Objective To investigate the cl inical results and complications of minimally invasive anterior transarticular screw fixation and fusion for atlantoaxial instabil ity. Methods Between May 2007 and December 2010, 13 patients with atlantoaxial instabil ity were treated with minimally invasive anterior transarticular screw fixation and fusion under endoscope. There were 11 males and 2 females, aged 17-61 years (mean, 41.3 years). The time between injury and operation was 5-14 days (mean, 7.4 days). All cases included 6 patients with Jefferson fracture, 5 with odontoid fracture, and 2 with os odontoideum. According to Frankel classification of nerve functions, 2 cases were rated as grade D and 11 cases as graed E. The operation time, intra-operative blood loss, radiation exposure time, and complications were recorded and analyzed. The stabil ity was observed by X-ray films. The cl inical outcome was assessed using the Frankel scale, and the fusion rates were determined by CT scan threedimensional reconstruction at last follow-up. Results The mean operation time was 124 minutes (range, 95-156 minutes); the mean intra-operative blood loss was 65 mL (range, 30-105 mL); and the mean radiation exposure time was 41 seconds (range, 30-64 seconds). Thirteen patients were followed up 12-47 months (mean, 25.9 months). No blood vessel and nerve injuries or internal fixator failure occurred. The bone fusion time was 6 months, and the dynamic cervical radiography showed no instabil ity occured. At last follow-up, the neurological function was grade E in all patients. The fusion rate was 84.6% (11/13). No continuous bone bridge was seen in the joint space of 2 patients, but they achieved stabil ity. Conclusion Minimally invasive anterior transarticular screw fixation and fusion is a safe and effective procedure for treatment of atlantoaxial instabil ity.
ObjectiveTo summarize the data of robotic hysterectomy in patients with large and super-large uterus in single center, and explore the relevant clinical experience and advantages of robotic surgery.MethodsThe medical records of the patients with large uterus caused by gynecological diseases who underwent robotic hysterectomy in the Chinese PLA General Hospital from January 2016 to December 2018 were retrospectively analyzed. The patients with uterine size from 12 to 16 weeks of gestation were divided into large uterus group and those with uterine volume larger than 16 weeks of gestation were divided into super large uterus group.ResultsA total of 62 patients were included, including 28 in the large uterus group with the average uterus size of (14.3±2.1) gestational weeks, and 34 in the super large uterus group with the average uterus size of (19.9±2.8) gestational weeks. There was no significant difference in mean age, body mass index, history of abdominal surgery or diagnostic composition between the two groups (P>0.05), except for the size of the uterus (t=8.772, P<0.001). The operation time in the large uterus group was less than that in the super-large uterus group [(75.4±22.6) vs. (91.7±27.8) min; t=2.495, P=0.015]. The incidence of complications after robotic hysterectomy was 14.5% (9/62) in the 62 patients, including 14.3% (4/28) in the large uterus group and 14.7% (5/34) in the super-large uterus group. There was no significant difference in the amount of bleeding, blood transfusion rate, ratio of conversion to open surgery, average hospitalization days or incidence of postoperative complications between the two groups (P>0.05).ConclusionsRobotic hysterectomy has the advantages of flexible manipulator, 3-D operative field of vision and stability of manipulation. In addition, increased uterine volume does not lead to increased surgical trauma, nor apparently affect the prognosis.
ObjectiveTo explore the effectiveness of thoracoscopic surgery for treating late-presenting congenital diaphragmatic hernias and summarize the experience. MethodsBetween October 2012 and February 2015, 21 children with late-presenting congenital diaphragmatic hernias underwent thoracoscopic surgery. Of the 21 cases, 12 were girls and 9 were boys with a median age of 1 year and 3 months (range, 2 months to 8 years). Eight patients had obvious symptom in the initial stage:shortness of breath and dyspnea; 13 cases were found occasionally through chest radiography. Of 21 cases, 17 had left diaphragmatic hernias and 4 had right diaphragmatic hernias. The emergency surgery was performed in 5 cases because oppressed obviously and selective operation in 16 cases. Hernial sac existed in 5 cases; there were 19 cases of Bochdalek's hernia and 2 cases of Morgagni's hernia. The size of diaphragmatic defect ranged from 3 cm×2 cm to 5 cm×5 cm. ResultsThe operation time was 35-80 minutes (mean, 50 minutes), and intraoperative blood loss was 3-5 mL (mean, 3.8 mL). Primary healing of incision was obtained. Postoperative abdominal distension and pneumothorax occurred in 12 and 2 cases respectively. The follow-up time was 1-3 years (mean, 20 months). All the cases had a good recovery and satisfactory appearance of the thoracic incision. The symptoms and signs of shortness of breath and dyspnea disappeared. There was no recurrence and chest infection. ConclusionUnder the conditions of mastering operative indications strictly, thoracoscopic repair for late-presenting congenital diaphragmatic hernia is safe and feasible. It can facilitate the procedure and decrease the recurrence rate relying on intraoperative application of hernia repair needle, knot pusher-assistant, and reasonable processing defect periphery.
