw fixation. Results For the single level patients the mean blood loss was 90 ml, surgery time 43 minutes, fluoroscopy time 293 seconds, and hospital stay two days. For the two-level surgeries, the mean blood loss was 27 ml, surgery time 61 minutes, fluoroscopy time 321 seconds, and hospital stay three days. We did not encounter any clinically significant complications. Thirty days post-surgery, the patients reported a statistically significant reduction of 5.3 points on a 10-point sliding pain scale. Conclusions MIS-DTIF with pedicle screw fixation is a safe and clinically effective procedure for fusions of the thoracic spine. The procedure is technically straightforward and overcomes many of the limitations of the current minimally invasive (MI) approaches to the thoracic spine. MIS

  14. Minimally invasive oesophagectomy in prone versus lateral decubitus position: A comparative study

    PubMed Central

    Javed, Amit; Manipadam, John Mathew; Jain, Amit; Kalayarasan, R.; Uppal, Rajeev; Agarwal, Anil K.

    2016-01-01

    BACKGROUND: Thoracoscopic oesophageal mobilisation during a minimally invasive oesophagectomy (MIE) is most commonly performed with the patient placed in the lateral decubitus position (LDP). The prone position (PP) for thoracoscopic oesophageal mobilisation has been proposed as an alternative. MATERIALS AND METHODS: This was a retrospective, comparative study designed to compare early outcomes following a minimally invasive thoracolaparoscopic oesophagectomy for oesophageal cancer in LDP and in PP. RESULTS: During the study period, between January 2011 and February 2014, 104 patients underwent an oesophagectomy for cancer. Of these, 42 were open procedures (transhiatal and transthoracic oesophagectomy) and 62 were minimally invasive. The study group included patients who underwent thoracolaparoscopic oesophagectomy in LDP (n = 23) and in PP (n = 25). The median age of the study population was 55 (24-71) years, and there were 25 males. Twenty-one (21) patients had tumours in the middle third of the oesophagus, 24 in the lower third, and 3 arising from the gastro-oesophageal junction. The most common histology was squamous cell cancer (85.4%). The median duration of surgery was similar in the two groups; however, the estimated median intraoperative blood loss was less in the PP group [200 (50-400) mL vs 300 (100-600) mL; P = 0.01)]. In the post-operative period, 26.1% patients in the LDP group and 8% in the PP group (8%) developed respiratory complications. The incidence of other post-operative complications, including cervical oesophagogastric anastomosis, hoarseness of voice and chylothorax, was not different in the two groups. The T stage of the tumour was similar in the two groups, with the majority (37) having T3 disease. A mean of 8 lymph nodes (range 2-33) were retrieved in the LDP group, and 17.5 (range 5-41) lymph nodes were retrieved in the PP group (P = 0.0004). The number of patients with node-positive disease was also higher in the PP group (19 vs 10, P

  15. Direct vision in minimally invasive epicardial procedures: preliminary tests of prototype instrumentation.

    PubMed

    Hack, B J; Ramon, S G; Hagen, Z A; Theran, M E; Burkhardt, J D; Gillies, G T

    2015-01-01

    This study investigated the use of direct visualization to enhance minimally invasive epicardial procedures. A commercially available miniature camera was placed in a prototype subxiphoid introducer needle and bench top, in vitro and in vivo tests of system performance were made during simulated and actual attempts at pericardial access and cardio-endoscopy. This system had an unshielded field of view of 100° and a resolution of 220 × 224 pixels. When a sleeve used to maintain depth of field was slid past the distal tip of the camera probe, the field of view would decrease by ≈15° per millimetre of sleeve extension, but without loss of image quality. While tests during in vivo subxiphoid access in a porcine model revealed that the pericardial membrane was difficult to localize, the results also showed excellent resolution of the coronary arteries on the epicardial surface. These findings and potential improvements are discussed in detail. PMID:26005103

  16. Minimally invasive central corpectomy for ossified posterior longitudinal ligament in the cervical spine.

    PubMed

    Hirano, Yoshitaka; Mizuno, Junichi; Nakagawa, Hiroshi; Itoh, Yasunobu; Kubota, Keiichi; Watanabe, Sadayoshi; Matsuoka, Hidenori; Numazawa, Shinichi; Tomii, Masato; Watanabe, Kazuo

    2011-01-01

    Minimally invasive central corpectomy (MICC) for cervical segmental ossified posterior longitudinal ligament (OPLL) is described. The procedure of MICC includes upper- or lower-half central corpectomy of the involved cervical spine, transdiscal decompression of the adjacent disc level, dissection and partial removal of the OPLL, removal of the OPLL behind the vertebral body via these windows, and fusion with cylindrical titanium cages. Anterior plate fixation is not necessary. From January 2008 to December 2009 we surgically treated three patients with cervical OPLL by MICC. All three patients showed remarkable improvement of their symptoms within a few days after the operation. No neurological or radiological complication was observed during that period. MICC is beneficial in avoiding complete corpectomy and long fusion, usage of an anterior plate, and usage of a large external orthosis. MICC also reduces the risk of postoperative esophageal perforation due to a screw backing out of the plate. PMID:20888772

  17. CAD/CAM Solutions for Minimally Invasive All-Ceramic Rehabilitation of Extended Erosive Lesions.

    PubMed

    Guess Gierthmuehlen, Petra C; Steger, Enrico

    2016-05-01

    Dental erosion is a global oral health problem that can lead to significant functional and esthetic impairments of the affected patients. Treatment of severe cases with augmented loss of the vertical dimension of occlusion (VDO) represents a challenge for both the dental team and the patient. CAD/CAM technology was used in the presented case to analyze the interocclusal space. Based on a virtual wax-up of the final restorations, CAD/CAM-fabricated preparation splints served as a guide and ensured a most minimally invasive preparation design. Milled polymer provisionals enabled the patient to visualize the final treatment outcome and served as a fracture-resistant temporary restoration to test the increased VDO. Monolithic lithium-disilicate ceramic, defect-oriented restorations with reduced ceramic thickness enabled a functional and reliable reconstruction of the severely compromised dentition. This case report documents a practical, digital approach and discusses the advantages related to treatment time, ease of treatment, and predictability. PMID:27419357

  18. Towards Clinically Optimized MRI-guided Surgical Manipulator for Minimally Invasive Prostate Percutaneous Interventions: Constructive Design*

    PubMed Central

    Eslami, Sohrab; Fischer, Gregory S.; Song, Sang-Eun; Tokuda, Junichi; Hata, Nobuhiko; Tempany, Clare M.; Iordachita, Iulian

    2013-01-01

    This paper undertakes the modular design and development of a minimally invasive surgical manipulator for MRI-guided transperineal prostate interventions. Severe constraints for the MRI-compatibility to hold the minimum artifact on the image quality and dimensions restraint of the bore scanner shadow the design procedure. Regarding the constructive design, the manipulator kinematics has been optimized and the effective analytical needle workspace is developed and followed by proposing the workflow for the manual needle insertion. A study of the finite element analysis is established and utilized to improve the mechanism weaknesses under some inevitable external forces to ensure the minimum structure deformation. The procedure for attaching a sterile plastic drape on the robot manipulator is discussed. The introduced robotic manipulator herein is aimed for the clinically prostate biopsy and brachytherapy applications. PMID:24683502

  19. Minimally invasive molecular delivery into the brain using optical modulation of vascular permeability

    PubMed Central

    Choi, Myunghwan; Ku, Taeyun; Chong, Kyuha; Yoon, Jonghee; Choi, Chulhee

    2011-01-01

    Systemic delivery of bioactive molecules in the CNS is hampered by the blood–brain barrier, which has bottlenecked noninvasive physiological study of the brain and the development of CNS drugs. Here we report that irradiation with an ultrashort pulsed laser to the blood vessel wall induces transient leakage of blood plasma without compromising vascular integrity. By combining this method with a systemic injection, we delivered target molecules in various tissues, including the brain cortex. This tool allows minimally invasive local delivery of chemical probes, nanoparticles, and viral vectors into the brain cortex. Furthermore, we demonstrated astrocyte-mediated vasodilation in vivo without opening the skull, using this method to load a calcium indicator in conjunction with label-free photoactivation of astrocytes. PMID:21576460

  20. Natural orifice transluminal endoscopic surgery: new minimally invasive surgery come of age.

    PubMed

    Huang, Chen; Huang, Ren-Xiang; Qiu, Zheng-Jun

    2011-10-21

    Although in the past two decades, laparoscopic surgery, considered as a great revolution in the minimally invasive surgery field, has undergone major development worldwide, another dramatic surgical revolution has quietly appeared in recent years. Ever since Kalloo's first report on transgastric peritoneoscopy in a porcine model in 2004, interest in a new surgical procedure named natural orifice transluminal endoscopic surgery (NOTES) has blossomed worldwide. Considering that a NOTES procedure could theoretically avoid any abdominal incision, operation-related pain and scarring, many surgeons and endoscopists have been enthusiastic in their study of this new technique. In recent years, several NOTES studies have been carried out on porcine models and even on humans, including transvaginal cholecystectomy, transgastric appendectomy, transvaginal appendectomy, and transvesical peritoneoscopy. So what is the current situation of NOTES and how many challenges do we still face? This review discusses the current research progress in NOTES. PMID:22110263

  1. Large Deflection Shape Sensing of a Continuum Manipulator for Minimally-Invasive Surgery

    PubMed Central

    Liu, Hao; Farvardin, Amirhossein; Pedram, Sahba Aghajani; Iordachita, Iulian; Taylor, Russell H.; Armand, Mehran

    2015-01-01

    Shape sensing techniques utilizing Fiber Bragg grating (FBG) arrays can enable real-time tracking and control of dexterous continuum manipulators (DCM) used in minimally invasive surgeries. For many surgical applications, the DCM may need to operate with much larger curvatures than what current shape sensing methods can detect. This paper proposes a novel shape sensor, which can detect a radius of curvature of 15 mm for a 35 mm long DCM. For this purpose, we used FBG sensors along with nitinol wires as the supporting substrates to form a triangular cross section. For verification, we assembled the sensor inside the wall of the DCM. Experimental results indicate that the proposed sensor can detect the DCM's curvature with an average error of 3.14%. PMID:26312136

  2. Why have we embraced minimally invasive surgery and ignored enhanced recovery after surgery?

    PubMed Central

    Nanavati, Aditya J; Nagral, Sanjay

    2016-01-01

    There has been a lot of enthusiasm about minimally invasive surgery (MIS) in the surgical community in recent times. Some of the main reasons for this are an unmatched appeal to patients, doctors and healthcare systems alike. Push from the industry also serves as an important reason for its popularity. 'Enhanced recovery after surgery' (ERAS) is a programme of implementing multimodal interventions in the perioperative period to promote faster recovery. Even though MIS is an important component of ERAS protocols, the latter has not seen the reception the former has received. In this article, the authors present their personal viewpoint on the matter. The authors intend to highlight issues surrounding an increasing emphasis on MIS and to caution against the MIS operative technique superseding comprehensive perioperative care. PMID:27279409

