Minimally invasive techniques for treatment of special cardiac malformations / 中国胸心血管外科临床杂志

@#Objective    To share the experience of treating special cardiac malformations by applying minimally invasive techniques. Methods    Eight children with special cardiac malformations admitted to our hospital from July 2014 to September 2020 were recruited, including 3 males and 5 females, aged 0.8-1.2 (1.1±0.4) years, and weighted 7.8-11.5 (9.6±2.9) kg. There were 2 patients of huge muscular ventricular septal defect (VSD), 3 perimembranous cribriform VSD, 1 right coronary-right atrial fistula, 1 right coronary-right ventricular fistula, and 1 young, low-weight child with large aortopulmonary. All were treated with minimally invasive techniques using transesophageal echocardiography (TEE) as a guiding tool. All children received intraoperative TEE immediately to evaluate the curative effect of the surgery, and all went to outpatient clinic for reexamination of echocardiography, electrocardiogram and chest X-ray after discharge. Results    Eight children underwent minimally invasive surgery successfully without any incision infection, intracardiac infection, arrhythmia or pericardial effusion. None of the 8 children were lost to follow-up, and the results of all reexaminations were satisfactory. Conclusion    The application of minimally invasive techniques is a bold and innovative attempt for the treatment of a few special types of cardiac malformations. It has significant advantages in reducing trauma and medical costs in some suitable patients, and has certain clinical reference values.

Research progress and prospect of gastric cancer surgery in 2021 / 中华胃肠外科杂志

The incidence and mortality rates of gastric cancer are among the top three cancers in China, which poses great threat to people's lives and health. So far, surgery remains to be the cornerstone of treatment for gastric cancer. With the development of laparoscopic surgery, minimally invasive treatment techniques, together with the deepening of clinical researches, as we review the research progress in 2021, the core controversial issues of gastric cancer surgery have been basically addressed. The series of "minimal-innovation" concepts and technologies represented by single-incision/reduced-port laparoscopic surgeries have been further developed; radiomics and artificial intelligence aided prediction have been applied into the forefront of surgical accurate decision-making; targeted and immune-therapy is about to break through the bottleneck of surgical efficacy of gastric cancer. Currently, molecular imaging and targeted tracer guided precision cancer surgery are being explored, which is expected to revolutionize in key links such as real-time in-vivo determination of tumor margin, tracing of metastatic lymph nodes and visualization of nerves. Looking forward into the future, gastric cancer surgery will break through the century-old ceiling of "gross appearance by naked eye" and "traditional extensive experience", and set off a new round of technological revolutions in molecular visualization intelligent precision minimally invasive surgery.

Two-Year Outcomes of Midline lumbar Fusion Versus Minimally Invasive Transforaminal Lumbar Interbody Fusion in the Treatment of L4-L5 Degenerative Disease / 生物医学与环境科学（英文）

Objective@#We aimed to compare the clinical and radiological outcomes of midline lumbar fusion (MIDLF) versus minimally invasive transforaminal lumbar interbody fusion (MI-TLIF) in patients with degenerative spondylolisthesis and/or stenosis in L4-L5 two years after surgery.@*Methods@#Consecutively treated patients with lumbar pathology who underwent MIDLF ( @*Results@#The mean operative time and hematocrit (HCT, Day 1) were significantly shorter and lower in MIDLF cases (174 min @*Conclusion@#MIDLF is comparable to MI-TLIF at L4-5 in clinical outcomes and fusion rates, and the results verified the meaningful advantage of using MIDLF for the elderly with osteoporosis.

Effect of minimally invasive techniques for removing impacted wisdom teeth on local inflammatory response and pain / 局解手术学杂志

