http://www.hindawi.com The latest articles from Hindawi Publishing Corporation © 2013 , Hindawi Publishing Corporation . All rights reserved. Sun, 19 May 2013 12:47:07 +0000 http://www.hindawi.com/journals/mis/2013/283438/ Introduction. Single-incision laparoscopic colectomy (SILC) is a viable and safe technique; however, there are no single-institution studies comparing outcomes of SILC for colon cancer with well-established minimally invasive techniques. We evaluated the short-term outcomes following SILC for cancer compared to a group of well-established minimally invasive techniques. Methods. Fifty consecutive patients who underwent SILC for colon cancer were compared to a control group composed of 50 cases of minimally invasive colectomies performed with either conventional multiport or hand-assisted laparoscopic technique. The groups were paired based on the type of procedure. Demographics, intraoperative, and postoperative outcomes were assessed. Results. With the exception of BMI, demographics were similar between both groups. Most of the procedures were right colectomies () and anterior resections (). There were no significant differences in operative time (127.9 versus 126.7 min), conversions (0 versus 1), complications (14% versus 8%), length of stay (4.5 versus 4.0 days), readmissions (2% versus 2%), and reoperations (2% versus 2%). Oncological outcomes were also similar between groups. Conclusions. SILC is an oncologically sound alternative for the management of colon cancer and results in similar short-term outcomes as compared with well-established minimally invasive techniques. Rodrigo Pedraza, Ali Aminian, Javier Nieto, Chadi Faraj, T. Bartley Pickron, and Eric M. Haas Copyright © 2013 Rodrigo Pedraza et al. All rights reserved. Thu, 09 May 2013 14:08:31 +0000 http://www.hindawi.com/journals/mis/2013/381628/ Objectives. We report the single-incision laparoscopic cholecystectomy (SILC) learning experience of 2 hepatobiliary surgeons and the factors that could influence the learning curve of SILC. Methods. Patients who underwent SILC by Surgeons A and B were studied retrospectively. Operating time, conversion rate, reason for conversion, identity of first assistants, and their experience with previous laparoscopic cholecystectomy (LC) were analysed. CUSUM analysis is used to identify learning curve. Results. Hundred and nineteen SILC cases were performed by Surgeons A and B, respectively. Eight cases required additional port. In CUSUM analysis, most conversion occurred during the first 19 cases. Operating time was significantly lower (62.5 versus 90.6 min, P = 0.04) after the learning curve has been overcome. Operating time decreases as the experience increases, especially Surgeon B. Most conversions are due to adhesion at Calot’s triangle. Acute cholecystitis, patients’ BMI, and previous surgery do not seem to influence conversion rate. Mean operating times of cases assisted by first assistant with and without LC experience were 48 and 74 minutes, respectively (P = 0.004). Conclusion. Nineteen cases are needed to overcome the learning curve of SILC. Team work, assistant with CLC experience, and appropriate equipment and technique are the important factors in performing SILC. Chee Wei Tay, Liang Shen, Mikael Hartman, Shridhar Ganpathi Iyer, Krishnakumar Madhavan, and Stephen Kin Yong Chang Copyright © 2013 Chee Wei Tay et al. All rights reserved. Wed, 03 Apr 2013 11:54:56 +0000 http://www.hindawi.com/journals/mis/2013/142616/ The “hybrid” approach to multivessel coronary artery disease combines surgical left internal thoracic artery (LITA) to left anterior descending coronary artery (LAD) bypass grafting and percutaneous coronary intervention of the remaining lesions. Ideally, the LITA to LAD bypass graft is performed in a minimally invasive fashion. This review aims to clarify the place of hybrid coronary revascularization (HCR) in the current therapeutic armamentarium against multivessel coronary artery disease. Eighteen studies including 970 patients were included for analysis. The postoperative LITA patency varied between 93.0% and 100.0%. The mean overall survival rate in hybrid treated patients was 98.1%. Hybrid treated patients showed statistically significant shorter hospital length of stay (LOS), intensive care unit (ICU) LOS, and intubation time, less packed red blood cell (PRBC) transfusion requirements, and lower in-hospital major adverse cardiac and cerebrovascular event (MACCE) rates compared with patients treated by on-pump and off-pump coronary artery bypass grafting (CABG). This resulted in a significant reduction in costs for hybrid treated patients in the postoperative period. In studies completed to date, HCR appears to be a promising and cost-effective alternative for CABG in the treatment of multivessel coronary artery disease in a selected patient population. Arjan J. F. P. Verhaegh, Ryan E. Accord, Leen van Garsse, and Jos G. Maessen Copyright © 2013 Arjan J. F. P. Verhaegh et al. All rights reserved. Wed, 27 Mar 2013 13:21:23 +0000 http://www.hindawi.com/journals/mis/2013/216416/ The paper reports the results of a retrospective review of the medical charts of 203 patients admitted to a pediatric surgical unit with a diagnosis of acute appendicitis between January 2006 and December 2010 when a transumbilical laparoscopic-assisted appendectomy (TULAA) was introduced as a new surgical technique. Among 203 admitted patients, 7 (3.5%) had a localized appendiceal abscess and were treated with antibiotics. All of them responded to antibiotics and underwent TULAA interval appendectomy 8 weeks later. 