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1.
World Neurosurg ; 133: e745-e750, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31605853

RESUMO

BACKGROUND: Minimally invasive fusion of the sacroiliac (SI) joint has gained popularity for the treatment of refractory dysfunction. The purpose of this study was to compare the clinical outcomes of minimally invasive SI joint fusion between cylindrical threaded implants (CTIs) and triangular dowel implants (TDIs). METHODS: We retrospectively reviewed consecutive patients who underwent SI joint fusions with either CTIs or TDIs. Data collected included patient demographics, perioperative data, and all patient-reported outcomes (PROs) including postoperative visual analog scale (VAS), Oswestry Disability Index, and Short Form-12 at 6 months and 1 year. The change from baseline PROs between the cohorts was analyzed as the primary outcome. Secondary outcomes included revision rates and time to revision between the two cohorts. A P value <0.05 was considered significant. RESULTS: One hundred fifty-six consecutive patients underwent SI joint fusion, 74 patients with CTIs and 82 with TDIs. There was a significant difference in procedure length with CTI averaging 60.0 minutes (confidence interval: 55.7-64.3) and TDI averaging 41.2 minutes (confidence interval: 38.4-43.9, P < 0.0005). In both cohorts, there was a significant improvement in all PROs at 6 months when compared with preoperative values. However, when compared, there was no significant difference between the cohorts at 6-month follow-up or 1-year follow-up for either VAS-back, VAS-leg, Oswestry Disability Index, or Short Form-12. A 6.1% revision rate in the CTI cohort was observed compared with a 2.4% revision rate in the TDI cohort (P = 0.11). CONCLUSIONS: SI joint fusions with TDI or CTI offer a significant improvement in pain, disability, and quality of life. However, no difference was observed between devices to suggest superior clinical outcomes. Increased revision rates in the Rialto group warrants further investigation.


Assuntos
Procedimentos Cirúrgicos Minimamente Invasivos/instrumentação , Procedimentos Cirúrgicos Minimamente Invasivos/métodos , Articulação Sacroilíaca/cirurgia , Fusão Vertebral/instrumentação , Fusão Vertebral/métodos , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Medidas de Resultados Relatados pelo Paciente , Próteses e Implantes , Estudos Retrospectivos , Titânio , Resultado do Tratamento
2.
Medicine (Baltimore) ; 98(46): e18044, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31725682

RESUMO

Lumbar disc herniation (LDH) often results in back pain and radicular pain and is frequently treated with minimally invasive non-surgical methods in Korean Armed Forces Hospitals. Automated percutaneous lumbar discectomy (APLD) has been reported to have good clinical outcomes with low complication rates; however, the clinical efficacy of APLD performed in young male soldiers is uncertain. In order to clarify the efficacy of APLD for the treatment of LDH in young male soldiers, we designed a retrospective case-control study to compare patients who received APLD with patients treated with epidural steroid injection (ESI) alone.A total of 181 patients were enrolled and divided into the APLD (n = 92) and ESI (n = 89) groups according to the treatment modality. A simple logistic regression analysis was conducted to clarify the difference between the two. To optimize patient selection, APLD group was additionally divided for subgroup analysis into favorable (n = 59) and unfavorable (n = 33) groups based on satisfaction scales. A simple logistic analysis was also performed.The differences between pre- and postoperative numerical rating scale of pain (P = .0027) and hospital-own satisfaction scale (P = .0045) of the APLD group were significantly better compared to those of the ESI group. In terms of subgroup analysis, single-level pathology (P = 0.244) and protruded disc (P = .0443) were associated with favorable outcomes, whereas dual pathology and extruded disc were related with unfavorable outcomes.APLD using Dekompressor, performed in young male soldiers with back and radicular pain owing to LDH, showed better clinical outcomes compared to the ESI only therapy. Additionally, a single-level pathology with protruded disc was associated with favorable outcomes and may be indicated for treatment.


Assuntos
Discotomia Percutânea/métodos , Deslocamento do Disco Intervertebral/cirurgia , Vértebras Lombares/cirurgia , Militares , Procedimentos Cirúrgicos Minimamente Invasivos/métodos , Estudos de Casos e Controles , Discotomia Percutânea/instrumentação , Humanos , Modelos Logísticos , Masculino , Procedimentos Cirúrgicos Minimamente Invasivos/instrumentação , Medição da Dor , Estudos Retrospectivos , Adulto Jovem
3.
Arq Bras Cir Dig ; 32(3): e1447, 2019.
Artigo em Inglês, Português | MEDLINE | ID: mdl-31644667

