scholarly journals Robot-assisted revision of sacroiliac joint fusion using a triangular titanium implant in an S2-alar-iliac trajectory: illustrative case

2021 ◽  
Vol 2 (1) ◽  
Author(s):  
Matthew Triano ◽  
Islam Fayed ◽  
Faheem A. Sandhu
Keyword(s):  
Quality Of Life ◽  
Minimally Invasive ◽  
Elderly Patients ◽  
Sacroiliac Joint ◽  
Titanium Implant ◽  
Invasive Technique ◽  
Illustrative Case ◽  
Robot Assisted ◽  
Invasive Approach

BACKGROUND Sacroiliac joint (SIJ) dysfunction can lead to significant pain and disability, greatly impairing quality of life. Arthrodesis may take up to 1 year to occur, after which revision can be considered. There is a need for highly accurate and reproducible techniques for revision that allow for purchase through undisturbed bone to prevent prolonged pain and disability. Moreover, a minimally invasive technique for revision would be favorable for recovery, particularly in elderly patients. OBSERVATIONS An 84-year-old man with a prior history of lumbar fusion presented with severe buttock pain limiting ambulation and sitting because of the failure of arthrodesis after SIJ fusion 1 year earlier. He underwent revision using a triangular titanium implant (TTI) in an S2-alar-iliac (S2-AI) trajectory under robotic guidance, which is a novel technique not yet described in the literature. The patient’s pain largely resolved, he was able to ambulate independently, and his quality of life improved tremendously. There were no complications of surgery. LESSONS Placement of a TTI using an S2-AI trajectory is a safe and effective method for revision that can be considered for elderly patients. Robot-assisted navigation can be used to facilitate an accurate and reproducible approach using a minimally invasive approach.

Minimally Invasive Separation Surgery for Metastases in the Vertebral Column: A Technical Report

2019 ◽  
Vol 18 (6) ◽  
pp. 606-613
Author(s):  
Rafael A Vega ◽  
Jeffrey I Traylor ◽  
Ahmed Habib ◽  
Laurence D Rhines ◽  
Claudio E Tatsui ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Spinal Cord ◽  
Minimally Invasive ◽  
Definitive Treatment ◽  
Invasive Technique ◽  
Thoracic Vertebrae ◽  
Minimally Invasive Techniques ◽  
Invasive Approach ◽  
Invasive Techniques

Abstract BACKGROUND Epidural spinal cord compression (ESCC) is a common and severe cause of morbidity in cancer patients. Minimally invasive surgical techniques may be utilized to preserve neurological function and permit the use of radiation to maximize local control. Minimally invasive techniques are associated with lower morbidity. OBJECTIVE To describe a novel, minimally invasive operative technique for the management of metastatic ESCC. METHODS A minimally invasive approach was used to cannulate the pedicles of the thoracic vertebrae, which were then held in place by Kirschner wires (K-wires). Following open decompression of the spinal cord, cannulated screws were placed percutaneously with stereotactic guidance through the pedicles followed by cement induction. Stereotactic radiosurgery is performed in the postoperative period for residual metastatic disease in the vertebral body. RESULTS The minimally invasive technique used in this case reduced tissue damage and optimized subsequent recovery without compromising the quality of decompression or the extent of metastatic tumor resection. Development of more minimally invasive techniques for the management of metastatic ESCC has the potential to facilitate healing and preserve quality of life in patients with systemic malignancy. CONCLUSION ESCC from vertebral metastases poses a challenge to treat in the context of minimizing potential risks to preserve quality of life. Percutaneous pedicle screw fixation with cement augmentation provides a minimally invasive alternative for definitive treatment of these patients.

scholarly journals Minimally invasive treatment of peristomal metastases from gastric cancer at an ileostomy site by electrochemotherapy

2013 ◽  
Vol 47 (4) ◽  
pp. 370-375 ◽  
Author(s):  
Luca G. Campana ◽  
Marco Scarpa ◽  
Antonio Sommariva ◽  
Elena Bonandini ◽  
Sara Valpione ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Gastric Cancer ◽  
Minimally Invasive ◽  
Tumor Regression ◽  
Tumor Control ◽  
Invasive Treatment ◽  
Invasive Approach ◽  
Electric Pulses ◽  
Skin Conditions

