Minimally invasive video-assisted kidney transplantation (MIVAKT)

BACKGROUND: Minimally invasive surgery has been applied to nearly all fields of surgery due to its advantages such as reduced morbidity, a better cosmetic outcome, and early recovery. The recent advances in its technique have allowed us to use modified minimally invasive surgery technique in the field of kidney transplantation. MATERIALS AND METHODS: From January 2004 to March 2006, minimally invasive video-assisted kidney transplantation was carried out in 20 patients. Many clinical variables were compared with the conventional method. The operative procedure began with a 7 to 8 cm skin incision. A laparoscopic balloon dissector was used to create the retroperitoneal space for the placement of the grafted kidney. Vascular anastomosis and ureteroneocystostomy were performed under direct vision and with video-assisted TV monitoring. RESULTS: The average length of the wound was 7.8 cm and it was placed below the belt line. The average operating time was 186 min. Less analgesic was given compared with conventional methods. There was one postoperative complication, a mild lymphocele. All patients showed normalized serum creatinine levels within 4 d. All grafted kidneys showed normal findings on the postoperative ultrasound and renal scans. CONCLUSIONS: Minimally invasive video-assisted kidney transplantation is technically feasible and may offer benefits in terms of better cosmetic outcomes, less pain, and quicker recuperation than conventional kidney transplantation.     

Minimally invasive open thyroidectomy

We recently developed a new surgical technique for carrying out thyroidectomy, to minimize tissue trauma by obviating unnecessary neck exploration. This report describes our technique of performing minimally invasive open thyroidectomy and compares the results with those of conventional thyroidectomy. Minimally invasive open thyroidectomy was performed by making a small skin incision, 3.0–4.5 cm long, and approaching the thyroid directly via a transverse divi-sion of the strap muscles without raising skin flaps. The outcomes of 466 patients who underwent a minimally invasive open thyroidectomy were retrospectively compared with those of 437 patients who underwent conventional thyroidectomy for various types of thyroid nodules. There was no significant difference in the extent of surgery between the group of patients who underwent minimally invasive thyroidectomy and the group of patients who underwent conventional thyroidectomy. However, the length of the skin incision, at 3.7 ± 0.7 vs 9.6 ± 3.3 cm, respectively, operative time, at 57.6 ± 11.7 vs 85.2 ± 32.3 min, respectively, blood loss, at 18.4 ± 15.3 vs 43.1 ± 21.8 ml, respectively, and hospital stay, at 1.6 ± 0.5 vs 4.3 ± 1.6 days, respectively, were significantly reduced in the minimally invasive open thyroidectomy group (P < 0.05). Moreover, the number of patients who required postoperative analgesia was significantly less in the minimally invasive open thyroidectomy group. These results show that minimally invasive open thyroidectomy provides surgeons with a clear operative field, and that it has proven to be simple, safe, and practical for selected patients. Received: September 11, 2000 / Accepted: March 6, 2001     

麦默通微创旋切术与传统手术治疗乳腺良性肿块的对比研究

目的 比较超声引导下麦默通微创旋切术与传统手术治疗乳腺良性肿块的疗效.方法 将北京市大兴区人民医院普外科2015年10月-2016年4月收治的80例乳腺良性肿块患者按随机数字表法分为A组40例,B组40例.A组为微创手术组,在超声引导下应用麦默通微创旋切术;B组为传统手术组.对比分析两组患者手术时间、手术切口长度、术中出血量、患者满意度、术后疼痛情况、并发症发生率情况.结果 两组患者的肿块均获得完整切除.A组患者手术时间(10.4±1.0) min,术中出血量(4.1±0.5)ml,切口长度(0.34±0.04) cm明显小于B组(P＜0.05或P＜0.01);并发症发生率少于B组(P＜0.05);患者满意度(95％)明显高于B组(P＜0.01).结论 超声引导下麦默通微创旋切术具有手术时间短、出血量少、瘢痕小、患者满意度高等优点,值得在基层医院推广应用.     