RESUMO

BACKGROUND: The pilonidal cyst is an infection of the skin and the subcutaneous tissue, secondary to a chronic inflammation with a greater frequency in the sacrococcygeal region, and associated to the presence of hair. The treatment is eminently surgical. AIM: To demonstrate the endoscopic treatment of pilonidal cyst. METHOD: Prospective study with 67 patients who had as surgical indication the diagnosis of pilonidal cyst. They were submitted to a surgical procedure from June 2014 to March 2018. The equipment used was the Meinero fistuloscope, a shutter, a monopolar electrode, a brush and endoscopic forceps. RESULTS: Of the 67 patients, 67% (n=45) were male and 33% (n=22) female, with a mean age of 25 years (17-45). Surgical time in average was 40 min (20-120) and mean healing time of four weeks (3-12). Surgical complications were presented in 7% cases (n=5) and recurrences in 9% (n=6). CONCLUSION: The endoscopic treatment of the pilonidal cyst is feasible and presents good surgical results.


Assuntos
Procedimentos Cirúrgicos Minimamente Invasivos/métodos , Seio Pilonidal/cirurgia , Adolescente , Adulto , Argentina , Brasil , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Procedimentos Cirúrgicos Minimamente Invasivos/instrumentação , Duração da Cirurgia , Estudos Prospectivos , Região Sacrococcígea/cirurgia , Resultado do Tratamento , Adulto Jovem
4.
Orv Hetil ; 160(40): 1584-1590, 2019 Oct.
Artigo em Húngaro | MEDLINE | ID: mdl-31565974

RESUMO

Introduction: Malignant tumours of the sinonasal region - including those with invasion of the skull base - necessitate surgical resection. The majority of the cases give an opportunity to perform the procedure via minimally invasive, endoscopic approach, without external, craniofacial surgery. Aim: To assess our clinical experience in treating anterior skull base malignancies, performing minimally invasive endoscopic transcribriform resection. Method: Between February 2015 and July 2017, four male and one female patient underwent minimally invasive, endoscopic skull base procedure. The mean age was 64.6 years (59-70, median: 66). Every surgery was performed via transnasal, endoscopic transcribriform approach. In two cases Kadish C esthesioneuroblastomas, while in one case a T3N0 sinonasal non-differentiated carcinoma, a T1N0 intestinal type adenocarcinoma and a T4N0 squamous cell carcinoma was the indication of surgery, respectively. Results: The mean follow-up time was 22.8 months, between 14 and 46 months. Intraoperative complications did not occur during the procedures. Regarding the postoperative period, liquorrhoea and pneumocephalus occurred in one case. Complications were solved with lumbar drainage. During follow-up, neither residual nor recurrent tumour was observed in our patients. Conclusion: Endoscopic transcribriform resection of the skull base malignancies is a safe and viable alternative to the traditional open approach. Orv Hetil. 2019; 160(40): 1584-1590.


Assuntos
Endoscopia , Procedimentos Cirúrgicos Minimamente Invasivos/instrumentação , Neuroendoscopia/métodos , Procedimentos Neurocirúrgicos/métodos , Neoplasias dos Seios Paranasais/cirurgia , Neoplasias da Base do Crânio/cirurgia , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Procedimentos Cirúrgicos Minimamente Invasivos/métodos , Recidiva Local de Neoplasia , Neuroendoscopia/efeitos adversos , Neoplasias dos Seios Paranasais/patologia , Base do Crânio/cirurgia , Neoplasias da Base do Crânio/patologia , Resultado do Tratamento
5.
Sheng Wu Yi Xue Gong Cheng Xue Za Zhi ; 36(5): 870-878, 2019 Oct 25.
Artigo em Chinês | MEDLINE | ID: mdl-31631638

RESUMO

The application of minimally invasive surgical tool detection and tracking technology based on deep learning in minimally invasive surgery is currently a research hotspot. This paper firstly expounds the relevant technical content of the minimally invasive surgery tool detection and tracking, which mainly introduces the advantages based on deep learning algorithm. Then, this paper summarizes the algorithm for detection and tracking surgical tools based on fully supervised deep neural network and the emerging algorithm for detection and tracking surgical tools based on weakly supervised deep neural network. Several typical algorithm frameworks and their flow charts based on deep convolutional and recurrent neural networks are summarized emphatically, so as to enable researchers in relevant fields to understand the current research progress more systematically and provide reference for minimally invasive surgeons to select navigation technology. In the end, this paper provides a general direction for the further research of minimally invasive surgical tool detection and tracking technology based on deep learning.


