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Zhou T, Gu Y. Percutaneous transforaminal endoscopic surgery (PTES) and mini-incision L5/S1 OLIF with a self-lock cage for the surgical treatment of L5 spondylolisthesis. J Orthop Surg Res 2023; 18:527. [PMID: 37488544 PMCID: PMC10367385 DOI: 10.1186/s13018-023-04022-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2023] [Accepted: 07/15/2023] [Indexed: 07/26/2023] Open
Abstract
OBJECTIVES We reported thirteen cases of percutaneous transforaminal endoscopic surgery (PTES) under local anesthesia and mini-incision L5/S1 OLIF (OLIF51) with a self-lock cage for the treatment of L5 spondylolisthesis. METHODS From Jan 2019 to Feb 2020, the patients with L5 spondylolisthesis with nerve root symptoms undergoing PTES and OLIF51 were included in this study. PTES under local anesthesia was performed in a prone position, and OLIF51 with a self-lock cage and allograft was then undertaken through a left abdominal mini-incision and oblique retroperitoneal approach between bilateral iliac vessels with the external oblique, internal oblique and transverse abdominal muscles bluntly separated in turn for L5/S1 in a right oblique position under general anesthesia. Back and leg pain were preoperatively and postoperatively evaluated using the VAS, and the clinical outcomes were evaluated with the ODI before surgery and at the 2-year follow-up. The anterior and posterior intervertebral space height (AISH, PISH), lumbar lordotic, and surgical segmental lordotic angle (SLA) were measured on lumbar spine X-rays preoperatively and postoperatively. The fusion status was assessed according to Bridwell's fusion grades. RESULTS Thirteen cases of L5 spondylolisthesis were included. The operation duration was 49.1 ± 5.6 min for PTES and 73.6 ± 8.2 min for OLIF. There was blood loss of 25 (15-45) ml. The incision length was 7.5 ± 1.1 mm for PTES and 46.8 ± 3.8 mm for OLIF. The hospital stay was 5 (4-6) days, and the follow-up duration was 29 (24-37) months. For the clinical evaluation, the VAS of back and leg pain significantly dropped after surgery (p < 0.001), and the ODI significantly decreased from 64.7 ± 7.8% to 12.9 ± 4.3% 2 years after surgery (p < 0.001). AISH, PISH and SLA significantly improved after surgery (p < 0.05). Fusion grades based on the Bridwell grading system at the 2-year follow-up were grade I in 9 segments (69.2%) and grade II in 4 segments (30.8%). No patients had any form of permanent iatrogenic nerve damage or major complications. No failure of instruments was observed. CONCLUSIONS PTES and mini-incision OLIF51 with a self-lock cage is a viable option of minimally invasive surgery for L5 spondylolisthesis, which can achieve direct neurologic decompression, satisfactory fusion and hardly destroys the rectus abdominis and its sheath, paraspinal muscles and bone structures.
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Affiliation(s)
- Tianyao Zhou
- Department of Orthopaedic Surgery, Zhongshan Hospital Fudan University, Shanghai, China
- Shanghai Southwest Spine Surgery Center, Shanghai, China
| | - Yutong Gu
- Department of Orthopaedic Surgery, Zhongshan Hospital Fudan University, Shanghai, China.
- Shanghai Southwest Spine Surgery Center, Shanghai, China.
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Fan J, Huang R, Yang J, Zhang T, Zeng Y, Su Z. Medial gastrocnemius resection for calf reduction by using a popliteal mini-incisional approach in Asians. J Plast Reconstr Aesthet Surg 2022; 75:3568-3573. [PMID: 35989147 DOI: 10.1016/j.bjps.2022.06.066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Revised: 04/21/2022] [Accepted: 06/10/2022] [Indexed: 10/17/2022]
Abstract
BACKGROUND To create a new approach of resecting medial gastrocnemius for calf reduction and to meet the increasing requirement of the beauty standard of calf sliming in Asian. METHODS Twenty patients with 39 calves underwent gastrocnemius resection for calf reduction. Under general anesthesia, a 5 cm incision, along the popliteal crease, was made down to the sub-popliteal deep fascia on a prone position. The medial belly of the gastrocnemius muscle was then dissected, in a blunt way, from the popliteal fossa down to the Achilles tendon around the muscular belly when its neurovascular bundle was ligated and cut off. Thereafter, the medial gastrocnemius was pulled out of the wound and incised transversely off at the level of the popliteal fossa while the attachment to the Achilles was transected with a long rectangular scissors. The incisional wound was finally closed in layers. RESULTS Twenty patients with 39 calves were treated using the above-mentioned technique without severe complications. The harvested gastrocnemius muscle weighed 192.1 g in mean (from 104.5 g to 307.6 g). The calf circumference was significantly decreased from 36.3 cm in mean to 32.8 cm in mean before and after the operation (p <0.05). CONCLUSIONS The above-mentioned technique may be a safer, simpler, and more efficient method for calf reduction with less morbidity of the potential complications, in comparison with the traditional techniques.