196 patients (96.5%) underwent immediate surgery. In 12/181 (6.6%) urgent cases, conversion to laparotomy was necessary, in 3 patients because of bowel distension and in 9 for retrocecal position of appendix. In all 181 TULAA completed procedures, one trocar was used in 151 cases (89.4%), two trocars in 16 (9.4%), and three trocars in 2 (1.2%). The mean operative time for single port TULAA was 52′ Complications included 5 wound infections and 5 intra-abdominal abscesses, all managed conservatively. In conclusion, TULAA is a safe, minimally invasive approach with acute appendicitis, regardless of the perforation status, and can be recommended in the pediatric urgical settings. D. Codrich, M. G. Scarpa, M. A. Lembo, F. Pederiva, D. Olenik, F. Gobbo, A. Giannotta, S. Cherti, and J. Schleef Copyright © 2013 D. Codrich et al. All rights reserved. Wed, 27 Mar 2013 11:53:34 +0000 http://www.hindawi.com/journals/mis/2013/179569/ In the recent years minimally invasive mitral valve surgery (MIMVS) has become a well-established and increasingly used option for managing patients with a mitral valve pathology. Nonetheless, whether the purported benefits of MIMVS translate into clinically important outcomes remains controversial. Therefore, in this paper we provide an overview of MIMVS and discuss results, morbidity, mortality, and quality of life following mitral minimally invasive procedures. MIMVS has been proven to be a feasible alternative to the conventional full sternotomy approach with low perioperative morbidity and short-term mortality. Reported benefits of MIMVS include also decreased postoperative pain, improved postoperative respiratory function, reduced surgical trauma, and greater patient satisfaction. Finally, compared to standard surgery, MIMVS demonstrated comparable efficacy across a range of long-term efficacy measures such as freedom from reoperation and long-term survival. Fabiana Lucà, Leen van Garsse, Carmelo Massimiliano Rao, Orlando Parise, Mark La Meir, Calogero Puntrello, Gaspare Rubino, Rocco Carella, Roberto Lorusso, Gian Franco Gensini, Jos G. Maessen, and Sandro Gelsomino Copyright © 2013 Fabiana Lucà et al. All rights reserved. Wed, 20 Mar 2013 11:47:53 +0000 http://www.hindawi.com/journals/mis/2013/687134/ Introduction. Single-access laparoscopic surgery (SALS) has been successfully introduced for colectomy surgery; however, for mid to low rectum procedures such as total mesorectal excision, it can be technically complicated. In this study, we introduced a single-access technique for rectum cancer operations without the use of other instruments. Aims. To show the short-term results of single-access laparoscopic rectal surgery in terms of pathologic results and immediate complications. Settings and Design. Prospective study. Materials and Methods. We selected middle rectum to anal canal cancer patients to undergo single-access laparoscopic rectal resection for rectal cancer. All patients had total mesorectal excisions. An umbilical incision was made for the insertion of a single multichannel port, and a mesocolic window was created to identify the inferior mesenteric artery and vein. Total mesorectal excision was performed. There were no perioperative complications. The mean operative time was 269 minutes; the median hospital stay was 7 days; the mean wound size was 5.5 cm; the median number of harvested lymph nodes was 15; and all patients had intact mesorectal capsules. Statistical Analysis Used. Mean, minimum–maximum. Conclusion. Single-access laparoscopic surgery for rectal cancer is feasible while oncologic principles and patient safety are maintained. Siripong Sirikurnpiboon and Paiboon Jivapaisarnpong Copyright © 2013 Siripong Sirikurnpiboon and Paiboon Jivapaisarnpong. All rights reserved. Thu, 07 Feb 2013 12:05:49 +0000 http://www.hindawi.com/journals/mis/2013/823506/ Purpose. We present our experience with laparoscopic colorrhaphy as definitive surgical modality for the management of colonoscopic perforations. Methods. Over a 17-month period, we assessed the outcomes of consecutive patients presenting with acute colonoscopic perforations. Patient characteristics and perioperative parameters were tabulated. Postoperative outcomes were evaluated within 30 days following discharge. Results. Five female patients with a mean age of 71.4 ± 9.7 years (range: 58–83), mean BMI of 26.4 ± 3.4 kg/m2 (range: 21.3–30.9), and median ASA score of 2 (range: 2-3) presented with acute colonoscopic perforations. All perforations were successfully managed through laparoscopic colorrhaphy within 24 hours of development. The perforations were secondary to direct trauma or thermal injury and were localized to the sigmoid or cecum . None of the patients required surgical resection, diversion, or conversion to an open