Less invasive quick replacement of the proximal arch with aggressive rapid rewarming for type A acute aortic dissection

We describe a newly modified technique, which we term “less invasive quick replacement” (LIQR) for type A acute aortic dissection (AAD). After cooling to a rectal temperature of 28°C without any cerebral perfusion, circulating blood in the cardiopulmonary bypass (CPB) circuit was warmed up to 40°C during open distal anastomosis. As soon as the distal anastomosis was completed, rapid rewarming was initiated by perfusing blood at 40°C. The average CPB and total operative times were 71.8 ± 9.6 and 130.6 ± 7.7 min, respectively. The shortest operative time was 101 min from skin incision to skin closure. All patients were weaned off the ventilator within 12 h of surgery. The postoperative hospital stay was 9.3 ± 1.2 days. There was no incidence of cerebral damage or hospital mortality. Our initial results showed LIQR to be safe and effective.     

Effects of Laparoscopic Hernia Repair by PIRS (Percutan Internal Ring Suturing) Technique on Testicular Artery Blood Supply

Purpose: Percutaneous internal ring suturing technique (PIRS) is a minimally invasive technique in pediatric inguinal hernia repair. In the present study, a negative effect on testicular blood flow using PIRS technique has been investigated. Methods: Forty male patients were included in the study prospectively. Two groups were formed as conventional open surgery (Group I) and PIRS technique (Group II). The resistive index (RI) value of the testicular artery was measured prospectively by using SMI (superb micro-vascular imaging) software with the color doppler ultrasound technique preoperatively and postoperatively at the first month. Results: Inguinal hernia was present on the left in 35% (n = 14) of the patients and on the right in 65% (n = 26) of the patients. There was no statistically significant difference (p = 0.727) between Group I and II with regard to preoperative RI value (0.66 ± 0.07 vs. 0.66 ± 0.45, respectively). Similarly, there was no statistically significant difference (p = 0.220) between Group I and II with regard to the RI values measured at the postoperative first month (0.58 ± 0.04 vs. 0.60 ± 0.04, respectively). Although the postoperative RI values decreased compared to the preoperative values in both groups, this difference was not statistically significant. (p = 0.447 in Group I, and p = 0.175 in Group II for intragroup comparison). Conclusions: Besides PIRS technique has the advantages provided by all other laparoscopic techniques defined for inguinal hernia repair, there is no significant difference between this technique and conventional open surgery with regard to testicular blood flow. It is an innovative candidate technique instead of the open surgery method besides its additional advantages.     

A Shorter Skin Incision Technique for the Repair of Infrarenal Abdominal Aortic Aneurysms

Purpose We evaluated the effectiveness of a shorter skin incision technique for the treatment of infrarenal abdominal aortic aneurysms (AAA). The aim of the present study was to evaluate whether or not the difference in the length of the skin incision contributed to an early recovery after the operation. Methods Between October 2001 and December 2004, we performed 105 elective repairs for AAA. The patients were divided into three groups according to the length of the skin incision as follows: group A, less than 15 cm, group B, from 15 cm to less than 20 cm, and group C, 20 cm or more. Results There was no significant difference in the intraoperative course among the three groups. The duration of paralytic ileus was shorter in group A than in group C (2.0 ± 0.9 days versus 3.2 ± 2.3 days; P = 0.0428). Although the periods before removal of nasogastric suction and before starting a solid diet were slightly shorter in group A than in groups B and C, there were no statistically significant differences. Conclusion We define minimally invasive vascular surgery as surgery performed with a small abdominal skin incision that does not expose the intestine to air while providing a good operative field that does not place any undue stress on the surgeon.     

内镜辅助下甲状腺手术12例报告

目的　探讨微创内镜辅助下甲状腺手术可行性及优点。方法　自 2 0 0 3年 9月至2 0 0 3年 12月进行微创内镜辅助下甲状腺手术 12例。其中结节性甲状腺肿 7例 ,甲状腺腺瘤 5例。结果　 12例病人均完成手术 ,无一例中转为常规手术 ,无明显术后并发症。手术时间 3 8～ 110min ,平均约 65min。所有病人经过 1～ 3个月的随访 ,对切口的美容效果感到满意。结论　微创内镜辅助下甲状腺手术安全 ,切实可行 ,具有良好的切口美容效果。     