Objective To explore the effect of minimally invasive techniques for removing impacted wisdom teeth on local inflammation and pain. Methods A total of 110 patients with impacted wisdom teeth removed in our department from June 2016 to February 2018 were divided into observation group(55 cases,minimally invasive removal) and control group (55 cases, traditional chisel) according to the surgical method. The operative status, the inflammatory mediators and pain mediators in the gingival sulcus before and after the treatment, and the therapeutic effects of the two groups were compared. Results The operative time of the observation group was shorter than that of the control group,the intraoperative blood loss was less than that in the control group, the differences were significant(P ＜ 0. 05). The levels of PTX3, cells in the gingival sulcus adhesion of cytokine 1 (ICAM1),peroxidase (MPO),prostaglandin E2 (PGE2) levels,pain mediator 5-hydroxytryptamine(5-HT), calcitonin gene-related peptide(CGRP), substance P(SP), galanin(Gla) and adenosine triphosphate(ATP) in the observation group after treatment was lower than those in the control group, the differences were significant(P ＜ 0. 05); The degree of mouth opening restriction, facial swelling and visual analog scale score(VAS) in the observation group were lower than those in the control group, the differences were significant(P ＜ 0. 05). Conclusion Compared with traditional chisel in extraction of impacted wisdom teeth, the minimally invasive wisdom tooth extraction can relieve the inflammatory response and pain sensation of patients,and the clinical treatment effect is significant.

The trends in surgical treatment and the outcomes of critical acute pancreatitis / 中华肝胆外科杂志

Objective To study the trends in surgical treatment and the outcomes of critical acute pancreatitis (CAP).Methods The clinical data of 76 patients with CAP who were treated in the Department of Biliopancreatic Surgery of the Xiangya Hospital,Central South University from January 2010 to December 2017 were retrospectively reviewed.Data which included demographics,micro-organisms,surgical interventions and mortality were compared between the time periods of 2010 to 2013 and 2014 to 2017.Results Before 2014,19 patients with CAP were treated in the Department of Biliopancreatic Surgery of the Xiangya Hospital,Central South University.The percentage of multidrug resistant organisms (MDRO) in pancreatic drainage was 5.3％ (1/19).In the latter 4 years,57 patients with CAP were treated.The percentage of MDRO was 50.9％ (29/57),which was significandy higher than the initial 4 years (P＜0.001).For surgical treatment,the proportion of minimally invasive surgery in the latter 4 years was significantly higher than that in the initial 4 years.The percentage of percutaneous catheter drainage (PCD) increased from 63.2％ in the initial 4 years to 86.0％ in the latter 4 years.The proportion of minimal access retroperitoneal pancreatic necrosectomy (MARPN) increased from zero in the initial 4 years to 59.6％,while the proportion of open pancreatic necrosectomy (OPN) decreased from 68.4％ in the initial 4 years to 24.6％.The mortality rate of patients with CAP dropped from 52.6％ (10/19) in the initial 4 years to 24.6％ (14/57) in the latter four years.Conclusions In the center which specializes in treating pancreatitis,although the problem of bacterial resistance had become increasingly prominent,the mortality rate of CAP had shown a significant downward trend due to the development of various minimally invasive techniques.

Contemporary surgical treatment of benign prostatic hyperplasia / Tratamento cirúrgico contemporâneo da hiperplasia prostática benigna

Summary Benign prostatic hyperplasia (BPH) is a common condition in adult men and its incidence increases progressively with aging. It has an important impact on the individual's physical and mental health and its natural progression can lead to serious pathological situations. Although the initial treatment is pharmacological, except in specific situations, the tendency of disease progression causes a considerable portion of the patients to require surgical treatment. In this case, there are several options available today in the therapeutic armamentarium. Among the options, established techniques, such as open surgery and endoscopic resection using monopolar energy, still prevail in the choice of surgeons because they are more accessible, both from a socioeconomic standpoint in the vast majority of medical services and in terms of training of medical teams. On the other hand, new techniques and technologies arise sequentially in order to minimize aggression, surgical time, recovery and complications, optimizing results related to the efficacy/safety dyad. Each of these techniques has its own peculiarities regarding availability due to cost, learning curve and scientific consolidation in order to achieve recognition as a cutting-edge method in the medical field. The use of bipolar energy in endoscopic resection of the prostate, laser vaporization and enucleation techniques, and videolaparoscopy are examples of new options that have successfully traced this path. Robot-assisted surgery has gained a lot of space in the last decade, but it still needs to dodge the trade barrier. Other techniques and technologies will need to pass the test of time to be able to conquer their space in this growing market.