procedure. No intra- or postoperative complications were encountered. The mean length of hospital stay was 3.8 ± 0.8 days (range: 3–5). There were no readmissions or reoperations. Conclusion. Acute colonoscopic perforations can be safely managed via laparoscopic primary repair without requiring resection or diversion. Early recognition and intervention are essential for successful outcomes. Eric M. Haas, Rodrigo Pedraza, Madhu Ragupathi, Ali Mahmood, and T. Bartley Pickron Copyright © 2013 Eric M. Haas et al. All rights reserved. Wed, 16 Jan 2013 11:45:39 +0000 http://www.hindawi.com/journals/mis/2013/630753/ 90 percent of symptomatic patients undergoing cholecystectomy have cholelithiasis with 10% categorized as asymptomatic cholecystitis. In both instances, the gallbladder is evident on ultrasonography. In children with symptomatic biliary dyspepsia, the decision to proceed to cholecystectomy is made difficult if choleliths are not seen on ultrasonography. This decision is made even more difficult if the gallbladder itself is not seen on repeated imaging. In a cohort of 54 cholecystectomies, 3 cases, with recurrent right upper quadrant pain and undetectable gallbladders on repeat ultrasonography, were identified. After prolonged observation all underwent successful cholecystectomy. Histology demonstrated a markedly fibrotic and thickened gallbladder in all. Given this experience, we suggest that nonvisibility of the gallbladder, in fact, maybe be a feature of a chronic acalculous cholecystitis. We advise consideration of cholecystectomy for chronic biliary dyspepsia where repeat ultrasonography fails to demonstrate a gallbladder. Stephen D. Adams, Simon C. Blackburn, Victoria A. Adewole, and Anies A. Mahomed Copyright © 2013 Stephen D. Adams et al. All rights reserved. Sun, 30 Dec 2012 11:39:10 +0000 http://www.hindawi.com/journals/mis/2012/575301/ Luigi Boni, Paul G. Curcillo, and Silvana Perretta Copyright © 2012 Luigi Boni et al. All rights reserved. Sun, 30 Dec 2012 07:31:00 +0000 http://www.hindawi.com/journals/mis/2012/508415/ Richard G. Fessler, Zachary A. Smith, Nicholas Slimack, Justin S. Smith, and Richard J. Parkinson Copyright © 2012 Richard G. Fessler et al. All rights reserved. Thu, 27 Dec 2012 16:12:17 +0000 http://www.hindawi.com/journals/mis/2012/484135/ Background. Laparoscopic hernia repair in infancy and childhood is still debatable. The objective of this study is to compare laparoscopic assisted hernia repair versus open herniotomy as regards operative time, hospital stay, postoperative hydrocele formation, recurrence rate, iatrogenic ascent of the testis, testicular atrophy, and cosmetic results. Patients and Methods. Two hundred and fifty patients with inguinal hernia were randomized into two equal groups. Group A was subjected to laparoscopic inguinal hernia repair. Group B was subjected to open herniotomy. The demographic data were matched between both groups. Assessment of the testicular volume and duplex assessment in preoperative, early, and late postoperative periods were done. Results. All cases were completed successfully without conversion. The mean operative time for group A was minutes, minutes and minutes, for unilateral hernia, unilateral hernia in obese child, and bilateral hernia, respectively. The recurrence rate was 0.8% in group A, whereas in group B the recurrence rate was 2.4%. Conclusion. Laparoscopic hernia repair by RN is an effective line of hernia repair. It resulted in marked reduction of operative time, low rate of recurrence, no testicular atrophy, no iatrogenic ascent of the testis, and excellent cosmetic results. Rafik Shalaby, Refaat Ibrahem, Mohamed Shahin, Abdelaziz Yehya, Mohamed Abdalrazek, Ibrahim Alsayaad, and Maged Ali Shouker Copyright © 2012 Rafik Shalaby et al. All rights reserved. Wed, 12 Dec 2012 10:23:08 +0000 http://www.hindawi.com/journals/mis/2012/412623/ Background. Single Incision Laparoscopic Surgery (SILS) has been highlighted in the recent literature as a means of performing a range of common, minimal access, paediatric surgical procedures. The primary attraction is the absence of visible scarring. Aim. This study aims to describe a cosmetically advantageous means of SILS port placement in children, which preserves the umbilical profile. Methods. We describe a paediatric case series utilising a semicircular incision in the superior umbilical fold for SILS procedures. The linea alba is exposed over 2 cm just superior to the umbilical ring and stay sutures are applied. A vertical incision is made over this distance without entering the umbilical ring. Data were recorded prospectively in a Microsoft Excel database. Results. Twenty-one cases were performed in a 1-year period. Ten appendicectomies, 5 ovarian/paraovarian cystectomies, 2 Palomo procedures, 3 nephrectomy/heminephrectomies, and 1 Meckel’s diverticulectomy were performed. There was 1 wound infection. No incisional hernias occurred. Discussion. We believe that our technique, which maintains the integrity of the umbilical ring and allows preservation of the umbilical profile, offers a distinct cosmetic advantage over other incisions for SILS which distort it. Conclusion. We have demonstrated the aesthetic