Comparison of limited and full sternotomy in aortic valve replacement

Objective: The practice of minimally invasive valve surgery remains controversial. The aim of this study was to evaluate the technical feasibility and postoperative course of aortic valve replacement through limited upper sternotomy compared to conventional full sternotomy. Methods: From May 1998 to August 2000, we performed 24 cases of isolated aortic valve replacements through the limited upper sternotomy approach (group M). During the same period, 18 patients received isolated aortic valve replacements through the conventional full sternotomy approach (group C). Operation duration, postoperative course and laboratory data were compared between the two groups. Results: All patients received a valve replacement with a prosthetic valve. There was no significant difference between the two groups in mean aortic cross-clamping time, mean cardiopulmonary bypass time or mean operation duration (skin to skin). No patient required blood transfusion. Patients in the group M were extubated earlier, with less postoperative blood loss and discharged earlier after the operation than those in group C. On the first postoperative day, the peak level of lactic acid dehydrogenease was significantly lower in the group M than those in group C. Conclusion: Limited upper sternotomy for aortic valve replacement resulted in shorter operation duration and minimized operative risks for the patients. We believe this method brings not only cosmetic benefits but also improved postoperative course.     

Minimally Invasive Video-Assisted Thyroidectomy for Follicular Neoplasm: Is There an Advantage Over Conventional Thyroidectomy?

Background Minimally invasive video-assisted thyroidectomy (MIVAT) is safe and effective for selected patients, but its advantages are not clearly defined. Results of MIVAT for follicular neoplasms at a single institution were retrospectively evaluated to define its advantages or disadvantages. Methods Between October 2002 and May 2004, 22 patients underwent MIVAT. Twenty-six patients who underwent conventional thyroidectomy during the same time period served as matched controls. Operative times, pathologic findings, complications, analgesic requirements, and incision lengths were retrospectively evaluated. Results Four MIVAT and three conventional surgery patients underwent total thyroidectomy. Eighteen MIVAT and 23 conventional patients underwent hemithyroidectomy. The operative time (mean ± SEM) for hemithyroidectomy was 102 ± 4 minutes for MIVAT and 86 ± 3 minutes for conventional surgery (P < .05). In subgroup analysis that excluded patients with thyroiditis, operative times were not significantly different: MIVAT, 99 ± 4 minutes; conventional, 88 ± 4 minutes. The mean incision length was 2.3 ± .5 cm in the MIVAT group. Conventional thyroidectomy was performed through a 4- to 5-cm incision. The average amount of narcotic used was not significantly different (intravenous, 9.9 ± 3.1 mg [MIVAT] vs. 12.4 ± 3.8 mg; oral, 10.3 ± 4.2 mg [MIVAT] vs. 3.5 ± 2.0 mg). The conventional group received more cyclooxygenase 2 inhibitor (527 ± 9 mg vs. 187 ± 84 mg; P < .05). One patient in each group experienced transient hoarseness. There were no cases of permanent hypoparathyroidism or recurrent laryngeal nerve injury in either group. Conclusions MIVAT is as safe and effective as conventional thyroidectomy and is associated with similar narcotic analgesic requirements, but it can be performed through smaller incisions. Operative times were significantly longer for MIVAT, but when patients with thyroiditis were excluded, operative times were not significantly different. Presented at the 58th Annual Cancer Symposium of the Society of Surgical Oncology, Atlanta, Georgia, March 3–5, 2005.     

高龄粗隆间骨折的微创治疗应用探讨

目的 探讨小切口微创技术治疗高龄股骨粗隆间骨折的方法及其疗效。方法 收集近2年来65岁以上高龄粗隆间骨折病例33例，其中小切口DHS治疗18例，微创Gamma钉治疗15例，对手术切口大小、操作时间、术中术后出血量、并发症、术后髋关节功能评定进行临床随访分析。结果 33例均得到随访，小切口DHS组：切口长度为4cm（3～5cm），平均手术时间70min（60～100min），平均出血100mL（50～200mL）；微创Gamma钉：切口长度为3cm（2．5～4．5cm），平均手术时间50min（40～70min），平均出血65mL（30～100mL）。对两组进行术后功能评定，优30例（90．9％），良3例（9．1％）。结论 小切口技术治疗股骨粗隆骨折创伤小，是高龄患者一种理想的治疗方法。     

