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ABSTRACT Introduction: Robotic transanal surgery (RTS) is the analog of TAMIS and represents a new focus for the advancement of transanal platforms robotic transanal surgery is sometimes referred to as robotic TAMIS. Though limited to only a few centers world-wide, experience with robotic transanal surgery has been encouraging. Most research with robotic transanal surgery has concentrated on local excision of rectal neoplasia, although more complex procedures such as transanal proctectomy are possible using the robotic approach. This article reports the surgical technique of R-TAMIS performed in the Brazilian National Cancer Institute (INCA, Rio de Janeiro). Methods: 71-year-old, female with cardiologic disease (heart failure), with a 1.5 cm rectal neoplasm at 4 cm from the anal verge in the right anterolateral position. Biopsy revealed neuroendocrine tumor. A compete colonoscopy revealed no evidence of synchronous lesions. Work-up included 3D endorectal ultrasonography and magnetic resonance imaging, which demonstrated the lesion to be uT1uN0. The patient was counseled about surgical options − local excision versus low anterior resection. Due to the cardiologic condition, the patient was elected to proceed with local excision with robotic transanal surgery. Conclusion: Robotic TAMIS is a safe and effective operative procedure for high selected cases of rectal neoplasm. It enhances surgeon ergonomics and facilitates tumor removal and suture in the transanal approach.
RESUMO Introdução: A cirurgia transanal robótica (RTS,Robotic Transanal Surgery) é análoga da TAMIS (cirurgia minimamente invasiva transanal) e representa um novo foco para o avanço das plataformas transanais. A cirurgia transanal robótica é algumas vezes chamada de TAMIS robótica. Embora limitada a apenas alguns centros em todo o mundo, a experiência com a cirurgia transanal robótica tem sido encorajadora. A maioria das pesquisas com cirurgia transanal robótica tem se concentrado na excisão local da neoplasia retal, embora procedimentos mais complexos, como a proctectomia transanal, sejam possíveis utilizando a abordagem robótica. Este artigo relata a técnica cirúrgica de R-TAMIS realizada no Instituto Nacional do Câncer (INCA, Rio de Janeiro). Métodos: paciente de 71 anos, sexo feminino, com doença cardiológica (insuficiência cardíaca), com neoplasia retal de 1,5 cm a 4 cm da borda anal em posição anterolateral direita. A biópsia revelou tumor neuroendócrino. Uma colonoscopia completa não revelou evidências de lesões sincrônicas. A investigação incluiu ultrassonografia endorretal em 3D e ressonância magnética, que demonstrou que a lesão era uT1uN0. A paciente foi aconselhada sobre as opções cirúrgicas - excisão localversus ressecção anterior baixa. Devido à condição cardiológica, optou-se por proceder à excisão local com cirurgia transanal robótica. Conclusão: A TAMIS robótica é um procedimento cirúrgico seguro e eficaz para casos altamente selecionados de neoplasia retal. Ela melhora a ergonomia do cirurgião e facilita a remoção do tumor e a sutura na abordagem transanal.
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Humans , Female , Aged , Rectal Neoplasms/surgery , Carcinoma, Neuroendocrine/surgery , Robotic Surgical Procedures/methods , Transanal Endoscopic Surgery/methodsABSTRACT
BACKGROUND:The calcaneal fracture is the most common tarsal bone fracture. Approximately 75% calcaneal fractures presented as the displaced intraarticular fractures. How to treat intraarticular calcaneal fractures remains controversial. OBJECTIVE:To observe the anatomy and clinical effect of minimaly invasive percutaneous screw fixation in repair of Sander II calcaneal fractures under the arthroscope. METHODS:From May 2009 to May 2012, 61 patients (61 feet) with Sander II calcaneal fractures were repaired by minimaly invasive percutaneous screw fixation under the arthroscope. Al patients received clinical and imaging evaluation at 3, 6, 21 weeks, and 1 year after treatment. From then on, the evaluation was performed every year. American Orthopaedic Foot and Ankle Society ankle hindfoot score was used to assess ankle joint function. Simultaneously, complications such as skin necrosis and wound infection were recorded. Radiographic outcomes were assessed by Bohler angle, Gissane angle, calcaneal height and width. RESULTS AND CONCLUSION: A total of 61 patients were folowed up for 24 to 60 months. No complications were seen such as wound healing or deep infection. The time of hospitalization was 6-25 days, averagely (12.7±6.9) days. At the final folow-up, American Orthopaedic Foot and Ankle Society ankle hindfoot score was 88-100, averagely (93.6±3.1), with an excelent and good rate of 100%. The time of return to work after treatment was 8-14 weeks, averagely (10.7±2.9) weeks. Range of motion of ankle or subtalar joint of al patients was limited less than 10°. Immediate postoperative X-ray showed that anatomic reduction of the articular surface was detected in 56 patients (92%), and non-anatomic reduction was found in 5 patients (8%). At last folow-up, the mean Bohler angle was (28.4±4.9)° (range, 23°-30°); the mean Gissane angle was (119.9±7.8)° (range, 112°-124°); the mean calcaneal height was (43.4±4.2) mm (range, 39-45 mm); the mean calcaneal width was (30.4±2.5) mm (range, 27-32 mm); the average fracture healing time was (16.7±4.2) weeks (range, 12-20 weeks). Bohler angle, Gissane angle, calcaneal height, and calcaneal width at last folow-up were significantly improved compared with pretreatment (P < 0.05). These findings suggest that under the arthroscope, minimaly invasive percutaneous screw fixation for Sander II calcaneal fractures can restore calcaneal anatomy, achieve a satisfactory clinical function, without complications such as poor woundhealing or infection.
