Percutaneous drainage of iliopsoas abscess: an effective option in cases not suitable for surgery / Drenagem percutânea de abscesso de iliopsoas: uma opção efetiva em casos não candidatos à cirurgia

ABSTRACT The aim of this study were to describe the technique of percutaneous drainage of iliopsoas abscess, and to discuss the benefits of using this minimally-invasive tool. A single center study with retrospective analysis of patients with psoas abscess confirmed by imaging scans, sent to the interventional medicine center and submitted to computed tomography and ultrasound-guided percutaneous drainage, from November 2013 to August 2016. Seven patients underwent percutaneous drainage of psoas abscess in this period. The mean initial drained volume was 61.4±50.7mL (ranging from 10 to 130mL), and the mean drainage duration was 8.3±2.8 days (ranging from 4 to 12 days). The success rate of the percutaneous procedures was 71.5%, and two patients required re-intervention. Image-guided percutaneous drainage of iliopsoas abscess is a minimally invasive, efficient and safe procedure, and an extremely valuable technique, especially for patients who are not suitable for surgical repair.

RESUMO Os objetivos deste estudo foram descrever a técnica de drenagem percutânea de abscesso de iliopsoas e discutir os benefícios do uso desta ferramenta minimamente invasiva. Trata-se de estudo unicêntrico com análise retrospectiva de pacientes com abscesso de psoas confirmado por exames de imagem, encaminhados a um centro de medicina intervencionista e submetidos à drenagem percutânea guiada por tomografia computadorizada e ultrassonografia, de novembro de 2013 a agosto de 2016. Sete pacientes foram submetidos à drenagem percutânea de abscesso de psoas no período avaliado. O volume drenado inicial médio foi 61,4±50,7mL (variação de 10 a 130mL), e a duração média da drenagem foi de 8,3±2,8 dias (variação de 4 a 12 dias). A taxa de sucesso dos procedimentos percutâneos foi 71,5%, e dois pacientes necessitaram de reintervenção. A drenagem percutânea guiada por imagem de abscesso de iliopsoas é um procedimento minimamente invasivo, eficiente e seguro, além de ser uma técnica muito valiosa, especialmente em pacientes que não são candidatos à abordagem cirúrgica.

Minimal abdominal incisions / Incisões abdominais mínimas

ABSTRACT Minimally invasive procedures aim to resolve the disease with minimal trauma to the body, resulting in a rapid return to activities and in reductions of infection, complications, costs and pain. Minimally incised laparotomy, sometimes referred to as minilaparotomy, is an example of such minimally invasive procedures. The aim of this study is to demonstrate the feasibility and utility of laparotomy with minimal incision based on the literature and exemplifying with a case. The case in question describes reconstruction of the intestinal transit with the use of this incision. Male, young, HIV-positive patient in a late postoperative of ileotiflectomy, terminal ileostomy and closing of the ascending colon by an acute perforating abdomen, due to ileocolonic tuberculosis. The barium enema showed a proximal stump of the right colon near the ileostomy. The access to the cavity was made through the orifice resulting from the release of the stoma, with a lateral-lateral ileo-colonic anastomosis with a 25 mm circular stapler and manual closure of the ileal stump. These surgeries require their own tactics, such as rigor in the lysis of adhesions, tissue traction, and hemostasis, in addition to requiring surgeon dexterity - but without the need for investments in technology; moreover, the learning curve is reported as being lower than that for videolaparoscopy. Laparotomy with minimal incision should be considered as a valid and viable option in the treatment of surgical conditions.

RESUMO Procedimentos minimamente invasivos visam resolver a doença com o mínimo de trauma ao organismo, resultando em retorno rápido às atividades, reduções nas infecções, complicações, custos e na dor. A laparotomia com incisão mínima, algumas vezes referida como minilaparotomia, é um exemplo desses procedimentos minimamente invasivos. O objetivo deste trabalho é demonstrar a viabilidade e utilidade das laparotomias com incisão mínima com base na literatura e exemplificando com um caso. O caso descreve uma reconstrução de trânsito intestinal com o uso desta incisão. Paciente masculino, jovem, HIV-positivo, pós-operatório tardio de ileotiflectomia, ileostomia terminal e fechamento do cólon ascendente por abdome agudo perfurativo devido a uma tuberculose íleo-colônica. Enema opaco mostrava coto proximal do cólon direito próximo da ileostomia. O acesso à cavidade foi feito através do orifício resultante da liberação do ostoma-realização de anastomose íleo-colônica látero-lateral com grampeador circular de 25 mm e fechamento manual do coto ileal. Estas cirurgias exigem táticas próprias, como rigor na lise de aderências, tração dos tecidos e hemostasia, além de demandar destreza do cirurgião; contudo, sem necessidade de investimentos em tecnologia e, além disso, a curva de aprendizado é relatada como menor que a da videolaparoscopia. A laparotomia com incisão mínima deve ser considerada como opção válida e viável no tratamento de afecções cirúrgicas.