Assuntos
Aprendizado Profundo , Procedimentos Cirúrgicos Minimamente Invasivos/instrumentação , Algoritmos
6.
BMC Musculoskelet Disord ; 20(1): 381, 2019 Aug 17.
Artigo em Inglês | MEDLINE | ID: mdl-31421675

RESUMO

BACKGROUND: Our hypothesis was that minimally invasive plate osteosynthesis (MIPO) using long philos plate (LPP) would show better clinical and radiological outcomes and less complications than narrow locking compression plate (NLCP) for spiral humerus shaft fractures with or without metaphyseal fracture extension. METHODS: From January 2009 to May 2016, we retrospectively studied 35 patients who underwent MIPO for spiral humerus shaft fractures with or without metaphyseal fracture extension (AO classification 12 A, B, C except A3). Eighteen patients underwent MIPO with a 4.5 mm NLCP (group I) in the early period of this study, while 17 patients underwent MIPO with LPP (group II) in the later period. Range of motion (ROM), pre- and post-operative anteroposterior (AP) and lateral angulation of the fracture, operation time, amount of bleeding, and functional outcomes including American Shoulder and Elbow Surgeons score, University of California at Los Angeles score, and Simple Shoulder Test score were analyzed at the final follow up. RESULTS: All patients had complete bony union and achieved satisfactory functional outcomes except 2 patients. In LPP group, better outcomes in postoperative fracture angulation on X-ray and operation time (p < 0.05) were shown. But, two revision surgery with NLCP and bone graft was performed owing to 2 metal failures. CONCLUSIONS: In spiral humeral shaft fractures, LPP group showed better fracture reduction on X-ray and shorter operation time except metal failure owing to weak fixation. Even though MIPO technique using LPP is easier and more accurate reduction method, rigid fixation should be considered.


Assuntos
Placas Ósseas/efeitos adversos , Fixação Interna de Fraturas/instrumentação , Fraturas do Úmero/cirurgia , Procedimentos Cirúrgicos Minimamente Invasivos/instrumentação , Falha de Prótese , Articulação do Cotovelo/diagnóstico por imagem , Articulação do Cotovelo/fisiopatologia , Feminino , Fixação Interna de Fraturas/efeitos adversos , Fixação Interna de Fraturas/métodos , Consolidação da Fratura/fisiologia , Humanos , Fraturas do Úmero/diagnóstico por imagem , Fraturas do Úmero/fisiopatologia , Úmero/diagnóstico por imagem , Úmero/lesões , Úmero/cirurgia , Masculino , Pessoa de Meia-Idade , Procedimentos Cirúrgicos Minimamente Invasivos/efeitos adversos , Procedimentos Cirúrgicos Minimamente Invasivos/métodos , Duração da Cirurgia , Período Pós-Operatório , Amplitude de Movimento Articular/fisiologia , Estudos Retrospectivos , Resultado do Tratamento
7.
World Neurosurg ; 131: 52, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31376553

RESUMO

Brain retraction is crucial for adequate exposure during many intracranial procedures. It facilitates the access to the area of interest inside the brain and gives the surgeon the ability to create a corridor to visualize the deeply seated lesions. Retraction-related injury is a well-known complication. A minimally invasive retraction system has been invented and modified to improve the downside of retraction and overcome the complications. The syringe brain port system is a transtubular system composed of simple tools that are available in all medical facilities. It can help the neurosurgeons to achieve brain retraction in a safe, simple, and cost-effective technique. We are presenting a video of how to make this system. Also, we are demonstrating an intraoperative application of this system in a case of a 36-year-old male with deep-seated recurrent right frontal glioblastoma multiforme grade IV.


Assuntos
Neoplasias Encefálicas/cirurgia , Glioblastoma/cirurgia , Procedimentos Cirúrgicos Minimamente Invasivos/instrumentação , Recidiva Local de Neoplasia/cirurgia , Procedimentos Neurocirúrgicos/instrumentação , Seringas , Adulto , Humanos , Masculino
8.
World Neurosurg ; 130: e1077-e1083, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31323412