  3. An ultrasound-based navigation system for minimally invasive neck surgery.

    PubMed

    Brennecke, Thorsten; Jansen, Nils; Raczkowsky, Joerg; Schipper, Joerg; Woern, Heinz

    2014-01-01

    Future minimally invasive neck surgery requires a navigation system adapted to the actual intra-operative bedding of the patient. The detection of the bedding-caused tissue shift is essential for a safe orientation for the surgeon new endoscopic operation procedures in neck surgery. It is essential to visualize the relation between important anatomic landmarks and operation instruments at any time. Within the scientific project SACAS we focus on developing an ultrasound supported navigation system based on preoperative imaging which considers the intra-operative tissue shift. A rotatable, flexible neck-model provides the basis for our analysis to evaluate the tissue shift and to invent the new navigation system for endoscopic neck surgery. The total registration error of the system was 2 mm. PMID:24732476

  4. Myocardial protection during minimally invasive mitral valve surgery: strategies and cardioplegic solutions

    PubMed Central

    Davierwala, Piroze; Seeburger, Joerg; Pfannmueller, Bettina; Misfeld, Martin; Borger, Michael A.; Mohr, Friedrich-Wilhelm

    2013-01-01

    Effective myocardial protection and perfusion strategies during minimally invasive mitral valve surgery (Mini-MV) have evolved over the last decade. Our institutional approach for right-sided Mini-MV has been standardized over the last 15 years in more than 4,500 cases. Cardiopulmonary bypass (CPB) is usually instituted by right-sided femoral arterial and venous cannulation with additional cannulation of the right jugular vein in patients with a body weight greater than 75 kg or when a concomitant tricuspid valve (TV) procedure and/or atrial septal defect closure is performed. A single dosage of crystalloid-based cardioplegia [Custodial- histidine-trypthophan-ketoglutarate (Custodial-HTK)] administered via the aortic root in combination with moderate hypothermia (34-35 °C) has become the standard of care for induction and maintenance of myocardial protection at our institution. The present article highlights and discusses the principal techniques of myocardial protection for Mini-MV. PMID:24349985

  5. Minimally Invasive Approach For Extraforaminal Synovial Cyst L5-S1

    PubMed Central

    Torres Campa-Santamarina, Jose; Towne, Sara; Alimi, Marjan; Härtl, Roger

    2015-01-01

    Symptoms from synovial cysts are produced by neural compression in the spinal canal or the foramen. Few cases of extraforaminal synovial cyst have been published in the literature. This is a case report of a 65-year-old female who presented with a three-month history of sciatic pain and no relief with conservative treatment. MRI showed a left-sided extraforaminal synovial cyst at L5-S1 with compression of the L5 nerve root at the lateral portion of the foramen. Minimally invasive surgery for resection was performed using an extraforaminal tubular microscopic endoscopy-assisted approach. The patient improved clinically and remained symptom-free for the entire follow-up of 30 months. PMID:26623217

  6. Stricture caused by a plastic vascular clip used during an operation of minimally invasive esophagectomy.

    PubMed

    Wójcik, Janusz; Grodzki, Tomasz; Kubisa, Bartosz; Pieróg, Jaroslaw

    2011-10-01

    This article describes the case of a 62-year-old female who had had minimally invasive esophagectomy (Ivor-Lewis) for squamous cell carcinoma of the distal third of the esophagus. The anastomotic stenosis was accompanied by solid food dysphagia and the presence of a foreign body in the esophagus. The foreign body was fixed to the esophageal wall and could not be removed endoscopically. The patient was reoperated on through a 8 cm right thoracotomy. The anastomosis was reached via a gastrotomy, and the large-size plastic vascular clip was removed. The clip was primarily used to close the transsected azygos vein, it was then incorporated into the esophageal anastomotic region and subsequently partially protruded into the lumen of the gastrointestinal tract. After removal of the clip, backward dilatation of the anastomosis was performed by Savary-Gilliard dilators, with restoration of its proper diameter. PMID:21798890

  7. Penile prosthesis implant for erectile dysfunction: A new minimally invasive infrapubic surgical technique.

    PubMed

    Antonini, Gabriele; Busetto, Gian Maria; De Berardinis, Ettore; Giovannone, Riccardo; Vicini, Patrizio; Gentile, Vincenzo; Perito, Paul E

    2015-12-01

    Erectile dysfunction, the most common male sexual disorder after premature ejaculation, with its important impact on man and partner's sexuality and quality of life is a persistent inability to obtain and maintain an erection sufficient to permit satisfactory sexual performance. Non-surgical treatments with controversial results are usually applyed before surgical treatment that has reached high levels of satisfaction. We describe a new surgical technique to implant three-pieces penile prosthesis in patients suffering from erectile dysfunction (ED) not responding to conventional medical therapy or reporting side effects with such a therapy. Implantation of an inflatable prosthesis, for treatment of ED, is a safe and efficacious approach with high satisfaction reported by patients and partners. Surgical technique should be minimally invasive and latest technology equipment should be implanted in order to decrease common complications and to obtain a better aesthetic result. PMID:26766806

  8. Laparoscopic segmental colectomy for colonic lymphangiomas: A definitive, minimally invasive surgical option

    PubMed Central

    Zhuo, Chang-Hua; Shi, De-Bing; Ying, Min-Gang; Cheng, Yu-Fan; Wang, Yu-Wei; Zhang, Wen-Ming; Cai, San-Jun; Li, Xin-Xiang

    2014-01-01

    Colonic lymphangioma is an unusual benign malformation. We herein describe two cases. A 36-year-old woman was admitted with one year of intermittent abdominal pain; colonoscopy, abdominopelvic computed tomography and endoscopic ultrasonography (EUS) revealed enlarged cystic masses at the ascending colon. In another 40-year-old man, colonoscopy and EUS revealed an asymptomatic lobulated cystic mass with four small sessile polyps at the sigmoid colon. Both patients underwent laparoscopic segmental colectomy. Both masses were histologically confirmed as cystic lymphangiomas, and the patients were discharged without complications. The management of colonic lymphangioma depends on the individual situation; close surveillance or endoscopic therapy may be appropriate for asymptomatic lesions smaller than 2.5 cm in diameter. Surgical intervention can be considered for larger lesions or in patients who develop complication risks. Laparoscopic segmental colon resection may be recommended to excise relatively large submucosal lesions because it is a definitive, minimally invasive intervention with a fast postoperative recovery. PMID:25024636

  9. Multi-channel LED light source for fluorescent agent aided minimally invasive surgery.

    PubMed

    Ren, Jiacheng; Venugopalan, Janani; Xu, Jian; Kairdolf, Brad; Durfee, Robert; Wang, May D

    2014-01-01

    Cancer is one of the most common and deadly diseases around the world. Amongst all the different treatments of cancer such as surgery, chemotherapy and radiation therapy, surgical resection is the most effective. Successful surgeries greatly rely on the detection of the accurate tumor size and location, which can be enhanced by contrast agents. Commercial endoscope light sources, however, offer only white light illumination. In this paper, we present the development of a LED endoscope light source that provides 2 light channels plus white light to help surgeons to detect a clear tumor margin during minimally invasive surgeries. By exciting indocyanine green (ICG) and 5-Aminolaevulinic acid (ALA)-induced protoporphyrin IX (PPIX), the light source is intended to give the user a visible image of the tumor margin. This light source is also portable, easy to use and costs less than $300 to build. PMID:25571589

  10. Multi-Channel LED Light Source for Fluorescent Agent Aided Minimally Invasive Surgery

    PubMed Central

    Ren, Jiacheng; Venugopalan, Janani; Xu, Jian; Kairdolf, Brad; Durfee, Robert; Wang, May D.

    2016-01-01

    Cancer is one of the most common and deadly diseases around the world. Amongst all the different treatments of cancer such as surgery, chemotherapy and radiation therapy, surgical resection is the most effective. Successful surgeries greatly rely on the detection of the accurate tumor size and location, which can be enhanced by contrast agents. Commercial endoscope light sources, however, offer only white light illumination. In this paper, we present the development of a LED endoscope light source that provides 2 light channels plus white light to help surgeons to detect a clear tumor margin during minimally invasive surgeries. By exciting indocyanine green (ICG) and 5-Aminolaevulinic acid (ALA)-induced protoporphyrin IX (PPIX), the light source is intended to give the user a visible image of the tumor margin. This light source is also portable, easy to use and costs less than $300 to build. PMID:25571589

  11. Minimally Invasive Anterolateral Ligament Reconstruction in the Setting of Anterior Cruciate Ligament Injury.

    PubMed

    Sonnery-Cottet, Bertrand; Barbosa, Nuno Camelo; Tuteja, Sanesh; Daggett, Matt; Kajetanek, Charles; Thaunat, Mathieu

    2016-02-01

    Recent evidence on the anatomy, function, and biomechanical properties of the anterolateral ligament has led to the recognition of the importance of this structure in the rotational control of the knee. This article describes a technique that allows for minimally invasive anterolateral ligament reconstruction as a complement to most techniques of anterior cruciate ligament reconstruction. A gracilis tendon autograft is harvested and prepared in a double-strand, inverted V-shaped graft. The graft is percutaneously placed through a femoral stab incision, and each strand is then passed deep to the iliotibial band, emerging through each tibial stab incision. After the femoral-end loop graft is fixed, the tibial fixation of each strand is performed in full extension for optimal isometry. PMID:27274456

  12. 3D reconstruction of internal organ surfaces for minimal invasive surgery.

    PubMed

    Hu, Mingxing; Penney, Graeme; Edwards, Philip; Figl, Michael; Hawkes, David

    2007-01-01

    While Minimally Invasive Surgery (MIS) offers great benefits to patients compared with open surgery surgeons suffer from a restricted field-of-view and obstruction from instruments. We present a novel method for 3D reconstruction of soft tissue, which can provide a wider field-of-view with 3D information for surgeons, including restoration of missing data. The paper focuses on the use of Structure from Motion (SFM) techniques to solve the missing data problem and application of competitive evolutionary agents to improve the robustness to missing data and outliers. The method has been evaluated with synthetic data, images from a phantom heart model, and in vivo MIS image sequences using the da Vinci telerobotic surgical system. PMID:18051045

  13. Minimally invasive corticotomy in orthodontics: a new technique using a CAD/CAM surgical template.

    PubMed

    Cassetta, M; Pandolfi, S; Giansanti, M

    2015-07-01

    Accelerating orthodontic tooth movement is a topical issue. Despite the different techniques described in the literature, the corticotomy is the only effective and safe means of accelerating orthodontic tooth movement. Although effective, the corticotomy presents significant postoperative discomfort. The aggressive nature of these particular methods, related to the elevation of mucoperiosteal flaps and to the length of the surgery, has resulted in reluctance to proceed with this technique among both patients and the dental community. To overcome the disadvantages of the corticotomy, this technical note describes an innovative, minimally invasive, flapless procedure combining piezoelectric surgical cortical micro-incisions with the use of a 3D Printed CAD/CAM surgical guide. PMID:25840860

  14. Update on Pharmaceutical and Minimally Invasive Management Strategies for Chronic Obstructive Pulmonary Disease

    PubMed Central

    Rafii, Rokhsara; Albertson, Timothy E.; Louie, Samuel; Chan, Andrew L.