benefits of utilising a superior umbilical-fold incision for SILS in children. S. C. Blackburn, S. D. Adams, and A. A. Mahomed Copyright © 2012 S. C. Blackburn et al. All rights reserved. Mon, 19 Nov 2012 07:54:13 +0000 http://www.hindawi.com/journals/mis/2012/260273/ Purpose. Short hospital stay and equal or reduced complication rates have been demonstrated after fast track open colonic surgery. However, fast track principles of perioperative care can be difficult to implement and often require increased nursing staff because of more concentrated nursing tasks during the shorter hospital stay. Specific data on nursing requirements after laparoscopic surgery are lacking. The purpose of the study was to evaluate the effect of operative technique (open versus laparoscopic operation), but without changing nurse staffing or principles for peri- or postoperative care, that is, without implementing fast track principles, on length of stay after colorectal resection for cancer. Methods. Records of all patients operated for colorectal cancer from November 2004 to December 2008 in our department were reviewed. No specific patients were selected for laparoscopic repair, which was solely dependent on the presence of two specific surgeons at the same time. Thus, the patients were not selected for laparoscopic repair based on patient-related factors, but only on the simultaneous presence of two specific surgeons on the day of the operation. Results. Of a total of 540 included patients, 213 (39%) were operated by a laparoscopic approach. The median hospital stay for patients with a primary anastomosis was significantly shorter after laparoscopic than after conventional open surgery (5 versus 8 days, ) while there was no difference in patients receiving a stoma (10 versus 10 days, ns), with no changes in the perioperative care regimens. Furthermore there were significant lower blood loss (50 versus 200 mL, ) and lower complication rate (21% versus 32%, ) in the laparoscopic group. Conclusion. Implementing laparoscopic colorectal surgery in our department resulted in shorter hospital stay without using fast track principles for peri- and postoperative care in patients not receiving a stoma during the operation. Consequently, we aimed to reduce hospitalisation without increasing cost in nursing staff per hospital bed. Length of stay was not reduced in patients receiving a stoma pointing at this group for specific intervention in the future. Furthermore, the complication rate was reduced in the laparoscopic group. Stefan K. Burgdorf and Jacob Rosenberg Copyright © 2012 Stefan K. Burgdorf and Jacob Rosenberg. All rights reserved. Sun, 11 Nov 2012 13:13:45 +0000 http://www.hindawi.com/journals/mis/2012/456541/ Boris Kirshtein and Eric M. Haas Copyright © 2012 Boris Kirshtein and Eric M. Haas. All rights reserved. Sun, 04 Nov 2012 13:45:42 +0000 http://www.hindawi.com/journals/mis/2012/760292/ This study examined the effect of surgeons’ volume on outcomes in lung surgery: lobectomies and wedge resections. Additionally, the effect of video-assisted thoracoscopic surgery (VATS) on cost, utilization, and adverse events was analyzed. The Premier Hospital Database was the data source for this analysis. Eligible patients were those of any age undergoing lobectomy or wedge resection using VATS for cancer treatment. Volume was represented by the aggregate experience level of the surgeon in a six-month window before each surgery. A positive volume-outcome relationship was found with some notable features. The relationship is stronger for cost and utilization outcomes than for adverse events; for thoracic surgeons as opposed to other surgeons; for VATS lobectomies rather than VATS wedge resections. While there was a reduction in cost and resource utilization with greater experience in VATS, these outcomes were not associated with greater experience in open procedures. Guy David, Candace L. Gunnarsson, Matt Moore, John Howington, Daniel L. Miller, Michael A. Maddaus, Robert Joseph McKenna Jr., Bryan F. Meyers, and Scott J. Swanson Copyright © 2012 Guy David et al. All rights reserved. Thu, 01 Nov 2012 10:19:12 +0000 http://www.hindawi.com/journals/mis/2012/289342/ Objective. To evaluate the surgical outcomes of robotic-assisted sacrocolpopexy (RASCP) before and after the incorporation of hands-on training for urology and gynecology residents. Study Design. Forty-one patients underwent RASCP between December 2008 and March 2010 with one surgeon. RASCP was performed in the context of surgical repair of complex pelvic organ prolapse and/or stress urinary incontinence. The first 20 cases (group I) were performed exclusively by the attending surgeon. In the last 21 cases (group II), the urology resident performed a 50% or more of the RASCP while the gynecology resident performed the supracervical hysterectomy. The primary outcome measure was vaginal vault support at 24 weeks postoperatively based on pelvic organ prolapse quantification (POP-Q). Results. Mean ± SD operative time for the entire surgery including RASCP was  min and median EBL was  mL. Patient demographics and stage of disease did not differ between groups. Procedure time, PACU time, blood loss, and