微创直视手术在成人先天性心脏病中的应用（附52例分析）

目的 初步评价微创直视心脏手术治疗成人先天性心脏病的安全性和有效性.方法 2010年4月～ 2012年12月,单组共完成微创直视先天性心脏病手术52例.建立闭式体外循环,做右胸前外侧切口3 ～～5 cm,经肋间入胸腔,剪开心包,进入心腔完成畸形矫治.实施手术包括房间隔缺损（ASD）修补术29例,室间隔缺损（VSD）修补术15例,部分型心内膜垫缺损（PECD）矫治术2例,Ebstein畸形矫治术2例,二次二尖瓣置换术（redo-MVR）1例,主动脉窦瘤修补1例,主动脉窦瘤修补联合主动脉瓣置换术（AVR）1例,二尖瓣成形术（MVP）1例.同期手术包括三尖瓣成形术（TVP）5例,射频消融术2例,肺动脉瓣狭窄（PS）球囊扩张术1例,MVR术1例.结果 手术均在闭式体外循环下完成,无转为传统胸正中切口开胸手术.手术时间（3.7±0.8）h.体外循环时间36 ～209 min,（76.9±31.3）min.心脏不停跳下完成手术25例;心脏停跳下完成手术27例,主动脉阻断时间13 ～ 138 min,（57.6±18.2）min,术后自动复跳23例.气管插管时间3～30 h,（10.9±4.0） h;ICU时间9～41 h,（16.7±4.4）h;术后住院时间3～14d,（5.4±4.1）d;切口长度3～5 cm,（4.5±0.6）cm;术后第1天引流量（349.5±294.2）ml;34例（65.4％）未输血.无围术期及出院后死亡,无二次开胸探查止血和切口感染.出院时心功能Ⅰ级45例,Ⅱ级6例,Ⅲ级1例.25例随访时间1 ～ 24月,（7.0±4.5）月,无明显并发症发生,心功能均为Ⅰ级.结论 微创直视手术在成人先心病应用的近期手术效果良好,适用范围相对广泛,具有创伤小、切口美观、无胸骨感染并发症等特点.     

Two Different Minimally Invasive Techniques for Female Patients with Atrial Septal Defects: Totally Thoracoscopic Technique and Right Anterolateral Thoracotomy Technique

Background: To compare the outcomes of totally thoracoscopic technique (TTS) vs. right anterolateral thoracotomy technique (RALT) in female patients undergoing minimal invasive atrial septal defect (ASD) correction.Methods: From March 2011 to January 2013, 125 female patients underwent minimally invasive atrial septal defect closure, of whom 62 patients were in the TTS group and 63 were in the RALT group.Results: Procedures were performed successfully in all patients without in-hospital mortality or major complications. cardiopulmonary bypass (CPB) time were 48.95 ± 15.63 min in TTS group, 31.4 ± 8.04 min in RALT group (p <0.001); the cross-clamp time were 26.92 ± 11.84 min in TTS group and 18.51 ± 6.11 min in RALT group (p <0.001). The length of incision in RALT group (6.02 ± 1.03 cm) was longer than TTS group (5.31 ± 0.68 cm) and the difference was significant (p <0.001). The overall satisfaction rate for the cosmetic results of TTS was 100% and was 96.83% (61/63 patients) in RALT patients. During follow-up, all patients in TTS group were satisfied expect two patients complained that scar was too long at groin. Reasons for a lower score in RALT group included the long scar in the chest; a RALT incision that was located too medially (coming off the bra line) and asymmetrical breast development.Conclusions: Both TTS and RALT are valid and reliable cosmetic surgical techniques for repairing ASDs in female patients. Both techniques allow excellent cosmetic and functional results in most female patients. The totally thoracoscopic technique may gain shorter incision and cosmetic results compared with RALT.     