    2011-01-01

    Chronic obstructive pulmonary disease (COPD) is a debilitating pulmonary disorder with systemic effects, and it is the fourth leading cause of death in the United States. COPD patients not only develop respiratory limitations, but can also demonstrate systemic wasting, features of depression, and can succumb to social isolation. Smoking cessation is crucial, and pharmacotherapy with bronchodilators is helpful in symptom management. Inhaled corticosteroids may be beneficial in some patients. In addition, pulmonary rehabilitation and palliative care are important components under the right clinical circumstance. This review highlights current guidelines and management strategies for COPD and emphasizes novel pharmacotherapy and minimally invasive (nonsurgical) lung-volume reduction interventions that may prove to be of significant benefit in the future. PMID:21660228

  15. C-view omnidirectional endoscope for minimally invasive surgery/diagnostics

    NASA Astrophysics Data System (ADS)

    Ma, Jiayin; Simkulet, Michelle; Smith, Jason

    2007-03-01

    A novel omnidirectional endoscope which covers a field-of-view of +/-135° away from the optical axis and 360° panoramically (3π steradians) can significantly improve the visual reality for in-vivo minimally invasive surgery and diagnostics. The inventive integration of a wide angle objective lens and catadioptric optics provides an omnidirectional viewing angle without severe optical distortion. Optical fibers/LEDs are used for illumination of the entire field-of-view. The omnidirectional viewing capability of this endoscope enables the user to visualize and relate positions in the entire operating field eliminating the need for registration when using multiple scopes. It also prevents repetitive insertions of conventional endoscopes with different direction of view and reduces the risk of misguidance due to the limited field-of-view of conventional endoscopes.

  16. Minimally Invasive Harvest of a Quadriceps Tendon Graft With or Without a Bone Block

    PubMed Central

    Fink, Christian; Herbort, Mirco; Abermann, Elisabeth; Hoser, Christian

    2014-01-01

    The quadriceps tendon (QT) as a graft source for anterior cruciate ligament (ACL) and posterior cruciate ligament reconstruction has recently achieved increased attention. Although many knee surgeons have been using the QT as a graft for ACL revision surgery, it has never gained universal acceptance for primary ACL reconstruction. The QT is a very versatile graft that can be harvested in different widths, thicknesses, and lengths. Conventionally, the QT graft is harvested by an open technique, requiring a 6 to 8 cm longitudinal incision, which often leads to unpleasant scars. We describe a new, minimally invasive, standardized approach in which the QT graft can be harvested through a 2- to 3-cm skin incision and a new option of using the graft without a bone block. PMID:25264512

  17. Minimally invasive harvest of a quadriceps tendon graft with or without a bone block.

    PubMed

    Fink, Christian; Herbort, Mirco; Abermann, Elisabeth; Hoser, Christian

    2014-08-01

    The quadriceps tendon (QT) as a graft source for anterior cruciate ligament (ACL) and posterior cruciate ligament reconstruction has recently achieved increased attention. Although many knee surgeons have been using the QT as a graft for ACL revision surgery, it has never gained universal acceptance for primary ACL reconstruction. The QT is a very versatile graft that can be harvested in different widths, thicknesses, and lengths. Conventionally, the QT graft is harvested by an open technique, requiring a 6 to 8 cm longitudinal incision, which often leads to unpleasant scars. We describe a new, minimally invasive, standardized approach in which the QT graft can be harvested through a 2- to 3-cm skin incision and a new option of using the graft without a bone block. PMID:25264512

  18. Towards a minimally invasive sampling tool for high resolution tissue analytical mapping

    NASA Astrophysics Data System (ADS)

    Gottardi, R.

    2015-09-01

    Multiple spatial mapping techniques of biological tissues have been proposed over the years, but all present limitations either in terms of resolution, analytical capacity or invasiveness. Ren et al (2015 Nanotechnology 26 284001) propose in their most recent work the use of a picosecond infrared laser (PIRL) under conditions of ultrafast desorption by impulsive vibrational excitation (DIVE) to extract small amounts of cellular and molecular components, conserving their viability, structure and activity. The PIRL DIVE technique would then work as a nanobiopsy with minimal damage to the surrounding tissues, which could potentially be applied for high resolution local structural characterization of tissues in health and disease with the spatial limit determined by the laser focus.

  19. [Analysis of stability and healing on minimally invasive osteotomy for the treatment of hallux valgus].

    PubMed

    Sun, Wei-dong; Wen, Jian-min

    2016-03-01

    To treat hallux valgus, minimally invasive osteotomy on 1st metatarsal neck,immobilization with "8-shape" bandagev was performed, and the effect was definited. The principles of osteotomy stability were analyzed from the osteotomy position, methods, direction and angle. The grinding drill was used to increase friction coefficient between the ends of osteotomy. Correct direction of osteotomy and suitable angle were the key point of stability. The immobilization with "8-shape" bandage complied with the principle of elastic fixation created the conditions for the slight movement of the osteotomy ends. Compared with internal fixation ,it was better on osteotomy healing,and the osteotomy ends were stable and healed with cartilage PMID:27149792

  20. Secondary Radial Nerve Palsy after Minimally Invasive Plate Osteosynthesis of a Distal Humeral Shaft Fracture

    PubMed Central

    Bichsel, Ursina; Nyffeler, Richard Walter

    2015-01-01

    Minimally invasive plate osteosynthesis is a widely used procedure for the treatment of fractures of the femur and the tibia. For a short time it is also used for the treatment of humeral shaft fractures. Among other advantages, the ambassadors of this technique emphasize the lower risk of nerve injuries when compared to open reduction and internal fixation. We report the case of secondary radial nerve palsy caused by percutaneous fixation of a plate above the antecubital fold. The nerve did not recover and the patient needed a tendon transfer to regain active extension of the fingers. This case points to the importance of adequate exposure of the bone and plate if a humeral shaft fracture extends far distally. PMID:26558125

  1. Minimally Invasive Treatment of Small Renal Tumors: Trends in Renal Cancer Diagnosis and Management

    SciTech Connect

    Breen, David J. Railton, Nicholas J.

    2010-10-15

    Renal cell carcinoma is a common malignancy causing significant mortality. In recent years abdominal imaging, often for alternate symptomatology, has led the trend toward the detection and confirmation of smaller renal tumors. This has permitted the greater use of localized and nephron-sparing techniques including partial nephrectomy and image-guided ablation. This article aims to review the current role of image-guided biopsy and ablation in the management of small renal tumors. The natural history of renal cell carcinoma, the role of renal biopsy, the principles and procedural considerations of thermal energy ablation, and the oncological outcomes of these minimally invasive treatments are discussed and illustrated with cases from the authors' institution. Image-guided ablation, in particular, has changed the treatment paradigm and, by virtue of its increasingly evident efficacy and low morbidity, now favors the treatment of smaller tumors in patients previously unfit for surgery.

  2. [Stereotactic Radiofrequency Ablation (SRFA) of intrahepatic cholangiocellular carcinomas: a minimal invasive alternative to liver resection].

    PubMed

    Bale, Reto; Schullian, Peter; Haidu, Marion; Widmann, Gerlig

    2013-03-01

    Up to now resection and liver transplantation are concerned as the only curative treatment options for intrahepatic cholangiocellular carcinomas (ICCs). For patients with inoperable ICCs systemic chemotherapy and various locoregional therapies including transarterial (chemo)embolization (TACE), selective internal radiation therapy (SIRT), radiofrequency ablation (RFA) and microwave ablation (MWA) are applied. Stereotactic RFA (SRFA) allows for precise 3D planning and positioning of multiple RF electrodes. Due to overlapping necroses tumors > 5 cm can be completely ablated in one session. 17 inoperable consecutive patients with 52 ICCs were treated with stereotactic RFA (SRFA). A median overall survival of 60 months was achieved. The two largest tumors with diameters > 10 cm were completely ablated. These SRFA data of irresectable ICCs are superior to the published data on resection. SRFA is a minimal invasive alternative treatment to resection and may be considered as the first-line local treatment of patients with ICCs in selected patients. PMID:23392811

  3. Minimally invasive technique for transcrestal sinus floor elevation: a case report.

    PubMed

    Trombelli, Leonardo; Minenna, Pasquale; Franceschetti, Giovanni; Minenna, Luigi; Itro, Angelo; Farina, Roberto

    2010-05-01

    The present report describes a minimally invasive technique for transcrestal sinus floor elevation, namely the Smart Lift technique, which is based on the controlled use of drills and osteotomes. The rationale of this technique is to provide predictable vertical bone augmentation into the sinus cavity by (1) using the existing residual bone as a viable graft and (2) limiting the incidence of membrane perforation and postsurgery morbidity. Surgical steps of the procedure are thoroughly illustrated by means of a paradigmatic case. The Smart Lift procedure was compatible with sinus floor elevation and implant stability for up to 1 year following surgery. No complications occurred during or after surgery. On periapical radiographs, a radiopaque area corresponding to the augmented sinus floor was present above the apical portion of the implant. PMID:20376370

  4. Towards Clinically Optimized MRI-guided Surgical Manipulator for Minimally Invasive Prostate Percutaneous Interventions: Constructive Design.

    PubMed

    Eslami, Sohrab; Fischer, Gregory S; Song, Sang-Eun; Tokuda, Junichi; Hata, Nobuhiko; Tempany, Clare M; Iordachita, Iulian

    2013-12-31

    This paper undertakes the modular design and development of a minimally invasive surgical manipulator for MRI-guided transperineal prostate interventions. Severe constraints for the MRI-compatibility to hold the minimum artifact on the image quality and dimensions restraint of the bore scanner shadow the design procedure. Regarding the constructive design, the manipulator kinematics has been optimized and the effective analytical needle workspace is developed and followed by proposing the workflow for the manual needle insertion. A study of the finite element analysis is established and utilized to improve the mechanism weaknesses under some inevitable external forces to ensure the minimum structure deformation. The procedure for attaching a sterile plastic drape on the robot manipulator is discussed. The introduced robotic manipulator herein is aimed for the clinically prostate biopsy and brachytherapy applications. PMID:24683502

  5. Ultrasonography-guided minimally invasive removal of parotid calculi: A prudent approach.

    PubMed

    Patnaik, Uma; Nair, Sreejith; Mishra, Atul

    2016-02-01

    The trend in modern salivary calculi surgery is toward minimally invasive procedures because these benign conditions do not warrant open salivary gland surgery. Since ultrasonography is readily available, highly specific, noninvasive, and cost-effective, we have used an ultrasonography-guided technique for patients with parotid gland calculi, as both a diagnostic and a therapeutic tool for calculi removal, thus avoiding the morbidity of open surgery. We describe a case in which we used this novel technique for the peroral removal of multiple parotid calculi in a 29-year-old man. The use of ultrasonography in parotid calculi removal has been reported in the literature, but only infrequently. Our extensive search of the peer-reviewed English-language literature found no article reporting the technique that we describe here. PMID:26930334