intraoperative complications were similar between groups. Follow-up POP-Q evaluations demonstrated significant correction of all points on vaginal examination for both groups (). Conclusions. Incorporation of resident training during RASCP allows teaching of robotic surgery techniques in an effective manner without prolonging operative time or affecting the overall surgical outcome. Mohamed A. Bedaiwy, Mohamed Abdelrahman, Stephanie Deter, Tarek Farghaly, Mahmoud M. Shalaby, Heidi Frasure, and Sangeeta Mahajan Copyright © 2012 Mohamed A. Bedaiwy et al. All rights reserved. Tue, 16 Oct 2012 09:55:26 +0000 http://www.hindawi.com/journals/mis/2012/145381/ Minimally invasive cardiac surgery is less traumatic and therefore leads to quicker recovery. With the assistance of engineering technologies on devices, imaging, and robotics, in conjunction with surgical technique, minimally invasive cardiac surgery will improve clinical outcomes and expand the cohort of patients that can be treated. We used transapical aortic valve implantation as an example to demonstrate that minimally invasive cardiac surgery can be implemented with the integration of surgical techniques and engineering technologies. Feasibility studies and long-term evaluation results prove that transapical aortic valve implantation under MRI guidance is feasible and practical. We are investigating an MRI compatible robotic surgical system to further assist the surgeon to precisely deliver aortic valve prostheses via a transapical approach. Ex vivo experimentation results indicate that a robotic system can also be employed in in vivo models. Ming Li, Dumitru Mazilu, and Keith A. Horvath Copyright © 2012 Ming Li et al. All rights reserved. Mon, 17 Sep 2012 10:43:12 +0000 http://www.hindawi.com/journals/mis/2012/347131/ Objective. Robot-assisted sleeve gastrectomy has the potential to treat patients with obesity and its comorbidities. To evaluate the learning curve for this procedure before undergoing Roux en-Y gastric bypass is the objective of this paper. Materials and Methods. Robot-assisted sleeve gastrectomy was attempted in 32 consecutive patients. A survey was performed in order to identify performance variables during completion of the learning curve. Total operative time (OT), docking time (DT), complications, and length of hospital stay were compared among patients divided into two cohorts according to the surgical experience. Scattergrams and continuous curves were plotted to develop a robotic sleeve gastrectomy learning curve. Results. Overall OT time decreased from 89.8 minutes in cohort 1 to 70.1 minutes in cohort 2, with less than 5% change in OT after case 19. Time from incision to docking decreased from 9.5 minutes in cohort 1 to 7.6 minutes in cohort 2. The time required to dock the robotic system also decreased. The complication rate was the same in the two cohorts. Conclusion. Our survey indicates that technique and outcomes for robot-assisted sleeve gastrectomy gradually improve with experience. We found that the learning curve for performing a sleeve gastrectomy using the da Vinci system is completed after about 20 cases. Ramon Vilallonga, José Manuel Fort, Oscar Gonzalez, Enric Caubet, Angeles Boleko, Karl John Neff, and Manel Armengol Copyright © 2012 Ramon Vilallonga et al. All rights reserved. Thu, 06 Sep 2012 17:45:00 +0000 http://www.hindawi.com/journals/mis/2012/464853/ Introduction. Intussusception after bariatric surgery is an uncommon complication that is now being frequently reported. Most people consider dysmotility to be the causative mechanism in the absence of obvious etiology. Material and Methods. A worldwide search identified literature describing intussusception after bariatric surgery. We also included our own patients and analyzed information regarding demographic profile, risk factors, presentation, diagnosis, and post treatment course. Results. Seventy one patients were identified between 1991 and 2011. Majority of the affected patients were females (𝑛=70, 98.6%); median time to presentation after gastric bypass surgery was 36 months. Most patients presented with abdominal pain, nausea and vomiting, but without obvious peritonitis. Sixty eight patients (96%) required surgery; 48 (70.6%) underwent revision of anastomosis, 16 (23.5%) had reduction without resection, while 4 patients (5.9%) had plication only. Amongst these, most patients (𝑛=51, 75%) were found to have retrograde intussusception. Post-operatively, 9 patients presented with recurrence (range, 0.5–32 months). Five patients, who had earlier been treated without resection, eventually required revision of the anastomosis. There was no mortality noted. Conclusion. Intussusception after bariatric surgery is uncommon and its diagnosis is based on a combination of physicial, radiological and operative findings. An early surgical intervention reduces morbidity and prevents recurrence. Smit Singla, Brandon A. Guenthart, Lauren May, John Gaughan, and John E. Meilahn Copyright © 2012 Smit Singla et al. All rights reserved. Tue, 04 Sep 2012 15:15:34 +0000 http://www.hindawi.com/journals/mis/2012/543627/ Objectives. To present our initial experiences with laparoscopically assisted vaginal