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Affiliation(s)
- Jincai Fan
- Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 33 Ba-Da-Chu Road, Beijing 100144, China.
| | - Rong Huang
- Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 33 Ba-Da-Chu Road, Beijing 100144, China
| | - Jifan Yang
- Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 33 Ba-Da-Chu Road, Beijing 100144, China
| | - Tiran Zhang
- Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 33 Ba-Da-Chu Road, Beijing 100144, China
| | - Yan Zeng
- Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 33 Ba-Da-Chu Road, Beijing 100144, China
| | - Zhiguo Su
- Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 33 Ba-Da-Chu Road, Beijing 100144, China
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Zhang Y, Yang G, Zhou T, Chen Y, Gao Z, Zhou W, Gu Y. Efficacy and safety of anterior cervical discectomy and fusion (ACDF) through mini-incision and posterior laminoplasty (LAMP) for treatment of long-level cervical spondylosis: a retrospective cohort study. BMC Surg 2022; 22:115. [PMID: 35337311 DOI: 10.1186/s12893-022-01567-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Accepted: 03/21/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The efficacy and safety of anterior cervical discectomy and fusion (ACDF) through mini-incision and posterior laminoplasty for long-level cervical spondylosis were investigated. METHOD From January 2018 to September 2019, clinical patients data with 3-4 segments (C3-7) cervical spondylotic radiculopathy, cervical spondylotic myelopathy, or mixed cervical spondylosis who received ACDF (42 cases) throughwith mini-incision or LAMP (36 cases) treatment were retrospectively collected and analyzed. The operative time, bleeding volume, incisive length, and hospital stay were recorded. Moreover, the intervertebral height, functional segment height, cervical lordosis, cervical hyperextension and hyperflexion range-of-motion (ROM) and ROM in all directions of the cervical spine before and after the operation were measured. Additionally, all relevant postoperative complications were also recorded. Then, the therapeutic effects of both surgical methods were investigated. RESULTS Patients in the ACDF group had less bleeding, shorter incision, and fewer hospitalization days than the LAMP group. There was no significant difference in JOA, VAS score of the upper limb, NDI score after surgery between two groups. Postoperative intervertebral height and functional segment height in the ACDF group were significantly higher than those before the operation, and postoperative functional segment height of the ACDF group was significantly higher than that of the LAMP group. Moreover, the postoperative cervical lordosis angle in the ACDF group was significantly larger than the LAMP group. There was no significant difference between preoperative and postoperative ROM in all directions of the cervical spine for the two groups. CONCLUSIONS Both ACDF through mini-incision and LAMP are effective treatments for long-level cervical spondylosis. However, ACDF through mini-incision shows minor trauma, less bleeding, fast recovery, and it is beneficial for cervical lordosis reconstruction.
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Ge M, Pan S, Ni F, Bie Z, Yu D, Song N. Mini-incision Blepharoplasty with Pretarsal Fasciectomy for Double-Eyelid Surgery. Aesthetic Plast Surg 2021; 45:2201-2205. [PMID: 34036442 DOI: 10.1007/s00266-021-02349-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2021] [Accepted: 05/09/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND Double-eyelid surgery has been one of the most popular aesthetic surgeries in oriental populations. The objective of this study was to introduce a simple procedure for double-eyelid surgery. METHODS The mini-incision blepharoplasty with pretarsal fasciectomy technique is described and illustrated. Blepharoplasty cases in our practice from June 2018 to December 2019 were retrospectively reviewed. Patients who underwent mini-incision blepharoplasty with pretarsal fasciectomy were followed up for at least 6 months. RESULTS Of 280 blepharoplasty cases, 32 patients underwent mini-incision blepharoplasty with pretarsal fasciectomy on both upper eyelids. Nineteen patients experienced resolve of swelling within 5 days postoperatively. No loss of fold was observed during follow-up. The satisfaction rate was 93.8%. CONCLUSIONS The mini-incision blepharoplasty with pretarsal fasciectomy is ideal for selected patients requesting double-eyelid surgery. It provides stable, natural, scarless result with minimum complication and rapid recovery. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Min Ge
- Department of Plastic and Cosmetic Surgery, Basilica Clinic, 88 Caoxi Road (N), Shanghai, 200030, China
| | - Sida Pan
- Department of Plastic Surgery, Huashan Hospital, Fudan University, No.12 Middle Urumqi Road, Shanghai, 200040, China
| | - Feng Ni
- Department of Plastic and Cosmetic Surgery, Basilica Clinic, 88 Caoxi Road (N), Shanghai, 200030, China
| | - Zheng Bie
- Department of Plastic and Cosmetic Surgery, Basilica Clinic, 88 Caoxi Road (N), Shanghai, 200030, China
| | - Dong Yu
- Department of Plastic and Cosmetic Surgery, Basilica Clinic, 88 Caoxi Road (N), Shanghai, 200030, China.
