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The history of lymphatic mapping: a gynecologic perspective
Published in Charles F. Levenback, Ate G.J. van der Zee, Robert L. Coleman, Clinical Lymphatic Mapping in Gynecologic Cancers, 2022
During the same period of the development of sentinel lymph node biopsy, health care leaders have observed industries such as commercial aviation and nuclear energy that are ultrasafe and still provide high satisfaction to consumers. High-reliability organizations (HROs) operate in high-risk environments by being highly sensitive to operations, deferring to expertise, and not trying to simplify complex operations, in addition to a preoccupation with failure and a commitment to resilience. The lessons of HROs are being applied in health care, especially in surgery and anesthesiology. For example, the World Health Organization Surgical Safety Checklist has transformed how surgical procedures are conducted. Risk-adjusted data, such as the National Surgical Quality Improvement Database (NSQIP), allow accurate measurement of new protocols to reduce surgical site infections. Minimally invasive surgery and enhanced recovery protocols have reduced the surgical length of stay dramatically. Low-risk anesthesia for outpatient procedures is ultrasafe.
Damage to the uterus, the fallopian tubes and the ovaries
Published in David J Cahill, Practical Patient Management in Reproductive Medicine, 2019
Minimally invasive surgery is increasing in popularity and in demand as patients become increasingly aware of its advantages – a shorter period in hospital, and generally a shortened postoperative recovery time. Within the United Kingdom, it is likely that it is being used increasingly, but accurate data about its use is not available. A UK survey of all consultant-level gynaecologists undertaken in 2015 had a low (22%) response rate. The authors considered that the sample reflected the consultant body in age, years as a consultant and gender. Of the 243 who performed myomectomies, 74% were still performing open laparotomy for fibroid removal, while 32% did laparoscopic removal (30). Over the past 20 years, in the United States, there has been a definite shift in the proportion of myomectomies being undertaken by the open versus the laparoscopic route. In 1995, 95% of myomectomies were undertaken using the open route, but in 2014, only 10% were undertaken by that route (31). During that time, laparoscopic myomectomy rose to about one-third of all myomectomy cases. It is interesting that both countries have reached that level of usage (of 30%) for the laparoscopic approach for myomectomy. Concerns about sarcoma spread, and even more so about morcellation injuries (injury to the bowel and other structures from the device used to shatter the fibroid), have led to the adoption of the mini-laparotomy technique (a small incision in the abdomen to facilitate fibroid removal) in combination with laparoscopic removal of the fibroid, as described very well by Glasser (32).
Neurosurgery: Minimally invasive neurosurgery
Published in Hemanshu Prabhakar, Charu Mahajan, Indu Kapoor, Essentials of Geriatric Neuroanesthesia, 2019
Charu Mahajan, Indu Kapoor, Hemanshu Prabhakar
Lumbar spine stabilization is often required in geriatric patients having trauma, degenerative changes, infection, or malignancy. Minimally invasive techniques for spinal fusion are anterior lumbar interbody fusion (ALIF), posterior lumbar interbody fusion, transforaminal lumbar interbody fusion, intertransverse fusion, and pedicle screw/rod placement. Decreased muscle and soft tissue injury, decreased operative time, less blood loss, less pain, earlier mobilization, and faster return to work are important advantages of minimally invasive surgery. ALIF can be done through either the laparoscopic transperitoneal or retroperitoneal route. The transperitoneal route provides the best access to the L5−S1 level, as the bifurcation of great vessels lies above this level. However, injury to the bowel, superior hypogastric plexus, and blood vessels are potential concerns. Retroperitoneal lumbar fusion is performed either in the supine or lateral decubitus position using carbon dioxide (CO2) insufflation, balloon insufflation, or a combination of both to create and maintain the retroperitoneal working cavity. The related concerns of laparoscopic surgery such as trendelenburg position hypercapnia, right bronchus intubation, and CO2 embolism should be kept in mind. Transforaminal, posterolateral procedures and percutaneous spinal fixation are performed in the prone position.
The risk of inguinal hernia repair after radical prostatectomy – a population-based cohort study
Published in Scandinavian Journal of Urology, 2022
Mikko Ahtinen, Jaana Vironen, Teemu J. Murtola
Further, we cannot rule out selection bias despite the similar distribution of comorbidities between the prostatectomy and EBRT groups; men whose PCa is managed surgically may be more eligible to undergo further surgical operations. Mortality during the follow-up was lower in the prostatectomy group (159/1000) than in the EBRT group (244/1000), which may be an expression of the same thing. In general, the male population has a 0.4–0.7% approximated annual incidence of inguinal hernia, which has to be considered interpreting the results. Even though we had information for a long period, some subjects may have had an inguinal hernia repair before 1998, which may have introduced a bias towards the null. Further, there has been a profound change in prostatectomy technique from open to minimally invasive during our study timeline. Thus follow-up periods after minimally invasive surgery are generally shorter than for open procedures.
A multicenter, descriptive epidemiologic survey of the clinical features of spinal metastatic disease in China
Published in Neurological Research, 2020
Hao-Ran Zhang, Rui-Qi Qiao, Xiong-Gang Yang, Yong-Cheng Hu
The management of spinal metastases requires multidisciplinary collaboration, of which surgery and radiotherapy are the main treatment methods. Surgical treatment can be divided into open surgery and minimally invasive surgery. Open surgery includes palliative surgery and radical surgery. Palliative surgery is aimed at alleviating the symptoms of patients and improving the quality of life of patients without pursuing the thoroughness of tumor resection, including laminectomy and vertebra corpectomy. Radical surgery is based on the principle of complete resection of tumor lesions. The goal is to extend the survival time of cancer patients as much as possible, including piecemeal resection and total en bloc spondylectomy. Minimally invasive surgery has the advantages of rapid postoperative recovery, low incidence of complication, and no delay in adjuvant treatment. It is suitable for patients with poor general conditions, including percutaneous vertebroplasty, radiofrequency ablation, and percutaneous pedicle screw fixation.
Should minimally invasive approaches in rectal surgery be regarded as a key element of modern enhanced recovery perioperative care?
Published in Acta Chirurgica Belgica, 2023
Petr Kocián, Filip Pazdírek, Petr Přikryl, Tomáš Vymazal, Jiří Hoch, Adam Whitley
One of the potential limitations of the study is the selection of procedures for minimally invasive surgery. When we began with laparoscopic and robotic surgery we preferentially selected patients with smaller tumours, with normal BMIs, without a history of major abdominal surgery and patient who had not received neoadjuvant therapy. As we became more experienced with these procedures, we began to indicate more complicated cases and currently with the exception of multi-visceral resections, which were all excluded from this analysis, all rectal resections are performed laparoscopically or robotically. Although it did not reach statistical significance there were noticeable differences in tumour stage and neoadjuvant therapy between the groups.