hysterectomy performed using homemade transumbilical single-port system. Materials and Methods. We reviewed the medical records of one hundred patients who underwent single-port access laparoscopically assisted vaginal hysterectomy (SPA-LAVH). SPA-LAVH was performed with homemade single port system and conventional rigid laparoscopic instruments. Results. All procedures were successfully completed through the single-port system and vagina without need for extraumbilical puncture or conversion to laparotomy. The median patient age was 48.2 ± 6.5 years. Thirty-three patients had history of past abdominopelvic surgery. The median total operative time, largest dimension of the uterus, and weight of the uterus were 73.1 ± 24.6 min, 10.5 ± 2.1 cm, and 300.8 ± 192.5 gram, respectively. The median decline in the hemoglobin from before surgery to postoperative day 1 was 1.8 ± 0.9 g/dL. Bladder injury in occurred one patient who was repaired through intraoperative laparoscopic suture. The postoperative course was uneventful in most patients except for three who had a transient paralytic ileus, five who had pelvic hematoma, but they were recovered following conservative managements. No port-related complications were noted, and the cosmetic results were excellent. Conclusions. SPA-LAVH is technically safe procedure, and the homemade single-port system offers reliable access for single-port surgery. Young-Sam Choi, Kwang-Sik Shin, Jin Choi, Ji-No Park, Yun-Sang Oh, and Tae-Eel Rhee Copyright © 2012 Young-Sam Choi et al. All rights reserved. Thu, 30 Aug 2012 12:16:30 +0000 http://www.hindawi.com/journals/mis/2012/507826/ We describe a percutaneous or minimally invasive approach to apply an augmentation of pedicle fenestrated screws by injection of the PMMA bone cement through the implant and determine the safety and efficiency of this technique in a clinical series of 15 elderly osteoporotic patients. Clinical outcome and the function were assessed using respectively the Visual Analogue Scale (VAS) score and the Oswestry Disability Index (ODI). Peri- and post-operative complications were monitored during a minimum of 2 years of follow-up. Radiographic follow-up was based on plain fluoroscopic control at 3, 6 and 12 months and every year. In this approach, four steps were considered with care: optimal positioning of the screws, correct alignment of the screw heads, waiting time before the injection of cement, fluoroscopic control of the cement injection. Using these precautions, only 2 minor complications occurred. VAS scores and ODI questionnaires showed a statistically significant improvement up to 13.3 months postoperatively. No radiological complications were observed. Based on this experience, PMMA augmentation technique through the novel fenestrated screws provided an effective and long lasting fixation in osteoporotic patients. Applying this procedure through percutaneous or minimally invasive approach under fluoroscopic control seems to be safe. Alphonse Lubansu, Michal Rynkowski, Laurence Abeloos, Geoffrey Appelboom, and Olivier Dewitte Copyright © 2012 Alphonse Lubansu et al. All rights reserved. Sun, 05 Aug 2012 10:22:54 +0000 http://www.hindawi.com/journals/mis/2012/657342/ This paper reviews the current published data regarding open transforaminal lumbar interbody fusion (TLIF) in relation to minimally invasive transforaminal lumbar interbody fusion (MI-TLIF). Introduction. MI-TLIF, a modern method for lumbar interbody arthrodesis, has allowed for a minimally invasive method to treat degenerative spinal pathologies. Currently, there is limited literature that compares TLIF directly to MI-TLIF. Thus, we seek to discuss the current literature on these techniques. Methods. Using a PubMed search, we reviewed recent publications of open and MI-TLIF, dating from 2002 to 2012. We discussed these studies and their findings in this paper, focusing on patient-reported outcomes as well as complications. Results. Data found in 14 articles of the literature was analyzed. Using these reports, we found mean follow-up was 20 months. The mean patient study size was 52. Seven of the articles directly compared outcomes of open TLIF with MI-TLIF, such as mean duration of surgery, length of post-operative stay, blood loss, and complications. Conclusion. Although high-class data comparing these two techniques is lacking, the current evidence supports MI-TLIF with outcomes comparable to that of the traditional, open technique. Further prospective, randomized studies will help to further our understanding of this minimally invasive technique. Ali Habib, Zachary A. Smith, Cort D. Lawton, and Richard G. Fessler Copyright © 2012 Ali Habib et al. All rights reserved. Wed, 01 Aug 2012 08:11:08 +0000 http://www.hindawi.com/journals/mis/2012/538697/ Purpose. The relatively new and less-invasive therapeutic alternative “interspinous process decompression device (IPD)” is expected to result in improved symptoms of neurogenic intermittent claudication (NIC) caused by lumbar spinal stenosis. The aim of the study was to analyze IPD position particularly regarding damage originating from surgical implantation. Methods. Anatomic assessments were performed on a fresh