| | - Nan Song
- Department of Facial Plastic and Reconstructive Surgery, Eye & ENT Hospital, Fudan University, No.83 Fen-Yang Road, Shanghai, 200031, China.
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Jiang X, Qian S, Chen C, Wu H, Zhi X, Xu D, Lian J, Liu X, Wei S, Xu F. Modified mini-incision "internal splinting" versus percutaneous repair technique of acute Achilles tendon rupture: five year retrospective case-controlled study. Int Orthop 2021; 45:3243-3251. [PMID: 34386884 DOI: 10.1007/s00264-021-05185-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/28/2021] [Accepted: 07/30/2021] [Indexed: 11/24/2022]
Abstract
PURPOSE Several kinds of minimally invasive surgical techniques are applied to acute Achilles tendon rupture. The risks of sural never injury and re-ruptures are still major issues. The purpose of this study was to compare the middle-term results of two different minimally invasive repair techniques for acute Achille tendon rupture. METHODS Twenty-four cases underwent the modified mini-incision "internal splinting" repair technique in group A, and 29 cases underwent a percutaneous repair technique in group B and were evaluated. The intra-operative data, complications, the time of recovery, and the post-operative magnetic resonance imaging were analyzed. At the final follow-up, the American Orthopedic Foot and Ankle Society (AOFAS) ankle-hindfoot score and Thermann score were evaluated. RESULTS The mean follow-up time was 59.96 ± 4.16 months (range 48-67). At the final follow-up, the AOFAS score and Thermann score in both groups had similar feedback. No nerve injury, infection, or re-rupture was encountered in group A, except two cases with anchor irritation. One case with sural nerve injury and one with a re-rupture were recorded in group B, respectively. The final MRI showed thicker regeneration of the tendon in both groups. CONCLUSIONS The middle-term results indicated the modified mini-incision "internal splinting" technique for acute Achilles tendon rupture is similar to the percutaneous repair technique. A lower risk of sural nerve injury and re-rupture may be advantages.
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Affiliation(s)
- Xiang Jiang
- Department of Orthopaedics, General Hospital of Central Theater Command (Wuhan General Hospital of Guangzhou Command, Previously), Wuhan, Hubei Province, People's Republic of China
| | - Shenglong Qian
- Department of Orthopaedics, General Hospital of Central Theater Command (Wuhan General Hospital of Guangzhou Command, Previously), Wuhan, Hubei Province, People's Republic of China
| | - Cheng Chen
- Department of Orthopaedics, General Hospital of Central Theater Command (Wuhan General Hospital of Guangzhou Command, Previously), Wuhan, Hubei Province, People's Republic of China
| | - Helin Wu
- The First Clinical Medical School Of, Southern Medical University, Guangzhou, Guangdong Province, People's Republic of China
| | - Xiaosong Zhi
- Department of Orthopaedics, General Hospital of Central Theater Command (Wuhan General Hospital of Guangzhou Command, Previously), Wuhan, Hubei Province, People's Republic of China
| | - Dan Xu
- Department of Rehabilitation, General Hospital of Central Theater Command (Wuhan General Hospital of Guangzhou Command, Previously), Wuhan, Hubei Province, People's Republic of China
| | - Junhong Lian
- Department of Orthopaedics, General Hospital of Central Theater Command (Wuhan General Hospital of Guangzhou Command, Previously), Wuhan, Hubei Province, People's Republic of China.
| | - Ximing Liu
- Department of Orthopaedics, General Hospital of Central Theater Command (Wuhan General Hospital of Guangzhou Command, Previously), Wuhan, Hubei Province, People's Republic of China
- The First Clinical Medical School Of, Southern Medical University, Guangzhou, Guangdong Province, People's Republic of China
| | - Shijun Wei
- Department of Orthopaedics, General Hospital of Central Theater Command (Wuhan General Hospital of Guangzhou Command, Previously), Wuhan, Hubei Province, People's Republic of China.