Resumo A hiperplasia prostática benigna (HPB) é uma condição comum em homens adultos, de incidência progressiva com o envelhecimento, com importante impacto nas saúdes física e mental do indivíduo e história natural que pode levar a situações patológicas graves. Embora o tratamento inicial, salvo em situações específicas, seja farmacológico, a tendência de progressão da doença leva uma considerável parcela dos pacientes a necessitar do tratamento cirúrgico. Neste caso, existem diversas opções hoje disponíveis no arsenal terapêutico. Dentre estas, as técnicas consagradas, como as cirurgias por via aberta e a ressecção endoscópica por energia monopolar, ainda ocupam extenso terreno na escolha dos cirurgiões por serem mais acessíveis, tanto do ponto de vista socioeconômico na imensa maioria dos serviços médicos quanto do de aprendizado por parte das equipes médicas. Por outro lado, novas técnicas e tecnologias surgem sequencialmente no intuito de minimizar a agressão, o tempo cirúrgico, as complicações, bem como favorecer a recuperação, otimizando resultados em relação ao binômio eficácia/segurança. Cada uma destas tem seu próprio curso em relação à disponibilidade de acesso em decorrência de custo, curva de aprendizagem e consolidação científica, a fim de atingir conceituação e utilização de ponta no meio médico. O uso da energia bipolar na ressecção endoscópica da próstata, as técnicas de vaporização e enucleação a laser e a videolaparoscopia são exemplos de novas opções que trilharam esse caminho com sucesso. A cirurgia robô-assistida tem conquistado bastante espaço na última década, embora ainda esbarre na barreira comercial. Outras técnicas e tecnologias devem passar pelo crivo do tempo para poderem cavar espaço neste mercado que, tempo após tempo, torna-se mais vasto.

Percutaneous and minimally invasive approaches to mitral valve repair for severe mitral regurgitation‑new devices and emerging outcomes.

Mitral valve disease is common in the United States and around the world, and if left untreated, increases cardiovascular morbidity and mortality. Mitral valve repair is technically more demanding than mitral valve replacement. Mitral valve repair should be considered the first line of treatment for mitral regurgitation in younger patients, mitral valve prolapse, annular dilatation, and with structural damage to the valve. Several minimally invasive percutaneous treatment options for mitral valve repair are available that are not restricted to conventional surgical approaches, and may be better received by patients. A useful classification system of these approaches proposed by Chiam and Ruiz is based on anatomic targets and device action upon the leaflets, annulus, chordae, and left ventricle. Future directions of minimally invasive techniques will include improving the safety profile through patient selection and risk stratification, improvement of current imaging and techniques, and multidisciplinary education.

Opção minimamente invasiva lateral para artrodese intersomática tóraco-lombar / Minimally invasive lateral option for thoracic-lumbar intersomatic arthrodesis / Opción mínimamente invasiva lateral para artrodesis intersomática toracolumbar

OBJETIVO: O objetivo deste artigo é mostrar resultados clínicos e radiográficos do acesso lateral transpoas na experiência brasileira em condições degenerativas do disco intervertebral. MÉTODOS: 46 pacientes foram submetidos à fusão intersomática lombar por via lateral. Dentre os casos, 18 eram do sexo masculino e 28 do sexo feminino, com idade média de 57,3 (84-32 anos) e média de IMC de 25,9 ± 3,1. Todos os pacientes completaram um ano de acompanhamento. Foram coletados exames radiológicos, como raio X e tomografia computadorizada, exame neurológico e resultados clínicos usando os questionários ODI e VAS (costas e membros inferiores). RESULTADOS: Os procedimentos foram realizados, sem ocorrência de complicações intra-operatórias importantes, em uma média de 103,9 ± 105,5 minutos e com menos de 50cc de perda sanguínea. Em oito dos 46 procedimentos (17,4 por cento) foi utilizada suplementação por parafusos pediculares percutâneos por apresentarem instabilidade segmentar. Foram tratados 80 níveis (de um a cinco níveis) tóraco-lombares (de T12-L1 a L4-L5). Os resultados clínicos avaliados pelos questionários revelaram melhora significante de dor logo após uma semana da cirurgia e da função física após seis semanas. A lordose lombar foi de 36,5 ± 14,7 no pré-operatório para 43,4 ± 12,4 no seguimento de 12 meses. Todos os pacientes apresentaram formação óssea após 12 meses da cirurgia. Sete casos foram revisados (15,2 por cento), ainda de forma minimamente invasiva devido à estenose persistente (três casos; 6,5 por cento), afundamento do espaçador (três casos; 6,5 por cento) ou mal-alinhamento de barra da suplementação (um caso; 2,8 por cento). CONCLUSÕES: Com melhora de parâmetros clínicos e radiológicos, a técnica se mostrou segura e eficaz no tratamento de condições degenerativas da coluna lombar.

