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Objective:To study the influence of Mei mini maze procedure for atrial functional mitral regurgitation.Methods:The data of 33 patients with atrial fibrillation and atrial functional mitral regurgitation from January 2017 to June 2020 were retrospectively analyzed. All patients received Mei mini maze procedure for atrial fibrillation. The procedure is carried out thoracoscopically through the left thoracic approach. The ablation of atrial fibrillation includes bilateral circumferential pulmonary vein ablation, isolation of the left atrium posterior wall, left atrial appendage resection, ablation of Marshall's ligament and autonomic ganglion, etc. Follow-up was conducted by outpatient follow-up and telephone. Postoperative heart rhythm was recorded by the patient's symptoms, electrocardiogram, 24 h holter and other examinations. Postoperative mitral valve lesions were obtained by echocardiography.Results:33 patients successfully completed the operation. There was no conversion to thoracotomy and no perioperative death. Thirty patients(90.9%) maintained sinus rhythm at discharge. Before discharge, 16 patients had no mitral regurgitation in echocardiography, 8 patients had mild mitral regurgitation, and 9 patients had moderate mitral regurgitation. Follow-up was 1-4 years after discharge, with a mean of(2.6±1.1) years. Sinus rhythm was maintained in 23 patients(69.7%). 17 patients had no mitral regurgitation, 9 had mild mitral regurgitation, 6 had moderate, and 1 had severe mitral regurgitation. The degree of regurgitation in 25 patients was reduced compared with pre-operation, 5 patients remained unchanged, and 3 patients mitral regurgitation aggravated. Unreduced atrial functional mitral regurgitation was associated with recurrence of atrial fibrillation by Cox multivariate analysis.Conclusion:This study found a close relationship between atrial fibrillation rhythm and atrial functional mitral regurgitation. Most moderate atrial functional mitral regurgitation can be alleviated by effective treatment for atrial fibrillation. It is not recommended that patients with severe atrial functional mitral regurgitation only receive treatment for atrial fibrillation.
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Objective:To investigate the effects of a novel retrograde tibial nail (RTN) in the treatment of distal tibial fractures.Methods:A retrospective study was conducted in the 11 patients with distal tibial fracture who had been admitted to Department of Traumatic Orthopedics, The Second Affiliated Hospital, Hengyang Medical School from July 2020 to July 2021. There were 5 male and 6 females, aged from 18 to 70 years (average 54.7 years). By the AO/OTA classification, there were 7 extra-articular distal fractures (3 cases of type 43-A1, 3 cases of type 43-A2 and one type 43-A3) and 4 intra-articular fractures (2 cases of type 43-C1 and 2 cases of type 43-C2); by the Gustilo classification, there were 7 closed fractures and 4 open fractures (2 cases of type I and 2 cases of type Ⅱ). All fractures were fixated with a novel RTN. Deformities like distal tibial varus and valgus as well as fracture-related complications were observed after operation while the curative effects evaluated by the ankle-hindfoot score of the American Orthopaedic Foot and Ankle Society (AOFAS).Results:This cohort was followed up for an average of 7.4 months (from 5 to 12 months). All patients obtained clinical union and recovered daily life and work. Radiographic evaluation showed no distal tibial varus or valgus. There were no such complications as postoperative infection, exposure of bone and internal fixation, compartment syndrome, or neurovascular lesion. According to the ankle-hindfoot score of AOFAS, 7 cases were excellent and 4 cases good.Conclusion:This novel retrograde tibial nail may result in good efficacy in the treatment of distal tibial fracture, but its advantages still need further verification.
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Resumen: Introducción: El hallux valgus es una de las patologías más frecuentes y complejas en la ortopedia. Afecta a los tejidos blandos y óseos del primer dedo. Se encuentran descritas múltiples técnicas para su corrección, todas con un último fin: lograr restaurar el ángulo fisiológico del primer dedo mediante una osteotomía estable y con el menor dolor postquirúrgico posible. Las técnicas de invasión mínima han venido ganando adeptos desde los años 2000 como una alternativa para el tratamiento de esta patología. Material y métodos: Se incluyeron pacientes con diagnóstico de hallux valgus leve o moderado en los que se realizó un procedimiento mínimamente invasivo para corregir la deformidad del primer dedo del pie. Se realizó una osteotomía distal de Reverdin/Isham en el primer metatarsiano y una osteotomía de Akin en la falange proximal, una liberación capsular lateral y una tenotomía abductora. Estos casos fueron seguidos durante 24 meses después de su cirugía. Resultado: Nuestros pacientes presentaron una adecuada corrección de la sintomatología dolorosa, retorno a la movilidad articular prequirúrgica y una adecuada satisfacción personal con 87.3% de buenos resultados. Encontramos una mejoría importante en la escala de Kitaoka. Tenemos una adecuada corrección angular para una osteotomía distal. Conclusiones: Las técnicas de invasión mínima para la corrección de hallux valgus moderado y leve son una adecuada herramienta. Nuestros pacientes se encuentran satisfechos con los resultados estéticos y funcionales.