human cadaver. For the anatomic examination, the lumbar spine was plastinated after implantation of the IPDs. After radiographic control, serial 4 mm thick sections of the block plastinate were cut in the sagittal (L1–L3) and horizontal (L3–L5) planes. The macroanatomical positioning of the implants was then analyzed. The insertion procedure caused only little injury to osteoligamentous or muscular structures. The supraspinous ligament was completely intact, and the interspinous ligaments were not torn as was initially presupposed. No osseous changes at the spinal processes were apparent. Contact of the IPD with the spinous processes was visible, so that sufficient biomechanical limitation of the spinal extension seems likely. Conclusions. Minimally invasive IPD implantation with accurate positioning in the anterior portion of the interspinous place is possible without severe surgical trauma. Thomas Kaulhausen, Kourosh Zarghooni, Gregor Stein, Jutta Knifka, Peer Eysel, Juergen Koebke, and Rolf Sobottke Copyright © 2012 Thomas Kaulhausen et al. All rights reserved. Tue, 31 Jul 2012 13:58:14 +0000 http://www.hindawi.com/journals/mis/2012/325095/ Lumbar stenosis is a well-defined pathologic condition with excellent surgical outcomes. Empiric evidence as well as randomized, prospective trials has demonstrated the superior efficacy of surgery compared to medical management for lumbar stenosis. Traditionally, lumbar stenosis is decompressed with open laminectomies. This involves removal of the spinous process, lamina, and the posterior musculoligamentous complex (posterior tension band). This approach provides excellent improvement in symptoms, but is also associated with potential postoperative spinal instability. This may result in subsequent need for spinal fusion. Advances in technology have enabled the application of minimally invasive spine surgery (MISS) as an acceptable alternative to open lumbar decompression. Recent studies have shown similar to improved perioperative outcomes when comparing MISS to open decompression for lumbar stenosis. A literature review of MISS for decompression of lumbar stenosis with tubular retractors was performed to evaluate the outcomes of this modern surgical technique. In addition, a discussion of the advantages and limitations of this technique is provided. Albert P. Wong, Zachary A. Smith, Rohan R. Lall, Lacey E. Bresnahan, and Richard G. Fessler Copyright © 2012 Albert P. Wong et al. All rights reserved. Mon, 30 Jul 2012 09:29:03 +0000 http://www.hindawi.com/journals/mis/2012/807609/ The aim of the study was to review our experience with single-incision laparoscopic surgery (SILS) and to compare costs and operative time to standard laparoscopic surgery (SLS). A prospectively collected database of operative times and costs was analysed for the years 2008–2011. SILS cases were compared to standard laparoscopy on a procedure-matched basis. Patient demographics, on-table time and consumable costs were collated. Descriptive statistics and Mann-Whitney U-test were utilized with SPSS for windows. Analysis of the data demonstrate that neither consumable costs nor operative time were significantly different in each group. Comparing operative costs, SILS appendicectomy, nephrectomy/heminephrectomy, and ovarian cystectomy/oophorectomy showed cost benefit over SLS (£397 versus £467; £942 versus £1127; £394 versus £495). A trend toward higher cost for SILS Palomo procedure is noted (£734 versus £400). Operative time for SILS appendicectomy, nephrectomy/heminephrectomy, and Palomo was lower compared to SLS (60 versus 103 minutes[mins.]; 130 versus 60 mins.; 60 versus 80 mins.). In conclusion, SILS appears to be cost-effective for the common pediatric surgical operations. There is no significant difference in operating time in this series, but small sample size is a limiting factor. Studies with larger numbers will be necessary to validate these initial observations. Saidul Islam, Stephen D. Adams, and Anies A. Mahomed Copyright © 2012 Saidul Islam et al. All rights reserved. Sun, 29 Jul 2012 13:57:20 +0000 http://www.hindawi.com/journals/mis/2012/173685/ Introduction. Adult spinal deformity (ASD) surgeries carry significant morbidity, and this has led many surgeons to apply minimally invasive surgery (MIS) techniques to reduce the blood loss, infections, and other peri-operative complications. A spectrum of techniques for MIS correction of ASD has thus evolved, most recently the application of percutaneous iliac screws. Methods. Over an 18 months 10 patients with thoracolumbar scoliosis underwent MIS surgery. The mean age was 73 years (70% females). Patients were treated with multi-level facet osteotomies and interbody fusion using expandable cages followed by percutaneous screw fixation. Percutaneous iliac screws were placed bilaterally using the obturator outlet view to target the ischial body. Results. All patients were successfully instrumented without conversion to an open technique. Mean operative time was 302 minutes and the mean blood loss was 480 cc, with no intraoperative complications. A total of 20 screws were placed successfully as judged by CT scanning to confirm no bony violations. Complications