  6. Case study: a minimally invasive approach to the treatment of Klippel-Trenaunay syndrome.

    PubMed

    Latessa, Victoria; Frasier, Krista

    2007-12-01

    Klippel-Trenaunay syndrome (KTS) is a congenital developmental disorder characterized by port wine stain, venous abnormalities, soft tissue, and bony deformities of the affected extremity. It is usually diagnosed in early childhood and has many long-term sequelae. Patients not only have physical health problems but also must learn to cope with psychosocial factors that will affect their self-esteem and interpersonal relationships. This article describes the syndrome of KTS and the minimally invasive techniques used in the treatment of superficial varicosities in patients with reasonably mild KTS with an intact deep venous system. Treating the varicosities relatively early to avoid the long-term complications of chronic venous insufficiency may improve the quality of life, maintain limb function, and decrease the risk of long-term venous complications. PMID:18036494

  7. Gaze-contingent motor channelling and haptic constraints for minimally invasive robotic surgery.

    PubMed

    Mylonas, George P; Kwok, Ka-Wai; Darzi, Ara; Yang, Guang-Zhong

    2008-01-01

    The use of master-slave surgical robots for Minimally Invasive Surgery (MIS) has created a physical separation between the surgeon and the patient. Reconnecting the essential visuomotor sensory feedback is important for the safe practice of robotic assisted MIS procedures. This paper introduces a novel gaze contingent framework with real-time haptic feedback by transforming visual sensory information into physical constraints that can interact with the motor sensory channel. We demonstrate how motor tracking of deforming tissue can be made more effective and accurate through the concept of gaze-contingent motor channelling. The method also uses 3D eye gaze to dynamically prescribe and update safety boundaries during robotic assisted MIS without prior knowledge of the soft-tissue morphology. Initial validation results on both simulated and robotic assisted phantom procedures demonstrate the potential clinical value of the technique. PMID:18982663

  8. Gaze-contingent soft tissue deformation tracking for minimally invasive robotic surgery.

    PubMed

    Mylonas, George P; Stoyanov, Danail; Deligianni, Fani; Darzi, Ara; Yang, Guang-Zhong

    2005-01-01

    The introduction of surgical robots in Minimally Invasive Surgery (MIS) has allowed enhanced manual dexterity through the use of microprocessor controlled mechanical wrists. Although fully autonomous robots are attractive, both ethical and legal barriers can prohibit their practical use in surgery. The purpose of this paper is to demonstrate that it is possible to use real-time binocular eye tracking for empowering robots with human vision by using knowledge acquired in situ. By utilizing the close relationship between the horizontal disparity and the depth perception varying with the viewing distance, it is possible to use ocular vergence for recovering 3D motion and deformation of the soft tissue during MIS procedures. Both phantom and in vivo experiments were carried out to assess the potential frequency limit of the system and its intrinsic depth recovery accuracy. The potential applications of the technique include motion stabilization and intra-operative planning in the presence of large tissue deformation. PMID:16685925

  9. Microbiopsy engineered for minimally invasive and suture-free sub-millimetre skin sampling

    PubMed Central

    Prow, Tarl W

    2013-01-01

    We describe the development of a sub-millimetre skin punch biopsy device for minimally invasive and suture-free skin sampling for molecular diagnosis and research. Conventional skin punch biopsies range from 2-4 mm in diameter. Local anaesthesia is required and sutures are usually used to close the wound. Our microbiopsy is 0.50 mm wide and 0.20 mm thick. The microbiopsy device is fabricated from three stacked medical grade stainless steel plates tapered to a point and contains a chamber within the centre plate to collect the skin sample. We observed that the application of this device resulted in a 0.21 ± 0.04 mm wide puncture site in volunteer skin using reflectance confocal microscopy. Histological sections from microbiopsied skin revealed 0.22 ± 0.12 mm wide and 0.26 ± 0.09 mm deep puncture sites. Longitudinal observation in microbiopsied volunteers showed that the wound closed within 1 day and was not visible after 7 days. Reflectance confocal microscope images from these same sites showed the formation of a tiny crust that resolved by 3 weeks and was completely undetectable by the naked eye. The design parameters of the device were optimised for molecular analysis using sampled DNA mass as the primary end point in volunteer studies. Finally, total RNA was characterized. The optimised device extracted 5.9 ± 3.4 ng DNA and 9.0 ± 10.1 ng RNA. We foresee that minimally invasive molecular sampling will play an increasingly significant role in diagnostic dermatology and skin research. PMID:24627782

  10. Visual intraoperative estimation of cup and stem position is not reliable in minimally invasive hip arthroplasty.

    PubMed

    Woerner, Michael; Sendtner, Ernst; Springorum, Robert; Craiovan, Benjamin; Worlicek, Michael; Renkawitz, Tobias; Grifka, Joachim; Weber, Markus

    2016-06-01

    Background and purpose - In hip arthroplasty, acetabular inclination and anteversion-and also femoral stem torsion-are generally assessed by eye intraoperatively. We assessed whether visual estimation of cup and stem position is reliable. Patients and methods - In the course of a subgroup analysis of a prospective clinical trial, 65 patients underwent cementless hip arthroplasty using a minimally invasive anterolateral approach in lateral decubitus position. Altogether, 4 experienced surgeons assessed cup position intraoperatively according to the operative definition by Murray in the anterior pelvic plane and stem torsion in relation to the femoral condylar plane. Inclination, anteversion, and stem torsion were measured blind postoperatively on 3D-CT and compared to intraoperative results. Results - The mean difference between the 3D-CT results and intraoperative estimations by eye was -4.9° (-18 to 8.7) for inclination, 9.7° (-16 to 41) for anteversion, and -7.3° (-34 to 15) for stem torsion. We found an overestimation of > 5° for cup inclination in 32 hips, an overestimation of > 5° for stem torsion in 40 hips, and an underestimation < 5° for cup anteversion in 42 hips. The level of professional experience and patient characteristics had no clinically relevant effect on the accuracy of estimation by eye. Altogether, 46 stems were located outside the native norm of 10-20° as defined by Tönnis, measured on 3D-CT. Interpretation - Even an experienced surgeon's intraoperative estimation of cup and stem position by eye is not reliable compared to 3D-CT in minimally invasive THA. The use of mechanical insertion jigs, intraoperative fluoroscopy, or imageless navigation is recommended for correct implant insertion. PMID:26848628

  11. Tissue-Engineered Heart Valve with a Tubular Leaflet Design for Minimally Invasive Transcatheter Implantation

    PubMed Central

    Moreira, Ricardo; Velz, Thaddaeus; Alves, Nuno; Gesche, Valentine N.; Malischewski, Axel; Schmitz-Rode, Thomas; Frese, Julia

    2015-01-01

    Transcatheter aortic valve implantation of (nonviable) bioprosthetic valves has been proven a valid alternative to conventional surgical implantation in patients at high or prohibitive mortality risk. In this study we present the in vitro proof-of-principle of a newly developed tissue-engineered heart valve for minimally invasive implantation, with the ultimate aim of adding the unique advantages of a living tissue with regeneration capabilities to the continuously developing transcatheter technologies. The tube-in-stent is a fibrin-based tissue-engineered valve with a tubular leaflet design. It consists of a tubular construct sewn into a self-expandable nitinol stent at three commissural attachment points and along a circumferential line so that it forms three coaptating leaflets by collapsing under diastolic back pressure. The tubular constructs were molded with fibrin and human umbilical vein cells. After 3 weeks of conditioning in a bioreactor, the valves were fully functional with unobstructed opening (systolic phase) and complete closure (diastolic phase). Tissue analysis showed a homogeneous cell distribution throughout the valve's thickness and deposition of collagen types I and III oriented along the longitudinal direction. Immunohistochemical staining against CD31 and scanning electron microscopy revealed a confluent endothelial cell layer on the surface of the valves. After harvesting, the valves underwent crimping for 20 min to simulate the catheter-based delivery. This procedure did not affect the valvular functionality in terms of orifice area during systole and complete closure during diastole. No influence on the extracellular matrix organization, as assessed by immunohistochemistry, nor on the mechanical properties was observed. These results show the potential of combining tissue engineering and minimally invasive implantation technology to obtain a living heart valve with a simple and robust tubular design for transcatheter delivery. The effect

  12. Estimating heart shift and morphological changes during minimally invasive cardiac interventions

    NASA Astrophysics Data System (ADS)

    Linte, Cristian A.; Carias, Mathew; Cho, Daniel S.; Pace, Danielle F.; Moore, John; Wedlake, Chris; Bainbridge, Daniel; Kiaii, Bob; Peters, Terry M.

    2010-02-01

    Image-guided interventions rely on the common assumption that pre-operative information can depict intraoperative morphology with sufficient accuracy. Nevertheless, in the context of minimally invasive cardiac therapy delivery, this assumption loses ground; the heart is a soft-tissue organ prone to changes induced during access to the heart and especially intracardiac targets. In addition to its clinical value for cardiac interventional guidance and assistance with the image- and model-to-patient registration, here we show how ultrasound imaging may be used to estimate changes in the heart position and morphology of structures of interest at different stages in the procedure. Using a magnetically tracked 2D transesophageal echocardiography transducer, we acquired in vivo images of the heart at different stages during the procedural workflow of common minimally invasive cardiac procedures, including robot-assisted coronary artery bypass grafting, mitral valve replacement/repair, or modelenhanced US-guided intracardiac interventions, all in the coordinate system of the tracking system. Anatomical features of interest (mitral and aortic valves) used to register the pre-operative anatomical models to the intraoperative coordinate frame were identified from each dataset. This information allowed us to identify the global position of the heart and also characterize the valvular structures at various peri-operative stages, in terms of their orientation, size, and geometry. Based on these results, we can estimate the differences between the preand intra-operative anatomical features, their effect on the model-to-subject registration, and also identify the need to update or optimize any pre-operative surgical plan to better suit the intra-operative procedure workflow.

  13. Minimally Invasive Lumbar Port System for the Collection of Cerebrospinal Fluid from Rhesus Macaques (Macaca mulatta).