后路微创化技术治疗下腰椎退变性疾病

目的介绍两种微创手术,通过减压和椎体间融合治疗部分下腰椎退变性疾病,总结该技术相对于传统开放术的利弊。方法 (1)经皮椎弓根螺钉植入+小切口椎板开窗或椎间盘镜下开窗减压,椎间植骨融合术,共9例;(2)小切口棘旁两侧分次有限暴露固定并减压椎间植骨融合术,共38例。所有病例分别于术后3、6、12个月得到随访。结果本组与传统术式相比,手术时间、出血量及骨性融合率都无显著性差异,但融合病发生率显著降低,术后开始训练时间显著提早。结论微创化术式可减少局部创伤,提早康复锻炼,降低融合病发生率。     

全胸腔镜下室间隔缺损修补手术单中心临床分析

目的总结全胸腔镜下室间隔缺损修补手术临床经验。方法回顾性分析2008年5月至2018年12月我院449例行全胸腔镜下心脏手术的室间隔缺损患者的临床资料,男232例、女217例,年龄3~55(17.3±11.2)岁。结果449例患者手术时间为1.8~4.0(2.4±0.3)h,体外循环时间42~136(64.2±11.6)min,升主动脉阻断时间17~84(28.4±10.7)min,术后呼吸机辅助时间3~45(6.9±3.8)h,术后住重症监护室时间16~68(20.5±5.6)h,术后胸腔闭式引流量50~1060(213.1±117.2)mL,术后住院时间5~16(6.9±1.3)d。全组患者均治愈出院,无中转正中开胸患者。出现并发症11例(2.4%),包括术中再次手术1例,术后胸腔镜下二次止血3例,切口感染3例,室间隔缺损残余漏2例,股动脉切口狭窄合并血栓栓塞1例,右侧气胸1例。患者术后随访1~128(72.2±33.9)个月,无再次手术患者,室间隔缺损残余漏2例,二尖瓣及主动脉瓣轻中度关闭不全各1例,心功能明显好转。结论全胸腔镜下室间隔缺损修补手术具有并发症少、术后恢复快及安全可靠等优势,近中期疗效良好。     

Examination of mitral valve repair with port-access method—Aiming at early and less invasive mitral valve repair—

Objective  We reviewed the results of mitral valvuloplasty by port-access minimally invasive cardiac surgery to examine the validity of operating during an early phase. Methods  From 1988 through March 2007, a total of 126 patients requiring mitral valvuloplasty were treated with port-access minimally invasive cardiac surgery. Their mean age was 51 ± 13 years, and 88 were male. The operative procedures were resection-suture in 51 cases, artificial chordal replacement in 5 cases, chordal translocation in 3 cases, leaflet plication in 3 cases, and artificial chordal reconstruction by the loop technique in 64 cases. Results  There was one hospital death, and two patients required reoperation at 1 and 21 postoperative days because of hemolysis and intractable systolic anterior motion, respectively. Except for the two patients undergoing reoperation, the duration of the postoperative hospital stay was 9.7 ± 3 days. The results of the other cases were satisfactory during each follow-up period. Conclusion  Complete valvuloplasty with port-access MIS is thought to be an increasingly important procedure for treating mitral regurgitation. This study was presented at the 60th annual scientific meeting of the Japanese Association for Thoracic Surgery.     

Laparoendoscopic single‐site cholecystectomy versus conventional laparoscopic cholecystectomy: a systematic review of randomized controlled trials