included: two asymptomatic medial breaches at T10 and L5, and one patient requiring delayed epidural hematoma evacuation. Conclusions. Percutaneous iliac screws can be placed safely in patients with ASD. This MIS technique allows for successful caudal anchoring to stress-shield the sacrum and L5-S1 fusion site in long-segment constructs. Michael Y. Wang Copyright © 2012 Michael Y. Wang. All rights reserved. Tue, 24 Jul 2012 14:49:02 +0000 http://www.hindawi.com/journals/mis/2012/213791/ The rapid expansion of minimally invasive techniques for corpectomy in the thoracic spine provides promise to redefine treatment options in this region. Techniques have evolved permitting anterior, lateral, posterolateral, and midline posterior corpectomy in a minimally invasive fashion. We review the numerous techniques that have been described, including thoracoscopy, tubular retraction, and various instrumentation techniques. Minimally invasive techniques are compared to their open predecessors from a technical and complication standpoint. Advantages and disadvantages of different approaches are also considered, with an emphasis on surgical strategies and nuance. Rohan R. Lall, Zachary A. Smith, Albert P. Wong, Daniel Miller, and Richard G. Fessler Copyright © 2012 Rohan R. Lall et al. All rights reserved. Thu, 19 Jul 2012 08:40:23 +0000 http://www.hindawi.com/journals/mis/2012/783074/ Objectives. This paper aims to analyze the feasibility and safety of single-incision laparoscopic colectomy (SILC) and its potential benefits. Methods. Systematic review was performed for the years 1983–August 2011 to retrieve all relevant literature. A total of 21 studies with 477 patients undergoing SILC were selected. Results. Range of operative times and estimated blood losses were 75–229 min and 0–100 mL, respectively. Overall conversion rate was 5.9% (28/477) and an additional laparoscopic port was used in 4.9% (16/329) cases. Range of lymph node number for malignant cases was 12–24.6 and surgical margins were all negative. Overall mortality and morbidity rate was 0.4% (2/477) and 11.7% (43/368), respectively. The length of hospital stay (LOS) varied across reports (2.7–9.2 days). Among 6 case-matched studies, one showed less blood loss in SILC as compared to LAC and 2 showed shorter LOS after SILC versus HALC or LAC/HALC groups. In addition, one study reported maximum pain score on postoperative days 1 and 2 was lower in SILS compared to LAC and HALC. Conclusions. SILC procedure is feasible and safe when performed by surgeons highly skilled in laparoscopy. In spite of technical difficulties, there may be potential benefits associated with SILC over LAC/HALC. Tomoki Makino, Jeffrey W. Milsom, and Sang W. Lee Copyright © 2012 Tomoki Makino et al. All rights reserved. Mon, 16 Jul 2012 09:19:30 +0000 http://www.hindawi.com/journals/mis/2012/141032/ We studied 122 patients with 163 fractures of the thoracic and lumbar spine undergoing the surgical treatment by percutaneous transpedicular fixation and stabilization with minimally invasive technique. Patient followup ranged from 6 to 72 months (mean 38 months), and the patients were assessed by clinical and radiographic evaluation. The results show that percutaneous transpedicular fixation and stabilization with minimally invasive technique is an adequate and satisfactory procedure to be used in specific type of the thoracolumbar and lumbar spine fractures. Federico De Iure, Michele Cappuccio, Stefania Paderni, Giuseppe Bosco, and Luca Amendola Copyright © 2012 Federico De Iure et al. All rights reserved. Tue, 03 Jul 2012 11:01:23 +0000 http://www.hindawi.com/journals/mis/2012/696348/ Introduction. Laparoscopic greater curvature plication is an operation that is gaining ground in the treatment of morbid obesity, as it appears to replicate the results of laparoscopic sleeve gastrectomy with fewer complications. Aim. Review of current literature, especially results on weight loss and complications. Method. 11 (eleven) published articles on laparoscopic gastric plication, of which 1 preclinical study, 8 prospective studies for a total of 521 patients and 2 case reports of unusual complications. Results. Reported Paracentage of EWL in all studies is comparable to Laparoscopic Sleeve Gastrectomy (around 50% in 6 months, 60–65% in 12 months, 60–65% in 24 months) and total complication rate is at 15,1% with minor complications in 10,7%, major complications in 4,4%. Reoperation rate was 3%, conversion rate was 0,2%, and mortality was zero. Conclusion. Current literature on gastric plication and its modifications is limited and sketchy at times. Low cost, short hospital stay, absence of prosthetic material, and reversibility make it an attractive option. Initial data show that LGCP is effective for short- and medium-term weight loss, complication and reoperation rates are low, and GERD symptoms are unaffected. More data is required, and randomized control trials must be completed in order to reach safe conclusions. Michael Kourkoulos, Emmanouil Giorgakis, Charalampos Kokkinos, Theodoros Mavromatis, John Griniatsos, Nikolaos Nikiteas, and Christos Tsigris Copyright © 2012 Michael Kourkoulos et al. All rights reserved.