ObjectiveTo assess the feasibility of the treatment of unresectable late pancreatic cancer with laparoscopic choledochojejunostomy and gastric bypass. MethodsFrom June 2000 to December 2003, laparoscopic choledochojejunostomy and gastric bypass were successfully performed in 15 patients with unresectable late pancreatic cancer. Endoscopic nosobiliary drainage (ENBD) was performed before the operation. ResultsAll procedures were completed laparoscopically. Jaundice and hepatic function of the patients were obviously improved after the bypass. Oral nutrition was recovered after operation. The mean operative time was (100±26) min (range 70-200 min); the mean operative blood loss was (60±15) ml (range 30-120 ml); the bowel function recovery was on the 3rd-5th postoperative day; the average hospital stay was (8.1±0.7) days (range 6-13 days). Incision infection ocurred in one patient. No operative complications occurred in other patients. ConclusionTreatment of unresectable late carcinoma of the pancreas with laparoscopic choledochojejunostomy and gastric bypass aided by ENBD is a minimally invasive technique with less postoperative pain，shorter hospital stay, lower procedurerelated morbidity,and better oral nutrition. The life quality of patients with late pancreatic cancer can be obviously improved.
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 summarize the recent development of the magnetic compression anastomosis in surgery.
MethodsThe abroad and domestic relevant literature about magnetic compression anastomosis was extensively reviewed, and comprehensive analyzed.
ResultsMagnetic compression anastomosis in the reconstruction of the body lumen is a simple and effective way; laparoscopy combined with magnetic compression anastomosis has the advantages of small wound and quick recovery. Magnetic compression anastomosis has been increasingly used in cl inical practice. But its mechanism has not been fully revealed, and it is difficulty in expelling out of the magnet for the gastrointestinal and certain large-size lumen, so further research and optimization are still needed.
ConclusionRelative to the traditional manual suture, magnetic anastomosis has great advantage, especially a combination of magnetic compression anastomosis and minimally invasive surgery has bright prospects for development.
Objective To investigate the development and appl ication of the computer aided surgery systems in the joint surgery field. Methods The l iteratures were extensively reviewed to analysis the usefulness of current active, semi-active and passive computer aided surgery systems in solving the cl inical problems of joint surgery. Results Several computer aided surgery systems have met the high technique demands, such as the precision of anatomical position and orientation, the accuracy of normal l imb al ignment restoration, the optimum of instrumentation control in arthroplasty, peri-articular osteotomy and minimally invasive procedure. Conclusion Computer aided joint surgery systems facil itate precise surgical techniques to achieve ideal operative outcome.
Atrial fibrillation (AF) is difficult to cure for its complex etiology and long disease duration. Heart failure, sudden death and stroke are the main causes for consequent high mortality and morbidity. In recent years, minimally invasive surgery has made rapid progress, not only improved treatment efficiency of traditional Cox Maze procedure but also massively reduced surgical injuries, and has become a preferred treatment strategy for lone AF. Minimally invasive surgery and catheter ablation complement each other, and are likely to open up a new prospect of AF treatment.
Objective
To retrospectively analyze the effectiveness of percutaneous anterior odontoid and transarticular screw fixation for type II odontoid fracture treated in the elderly patients.
Methods
Between October 2009 and March 2012, 5 patients with odontoid fracture were treated with anterior triple screws fixation. There were 4 males and 1 female with an average age of 69.4 years (range, 65-74 years). Fracture was caused by falling injury from height in all cases. The average time between injury and operation was 6.8 days (range, 3-12 days). According to Anderson-D’Alonzo classification system, all 5 cases were classified as type II odontoid fractures; 1 case accompanied by anterior arch fracture. Four cases were rated as grade E and 1 case as grade D on the basis of Frankel classification system on nerve function evaluation. Percutaneous anterior odontoid and transarticular screw fixation were used in all cases. The operation time, intra-operative blood loss, X-ray exposure time, and complications were recorded. The X-ray films were taken to observe atlantoaxial stability and implant conditions.
Results
All patients were successfully complete the surgery, and no open operation was needed. The average operation time was 103.6 minutes (range, 93-114 minutes). The average intra-operative blood loss was 5.6 mL (range, 3-10 mL). The average X-ray exposure time was 24.2 seconds (range, 17-32 seconds). Good reduction of atlantoaxial joint and primary healing of incision were obtained in 5 patients. The average follow-up duration was 21.4 months (range, 12-35 months). Transient dysphagia occurred in 3 cases, and was cured after 5 days of expectant treatment. No major complications of carotid artery laceration, spinal cord injury, esophageal perforation, airway obstruction, and implant failure occurred. The X-ray films showed odontoid bony union, atlantoaxial stability and good position of screws. The average time of odontoid fracture union was 7 months (range, 5-10 months). Five patients had normal neurological function (Frankel grade E) at last follow-up. Three patients complained of neck discomfort and movement limitation and had normal daily activities without special therapy; the other 2 patients had no clinical symptom of discomfort.