RESUMO

BACKGROUND: Lateral interbody fusion (LIF) is an effective adjuvant for circumferential minimally invasive surgery (CMIS) treatment of adult spinal deformity (ASD). Accessing L5-S1 via an oblique LIF (OLIF) approach (OLIF 5-1) allows for anterior LIF (ALIF) at the lumbosacral junction without repositioning the patient. We review the early outcomes and complications of OLIF 5-1 at the bottom of a long construct for an MIS approach to treat ASD. METHODS: We queried a prospectively collected registry of 111 consecutive patients with ASD (Cobb angle >20°, sagittal vertical alignment [SVA] >50, or pelvic incidence [PI]-lumbar lordosis [LL] mismatch>10) patients who underwent CMIS correction between January 2015 and January 2019. Sixty patients had ≥4 levels fused and OLIF 5-1. Multilevel pre-psoas LIF + OLIF 5-1 were performed in the first stage. Three days later, stage 2 involved MIS installation of pedicle screws with aggressive rod contouring and derotation/translation. RESULTS: The mean patient age was 66.8 years (range, 48-79 years), and the mean duration of follow-up was 24 months (range, 3-60 months). A mean of 7 levels were fused (range, 4-9). Significant improvements in L5-S1 segmental lordosis (SL), LL, SVA, PI-LL mismatch, and pelvic tilt were seen following the first stage (P < 0.05). There was no intraoperative vascular, ureteral, or sympathetic chain injury, and no transient or permanent lumbar plexopathy. In 2 patients, OLIF 5-1 was abandoned due to difficult access, and transforaminal LIF was done at L5-S1 at the second stage. Five patients required intraoperative transfusion. No patient experienced postoperative ileus or L5-S1 pseudarthrosis. Significant improvements in visual analog scale pain score, Oswestry Disability Index, 36-Item Short Form Health Survey, and Scoliosis Research Society Outcomes Questionnaire were found. CONCLUSIONS: A single-position MIS OLIF 5-1 at the bottom of a long construct in conjunction with multilevel pre-psoas LIF seems to be a safe and effective technique for improving SL, global LL, and SVA with a low risk of perioperative and postoperative complications.


Assuntos
Lordose/cirurgia , Vértebras Lombares/cirurgia , Procedimentos Cirúrgicos Minimamente Invasivos/métodos , Ossos Pélvicos/cirurgia , Sacro/cirurgia , Fusão Vertebral/métodos , Idoso , Estudos de Coortes , Feminino , Humanos , Lordose/diagnóstico por imagem , Vértebras Lombares/diagnóstico por imagem , Masculino , Pessoa de Meia-Idade , Procedimentos Cirúrgicos Minimamente Invasivos/instrumentação , Ossos Pélvicos/diagnóstico por imagem , Estudos Prospectivos , Sacro/diagnóstico por imagem , Fusão Vertebral/instrumentação
9.
Sensors (Basel) ; 19(14)2019 Jul 11.
Artigo em Inglês | MEDLINE | ID: mdl-31336770

RESUMO

In order to improve the precision and stability of puncture surgical operations to assist doctors in completing fine manipulation, a new of type puncturing needle sensor is proposed based on a fiber Bragg grating (FBG). Compared with the traditional puncture needle sensor, the new type of puncturing needle sensor is able to sense not only the axial force, but also the torque force during the puncture process. A spoke-type structure is designed near the needle tip. In order to eliminate the influence of temperature and realize temperature compensation, a reference fiber method using three FBGs is applied. FBG1 and the reference FBG2 are pasted on the upper and lower surfaces of the new-type elastic beam, and FBG3 is pasted into the groove on the surface of the new type of puncturing needle cylinder. The difference of Bragg wavelength between FBG1 and the reference FBG2 is calibrated with the torque force, while the difference between the Bragg wavelength of the FBG3 and the reference FBG2 is calibrated with the axial force. Through simulation and sensing tests, when the torque force calibration range is 10 mN·m, the torque average sensitivity is 22.8 pm/mN·m, and the determination coefficient R2 is 0.99992, with a hysteresis error YH and repetition error YR of 0.03%FS and 0.81%FS, respectively. When the axial force calibration rang is 5 N, the axial force average sensitivity is 0.089 nm/N, and the determination coefficient R2 is 0.9997, with hysteresis error YH and repetition error YR of 0.014%FS and 0.11%FS, respectively. The axial force resolution and torque resolution of the new type of puncturing needle sensor are 0.03 N and 0.8 mN·m, respectively. The experimental data and simulation analysis show that the proposed new type of puncturing needle sensor has good practicability and versatility.


Assuntos
Tecnologia de Fibra Óptica/instrumentação , Procedimentos Cirúrgicos Minimamente Invasivos/instrumentação , Punções/instrumentação , Calibragem , Desenho de Equipamento , Tecnologia de Fibra Óptica/métodos , Análise de Elementos Finitos , Humanos , Procedimentos Cirúrgicos Minimamente Invasivos/métodos , Agulhas , Torque
10.
Ann R Coll Surg Engl ; 101(7): 522-528, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31155918