Abstract: Introduction: The hallux valgus is a very frequent and complex orthopedic pathology. It involves the bone and soft tissue structures of the first toe. There are multiple techniques described for the alignment of the first toe. All technics aim to restore the normal angulation of the toe while using a stable osteotomy through a painless surgical procedure. The minimal invasive techniques have been growing in acceptance since the year 2000, as a viable surgical alternative to treat this pathology. Material and methods: We included patients with a diagnostic of mild or moderate hallux valgus on whom a minimal invasive procedure was performed to correct the deformity of the first toe. We performed a distal Reverdin/Isham osteotomy on the first metatarsal and an akin osteotomy in the proximal phalanx, a lateral capsular release and a abductor tenotomy. These patients were followed for 24 months after their surgery. Results: Our patients had an adequate correction angular correction, for a distal osteotomy. They had a good pain control, with an adequate mobility in the postoperative period. The patients presented an adequate personal satisfaction, 87% of them had good results. We found an important and statistically significant improvement in the Kitaoka scale. Conclusion: The minimal invasive technics for the correction of mild or moderated hallux valgus are a good alternative. Our patients are satisfied with the functional, and cosmetic results.
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@#Objective To study the learning curve of minimal invasive coronary artery bypass grafting (MICS CABG) and the influence on the perioperative clinical effects by analyzing operation time. Methods From March 2012 to November 2020, 212 patients underwent MICS CABG by the same surgeon. Among them, 59 patients (52 males and average age of 62.89±8.27 years) with single vessel bypass grafting were as a single-vessel group and 153 patients (138 males, average age of 59.80±9.22 years) with multi-vessel bypass grafting were as a multi-vessel group. Two sets of operation time-operation sequence scatter plots were made and learning curve was analyzed by cumulative summation (CUSUM) and regression method of operation time. The surgical data of each group before and after the inflection point of the learning curve were compared with the main clinical outcome events within 30 days after surgery. Results There was no death, perioperative myocardial infarction and stroke in 212 MICS CABG patients and no transfer to cardiopulmonary bypass or redo thoracotomy. The learning curve conformed to the cubic fitting formula. In the single- vessel group, CUSUM (x operation number)=–1.93+93.45×x–2.33×x2+0.01×x3, P=0.000, R2=0.986, the tipping point was 27 patients. In the multi-vessel group, CUSUM (x)=y=2.87+1.15×x–1.29× x2+3.463×x3, P=0.000, R2=0.993, and the tipping point was 59 patients. The two sets of case data were compared before and after the learning curve and there was no statistical difference in main clinical outcomes within 30 days (mortality, acute myocardial infarction, stroke, perioperative blood transfusion rate), ventilator tube, and intensive care unit retention. Conclusion The learning curve of MICS CABG conforms to the cubic formula, and the process transitions from single to multiple vessels bypass. To enter the mature stage of the learning phase, a certain number of patients need to be done. Reasonable surgical procedures and quality control measures can ensure the safety during the learning phase.