ObjectiveTo compare the safety and clinical outcomes of isolated aortic valve replacement (AVR)through right anterior minithoracotomy (RAMT)and conventional median sternotomy. MethodsFrom March 2006 to March 2013, 169 patients underwent isolated AVR in Department of Cardiothoracic Surgery, Xinhua Hospital, Shanghai Jiaotong University School of Medicine. Among them, 42 patients received AVR via RAMT (RAMT group)including 30 males and 12 females with their age of 59.31±8.30 years. And 127 patients received AVR via conventional median sternotomy (conventional surgery group)including 89 males and 38 females with their age of 60.02±5.93 years. There were 75 patients with aortic valve stenosis (AS), 42 patients with aortic regurgitation (AR)and 52 patients with AS+AR. Postoperative outcomes were compared between the 2 groups. ResultsThere was no statistical difference in preoperative clinical characteristics between the 2 groups. All the patients successfully received isolated AVR. 153 patients received mechanical prosthesis and 16 patients received bioprosthetic valves. Fifty-two patients received 21 mm valves, and 117 patients received 23 mm valves. Cardiopulmonary bypass time and aortic cross-clamping time of RAMT group were significantly longer than those of conventional surgery group (P < 0.001). But mechanical ventilation time, length of postoperative ICU stay and hospital stay of RAMT group were significantly shorter than those of conventional surgery group (P < 0.001). Postoperative thoracic drainage, intraoperative and postoperative blood transfusion of RAMT group were significantly less than those of conventional surgery group (P < 0.001). In conventional surgery group, 2 patients underwent reexploration for bleeding and 2 patients had wound infection postoperatively. Two patients died postoperatively, both in conventional surgery group, including 1 patient with low cardiac output syndrome and multiple organ dysfunction syndrome, and another patient with prosthetic valve endocarditis secondary to sternal wound infection. ConclusionCompared with conventional median sternotomy, RAMT is safe and efficacious for patients undergoing isolated AVR with minimal surgical injury, better postoperative recovery and cosmetic outcomes.
ObjectiveTo compare the early clinical and radiographic outcomes of hemiarthroplasty by a minimal invasive Supercap approach and by a conventional approach for elderly displaced femoral neck fractures. MethodsBetween January and June 2015, 70 geriatric patients with displaced femoral neck fracture underwent cementless bipolar hemiarthroplasty by minimally invasive Supercap approach (group A, n=35) or by posterolateral approach (group B, n=35). One patient was excluded from the study in group B because of too wide femur cavity. There was no significant difference in gender, age, body mass index, fracture cause, time from fracture to operation, fracture side, fracture classification, and preoperative visual analogue scale (VAS), and hemoglobin-level between the 2 groups (P > 0.05). The operation time, intraoperative blood loss, incision length, and complications were recorded. The early clinical evaluations included timed up and go test (TUG), hemoglobin-level, VAS score, and satisfaction. The anteroposterior and lateral X-ray films were taken to measure the stem alignment, difference in leg length, and difference in femoral offset. ResultsAll the patients were followed up 6-11 months (mean, 7.32 months). No patients died during follow-up. There was no significant difference in operation time and intraoperative blood loss between the 2 groups (P > 0.05). The incision length of group A was significantly smaller than that of group B (P < 0.05). One patient had delayed union of incision in group A (2.86%); 2 patients had deep vein thrombosis in group B (5.88%); and there was no significant difference in the complication rate (χ2=0.764, P=0.512). The postoperative hemoglobin level showed no significant difference between the 2 groups (P > 0.05). Group A had lower VAS score and higher subjective satisfaction than group B, showing significant difference at 1, 5, and 14 days after operation (P < 0.05). The TUG of group A was significantly shorter than that of group B at 5, 14, and 30 days (P < 0.05). There was no significant difference in femoral offset or leg length on the X-ray films (t=1.273, P=0.851; t=0.409, P=0.327). The good rate of stem alignment was 82.86% (29/35) in group A, and was 85.30% (29/34) in group B, showing no significant difference (χ2=0.584, P=0.497). ConclusionBoth minimal invasive Supercap approach and conventional posterolateral approach are effective and safe for elderly displaced femoral neck fractures in hemiarthroplasty. Supercap approach has the advantages of less trauma, pain relief, and improvement of mobility and rapid rehabilitation.
