Minimally Invasive Surgery最新文献

{"title":"Challenges and Results of Laparoscopic Splenectomy for Hematological Diseases in a Developing Country.","authors":"Vikal Chandra Shakya,&nbsp;Bikram Byanjankar,&nbsp;Rabin Pandit,&nbsp;Anang Pangeni,&nbsp;Anir Ram Moh Shrestha,&nbsp;Bishesh Poudyal","doi":"10.1155/2018/4256570","DOIUrl":"https://doi.org/10.1155/2018/4256570","url":null,"abstract":"<p><strong>Introduction: </strong>Though, in developed countries, laparoscopy is now a gold standard for splenectomy, we are lacking in this aspect in the eastern world. Splenectomy has mostly been performed by open surgery in our region. This is our effort to introduce laparoscopic splenectomy in our country.</p><p><strong>Methods: </strong>This is a retrospective cohort study done in patients presenting to hematology and surgery department of our hospital who underwent laparoscopic splenectomy for hematological diseases from January 2013 to December 2016.</p><p><strong>Results: </strong>There were 50 patients (38 females, 12 males). The diagnoses were idiopathic thrombocytopenic purpura in 31, (steroid/azathioprine-resistant, steroid dependent), hereditary spherocytosis in 9, alpha-thalassemia in 3, beta-thalassemia in 2, autoimmune hemolytic anemia in 4, and isolated splenic tuberculosis in 1. Average platelet counts preoperatively were 62000 ± 11000/mm3 (range 52000-325000/mm3). The mean operative time was 130 ± 49 minutes (range 108-224 min). The mean postoperative stay was 4 ± 2.11 days (range 3-9 days). Laparoscopic splenectomy could be completed in 45 (90%) patients.</p><p><strong>Conclusion: </strong>Laparoscopic splenectomy could be successfully contemplated in patients with hematological diseases, especially if spleen is normal or only mildly enlarged, and is an advantageous alternative to open splenectomy. Absence of ideal resources has not limited our progress in minimal access approach.</p>","PeriodicalId":45110,"journal":{"name":"Minimally Invasive Surgery","volume":"2018 ","pages":"4256570"},"PeriodicalIF":1.8,"publicationDate":"2018-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1155/2018/4256570","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"36438442","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"'True Day Case' Laparoscopic Cholecystectomy in a High-Volume Specialist Unit and Review of Factors Contributing to Unexpected Overnight Stay.","authors":"A Solodkyy,&nbsp;A R Hakeem,&nbsp;N Oswald,&nbsp;F Di Franco,&nbsp;S Gergely,&nbsp;A M Harris","doi":"10.1155/2018/1260358","DOIUrl":"https://doi.org/10.1155/2018/1260358","url":null,"abstract":"<p><strong>Introduction: </strong>Laparoscopic cholecystectomy (LC) is the gold standard treatment for gallstones. British Association of Day Case Surgery recommends at least 60% of LCs be performed as day cases. The aim of this study was to assess our rate of true day case LCs and review factors preventing same-day discharge.</p><p><strong>Methods: </strong>We prospectively collected data of all elective LCs performed in a district general hospital over 32 months.</p><p><strong>Results: </strong>500 patients underwent LC during this period; 438 (88.2%) patients were planned day cases and 59 patients (11.8%) planned overnight stays. Of the planned day cases, 75.8% (n=332) were discharged on the same day and 106 (24.2%) had unexpected overnight stay (UOS). Most patients with BMI >35 and ASA3 planned day case patients were successfully discharged. Drain insertion, longer operations, and late recovery departure were the main reasons for UOS. There were more complications in this group compared to day cases.</p><p><strong>Conclusions: </strong>This unit has a high 'true day case' rate of 75.8%. High BMI and ASA3 should not be absolute contraindications to day case surgery. The majority of unexpected overnight stays are unavoidable but may be reduced by patient selection, stringent preoperative assessment, operation scheduling, and reduction in unnecessary drain insertion.