- The First Clinical Medical School Of, Southern Medical University, Guangzhou, Guangdong Province, People's Republic of China.
| | - Feng Xu
- Department of Orthopaedics, General Hospital of Central Theater Command (Wuhan General Hospital of Guangzhou Command, Previously), Wuhan, Hubei Province, People's Republic of China
- The First Clinical Medical School Of, Southern Medical University, Guangzhou, Guangdong Province, People's Republic of China
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Al Dhaheri M, Nada MA, El Ansari W, Kurer M, Ahmed AA. Left iliac fossa mini-incision sigmoidectomy for treatment of sigmoid volvulus. Case series of six patients from Qatar. Int J Surg Case Rep 2020; 75:534-538. [PMID: 32950438 PMCID: PMC7567052 DOI: 10.1016/j.ijscr.2020.09.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2020] [Revised: 09/03/2020] [Accepted: 09/03/2020] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Midline laparotomy is the definitive treatment for sigmoid volvulus after initial colonoscopic detorsion. We successfully adopted another technique at our center on 6 patients, treating sigmoid volvulus by left iliac fossa mini-incision. PRESENTATION OF CASES We report our experience of six non-consecutive cases of sigmoid volvulus treated by left iliac fossa mini-incision. The cases were a 33 year old Egyptian female, a 21 year old Bangladeshi male, a 58 year old Qatari male, a 30 year old Ethiopian male, a 36 year old Ugandan male, and a 58 year old Indian male. The six cases are unique in the surgical technique employed in their management. This is possibly the second case series of left iliac fossa mini-incision for sigmoid volvulus in the Middle East and North Africa Region. DISCUSSION All patients underwent initial colonoscopic detorsion followed by sigmoidectomy and anastomosis. The procedure was successful in treating the volvulus in five patients with no complication or recurrence over a mean follow up of 8 months (range: 1-36 months). One patient required further laparotomy and resection with anastomosis due to incompletely removed sigmoid colon. CONCLUSIONS Left iliac fossa mini-incision for sigmoid volvulus is safe, feasible, cosmetically appealing and with low morbidity.
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Affiliation(s)
- Mahmood Al Dhaheri
- Department of Colorectal Surgery, Hamad General Hospital, Hamad Medical Corporation, Doha, Qatar
| | - Mohamed Abu Nada
- Department of Colorectal Surgery, Hamad General Hospital, Hamad Medical Corporation, Doha, Qatar
| | - Walid El Ansari
- Department of Surgery, Hamad General Hospital, Hamad Medical Corporation, Doha, Qatar; College of Medicine, Qatar University, Doha, Qatar; School of Health and Education, University of Skovde, Skovde, Sweden.
| | - Mohamed Kurer
- Department of Colorectal Surgery, Hamad General Hospital, Hamad Medical Corporation, Doha, Qatar
| | - Ayman Abdelhafiz Ahmed
- Department of Colorectal Surgery, Hamad General Hospital, Hamad Medical Corporation, Doha, Qatar
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Liu R, Rui L, Zhang B, Lin Y, Li S, Hua Z. Through Tricuspid Closure for Doubly Committed Subarterial Ventricular Septal Defect with Right Vertical Subaxillary Mini-incision: A Matched-Pair Analysis. Pediatr Cardiol 2019; 40:1247-1252. [PMID: 31338560 DOI: 10.1007/s00246-019-02144-w] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2019] [Accepted: 06/19/2019] [Indexed: 11/28/2022]
Abstract
To evaluate the feasibility and efficacy of the right subaxillary vertical mini-incision (RAVI) used for the closure of doubly committed subarterial ventricular septal defect (SAVSD) through tricuspid approach only. From June 2015 to September 2016, 32 SAVSD patients (mean age 2.4 ± 1.9 years, range 0.7-8 years) underwent surgical repair with either RAVI (incision length 3-4 cm) through tricuspid (group A, n = 16) or conventional median sternotomy incision through the main pulmonary artery approach (group B, n = 16). A retrospective 1:1 matched-pair analysis was performed with the group B matched for defect size, body weight, gender, patching, and operation year. The demographic characteristics in both groups were similar. No patient died and only 1 patient in group B needed reoperation for sternal infection. The mean cardiopulmonary bypass (CPB) time and aortic cross-clamp time were 48.6 ± 12.6 min, 29.3 ± 8.5 min in the group A and 57.8 ± 14.1 min (p = 0.03), 34.3 ± 12.1 min ( p = 0.18) in the group B. There was no significant difference between the two groups in the ICU stay (17.8 ± 8.9 h in group A, 18.7 ± 9.5 h in group B, p = 0.79), mechanical ventilation support time (2.7 ± 1.7 h in group A, 3.6 ± 1.5 h in group B, p = 0.11), postoperative hospital stay (6.3 ± 1.5 days in group A, 7.4 ± 1.7 days in group B, p = 0.06), and chest tube drainage (6.4 ± 4.3 ml/kg in group A, 8.5 ± 3.8 ml/kg in group B, p = 0.16). No significant residual defects were found in both groups. The post-operation pressure gradient across the right ventricular outflow tract (RVOT) was significantly different between the two groups with 4.6 ± 1.8 mmHg in group A and 10.0 ± 6.8 mmHg in group B (p = 0.004) even if no significant difference was found between both groups before operation. No arrhythmia was found after operation. All the patients or the parents (100%) in the group A were satisfied with the cosmetic results, while the number in B group was 7 (43.8%) in questionnaire. The RAVI through tricuspid approach to repair doubly committed subarterial ventricular septal defect is a safe and feasible procedure with better hemodynamic performance of RVOT and less CPB time because of keeping pulmonary artery intact comparing to conventional approach. More importantly, the RAVI through tricuspid approach can be performed with favorable cosmetic results.