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@#Objective To investigate the safety and effectiveness of the multi-artery graf tstrategy for coronary bypass (MICS-CABG) with small incision in the left chest, and to provide experience for the promotion of this technique. Methods The clinical data of 64 patients with MICS-CABG in Department of Cardiac Surgery of Peking University Third Hospital from December 2015 to November 2019 were retrospectively analyzed. There were 54 males and 10 females, aged 36-77 (61.1±8.7) years. The left lateral thoracic incision (5-8 cm) was made through the 5th intercostal incision, and the operation was performed under off-pump CABG. With the help of the chest wall suspension device and the heart fixator, the proximal anastomosis of the ascending aorta, anastomosis of the target vessels of the left anterior descending (LAD), left circumflex (LCX) and right coronary artery (RCA) systems were completed. The number of grafts was 2-4 (2.3±0.5) including 2 grafts in 45 patients, 3 grafts in 17 patients and 4 grafts in 2 patients. Three patients were treated with percutaneous intervention (PCI) hybridization and 62 patients were treated with total artery bypass graft. Coronary angiography was performed within 7 days after the operation to evaluate the graft patency rate. The incidence of major adverse cardiac and cerebrovascular events (MACCE) was recorded in the follow-up. The MACCE rate was calculated by Kaplan-Meier method. Results None of the patients was transferred to thoracotomy and no intra-aortic balloon counterpulsation (IABP) or extracorporeal membrane oxygenation (ECMO) was used during the operation. Incision infection was in 1 patient and reoperation in 2 patients (all were postoperative hemorrhage). Within 30 days after surgery, MACCE occurred in 1 patient, including 1 patient of non-fatal myocardial infarction. The overall patency rate of angiography bypass was 96.2%, and the patency rate of anterior descending branch bypass was 98.2%. Follow-up was performed from 12 to 60 months (median follow-up time was 28 months). The loss rate was 7.8% (5/64). The incidence of MACCE was 84.9% (95%CI 79.5%-90.3%). Conclusion The MICS-CABG can achieve completed re-vascularization and totally artery-CABG and the short-term and medium-term clinical results of the operation are good.
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Venous varicose of epidura is considered a rare cause of nerve root and thecal sac compression and impingement that leads to lower limb radiculopathy. The purpose of this study is to draw attention to this problem during operation. It also aims to focus shed a light on using magnetic resonance imaging (MRI) before the operation. This research also attempts to evaluate the outcome of the surgery. Symptoms of epidural varicose with radiculopathy are rare and the diagnosis is often inaccurate by preoperative clinical examination and radiology investigations. Thus, in many cases the diagnosis is made intra- operatively. The case was a 40 years old female who consulted our outpatient clinic complaining from acute radicular pain in the lower back and down of her right lower limb. MRI was done for her and showed paracentral disc herniation. Intra operatively, an abnormal dilatation of epidural vein impingement on L4 nerve root with no foraminal stenosis was seen. We initiated a thermo coagulation of the epidural vein from proximal to distal ends at disc level and used gel foam patch to control bleeding that was removed all at the end of operation. Then, coagulation ablation was performed. The operation resulted in relief of symptoms and neurologic recovery occurred during follow up period. According to our case and previously published case reports, the outcome is good with recovery of neurological signs and symptoms that can be obtained by coagulation ablation of epidural varicose vein.
Subject(s)
Humans , Female , Adult , Radiculopathy/therapy , Varicose Veins/therapy , Magnetic Resonance Spectroscopy , Outcome Assessment, Health Care , Minimally Invasive Surgical Procedures , Anesthesia, Epidural , Lumbosacral RegionABSTRACT
Introducción: La introducción del sistema Da Vinci, ha revolucionado el campo de la cirugía mínima invasiva en el cual el cirujano tiene control de la cámara 3D y los instrumentos son de gran destreza y confort ergonómico, acortando la curva de aprendizaje quirúrgica. Objetivo: Describir nuestra experiencia inicial de cirugía robótica colorectal en un hospital de comunidad cerrada de la Ciudad Autónoma de Buenos Aires. Materiales y Método: Estudio retrospectivo descriptivo sobre una base prospectiva de cirugías colorectales robóticas realizadas por el mismo equipo quirúrgico desde mayo de 2016 a abril de 2019. Resultados: Se operaron 41 pacientes. Trece de ellos fueron colectomías derechas, 17 colectomías izquierdas y 11 cirugías de recto. El tiempo quirúrgico promedio fue de 170 minutos (90-330), la estadía hospitalaria de 4 días (3-30), la tasa de conversión de 7,31% (3/41 pacientes) y la tasa de dehiscencia anastomótica del 9,75% (4/41 pacientes). Morbilidad global del 19.5% (8/41 pacientes). Conclusión: Hemos repasado los resultados iniciales de nuestra experiencia en cirugía robótica colorectal en un número reducido de casos, pero suficiente para evaluar la seguridad y reproducibilidad del método al comienzo de una curva de aprendizaje.