    PubMed

    MacAllister, Rhonda Pung; Lester McCully, Cynthia M; Bacher, John; Thomas Iii, Marvin L; Cruz, Rafael; Wangari, Solomon; Warren, Katherine E

    2016-01-01

    Biomedical translational research frequently incorporates collection of CSF from NHP, because CSF drug levels are used as a surrogate for CNS tissue penetration in pharmacokinetic and dynamic studies. Surgical placement of a CNS ventricular catheter reservoir for CSF collection is an intensive model to create and maintain and thus may not be feasible or practical for short-term studies. Furthermore, previous NHP lumbar port models require laminectomy for catheter placement. The new model uses a minimally invasive technique for percutaneous placement of a lumbar catheter to create a closed, subcutaneous system for effective, repeated CSF sample collection. None of the rhesus macaques (Macaca mulatta; n = 10) implanted with our minimally invasive lumbar port (MILP) system experienced neurologic deficits, postoperative infection of the surgical site, or skin erosion around the port throughout the 21.7-mo study. Functional MILP systems were maintained in 70% of the macaques, with multiple, high-quality, 0.5- to 1.0-mL samples of CSF collected for an average of 3 mo by using aspiration or gravitational flow. Among these macaques, 57% had continuous functionality for a mean of 19.2 mo; 50% of the cohort required surgical repair for port repositioning and replacement during the study. The MILP was unsuccessful in 2 macaques, at an average of 9.5 d after surgery. Nonpatency in these animals was attributed to the position of the lumbar catheter. The MILP system is an appropriate replacement for temporary catheterization and previous models requiring laminectomy and is a short-term alternative for ventricular CSF collection systems in NHP. PMID:27538866

  14. Prototype development and preclinical immunogenicity analysis of a novel minimally invasive electroporation device.

    PubMed

    Broderick, K E; Shen, X; Soderholm, J; Lin, F; McCoy, J; Khan, A S; Yan, J; Morrow, M P; Patel, A; Kobinger, G P; Kemmerrer, S; Weiner, D B; Sardesai, N Y

    2011-03-01

    The magnitude of the immune response to a DNA vaccine depends on three criteria--the optimized vector design, the use of a suitable adjuvant and the successful delivery and subsequent expression of the plasmid in the target tissue. In vivo electroporation (EP) has proved to be particularly effective in efficiently delivering DNA immunogens to the muscle and the skin, and indeed several devices have entered into human clinical trials. Here, we report on a novel concept of DNA delivery to the dermal tissue using a minimally invasive EP device, which is powered using low-voltage parameters. We show that this prototype device containing a novel 4 × 4-electrode array results in robust and reproducible transfection of dermal tissue and subsequent antigen expression at the injection site. Using DNA encoding for NP and M2e influenza antigens, we further show induction of potent cellular responses in a mouse model as measured by antigen-specific T-cell ELISpot assays. Importantly, 100% of the immunized animals were protected when challenged with VN/1203/04 (H5N1) strain of influenza. We have also extended our findings to a guinea-pig model and demonstrated induction of HI titers greater than 1:40 against a pandemic novel H1N1 virus showing proof of concept efficacy for DNA delivery with the prototype device in a broad spectrum of species and using multiple antigens. Finally, we were able to generate protective HI titers in macaques against the same novel H1N1 strain. Our results suggest that the minimally invasive dermal device may offer a safe, tolerable and efficient method to administer DNA vaccinations in a prophylactic setting, and thus potentially represents an important new option for improved DNA vaccine delivery in vivo. PMID:20962869

  15. Visual intraoperative estimation of cup and stem position is not reliable in minimally invasive hip arthroplasty

    PubMed Central

    Woerner, Michael; Sendtner, Ernst; Springorum, Robert; Craiovan, Benjamin; Worlicek, Michael; Renkawitz, Tobias; Grifka, Joachim; Weber, Markus

    2016-01-01

    Background and purpose In hip arthroplasty, acetabular inclination and anteversion—and also femoral stem torsion—are generally assessed by eye intraoperatively. We assessed whether visual estimation of cup and stem position is reliable. Patients and methods In the course of a subgroup analysis of a prospective clinical trial, 65 patients underwent cementless hip arthroplasty using a minimally invasive anterolateral approach in lateral decubitus position. Altogether, 4 experienced surgeons assessed cup position intraoperatively according to the operative definition by Murray in the anterior pelvic plane and stem torsion in relation to the femoral condylar plane. Inclination, anteversion, and stem torsion were measured blind postoperatively on 3D-CT and compared to intraoperative results. Results The mean difference between the 3D-CT results and intraoperative estimations by eye was −4.9° (−18 to 8.7) for inclination, 9.7° (−16 to 41) for anteversion, and −7.3° (−34 to 15) for stem torsion. We found an overestimation of > 5° for cup inclination in 32 hips, an overestimation of > 5° for stem torsion in 40 hips, and an underestimation < 5° for cup anteversion in 42 hips. The level of professional experience and patient characteristics had no clinically relevant effect on the accuracy of estimation by eye. Altogether, 46 stems were located outside the native norm of 10–20° as defined by Tönnis, measured on 3D-CT. Interpretation Even an experienced surgeon’s intraoperative estimation of cup and stem position by eye is not reliable compared to 3D-CT in minimally invasive THA. The use of mechanical insertion jigs, intraoperative fluoroscopy, or imageless navigation is recommended for correct implant insertion. PMID:26848628

  16. More nerve root injuries occur with minimally invasive lumbar surgery: Let's tell someone

    PubMed Central

    Epstein, Nancy E.

    2016-01-01

    Background: In a recent study entitled: “More nerve root injuries occur with minimally invasive lumbar surgery, especially extreme lateral interbody fusion (XLIF): A review”, Epstein documented that more nerve root injuries occurred utilizing minimally invasive surgery (MIS) versus open lumbar surgery for diskectomy, decompression of stenosis (laminectomy), and/or fusion for instability. Methods: In large multicenter Spine Patient Outcomes Research Trial reviews performed by Desai et al., nerve root injury with open diskectomy occurred in 0.13–0.25% of cases, occurred in 0% of laminectomy/stenosis with/without fusion cases, and just 2% for open laminectomy/stenosis/degenerative spondylolisthesis with/without fusion. Results: In another MIS series performed largely for disc disease (often contained nonsurgical disc herniations, therefore unnecessary procedures) or spondylolisthesis, the risk of root injury was 2% for transforaminal lumbar interbody fusion (TLIF) versus 7.8% for posterior lumbar interbody fusion (PLIF). Furthermore, the high frequencies of radiculitis/nerve root/plexus injuries incurring during anterior lumbar interbody fusions (ALIF: 15.8%) versus extreme lumbar interbody fusions (XLIF: 23.8%), addressing disc disease, failed back surgery, and spondylolisthesis, were far from acceptable. Conclusions: The incidence of nerve root injuries following any of the multiple MIS lumbar surgical techniques (TLIF/PLIF/ALIF/XLIF) resulted in more nerve root injuries when compared with open conventional lumbar surgical techniques. Considering the majority of these procedures are unnecessarily being performed for degenerative disc disease alone, spine surgeons should be increasingly asked why they are offering these operations to their patients? PMID:26904373

  17. Minimally invasive versus open thymectomy: a systematic review of surgical techniques, patient demographics, and perioperative outcomes

    PubMed Central

    Hess, Nicholas R.; Pennathur, Arjun; Levy, Ryan M.; Christie, Neil A.; Luketich, James D.

    2016-01-01

    Background Thymectomy is the mainstay of treatment for thymoma and other anterior mediastinal tumors, and is often utilized in the management of patients with myasthenia gravis (MG). While traditionally approached through a median sternotomy, minimally invasive approaches to thymectomy have increasingly emerged. The present systematic review was conducted to compare perioperative and clinical outcomes following minimally invasive thymectomy (MIT) and open thymectomy (OT). Methods Articles were obtained through a PubMed literature search. Comparative studies reporting clinical outcomes following MIT and OT were eligible for inclusion. We selected studies with full text availability, written in the English language, published after 2005 and with at least 15 patients in each arm. A descriptive analysis was performed. Results Twenty studies were included, involving a total of 2,068 patients undergoing either MIT (n=838) or OT (n=1,230). Within individual studies, MIT and OT cohorts were well matched with regards to patient age and gender, but there was considerable variation across studies. Resected thymomas were consistently larger in OT groups, with mean diameter significantly larger in five studies (MIT, 29–52 mm; OT, 31–77 mm). MIT was consistently associated with a lower estimated blood loss (MIT, 20–200 mL; OT, 86–466 mL), chest tube duration (MIT, 1.3–4.1 days; OT, 2.4–5.3 days), and hospital length of stay (MIT, 1–10.6 days; OT, 4–14.6 days). There were no consistent differences in rates of perioperative complications, thymoma recurrence, MG complete stable remission, or 5-year survival. Conclusions In appropriately selected patients, MIT may reduce blood loss, chest tube duration, and hospital length of stay, with comparable clinical outcomes compared to OT via median sternotomy. PMID:26904425

  18. 3D shape tracking of minimally invasive medical instruments using optical frequency domain reflectometry

    NASA Astrophysics Data System (ADS)

    Parent, Francois; Kanti Mandal, Koushik; Loranger, Sebastien; Watanabe Fernandes, Eric Hideki; Kashyap, Raman; Kadoury, Samuel

    2016-03-01

    We propose here a new alternative to provide real-time device tracking during minimally invasive interventions using a truly-distributed strain sensor based on optical frequency domain reflectometry (OFDR) in optical fibers. The guidance of minimally invasive medical instruments such as needles or catheters (ex. by adding a piezoelectric coating) has been the focus of extensive research in the past decades. Real-time tracking of instruments in medical interventions facilitates image guidance and helps the user to reach a pre-localized target more precisely. Image-guided systems using ultrasound imaging and shape sensors based on fiber Bragg gratings (FBG)-embedded optical fibers can provide retroactive feedback to the user in order to reach the targeted areas with even more precision. However, ultrasound imaging with electro-magnetic tracking cannot be used in the magnetic resonance imaging (MRI) suite, while shape sensors based on FBG embedded in optical fibers provides discrete values of the instrument position, which requires approximations to be made to evaluate its global shape. This is why a truly-distributed strain sensor based on OFDR could enhance the tracking accuracy. In both cases, since the strain is proportional to the radius of curvature of the fiber, a strain sensor can provide the three-dimensional shape of medical instruments by simply inserting fibers inside the devices. To faithfully follow the shape of the needle in the tracking frame, 3 fibers glued in a specific geometry are used, providing 3 degrees of freedom along the fiber. Near real-time tracking of medical instruments is thus obtained offering clear advantages for clinical monitoring in remotely controlled catheter or needle guidance. We present results demonstrating the promising aspects of this approach as well the limitations of using the OFDR technique.

  19. The development and current status of minimally invasive surgery to manage urological complications after renal transplantation

    PubMed Central

    Sabnis, Ravindra B.; Singh, Abhishek G.; Ganpule, Arvind P.; Chhabra, Jaspreet S.; Tak, Gopal R.; Shah, Jaimin H.

