scholarly journals Two-Level Minimally Invasive Lumbar Laminectomy and Foraminotomy: 2-Dimensional Operative Video

2021 ◽  
Author(s):  
Ethan S Srinivasan ◽  
Clifford L Crutcher ◽  
Timothy Y Wang ◽  
Peter M Grossi ◽  
Khoi D Than
Keyword(s):  
Minimally Invasive ◽  
High Speed ◽  
Hospital Length ◽  
Spinal Nerve ◽  
Hospital Length Of Stay ◽  
Foraminal Stenosis ◽  
Tubular Retractor ◽  
Open Operation ◽  
Spinous Processes ◽  
Patient Reported

Abstract Minimally invasive lumbar laminectomies utilize tubular retractors to minimize tissue disturbance, blood loss, and hospital length of stay compared to open operations. Here, we highlight the operative treatment of a 68-yr-old male entailing a 2-level minimally invasive lumbar laminectomy and foraminotomy at L2-L3 and L3-L4. The patient initially presented with symptoms of treatment-refractory lower extremity numbness and limited ambulation. His imaging demonstrated coronal scoliosis and severe lumbar central and foraminal stenosis at L2-L3 and L3-L4, with enlarged spinous processes, laminae, and facets. The patient consented to the procedure and publication of their image. The operation proceeded with the patient in a prone position with paramedian dissection to the lamina through a minimally invasive tubular retractor. Laminectomies and foraminotomies were performed at each level with high-speed drill and a Kerrison rongeur, with care to identify and protect the relevant spinal nerve roots. Postoperatively, the patient reported significantly reduced numbness and improved ambulation, with a well-healed surgical incision notably smaller than those produced in an open operation.

PS01.212: OUTCOMES OF HYBRID VERSUS FULLY MINIMALLY INVASIVE 2-STAGE ESOPHAGECTOMY FOR CANCER OF THE DISTAL ESOPHAGUS AND GASTRO-ESOPHAGEAL JUNCTION

2018 ◽  
Vol 31 (Supplement_1) ◽  
pp. 110-110
Author(s):  
Kanatheepan Shanmuganathan ◽  
Temisanren Akitikori ◽  
Oluwasunmisola Soile ◽  
Aadil Hussain ◽  
Neda Farhangmehr ◽  
...  
Keyword(s):  
Length Of Stay ◽  
Minimally Invasive ◽  
Anastomotic Leak ◽  
Minimally Invasive Esophagectomy ◽  
Hospital Length ◽  
Leak Rate ◽  
Hospital Length Of Stay ◽  
Cardiac Complications ◽  
Invasive Esophagectomy ◽  
Anastomotic Leak Rate

Abstract Background Esophagectomy is associated with high complication rate and mortality. Numerous approaches have been introduced over the last two decades, with the ambition of reducing rate of complications, morbidity and mortality. Two-stage minimally invasive esophagectomies include hybrid (laparoscopic/thoracotomic) and fully minimally invasive and have recently gained popularity in the treatment of distal esophageal and gastro-esophageal junction cancer. We aim to compare the short-term outcomes between 2-stage hybrid and fully minimally invasive esophagectomy with intrathoracic hand-sewn anastomosis. Methods A retrospective analysis of a 4-year period prospectively collected data of 100 consecutive 2-stage minimally invasive esophagectomies was conducted. All operations were performed in a UK tertiary centre by a single surgical team between 2014 and 2018. All 3-stage and open esophagectomies were excluded from the study. A comparison of anastomotic leak rate, ITU length of stay, hospital length of stay, pulmonary complications, cardiac complications and 30 and 90-day mortality rates was made. Statistical analysis was performed using Graph-Prism 7.04. Results Seventy patients underwent hybrid and 30 underwent fully minimally invasive esophagectomy with intra-thoracic manual anastomosis. Chest infection and anastomotic leak rate were higher in the hybrid group (21.4% vs 16.8% and 10% vs 3.3%); however, cardiac complications were two times more common in fully minimally invasive compared to hybrid esophagectomies (3.3% vs 1.4%). Fully minimally invasive esophagectomies were associated with a shorter ITU stay as well as hospital length of stay compared to hybrid esophagectomies (5.5 vs 6.2 days, P = 0.47 and 10.5 vs 15.6 days P = 0.0018). Complete tumour resection (R0) rate was slightly higher in hybrid compared to fully minimally invasive esophagectomies (70.8% vs 64.3%). Thirty and 90-day mortality rate was 6.67% (1 cardiac and 1 respiratory arrest) in fully minimally invasive and 1.43% in hybrid esophagectomies. None of the mortality cases were related to surgical complications like anastomotic leak or conduit necrosis. Conclusion In our study 2-stage fully minimally invasive esophagectomy is associated with reduced post-operative complication rates compared to 2-stage hybrid oesophagectomy. Further larger studies are needed to assess the 30- and 90-day mortality risk associated with both procedures. Disclosure All authors have declared no conflicts of interest.