RESUMO

INTRODUCTION: Longer durations of cardiopulmonary bypass and aortic cross clamp are associated with increased morbidity and mortality. Little is known about the effect of automated knot fasteners (Cor-Knot®) in minimally invasive mitral valve repair on operative times and outcomes. The aim of this study was to evaluate whether these devices shortened cardiopulmonary bypass and aortic cross clamp times and whether this impacted on postoperative outcomes. MATERIALS AND METHODS: All patients undergoing isolated minimally invasive mitral valve repair by a single surgeon between March 2011 and March 2016 were included (n = 108). Two cohorts were created based on the use (n = 52) or non-use (n = 56) of an automated knot fastener. Data concerning intraoperative variables and postoperative outcomes were collected and compared. RESULTS: Preoperative demographics were well matched between groups with no significant difference in logistic Euroscore (manual vs automated: median 3.1, interquartile range, IQR, 2.1-5.5, vs 5.4, IQR 2.2-8.3; P = 0.07, respectively). Comparing manually tied knots to an automated fastener, cardiopulmonary bypass and aortic cross clamp times were significantly shorter in the automated group (cardiopulmonary bypass: median 200 minutes, IQR 180-227, vs 165 minutes (IQR 145-189 minutes), P < 0.001; aortic cross clamp 134 minutes (IQR 121-150 minutes) vs 111 minutes (IQR 91-137 minutes), P < 0.001, respectively). There was no mortality and no strokes, nor were there any differences in postoperative outcomes including reoperation for bleeding, renal failure, intensive care or hospital stay. CONCLUSIONS: The use of an automated knot fastener significantly reduces cardiopulmonary bypass and aortic cross clamp times in minimally invasive mitral valve repair but this does not translate into an improved clinical outcome.


Assuntos
Procedimentos Cirúrgicos Cardíacos/métodos , Doenças das Valvas Cardíacas/cirurgia , Procedimentos Cirúrgicos Minimamente Invasivos/métodos , Valva Mitral/cirurgia , Técnicas de Sutura/instrumentação , Idoso , Procedimentos Cirúrgicos Cardíacos/instrumentação , Ponte Cardiopulmonar/efeitos adversos , Feminino , Humanos , Tempo de Internação/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Procedimentos Cirúrgicos Minimamente Invasivos/instrumentação , Duração da Cirurgia , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/prevenção & controle , Reoperação/estatística & dados numéricos , Resultado do Tratamento
11.
Proc Inst Mech Eng H ; 233(9): 909-920, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31210594

RESUMO

A miniature resonant tactile sensor for tissue stiffness detection in robot-assisted minimally invasive surgery is proposed in this article. The proposed tactile sensor can detect tissue stiffness based on the principle of the resonant frequency shift when it contacts with tissue of different stiffness. A PZT (lead zirconate titanate) bimorph works simultaneously as the actuator and the sensing element, which is helpful for simplifying the structure. The resonant frequency shift can be deduced by measuring the electrical impedance of the PZT bimorph, since there will be an abrupt change of the impedance when resonance occurs. A unique structure of an Archimedean spiral metal sheet is introduced to restrict the outer size of the sensor within 10 mm and to keep the resonant frequency low. A theoretical model is established. Finite element method analyses are carried out to validate the working principle and it meets the theoretical model quite well. Several silicone samples are tested with the sensor and the results show that the proposed sensor is capable of measuring tissue stiffness within the range of 0-2 MPa, detecting and locating lumps inside tissue.


Assuntos
Fenômenos Mecânicos , Procedimentos Cirúrgicos Minimamente Invasivos/instrumentação , Robótica/instrumentação , Tato , Análise de Elementos Finitos
12.
Ann Thorac Surg ; 108(3): e207-e209, 2019 09.
Artigo em Inglês | MEDLINE | ID: mdl-31175867

RESUMO

In minimally invasive mitral valve surgery, exposure in the medial left atrium is occasionally poor. A flexible exposure system for minimally invasive surgery was constructed using a tin plate (99.9% pure tin). The tin plate is very flexible and embossed to prevent slippage, and it is attached to a left atrial retractor. The folded tin plate is inserted into the left atrium via a minithoracotomy, and the plate is easily expanded using forceps, as needed. The tin plate pushes the medial atrial wall outward, which provides an excellent view of the entire mitral valve.


Assuntos
Desenho de Equipamento , Valva Mitral/cirurgia , Estanho , Septo Interatrial/cirurgia , Humanos , Procedimentos Cirúrgicos Minimamente Invasivos/instrumentação , Procedimentos Cirúrgicos Minimamente Invasivos/métodos , Sensibilidade e Especificidade , Instrumentos Cirúrgicos , Toracotomia/métodos
13.
Med Biol Eng Comput ; 57(9): 1901-1916, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31243623

RESUMO

Needles are tools that are used daily during minimally invasive procedures. During the insertions, needles may be affected by deformations which may threaten the success of the procedure. To tackle this problem, needles with embedded strain sensors have been developed and associated with navigation systems. The localization of the needle in the tissues is then obtained in real time by reconstruction from the strain measurements, allowing the physician to optimize its gesture. As the number of strain sensors embedded is limited in number, their positions on the needle have a great impact on the accuracy of the shape reconstruction. The main contribution of this paper is a novel strain sensor positioning method to improve the reconstruction accuracy. A notable feature of our method is the use of experimental needle insertion data, which increases the relevancy of the resulting sensor optimal locations. To the best of the author's knowledge, no experimentally based needle sensor positioning method has been presented yet. Reconstruction validations from clinical data show that the localization accuracy of the needle tip is improved by almost 40% with optimal locations compared with equidistant locations when reconstructing with two sensor triplets or more. Graphical Abstract Improvement of the reconstruction accuracy of a deformed needle shape by using experimental data to position strain sensors.