A systematic review on efficacy and safety of gasless laparoscopy in the management of uterine leiomyoma / 华中科技大学学报（医学）（英德文版）

Uterine leiomyoma causes considerable morbidity in women. This study systematically reviewed the efficacy and safety of gasless laparoscopic myomectomy (GLM) in the management of uterine leiomyoma by comparing GLM with other minimally invasive procedures. Cochrane Library, Pub- Med, EMBASE, Web of Science, WANFANG database and China National Knowledge Infrastructure (CNKI) were searched for studies published in English or Chinese between January 1995 and May 2015, and related references were traced. Study outcomes from randomized controlled trials and retrospective cohort studies were presented as mean difference (MD) or odds ratio (OR) with a 95% confidence interval (CI). Seventeen studies (including 1862 patients) meeting the inclusion criteria, including 934 treated with GLM and 928 treated with other minimally invasive procedures were reviewed. The results of meta-analysis revealed that GLM resulted in significantly shorter operating time [MD=-10.34, 95% CI (-18.12,-2.56), P<0.00001], shorter hospital stay [MD=-0.47, 95% CI (-0.88,-0.06)], less time to flatus [MD=-2.04, 95% CI (-2.59,-1.48)], less postoperative complications [OR=0.20, 95% CI (0.06, 0.62)] and less blood loss [MD =-30.74, 95% CI (-47.50,-13.98)]. On the other hand, there were no significant differences in duration of post-operative fever [MD=-0.52, 95% CI (-1.46, 0.42)] between the two groups. Additionally, GLM was associated with lower febrile morbidity, lower postoperative abdominal pain, and higher postoperative hemoglobin than other minimally invasive procedures for the treatment of uterine leiomyoma. In conclusion, GLM and other minimally invasive procedures are feasible, safe, and reliable for uterine leiomyoma treatment. However, available studies show that GLM is more effective and safer than other minimally invasive approaches.

Epiduroscopic Removal of a Lumbar Facet Joint Cyst

Facet joint synovial cysts are usually associated with osteoarthritis of the adjacent facet joint and/or spondylolisthesis. In between the conservative and operative ends of the treatment spectrum lie minimally invasive techniques such as cyst rupture using epiduroscopy. In this report, we describe an 82-year-old male patient presenting with low back pain radiating to his lower left extremity and associated paresthesia. Magnetic resonance imaging of the lumbar spine revealed a synovial cyst at left L4/5 facet joint. Using epiduroscopy, the cyst was mechanically ruptured by popping it with the tip of the scope. The patient remained symptom-free at his successive visits until 12 months after the procedure, and was opened for desired follow up.

Percutaneous Thoracic Intervertebral Disc Nucleoplasty: Technical Notes from 3 Patients with Painful Thoracic Disc Herniations

Symptomatic thoracic disc herniation is an uncommon condition and early surgical approaches were associated with significant morbidity and even mortality. We are the first to describe the technique of percutaneous thoracic nucleoplasty in three patients with severe radicular pain due to thoracic disc herniation. Two of the patients experienced more than 75% pain relief and one patient experienced more than 50% pain relief. Post-procedural pain relief was maintained up to an average of 10 months after nucleoplasty. One patient with preoperative neurological signs improved postoperatively. There were no reported complications in all three patients. In view of the reduced morbidity and shorter operating time, thoracic intervertebral disc nucleoplasty can be considered in patients with pain due to thoracic disc herniation, with no calcification of the herniated disc, and in patients who may be otherwise be unfit for conventional surgery.

Current status of natural orifice trans-endoscopic surgery (NOTES) and laparoendoscopic single site surgery (LESS) in urologic surgery

Laparoendoscopic single site surgery (LESS) and natural orifice transluminal endoscopic surgery (NOTES) represent novel approaches in urological surgery. To perform a review of the literature in order describe the current status of LESS and NOTES in Urology. References for this manuscript were obtained by performing a review of the available literature in PubMed from 01-01-02 to 15-05-09. Search terms included single port, single site, NOTES, LESS and single incision. A total of 412 manuscripts were initially identified. Out of these, 64 manuscripts were selected based in their urological content. The manuscript features subheadings for experimental and clinical studies, as NOTES-LESS is a new surgical technique and its future evolution will probably rely in initial verified feasibility. A subheading for reviews presents information regarding common language and consensus for the techniques. The issue of complications published in clinical series and the future needs of NOTES-LESS, are also presented.

Use of enamel matrix protein derivative with minimally invasive surgical approach in intra-bony periodontal defects: clinical and patient-centered outcomes

This case series evaluated the clinical performance and patient-centered outcomes after a minimally invasive surgical technique (MIST) associated with enamel matrix protein derivative (EMD), for the treatment of intra-bony defects. Twelve patients presenting teeth with probing depth >5 mm and bleeding on probing associated with radiographic evidence of intra-bony defect were treated by MIST associated with EMD. Clinical parameters were measured at baseline, 3 and 6 months. Patient perception during the intraoperative period and during the first postoperative week was evaluated. The use of MIST with EDM promoted significant improvements in clinical parameters, minimal pain/discomfort and maximum esthetics satisfaction. Within of limits of the present study, it could be shown that MIST combined with EMD for the treatment of intra-bony defects promotes satisfactory clinical and patient-centered outcomes.