Case-Controlled Comparison of Video-Assisted and Conventional Minimally Invasive Parathyroidectomy

2012 ◽  
Vol 78 (1) ◽  
pp. 125-132 ◽  
Author(s):  
Adrienne L. Melck ◽  
Michael J. Armstrong ◽  
Linwah Yip ◽  
Sally E. Carty
Keyword(s):  
Minimally Invasive ◽  
Hospital Stay ◽  
Hospital Length ◽  
Minimally Invasive Parathyroidectomy ◽  
Hospital Length Of Stay ◽  
Complication Rates ◽  
Invasive Parathyroidectomy ◽  
Video Assisted ◽  
Imaging Results ◽  
Added Benefit

Video-assisted parathyroidectomy (VAP) is a new approach to parathyroid exploration for primary hyperparathyroidism (PH). We examined the VAP learning curve and hypothesized that compared with conventional minimally invasive parathyroidectomy (MIS), VAP has similar complication rates and the added benefit of a shorter hospital length of stay. Using a case-control study design, patients with PH with single-focus imaging results undergoing VAP or MIS were compared during a 5-year VAP implementation period. VAP was possible in 18 per cent of patients undergoing initial parathyroid exploration. In comparing 125 VAP cases with 95 MIS control subjects, patients undergoing MIS had higher mean preoperative levels of calcium ( P = 0.007) and parathyroid hormone ( P = 0.008), greater mean adenoma weight ( P < 0.001), and increased long-term mortality (4% MIS vs 0% VAP, P = 0.03). Mean operative time, in-house analgesia use, and operative complications did not differ. The rate of conversion from VAP to MIS was 14 per cent. Patients undergoing VAP were less likely to require an overnight hospital stay ( P = 0.01). VAP is a safe surgical option for selected patients with PH, offering improved cosmesis with operative times comparable to conventional MIS. VAP can be done with a low conversion rate even during implementation and allows the added benefit of shorter hospital stay.

scholarly journals Surgical approach to solid pseudopapillary neoplasms of the proximal pancreas: minimally invasive vs. open

2019 ◽  
Vol 17 (1) ◽  
Author(s):  
Emmanuel II Uy Hao ◽  
Seoung Yoon Rho ◽  
Ho Kyoung Hwang ◽  
Jae Uk Chung ◽  
Woo Jung Lee ◽  
...  
Keyword(s):  
Minimally Invasive Surgery ◽  
Minimally Invasive ◽  
Head And Neck ◽  
Surgical Approach ◽  
Tumor Size ◽  
Open Surgery ◽  
Hospital Length ◽  
Hospital Length Of Stay ◽  
Minimally Invasive Surgical ◽  
Solid Pseudopapillary Neoplasms

Abstract Background Solid pseudopapillary neoplasms (SPN) of the pancreas are rare pancreatic neoplasms where complete resection is the cornerstone in management. It has been demonstrated in previous studies that minimally invasive surgical approaches are effective management options in treating SPNs of the distal pancreas. The purpose of this study is to evaluate the feasibility of minimally invasive surgery in treating SPNs of the uncinate, head, and neck of the pancreas. Methods Data from 2005 to 2017 at Severance Hospital of the Yonsei University Health systems in Seoul, South Korea, were retrospectively collected for 25 patients who were diagnosed with SPN of the uncinate, head, and neck of the pancreas and who underwent curative resection. Three groups of patients were considered, depending on the year of surgery, in order to determine trends in the surgical management of SPN. The patients were also divided into two groups corresponding to the type of operation done (minimally invasive surgery vs. open surgery). Perioperative patient data, including age, gender, body mass index (BMI), tumor size, and operation done, were compared and analyzed statistically. Long-term nutritional effects were measured using the Controlling Nutritional Status (CONUT) scoring system. Results There were no statistically significant differences in age, gender, BMI, symptomatic presentation, operation type, tumor size, and tumor stage between the three time periods. In comparing between minimally invasive and open surgery, there were no statistically significant differences in age, gender, symptomatic presentation, BMI, tumor size, preoperative stage, type of operation, operation time, pancreatic duct size, post-operative pancreatic fistula (POPF) grade, death associated with disease, recurrence, pathological parameters, and change in CONUT score. There was a significant difference in tumor size (4.5 ± 1.8 vs. 2.6 ± 1.0 cm, p = 0.004), blood loss (664.2 ± 512.4 vs. 277.7 ± 250.8 mL, p = 0.024), need to transfuse (33% vs. 0%, p = 0.023), hospital length of stay (27.4 ± 15.3 vs. 11.5 ± 5.3 days, p = 0.002), and complication rate (75% vs. 30.8%, p = 0.027) between the two groups. Conclusions In appropriately selected patients with SPNs of the uncinate, head, and neck of the pancreas, a minimally invasive surgical approach offers at least equal oncologic and nutritional outcomes, while demonstrating decreased complications and decreased hospital length of stay compared with that of an open surgical approach.