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Affiliation(s)
- Rui Liu
- Division of Pediatric Cardiac Surgical Centre, Chinese Academy of Medical Sciences and Peking Union Medical College Fuwai Hospital, No.167 North Lishi Road, Xicheng District, Beijing, 100037, China
| | - Lu Rui
- Division of Pediatric Cardiac Surgical Centre, Chinese Academy of Medical Sciences and Peking Union Medical College Fuwai Hospital, No.167 North Lishi Road, Xicheng District, Beijing, 100037, China
| | - Benqing Zhang
- Division of Pediatric Cardiac Surgical Centre, Chinese Academy of Medical Sciences and Peking Union Medical College Fuwai Hospital, No.167 North Lishi Road, Xicheng District, Beijing, 100037, China
| | - Ye Lin
- Division of Pediatric Cardiac Surgical Centre, Chinese Academy of Medical Sciences and Peking Union Medical College Fuwai Hospital, No.167 North Lishi Road, Xicheng District, Beijing, 100037, China
| | - Shoujun Li
- Division of Pediatric Cardiac Surgical Centre, Chinese Academy of Medical Sciences and Peking Union Medical College Fuwai Hospital, No.167 North Lishi Road, Xicheng District, Beijing, 100037, China
| | - Zhongdong Hua
- Division of Pediatric Cardiac Surgical Centre, Chinese Academy of Medical Sciences and Peking Union Medical College Fuwai Hospital, No.167 North Lishi Road, Xicheng District, Beijing, 100037, China.
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Runge T, Inglin R, Riss P, Selberherr A, Kaderli RM, Candinas D, Seiler CA. The advantages of extended subplatysmal dissection in thyroid surgery-the "mobile window" technique. Langenbecks Arch Surg 2017. [PMID: 28050728 DOI: 10.1007/s00423-016-1545-6/tables/3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/18/2023]
Abstract
PURPOSE Minimal access thyroidectomy, using various techniques, is widely known, but respective data on thyroidectomy for thyroid cancer with lymphadenectomy is scarce. The present study aims to evaluate the feasability of extended subplatysmal dissection in combination with a small incision ("mobile window" technique). METHODS A retrospective study was performed analysing data from 93 patients. All patients suffered from thyroid carcinoma and underwent (total) thyroidectomy, bilateral cervico-central (levels VI and VII) and functional lateral neck dissection (levels II to V) on the side of the malignancy. In group A, consisting of 47 patients, the operation was performed by a traditional Kocher incision (minimal range 6-7 cm), in 46 patients (group B) a mini-incision (≤4 cm) was made. Intra- and postoperative morbidity as well as oncological accuracy were assessed. RESULTS There was no significant difference between the two groups comparing postoperative pathological diagnosis, intra- and postoperative complications and the number of removed lymph nodes. However, operating time was slightly longer in group A and thyroid weight was heavier in group B. CONCLUSIONS Extended subplatymsal dissection allows thyroidectomy and even lateral lymphadenectomy for thyroid carcinoma via "mobile" mini-incision. The procedure is safe, of equivalent oncological accuracy compared to traditional incision and the cosmetic results are excellent.