Assuntos
Processamento de Imagem Assistida por Computador , Procedimentos Cirúrgicos Minimamente Invasivos/instrumentação , Agulhas , Animais , Bases de Dados Factuais , Desenho de Equipamento , Humanos , Suínos , Tomografia Computadorizada por Raios X
14.
Am J Case Rep ; 20: 816-821, 2019 Jun 10.
Artigo em Inglês | MEDLINE | ID: mdl-31178585

RESUMO

BACKGROUND The diagnosis of Boerhaave's syndrome is often missed or delayed. This subsequently leads to a high mortality rate, which could be greatly reduced if treatment is instituted early, within 24 hours of perforation. Treatment ranges from conservative management to operative intervention depending on the time of presentation and the patient's clinical condition. Endoscopic intervention in the form of over-the-scope clip (OTSC) application is gaining popularity with very promising results. CASE REPORT A 43-year-old male was diagnosed with Boerhaave's syndrome and treated initially by insertion of bilateral chest drainage, intravenous broad-spectrum antibiotics, and total parenteral nutrition. He was transferred to our facility 9 days later. Upper gastrointestinal endoscopy revealed a 1.5 cm deep longitudinal ulcer involving the distal esophagus and extending to the Z-line. Due to the perforation site, a size 12 OTSC clip was used. Application of a second clip was needed to achieve complete closure of the perforation site. Contrast swallow was done 4 days later showed no leak. The patient was started on oral intake and was discharged home in good general condition after a hospital stay of 16 days. CONCLUSIONS Delayed presentation of Boerhaave's syndrome can be treated safely by an over-the-scope clip. This endoscopic method hastens recovery and shortens the hospital stay.


Assuntos
Perfuração Esofágica/diagnóstico por imagem , Perfuração Esofágica/cirurgia , Doenças do Mediastino/diagnóstico por imagem , Doenças do Mediastino/cirurgia , Procedimentos Cirúrgicos Minimamente Invasivos/instrumentação , Ruptura Espontânea/cirurgia , Dor Abdominal/diagnóstico , Dor Abdominal/etiologia , Adulto , Diagnóstico Tardio , Esofagoscopia/métodos , Seguimentos , Gastroscopia/métodos , Humanos , Masculino , Procedimentos Cirúrgicos Minimamente Invasivos/métodos , Doenças Raras , Ruptura Espontânea/diagnóstico por imagem , Índice de Gravidade de Doença , Instrumentos Cirúrgicos , Tomografia Computadorizada por Raios X/métodos , Resultado do Tratamento
15.
World Neurosurg ; 129: 378-385, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31252081

RESUMO

BACKGROUND: The benefits of minimally invasive spine surgery are attainable only if hospitals have the financial resources to acquire essential equipment. We present a surgical approach readily available to countries where unacceptably expensive materials are the main limitation for use of minimally invasive spine surgery. METHODS: This retrospective study included 30 patients who underwent minimally invasive spine surgery using syringes as dilators and retractors for posterior lumbar approaches. Inclusion criteria were lumbar radicular/back pain, degenerative disc, spondylolysis, unilateral approach, and maximum of 2 affected spine levels. Demographic characteristics, affected radicular level, diagnosis, type and length of surgery, hospital length of stay, MacNab criteria, complications, and resumption of daily activities were analyzed. RESULTS: Of 30 patients, 17 (56.6%) presented with S1 radicular pain. Pain was mainly due to posterolateral hernia (70%; n = 21) requiring 1-level discectomy. In 6 patients (20%), discectomy and an interspinous process device were required. One patient (3.33%) underwent 2-level discectomy. All surgeries were performed using syringes as dilators and retractors. Maximum syringe diameter used was 2 cm (20-mL syringes) in 29 patients (96.6%) and 3 cm (60-mL syringe) in 1 patient. Average length of surgery was 1.5 hours, and average hospital stay was 1.8 days. Based on MacNab criteria, excellent, good, and fair outcomes were achieved in 25 patients (83%), 3 patients (10%), and 2 patients (6.7%). Complications were observed in 5 patients (16.7%). CONCLUSIONS: This is a safe and feasible technique with excellent results obtained at low cost and is becoming an attractive surgical option in developing countries.