Abstract Background. Peristomal metastases are rare, but potentially associated with relevant morbidity. Surgical resection, followed by stoma relocation, represent the gold standard in most patients. We describe electrochemotherapy (ECT), a minimally invasive method for locally-enhancing drug delivery by means of electric pulses, as an alternative approach. Patient and methods. A 49-year-old man with advanced gastric cancer developed skin metastases around an ileostomy site. The ulcerated and oozing tumor growth impaired patient’s quality of life due to continuous trouble in fitting the ostomy appliance, its poor adherence and consequent stools spillage. ECT consisted of a 20-minute course under mild general sedation. A bleomycin bolus of 15 000 IU/m2 was followed by the percutaneous application of multiple, 1.5 ms -long electric pulses by means of a needle electrode. Results. Post ECT course was uneventful and the patient was discharged on the same day. After one week, tumor nodules were flattened and partial tumor regression was appreciable at one-month follow-up. More importantly, peristomal skin conditions significantly improved, thus allowing for an effective application of the ostomy appliance during the following moths, until patient’s death. Conclusions. This report suggests the feasibility of ECT as a minimally invasive approach for peristomal tumors. In selected cases, ECT, by achieving a rapid tumor control, may ensure effective ostomy management and preserve patients’ quality of life.

scholarly journals Electrochemotherapy and Simultaneous Photodynamic Bone Stabilization of Upper Limbs in Metastatic Renal Cancer Disease: Case Report and Literature Review

2020 ◽  
Vol 2020 ◽  
pp. 1-7
Author(s):  
Ugo Albertini ◽  
Andrea Conti ◽  
Nicola Ratto ◽  
Pietro Pellegrino ◽  
Michele Boffano ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Minimally Invasive ◽  
Bone Disease ◽  
Metastatic Bone Disease ◽  
Invasive Technique ◽  
Bone Lesions ◽  
Disease Case ◽  
Lytic Bone Lesions

Introduction. Metastatic bone disease represents a systemic pathology that heavily affects the quality of life of oncologic patients causing pain and functional disability. Methodology. We present the case of a patient with a history of renal cell cancer presenting pathologic fractures of both humeri and proximal right radius. Results. After a careful multidisciplinary approach, an adjuvant anticancer therapy and a photodynamic bone stabilization procedure were performed with a minimally invasive technique aiming to minimize pain and local disease progression, while restoring functional autonomy and improving the patient’s quality of life. Electrochemotherapy was delivered on the lytic bone lesions with extraskeletal involvement of the proximal left humerus and the proximal right radius, and then polymeric bone stabilization was performed on both humeri. At two months of follow-up, the patient presented satisfactory functional scores (MSTS score: 12/30 bilaterally; DASH scores: 46.7/100 for the right side and 48.3/100 for the left one), and pain was well controlled with opioid analgesics. Radiographs showed good results in terms of ossification of lytic bone lesions and durability of polymeric stabilization. At four months of follow-up, the patient reported a stable clinical scenario. Six months after surgery, due to extremely poor prognosis after the progression of primary disease, the patient was referred to palliative care and died shortly thereafter. Conclusion. Over the last decade, the management of metastatic bone disease has changed. Low-toxicity and minimally invasive procedures such as electrochemotherapy and polymeric bone stabilization might be performed concomitantly in selected patients, as an alternative to radiation therapy and to more demanding surgical procedures such as plating and adjuvant cementing.

Long-Term Follow-Up of Minimally Invasive Cardiac Surgery Using an Endoaortic Occlusion System

2014 ◽  
Vol 17 (2) ◽  
pp. 93 ◽  
Author(s):  
Arndt-H. Kiessling ◽  
Philipp Kisker ◽  
Alexandra Miskovic ◽  
Nestoras Papadopoulos ◽  
Andreas Zierer ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Minimally Invasive ◽  
Structural Damage ◽  
Aortic Wall ◽  
Artery Bypass ◽  
Mitral Valve Surgery ◽  
Ascending Aorta ◽  
Invasive Technique

