scholarly journals Lessons learned on a new procedure: Nonsternotomy minimally invasive pulmonary embolectomy

2021 ◽  
Vol 36 (4) ◽  
pp. 1258-1263
Author(s):  
Omar M. Lattouf ◽  
Danuel Laan ◽  
David Zapata ◽  
Edwyn J. Assaf ◽  
John Fallon
Keyword(s):  
Minimally Invasive ◽  
Lessons Learned ◽  
Pulmonary Embolectomy

A Single-Center Experience with Minimally Invasive Transgastric ERCP in Patients with Previous Gastric Bypass: Lessons Learned and Technical Considerations

2020 ◽  
Vol 86 (4) ◽  
pp. 300-307
Author(s):  
Maria Baimas-George ◽  
Michael J. Passeri ◽  
William B. Lyman ◽  
Andrew Dries ◽  
Tarun Narang ◽  
...  
Keyword(s):  
Minimally Invasive ◽  
Biliary Obstruction ◽  
Operative Time ◽  
Lessons Learned ◽  
High Rate ◽  
Single Center Experience ◽  
Estimated Blood Loss ◽  
Chart Abstraction ◽  
Feasible Alternative ◽  
Median Operative Time

As bariatric surgery increases, there is a growing population of patients with biliary obstruction and anatomy which precludes transoral access through endoscopic retrograde cholangiopancreatography (ERCP). Minimally invasive transgastric ERCP (TG-ERCP) offers a feasible alternative for the treatment. A retrospective review was performed of all patients who underwent laparoscopic or robotic-assisted TG-ERCP between 2010 and 2017. Chart abstraction collected demographics, procedural details, success rate, and postoperative outcomes. Forty patients were identified, of which 38 cases were performed laparoscopically and two robotically. Median operative time was 163 minutes, with an estimated blood loss of 50 cc. TG-ERCP was performed successfully in 36 cases (90%); sphincterotomy was completed in 35 patients (97%). Sixty per cent already had a cholecystectomy; in the remaining patients, it was performed concurrently. Major complications included stomach perforation (n = 1), pancreatitis (n = 3), and anemia requiring transfusion (n = 2). In patients with biliary obstruction and anatomy not suitable for ERCP, TG-ERCP can be performed in a minimally invasive fashion, with a high rate of technical success and low morbidity. We describe a stepwise, reproducible technique because it is an essential tool for the shared armamentarium of endoscopists and surgeons.

scholarly journals Results and Lessons Learned on Robotic Assisted Kidney Transplantation

2020 ◽  
Vol 2020 ◽  
pp. 1-8
Author(s):  
Mireia Musquera ◽  
Lluis Peri ◽  
Tarek Ajami ◽  
Ignacio Revuelta ◽  
Laura Izquierdo ◽  
...  
Keyword(s):  
Kidney Transplantation ◽  
Minimally Invasive ◽  
Late Complications ◽  
Lessons Learned ◽  
Ureteral Stenosis ◽  
Robotic Assisted ◽  
Conversion To Open Surgery ◽  
Invasive Method ◽  
The Mean

Introduction. Nowadays, minimally invasive surgery in kidney transplantation is a reality thanks to robotic assistance. In this paper, we describe our experience, how we developed the robotic assisted Kidney transplantation (RAKT) technique, and analyze our results. Material and Methods. This is a retrospective study of all RAKTs performed at our center between July 2015 and March 2020. We describe the donor selection, surgical technique, and analyze the surgical results and complications. A comparison between the first 20 cases and the following ones is performed. Results. During the aforementioned period, 82 living donor RAKTs were performed. The mean age was 47.4±13.4 and 50 (61%) were male. Mean body mass index was 25±4.7 and preemptive in 63.7% of cases. Right kidneys and multiple arteries were seen in 14.6% and 12.2%, respectively. Mean operative and rewarming time was 197±42 and 47±9.6 minutes, respectively. Five cases required conversion to open surgery because of abnormal kidney vascularization. Two patients required embolization for subcapsular and hypogastric artery bleeding without repercussion. Three kidneys were lost, two of them due to acute rejection and one because venous thrombosis. Late complications requiring surgery included one kidney artery stenosis, one ureteral stenosis, two lymphoceles, and three hernia repairs. We noticed a significant reduction in time between the first 20 cases and the following ones from 248.25±38.1 to 189.75±25.3 (p<0.05). With a mean follow-up time of 1.8 years (SD 1.3), the mean creatinine was 1.52 (SD 0.7) and RAKT graft survival was 98%. Conclusions. The robotic approach is an attractive, minimally invasive method for kidney transplantation, yielding good results. Further studies are needed to consider it a standard approach.

scholarly journals Minimally invasive lateral approach for adult degenerative scoliosis: lessons learned

2013 ◽  
Vol 35 (2) ◽  
pp. E4 ◽  
Author(s):  
Armen R. Deukmedjian ◽  
Amir Ahmadian ◽  
Konrad Bach ◽  
Alexandros Zouzias ◽  
Juan S. Uribe
Keyword(s):  
Minimally Invasive ◽  
Cobb Angle ◽  
Clinical Outcomes ◽  
Lumbar Lordosis ◽  
Traditional Approach ◽  
Lateral Approach ◽  
Lessons Learned ◽  
Degenerative Scoliosis ◽  
Adult Degenerative Scoliosis ◽  
Scoliosis Correction