</p>","PeriodicalId":45110,"journal":{"name":"Minimally Invasive Surgery","volume":"2018 ","pages":"1260358"},"PeriodicalIF":1.8,"publicationDate":"2018-07-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1155/2018/1260358","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"36421249","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Interspinous Process Decompression Improves Quality of Life in Patients with Lumbar Spinal Stenosis.","authors":"Pierce D Nunley,&nbsp;Vikas V Patel,&nbsp;Douglas G Orndorff,&nbsp;William F Lavelle,&nbsp;Jon E Block,&nbsp;Fred H Geisler","doi":"10.1155/2018/1035954","DOIUrl":"https://doi.org/10.1155/2018/1035954","url":null,"abstract":"<p><p>Lumbar spinal stenosis has been shown to negatively impact health-related quality of life. Interspinous process decompression (IPD) is a minimally invasive procedure that utilizes a stand-alone spacer to serve as a joint extension blocker to relieve neural compression in patients with spinal stenosis. Using the 5-year results from an FDA randomized controlled trial of IPD, the quality of life in 189 patients treated with the Superion® spacer was evaluated with the SF-12. Physical and mental component summary (PCS, MCS) scores were computed preoperatively and at annual intervals. For the PCS, mean scores improved from 29.4 ± 8.1 preoperatively to 41.2 ± 12.4 at 2 years (40%) and to 43.8 ± 11.6 at 5 years (49%) (p<0.001 for both comparisons). At 2 years, 81% (103 of 128) of subjects demonstrated maintenance or improvement in PCS scores. The mean MCS score improved from 50.0 ± 12.7 preoperatively to 54.4 ± 10.6 and 54.7 ± 8.6 at 2 and 5 years, respectively (p>0.10 for both comparisons). These results demonstrate that the significant impairment in physical well-being found in patients with lumbar spinal stenosis can be ameliorated, in large part, by IPD treatment.</p>","PeriodicalId":45110,"journal":{"name":"Minimally Invasive Surgery","volume":"2018 ","pages":"1035954"},"PeriodicalIF":1.8,"publicationDate":"2018-07-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1155/2018/1035954","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"36352827","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Association between Obesity, Surgical Route, and Perioperative Outcomes in Patients with Uterine Cancer.","authors":"Entidhar Al Sawah,&nbsp;Jason L Salemi,&nbsp;Mitchel Hoffman,&nbsp;Anthony N Imudia,&nbsp;Emad Mikhail","doi":"10.1155/2018/5130856","DOIUrl":"https://doi.org/10.1155/2018/5130856","url":null,"abstract":"<p><strong>Objective: </strong>To study temporal trends of hysterectomy routes performed for uterine cancer and their associations with body mass index (BMI) and perioperative morbidity.</p><p><strong>Methods: </strong>A retrospective review of the American College of Surgeons-National Surgical Quality Improvement Program (ACS-NSQIP) 2005-2013 databases was conducted. All patients who were 18 years old and older with a diagnosis of uterine cancer and underwent hysterectomy were identified using ICD-9-CM and CPT codes. Surgical route was classified into four groups: total abdominal hysterectomy (TAH), total vaginal hysterectomy (TVH), laparoscopic assisted vaginal hysterectomy (LAVH), and total laparoscopic hysterectomy (TLH) including both conventional and robotically assisted. Patients were then stratified according to BMI.</p><p><strong>Results: </strong>7199 records were included in the study. TLH was the most commonly performed route of hysterectomy regardless of BMI, with proportions of 50.9%, 48.9%, 50.4%, and 51.2% in ideal, overweight, obese, and morbidly obese patients, respectively. The median operative time for TAH was 2.2 hours compared to 2.7 hours for TLH (<i>p</i> < 0.01). The median length of stay for TAH was 3 days compared to 1 day for TLH (<i>p</i> < 0.01). The percentage of patients with an adverse outcome (composite indicator including transfusion, deep venous thrombosis, and infection) was 17.1 versus 3.7 for TAH and TLH, respectively (<i>p</i> < 0.01).</p><p><strong>Conclusion: </strong>During the last decade, TLH has been increasingly performed in women with uterine cancer. The increased adoption of TLH was seen in all BMI subgroups.