    2016-01-01

    Introduction: In the past, urological complications after renal transplantation were associated with significant morbidity. With the development and application of endourological procedures, it is now possible to manage these cases with minimally invasive techniques. Materials and Methods: A MEDLINE search for articles published in English using key words for the management of urological complications after renal transplantation was undertaken. Forty articles were selected and reviewed. Results: The incidence of urological complications postrenal transplantation was reported to be 2–13%. Ureteric leaks occurred in up to 8.6%, and 55% were managed endourologically. The incidence of lymphocele was as high as 20%, and less that 12% of the cases required treatment. Ureteric stricture was the most common complication, and endourological management was successful in 50–70%. The occurrence of complicated vesicoureteral reflux was 4.5%, and 90% of low-grade reflux cases were successfully treated with deflux injections. Stones and obstructive voiding dysfunction occurred in about 1% of kidney transplant recipients. Conclusion: Minimally invasive techniques have a critical role in the management of urological complications after renal transplantation. Urinary leakage should be managed with complete decompression. Percutaneous drainage should be the first line of treatment for lymphocele that is symptomatic or causing ureteric obstruction. Laparoscopic lymphocele deroofing is successful in aspiration-resistant cases. Deflux is highly successful for the management of complicated low-grade kidney transplant reflux. The principles of stone management in a native solitary kidney are applied to the transplanted kidney. Early identification and treatment of bladder outlet obstruction after renal transplantation can prevent urinary leakage and obstructive uropathy. PMID:27555675

  20. Tissue-engineered heart valve with a tubular leaflet design for minimally invasive transcatheter implantation.

    PubMed

    Moreira, Ricardo; Velz, Thaddaeus; Alves, Nuno; Gesche, Valentine N; Malischewski, Axel; Schmitz-Rode, Thomas; Frese, Julia; Jockenhoevel, Stefan; Mela, Petra

    2015-06-01

    Transcatheter aortic valve implantation of (nonviable) bioprosthetic valves has been proven a valid alternative to conventional surgical implantation in patients at high or prohibitive mortality risk. In this study we present the in vitro proof-of-principle of a newly developed tissue-engineered heart valve for minimally invasive implantation, with the ultimate aim of adding the unique advantages of a living tissue with regeneration capabilities to the continuously developing transcatheter technologies. The tube-in-stent is a fibrin-based tissue-engineered valve with a tubular leaflet design. It consists of a tubular construct sewn into a self-expandable nitinol stent at three commissural attachment points and along a circumferential line so that it forms three coaptating leaflets by collapsing under diastolic back pressure. The tubular constructs were molded with fibrin and human umbilical vein cells. After 3 weeks of conditioning in a bioreactor, the valves were fully functional with unobstructed opening (systolic phase) and complete closure (diastolic phase). Tissue analysis showed a homogeneous cell distribution throughout the valve's thickness and deposition of collagen types I and III oriented along the longitudinal direction. Immunohistochemical staining against CD31 and scanning electron microscopy revealed a confluent endothelial cell layer on the surface of the valves. After harvesting, the valves underwent crimping for 20 min to simulate the catheter-based delivery. This procedure did not affect the valvular functionality in terms of orifice area during systole and complete closure during diastole. No influence on the extracellular matrix organization, as assessed by immunohistochemistry, nor on the mechanical properties was observed. These results show the potential of combining tissue engineering and minimally invasive implantation technology to obtain a living heart valve with a simple and robust tubular design for transcatheter delivery. The effect

  1. Minimally invasive video-assisted thyroidectomy: experience of 200 cases in a single center

    PubMed Central

    Jie, Xu; Lixin, Jiang

    2014-01-01

    Introduction Minimally invasive techniques in thyroid surgery including video-assisted technique originally described by Miccoli have been accepted in several continents for more than 10 years. Aim To analyze our preliminary results from minimally invasive video-assisted thyroidectomy (MIVAT) and to evaluate the feasibility and effects of this method in a general department over a 4-year period. Material and methods Initial experience was presented based on a series of 200 patients selected for MIVAT at the General Surgery Department of Yantai Yuhuangding Hospital affiliated with Qingdao University during the period from May 2008 to June 2012. The enrolling criteria were rigorously observed. An above sternal incision with average length of 2.5 cm (1.5–3.0 cm) was made. Clinicopathologic characteristics, postoperative pain, length of hospital stay, cosmetic results and complications were retrospectively analyzed. Results All patients received general anesthesia. Thyroid unilateral lobectomy was successfully accomplished in 108 cases, total thyroidectomy in 84, and partial lobectomy in 8. Conversion to standard conventional thyroidectomy was required in 6 patients (3%) because of thyroiditis and bleeding. The mean lymph node yield of the cancer specimens was 3.6 per patient. Permanent unilateral recurrent laryngeal nerve (RLN) palsy occurred in 1 case (0.5%), transient unilateral RLN palsy in 6 patients (3.0%, complete recovery after 1–6 months), and transient hypocalcemia in 7 patients (3.5%). No definitive hypocalcemia was observed. No postoperative hematomas occurred. Postoperative pain was endurable. The cosmetic result was excellent in most cases. Conclusions The MIVAT is feasible and safe in selected patients, with better results comparable to conventional thyroidectomy. The MIVAT can also be performed in a general surgery department. PMID:25337155

  2. Hiatal Hernia After Open versus Minimally Invasive Esophagectomy: A Systematic Review and Meta-analysis.

    PubMed

    Oor, J E; Wiezer, M J; Hazebroek, E J

    2016-08-01

    Hiatal hernia (HH) is an infrequent yet potentially life-threatening complication after esophagectomy. Several studies have reported the incidence of this complication after both open and minimally invasive esophagectomy (MIE). This meta-analysis aimed to determine the pooled incidence of HH after both types of esophagectomy and, importantly, to provide insight in the outcome of subsequent HH repair. A systematic search was performed of the PubMed, Embase, CINAHL, and Cochrane databases. Article selection was performed using the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) criteria. Articles describing the incidence of HH after different open and minimally invasive techniques were included. Only when five or more comparable studies reported on the same outcome were data pooled. The incidence of postoperative HH and the outcome of HH repair were analyzed. Twenty-six studies published between 1985 and 2015 were included, describing a total of 6058 patients who underwent esophagectomy, of whom 240 were diagnosed with a postoperative HH. The pooled incidence of symptomatic HH after MIE was 4.5 %, compared to a pooled incidence of 1.0 % after open esophagectomy. 11 studies reported on the outcome of HH repair in 125 patients. A pooled morbidity rate after HH repair of 25 % was found. During follow-up, a pooled recurrence rate of 14 % was reported in 11 of the included studies. The pooled incidence of HH after MIE is higher compared to open esophagectomy. Most importantly, surgical repair of these HHs is associated with a high morbidity rate. Both radiologists and surgeons should be aware of this rare yet potentially life-threatening complication. PMID:26926480

  3. Minimally invasive surgery using mini anterior incision for thyroid diseases: a prospective cohort study

    PubMed Central

    Sabuncuoglu, Mehmet Zafer; Sabuncuoglu, Aylin; Sozen, Isa; Benzin, Mehmet Fatih; Cakir, Tugrul; Cetin, Recep

    2014-01-01

    Aim: Minimally invasive surgical techniques have attracted interest in all surgical specialties since 1980. The thyroidectomy technique requires meticulous surgical dissection, absolute hemostasis, en bloc tumor resection and adequate visualization of the operative field, all of which can be accomplished with minimally invasive techniques. Methods: The study group comprised all patients undergoing MITS from its introduction in 2010 until July 2012. All data were prospectively recorded in the Elbistan Hospital and Suleyman Demirel University in Turkey. This study was designed to demonstrate our experience with mini-incision-technique in thyroidectomy. Results: Over the 2-year period, 37 patients underwent bilateral MITS procedures. The procedure made with a small (2.5 cm) anterior incision made above the isthmus. The final diagnoses were benign multinodular goitre (37%), follicular adenoma (28%) incidental carcinoma (11%), Hashimoto’s thyroiditis (15%), Hurtle cell adenoma (5%), subacute thyroiditis (3%), residual thyroid-non carcinoma (2%), simple cyst (1%), diffuse hyperplasia (1%) and other (1%). Of the carcinomas, 80% were papillary thyroid cancer, 13% were follicular, and the remaining 7% were Hurtle cell carcinomas. We dont need to extend our incision in any cases. Two patients had temporary recurrent laryngeal nevre paresis and one patient had temporary hypocalcemia. Conclusions: It is not easy to demonstrate the advantages of MIT over conventional and video-assisted surgery. The main complications, such as nerve injury, hypoparathyroidism, or hemorrhage, are the same as in other surgical approaches. MIT has demonstrated advantages over conventional open approaches for both hemi- and total thyroidectomy and the benefits do not depend on the open or video-assisted approach. The anterior mini-incision approach can be performed with an operative time and postoperative complication profile equivalent to conventional thyroidectomy while providing excellent

  4. Shaeer’s Technique: A Minimally Invasive Procedure for Monsplasty and Revealing the Concealed Penis

    PubMed Central

    2016-01-01

    Background: A concealed penis is a condition where part of the penis is invisible below the surface of the prepubic skin. Dermolipectomy can correct this condition, although it involves a long abdominal crease incision, or infrapubic incision around the base of the penis, and a possibility for genital lymphedema. This study describes Shaeer’s technique, a minimally invasive method for revealing the concealed penis. Methods: A 1- to 2-cm-long incision was cut over the anterior superior iliac spine (ASIS) on either side. A long curved blunt forceps was inserted from one incision, down to the base of the penis and then up to the contralateral ASIS. A 5-mm wide nonabsorbable tape was picked up by the forceps from 1 incision and pulled through to emerge from the other. Pulling on the tape cephalad pulled the mons pubis and revealed the penis. The tape was sutured to the periosteum overlying the ASIS on either side. Patients were followed up for 18 months for penile length, complications, and overall satisfaction. Results: Twenty patients were operated upon. Preoperatively, flaccid visible length was 3 ± 0.9 cm, and erect visible length was 8 ± 4.6 cm. Postoperatively, the flaccid visible length was 7.1 ± 2.1 cm, with a 57.9% improvement in length (P < 0.0001). Erect visible length was 11.8 ± 2.1 cm, with a 32% improvement in length (P < 0.0001). Length gain was maintained for 18 months. Conclusion: Shaeer’s technique is a minimally invasive, short, and simple procedure for monsplasty and revealing the concealed penis. PMID:27622092

  5. Radiologic Outcomes According to Varus Deformity in Minimally Invasive Surgery Total Knee Arthroplasty

    PubMed Central

    Yoo, Ju-Hyung; Han, Chang-Dong; Oh, Hyun-Cheol; Park, Jun-Young; Choi, Seung-Jin

    2016-01-01

    Purpose To identify the accuracy of postoperative implant alignment in minimally invasive surgery total knee arthroplasty (MIS-TKA), based on the degree of varus deformity. Materials and Methods The research examined 627 cases of MIS-TKA from November 2005 to December 2007. The cases were categorized according to the preoperative degree of varus deformity in the knee joint in order to compare the postoperative alignment of the implant: less than 5° varus (Group 1, 351 cases), 5° to less than 10° varus (Group 2, 189 cases), 10° to less than 15° varus (Group 3, 59 cases), and 15° varus or more (Group 4, 28 cases). Results On average, the alignment of the tibial implant was 0.2±1.4°, 0.1±1.3°, 0.1±1.6°, and 0.3±1.7° varus, and the tibiofemoral alignment was 5.2±1.9°, 4.7±1.9°, 4.9±1.9°, and 5.1±2.0° valgus for Groups 1, 2, 3, and 4, respectively, in the preoperative stage, indicating no difference between the groups (p>0.05). With respect to the accuracy of the tibial implant alignment, 98.1%, 97.6%, 87.5%, and 86.7% of Groups 1, 2, 3, and 4, respectively, had 0±3° varus angulation, demonstrating a reduced level of accuracy in Groups 3 and 4 (p<0.0001). There was no difference in terms of tibiofemoral alignment, with 83.9%, 82.9%, 85.4%, and 86.7% of each group, respectively, showing 6±3° valgus angulation (p>0.05). Conclusion Satisfactory component alignment was achieved in minimally invasive surgery in total knee arthroplasty, regardless of the degree of varus deformity. PMID:26632405

  6. Risk of Incisional Hernia after Minimally Invasive and Open Radical Prostatectomy

    PubMed Central

    Carlsson, Sigrid V.; Ehdaie, Behfar; Atoria, Coral L.; Elkin, Elena B.; Eastham, James A.