Introduction: The introduction of the Da Vinci System, has revolved the field of invasive minimal surgery in which the surgeon has control of the 3d camera and the instruments are of great strength and ergonomic comfort by cutting the surgical learning curve. Objective: Of this preliminary presentation is to describe our initial experience of colorectal robotic surgery in a closed community hospital of the Autonomous City of Buenos Aires. Materials and Method: Retrospective descriptive study on a prospective basis of robotic colorectal surgeries performed by the same surgical team from May 2016 to April 2019.Results: 41 patients were operated. 13 of them were right colectomies, 17 left colectomies and 11 rectum surgeries. The average surgical time was 170 minutes (90-330), the average hospital stay of 4 days (3-30), the conversion rate of 7.31% (3/41 patients) and the anastomotic dehiscence rate of 9 , 75% (4/41 patients). Overall morbidity of 19.5% (8/41 patients).Conclusion: We have reviewed the initial results of our experience in colorectal robotic surgery in a reduced number of cases but sufficient to evaluate the security and reproducibility of the methodic learning of a learning curve.
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Humans , Male , Female , Adult , Middle Aged , Aged , Aged, 80 and over , Colorectal Neoplasms/surgery , Robotic Surgical Procedures/methods , Retrospective Studies , Treatment Outcome , Colectomy/methods , Minimally Invasive Surgical Procedures/methods , Hospitals, CommunityABSTRACT
Objective@#To evaluate the indication, safety and effectiveness of transoral robotic surgery (TORS) for oropharyngeal cancer based on our preliminary experience.@*Methods@#Twelve patients, including six with tonsil cancer, five with tongue base cancer and one with posterior pharyngeal wall cancer, who underwent TORS with Da Vinci Si surgical system from March 2017 to October 2018 at Tongji Hospital of Huazhong University of Science Technology were respectively analyzed. And the surgical time, intraoperative blood loss, postoperative local bleeding, dyspnea, nerve function injury, oral intake time, whether or not to receive chemoradiotherapy were analyzed.@*Results@#All tumors in the 12 patients were en bloc removed by TORS. Surgical time ranged from 25 to 80 min with an average of 34.2 min. The blood loss ranged from 10 ml to 50 ml with an average of 20.8 ml. The recovery time for oral intake ranged from 1 day to 30 days with an average of 8.4 days. No patient underwent tracheostomy after TORS. Also, no patient manifested with airway obstruction, bleeding or nerve injury symptoms after operation. All 12 patients reached pathologically negative surgical margins. The patients were followed up for 4 to 22 months, with a median of 12 months. All patients who combined with more advanced than T3 stage, or more advanced than N2 stage were recommended to oncologist, then, followed with radiotherapy or chemoradiotherapy if no relevant contradictions occurred. No local recurrence or distant metastasis case was found.@*Conclusion@#With proper indications, the application of TORS in oropharyngeal cancer is a relatively safe, effective and minimal invasive therapy, which merits more clinical applications.
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To evaluate the indication, safety and effectiveness of transoral robotic surgery (TORS) for oropharyngeal cancer based on our preliminary experience. Twelve patients, including six with tonsil cancer, five with tongue base cancer and one with posterior pharyngeal wall cancer, who underwent TORS with Da Vinci Si surgical system from March 2017 to October 2018 at Tongji Hospital of Huazhong University of Science Technology were respectively analyzed. And the surgical time, intraoperative blood loss, postoperative local bleeding, dyspnea, nerve function injury, oral intake time, whether or not to receive chemoradiotherapy were analyzed. All tumors in the 12 patients were en bloc removed by TORS. Surgical time ranged from 25 to 80 min with an average of 34.2 min. The blood loss ranged from 10 ml to 50 ml with an average of 20.8 ml. The recovery time for oral intake ranged from 1 day to 30 days with an average of 8.4 days. No patient underwent tracheostomy after TORS. Also, no patient manifested with airway obstruction, bleeding or nerve injury symptoms after operation. All 12 patients reached pathologically negative surgical margins. The patients were followed up for 4 to 22 months, with a median of 12 months. All patients who combined with more advanced than T3 stage, or more advanced than N2 stage were recommended to oncologist, then, followed with radiotherapy or chemoradiotherapy if no relevant contradictions occurred. No local recurrence or distant metastasis case was found. With proper indications, the application of TORS in oropharyngeal cancer is a relatively safe, effective and minimal invasive therapy, which merits more clinical applications.