Assuntos
Discotomia/métodos , Procedimentos Cirúrgicos Minimamente Invasivos/métodos , Adulto , Idoso , Países em Desenvolvimento , Discotomia/instrumentação , Feminino , Humanos , Vértebras Lombares , Masculino , Pessoa de Meia-Idade , Procedimentos Cirúrgicos Minimamente Invasivos/instrumentação , Estudos Retrospectivos , Seringas , Adulto Jovem
16.
J Card Surg ; 34(7): 620-623, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31212364

RESUMO

Heart Teams are increasingly confronted with decision-making in anatomically and clinically complex surgical candidates. Herein, we discuss the versatility of the endoaortic occlusion device (Intraclude; Edwards Lifesciences Inc) for the management of a various array of complex primary and reoperative cardiac cases. Three clinical scenarios are illustrated (ascending aortic pseudoaneurysm, mitral valve surgery after previous CABG, extensive thoracic aortic surgery with continuous visceral perfusion), suggesting the effectiveness of the patient-specific strategy to minimize operative morbidity. Evolution of surgical techniques needs to be considered in decision-making among alternative treatment strategies.


Assuntos
Falso Aneurisma/cirurgia , Aorta , Aneurisma Aórtico/cirurgia , Oclusão com Balão/instrumentação , Procedimentos Cirúrgicos Cardíacos/instrumentação , Procedimentos Cirúrgicos Minimamente Invasivos/instrumentação , Insuficiência da Valva Mitral/cirurgia , Complicações Pós-Operatórias/cirurgia , Idoso , Procedimentos Cirúrgicos Cardíacos/métodos , Ponte de Artéria Coronária , Feminino , Humanos , Masculino , Procedimentos Cirúrgicos Minimamente Invasivos/métodos
17.
World Neurosurg ; 130: e467-e474, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31247354

RESUMO

OBJECTIVE: The treatment of spinal metastasis carries significant surgical morbidity, and decompression and stabilization are often necessary. Less invasive techniques may reduce risks and postoperative pain. This study describes the differences between a mini-open (MO) procedure and a traditional open surgery (OS) for symptomatic spinal metastasis, and reports differences in outcome for similar patients undergoing each procedure. METHODS: We describe a MO technique and retrospective analysis of 20 OS patients who were matched to 20 MO patients by histology, spinal region, and levels instrumented. MO surgery combined a traditional midline exposure for tumor resection with transfascial pedicle screw fixation. Outcome measures included estimated blood loss (EBL), operative time (OT), length of stay (LOS), transfusion rate, complication rate, ASIA Impairment Scale motor score (AMS), and pain scores. Statistical analysis used unpaired t tests and Fisher exact test. RESULTS: Average age of the patients was 58.3 years. Forty-eight percent of patients were women. Average number of levels treated was 5.9. Both groups had similar LOS (P = 0.98), OT (P = 0.30), perioperative complication rates (P = 0.51), transfusion rates (P = 0.33), and AMS (P = 0.17). EBL was found to be significantly lower in the MO group than the open group (805 ± 138 mL vs. 1732 ± 359 mL, respectively; P = 0.019). The MO group had a significant reduction in postoperative pain (-1.71 ± 0.5 vs. 0.33 ± 0.7, P = 0.018). CONCLUSIONS: Although further studies are needed, the MO approach appears to result in decreased blood loss and postoperative pain, without compromising neural element decompression or spinal stability. These findings are consistent with the use of muscle sparing, minimally invasive pedicle screw fixation.


Assuntos
Procedimentos Neurocirúrgicos/métodos , Compressão da Medula Espinal/cirurgia , Neoplasias da Coluna Vertebral/cirurgia , Idoso , Descompressão Cirúrgica/métodos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Procedimentos Cirúrgicos Minimamente Invasivos/instrumentação , Procedimentos Cirúrgicos Minimamente Invasivos/métodos , Procedimentos Neurocirúrgicos/instrumentação , Dor Pós-Operatória/prevenção & controle , Parafusos Pediculares , Compressão da Medula Espinal/etiologia , Neoplasias da Coluna Vertebral/complicações , Neoplasias da Coluna Vertebral/secundário , Resultado do Tratamento
18.
Int J Med Robot ; 15(4): e2007, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31050135

RESUMO

BACKGROUND: Due to the outstanding compliance and dexterity, continuum robot have great advantages in confined space applications, especially in minimally invasive surgery (MIS). However, the vascular environment is complicated and tortuous, it is necessary to preoperative motion planning and navigation for a continuum robot. METHODS: A cable-driven continuum robot is proposed, and the mapping relationship among the driven space, joint space and task space, as well as the decoupling algorithm are analyzed based on piecewise constant curvature assumption. Moreover, a navigation method is presented to achieve semi-autonomous interventional surgery based on the vascular constraints by using the backbone cure method. RESULTS: Finally, by using the prototype, the interventional simulations and experiments for a simulated glass blood vessel are developed to validate the feasibility and maneuverability of the proposed model and navigation method. CONCLUSIONS: The established motion model and navigation method can be used as a motion control and navigation reference.