    2013-01-01

    Purpose The number of radical prostatectomies has increased. Many urologists have shifted from the open surgical approach to minimally invasive techniques. It is not clear whether the risk of post-prostatectomy incisional hernia varies by surgical approach. Materials and Methods In the linked Surveillance, Epidemiology, and End Results (SEER)-Medicare dataset we identified men age 66 and older who had minimally invasive (MIRP) or open radical prostatectomy (ORP) for prostate cancer diagnosed 2003–2007. The main outcome was incisional hernia repair identified in Medicare claims following prostatectomy. We also examined the frequency of umbilical, inguinal and other hernia repairs. Results We identified 3,199 patients who had MIRP and 6,795 who had open radical prostatectomy ORP. The frequency of incisional hernia repair was 5.3% (median follow-up 3.1 years) in the MIRP group and 1.9% (median follow-up 4.4 years) in the ORP group, corresponding to incidence rates of 16.1 and 4.5 per 1000 person-years for MIRP and ORP, respectively. Compared with ORP, MIRP was associated with a more than 3-fold increased risk of incisional hernia repair, controlling for patient and disease characteristics (adjusted hazard ratio 3.39, 95% CI, 2.63–4.38, p <0.0001). MIRP was associated with an attenuated but increased risk of any hernia repair compared with ORP (adjusted hazard ratio 1.48, 95% CI 1.29–1.70, p <0.0001). Conclusions MIRP was associated with a significantly increased risk of incisional hernia compared with ORP. This is a potentially remediable complication of prostate cancer surgery that warrants increased vigilance with respect to surgical technique. PMID:23688847

  7. Minimally-Invasive, Image-Guided Cochlear Implantation Surgery: First report of clinical implementation

    PubMed Central

    Labadie, Robert F; Balachandran, Ramya; Noble, Jack H; Blachon, Grégoire S; Mitchell, Jason E; Reda, Fitsum A; Dawant, Benoit M; Fitzpatrick, J Michael

    2015-01-01

    OBJECTIVE Minimally-invasive image-guided approach to cochlear implantation (CI) involves drilling a narrow, linear tunnel to the cochlea. Reported herein is the first clinical implementation of this approach. STUDY DESIGN Prospective, cohort study. METHODS On preoperative CT, a safe linear trajectory through the facial recess targeting the scala tympani was planned. Intraoperatively, fiducial markers were bone-implanted, a second CT was acquired, and the trajectory was transferred from preoperative to intraoperative CT. A customized microstereotactic frame was rapidly designed and constructed to constrain a surgical drill along the desired trajectory. Following sterilization, the frame was employed to drill the tunnel to the middle ear. After lifting a tympanomeatal flap and performing a cochleostomy, the electrode array was threaded through the drilled tunnel and into the cochlea. RESULTS Eight of nine patients were successfully implanted using the proposed approach with six insertions completely within scala tympani. Traditional mastoidectomy was performed on one patient following difficulty threading the electrode array via the narrow tunnel. Other difficulties encountered included use of the back-up implant when an electrode was dislodged during threading via the tunnel, tip fold-over, and facial nerve paresis (House-Brackmann II/VII at 12 months) secondary to heat during drilling. Average time of intervention was 182±36 minutes. CONCLUSION Minimally-invasive, image-guided CI is clinically achievable. Further clinical study is necessary to address technological difficulties during drilling and insertion and to assess potential benefits including decreased time of intervention, standardization of surgical intervention, and decreased tissue dissection potentially leading to shorter recovery and earlier implant activation. PMID:24272427

  8. [Further technical and digital development in minimally invasive and conventional surgery].

    PubMed

    Feussner, H; Reiser, S B; Bauer, M; Kranzfelder, M; Schirren, R; Kleeff, J; Wilhelm, D

    2014-03-01

    Technological innovations have initiated a fundamental change in invasive therapeutic approaches which has led to a welcome reduction of surgical trauma but was also associated with a declining role of conventional surgery. Active utilization of future technological developments is decisive to promote new therapeutic strategies and to avoid a further loss of importance of surgery. This includes individualized preoperative therapy planning as well as intraoperative diagnostic work-up and navigation and the use of new functional intelligent implants. The working environment "surgical operating room" has to be refurbished into an integrated cooperating functional system. The impact of new technological developments is particularly obvious in minimally invasive surgery. There is a clear tendency towards further reduction in trauma in the surgical access. The incision will become smaller and the number of ports will be further reduced, with the aim of ultimately having just one port (monoport surgery) or even via natural access routes (scarless surgery). Among others, improved visualization including, e.g. autostereoscopy, digital image processing and intelligent support systems, which are able to assist in a cooperative way, will enable these goals to be achieved. PMID:24522491

  9. Minimally Invasive Adenocarcinoma of the Lung as Second Malignant Neoplasm Following Pediatric Rhabdomyosarcoma.

    PubMed

    Bradee, Allison R; Lehman, Alice; Reed, Robyn C; Watson, Andrea; Acton, Robert

    2016-02-01

    Primary pulmonary tumors are extremely rare in the pediatric population; however, sporadic cases of invasive pulmonary adenocarcinoma as a second malignant neoplasm (SMN) have been described in survivors of pediatric cancers. Pediatric patients with rhabdomyosarcoma (RMS) have a particularly increased risk of developing a SMN when compared to the general population, though pulmonary adenocarcinoma has not been previously described in a RMS patient. A 12-year-old female previously treated for stage IV pelvic RMS was found to have a left pulmonary nodule on surveillance computed tomography. The nodule was detected 4.25 years after the completion of treatment, which included resection, chemotherapy, and radiation to the abdomen and pelvis. Wedge resection of the pulmonary lesion was performed with negative margins. Histopathological examination revealed minimally invasive adenocarcinoma. Pulmonary adenocarcinoma may rarely present as a SMN in pediatric cancer survivors. The pathogenesis of this association is not yet entirely clear, but may include chemotherapy-induced mutagenesis and/or genetic predisposition. As pulmonary adenocarcinoma may present as a lung lesion radiographically indistinguishable from metastatic RMS, it should be considered in the differential diagnosis of any pediatric RMS survivor presenting with a new pulmonary nodule, especially in cases with late recurrence. PMID:26174135

  10. Evaluation of the minimally invasive parathyroidectomy in patients with primary hyperparathyroidism: A retrospective cohort study

    PubMed Central

    Toriie, Sayoko; Sugimoto, Takeki; Hokimoto, Norihiro; Funakoshi, Taku; Ogawa, Maho; Oki, Toyokazu; Dabanaka, Ken; Namikawa, Tsutomu; Sakurai, Akihiro; Hanazaki, Kazuhiro

    2016-01-01

    Introduction An accurate differential diagnosis between single adenoma (SA) and multiglandular disease (MGD) remains difficult in Technetium-99m sestamibi scintigraphy (MIBI)-negative patients with primary hyperparathyroidism (PHPT). The aim of the present study was to evaluate the minimally invasive parathyroidectomy (MIP) in patients with PHPT. Methods Clinical records of 48 patients who underwent neck exploration between November 2002 and June 2012 in Kochi Medical School Hospital were reviewed retrospectively to identify candidates that underwent for MIP which was defined as the selective removal of a SA using less invasive surgery. Results The preoperative detection rate of lesions using ultrasonography, MIBI, computed tomography, and magnetic resonance imaging was 90%, 83%, 76%, and 55%, respectively. Although all 39 patients in the MIBI-positive group were diagnosed with an SA and subsequently underwent curative MIP, 3 patients in MIBI-negative group (n = 6) were MGD, who underwent neck exploration. Preoperative mean intact parathyroid hormone (419 pg/ml vs. 149 pg/ml; P < 0.01) and alkaline phosphatase levels (746 U/l vs. 277 U/l; P < 0.01) were significantly higher in the SA than MGD group. Conclusions In MIBI-negative patients with indications for surgery, MIP should not be carried out without a clear localization of SA, or in MGD. PMID:27054033

  11. A minimally invasive technique for percutaneous lumbar facet augmentation: Technical description of a novel device

    PubMed Central

    Smith, Zachary A.; Armin, Sean; Raphael, Dan; Khoo, Larry T.

    2011-01-01

    Background: We describe a new posterior dynamic stabilizing system that can be used to augment the mechanics of the degenerating lumbar segment. The mechanism of this system differs from other previously described surgical techniques that have been designed to augment lumbar biomechanics. The implant and technique we describe is an extension-limiting one, and it is designed to support and cushion the facet complex. Furthermore, it is inserted through an entirely percutaneous technique. The purpose of this technical note is to demonstrate a novel posterior surgical approach for the treatment of lumbar degenerative. Methods: This report describes a novel, percutaneously placed, posterior dynamic stabilization system as an alternative option to treat lumbar degenerative disk disease with and without lumbar spinal stenosis. The system does not require a midline soft-tissue dissection, nor subperiosteal dissection, and is a truly minimally invasive means for posterior augmentation of the functional facet complex. This system can be implanted as a stand-alone procedure or in conjunction with decompression procedures. Results: One-year clinical results in nine individual patients, all treated for degenerative disease of the lower lumbar spine, are presented. Conclusions: This novel technique allows for percutaneous posterior dynamic stabilization of the lumbar facet complex. The use of this procedure may allow a less invasive alternative to traditional approaches to the lumbar spine as well as an alternative to other newly developed posterior dynamic stabilization systems. PMID:22145084

  12. Laparoscopic endoscopic cooperative surgery as a minimally invasive treatment for gastric submucosal tumor.

    PubMed

    Namikawa, Tsutomu; Hanazaki, Kazuhiro

    2015-10-10

    Laparoscopic wedge resection is a useful procedure for treating patients with submucosal tumor (SMT) including gastrointestinal stromal tumor (GIST) of the stomach. However, resection of intragastric-type SMTs can be problematic due to the difficulty in accurately judging the location of endoluminal tumor growth, and often excessive amounts of healthy mucosa are removed; thus, full-thickness local excision using laparoscopic and endoscopic cooperative surgery (LECS) is a promising procedure for these cases. Our experience with LECS has confirmed this procedure to be a safe, feasible, and minimally invasive treatment method for gastric GISTs less than 5 cm in diameter, with outcomes similar to conventional laparoscopic wedge resection. The important advantage of LECS is the reduction in the resected area of the gastric wall compared to that in conventional laparoscopic wedge resection using a linear stapler. Early gastric cancer fits the criteria for endoscopic resection; however, if performing endoscopic submucosal dissection is difficult, the LECS procedure might be a good alternative. In the future, LECS is also likely to be indicated for duodenal tumors, as well as gastric tumors. Furthermore, developments in endoscopic and laparoscopic technology have generated various modified LECS techniques, leading to even less invasive surgery. PMID:26468339