Conclusion
Percutaneous anterior odontoid and transarticular screw fixation is a safe and effective procedure for treatment of type II odontoid fractures in the elderly patients with minimally invasive surgical advantages.
ObjectiveTo investigate clinical outcomes of isolated atrial septal defect (ASD)repair on the beating or non-beating heart through minimally invasive right axillary approach.
MethodsForty-five patients underwent isolated ASD repair through minimally invasive right axillary approach in Research Institute of Surgery, Daping Hospital of the Third Military Medical University from September 2009 to August 2011. According to different surgical techniques, all the patients were divided into a beating-heart group and a non-beating heart group. In the beating-heart group, there were 22 patients including 13 males and 9 females with their mean age of 3.2±2.1 years and body weight of 13.1±4.0 kg. There were 20 patients with ostium secundum ASD and 2 patients with ostium primum ASD. Mean ASD diameter in the beating-heart group was 12.2±5.1 mm. In the non-beating heart group, there were 23 patients including 14 males and 9 females with their mean age of 3.5±2.5 years and body weight of 12.9±3.3 kg. There were 18 patients with ostium secundum ASD, 3 patients with sinus venosus ASD, and 2 patients with ostium primum ASD. Mean ASD diameter in the non-beating heart group was 11.6±4.7 mm. Serum creatine kinase (CK), creatine kinase isoenzyme (CK-MB), aspartate aminotransferase (AST)and highly sensitive cardiac troponin I (cTnI)were examined preoperatively, after weaning from cardiopulmonary bypass (CPB), 6 hours and 24 hours postoperatively.
ResultsThere was no in-hospital death. Postoperatively, 1 patient had right atelectasis and another patient had right pneumothorax. CPB time and operation time of the beating-heart group were significantly shorter than those of the non-beating heart group (P < 0.05). There was no statistical difference in intraoperative blood transfusion, mechanical ventilation time, length of postoperative ICU stay or hospital stay, chest drainage within 24 hours postoperatively, or postoperative cardiac function between the 2 groups (P > 0.05). Preoperative levels of CK, CK-MB, AST and cTnI were all within the normal limit, and there was no statistical difference between the 2 groups (P > 0.05). After CPB, CK, CK-MB, AST and cTnI levels increased in both groups, but increased significantly greater in the non-beating heart group (P < 0.05). Postoperative levels of CK, CK-MB, AST and cTnI of the beating-heart group were significantly lower than those of the non-beating heart group (P < 0.05).
ConclusionIsolated ASD repair on the beating heart via minimally invasive right axillary approach is a safe and cosmetic procedure with shorter operation time and less myocardial injury.
ObjectiveTo compare early outcomes of the minimally invasive mitral valve surgery (MIMVS) through right anterolateral mini-thoracotomy (ALMT) with conventional mitral valve surgery (MVS), and evaluate feasibility and safety of MIMVS.
MethodsFrom January 2011 to December 2013, 120 patients undergoing elective MVS in Nanjing First Hospital were prospectively enrolled in this study. There were 72 male and 48 female patients with their age of 22-71 (42.4±11.0) years. Using a random number table, all the patients were randomly divided into a portaccess MIMVS group (MIMVS group, n=60) and a conventional MVS group (conventional group, n=60). MIMVS group patients received port-access cardiopulmonary bypass (CPB) establishment via femoral artery, femoral vein and right internal jugular vein cannulation through right ALMT 5-6 cm in length. Special MIMVS operative instruments were used for mitral valve repair or replacement. Conventional group patients received mitral valve repair or replacement under conventional CPB through median sternotomy. Perioperative clinical data, morbidity and mortality were compared between the 2 groups.
ResultsThere was no death in-hospital or shortly after discharge in this study. CPB time (98.0±26.0 minutes vs. 63.0±21.0 minutes) and aortic cross-clamping time (68.0±9.0 minutes vs.37.0±6.0 minutes) of MIMVS group were significantly longer than those of conventional group (P<0.05). Postoperative mechanical ventilation time (6.0±3.9 hours vs. 11.2±5.6 hours), length of ICU stay (18.5±3.0 hours vs. 28.6±9.5 hours) and postoperative hospital stay (8.0±2.0 days vs. 13.5±2.5 days) of MIMVS group were significantly shorter than those of conventional group (P<0.05). Chest drainage volume within postoperative 12 hours (110.0±30.0 ml vs. 385.0±95.0 ml) and the percentage of patients receiving blood transfusion (25.0% vs. 58.3%) of MIMVS group were significantly lower than those of conventional group (P<0.05). Patients were followed up for 1-24 months, and the follow-up rate was 94.2%. There was no statistical difference in postoperative morbidity or mortality between the 2 groups (P>0.05).
ConclusionMIMVS through right ALMT is a safe and feasible procedure for surgical treatment of mitral valve diseases. MIMVS can achieve similar clinical outcomes as conventional MVS, but can significantly shorten postoperative ICU stay and hospital stay, reduce blood transfusion, and is a good alternative to conventional MVS.