Is the Laparotomy Here to Stay? A Review of the Disadvantages of Laparoscopy

2020 ◽  
Vol 30 (02) ◽  
pp. 181-186
Author(s):  
Brian C. Gulack ◽  
Kaitlyn Wong ◽  
Eric Sparks ◽  
Joshua Ramjist ◽  
Haitao Zhu ◽  
...  
Keyword(s):  
Minimally Invasive ◽  
Air Embolism ◽  
Hospital Length ◽  
Hospital Length Of Stay ◽  
Aesthetic Results ◽  
Abdominal Operations ◽  
Pediatric Patient Population ◽  
Laparoscopic Techniques ◽  
Neonates And Infants ◽  
Thoracic And Abdominal

AbstractMinimally invasive procedures have seen increasing utilization in the pediatric patient population since the 1990s. Most thoracic and abdominal operations in pediatric surgery can be performed in a minimally invasive manner including those performed in neonates and infants. Thoracoscopic or laparoscopic operations can reduce hospital length of stay, minimize postoperative pain, and lead to more aesthetic results. However, it is important to be aware of the inherent risks, limitations, and adverse effects associated with these thoracoscopic and laparoscopic techniques, particularly in special populations. In this article, we will review the risks and limitations of laparoscopy in pediatric patients such as cost, operative time, reduced effectiveness, air embolism, hypercarbia, hypothermia, and access-related injuries.

scholarly journals Development of an Enhanced Recovery After Surgery (ERAS) approach for lumbar spinal fusion

2017 ◽  
Vol 26 (4) ◽  
pp. 411-418 ◽  
Author(s):  
Michael Y. Wang ◽  
Peng-Yuan Chang ◽  
Jay Grossman
Keyword(s):  
Spinal Fusion ◽  
Surgical Procedure ◽  
Enhanced Recovery ◽  
Lumbar Fusion ◽  
Hospital Length ◽  
Hospital Length Of Stay ◽  
Improvement Program ◽  
Female Ratio ◽  
Open Operation ◽  
The Mean

OBJECTIVE Over the past decade, Enhancing Recovery After Surgery (ERAS) programs have been implemented throughout the world across multiple surgical disciplines. However, to date no spinal surgery equivalent has been described. In this report the authors review the development and implementation of a “fast track” surgical approach for lumbar fusion. METHODS The first 42 consecutive cases in which patients were treated with the new surgical procedure were reviewed. A combination of endoscopic decompression, expandable cage deployment, and percutaneous screw placement were performed with liposomal bupivacaine anesthesia to allow the surgery to be performed without general endotracheal anesthesia. RESULTS In all cases the surgical procedure was performed successfully without conversion to an open operation. The patients' mean age (± SD) was 66.1 ± 11.7 years, the male/female ratio was 20:22, and a total of 47 levels were treated. The mean operative time was 94.6 ± 22.4 minutes, the mean intraoperative blood loss was 66 ± 30 ml, and the mean hospital length of stay was 1.29 ± 0.9 nights. Early follow-up showed a significant improvement in the mean Oswestry Disability Index score (from 40 ± 13 to 17 ± 11, p = 0.0001). Return to the operating room was required in 2 cases due to infection and in 1 case due to cage displacement. An iterative quality improvement program demonstrated areas of improvement, including steps to minimize infection, improve postoperative analgesia, and reduce cage osteolysis. CONCLUSIONS ERAS programs for improving spinal fusion surgery are possible and necessary. This report demonstrates a first foray to apply these principles through 1) a patient-focused approach, 2) reducing the stress of the operation, and 3) an iterative improvement process.