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BACKGROUND:Intertrochanteric femoral fractures are one of the most common fractures in old patients. How to effectively fix has a great chalenge for orthopedic surgeons. No consensus on which fixation method is optimal has been obtained in the academia. OBJECTIVE: To evaluate the clinical therapeutic effects and complications of minimaly invasive percutaneous proximal femur locking compression plate for senile stable intertrochanteric fractures. METHODS:From May 2010 to May 2012, 98 patients (34 males and 64 females) with stable intertrochanteric fractures were treated with minimaly invasive percutaneous proximal femur locking compression plate fixation. The mean age was 76 years (range, 59-93 years). The mean time between fractures and operation was 3 days (range, 1-5 days). Patients were folowed up regularly after treatment. Healing time, Harris score of hip function recovery and the occurrence of complications were evaluated. RESULTS AND CONCLUSION: Al patients were folowed up for 12-24 months. Al incisions obtained healing by first intention. Al fractures reached clinical healing, and the healing time was 12-20 weeks (16 weeks on average). There was no fixation failure and loosing, rotation, crispatura deformity or screw cutting the femoral head. The function of the hip joint was assessed according to the Harris scoring: excelent in 75 cases and good in 18 cases, with the excelent and good rate of 95%. These data verify that proximal femur locking compression plate can be a feasible alternative to the treatment of stable intertrochanteric fractures. The patients obtained satisfactory outcomes, with less complication, indicating that there is a good biocompatibility between the implant and elderly host.
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BACKGROUND:Open reduction and Kirschner wire tension band technique has been a traditional surgical method for the treatment of patela fracture. However, there stil exist some complications such as Kirschner wire slippage and breakage. Cable-Pin system is a new fixation device. A series of good clinical results has been achieved in patients with patela fracture using this fixation device through a minimaly invasive way. OBJECTIVE:To compare and investigate the clinical results of minimaly invasive fixation with Cable-Pin system and Kirschner wire tension band technique for patela fracture and the complications. METHODS:Eighty patients with radiology-confirmed transverse displacement of patela participated in this trial, and were randomly divided into two groups. Forty patients underwent a minimaly invasive technique and the others had conventional open surgery using Kirschner wire. At postoperative intervals of 1, 3, 6, 12, and 24 months, pain was measured by Visual Analogue Scale scores, range of motion was measured by goniometry, and knee function was evaluated using the Bostman clinical grading scale. RESULTS AND CONCLUSION: Easement of pain was better in the minimaly invasive surgery group than in the control group at 1 and 3 months after treatment (P < 0.05). Above dominance disappeared at 6 months after treatment. At 3-24 months, the knee flexion training was faster and flexion angle was greater in the minimaly invasive surgery group, and results were significantly better than in the control group (P < 0.05). The incidence of discomfort fixation-induced complications was lower in the minimaly invasive surgery group than in the conventional open surgery group (P < 0.05). These data confirm that after minimaly invasive fixation with Cable-Pin system, pain was noticeably lessened, range of motion of affected knee was great, the recovery of knee function was better, the incidence of complications was reduced, and the repair effect was better than the conventional Kirschner wire fixation.