Background: Laparoendoscopic single‐site surgery is a revolution in minimally invasive surgery in recent years, and cholecystectomy is the most common intervention. However, laparoendoscopic single‐site cholecystectomy (LESSC) is a controversial procedure. Its safety, cosmetic results, complications, post‐operative pain and post‐operative stay are not confirmed by multi‐centre randomized controlled studies. Objectives: This review examined the impact of LESSC versus conventional laparoscopic cholecystectomy (CLC). The primary outcomes were conversional rate and intraoperative and post‐operative complications, and other outcomes were cosmetic results, operative time, post‐operative pain and post‐operative stay. Data sources: Pubmed, EMbase, Web of Science, Ovid, clinical trials of the US National Institutes of Health and Cochrane Database of Systematic Reviews and Controlled Trials Register were searched to identify all possible randomized controlled trials (RCTs). Methods: Two reviewers completed article search, and eligible data were entered into a computerized spreadsheet for analysis. Results: Nine studies were obtained using the search strategy. Patients accepting LESSC had a higher conversion rate than those having CLC (7.17 (3.00, 17.11) (P < 0.01)). There was no significant difference for total complications between the two groups (1.17 (0.76, 1.80) (P= 0.46)), but incidence of incisional hernia and haemorrhage (seroma) in the LESSC group was obviously higher than that in the CLC group. Operative time was much longer in the LESSC group (mean difference: 10.69 (3.14, 18.24) (P= 0.006)). Cosmetic results favoured LESSC; however, post‐operative abdominal pain and post‐operative stay were not significantly different between the two groups in most of the nine studies. Conclusions: LESSC can be safely performed with better cosmetic results; however, it carries a higher conversion rate and a longer operative time, and offers no benefit in terms of post‐operative abdominal pain and post‐operative stay. Further RCTs, according to the CONSORT statement, are advocated to validate its objective benefits.     

体外循环手术应用腋下及腋前外切口

自１９９５年３月至１９９６年８月作者应用腋下及腋前外切口进行体外循环手术５０例。房间隔缺损１７例，室间隔缺损２６例，二尖瓣狭窄及关闭不全３例，三房心、部分型心内膜垫缺损、双腔右心室、二尖瓣关闭不全各１例。全组手术顺利，主动脉阻断时间２２．５９±１１．０６分钟，体外循环时间４０．１９±１７．１７分钟。无手术死亡及并发症。创伤轻、出血少、恢复快、腋下切口看不见手术瘢痕、美容效果好。     

Minilaparotomy abdominal aortic aneurysm repair in the era of minimally invasive vascular surgery: preliminary results

Background: This study aimed to evaluate the early post‐operative clinical impact of minimal incision aortic surgery (MIAS) for infrarenal abdominal aortic aneurysm (AAA) repair in comparison with the standard open repair. Methods: A case‐control study was conducted. Patients of groups A (19 patients) and B (18 patients) were treated with the MIAS technique and the standard open method, respectively. Results: There were significant differences between the two groups in fluid resuscitation during the operation. Post‐operatively, there were significant differences between groups A and B in the time until starting liquid diet (2 ± 0.74 versus 3.55 ± 0.85 post‐operative days (PD), respectively; P < 0.05), the time until starting the solid diet (3.05 ± 0.77 versus 5.11 ± 0.75 PD, respectively; P < 0.05), the time of ambulation (2 ± 0.74 versus 3.4 ± 0.98 PD, respectively; P < 0.05) and in the hospital length of stay (4 ± 0.81 versus 9.7 ± 2.66 days, respectively; P < 0.05). Conclusions: The MIAS technique, for repair of infrarenal aortic aneurysms, is a safe and feasible procedure that combines the early advantages of endovascular repair with the long‐term advantages of the traditional open repair.     

小切口微创全髋关节置换术早期比较研究

目的：报告后路小切口微创与常规切口全髋关节置换术早期比较结果：方法：自2003年10月～2004年11月，15例患者行单侧后路小切口微创全髋关节置换术，同期24例患者接受常规切口手术，进行术中和术后指标比较：结果：小切口微创手术平均切口长8．3cm，术中出血量373ml，手术时间79min，术后12h引流量219ml。输血6例，平均输血量0．60U。2例发生切口皮肤擦伤：与常规切口手术比较，切口长度和手术时间有显著性差异，术中失血量、术后引流量以及输血量无显著性差异．结论：后路小切口微创全髋置换术具有创伤小、手术时间短等优点，手术切实可行，但要有严格的手术指征、熟练的操作技术和专用的器械。     

经右前外侧肋间小切口心脏多瓣膜手术154例中期疗效随访的回顾性队列研究

目的 分析经右前外侧肋间小切口心脏多瓣膜手术的早期疗效中期随访结果,探讨手术的安全性、有效性与外科医生学习曲线.方法 回顾性分析2015～2019年空军军医大学第一附属医院心血管外科完成的154例经右前外侧肋间小切口多瓣膜手术的临床资料.男103例,女51例,年龄23 ～ 68岁,全部手术经股动、静脉建立闭式体外循环,...