scholarly journals The Impact of NSAID Use After Lumbar Fusion Surgery on Fusion Rate and Complications: A Meta-Analysis

Neurosurgery ◽  
2019 ◽  
Vol 66 (Supplement_1) ◽  
Author(s):  
Yahya Othman ◽  
Avani Vaishnav ◽  
Steven Mcanany ◽  
Sravisht Iyer ◽  
Todd Albert ◽  
...  
Keyword(s):  
Length Of Stay ◽  
Spine Surgery ◽  
Spinal Surgery ◽  
Meta Analysis ◽  
Hospital Length ◽  
Hospital Length Of Stay ◽  
Opioid Use ◽  
Pain Scores ◽  
Patient Reported ◽  
The Impact

Abstract INTRODUCTION The purpose of this study is to compile data presented in literature regarding the efficacy of incorporating NSAIDs in the postoperative course for patients undergoing spine surgery, in particular its impact on pain levels, opioid use, complications, and hospital length of stay METHODS This is a meta-analysis and systematic review. A literature search was conducted using the backbone search [spinal surgery] [Nsaid] [complications]. Criteria for inclusion are as follows: use of NSAIDs for postoperative pain management of spinal surgery, comparison between NSAID and NSAID-free cohort, and reporting on any of pain scores, hospital opioid use, hospital length of stay, complications rate, and operative outcomes. RESULTS Out of 799 studies, 19 studies met the inclusion criteria. A total of 1522 patient were included in this analysis. The studies included randomized controlled trials, Prospective and retrospective cohorts. Operations included discectomies, laminectomies, and fusions. Most commonly regimens included the NSAID Ketorelac, as in injection given immediately postoperatively. Patients that received NSAID analgesia postoperatively had significantly lower VAS pain scores at 1 and 12 h postoperatively. This group also had a significantly lower opioid consumption and shorter hospital length of stay. A total of 7 fusion studies reported on arthrodesis, showing a significantly lower odds of fusion after NSAIDs use, however after subgrouping according to smoking, this difference proves to be no longer significant. CONCLUSION Incorporation of NSAIDs into the postoperative regimen for analgesia in patients undergoing spine surgery is an effective approach in reducing hospital length of stay, patient reported pain scores, hospital opioid use, and has no increased risk of complications. Furthermore, use of NSAIDs in the nonsmoking population does not seem to affect arthrodesis rates in patients undergoing spine surgery.

Repetitive Imaging following Minimally Invasive Repair of Pectus Excavatum Is Unnecessary

2018 ◽  
Vol 29 (05) ◽  
pp. 408-411 ◽  
Author(s):  
Richard Sola ◽  
Yangyang R. Yu ◽  
Tyler C. Friske ◽  
Abdur R. Jamal ◽  
Eric H. Rosenfeld ◽  
...  
Keyword(s):  
Minimally Invasive ◽  
Clinical Outcomes ◽  
Pectus Excavatum ◽  
Hospital Length ◽  
Hospital Length Of Stay ◽  
Tube Placement ◽  
Haller Index ◽  
Significant Difference ◽  
Repeat Imaging

Introduction The objective of this study was to evaluate the necessity of repeat imaging after an initial chest radiograph (CXR) following minimally invasive repair of pectus excavatum (MIRPE). Materials and Methods A retrospective review was performed on patients who underwent MIRPE from January 2012 to July 2016 at two academic children's hospitals. Data collected included demographics, severity of pectus defect (Haller index [HI]), utilization of CXRs, outpatient follow-up, and clinical outcomes. Results A total of 360 patients (171 at Hospital 1 and 189 at Hospital 2) underwent MIRPE. Median age was 15.6 years and 84% were males. The median HI was 4.0. Median postoperative hospital length of stay was 4.2 days and median time to bar removal was 34 months. There was significant variation in postoperative imaging between the hospitals, including frequency of immediate postoperative CXR, total number of CXRs during hospitalization, and number of postoperative outpatient CXRs prior to bar removal. However, there was no significant difference in outcomes between the hospitals, including postoperative pneumothorax, postoperative chest tube placement, and complications. Conclusion These data suggest that increased repetitive imaging after an initial postoperative CXR does not affect clinical outcomes and may not be necessary after MIRPE.

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