Extracorporeal membrane oxygenation combined with minimally invasive surgery for acute respiratory failure and sudden cardiac arrest: A case report.

Acute respiratory failure and sudden cardiac arrest caused by acute intrathoracic infection is a fatal clinical condition with a low resuscitation success rate. The present study describes the case of a patient with acute empyema secondary to an acute lung abscess rupture, complicated by acute respiratory failure and sudden cardiac arrest caused by severe hypoxemia. The patient recovered well through the administration of multiple therapeutic measures, including medication and closed chest drainage, cardiopulmonary resuscitation, extracorporeal membrane oxygenation combined with continuous renal replacement therapy, and minimally invasive surgical resection of the lung lesion with persistent alveolar fistula as the clinical manifestation. To the best of our knowledge, the treatment of such a severe condition combined with thoracoscopic surgery has rarely been reported before, and the present study may provide insight regarding therapeutic schedules for acute respiratory failure by intrathoracic infection, and excision of ruptured lung abscess.

Value of ultrasound BI­RADS classification in preoperative evaluation of the ultrasound­guided Mammotome­assisted minimally invasive resection of breast masses: A retrospective analysis.

The American College of Radiology Breast Imaging Reporting and Data System (BI-RADS) classification has been used for the diagnosis of breast masses for several decades and constantly updated, but the terminology used to describe breast ultrasound findings is still evolving and a great amount of large sample data is necessary to verify and improve ultrasound BI-RADS. The objective of the present study was to explore the value of ultrasound Breast Imaging Reporting and Data System (US BI-RADS) classification in the preoperative evaluation of the US-guided Mammotome-assisted minimally invasive resection of breast masses. A total of 1,028 patients with 1,341 breast masses from a single hospital were selected for retrospective analysis. All patients underwent minimally invasive resection using a US-guided Mammotome device, and postoperative pathological examinations were performed for all samples. The preoperative US BI-RADS classification and postoperative pathological examination results were compared and analyzed. A receiver operating characteristic (ROC) curve was used to analyze the preoperative evaluation efficacy of the US BI-RADS classification in US-guided Mammotome-assisted minimally invasive breast mass resection. Among the 1,341 breast masses that underwent resection, 1,307 were benign and 34 were malignant. The specificity, sensitivity, accuracy, positive predictive value and negative predictive value of the US BI-RADS classification in the preoperative diagnosis of malignant breast masses were 83.47, 100.00, 83.89, 13.60 and 100.00%, respectively, and the area under the ROC curve was 0.917. It may be concluded that the US BI-RADS classification has a good preoperative diagnostic performance and can provide an accurate assessment prior to Mammotome-assisted minimally invasive resection. It may help surgeons to make reasonable decisions for subsequent therapy and therefore is worthy of further clinical use.

Tubular minimally invasive resection of McCormick type II paraspinal schwannoma: preliminary experience.

PURPOSE: Complete removal of paraspinal schwannomas is generally required for full patient recovery. However, traditional open approaches to surgery are often extensive and may lead to more postoperative complications. Herein, we present our preliminary experience with tubular minimally invasive resection of McCormick type II paraspinal schwannomas and describe the technique by specifically reviewing two patient cases. MATERIALS AND METHODS: Type of study: Retrospective: Level of evidence: Level III: A total of 15 patients (six men; nine women; median age, 45 years) who underwent minimally invasive resection of McCormick type II paraspinal schwannomas were retrospectively analysed. Preoperative characteristics, including age, location of tumour, Visual Analog Scale score, Modified McCormick Scale score, and intraoperative findings and complications were analysed. Furthermore, postoperative outcomes using imaging, such as magnetic resonance imaging (MRI) and thin-slice computed tomography, and postoperative neural status using the Modified McCormick and Visual Analog Scales were also assessed. RESULTS: The mean operation time was 134.72 ± 34.21 min. The estimated mean blood loss and mean hospital stay were 25.33 ± 17.27 ml and 7.67 ± 1.88 days, respectively. Regarding complications, one of the patients had a local wound infection, which improved after antibiotic treatment. The total resection in all cases was verified using postoperative MRI. CONCLUSION: The tubular minimally invasive approach is a feasible technique for the total resection of McCormick type II paraspinal schwannomas. Using this technique, surgeons can resect paraspinal schwannomas while maintaining spinal stability.