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BACKGROUND:With the aging population, the incidence of lumbar degenerative disease was apparently increased, but how to treatment of degenerative lumbar disease remains controversial. OBJECTIVE:To compare clinical and radiographic results of minimaly invasive posterior lumbar interbody fusion and open posterior lumbar interbody fusion for single-segment degenerative lumbar disease. METHODS: We retrospectively analyzed the clinical data of 97 patients with single-segment degenerative lumbar disease, who were treated in the Huishan District People’s Hospital of Wuxi City from July 2006 to July 2012. These patients were divided into minimal group (minimaly invasive posterior lumbar interbody fusion;n=51) and open group (open posterior lumbar interbody fusion;n=46). These data were compared between the two groups, including operative time, blood loss (intraoperative blood volume+postoperative drainage volume), total blood transfusion, postoperative back pain (visual analogue scale), length of hospital stay, bed time, perioperative complications, clinical function (Oswestry disability index), and radiographic results. RESULTS AND CONCLUSION:Al of 97 patients were folowed up. The duration of folow-up was 28-78 months and 27-76 months in minimal group and open group, respectively. There was no significant difference between the minimal group and open group in term of folowed-up time (P=0.981). Operative time, blood loss, total blood transfusion, bed time, length of hospital stay and visual analogue scale score during final folow-up were significantly lower in the minimal group than in the open group (P 0.05). These results indicate that for the single-segment degenerative lumbar disease, the use of minimaly invasive posterior lumbar interbody fusion or open posterior lumbar interbody fusion can obtain satisfactory clinical function, but the minimaly invasive posterior lumbar interbody fusion has the advantages of a less trauma, shorter length of hospital stay and bed stay, and lighter back pain.
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BACKGROUND:A large number of studies have confirmed that minimaly invasive and open transforaminal lumbar interbody fusion approaches for single-segment and multi-segment lumbar degenerative diseases were effective, but their advantages and disadvantages remain inconclusive. OBJECTIVE:To systematicaly evaluate the effectiveness and safety of minimaly invasive versus open transforaminal lumbar interbody fusion for lumbar degenerative disease. METHODS: Databases including The Cochrane Library (Issue 2, 2014), PubMed, EMbase, MEDLINE, SCI, CNKI, CBM, Wanfang Data were searched to colect the randomized controled trails and non-randomized controled trails about minimaly invasive and open transforaminal lumbar interbody fusion for lumbar degenerative disease. The retrieval time was from foundation to February 2014. The studies were screened according to inclusion and exclusion criteria. The data were extracted and the quality was evaluated by two reviewers independently. Meta-analysis was conducted using RevMan 5.2 software. RESULTS AND CONCLUSION:A total of 1 randomized controled trail and 18 non-randomized controled trails involving 1 400 patients were included. The results of meta-analysis showed that: compared with open transforaminal lumbar interbody fusion, minimaly invasive transforaminal lumbar interbody fusion had many advantages, such as smal paraspinal muscle injury, less blood loss, short hospital stay, good early effects and high long-period remission rate of lumbago. However, minimaly invasive transforaminal lumbar interbody fusion was not superior to open transforaminal lumbar interbody fusion in improving long-period motor function, long-term remission rate of leg pain and in reducing complications. Moreover, the operation time of minimaly invasive transforaminal lumbar interbody fusion was longer. Therefore, under the premise of strict indications, minimaly invasive transforaminal lumbar interbody fusion could better solve the complaint of patients with lumbar degenerative disease. For the quantitative and qualitative limitation of the included studies, this conclusion stil requires to be further proved by performing a larger scale and a higher quality of randomized controled trails. It suggests that doctors should choose a best therapy for patients according to an integrative disease assessment.
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To investigate the efficacy and safety of minimal y invasive endovascular techniques treatment of hydronephrosis in pregnancy complicated by infection. 65 cases of pregnancy hydronephrosis coinfected patients with minimal y invasive endovascular treatment. Patients were fol owed up for 3-12 months, compared with 48 patients with the same period of conservative treatment . Ureteral perforation and other surgery-related complications occurred in 65 patients in the observation group has not occurred. The patient's duration of hospitalization、the recurrence rate of postoperative infection, antibiotic duration of treatment, fever days were significantly lower than the control group(P Compared with conservative treatment, minimal y invasive endovascular technical treatment of gestational hydronephrosis co-infection with faster recovery, shorter hospital stay, can significantly reduce the number of days of fever patients and reduce the number of days of antibiotic use, can be used as conventional means of treatment of gestational hydronephrosis infection combined conventional.
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For orthopaedic care of patients to continue to improve, new approaches, especially minimally invasive spinal technique, must be continually developed.To verify this technique actually provides improved outcomes, these approachs must be subjected to rigorous scientific study. However, because outcomes of clinical interventions only can be studied in human subjects, this practice must not only meet scientific criteria. it also must meet strict ethical criteria. The author analysised the state of minimally invasive spinal technique in china and foreign countries, and illustrated ethical problems and countermeasure on playing of minimally invasive technique into spinal practice.