ObjectiveTo analyze the effectiveness of direct screw repair for lumbar spondylolysis by using intraoperative O-arm based navigation and microendoscopic techniques. MethodsBetween February 2012 and May 2014, 11 consecutive patients with lumbar spondylolysis were treated with Buck's procedure by the aid of intraoperative O-arm based navigation and minimally invasive approach. The debridement and autograft of pars interarticularis defects was performed under microendoscopy. There were 7 males and 4 females, with an average age of 28.4 years (range, 19-47 years) and an average disease duration of 10.5 months (range, 8-23 months); no nerve symptoms or signs of lower limb was observed. The radiological examinations showed single level bilateral lumbar spondylolysis without obvious disc degeneration, lumbar instability, or spondylolisthesis. Isthmic injury located at L4 in 2 cases and at L5 in 9 cases. Of 11 patients, 7 were rated as grade 2 disc degeneration, and 4 as grade 3 disc degeneration according to the modified Pfirrmann classification system. The operation time, intraoperative blood loss, and complications were recorded. The fluoroscopic examinations were performed to assess defect repair and screw position. Visual analogue scale (VAS) score was used to evaluate the improvement of low back pain. ResultsThe average operation time was 147.6 minutes (range, 126-183 minutes). The average blood loss was 54.9 mL (range, 40-85 mL). Primary healing of incision was obtained. There was no complication of nerve root injury, dural tear, or infection. Three patients had pain at donor site postoperatively, and pain disappeared within 3 weeks. The average follow-up duration was 15.7 months (range, 10-23 months). VAS score of low back pain was significantly decreased from preoperative 7.1±2.3 to 1.8±0.4 at last follow-up (t=13.42, P=0.01). Of 22 isthmic bone grafting, bilateral isthmic bony fusion was achieved in 7 patients and unilateral isthmic bony fusion in 3 patients at 6-10 months (mean, 7.9 months). One patient failed bilateral isthmic bony fusion, and had bony resorption. ConclusionDebridement, autograft, and percutaneous intralaminar screw fixation by microendoscopy and O-arm based navigation may provide safe and effective treatment for spondylolysis. Minimally invasive direct repair can obtain satisfactory effectiveness.
ObjectiveTo investigate the significance of Fogarty catheter embolectomy combined with multiple minimally invasive techniques for acute limb ischemia. MethodsClinical data of 88 cases(88 limbs) of lower limb ischemia who were treated in our hospital from Feb. 2007 to Jan. 2011 were collected and analyzed. Of the 88 patients, 46 cases were operated by Fogarty catheter embolectomy(embolectomy group), 42 cases were operated by Fogarty catheter embolectomy combined with multiple minimally invasive techniques(combination group). Comparisons of the clinical indexes of ankle-brachial index(ABI), saturation of blood oxygen(SO2) of toes, and temperature of foot skin before and after operation were performed between the 2 groups, as well as the incidence of mortality, complication, and amputation after operation. ResultsCompared with before operation in the same group, the value of ABI, SO2, and temperature of foot skin in the 2 groups were higher(P<0.05), as well as the 3 kinds of indexes were both higher in combination group after operation(P<0.05). The rates of mortality, amputation, myonephropathic metabolic syndrome(MNMS), osteofascial compartment syndrome, and transient renal insufficiency were 13.04%(6/46), 17.39%(8/46), 26.09% (12/46), 26.09%(12/46), and 13.04%(6/46) respectively, the corresponding rates in combination group were 4.76% (2/42), 7.14%(3/42), 14.29%(6/42), 9.52%(4/42), and 9.52%(4/42) respectively, which were all lower in combination group(P<0.05). ConclusionFogarty catheter embolectomy combined with multiple minimally invasive techniques can be one of the surgical treatment methods for acute limb ischemia, which is characterized by minimally invasive surgery and effective treatment.