Evidence-based visualization analysis of literature of digestive endoscopic minimally-invasive resection in the past decade / 中华消化内镜杂志

Objective:To review publications in the field of digestive endoscopic minimally-invasive resection in the past 10 years in and outside China.Methods:Literature of digestive endoscopic minimally-invasive resection in the Web of Science and CNKI databases from January 1, 2011 to July 17, 2021 was retrieved. VOSviewer 1.6.11 was used for clustering and time series analysis of countries, institutions, authors and keywords, and drawing evidence-based visualization maps, so as to analyze the cooperation among countries, academic institutions and researchers, to compare the differences in research topics between Chinese and English databases, and to predict the future research hot spots and directions.Results:A total of 22 834 English articles and 4 636 Chinese articles were included. Over the past 10 years, the number of Chinese and English publications has been growing steadily, and most of them were published in professional journals. The publications were mainly from China, Japan, South Korea and the United States, where all exceeded 2 000. The National Cancer Center of Japan had 497 publications, ranking the first among all institutions. The cooperation between academic institutions showed obvious regional characteristics, and the inter-institutional and interpersonal cooperation needed improvement. In terms of keyword clustering, there was no significant difference between Chinese and English publications, but there were two additional clusters in Chinese publications, endoscopic nursing and submucosal tumor. Overlays analysis of key words showed that endoscopic surgery, tunneling technique, and submucosal tumor could be hot spots and future directions.Conclusion:Digestive endoscopic minimally-invasive resection has experienced a vigorous development in the past 10 years with a growing number of Chinese and English publications. China is playing an increasingly important role on the international stage. The advanced nature of research focus in Chinese publications is comparable to that in English publications, yet also showing Chinese characteristics. In the future, more efforts should be taken to strengthen regional cooperation and focus on research hot spots.

Limited resection for early-stage thymoma: minimally invasive resection does not mean limited resection.

Standard resection for patients with thymoma is resection of thymoma with total thymectomy (TTx) via median sternotomy. Hence, limited resection for thymoma means a lesser extent of resection of normal thymus compared with a standard procedure, i.e. resection of thymoma with partial thymectomy (PTx). In contrast, minimally invasive resection has been defined as resection of thymoma with TTx via a less-invasive approach. However, to date, few studies have precisely evaluated the differences in surgical and oncological outcomes among these three procedures. This report summarizes the differences among these three procedures with a review of studies (January 2000 to December 2020) focusing on the difference in surgical and oncological outcomes and presents current issues in the surgical management of thymoma. In this report, 16 studies were identified; 5 compared standard resection to limited resection, 9 compared standard resection to minimally invasive resection and 2 compared limited resection to minimally invasive resection. Most studies reported that the surgical and oncological outcomes of limited resection or minimally invasive resection were similar to those of standard resection in patients with early-stage thymoma. However, they did not include a sufficient follow-up period. Both limited resection and minimally invasive resection for early-stage thymoma might be reasonable treatment options. However, they are still promising modes of resection. Further studies with a long follow-up period are needed.

The effectiveness of preoperative assessment using a patient-specific three-dimensional pseudoarticulation model for minimally invasive posterior resection in a patient with Bertolotti's syndrome: a case report.

BACKGROUND: Bertolotti's syndrome is widely known to cause low back pain in young patients and must be considered as a differential diagnosis. Its treatment such as conservative therapy or surgery remains controversial. Surgical procedure is recommended for intractable low back pain. The three-dimensional (3D) lumbosacral transitional vertebrae anatomy should be completely understood for a successful surgery. Using an intraoperative 3D navigation and preoperative preliminary surgical planning with a patient-specific 3D plaster model contribute for safe surgery and good outcome. CASE PRESENTATION: A case of a 22-year-old Japanese male patient with intractable left low back pain due to lumbosacral transitional vertebrae with Bertolotti's syndrome. The symptom resisted the conservative treatment, and anesthetic injection at pseudoarticulation only provided a short-term pain relief. Posterior resection using intraoperative three-dimensional (3D) navigation has been performed through microendoscopic view. Pseudoarticulation was totally and successfully resected in a safe manner. CONCLUSIONS: Preoperative surgical planning and rehearsal using a patient-specific 3D plaster model was greatly useful and effective for surgeons in performing accurate and safe pseudoarticulation resection.