ObjectiveTo investigate the advantage and short- and medium-term effectivenesses of paramedian incision minimally invasive transforaminal lumbar interbody fusion (mini-TLIF) by comparing with open TLIF.
MethodsA retrospective analysis was made on the clinical data of 54 patients with single segmental lumbar degenerative disease who accorded with the inclusion criteria between January 2012 and March 2014. Open TLIF was performed in 26 patients (open group), mini-TLIF in 28 cases (minimally invasive group). There was no significant difference in gender, age, disease duration, etiology, and affected segments between 2 groups (P>0.05). The indexes of surgical trauma, systemic inflammatory response, clinical outcome, and interbody fusion rate were compared between 2 groups.
ResultsDural rupture occurred in 1 case of open group, L5 nerve root injury in 1 case of minimally invasive group. All patients obtained primary healing of incision. The operation time, intraoperative blood loss, and postoperative drainage of minimally invasive group were significantly lower than those of open group (P<0.05). C-reactive protein, leucocyte count, and creatine kinase-MM (CK-MM) of open group were significantly higher than those of minimally invasive group at 24 hours after operation (P<0.05). At 7 days after operation, the CK-MM of minimally invasive group was significantly lower than that of open group (P<0.05), but no significant difference was found in C-reactive protein and leucocyte count between 2 groups (P>0.05). The follow-up time was 1.2-3.1 years in open group and 1.4-2.9 years in minimally invasive group. At 1 year after operation, the Oswestry disability index (ODI) and visual analogue scale (VAS) scores were significantly improved in 2 groups (P<0.05). Minimally invasive group was better than open group in ODI and VAS score of back pain (P<0.05), but VAS score of leg pain showed no significant difference (P>0.05). According to the Suk interbody fusion standard, solid fusion was obtained in 18 cases, probable fusion in 4 cases, and nonunion in 4 cases, and the fusion rate was 84.61% in open group; solid fusion was obtained in 21 cases, probable fusion in 3 cases, and nonunion in 4 cases, and the fusion rate was 85.71% in minimally invasive group; and the interbody fusion rates showed no significant difference between 2 groups (χ2=0.072, P=0.821).
ConclusionCompared with open TLIF, paramedian incision mini-TLIF has advantages of minimal surgical trauma and little blood loss for single-level lumbar degenerative disease. The short- and medium-term effectivenesses are satisfactory.
Objective
To investigate the effectiveness of direct lateral interbody fusion (DLIF) for lumbar degenerative diseases.
Methods
A retrospective study was done on 25 cases of lumbar degenerative diseases treated with DLIF between May 2013 and May 2014. There were 15 males and 10 females with an average age of 61.4 years (range, 36-78 years), including 14 cases of lumbar disc herniation, 2 cases of degenerative lumbar scoliosis, 3 cases of lumbar spondylolisthesis, and 6 cases of lumbar instability with spinal stenosis. The disease duration was 8 months to 20 years (mean, 5.7 years). The involved segments included L4, 5 in 10 cases, L3, 4 in 6 cases, L2, 3 in 2 cases, L2-4 in 2 cases, L3-5 in 3 cases, and L2-5 in 2 cases. The operation time, intraoperative bleeding volume, postoperative hospitalization time, and complications were recorded. The visual analogue scale (VAS) and Oswestry disability index (ODI) criteria were used to assess the effectiveness; X-ray film and CT were used to evaluate the bone fusion.
Results
The mean operation time was 105?minutes (range, 85-155 minutes), and mean intraoperative bleeding volume was 158 mL (range, 80-300?mL). The postoperative hospitalization time was 2-5 days (mean, 3.2 days). All incisions healed by first intension. There was no complication of wound infection, vascular injuries, or intraoperative visceral injuries. All cases were followed up 24.6 months on average (range, 18-30 months). Four cases had iliopsoas weakness, 5 cases had iliopsoas weakness and anterior thigh hypoesthesia, which disappeared within 6 months after operation. No retrograde ejaculation, Cage displacement, or loosening was found after operation. Full bony fusion was observed in 20 segments and partial bony fusion in 12 segments. The mean bony fusion time was 10.8 months (mean, 6-18 months). The height of intervertebral space was significantly increased to (11.98±1.20)?mm at 2 days after operation and to (11.80±1.33) mm at last follow-up from preoperative (6.20±0.88) mm (P < 0.05), but no significant difference was found between at 2 days and last follow-up (P > 0.05). At last follow-up, VAS score was significantly decreased to 3.43±0.53 from preoperative 8.26±0.49 (t=26.275, P=0.000), and ODI was significantly decreased to 15.41%±3.91% from preoperative 40.80%±3.10% (t=22.902, P=0.000).
Conclusion
DLIF is a safe and effective treatment for lumbar degenerative diseases, which has the advantages of less tissue damage, less blood loss, and fast rehabilitation.
