ObjectiveTo study the learning curve of minimal invasive coronary artery bypass grafting (MICS CABG) and the influence on the perioperative clinical effects by analyzing operation time.MethodsFrom March 2012 to November 2020, 212 patients underwent MICS CABG by the same surgeon. Among them, 59 patients (52 males and average age of 62.89±8.27 years) with single vessel bypass grafting were as a single-vessel group and 153 patients (138 males, average age of 59.80±9.22 years) with multi-vessel bypass grafting were as a multi-vessel group. Two sets of operation time-operation sequence scatter plots were made and learning curve was analyzed by cumulative summation (CUSUM) and regression method of operation time. The surgical data of each group before and after the inflection point of the learning curve were compared with the main clinical outcome events within 30 days after surgery.ResultsThere was no death, perioperative myocardial infarction and stroke in 212 MICS CABG patients and no transfer to cardiopulmonary bypass or redo thoracotomy. The learning curve conformed to the cubic fitting formula. In the single-vessel group, CUSUM (x operation number)=–1.93+93.45×x–2.33×x2+0.01×x3, P=0.000, R2=0.986, the tipping point was 27 patients. In the multi-vessel group, CUSUM (x)=y=2.87+1.15×x–1.29× x2+3.463×x3, P=0.000, R2=0.993, and the tipping point was 59 patients. The two sets of case data were compared before and after the learning curve and there was no statistical difference in main clinical outcomes within 30 days (mortality, acute myocardial infarction, stroke, perioperative blood transfusion rate), ventilator tube, and intensive care unit retention.ConclusionThe learning curve of MICS CABG conforms to the cubic formula, and the process transitions from single to multiple vessels bypass. To enter the mature stage of the learning phase, a certain number of patients need to be done. Reasonable surgical procedures and quality control measures can ensure the safety during the learning phase.
ObjectiveTo evaluate the early and mid-term outcomes of total thoracoscopic Box Lesion radiofrequency ablation in patients with atrial fibrillation.MethodsThe clinical data of 31 patients with atrial fibrillation who underwent total thoracoscopic Box Lesion radiofrequency ablation between November 2011 and March 2018 at the Department of Cardiac Surgery in our hospital were retrospectively analyzed, including 23 males and 8 females at an average age of 66.17±8.32 years. All patients did not have concomitant severe organic heart disease which required surgical intervention.ResultsThere were 20 patients with paroxysmal atrial fibrillation, 8 with persistent atrial fibrillation, and 3 with long-standing persistent atrial fibrillation. Twenty-nine patients got the 3-year follow-up, and 2 patients were lost to the follow-up 6 months after the surgery. The procedure was successfully performed in all patients, with an average operation time of 113.00±26.00 min. There was no perioperative death or related complication. All patients were restored to sinus rhythm immediately after surgery. Five patients got atrial fibrillation during postoperative hospitalization, which reverted to sinus rhythm after electrical cardioversion. The rate of sinus rhythm maintenance was 62.9%, 55.9% and 52.4% in postoperative 1, 2 and 3 years, respectively. No patient died during the period, and no procedure-related complication was observed.ConclusionTotal thoracoscopic Box Lesion radiofrequency ablation effectively shortens operation time, and reduces surgical trauma and procedure-related complications, meanwhile, ensures the surgical outcomes.
【Abstract】Objective To study the advances of minimally invasive surgery for breast cancer. Methods The latest references on the minimally invasive surgery of breast cancer were reviewed. Results Electrochemotherapy,endoscopy, percutaneous microwave coagulation therapy, high intensity focused ultrasound, and targeting therapy were widely applied to treat breast cancer with the characteristics of minimal wound, little hemorrhage and fast rehabilitation. Conclusion The minimally invasive surgery for breast cancer will be extensively carried out in the future.
Objective To investigate arthroscopic treatment for acute acromioclavicular dislocation by using Twin Tail TightRope combined with distal joint capsular repair. Methods The clinical data of 40 patients with acromioclavicular dislocation treated between February 2016 and December 2017 were retrospectively analyzed. The patients were divided into arthroscopic group (20 cases, using arthroscopic Twin Tail TightRope combined with distal joint capsular repair for anatomical repair of stable structure of acromioclavicular joint) and control group (20 cases, treated with clavicular hook plate internal fixation) according to different surgical methods. There was no significant difference in gender, age, cause of injury, Rockwood classification, time from injury to operation, preoperative visual analogue scale (VAS) score and Constant score between the two groups (P>0.05), which were comparable. Postoperative VAS score and Constant score were used to assess shoulder function and re-dislocation was also observed. Results The incisions of the two groups healed by first intention, and no early postoperative complications occurred. All patients were followed up 12-18 months (mean, 13.5 months). Postoperative X-ray films showed good anatomical reduction in both groups, but the clavicular hook had a presense in the subacromial space in control group. All patients in arthroscopic group achieved satisfactory shoulder function and returned to work after operation; there was no obvious pain, no complications such as exposure of implant after operation, and no need to remove the implant. In the control group, 4 patients had obvious subacromial impingement pain after operation, and 1 patient had re-dislocation after removal of internal fixator at 1 year after operation; the rest had no complications related to internal fixation, and the internal fixators were removed at 1.0-1.5 years after operation, without re-dislocation. The VAS score and Constant score at 3 months and 1 year after operation in both groups significantly improved when compared with those before operation, and further improved at 1 year after operation (P<0.05). The VAS score and Constant score at 3 months and 1 year after operation in arthroscopic group were significantly better than those in control group (P<0.05). Conclusion Arthroscopic treatment for acute acromioclavicular joint dislocation by using Twin Tail TightRope combined with distal capsular repair is more effective than traditional incision surgery and can obtain more satisfactory results in patient compliance and function recovery because of minimally invasive surgery.