  13. Minimally invasive proximal interphalangeal joint arthrodesis using a locking compression plate and tissue engineering in horses: A pilot study

    PubMed Central

    Seo, Jong-pil; Yamaga, Takashi; Tsuzuki, Nao; Yamada, Kazutaka; Haneda, Shingo; Furuoka, Hidefumi; Tabata, Yasuhiko; Sasaki, Naoki

    2014-01-01

    This pilot study assessed the efficacy of 2 minimally invasive techniques for proximal interphalangeal (PIP) joint arthrodesis in horses. The PIP joints of both forelimbs (n = 6) were stabilized with locking compression plates (LCP) using a minimally invasive technique (LCP technique). Subsequently, for 1 randomly selected PIP joint of each horse, surgical drilling (SurD) was performed and tissue engineering (TE) was applied (LCP/SurD/TE technique). Minimally invasive PIP joint arthrodesis with LCP demonstrated low postoperative infection rates. Gross and histological evaluations revealed considerable destruction of the articular cartilage in the LCP/SurD/TE-treated joints. In contrast, almost no destruction of the cartilage was observed in the LCP-treated joints. Our results suggest that the LCP technique alone is not sufficient for PIP joint arthrodesis and that the LCP/SurD/TE technique may be useful for PIP joint arthrodesis in horses. PMID:25392547

  14. Minimally invasive proximal interphalangeal joint arthrodesis using a locking compression plate and tissue engineering in horses: a pilot study.

    PubMed

    Seo, Jong-pil; Yamaga, Takashi; Tsuzuki, Nao; Yamada, Kazutaka; Haneda, Shingo; Furuoka, Hidefumi; Tabata, Yasuhiko; Sasaki, Naoki

    2014-11-01

    This pilot study assessed the efficacy of 2 minimally invasive techniques for proximal interphalangeal (PIP) joint arthrodesis in horses. The PIP joints of both forelimbs (n = 6) were stabilized with locking compression plates (LCP) using a minimally invasive technique (LCP technique). Subsequently, for 1 randomly selected PIP joint of each horse, surgical drilling (SurD) was performed and tissue engineering (TE) was applied (LCP/SurD/TE technique). Minimally invasive PIP joint arthrodesis with LCP demonstrated low postoperative infection rates. Gross and histological evaluations revealed considerable destruction of the articular cartilage in the LCP/SurD/TE-treated joints. In contrast, almost no destruction of the cartilage was observed in the LCP-treated joints. Our results suggest that the LCP technique alone is not sufficient for PIP joint arthrodesis and that the LCP/SurD/TE technique may be useful for PIP joint arthrodesis in horses. PMID:25392547

  15. History of craniosynostosis surgery and the evolution of minimally invasive endoscopic techniques: the University of Florida experience.

    PubMed

    Clayman, Mark A; Murad, Gregory J; Steele, Mathew H; Seagle, M Brent; Pincus, David W

    2007-03-01

    Craniosynostosis is the premature and abnormal fusion of 1 of the 6 suture lines that form the living skull and can occur as part of a syndrome or as an isolated defect (nonsyndromic). The first reported surgical procedure for correction of craniosynostosis was performed in 1890 by Lannelongue who advocated releasing, but not resecting, the fused suture. Craniofacial surgery has developed its own identity in the last 3 decades, with the Frenchman Tessier seen as the founding father. There have been many new developments such as distraction osteogenesis, biodegradable miniplate fixation, and the development of minimally invasive endoscopic techniques. Through the pioneering work of Jimenez and Barone, minimally invasive approaches to the surgical correction of craniosynostosis are now gaining wider acceptance. Here the authors review the history of craniosynostosis, the current literature and technique for endoscopic repair of craniosynostosis, as well as their own experience at the University of Florida, with minimally invasive endoscope-assisted techniques. PMID:17471133

  16. Use of single-lumen tube for minimally invasive and hybrid esophagectomies with prone thoracoscopic dissection: case series.

    PubMed

    Singh, Manila; Uppal, Rajeev; Chaudhary, Kapil; Javed, Amit; Aggarwal, Anil

    2016-09-01

    Minimally invasive and hybrid minimally invasive esophagectomy (MIE) is a technically challenging procedure. Anesthesia for the same is equally challenging due to special requirements of the video-assisted thoracoscopic technique used and shared operative and respiratory fields. Standard ventilatory strategy for this kind of surgery has been 1-lung ventilation with the help of a double-lumen tube. Prone positioning for thoracoscopic dissection facilitates gravity-dependant collapse of the operative side lung induced by a unilateral capnothorax, thus making the use of single-lumen endotracheal tube a feasible option for this surgery. We report our experience of 10 consecutive cases of minimally invasive esophagectomy conducted in prone position at our center and the use of single-lumen endotracheal tube for ventilation. PMID:27555209

  17. Safe Sedation and Hypnosis using Dexmedetomidine for Minimally Invasive Spine Surgery in a Prone Position.

    PubMed

    Kim, Kyung Hoon

    2014-10-01

    Dexmedetomidine, an imidazoline compound, is a highly selective α2-adrenoceptor agonist with sympatholytic, sedative, amnestic, and analgesic properties. In order to minimize the patients' pain and anxiety during minimally invasive spine surgery (MISS) when compared to conventional surgery under general anesthesia, an adequate conscious sedation (CS) or monitored anesthetic care (MAC) should be provided. Commonly used intravenous sedatives and hypnotics, such as midazolam and propofol, are not suitable for operations in a prone position due to undesired respiratory depression. Dexmedetomidine converges on an endogenous non-rapid eye movement (NREM) sleep-promoting pathway to exert its sedative effects. The great merit of dexmedetomidine for CS or MAC is the ability of the operator to recognize nerve damage during percutaneous endoscopic lumbar discectomy, a representative MISS. However, there are 2 shortcomings for dexmedetomidine in MISS: hypotension/bradycardia and delayed emergence. Its hypotension/bradycardiac effects can be prevented by ketamine intraoperatively. Using atipamezole (an α2-adrenoceptor antagonist) might allow doctors to control the rate of recovery from procedural sedation in the future. MAC, with other analgesics such as ketorolac and opioids, creates ideal conditions for MISS. In conclusion, dexmedetomidine provides a favorable surgical condition in patients receiving MISS in a prone position due to its unique properties of conscious sedation followed by unconscious hypnosis with analgesia. However, no respiratory depression occurs based on the dexmedetomidine-related endogenous sleep pathways involves the inhibition of the locus coeruleus in the pons, which facilitates VLPO firing in the anterior hypothalamus. PMID:25317279

  18. Biological pacemaker created by minimally invasive somatic reprogramming in pigs with complete heart block

    PubMed Central

    Hu, Yu-Feng; Dawkins, James Frederick; Cho, Hee Cheol; Marbán, Eduardo; Cingolani, Eugenio

    2016-01-01

    Somatic reprogramming by reexpression of the embryonic transcription factor T-box 18 (TBX18) converts cardiomyocytes into pacemaker cells. We hypothesized that this could be a viable therapeutic avenue for pacemaker-dependent patients afflicted with device-related complications, and therefore tested whether adenoviral TBX18 gene transfer could create biological pacemaker activity in vivo in a large-animal model of complete heart block. Biological pacemaker activity, originating from the intramyocardial injection site, was evident in TBX18-transduced animals starting at day 2 and persisted for the duration of the study (14 days) with minimal backup electronic pacemaker use. Relative to controls transduced with a reporter gene, TBX18-transduced animals exhibited enhanced autonomic responses and physiologically superior chronotropic support of physical activity. Induced sinoatrial node cells could be identified by their distinctive morphology at the site of injection in TBX18-transduced animals, but not in controls. No local or systemic safety concerns arose. Thus, minimally invasive TBX18 gene transfer creates physiologically relevant pacemaker activity in complete heart block, providing evidence for therapeutic somatic reprogramming in a clinically relevant disease model. PMID:25031269

  19. Minimally invasive surgery for superior mesenteric artery syndrome: A case report.

    PubMed

    Yao, Si-Yuan; Mikami, Ryuichi; Mikami, Sakae

    2015-12-01

    Superior mesenteric artery (SMA) syndrome is defined as a compression of the third portion of the duodenum by the abdominal aorta and the overlying SMA. SMA syndrome associated with anorexia nervosa has been recognized, mainly among young female patients. The excessive weight loss owing to the eating disorder sometimes results in a reduced aorto-mesenteric angle and causes duodenal obstruction. Conservative treatment, including psychiatric and nutritional management, is recommended as initial therapy. If conservative treatment fails, surgery is often required. Currently, traditional open bypass surgery has been replaced by laparoscopic duodenojejunostomy as a curative surgical approach. However, single incision laparoscopic approach is rarely performed. A 20-year-old female patient with a diagnosis of anorexia nervosa and SMA syndrome was prepared for surgery after failed conservative management. As the patient had body image concerns, a single incision laparoscopic duodenojejunostomy was performed to achieve minimal scarring. As a result, good perioperative outcomes and cosmetic results were achieved. We show the first case of a young patient with SMA syndrome who was successfully treated by single incision laparoscopic duodenojejunostomy. This minimal invasive surgery would be beneficial for other patients with SMA syndrome associated with anorexia nervosa, in terms of both surgical and cosmetic outcomes. PMID:26668518

  20. Neurological complications using a novel retractor system for direct lateral minimally invasive lumbar interbody fusion.

    PubMed

    Sedra, Fady; Lee, Robert; Dominguez, Ignacio; Wilson, Lester

    2016-09-01

    We describe our experience using the RAVINE retractor (K2M, Leesburg, VA, USA) to gain access to the lateral aspect of the lumbar spine through a retroperitoneal approach. Postoperative neurological adverse events, utilising the mentioned retractor system, were recorded and analysed. We included 140 patients who underwent minimally invasive lateral lumbar interbody fusion (MI-LLIF) for degenerative spinal conditions between 2011 and 2015 at two major spinal centres. A total of 228 levels were treated, 35% one level, 40% two level, 20% three level and 5% 4 level surgeries. The L4/5 level was instrumented in 28% of cases. 12/140 patients had postoperative neurological complications. Immediately after surgery, 5% of patients (7/140) had transient symptoms in the thigh ranging from sensory loss, pain and paraesthesia, all of which recovered within 12weeks following surgery. There were five cases of femoral nerve palsy (3.6% - two ipsilateral and three contralateral), all of which recovered completely with no residual sensory or motor deficit within 6months. MI-LLIF done with help of the described retractor system has proved a safe and efficient way to achieve interbody fusion with minimal complications, mainly nerve related, that recovered quickly. Judicious use of the technique to access the L4/5 level is advised. PMID:27349467