Comparison of curative effects between mammotome-assisted minimally invasive resection (MAMIR) and traditional open surgery for gynecomastia in Chinese patients: A prospective clinical study.

To analyze and compare prospectively the curative effects between mammotome-assisted minimally invasive resection (MAMIR) and traditional open surgery (TOS) for gynecomastia in Chinese male patients, a total of 60 patients suffering from grade I and II gynecomastia, evaluated by automated whole-breast ultrasound (AWBU), were recruited and randomly divided into TOS and MAMIR groups (each n = 30). The postoperative scar size, healing time, patient hospital stay, postoperative satisfaction, postoperative pain, and complications including edema and bruising were analyzed. The participants were followed up for 1 week, 1 month, 6 months, and 1 year after surgery. Compared with patients who received TOS, patients in the MAMIR group had significantly smaller scar sizes (0.40 ± 0.08 cm vs 5.34 ± 0.38 cm, P < 0.01), shorter healing times (3.67 ± 0.71 days vs 7.90 ± 0.92 days, P < 0.01), and hospitalization (2.60 ± 0.62 vs 7.17 ± 0.83 days, P < 0.01), as well as higher postoperative satisfaction (4.70 ± 0.60 vs 3.20 ± 0.55 scores, P < 0.01), respectively. Patients in the MAMIR group experienced postoperative mild pain significantly more often than those in the TOS group (6.70 ± 1.06 vs 4.13 ± 0.78 scores, P < 0.01, respectively), but with significantly less postoperative severe pain (53.33% vs 0.00%, P < 0.000). While the incidence rate of edema and bruises was significantly higher in the MAMIR group compared with the TOS group (47% vs 17%, P = 0.013 and 54% vs 20%, P = 0.007, respectively). MAMIR had advantages for curative effects compared with traditional open surgery. However, the recurrence rate in patients needs to be further studied.

Minimally Invasive Surgery in Pediatric Surgical Oncology: Practice Evolution at a Contemporary Single-Center Institution and a Guideline Proposal for a Randomized Controlled Study.

Background: Despite the lack of randomized or controlled trials for minimally invasive surgery (MIS) in pediatric surgical oncology, the integration of MIS into the surgical practice of pediatric oncology has become increasingly popular. The aim of this study was to evaluate the implementation of MIS in a pediatric tertiary cancer center and compare present use of MIS to that in a previous analysis at our center. Methods: We retrospectively reviewed the medical records of patients with pediatric cancer treated with MIS at a single institution between 2000 and 2014. Results: A total of 252 MIS procedures were performed: 73 laparoscopic (29%) and 179 thoracoscopic (71%). MIS was used for diagnostic purposes in 59% (146 thoracoscopic and 34 laparoscopic) and the therapeutic resection in 24% (39 laparoscopic cases and 33 thoracoscopic cases). Conversion to an open procedure occurred in 18 tumor resections (6%) and in 22 diagnostic biopsies (7%), mostly due to technical challenges in identifying or mobilizing tumors. Complications occurred in seven tumor resections (2%) and included three pneumothoraces, two bleeding complications, one bowel injury, and one wound infection. Complications occurred in 10 diagnostic biopsies (3%), mostly pneumothoraces. No tumor upstaging or trocar site recurrences occurred (follow-up time, 1-15 years). Conclusions: Over the last decade, we demonstrate the evolution of MIS in the management of solid tumors in children. We encourage surgeons and oncologists to join the call to arms to establish prospective trials evaluating MIS in pediatric surgical oncology.

Evaluation of the metabolic response to open and minimally invasive resection of the oesophagus due to oesophageal cancer.