OBJECTIVE: The purpose of this article is to show clinical and radiological results of lateral transpsoas approach for degenerative conditions of intervertebral disc in Brazilian practice. METHODS: 46 patients have undergone lateral lumbar intersomatic fusion. Eighteen patients were male and 28 female. The mean age was 57.3 years (32 to 84 years), and mean BMI was 25.9 ± 3.1. All patients were followed up during one year. Radiology tests, such as X-ray and CT, and neurological tests were performed. The clinical results were obtained using ODI and VAS (back and leg) questionnaires. RESULTS: The procedures were performed during an average time of 103.9 ± 105.5 minutes, and less than 50 mL of blood loss occurred. Also, no significant intraoperative complication occurred. Supplementation with percutaneous pedicle screws due to segmental instability was used in eight of the 46 procedures (17.4 percent). Eighty thoracic-lumbar (from T12-L1 to L4-L5) levels (from one to five) were treated. According to the questionnaires, the clinical results showed significant pain and physical function improvement after one week and six weeks of surgery, respectively. The lumbar lordosis changed from 36.5 ± 14.7 before surgery to 43.4 ± 12.4 during one year follow-up. All patients showed bone formation 12 months after surgery. Seven cases were revised (15.2 percent), using minimally invasive approach due to persistent stenosis (three cases, 6.5 percent), depressed spacer (three cases, 6.5 percent), and malalignment of supplemental rod (one case, 2.8 percent). CONCLUSIONS: This technique showed to be a safe and efficacious treatment for degenerative diseases of lumbar spine as demonstrated by the improvement of clinical and radiological parameters.

OBJETIVO: El objetivo de este artículo es mostrar resultados clínicos y radiográficos del acceso lateral transpolar, en la experiencia brasileña, en condiciones degenerativas del disco intervertebral. MÉTODOS: 46 pacientes fueron sometidos a fusión intersomática lumbar por vía lateral. Dentro de los casos, 18 eran del sexo masculino y 28 del sexo femenino, con edad promedio de 57,3 años (84-32) y promedio de IMC de 25,9 ± 3,1. Todos los pacientes completaron un año de acompañamiento. Fueron realizados exámenes radiológicos, como rayos X y tomografía computadorizada, examen neurológico y se obtuvieron resultados clínicos usando los cuestionarios ODI y VAS (espaldas y miembros inferiores). RESULTADOS: Los procedimientos fueron realizados, sin ocurrencia de importantes complicaciones intraoperatorias, en un promedio de 103,9 ± 105,5 minutos y con menos de 50 cc de pérdida sanguínea. En ocho de los 46 procedimientos (17,4 por ciento) se utilizó suplementación mediante tornillos pediculares percutáneos porque se presentaba instabilidad de segmento. Se trataron 80 niveles (de uno a cinco niveles) toracolumbares (de T12-L1 a L4-L5). Los resultados clínicos, a los que se tuvo acceso por los cuestionarios, revelaron mejoría significativa del dolor, luego después de una semana de la cirugía y mejor función física después de 12 meses. La lordosis lumbar fue 36,5 ± 14,7 en el preoperatorio yendo para 43,4 ± 12,4 durante el seguimiento de 12 meses. Todos los pacientes presentaron formación ósea después de 12 meses de la cirugía. Siete casos tuvieron nueva intervención (15,2 por ciento), aunque de manera mínimamente invasiva, debido a la estenosis persistente (tres casos; 6,5 por ciento), hundimiento del espaciador (tres casos; 6,5 por ciento) o mala alineación de la barra de suplementación (un caso; 2,8 por ciento). CONCLUSIONES: con mejora de parámetros clínicos y radiológicos, la técnica se mostró segura y eficaz en el tratamiento de condiciones degenerativas de la columna lumbar.