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Affiliation(s)
- Tina Runge
- Department of Visceral Surgery and Medicine, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse 10, 3010, Bern, Switzerland
| | - Roman Inglin
- Department of Visceral Surgery and Medicine, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse 10, 3010, Bern, Switzerland
| | - Philipp Riss
- Section of Endocrine Surgery, Division of General Surgery, Department of Surgery, Medical University of Vienna, Waehringer Gürtel 18-20, 1090, Vienna, Austria
| | - Andreas Selberherr
- Section of Endocrine Surgery, Division of General Surgery, Department of Surgery, Medical University of Vienna, Waehringer Gürtel 18-20, 1090, Vienna, Austria
| | - Reto M Kaderli
- Department of Visceral Surgery and Medicine, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse 10, 3010, Bern, Switzerland
| | - Daniel Candinas
- Department of Visceral Surgery and Medicine, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse 10, 3010, Bern, Switzerland
| | - Christian A Seiler
- Department of Visceral Surgery and Medicine, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse 10, 3010, Bern, Switzerland.
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Oh WT, Kang HJ, Koh IH, Jang JY, Choi YR. Morphologic change of nerve and symptom relief are similar after mini-incision and endoscopic carpal tunnel release: a randomized trial. BMC Musculoskelet Disord 2017; 18:65. [PMID: 28158978 PMCID: PMC5291967 DOI: 10.1186/s12891-017-1438-z] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2016] [Accepted: 01/31/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The symptoms in carpal tunnel syndrome (CTS) can be ameliorated by open and endoscopic release of the transverse carpal ligament. It is unknown whether a mini-incision or endoscopic carpal tunnel release more effectively reverses the pathological changes that are observed in the median nerve in patients with CTS and these morphologic changes correlates with the subjective outcomes after carpal tunnel release. We hypothesized that (1) at 24 weeks after surgery, the subjective outcomes of mini-incision release and endoscopic release would not differ in patients with CTS; and (2) the ultrasonographic (US) morphology of the median nerve reverses similarly after mini-incision and endoscopic release; (3) the subjective outcomes correlates with these morphologic changes. METHODS Between November 2011 and January 2013, 67 patients with CTS in their dominant wrist were randomized to either mini-incision (n = 32) or endoscopic (n = 35) release. Each patient was assessed by both the Boston Carpal Tunnel Questionnaire (BCTQ) and the Disabilities of the Arm, Shoulder, and Hand (DASH) pre-operatively and 24 weeks' post-operation. An US examination was conducted at both time points to measure the cross-sectional area (CSA) at the inlet, middle, and outlet (CSA-I, CSA-M and CSA-O) and the flattening ratio (FR) at the middle and outlet (FR-M and FR-O) of the median nerve. RESULTS The post-operative mean BCTQ and DASH scores were improved significantly from the pre-operative scores in both groups (p < 0.001). The mean CSA-I decreased and CSA-M and CSA-O increased similarly in both groups (by 3.3, 3.0, and 3.8 mm2 in the mini-incision group and 2.9, 3.1. and 2.7 mm2 in the endoscopic group. The mean FR-M/FR-O decreased similarly from 3.6/4.2 to 3.2/3.0 in the mini-incision group and 3.8/4.3 to 3.2/2.9 in the endoscopic group. There were no significant differences in the subjective outcome scores or median nerve measures between the two groups. Improvement in the BCTQ-S only was significantly correlated with changes in the CSA at the inlet. CONCLUSIONS Mini-incision and endoscopic release both similarly relieved subjective symptoms and functions along with the pathological changes in the median nerve morphology along the carpal tunnel in patients with idiopathic CTS. Symptom relief after surgical decompression seems to correlate with reduced nerve swelling at carpal inlet and reversed nerve flattening inside carpal tunnel. TRIAL REGISTRATION This study was retrospectively registered in "ClinicalTrials.gov" at Oct 18th, 2013, and the registration number was NCT01972165 .
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Affiliation(s)
- Won-Taek Oh
- Department of Orthopedic Surgery, Severance Hospital, Yonsei University College of Medicine, 50 Yonseiro, Seoul, Seodaemungu, South Korea
| | - Ho-Jung Kang
- Department of Orthopedic Surgery, Severance Hospital, Yonsei University College of Medicine, 50 Yonseiro, Seoul, Seodaemungu, South Korea
| | - Il-Hyun Koh
- Department of Orthopedic Surgery, Severance Hospital, Yonsei University College of Medicine, 50 Yonseiro, Seoul, Seodaemungu, South Korea
| | - Jin-Young Jang
- Department of Orthopedic Surgery, Severance Hospital, Yonsei University College of Medicine, 50 Yonseiro, Seoul, Seodaemungu, South Korea
| | - Yun-Rak Choi
- Department of Orthopedic Surgery, Severance Hospital, Yonsei University College of Medicine, 50 Yonseiro, Seoul, Seodaemungu, South Korea.
