Minimally invasive removal of thoracic and lumbar spinal tumors using a nonexpandable tubular retractor

2013 ◽  
Vol 19 (6) ◽  
pp. 708-715 ◽  
Author(s):  
Andre Nzokou ◽  
Alexander G. Weil ◽  
Daniel Shedid
Keyword(s):  
Minimally Invasive ◽  
Spinal Tumors ◽  
Subtotal Resection ◽  
Minimally Invasive Approach ◽  
Tubular Retractor ◽  
Invasive Approach ◽  
Duration Of Surgery ◽  
Intradural Extramedullary ◽  
Mini Open

Object Resection of spinal tumors traditionally requires bilateral subperiosteal muscle stripping, extensive laminectomy, and, in cases of foraminal extension, partial or radical facetectomy. Fusion is often warranted in cases of facetectomy to prevent deformity, pain, and neurological deterioration. Recent reports have demonstrated safety and efficacy of mini-open removal of these tumors using expandable tubular retractors. The authors report their experience with the minimally invasive removal of extradural foraminal and intradural-extramedullary tumors using the nonexpandable tubular retractor. Methods A retrospective chart review of consecutive patients who underwent minimally invasive resection of spinal tumors at Notre Dame Hospital was performed. Results Between December 2005 and March 2012, 13 patients underwent minimally invasive removal of spinal tumors at Notre Dame Hospital, Montreal. There were 6 men and 7 women with a mean age of 55 years (range 20–80 years). There were 2 lumbar and 2 thoracic intradural-extramedullary tumors and 7 thoracic and 2 lumbar extradural foraminal tumors. Gross-total resection was achieved in 12 patients. Subtotal resection (90%) was attained in 1 patient because the tumor capsule was adherent to the diaphragm. The average duration of surgery was 189 minutes (range 75–540 minutes), and the average blood loss was 219 ml (range 25–500 ml). There were no major procedure-related complications. Pathological analysis revealed benign schwannoma in 8 patients and meningioma, metastasis, plasmacytoma, osteoid osteoma, and hemangiopericytoma in 1 patient each. The average equivalent dose of postoperative narcotics after surgery was 66.3 mg of morphine. The average length of hospitalization was 66 hours (range 24–144 hours). All working patients returned to normal activities within 4 weeks. The average MRI and clinical follow-up were 13 and 21 months, respectively (range 2–68 months). At last follow-up, 92% of patients had improvement or resolution of pain with a visual analog scale score that improved from 7.8 to 1.2. All patients with neurological impairment improved. The American Spinal Injury Association grade improved in all but 1 patient. Conclusions Intradural-extramedullary and extradural tumors can be completely and safely resected through a minimally invasive approach using the nonexpandable tubular retractor. This approach may be associated with even less tissue destruction than mini-open techniques, translating into a quicker functional recovery. In cases of foraminal tumors, by eliminating the need for facetectomy, this minimally invasive approach may decrease the incidence of postoperative deformity and eliminate the need for adjunctive fusion surgery.

Minimally Invasive Resection of a Cervical Anterolateral Meningioma: 2-Dimensional Operative Video

2018 ◽  
Vol 16 (4) ◽  
pp. 520-520
Author(s):  
Federico Landriel ◽  
Santiago Hem ◽  
Eduardo Vecchi ◽  
Claudio Yampolsky
Keyword(s):  
Spinal Cord ◽  
Minimally Invasive ◽  
Neck Pain ◽  
Video Recording ◽  
Tumor Resection ◽  
Spinal Tumors ◽  
Minimally Invasive Approach ◽  
En Bloc ◽  
Invasive Approach ◽  
Intradural Extramedullary

Abstract Intradural extramedullary spinal tumors were historically managed through traditional midline approaches. Although conventional laminectomy or laminoplasty provides a wide tumor and spinal cord exposure, they may cause prolonged postoperative neck pain and late kyphosis deformity. Minimally invasive ipsilateral hemilaminectomy preserves midline structures, reduces the paraspinal muscle disruption, and could avoid postoperative kyphosis deformity. A safe tumor resection through this approach could be complicated in large sized or anteromedullary located lesions. We present a surgical video of C3 antero located meningioma removed en bloc through a minimally invasive approach. The patient signed a written consent to publish video, recording, photograph, image, illustration, and/or information about him.