<p><b>Objectives:</b> We reviewed the initial patient series (n=116) of our institution performing minimally invasive coronary artery bypass grafting (CABG) (n=79), mitral valve surgery (n=1), or atrial septal closure (ASD) procedures (n=26) using an endoaortic occlusion system. With this technique relevant intra-aortic pressures are exerted on the aortic wall during the clamping time. This might lead to late aortic degeneration and aneurysm formation. Our study sought to evaluate postoperative aortic complications and the quality of life (modified SF-12).</p><p><b>Methods:</b> One hundred sixteen patients (56% male; 54 years � 14.5; range 19 years to 77 years) underwent a cardiac procedure using an endoaortic clamp. The endoaortic balloon clamp catheter was used to occlude the ascending aorta at pressures >300 mmHg. Patients were rescheduled for echocardiographic examination after a mean follow-up period of 8.8 years.</p><p><b>Results:</b> The analysis performed among 78 patients showed no incidence of any structural damage to the ascending aorta at the intraoperative position of the endoaortic balloon. The physical and mental summary scores are equal to those of comparable patient groups.</p><p><b>Conclusions:</b> The endoaortic occlusion system causes no damage to the aortic wall. If the system causes any problems, they occur immediately during surgery. Patients treated with this minimally invasive technique exhibited the same quality of life as those undergoing conventional surgery.</p>

scholarly journals 1-Year Results of a Randomized Controlled Trial of Conservative Management vs. Minimally Invasive Surgical Treatment for Sacroiliac Joint Pain

2017 ◽  
Vol 6 (20;6) ◽  
pp. 537-550 ◽  
Author(s):  
Julius Dengler
Keyword(s):  
Quality Of Life ◽  
Randomized Controlled Trial ◽  
Minimally Invasive ◽  
Sacroiliac Joint ◽  
Controlled Trial ◽  
Titanium Implants ◽  
Leg Pain ◽  
Recurrent Pain ◽  
Randomized Controlled

Background: Low back pain (LBP) emanating from the sacroiliac joint (SIJ) is a common finding. Devices to fuse the SIJ are now commercially available, but high-quality evidence supporting their effectiveness is limited. Objectives: To compare the safety and effectiveness of conservative management (CM) to minimally invasive sacroiliac joint fusion (SIJF) in patients with chronic LBP originating from the SIJ. Study Design: Prospective, multicenter randomized controlled trial. Setting: One hundred three adults in spine clinics with chronic LBP originating from the SIJ. Methods: Patients were randomly assigned to CM (n = 51) or SIJF using triangular titanium implants (n = 52). CM consisted of optimization of medical therapy, individualized physiotherapy, and adequate information and reassurance as part of a multifactorial treatment. The primary outcome was the difference in change in self-rated LBP at 6 months using a 0 – 100 visual analog scale (VAS). Other effectiveness and safety endpoints, including leg pain, disability using Oswestry Disability Index (ODI), quality of life using EQ-5D, and SIJ function using active straight leg raise test (ASLR), were assessed up to 12 months. Results: At 12 months, mean LBP improved by 41.6 VAS points in the SIJF group vs. 14.0 points in the CM group (treatment difference of 27.6 points, P < 0.0001). Mean ODI improved by 25.0 points in the SIJF group vs. 8.7 points in the CM group (P < 0.0001). Mean improvements in leg pain and EQ-5D scores were large after SIJF and superior to those after CM. CM patients were allowed to crossover to SIJF after 6 months. Patients who crossed to surgical treatment had no pre-crossover improvement in pain and ODI scores; after crossover, improvements were as large as those originally assigned to SIJF. One case of postoperative nerve impingement occurred in the surgical group. Two SIJF patients had recurrent pain attributed to possible device loosening and one had postoperative hematoma. In the CM group, one crossover surgery patient had recurrent pain requiring a revision surgery. Limitations: The primary limitation was lack of blinding and the subjective nature of self-assessed outcomes. Conclusions: For patients with chronic LBP originating from the SIJ, minimally invasive SIJF with triangular titanium implants was safe and more effective than CM in relieving pain, reducing disability, and improving patient function and quality of life. Our findings will help to inform decisions regarding its use as a treatment option in this patient population.

scholarly journals Wireless Neuromodulation for Chronic Back Pain: Delivery of High-Frequency Dorsal Root Ganglion Stimulation by a Minimally Invasive Technique