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The concept of minimally invasive surgery has gained increasing popularity in the last several decades, are being introduced as an alternative to limit the surgical complications while achieving best possible outcome. While minimally invasive spine surgery holds promise for lower blood loss, faster patient recovery, shorter hospital stays, and the potential to transition procedures to the ambulatory setting, safety in spinal surgery remains paramount and has (appropriately) tempered some of the enthusiasm for the results of aggressive early adapters. Until now, there has been no literature summarizing the evidence of MIS outcome in treating spondylitis TB of the bone. The purpose of this systematic review was to investigate the outcome of minimal invasive surgery approach for spine infection. authors comprehensively searched PubMed, EMBASE, and Cochrane Library to search for studies about minimally invasive surgery as management of tuberculous spondylitis up to June 7th, 2019. The selection of appropriate studies was performed by independent investigators based on PRISMA guideline. Given the limited number of studies, there was no restriction in terms of patient’s demographics, the specific minimal invasive surgical method, and publication status. Authors identified the method for minimally invasive approach and open approach, the functional outcome, intraoperative outcome, radiological outcome, length of stay, follow up period, and complication. Authors found 81 articles from database. After evaluating full text, 8 articles (346 patients) were found to be eligible. More than 110 patients were treated with open spine surgery, while more than 270 patients were treated using minimally invasive spine surgery the minimal invasive methods were posterior pedicle screws fixation, plate fixation, lateral nail bar fixation, and bilateral pedicle screw fixation. The visualization methods include C-arm fluoroscopy, X-ray fluoroscopy. The follow-up period ranges from 1 to 40 months. The functional outcome were found to be satisfying with minimal complications. MIS yielded satisfactory result in comparison to conventional open surgery for spine infection. More long term future studies should be conducted to in order to search for more solid evidence regarding this claim.
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Resumen: Introducción: Las técnicas de fijación transpedicular percutánea son una herramienta emergente en el tratamiento del trauma espinal, sin embargo, su uso no es totalmente aceptado. Objetivo: Comparar resultados en pacientes con fractura vertebral traumática que fueron tratados con cirugía de fijación transpedicular percutánea versus fijación transpedicular abierta. Material y métodos: De Enero a Diciembre de 2016, 15 pacientes con fractura vertebral traumática fueron divididos aleatoriamente en dos grupos: el grupo A fue de seis pacientes tratados con fijación transpedicular percutánea y el grupo B fue de seis pacientes tratados con fijación transpedicular con técnica abierta; tres pacientes fueron eliminados. Se evaluó el sangrado transoperatorio, el dolor postoperatorio con la escala visual análoga a las 24 horas y a las dos semanas del postoperatorio; también se evaluó el índice de discapacidad de dolor lumbar Oswestry a seis semanas, además de tres, seis, 12 y 24 meses del postoperatorio. Resultado: El seguimiento fue de 24 meses. Se reportaron diferencias estadísticamente significativas en el sangrado transoperatorio (p 2.43E-05), EVA al primer día (p < 0.0003), EVA a las dos semanas (p = 0.01); también en el cuestionario de discapacidad de dolor lumbar Oswestry a las seis semanas (p = 0.0007), tres meses (p = 0.005), seis meses (p = 0.005), 12 meses (p = 0.01) y 24 meses (p = 0.004). No se observaron diferencias significativas con respecto al tiempo operatorio (p = 0.12). Discusión: En nuestro trabajo encontramos que el sangrado transoperatorio, dolor postoperatorio y discapacidad funcional son significativamente menores en el grupo de fijación transpedicular percutánea.