Impact of biomineralization on resin/biomineralized dentin bond longevity in a minimally invasive approach: An “in vitro” 18-month follow-up

2021 ◽  
Vol 37 (5) ◽  
pp. e276-e289
Author(s):  
Kelly Maria Moreira ◽  
Luiz Eduardo Bertassoni ◽  
Robert Phill Davies ◽  
Felipe Joia ◽  
José Francisco Höfling ◽  
...  
Keyword(s):  
Minimally Invasive ◽  
Minimally Invasive Approach ◽  
Invasive Approach

Sutureless Aortic Valve Implantation through an Upper V-Type Ministernotomy: An Innovative Approach in High-Risk Patients

2013 ◽  
Vol 8 (1) ◽  
pp. 23-28 ◽  
Author(s):  
Giovanni Concistrè ◽  
Antonio Miceli ◽  
Francesca Chiaramonti ◽  
Pierandrea Farneti ◽  
Stefano Bevilacqua ◽  
...  
Keyword(s):  
High Risk ◽  
Aortic Valve ◽  
Minimally Invasive ◽  
Minimally Invasive Approach ◽  
Invasive Approach ◽  
High Risk Patients ◽  
Risk Patients ◽  
The Mean ◽  
Valve Implantation

Objective Aortic valve replacement in minimally invasive approach has shown to improve clinical outcomes even with a prolonged cardiopulmonary bypass and aortic cross-clamp (ACC) time. Sutureless aortic valve implantation may ideally shorten operative time. We describe our initial experience with the sutureless 3f Enable (Medtronic, Inc, ATS Medical, Minneapolis, MN USA) aortic bioprosthesis implanted in minimally invasive approach in high-risk patients. Methods Between May 2010 and May 2011, thirteen patients with severe aortic stenosis underwent aortic valve replacement with the 3f Enable bioprosthesis through an upper V-type ministernotomy interrupted at the second intercostal space. The mean ± SD age was 77 ± 3.9 years (range, 72–83 years), 10 patients were women, and the mean ± SD logistic EuroSCORE was 15% ± 13.5%. Echocardiography was performed preoperatively, at postoperative day 1, at discharge, and at follow-up. Clinical data, adverse events, and patient outcomes were recorded retrospectively. The median follow-up time was 4 months (interquartile range, 2–10 months). Results Most of the implanted valves were 21 mm in diameter (19–25 mm). The CPB and ACC times were 100.2 ± 25.3 and 66.4 ± 18.6 minutes. At short-term follow-up, the mean ± SD pressure gradient was 14 ± 4.9 mm Hg; one patient showed trivial paravalvular leakage. No patients died during hospital stay or at follow-up. Conclusions The 3f Enable sutureless bioprosthesis implanted in minimally invasive approach through an upper V-type ministernotomy is a feasible, safe, and reproducible procedure. Hemodynamic and clinical data are promising. This innovative approach might be considered as an alternative in high-risk patients. Reduction of CPB and ACC time is possible with increasing of experience and sutureless evolution of actual technology.

scholarly journals Standardized subannular repair for type IIIb functional mitral regurgitation in a minimally invasive mitral valve surgery setting†

2019 ◽  
Vol 56 (5) ◽  
pp. 968-975 ◽  
Author(s):  
Jonas Pausch ◽  
Eva Harmel ◽  
Christoph Sinning ◽  
Hermann Reichenspurner ◽  
Evaldas Girdauskas
Keyword(s):  
Mitral Valve ◽  
Mitral Regurgitation ◽  
Minimally Invasive ◽  
Functional Mitral Regurgitation ◽  
Invasive Approach ◽  
Type Iiib ◽  
Duration Of Surgery ◽  
Group A ◽  
Group B