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Runge T, Inglin R, Riss P, Selberherr A, Kaderli RM, Candinas D, Seiler CA. The advantages of extended subplatysmal dissection in thyroid surgery-the "mobile window" technique. Langenbecks Arch Surg 2017; 402:257-63. [PMID: 28050728 DOI: 10.1007/s00423-016-1545-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2016] [Accepted: 12/19/2016] [Indexed: 10/20/2022]
Abstract
PURPOSE Minimal access thyroidectomy, using various techniques, is widely known, but respective data on thyroidectomy for thyroid cancer with lymphadenectomy is scarce. The present study aims to evaluate the feasability of extended subplatysmal dissection in combination with a small incision ("mobile window" technique). METHODS A retrospective study was performed analysing data from 93 patients. All patients suffered from thyroid carcinoma and underwent (total) thyroidectomy, bilateral cervico-central (levels VI and VII) and functional lateral neck dissection (levels II to V) on the side of the malignancy. In group A, consisting of 47 patients, the operation was performed by a traditional Kocher incision (minimal range 6-7 cm), in 46 patients (group B) a mini-incision (≤4 cm) was made. Intra- and postoperative morbidity as well as oncological accuracy were assessed. RESULTS There was no significant difference between the two groups comparing postoperative pathological diagnosis, intra- and postoperative complications and the number of removed lymph nodes. However, operating time was slightly longer in group A and thyroid weight was heavier in group B. CONCLUSIONS Extended subplatymsal dissection allows thyroidectomy and even lateral lymphadenectomy for thyroid carcinoma via "mobile" mini-incision. The procedure is safe, of equivalent oncological accuracy compared to traditional incision and the cosmetic results are excellent.
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Abstract
BACKGROUND This study aims to compare surgical outcomes of severe carpal tunnel syndrome (CTS) treated with mini-incision versus extensile release. METHODS The method employed in this study was a retrospective review of patients with severe CTS, defined by electrophysiologic studies showing non-recordable distal sensory latency of the median nerve. Patients underwent either a mini-incision (2 cm) release of the transverse carpal ligament (group 1) or extensile release proximal to the wrist flexion crease (group 2). Exclusion criteria included prior carpal tunnel release, use of muscle flap, multiple concurrent procedures, or a prior diagnosis of peripheral neuropathy. Group 1 included 70 wrists (40 females, 30 males). Group 2 included 64 wrists (35 females, 29 males). Reported outcomes included pre- and post-operative grip strength as well as Boston Carpal Tunnel Questionnaires (BCTQ). RESULTS Patients in group 1 had a 22.6 % increase in grip strength postoperatively (4.5 months ± 5.0), while patients in group 2 had a 59.3 % increase (10.0 months ± 6.9). BCTQ surveys from group 1 (n = 46) demonstrated a symptom severity score of 12.93 and functional status score of 9.39 at an average follow-up of 41.9 ± 10.6 months. Group 2 (n = 42) surveys demonstrated averages of 12.88 and 9.10 at 43.1 ± 11.6 months. One patient in the mini-incision cohort required revision surgery after 2 years, while no patient in the extended release cohort underwent revision. CONCLUSION No significant differences between the two procedures with regard to patient-rated symptom severity or functional status outcomes were found. Both techniques were demonstrated to be effective treatment options for severe CTS.