</p>","PeriodicalId":45110,"journal":{"name":"Minimally Invasive Surgery","volume":"2018 ","pages":"5130856"},"PeriodicalIF":1.8,"publicationDate":"2018-06-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1155/2018/5130856","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"36321569","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Elective \"True Day Case\" Laparoscopic Inguinal Hernia Repair in a District General Hospital: Lessons Learned from 1000 Consecutive Cases.","authors":"A Solodkyy,&nbsp;M Feretis,&nbsp;A Fedotovs,&nbsp;F Di Franco,&nbsp;S Gergely,&nbsp;A M Harris","doi":"10.1155/2018/7123754","DOIUrl":"https://doi.org/10.1155/2018/7123754","url":null,"abstract":"<p><strong>Introduction: </strong>Laparoscopic inguinal hernia repair (LIHR) is ideal for day case surgery. It is recommended that at least 70% should be day cases as a measure of cost-effectiveness. The aims of this study were to (i) assess the rate of true day case (TDC) surgery and (ii) identify predictors associated with unexpected overnight stay (UOS).</p><p><strong>Methods: </strong>Data was collected prospectively on 1000 consecutive elective LIHR performed in a District General Hospital (DGH) over a 7-year period. Data was collected on baseline patient demographics, ASA grade, and intraoperative details. A multivariate analysis was performed in order to identify predictors of UOS.</p><p><strong>Results: </strong>1000 patients (927 males) underwent elective LIHR. Mean age was 57.3±15.2 years. 915 patients were planned as day case procedures. 822/915 day cases (89.8%) were discharged on the same day and 93 (10.2%) stayed overnight unexpectedly. Patient age, duration of procedure, and patient slot in the operating list were found to be independent predictors (p<0.05) of UOS.</p><p><strong>Conclusion: </strong>Our results demonstrate that LIHR is a \"true\" day case procedure in a DGH. Although some factors associated with UOS cannot be altered, careful patient selection and operating list planning are of paramount importance in order to minimise the burden on healthcare resources.</p>","PeriodicalId":45110,"journal":{"name":"Minimally Invasive Surgery","volume":"2018 ","pages":"7123754"},"PeriodicalIF":1.8,"publicationDate":"2018-06-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1155/2018/7123754","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"36282734","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Changes in Hysterectomy Route and Adnexal Removal for Benign Disease in Australia 2001-2015: A National Population-Based Study.","authors":"Natalie De Cure,&nbsp;Stephen J Robson","doi":"10.1155/2018/5828071","DOIUrl":"https://doi.org/10.1155/2018/5828071","url":null,"abstract":"<p><strong>Objective: </strong>Hysterectomy rates have fallen over recent years and there remains debate whether salpingectomy should be performed to reduce the lifetime risk of ovarian cancer. We examined trends in adnexal removal and route of hysterectomy in Australia between 2001 and 2015.</p><p><strong>Methods: </strong>Data were obtained from the national procedural dataset for hysterectomy approach (vaginal, VH; abdominal, AH; and, laparoscopic, LH) and rates of adnexal removal, as well as endometrial ablation. The total female population in two age groups (\"younger age group,\" 35 to 54 years, and \"older age group,\" 55 to 74 years) was obtained from the Australian Bureau of Statistics.</p><p><strong>Results: </strong>The rate of hysterectomy fell in both younger (61.7 versus 45.2/10000/year, <i>p</i> < 0.005) and older (38.8 versus 33.2/10000/year, <i>p</i> < 0.005) age groups. In both age groups there were significant decreases in the incidence rates for VH (by 53% in the younger age group and 29% in the older age group) and AH (by 53% and 55%, respectively). The rates of LH increased by 153% in the younger age group and 307% in the older age group. Overall, the proportion of hysterectomies involving adnexal removal increased (31% versus 65% in the younger age group, <i>p</i> < 0.005; 44% versus 58% in the older age group, <i>p</i> < 0.005). The increase occurred almost entirely after 2011.</p><p><strong>Conclusion: </strong>Hysterectomy is becoming less common, and both vaginal and abdominal hysterectomy are being replaced by laparoscopic hysterectomy. Removal of the adnexae is now more common in younger women.