O objetivo deste estudo foi avaliar os resultados clínicos e centrados no paciente após abordagem cirúrgica minimamente invasiva (CMI) associada à aplicação das proteínas derivadas da matriz do esmalte (PDE) no tratamento de defeitos infra-ósseos. Doze pacientes apresentando um sítio com profundidade de sondagem >5 mm e sangramento à sondagem , associado à evidência radiográfica de defeito infra-ósseo, foram tratados com CMI e aplicação das PDE. Os parâmetros clínicos foram avaliados imediatamente antes do procedimento e após 3 e 6 meses. A percepção de dor e desconforto do paciente durante o período trans-cirúrgico e ao longo da primeira semana de pós-operatório, bem como a satisfação estética 6 meses após o tratamento, foram avaliadas por meio de questionários. Os resultados mostraram que o uso da CMI associada à aplicação de PDE promoveu melhoras estatisticamente significantes nos parâmetros clínicos, mínima dor e desconforto e máxima satisfação estética aos pacientes. Dentro dos limites do estudo, foi demonstrado que a associação de CMI e PDE, no tratamento de defeitos infra-ósseos, é capaz de promover satisfatórios resultados clínicos e centrados no paciente.

Subcostal mini incision: a good option for donor nephrectomy

OBJECTIVES: We describe the results of over one hundred nephrectomies performed using a subcostal mini incision. INTRODUCTION: A major effort has been undertaken to encourage living donor renal transplantation. New techniques that use minimally invasive approaches to perform donor nephrectomy have been progressively accepted. Among these new procedures is the mini-incision approach. METHODS: We prospectively analyzed one hundred and seventeen consecutive donors that were subjected to subcostal mini-incision nephrectomy at a single center. Surgical time, warm and cold ischemia time, intraoperative complications, time until hospital discharge, presence of infection, bleeding, the need for a second operation, and death were analyzed. Eventual loss of donor renal function was indicated by increases in serum creatinine and proteinuria. RESULTS: The mean time of surgery was 180.5 ± 26.2 minutes. The mean warm ischemia time was 93 ±8.3 seconds, while the mean cold ischemia time was 85.9 (±23.5) minutes. We had one case with an intraoperative complication, and only two patients required another operation. An intra-abdominal abscess occurred in one patient (0.85 percent), proteinuria occurred in one patient (0.85 percent), and a transitory increase of creatinine levels occurred in two patients (1.7 percent). DISCUSSION: Reducing the length of the abdominal incision did not influence surgical time or result in an increase in intraoperative complications relative to our historical data or literature reports. Organ preparation was accomplished successfully with a brief warm ischemia time. Additionally, the mean hospital stay was short, and few surgical complications occurred. CONCLUSION: The use of a subcostal mini incision is both safe and similar to conventional techniques previously described in the literature.

The Miniarc® sling system in the treatment of female stress urinary incontinence

AIMS: To assess the technical feasibility of a new mini-invasive sling procedure (MiniArc®) and present short-term results in the treatment of female urinary incontinence. MATERIAL AND METHODS: A total of 97 women with mixed or stress urinary incontinence (SUI) were treated by placement of the new single-incision sling. Pelvic organ prolapse was graded using the POP-Q system (pelvic organ prolapse quantification system). Preoperative workup included urodynamic evaluation, cough stress test and introital ultrasound. Postoperatively, introital ultrasound was performed to determine residual urine and check tape position. Quality of life was measured using King's Health Questionnaire. A voiding diary and pad count served to verify the patients' subjective complaints. RESULTS: The MiniArc® single-incision sling procedure was the initial intervention in 37 (38.2 percent) patients and the second intervention in 60 (61.7 percent) patients with recurrent incontinence. The cough stress test was negative in 79 (83.1 percent) women 6 weeks after the sling procedure and in 74 (77.8 percent) at 12 months. De novo urge occurred in 32 (36.8 percent) women. Quality of life was significantly improved at 12-month follow-up in 65 (69.1 percent) patients (p < 0.001). The number of pads decreased significantly from 2.2 to 0.6 (p < 0.001) after the procedure. One patient developed an hematoma and bladder perforation occurred in another. CONCLUSIONS: Our short-term clinical results suggest that the MiniArc® is a safe and effective minimally invasive sling procedure for treating female SUI. Randomized comparative controlled trials and long-term results are still required to define the role of the new sling system in comparison to established mid-urethral tape techniques for treating incontinence.

The Consideration of Microsurgery Technique in the Cultivation of Rhinological Graduate Students / 中华医学教育探索杂志

This paper combines the concept,advancement and application of minimally invasive technique to investigate the methods and procedure in the cultivation of clinical graduate students.