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Affiliation(s)
- Praveen G. Murthy
- The Philadelphia Hand Center, P.C., Thomas Jefferson University, 834 Chestnut Street, Suite G114, Philadelphia, PA 19107 USA
| | - Peter Goljan
- The Philadelphia Hand Center, P.C., Thomas Jefferson University, 834 Chestnut Street, Suite G114, Philadelphia, PA 19107 USA
| | - Gregory Mendez
- The Philadelphia Hand Center, P.C., Thomas Jefferson University, 834 Chestnut Street, Suite G114, Philadelphia, PA 19107 USA
| | - Sidney M. Jacoby
- The Philadelphia Hand Center, P.C., Thomas Jefferson University, 834 Chestnut Street, Suite G114, Philadelphia, PA 19107 USA
| | - Eon K. Shin
- The Philadelphia Hand Center, P.C., Thomas Jefferson University, 834 Chestnut Street, Suite G114, Philadelphia, PA 19107 USA
| | - Arthur Lee Osterman
- The Philadelphia Hand Center, P.C., Thomas Jefferson University, 834 Chestnut Street, Suite G114, Philadelphia, PA 19107 USA
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Dot C, El Chehab H, Agard E, Russo A, Ract-Madoux G, Dussart C. [Optical quality after 2.2mm microincisional cataract surgery with bimanual I/A in 154 eyes]. J Fr Ophtalmol 2013; 36:868-73. [PMID: 24210935 DOI: 10.1016/j.jfo.2013.03.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2012] [Revised: 03/01/2013] [Accepted: 03/05/2013] [Indexed: 11/18/2022]
Abstract
PURPOSE A prospective study to analyze the effects of 2.2mm microincisional coaxial phacoemulsification with bimanual irrigation/aspiration on the optical quality of the cornea and whole eye. METHODS We compare two groups. Group A: 102 consecutive eyes undergoing this three-incision procedure and implanted with an Alcon® SN60WF IQ aspheric intraocular lens. Astigmatism, corneal and total asphericity, as well as H/B ratio were measured by OPD scann II, Nidek®, Japan, preoperatively (Day 0), 15 days postoperatively (Day 15) and 1 month postoperatively (M1). Group B: 52 eyes with corneal astigmatism greater than 1.25D, undergoing the same procedure but implanted with a Toric IOL (Alcon® Toric IQ SN6AT), followed in the same manner but with additional follow-up at 1 year. RESULTS Corneal surgically induced astigmatism (SIA) was essentially neutral: 0.065D ± 0.86 at Day 30 in group A, and 0.06D ± 0.34 at 1 month and -0.008D ± 0.4 at 12 months in group B. Corneal topographic astigmatism underwent a mean axis shift of 29.95° ± 27.6 in group A compared to 5.3° ± 3.7 in Group B, and remained stable at 1 year. Corneal asphericity did not change significantly between Day 0 and 30 in either group. H/B ratio increased significantly in both groups, with a gain of 22 % to 24 % after surgery. CONCLUSIONS This three-incision procedure does not degrade the optical quality of the cornea. Postoperative shift in the axis of astigmatism is only an issue in cases of low or asymmetric astigmatism and must be kept in mind for low-power toric IOL implantation.
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Affiliation(s)
- C Dot
- Service d'ophtalmologie, hôpital Desgenettes, 108, boulevard Pinel, 69275 Lyon cedex 03, France.
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Cornut PL, Soldermann Y, Robin C, Barranco R, Kerhoas A, Burillon C. [Optimizing the financial impact of transitioning to transconjunctival vitrectomy and microincisional phacoemulsification]. J Fr Ophtalmol 2013; 36:843-51. [PMID: 24144524 DOI: 10.1016/j.jfo.2013.01.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2012] [Revised: 01/14/2013] [Accepted: 01/15/2013] [Indexed: 11/19/2022]
Abstract
OBJECTIVES To report the financial impact of using modern lens and vitreoretinal surgical techniques. MATERIALS AND METHOD Bottom-up sterilization and consumables costs for new surgical techniques (microincisional coaxial phacoemulsification and transconjunctival sutureless vitrectomy) and the corresponding former techniques (phacoemulsification with 3.2-mm incision and 20G vitrectomy) were determined. These costs were compared to each other and to the target costs of the Diagnosis Related Groups for public hospitals (Groupes Homogènes de Séjours [GHS]) concerned, extracted from the analytic accounting data of the French National Cost Study (Étude Nationale des Coûts [ENC]) for 2009 (target=sum of sterilization costs posted under medical logistics, consumables, implantable medical devices, and special pharmaceuticals posted as direct expenses). RESULTS For outpatient lens surgery with or without vitrectomy (GHS code: 02C05J): the ENC's target cost for 2009 was 339€ out of a total of 1432€. The cost detailed in this study was 4 % higher than the target cost when the procedure was performed using the former technique (3.2mm sutured incision) and 12 % lower when the procedure was performed using the new technique (1.8mm sutureless) after removing now unnecessary consumables and optimization of the technique. For level I retinal detachment surgeries (GHS code: 02C021): the ENC's 2009 target cost was 641€ out of a total of 3091€. The cost specified in this study was 1 % lower than the target cost when the procedure was done using the former technique (20-G vitrectomy) and 16 % less when the procedure was performed using the new technique (transconjunctival vitrectomy) after removal of now unnecessary consumables and optimization of the technique. DISCUSSION AND CONCLUSIONS Contrary to generally accepted ideas, implementing modern techniques in ocular surgery can result in direct cost and sterilization savings when the operator takes advantage of the possibilities these techniques offer in terms of simplification of the procedures to do away with consumables that are no longer necessary.
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Affiliation(s)
- P-L Cornut
- Service d'ophtalmologie, université Lyon-1, hôpital E.-Herriot, hospices civils de Lyon, CHU de Lyon, 5, place d'Arsonval, 69437 Lyon cedex 03, France.
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