Abstract OBJECTIVES Subannular repair techniques in addition to undersized ring annuloplasty have been developed to address high mitral regurgitation (MR) recurrence rates after mitral valve repair in type IIIb MR. We compared the results of annuloplasty with simultaneous standardized subannular repair versus isolated annuloplasty, focusing on the periprocedural outcomes of minimally invasive procedures. METHODS A consecutive series of 108 patients with type IIIb functional MR with severe signs of bileaflet tethering underwent an annuloplasty + subannular repair (group A; n = 60) versus isolated annuloplasty (group B; n = 48). The primary end point of this prospective, parallel cohort study was death or recurrent MR >2, 1 year postoperatively. The secondary end points were survival and clinical outcomes, with special regard for the minimally invasively treated subgroups. RESULTS Duration of surgery, cardiopulmonary bypass time and aortic cross-clamp time were comparable between both study groups. Procedural outcomes as well as echocardiographic outcome parameters were similar and independent of access (fully endoscopic versus full sternotomy). At the 12-month follow-up, death or MR >2 occurred in 3.3% (2/60) of patients in group A vs in 20.8% (10/48) of patients in group B (P = 0.037). The overall mortality rate during the follow-up period was 1.7% (1/60) in group A vs 12.5% (6/48) in group B (P = 0.041). CONCLUSIONS Standardized realignment of papillary muscles is feasible and reproducible via a minimally invasive approach, resulting in excellent periprocedural outcomes, and has a clear potential to significantly decrease MR recurrence and improve 1-year outcomes compared to isolated annuloplasty.

A Simplified Technique for Correcting Mitral Valve Regurgitation via Minimally Invasive Approach

2018 ◽  
Vol 13 (3) ◽  
pp. 236-238
Author(s):  
Giuseppe Speziale ◽  
Marco Moscarelli
Keyword(s):  
Cardiopulmonary Bypass ◽  
Mitral Valve ◽  
Mitral Regurgitation ◽  
Minimally Invasive ◽  
Mitral Valve Regurgitation ◽  
Valve Regurgitation ◽  
Minimally Invasive Approach ◽  
Invasive Approach ◽  
Repair Techniques

Mitral valve regurgitation may require complex repair techniques that are challenging in minimally invasive and may expose patients to prolonged cardiopulmonary bypass and cross-clamp times. Here, we present a stepwise operative approach that may facilitate the repair of the mitral valve in a minimally invasive fashion and may be carried out even when multiple posterior segments are involved. This how-to-do article presents a method that was performed in 148 patients that were referred to our institution for severe organic mitral regurgitation between 2008 and 2016. At mean ± SD follow-up of 45.5 ± 27 months, freedom from recurrent of mitral regurgitation 2+ or greater and reoperation was 95.2%.

scholarly journals Minimally Invasive Approach to Spinal Tumors

2015 ◽  
Vol 5 (1_suppl) ◽  
pp. s-0035-1554599-s-0035-1554599
Author(s):  
Alvaro Silva ◽  
Carlos Thibaut ◽  
Manuel Valencia ◽  
Bartolome Marre ◽  
Ratko Yurac ◽  
...  
Keyword(s):  
Minimally Invasive ◽  
Spinal Tumors ◽  
Minimally Invasive Approach ◽  
Invasive Approach

MINIMALLY INVASIVE POSTERIOR OSTEOTOMIES

Neurosurgery ◽  
2008 ◽  
Vol 63 (suppl_3) ◽  
pp. A204-A210 ◽  
Author(s):  
Jean-Marc Voyadzis ◽  
Vishal C. Gala ◽  
John E. O'Toole ◽  
Kurt M. Eichholz ◽  
Richard G. Fessler
Keyword(s):  
Computed Tomography ◽  
Minimally Invasive ◽  
Muscle Injury ◽  
Pedicle Subtraction Osteotomy ◽  
Bone Resection ◽  
Minimally Invasive Approach ◽  
Tubular Retractor ◽  
Invasive Approach ◽  
Severe Postoperative Pain ◽  
Human Cadavers

ABSTRACT OBJECTIVE Surgery for thoracolumbar deformity can lead to significant muscle injury, excessive blood loss, and severe postoperative pain. The aim of the following studies was to determine the feasibility of minimally invasive posterior thoracic corpectomy and thoracolumbar osteotomy techniques for deformity in human cadavers and select clinical cases. METHODS Human cadaveric specimens were procured for thoracic corpectomy and Smith-Petersen and pedicle subtraction osteotomy using a minimally invasive approach. Post-procedural computed tomography was used to assess the degree of decompression following corpectomy and the extent of bone resection after osteotomy. Pre and post-osteotomy closure Cobb angles were measured to evaluate the degree of correction achieved. RESULTS The minimally invasive lateral extracavitary approach for thoracic corpectomy provided adequate exposure and allowed excellent spinal canal decompression while minimizing tissue disruption. Nearly complete osteotomies of both types could be achieved through a tubular retractor with a modest change in Cobb angle. CONCLUSION These techniques may play a role in deformity surgery for select cases with further technological advancements.