</p>","PeriodicalId":45110,"journal":{"name":"Minimally Invasive Surgery","volume":"2018 ","pages":"5828071"},"PeriodicalIF":1.8,"publicationDate":"2018-05-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1155/2018/5828071","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"36269416","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Corrigendum to \"A Comparative Study in Learning Curves of Two Different Intracorporeal Knot Tying Techniques\".","authors":"Manuneethimaran Thiyagarajan,&nbsp;Chandru Ravindrakumar","doi":"10.1155/2018/7646831","DOIUrl":"https://doi.org/10.1155/2018/7646831","url":null,"abstract":"<p><p>[This corrects the article DOI: 10.1155/2016/3059434.].</p>","PeriodicalId":45110,"journal":{"name":"Minimally Invasive Surgery","volume":"2018 ","pages":"7646831"},"PeriodicalIF":1.8,"publicationDate":"2018-05-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1155/2018/7646831","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"36210487","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Laparoscopic Choledochotomy in a Solitary Common Duct Stone: A Prospective Study.","authors":"K B Deo,&nbsp;S Adhikary,&nbsp;S Khaniya,&nbsp;V C Shakya,&nbsp;C S Agrawal","doi":"10.1155/2018/8080625","DOIUrl":"https://doi.org/10.1155/2018/8080625","url":null,"abstract":"<p><strong>Background: </strong>Laparoscopic common bile duct exploration has all the advantages of minimal access and is also the most cost effective compared to the other options.</p><p><strong>Objective: </strong>To study a profile on laparoscopic common bile duct exploration for a single common duct stone.</p><p><strong>Methods: </strong>A total of 30 consecutive patients with solitary common bile duct stone attending our hospital over a period of one year were enrolled in the study. Laparoscopic common bile duct exploration was done by transductal route in all the patients.</p><p><strong>Results: </strong>There were 18 females and 12 males with age ranging from 28 to 75 years. Jaundice was present in 12 (40%) patients. Twenty-four (80%) patients had raised alkaline phosphatase. The mean size of CBD on ultrasound was 11.55 mm. The mean size of calculus was 11.06 mm and was located in the distal CBD in 26 (86.7%) patients. The mean operative time was 158.4 ± 57.89 min. There were 8 (26.6%) conversions to open procedure. T-tube was used in 26 (86.7%) patients. The postoperative complications were hospital acquired chest infection in 3 (10%), surgical site infection in 3 (10%), acute coronary syndrome in one (3.3%), and bile leak after T-tube removal in one (3.3%) patient.</p><p><strong>Conclusions: </strong>Laparoscopic common bile duct exploration is an effective, safe management of common bile duct stone.</p>","PeriodicalId":45110,"journal":{"name":"Minimally Invasive Surgery","volume":"2018 ","pages":"8080625"},"PeriodicalIF":1.8,"publicationDate":"2018-05-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1155/2018/8080625","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"36189337","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Residency Training in Robotic General Surgery: A Survey of Program Directors.","authors":"Lea C George, Rebecca O'Neill, Aziz M Merchant","doi":"10.1155/2018/8464298","DOIUrl":"10.1155/2018/8464298","url":null,"abstract":"<p><strong>Objective: </strong>Robotic surgery continues to expand in minimally invasive surgery; however, the literature is insufficient to understand the current training process for general surgery residents. Therefore, the objectives of this study were to identify the current approach to and perspectives on robotic surgery training.</p><p><strong>Methods: </strong>An electronic survey was distributed to general surgery program directors identified by the Accreditation Council for Graduate Medical Education website. Multiple choice and open-ended questions regarding current practices and opinions on robotic surgery training in general surgery residency programs were used.