Objective To explore the variation about the application of fast-track surgery and laparoscopy in treatment for colorectal cancer in recent years． To investigate the probability of combining protocols of the two for treatment for colorectal cancer. Methods The clinical and basic literatures of related researches about colorectal treatment of laparoscopy and fast-track surgery were collected and reviewed. Results Compared with the traditional treatment modalities, both of fast-track surgery and laparoscopy used for the treatment of colorectal cancer have better clinical effects. Conclusions Fast-track surgery and laparoscopic techniques used for the treatment of colorectal cancer are feasible, but the combination of the two should be confirmed by further randomized controlled trials.
ObjectiveTo summarize the application and clinical effect of left anterior minimally invasive thoracotomy to surgical repair of subarterial ventricular septal defect (VSD) in children.MethodsFrom October 2015 to April 2019, 21 children with subarterial VSD underwent surgical repair via left anterior minimally invasive thoracotomy. There were 13 males and 8 females, aged 5-13 (9.1±2.2) years, and weighing 22-55 (35.6±9.5) kg. The diameter of subarterial VSD was 4-15 (9.1±3.3) mm. Eight patients had right coronary valve prolapse, and 4 aortic valve regurgitation (3 mild and 1 mild-to-moderate). The minimally invasive surgery was performed via left parasternal thoracotomy through the second or third intercostal space. The peripheral perfusion was performed with femoral arterial and venous cannulation. After aortic cross-clamp (ACC), subarterial VSD was performed with direct suture of patch closure through an incision on the root of pulmonary artery.ResultsAll patients successfully underwent surgical repair (patch closure, n=15; direct suture, n=6) of subarterial VSD through left anterior minimally invasive thoracotomy. The cardiopulmonary bypass time was 45-68 (57.1±6.3) min. The ACC time was 23-40 (32.6±4.7) min. The postoperative ventilation time was 5-9 (6.3±1.3) h, postoperative in-hospital time was 5-8 (5.7±1.0) d and drainage volume was 33-105 (57.5±17.7) mL in postoperative 24 h. No death, residual VSD shunt, atrioventricular block, wound infection or thoracic deformity occurred during the perioperation or follow-up. Only one patient still had trivial aortic valve regurgitation.ConclusionLeft anterior minimally invasive thoracotomy could be safely and effectively applied to surgical repair of subarterial VSD in children, with satisfactory early- and mid-term outcomes.
Objective To evaluate the efficacy of a combination of beating-heart minimally invasive approach and leaflets augmentation technique treating severe tricuspid regurgitation (TR) after cardiac surgery. Methods From January 2015 to August 2017, patients undergoing reoperative tricuspid valve repair (TVP) with minimally invasive approach and leaflets augmentation were enrolled. Cardiopulmonary bypass (CPB) was established via femoral vessels and the procedures were performed on beating heart with normothermic CPB. A bovine pericardial patch was sutured to leaflets to augment the native anterior and posterior leaflets. Other repair techniques, such as ring implantation and leaflet mobilization, were also applied as needed. Results A total of 28 patients (mean age 55.6±10.1 years, 5 males, 23 females) were enrolled. One patient was converted to median sternotomy due to pleural cavity adhesion. Twenty-seven patients underwent totally endoscopic TVP with leaflets augmentation. No patients was transferred to tricuspid valve replacement. Two patients died in hospital. All patients were followed up for 7.4±5.0 months and there was no late death and reoperation. Regurgitation area was converted from 20.7±10.1 cm2 to 3.3±3.3 cm2 after TVP according to the latest echocardiography (P<0.001). Conclusion Minimally TVP with leaflets augmentation is effective in treating severe isolated TR after primary cardiac surgery. It can significantly increase success rate of tricuspid valvuloplasty and decrease the surgical trauma.