scholarly journals Minimally invasive approach to extraforaminal disc herniations at the lumbosacral junction using an operating microscope: case series and review of the literature

2008 ◽  
Vol 25 (2) ◽  
pp. E10 ◽  
Author(s):  
Stephen M. Pirris ◽  
Sanjay Dhall ◽  
Praveen V. Mummaneni ◽  
Adam S. Kanter
Keyword(s):  
Minimally Invasive ◽  
Lumbar Disc ◽  
Case Series ◽  
Minimally Invasive Approach ◽  
Tubular Retractor ◽  
Invasive Approach ◽  
Surgical Access ◽  
Small Series ◽  
Disc Herniations ◽  
Anatomical Constraints

Surgical access to extraforaminal lumbar disc herniations is complicated due to the unique anatomical constraints of the region. Minimizing complications during microdiscectomies at the level of L5–S1 in particular remains a challenge. The authors report on a small series of patients and provide a video presentation of a minimally invasive approach to L5–S1 extraforaminal lumbar disc herniations utilizing a tubular retractor with microscopic visualization.

scholarly journals Fiber reinforced composite supported restoration of congenitally missing tooth by minimally invasive approach: Two years follow-up

2021 ◽  
Vol 37 (3) ◽  
Author(s):  
Muhammad Qasim Javed
Keyword(s):  
Minimally Invasive ◽  
Anterior Tooth ◽  
Fiber Reinforced ◽  
Minimally Invasive Approach ◽  
Invasive Approach ◽  
Fiber Reinforced Composite ◽  
Reinforced Composite ◽  
Congenitally Missing ◽  
Missing Tooth

Maxillary lateral incisor is the most frequent congenitally missing anterior tooth of the permanent dentition. The absence of the anterior tooth can adversely affect the production/transmission of speech sounds, mental health, and facial aesthetics of an individual. Considering this, prosthetic rehabilitation of missing front tooth is important. The treatment alternatives include implant supported single crown, conventional fixed partial dentures (FPDs), and resin bonded FPDs that are unilaterally or bilaterally supported by metallic wings. However, with the development in adhesive dentistry fiber reinforced composite (FRC) supported FPDs have provided a workable substitute for traditional techniques because of their improved esthetics, minimal invasiveness, less cost, enhanced bond strength, and revocable nature. The current case, reports the two years follow up of twenty-four years old female patient, for whom the congenitally absent maxillary right lateral incisor was restored with FRC supported FPD. doi: https://doi.org/10.12669/pjms.37.3.3873 How to cite this:Javed MQ. Fiber reinforced composite supported restoration of congenitally missing tooth by minimally invasive approach: Two years follow-up. Pak J Med Sci. 2021;37(3):---------. doi: https://doi.org/10.12669/pjms.37.3.3873 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Minimally Invasive Approach to Infected Pancreatic Necrosis

2017 ◽  
Author(s):  
Rachel J. Kwon
Keyword(s):  
Minimally Invasive ◽  
Pancreatic Necrosis ◽  
Necrotizing Pancreatitis ◽  
Infected Pancreatic Necrosis ◽  
Minimally Invasive Approach ◽  
Invasive Approach ◽  
Open Necrosectomy ◽  
Study Intervention ◽  
Landmark Study

This chapter provides a summary of a landmark study in abdominal surgery. Does a minimally invasive, “step-up” approach to necrotizing pancreatitis reduce mortality and major complications as compared to open necrosectomy? Starting with that question, it describes the basics of the study, including funding, year study began, year study was published, study location, who was studied, who was excluded, how many patients, study design, study intervention, follow-up, endpoints, results, and criticism and limitations. The chapter briefly reviews other relevant studies and information, gives a summary and discusses implications, and concludes with a relevant clinical case involving a patient with infected pancreatic necrosis.

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