Object Lateral minimally invasive thoracolumbar instrumentation techniques are playing an increasing role in the treatment of adult degenerative scoliosis. However, there is a paucity of data in determining the ideal candidate for a lateral versus a traditional approach, and versus a hybrid construct. The objective of this study is to present a method for utilizing the lateral minimally invasive surgery (MIS) approach for adult spinal deformity, provide clinical outcomes to validate our experience, and determine the limitations of lateral MIS for adult degenerative scoliosis correction. Methods Radiographic and clinical data were collected for patients who underwent surgical correction of adult degenerative scoliosis between 2007 and 2012. Patients were retrospectively classified by degree of deformity based on coronal Cobb angle, central sacral vertical line (CSVL), pelvic incidence, lumbar lordosis (LL), sagittal vertical axis (SVA), pelvic tilt (PT), presence of comorbidities, bone quality, and curve flexibility. Patients were placed into 1 of 3 groups according to the severity of deformity: “green” (mild), “yellow” (moderate), and “red” (severe). Clinical outcomes were determined by a visual analog scale (VAS) and the Oswestry Disability Index (ODI). Results Of 256 patients with adult degenerative scoliosis, 174 underwent a variant of the lateral approach. Of these 174 patients, 27 fit the strict inclusion/exclusion criteria (n = 9 in each of the 3 groups). Surgery in 17 patients was dictated by their category, and 10 were treated with surgery outside of their classification. The average age was 61 years old and the mean follow-up duration was 17 months. The green and yellow groups experienced a reduction in coronal Cobb angle (12° and 11°, respectively), and slight changes in CSVL, SVA, and PT, and LL. In the green group, the VAS and ODI improved by 35 and 17 points, respectively, while in the yellow group they improved by 36 and 33 points, respectively. The red subgroup showed a 22° decrease in coronal Cobb angle, 15° increase in LL, and slight changes in PT and SVA. Three patients placed in the yellow subgroup had “green” surgery, and experienced a coronal Cobb angle and LL decrease by 17° and 10°, respectively, and an SVA and PT increase by 1.3 cm and 5°, respectively. Seven patients placed in the red group who underwent “yellow” or “green” surgery had a reduction in coronal Cobb angle of 16°, CSVL of 0.1 cm, SVA of 2.8 cm, PT of 4°, VAS of 28 points, and ODI of 12 points; lumbar lordosis increased by 15°. Perioperative complications included 1 wound infection, transient postoperative thigh numbness in 2 cases, and transient groin pain in 1 patient. Conclusions Careful patient selection is important for the application of lateral minimally invasive techniques for adult degenerative scoliosis. Isolated lateral interbody fusion with or without instrumentation is suitable for patients with preserved spinopelvic harmony. Moderate sagittal deformity (compensated with pelvic retroversion) may be addressed with advanced derivatives of the lateral approach, such as releasing the anterior longitudinal ligament. For patients with severe deformity, the lateral approach may be used for anterior column support and to augment arthrodesis.

Perspectives and Lessons Learned after a Decade of Minimally Invasive Video-Assisted Thyroidectomy

ORL ◽  
2008 ◽  
Vol 70 (5) ◽  
pp. 282-286 ◽  
Author(s):  
P. Miccoli ◽  
P. Berti ◽  
C.E. Ambrosini
Keyword(s):  
Minimally Invasive ◽  
Lessons Learned ◽  
Video Assisted

Innovations in minimally invasive surgery: lessons learned from translational animal models

2013 ◽  
Vol 398 (7) ◽  
pp. 919-923 ◽  
Author(s):  
D. Mutter ◽  
B. Dallemagne ◽  
S. Perretta ◽  
M. Vix ◽  
J. Leroy ◽  
...  
Keyword(s):  
Minimally Invasive Surgery ◽  
Animal Models ◽  
Minimally Invasive ◽  
Invasive Surgery ◽  
Lessons Learned

Initial Experience with Non-Sternotomy Minimally Invasive Pulmonary Embolectomy with Thoracoscopic Assistance

2020 ◽  
Vol 15 (2) ◽  
pp. 180-184
Author(s):  
John M. Fallon ◽  
Jason W. Greenberg ◽  
Luvika Gupta ◽  
Omar M. Lattouf
Keyword(s):  
Length Of Stay ◽  
Minimally Invasive ◽  
Enhanced Recovery ◽  
Pulmonary Arteries ◽  
Median Sternotomy ◽  
Massive Pulmonary Embolism ◽  
Hospital Length Of Stay ◽  
Invasive Approach ◽  
Pulmonary Embolectomy ◽  
Recovery Times

The endpoint in emergent management of acute massive pulmonary embolism (PE) has traditionally been with embolectomy through standard median sternotomy. This approach is limited in both exposure and concomitant functional morbidity associated with sternotomy. Herein we describe a novel minimally invasive, thoracoscopically assisted approach to pulmonary embolectomy. This utilizes a small 5-cm left parasternal thoracotomy and femoral cardiopulmonary bypass to conduct thoracoscopically assisted surgical pulmonary embolectomy. This novel minimally invasive approach has been developed and successfully utilized in 3 patients with massive PE at our institution. The assistance of the thoracoscope allowed for complete visualization and clot extraction of the main and segmental pulmonary arteries bilaterally. The use of a non-sternotomy approach sped both functional and pulmonary recovery times and decreased length of stay. These initial data suggest that non-sternotomy minimally invasive surgical pulmonary embolectomy with thoracoscopic assistance is a feasible and safe approach for acute massive PE that may result in enhanced recovery times and decreased hospital length of stay.

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