Assuntos
Desenho de Equipamento , Procedimentos Cirúrgicos Minimamente Invasivos/instrumentação , Procedimentos Cirúrgicos Minimamente Invasivos/métodos , Procedimentos Cirúrgicos Robóticos/instrumentação , Procedimentos Cirúrgicos Robóticos/métodos , Algoritmos , Fenômenos Biomecânicos , Simulação por Computador , Computadores , Humanos , Movimento (Física) , Imagens de Fantasmas
19.
Ann Thorac Surg ; 108(3): e211-e212, 2019 09.
Artigo em Inglês | MEDLINE | ID: mdl-31082358

RESUMO

Extracorporeal knot tying is one of the challenges in minimally invasive surgery. The current aids are often associated with mechanical failures and application difficulties, a long learning curve, fraying of sutures, user errors, increased cost, and reduced haptic feedback. We describe a technique that is very conventional and uses a polytetrafluoroethylene pledget to lower the knot. Also, there is no contact between the suture and the instrument at any point, and therefore fraying and tearing of sutures is not an issue. The technique is simple and inexpensive and has an extremely short learning curve.


Assuntos
Procedimentos Cirúrgicos Minimamente Invasivos/instrumentação , Técnicas de Sutura/educação , Técnicas de Sutura/instrumentação , Humanos , Laparoscopia/métodos , Curva de Aprendizado , Procedimentos Cirúrgicos Minimamente Invasivos/métodos , Sensibilidade e Especificidade , Suturas
20.
Surg Technol Int ; 34: 129-133, 2019 May 15.
Artigo em Inglês | MEDLINE | ID: mdl-31037715

RESUMO

INTRODUCTION: Needlescopic cholecystectomy (NC) was introduced in the late 1990s. It uses a reduced trocar caliber in an otherwise standard four-port laparoscopic cholecystectomy (LC) and seeks to achieve "scarless" surgery without compromising patient safety. MATERIALS AND METHODS: Between May 2016 and November 2017, 29 patients underwent elective NC at the Department of General Surgery of Sant'Andrea Hospital (La Spezia, Italy). Inclusion criteria were female sex, age between 18 and 45 years, good performance status (ASA 1-2) and BMI lower than 25. Twenty-one patients underwent a standard 4-port technique: 12mm port in the supraumbilical area, 5mm port in the subxiphoid position, 3mm port in the mid-epigastric area and another 3 mm port in the right mid-clavicular position. In 8 patients, 3mm ports were replaced by 2mm angiocath. A Critical View of Safety (CVS) was achieved in all procedures. Intra-operative cholangiography (IOC) via the cystic duct before any transection of the structures was routinely performed in selected cases, such as those with an unclear biliary anatomy or risk factors for main-duct stones. In our institution, laparoscopic transcystic common bile duct (CBD) exploration is routinely performed in CBD lithiasis. RESULTS: The mean operative time was 66.79 min (range 25-120 min). IOC was performed in 12 patients (41.4%) with suspected choledocolythiasis. There was no conversion to conventional laparoscopic cholecystectomy or open cholecystectomy. The mean hospital stay was 1.48 days (1-7 days). A Clavien-Dindo IIIB complication occurred in one patient on the third postoperative day. The mean VAS pain score was 3 (0-7). Closure of the skin with primary intention was achieved in all patients. Mean return to work was 6.76 days (3-15 days) and the mean return to previous physical activity was 12.17 days (4-30 days). All of the patients completed the Scar Satisfaction Questionnaire: 26 (89.7% ) and 3 patients (10.3%) were very satisfied and satisfied, respectively. CONCLUSION: Any effort to reduce invasiveness and improve cosmesis must not jeopardize safety. Our case series demonstrates that needlescopy can be safely associated with intraoperative cholangiography to recognize CBD stones. This technique offers the advantage of minor postoperative pain, better cosmesis results, early return to routine life activities and great satisfaction for the patient. Needlescopy is a valuable and safe alternative that is suitable for elective cholecystectomy in properly selected patients, such as young female patients.


Assuntos
Colecistectomia Laparoscópica/instrumentação , Colecistectomia Laparoscópica/métodos , Adolescente , Adulto , Colangiografia/métodos , Coledocolitíase/cirurgia , Técnicas Cosméticas/instrumentação , Feminino , Humanos , Cuidados Intraoperatórios , Pessoa de Meia-Idade , Procedimentos Cirúrgicos Minimamente Invasivos/instrumentação , Procedimentos Cirúrgicos Minimamente Invasivos/métodos , Adulto Jovem
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