Abstract: Introduction: Percutaneous transpedicular fixation techniques are an emerging tool in the treatment of spinal trauma, however, their use is not fully accepted. Objective: Compare results in patients with traumatic vertebral fracture, treated with percutaneous transpedicular fixation surgery versus open transpedicular fixation. Material and methods: From January to December 2016, 15 patients with traumatic vertebral fracture were randomly divided into 2 groups, group A were six treated with percutaneous transpedicular fixation, group B were treated with open technique transpedicular fixation, three patients were eliminated. Transoperative bleeding, postoperative pain with the 24-hour and two-week postoperative visual scale, the six-week Oswestry lumbar pain disability index, and three, six, 12 and 24 months of postoperative control were evaluated. Results: The follow-up was 24 months. Statistically significant differences in transoperative bleeding (p 2.43E-05), EVA on the first day (p < 0.0003), EVA at two weeks (p = 0.01) were reported in the Oswestry lumbar pain disability questionnaire at six weeks (p = 0.0007), three months (p = 0.005), six months (p = 0.005), 12 months (p = 0.01) and 24 months (p = 0.004), no significant differences were observed with respect to operating time (p = 0.12). Discussion: In our work we find that transoperative bleeding, postoperative pain and functional disability are significantly minor in the percutaneous transpedicular fixation group.
Subject(s)
Humans , Thoracic Vertebrae/surgery , Thoracic Vertebrae/injuries , Spinal Fractures/surgery , Fracture Fixation, Internal/methods , Treatment Outcome , Lumbar VertebraeABSTRACT
Objective To compare the perioperative outcomes between patients who underwent multivessel off-pump coronary artery bypass graft(OPCABG) via single left intercoastal space and sternotomy,and to explore the perioperative outcomes and technigues about minimally coronary artery bypass grafting with multi-vessel lesion.Methods From January 2017 to July 2018,100 patients were recruited using both left internal mammary artery and vein graft.They were divided into minimal invasive coronary artery bypass grafting(MICS) group and control group.Perioperative outcomes were analyzed and surgical techniques were summarized.Results There was no statistical difference in preoperative profiles,mean grafts and postoperative complications(P ＞0.05).Compared with control group,MICS group had statistical benefits in length of operation incision [(8.2 ± 1.2) cm vs.(25.3 ± 3.5) cm,P =0.000],i ntraoperative washed blood loss [(301 ± 188) ml vs.(444 ± 331) ml,P =0.01],postoperative ventilation duration [(16.18 ± 5.90) h vs.(19.60 ± 3.92) h,P =0.001] and length of ICU stay [(19.19±6.85)hvs.(23.44±4.64)h,P=0.001].Conclusion There is a learning process for surgeons to perform minimal invasive OPCABG via single left intercoastal space.Surgery is feasible for patients with multiple coronary lesions.Mid and long term following up need to be studied.
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With the rapid development of liver surgery,minimally invasive techniques have been widely used in liver surgery. Many challenging liver can be performed laparoscopically to decrease the surgical trauma. At the same time,the efficiency and accuracy of liver surgeries have been highly improved by the advanced assisted technology of liver surgery. The purpose of this article is to summarize the current situation of liver surgery as well as the future of liver surgery.
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PURPOSE: This study evaluated the radiologic and clinical results in patients who underwent minimal invasive surgery using sinus tarsi approach in Sanders type IV calcaneal fracture. MATERIALS AND METHODS: This retrospective study evaluated 13 cases of Sanders type IV calcaneus fractures that were treated by minimal invasive surgery using the sinus tarsi approach from July 2012 to April 2017. Further, these cases could be followed up for more than 12 months. Bone union, radiologic parameters such as Böhler's angle, Gissane's angle, calcaneal height, length, and width, the American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot score, and the postoperative complications were evaluated. RESULTS: Bony union was achieved in all the cases at the final follow up, and the mean union time was 5.5 months. One patient underwent reoperation for a surgical site infection, six patients had post traumatic arthritis, and two of them underwent subtalar joint fusion. The mean AOFAS ankle-hindfoot score was 81.2. At the final follow-up, the mean values of Böhler's angle and Gissane's angle were 20° and 119.8°, respectively, and the mean values of the calcaneus height, length, and width were 46.8 mm, 81.8 mm, and 45.6 mm, respectively. CONCLUSION: Minimal invasive surgery using the sinus tarsi approach for Sanders type IV calcaneal fracture resulted in satisfactory anatomic reduction and stable fixation, and satisfactory clinical and radiologic results were obtained in most of the patients. Minimal invasive surgery is thought to reduce the soft tissue-related complications as compared to surgery using the extensile lateral approach.