AIM: The aim of this study was to compare the metabolic response in the early postoperative period after radical resection of stage I and II oesophageal cancer applying a minimally invasive procedure and an open procedure involving classical laparotomy and thoracotomy. MATERIAL AND METHODS: Serum concentrations of interleukin 6 (IL-6), procalcitonin (PCT), C-reactive protein (CRP), tumour necrosis factor-α (TNF-α), and total serum protein (TP) and leukocyte count (WBC) in blood collected on the day of surgery prior to the procedure (day 0) and on days 1, 2 and 7 after the surgery were measured in two groups of patients undergoing oesophageal resection due to cancer: applying a minimally invasive procedure involving laparoscopy and videothoracoscopy (group A) and applying a classical procedure involving full opening of the chest and abdominal cavity (group B). The study involved a total of 24 patients divided into two groups of 12 patients each. RESULTS: Tumour necrosis factor-α concentration was lower in group A compared to group B on day 0, PCT concentration was lower in group A compared to group B on day 2 after surgery, and on the remaining days TNF-α and PCT concentrations were not statistically different between groups. CONCLUSIONS: Lower concentration of PCT on post-surgery day 2 in the group of patients undergoing minimally invasive oesophageal resection seems to be associated with a smaller perioperative injury. Lower TNF-α concentration in serum collected on day 0 in the group of patients undergoing minimally invasive resection is associated with a lower stage of oesophageal cancer in this group.

[Video-assisted thoracic surgery : A global development]. / Videoassistierte Thoraxchirurgie : Eine globale Entwicklung.

More than 200 years ago the first attempts at thoracoscopy were made but only after its introduction 25 years ago has video-assisted thoracoscopic surgery (VATS) experienced rapid progress. Due to worldwide cooperation and international networking tremendous progress of the technique was made by thoracic surgeons on all continents developing the technique into a less invasive operating procedure on the thorax. For patients this meant improvement in the quality of life and ultimately better survival rates following lung cancer surgery. The VATS procedures are nowadays the preferred method unless the size and extent of the tumor prohibits a minimally invasive procedure. New trends in VATS are ambulatory, drainless or uniportal VATS, the latter being possible because insufflation of carbon dioxide is not necessary, allowing manipulation with multiple instruments through one small incision. The other trend is robotic-assisted thoracic surgery. The benefits of the robotics are higher degrees of freedom for movement of the instruments. The development of VATS is nowadays a global one with North America and Asian countries being the most active protagonists, but European countries also play an important role in shaping the future of minimally invasive surgery. Modern media help to further promote the technique.

A useful method to keep azygos arch in minimally invasive resection of esophageal leiomyoma.

Lifting azygos arch with a prolene line is a useful way to keep azygos arch in minimally invasive resection of esophageal leiomyoma without affecting surgical exposure and operative procedure.

Effects of minimally invasive breast resection on nonpalpable breast nodules / 中国综合临床

Objective To compare the efficacy of ATEC system and conventional surgery for the treatment of nonpalpable breast nodules.Methods Two hundred and forty cases patients with nonpalpable breast nodules who were treated in Maternal and Child Health Hospital of Pinggu District of Beijing from September 2014 to June 2016 were admitted and randomly divided into observation group and control group,120 cases in each group.The observation group was treated with minimally invasive treatment,while the control group was treated by conventional surgery.The postoperative pathologic results,surgical parameters and complications were compared between 2 groups.Results One hundred and eighteen cases were successfully removed and 210 pathological specimens were obtained in the observation group,including 201 benign lesions in 112 cases and 9 malignant lesions in 6 cases.In the control group,208 benign lesions in 113 cases and 11 malignant lesions in 7 cases were obtained from 120 cases.There was no significant difference in the proportion or type of pathology between 2 groups(P＞0.05).The operative time,blood loss,scar length and wound healing time were all significantly lower in the observation group than those in the control group((16.72±3.65)min vs.(41.21±5.94)min,(9.45±2.35)ml vs.(28.42±7.30)ml,(3.64±0.85)mm vs.(28.51±6.34)mm,(3.36±0.67)d vs.(6.79±1.58)d;t=38.245,26.891,42.238,21.738;P＜0.001).The incidence of breast collapse or deformity in the observation group was lower than that in the control group(0 vs.6.7％,P=0.007),but there was no significant difference in the incidence of hematoma,skin ecchymosis,local infection or nodular recurrence between 2 groups(P＞0.05).Conclusion Breast minimally invasive resection is effective in the treatment of nonpalpable breast nodules,and is suitable for patients with high demands on breast appearance.