</p><p><strong>Results: </strong>20 program directors were surveyed, a majority being from medium-sized programs (4-7 graduating residents per year). Most respondents (73.68%) had a formal robotic surgery curriculum at their institution, with 63.16% incorporating simulation training. Approximately half of the respondents believe that more time should be dedicated to robotic surgery training (52.63%), with simulation training prior to console use (84.21%). About two-thirds of the respondents (63.16%) believe that a formal robotic surgery curriculum should be established as a part of general surgery residency, with more than half believing that exposure should occur in postgraduate year one (55%).</p><p><strong>Conclusion: </strong>A formal robotics curriculum with simulation training and early surgical exposure for general surgery residents should be given consideration in surgical residency training.</p>","PeriodicalId":45110,"journal":{"name":"Minimally Invasive Surgery","volume":"2018 ","pages":"8464298"},"PeriodicalIF":1.8,"publicationDate":"2018-05-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5964613/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"36181976","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effects of Fatigue Based on Electroencephalography Signal during Laparoscopic Surgical Simulation.","authors":"Nyakuru Z Ndaro,&nbsp;Shu-Yi Wang","doi":"10.1155/2018/2389158","DOIUrl":"https://doi.org/10.1155/2018/2389158","url":null,"abstract":"<p><strong>Background: </strong>Following recent advances in technology, there is a growing interest in studying fatigue based on electrophysiological signals as a means of monitoring brain activity. While some existing works relate fatigue to performance, others consider the two as independent entities. Therefore, we must explore this intricate issue, particularly in laparoscopic training, for the sake of patient safety.</p><p><strong>Objective: </strong>This paper explores and evaluates effects of fatigue on efficiency and accuracy based on laparoscopic surgical training using Electroencephalography (EEG) signal.</p><p><strong>Materials and methods: </strong>20 college students performed peg transfer task on laparoscopic simulator, with real-time recording of EEG signals for each subject. To monitor degree of fatigue, a real-time fatigue monitoring system based on fatigue analysis algorithm was designed through the use of EEG in alpha (<i>α</i>) and theta (<i>θ</i>) rhythms. We designed data acquisition and fatigue analysis modules based on MATLAB platform. BrainLink was used to record EEG signals and send them to personal computer wirelessly via Bluetooth. While artifacts from the captured EEG signals were removed using Blind Source Separation (BSS), <i>α</i> and <i>θ</i> rhythms were extracted using wavelet analysis. Fatigue was evaluated based on Regression Model and Mahalanobis Distance (<i>D</i>_<i>C</i> ), and its threshold was determined from the experimental results using Receiver Operating Characteristic (ROC) curve analysis.</p><p><strong>Results: </strong>Completion time and number of errors behaved like a decreasing function during the first few trials while increasing afterwards with the increasing of perceived fatigue level. The results indicate that learning curve of the subjects is increasing until 13th trials when they have attained maximum learning benefits and decreases afterwards due to fatigue.</p><p><strong>Conclusion: </strong>Regression analysis shows that there are significant learning and fatigue effects when peg transfer task in the training is repeated in a series of trials. However, for the training to be effective and efficient, there should be monitoring during the training to observe where in the learning curve a trainee gains maximum learning benefits. Furthermore, fatigue is a significant indicator of efficiency and accuracy in terms of completion time and errors, respectively.</p>","PeriodicalId":45110,"journal":{"name":"Minimally Invasive Surgery","volume":"2018 ","pages":"2389158"},"PeriodicalIF":1.8,"publicationDate":"2018-05-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1155/2018/2389158","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"36181975","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}