Objective
To explore safety and efficacy of total laparoscopic radical resection of hilar cholangiocarcinoma.
Methods
From April 2016 and January 2017, 6 patients with hilar cholangiocarcinoma underwent laparoscopic radical resection in the Affiliated Hospital of Xuzhou Medical University were collected. The intra- and post-operative situation and the postoperative complications were analyzed.
Results
The radical resections of hilar cholangiocarcinoma were completed laparoscopically in all the patients. There was no conversion to the laparotomy. The procedure was finished within a time of (231.3±94.5) min and with an intraoperative blood loss of (123.3±46.8) mL. The first postoperative exhausting time and the postoperative hospital stay was (2.7±0.3) d and (11.9±1.7) d, respectively. All the patients had the R0 resection and the numbers of dissected lymph nodes were 9.4±2.7. The postoperative complications occurred in 2 patients, they were all cured spontaneously in one week, and there was no perioperative death. None of patients had a local recurrence and metastasis during an average 8 months of following-up.
Conclusions
Preliminary results of limited cases in this study show that with suitable case and skillful laparoscopic technique, laparoscopic radical resection of hilar cholangiocarcinoma is feasible and safe. Further studies are still needed to confirm benefits of this approach.
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 evaluate the safety of a less traumatic surgical approach in minimally invasive direct coronary artery bypass (MIDCAB).
MethodsWe retrospectively analyzed the clinical data of 70 patients underwent MIDCAB via left anterior small thoracotomy between May 2012 and August 2013. There were 60 male and 10 female patients with a mean age of 56.8±9.2 years (ranged 44-76 years), with single vessel disease (left anterior descending artery) in 42 patients,and double or three vessels disease in 28 patients (include left main vessel disease).
ResultsThe procedure were successfully completed in all 70 patients. No operation-related death or complication occurred. The extubation time was 4-16 (9.7±5.2) hours. The ICU time was 10-24(20.8±10.8)hours. They were followed up for 1-14 months. No deaths or angina or myocardial infarction occurred. Postoperative coronary angiography in 17 patients found no restenosis.
ConclusionMIDCAB via left anterior small thoracotomy can be performed safely by using the new left internal mammary artery (LIMA) harvesting system.
ObjectiveTo assess outcomes of transcatheter aortic valve replacement (TAVR) for pure native aortic valve regurgitation.MethodsA total of 129 patients underwent transfemoral TAVR in Fuwai Hospital from May 2019 to October 2020 were retrospectively analyzed. There were 83 males and 46 females with an average age of 72.26±8.97 years. The patients were divided into a pure native aortic valve regurgitation group (17 patients) and an aortic valve stenosis group (112 patients).ResultsThe incidence of valve in valve was higher in the pure native aortic valve regurgitation group (47.0% vs. 16.1%, P<0.01). There was no statistical difference between the two groups in conversion to surgery, intraoperative use of extracorporeal circulation, intraoperative left ventricular rupture, postoperative use of extracorporeal membrane oxygenation (ECMO), peripheral vascular complications, disabled stroke, death, or pacemaker implantation. There was no statistical difference in the diameter of annulus (25.75±2.21 mm vs. 24.70±2.90 mm, P=0.068) or diameter of outflow tract (25.82±3.75 mm vs. 25.37±3.92 mm, P=0.514) between the pure native aortic valve regurgitation group and the aortic valve stenosis group.ConclusionTransfemoral TAVR is a feasible method for patients with pure native aortic valve regurgitation. The diameter of annulus plane, the diameter of outflow tract and the shape of outflow tract should be evaluated.
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.
Objective
To compare the difference of traumatic related index in serum and its significance between minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF) and open TLIF.
Methods
Sixty patients were enrolled by the entry criteria between May and November 2012, and were divided into MIS-TLIF group (n=30) and open TLIF group (n=30). There was no significant difference in gender, age, type of lesions, disease segment, and disease duration between 2 groups (P gt; 0.05). The operation time, intraoperative blood loss, and postoperative hospitalization time were recorded, and the pain severity of incision was evaluated by visual analog scale (VAS). The serum levels of C-reactive protein (CRP) and creatine kinase (CK) were measured at preoperation and at 24 hours postoperatively. The levels of interleukin 6 (IL-6), IL-10, and tumor necrosis factor α (TNF-α) in serum were measured at preoperation and at 2, 4, 8, and 24 hours after operation.
Results
The operation time, intraoperative blood loss, and postoperative hospitalization time of MIS-TLIF group were significantly smaller than those of open TLIF group (P lt; 0.05), and the VAS score for incision pain in MIS-TLIF group was significantly lower than that of open TLIF group at 1, 2, and 3 days after operation (P lt; 0.05). The levels of CRP, CK, IL-6, and IL-10 in MIS-TLIF group were significantly lower than those in open TLIF group at 24 hours after operation (P lt; 0.05), but there was no significant difference between 2 groups before operation (P gt; 0.05). No significant difference was found in TNF-α level between 2 groups at pre- and post-operation (P gt; 0.05).
Conclusion
Compared with the open-TLIF, MIS-TLIF may significantly reduce tissue injury and systemic inflammatory reactions during the early postoperative period.