Subject(s)
Humans , Ankle , Arthritis , Calcaneus , Follow-Up Studies , Foot , Minimally Invasive Surgical Procedures , Postoperative Complications , Reoperation , Retrospective Studies , Subtalar Joint , Surgical Wound InfectionABSTRACT
Objective: To investigate arthroscopic treatment for acute acromioclavicular dislocation by using Twin Tail TightRope combined with distal joint capsular repair. Methods: The clinical data of 40 patients with acromioclavicular dislocation treated between February 2016 and December 2017 were retrospectively analyzed. The patients were divided into arthroscopic group (20 cases, using arthroscopic Twin Tail TightRope combined with distal joint capsular repair for anatomical repair of stable structure of acromioclavicular joint) and control group (20 cases, treated with clavicular hook plate internal fixation) according to different surgical methods. There was no significant difference in gender, age, cause of injury, Rockwood classification, time from injury to operation, preoperative visual analogue scale (VAS) score and Constant score between the two groups ( P>0.05), which were comparable. Postoperative VAS score and Constant score were used to assess shoulder function and re-dislocation was also observed. Results: The incisions of the two groups healed by first intention, and no early postoperative complications occurred. All patients were followed up 12-18 months (mean, 13.5 months). Postoperative X-ray films showed good anatomical reduction in both groups, but the clavicular hook had a presense in the subacromial space in control group. All patients in arthroscopic group achieved satisfactory shoulder function and returned to work after operation; there was no obvious pain, no complications such as exposure of implant after operation, and no need to remove the implant. In the control group, 4 patients had obvious subacromial impingement pain after operation, and 1 patient had re-dislocation after removal of internal fixator at 1 year after operation; the rest had no complications related to internal fixation, and the internal fixators were removed at 1.0-1.5 years after operation, without re-dislocation. The VAS score and Constant score at 3 months and 1 year after operation in both groups significantly improved when compared with those before operation, and further improved at 1 year after operation ( P<0.05). The VAS score and Constant score at 3 months and 1 year after operation in arthroscopic group were significantly better than those in control group ( P<0.05). Conclusion: Arthroscopic treatment for acute acromioclavicular joint dislocation by using Twin Tail TightRope combined with distal capsular repair is more effective than traditional incision surgery and can obtain more satisfactory results in patient compliance and function recovery because of minimally invasive surgery.
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Objective: To investigate the effectiveness of Nice knot combined with elastic intramedullary nailing fixation in treatment of Robinson type 2B midshaft clavicular fracture in adults. Methods: Between March 2016 and January 2018, 20 patients with Robinson type 2B midshaft clavicular fractures were treated with reduction and internal fixation by Nice knot and elastic intramedullary nailing. There were 13 cases and 7 cases, with an average age of 43 years (range, 18-56 years). The causes of injury included the traffic accident in 6 cases, falling in 12 cases, and falling from height in 2 cases. The interval between injury and admission ranged from 1 hour to 2 days (mean, 3.2 hours). The fractures were classified as Robinson type 2B1 in 16 cases and type 2B2 in 4 cases. The length of incision, the operation time, the visual analogue scale (VAS) score on the 2nd day after operation, the fracture healing time, the postoperative shoulder function and the Disability of Arm Shoulder and Hand (DASH) score, the complications, and the time of second surgical removal of internal fixator and incision length were recorded. Results: The length of incision was 2-6 cm (mean, 4.7cm). The operation time was 45-120 minutes (mean, 77.2 minutes). The VAS score was 1-5 (mean, 3.2) on the 2nd day after operation. All incisions healed by first intention and no infection or nerve injury occurred. All patients were followed up 12-32 months (mean, 18.6 months). All fractures healed with the healing time of 10-15 weeks (mean, 12.1 weeks). The Constant score was 92-98 (mean, 96.3) and DASH score was 0-6.4 (mean, 3.1). The elastic intramedullary nailing bending and hypertrophic nonunion occurred in 1 case and the skin stimulated by elastic nail tail in 1 case after operation. The internal fixators were removed at 12-26 months (mean, 14.6 months) after operation. And the length of incision was 1-2 cm (mean, 1.3 cm) and the operation time was 5-15 minutes (mean, 9.0 minutes). Conclusion: For the midshaft clavicular fracture in adults, the procedure of the Nice knot combined with elastic intramedullary nail has advantages of small incision, light pain, rapid fracture healing, small secondary operation injury, and avoiding the risk of clavicular epithelial nerve injury, and can obtain good effectiveness.