2017 ◽  
Vol 2017 ◽  
pp. 1-4 ◽  
Author(s):  
Bart Billet ◽  
Roel Wynendaele ◽  
Niek E. Vanquathem
Keyword(s):  
Quality Of Life ◽  
Back Pain ◽  
Dorsal Root Ganglion ◽  
Minimally Invasive ◽  
High Frequency ◽  
Dorsal Root ◽  
Chronic Back Pain ◽  
Leg Pain ◽  
Invasive Technique

Objective. To evaluate the analgesic effect of a dorsal root ganglion (DRG) stimulation technology utilizing high-frequency pulse rates to treat intractable chronic back and leg pain. Methods. This case study presents the outcomes, with a novel, wireless, minimally invasive miniature neurostimulator system in a case of chronic back pain. The subject was implanted bilaterally with a Freedom 4A quadripolar electrode array at the L2 dorsal root ganglion. Stimulation was applied using 10 kHz pulse rate and 30 μs pulse width. A VAS pain-rating scale, Oswestry Disability Index (ODI), EQ-5D-5L Quality of Life Questionnaire 5 dimensions, and Patients’ Global Impression of Change (PGIC) scale were evaluated at 12 weeks and 6 months post implantation. Results. VAS pain scores for back pain reduced from 91 to 31 mms and 80 to 35 mms for leg pain. Additionally, while stimulation remained paresthesia-free, there were a marked decrease in pain medications and an increase in quality of life. Also, an increase in functionality from crippled to moderate was reported. There were no adverse reactions related to the procedure or device. Conclusion. The minimally invasive, wireless approach to deliver high-frequency, paresthesia-free DRG stimulation for treatment of chronic back and leg pain associated with FBSS was effective and encouraging.

scholarly journals Evaluation of Functional Outcomes and Quality of Life in Elderly Patients (>75 y.o.) Undergoing Minimally Invasive Radical Cystectomy with Single Stoma Ureterocutaneostomy vs. Bricker Intracorporeal Ileal Conduit Urinary Diversion

2021 ◽  
Vol 11 (1) ◽  
pp. 136
Author(s):  
Andrea Fuschi ◽  
Yazan Al Salhi ◽  
Manfredi Bruno Sequi ◽  
Gennaro Velotti ◽  
Alessia Martoccia ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Minimally Invasive ◽  
Elderly Patients ◽  
Radical Cystectomy ◽  
Ileal Conduit ◽  
Elderly Subjects ◽  
Group A ◽  
The Mean ◽  
Group B

Background: Diversion after radical cystectomy (RC) is crucial when considering elderly subjects. Data on the quality of life (QoL) impact with different diversions is scarce. This study aims to compare complications and QoL in patients aged > 75 y.o., who underwent minimally invasive (MI) RC with Bricker intracorporeal urinary derivation and single stoma ureterocutaneostomy. Methods: We conducted a retrospective analysis of elderly patients who underwent MIRC and intracorporeal diversion. The 78 subjects were divided into two groups: group A, ileal conduit, and group B, single stoma ureterocutaneostomy. We evaluated the bowel’s recovery time and complications rate. We investigated QoL 3 and 6 months after surgery using the Stoma-QoL questionnaire. Results: Mean age was 77.2 in group A and 82.4 in group B. The mean ASA score and Charlson Comorbidity index were comparable between the two groups. Rates of complications were 57.6% and 37.4% in groups A and B, respectively. The mean postoperative Stoma-QoL score 3 months after surgery was 52.2 and 52.4 in groups A and B, respectively. At 6 months of follow-up the Stoma QoL mean score was 63.4, showing homogeneity between the groups. Conclusion: MIRC with single stoma ureterocutaneostomy represents an alternative to ileal conduit, with comparable QoL and ostomy management 6 months after surgery, reporting fewer complications.

Minimally invasive surgery for colorectal cancer: quality of life and satisfaction with care in elderly patients

2013 ◽  
Vol 27 (8) ◽  
pp. 2911-2920 ◽  
Author(s):  
Marco Scarpa ◽  
Loretta Di Cristofaro ◽  
Matteo Cortinovis ◽  
Eleonora Pinto ◽  
Maurizio Massa ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Colorectal Cancer ◽  
Minimally Invasive Surgery ◽  
Minimally Invasive ◽  
Elderly Patients ◽  
Invasive Surgery ◽  
Satisfaction With Care
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