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According to a recent systemic review, hallux valgus deformity has a prevalence rate of about 23% among adults aged 18 to 65 years. To date, more than 100 operative methods have been reported for the correction of hallux valgus deformity. For young female with mild to moderate hallux valgus deformity, minimally invasive surgery can be considered for aesthetic demands. Here, we report a case of a young female patient with mild hallux valgus deformity treated by minimally invasive surgery using intramedullary low profile plate fixation. This can be the favorable method for secure fixation of the osteotomy site and prevention of medial skin irritation symptoms derived from a sharp osteotomy margin.
Subject(s)
Adult , Female , Humans , Congenital Abnormalities , Hallux Valgus , Hallux , Methods , Minimally Invasive Surgical Procedures , Osteotomy , Prevalence , SkinABSTRACT
Surgical staging is essential in the management of patients with endometrial cancer apparently confined to the uterus. Minimally invasive surgery (MIS) with its conventional laparoscopic approach or more recently with laparoscopic-assisted robotics has become the standard of management with advantage in terms of blood loss, hospital stay and quality of life compared to laparotomy. The pelvic and paraaortic lymphadenectomy as part of the surgical staging is determinant of the prognosis and sets the pattern of adjuvant treatment and although it is still controversial in terms of its therapeutic value, it is feasible through MIS. The performance of the sentinel lymph node with lower intraoperative complications and postoperative morbidity can be considered as an alternative to lymphadenectomy, especially considering the additional value of detecting low volume metastatic lymph node disease by means of immunohistochemistry.
El estadiaje quirúrgico es esencial en el manejo de las pacientes con cáncer de endometrio aparentemente confinado al útero. La cirugía mínimamente invasiva (CMI) con su enfoque laparoscópico convencional o más recientemente mediante robótica asistida por laparoscopia se han convertido en el estándar de manejo gracias a sus ventajas en cuanto a pérdida sanguínea, estancia hospitalaria y calidad de vida en comparación a la laparotomía. La linfadenectomía pélvica y paraaórtica como parte del estadiaje quirúrgico es determinante del pronóstico y marca la pauta del tratamiento adyuvante; y aunque aún es controversial en cuanto a su valor terapéutico, es factible mediante CMI. La realización del ganglio centinela con menores compliaciones intraoperatorias y morbilidad postoperatoria puede ser considerada como una alternativa a la linfadenectomía, sobretodo teniendo en cuenta el valor agregado de permitir detectar enfermedad ganglionar metastásica de bajo volumen mediante inmunohistoquimica.
ABSTRACT
BACKGROUND: The aim of this study was to evaluate the clinical and radiological outcomes of minimally invasive total knee arthroplasty (MIS-TKA) in obese patients. METHODS: We examined the records of 371 cases of MIS-TKA performed using the mini-midvastus approach from January 2006 to December 2006. According to body mass index (BMI), the cases were classified into group A (BMI 0.05). There was no difference in terms of the accuracy of the tibial implant alignment, with 97.6%, 95.2%, and 93.4% of each group showing 90°± 3° varus angulation (p > 0.05). With respect to the accuracy of the femorotibial angle, 93.9%, 94.6%, and 90.2% of each group had 6°± 3° valgus angulation, with group C demonstrating the lowest level of accuracy (p 0.05). CONCLUSIONS: MIS-TKA in obese patients showed satisfactory clinical and radiological results without significant difference in surgical results compared to nonobese patients.
Subject(s)
Humans , Arthroplasty, Replacement, Knee , Body Mass Index , Follow-Up Studies , Knee , Obesity , Range of Motion, Articular , SkinABSTRACT
Minimal invasive surgery with short operation time and enhanced recovery after surgery can truly achieve biological minimal invasiveness. The minimal invasive lung cancer surgery includes several kinds, such as uni-portal video-assisted thoracoscopic surgery (VATS) and multi-portal VATS. Robotic-assisted thoracic surgery (RATS) can be categorized into multi-portal VATS. As a frontier technology of minimal invasive surgical technique, surgical robotic system has been broadly applied in many areas. The average RATS operation time is (91.51±30.80) min among our team, which is much shorter than reported uni-portal VATS operation time. For now, RATS has some drawbacks and is lacking of national practice guidelines, which, we believe, will be solved by technology development and large-scale randomized controlled trials. .