The minimally invasive cardiovascular surgery developed rapidly in last decades. In order to promote the development of minimally invasive cardiovascular surgery in China, the Chinese Minimally Invasive Cardiovascular Surgery Committee (CMICS) has gradually standardized the collection and report of the data of Chinese minimally invasive cardiovascular surgery since its establishment. The total operation volume of minimally invasive cardiovascular surgery in China has achieved substantial growth with a remarkable popularization of concepts of minimally invasive medicine in 2019. The data of Chinese minimally invasive cardiovascular surgery in 2019 was reported as a paper for the first time, which may provide reference to cardiovascular surgeons and related professionals.
Objective To assess the effectiveness of a novel minimally invasive Achilles tendon suture instrument in the treatment of fresh closed Achilles tendon rupture. Methods A retrospective study was conducted on 150 patients who underwent surgical intervention for fresh closed Achilles tendon rupture. Eighty patients were treated with the novel minimally invasive Achilles tendon suture instrument (minimally invasive group) and 70 patients with traditional open surgery (traditional group). The two groups were comparable in terms of gender, age, injured side, cause of injury, the interval between injury and operation, and the distance from the fracture end to the calcaneal tuberosity (P>0.05). The operation time, intraoperative blood loss, incision length, hospital stays, hospitalization expenses, and complications were recorded and compared. At 1 year after operation, the ankle joint function was evaluated by the American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot score. Results The minimally invasive group demonstrated significantly shorter operation time, smaller incision length, and lower intraoperative blood loss when compared with the traditional group (P<0.05). However, there was no significant difference in terms of hospital stays and hospitalization expenses between the two groups (P>0.05). All patients were followed up 12-24 months after operation (mean, 15.5 months). In the traditional group, 6 cases of incision necrosis and 7 cases of Achilles tendon adhesion occurred, while in the minimally invasive group, all incisions healed at first intention and no Achilles tendon adhesion occurred. The differences in the incidences of the two complications between the two groups were significant (P<0.05). At 1 year after operation, the AOFAS ankle-hindfoot score in the minimally invasive group was superior to that of the traditional group (P<0.05). Conclusion In comparison with traditional open surgery, the use of self-designed novel minimally invasive Achilles tendon suture instrument proves to be an ideal technique for treating fresh closed Achilles tendon ruptures. This approach offers the benefits of smaller incisions, fewer complications, and better postoperative functional recovery, without increasing hospital costs.
Objective To assess the effectiveness of the single Kocher-Langenbeck approach combined with anterograde channel screw technique for the treatment of acetabular transverse and posterior wall fractures. Methods Between March 2020 and October 2022, 17 cases of acetabular transverse and posterior wall fractures were treated with the single Kocher-Langenbeck approach combined with anterograde channel screw technique. There were 11 males and 6 females, with an average age of 53.6 years (range, 42-64 years). Causes of injury included traffic accident in 12 cases, and falling from height in 5 cases. The time from injury to operation ranged from 4 to 16 days with an average of 8.8 days. The operation time, intraoperative blood loss, and fluoroscopy frequency were recorded; X-ray films were reviewed regularly after operation to observe the fracture healing, and postoperative complications were recorded. At last follow-up, Matta score was used to evaluate the reduction of fracture, Harris score and modified Merle D’Aubigné-Postel scores system were used to evaluate the hip joint function. Results The operation time was 150-230 minutes (mean, 185.9 minutes), the intraoperative blood loss was 385-520 mL (mean, 446.2 mL), and the fluoroscopy frequency was 18-34 times (mean, 27.5 times). Postoperative fat liquefaction occurred in 1 case and the other incisions healed by first intention; 3 cases had limb numbness after operation, and the symptoms disappeared after active symptomatic treatment; no urogenital system and intestinal injury occurred. All patients were followed up 12-28 months (mean, 19.9 months). Bone union was achieved in all cases with an average healing time of 10.8 weeks (range, 8-14 weeks). There was no complication such as loosening and breakage of internal fixators. At last follow-up, according to Matta score, 12 cases achieved anatomic reduction, 3 satisfactory reduction, and 2 fair reduction, the satisfactory rate was 88.2%; according to Harris hip function score, 12 cases were excellent, 3 good, and 2 fair, the excellent and good rate was 88.2%; according to the modified Merle D’Aubign Aubigné-Postel scoring system, the results were excellent in 11 cases, good in 3 cases, and fair in 3 cases, with an excellent and good rate of 82.4%. Conclusion The single Kocher-Langenbeck approach combined with anterograde channel screw technique is a minimally invasive method for the treatment of acetabular transverse and posterior wall fractures with less complications, simple operation, and satisfactory effectiveness.
ObjectiveTo evaluate the short-term effectiveness of percutaneous endoscopic lumbar discectomy (PELD) in treatment of buttock pain associated with lumbar disc herniation.MethodsBetween June 2015 and May 2016, 36 patients with buttock pain associated with lumbar disc herniation were treated with PELD. Of 36 cases, 26 were male and 10 were female, aged from 18 to 76 years (mean, 35.6 years). The disease duration ranged from 3 months to 10 years (mean, 14 months). The location of the pain was buttock in 2 cases, buttock and thigh in 6 cases, buttock and the ipsilateral lower extremity in 28 cases. Thirty-four patients had single-level lumbar disc herniation, and the involved segments were L4, 5 in 15 cases and L5, S1 in 19 cases; 2 cases had lumbar disc herniation at both L4, 5 and L5, S1. The preoperative visual analogue scale (VAS) score of buttock pain was 6.1±1.3. VAS score was used to evaluate the degree of buttock pain at 1 month, 3 months, 6 months, and last follow-up postoperatively. The clinical outcome was assessed by the modified MacNab criteria at last follow-up.ResultsAll patients were successfully operated and the operation time was 27-91 minutes (mean, 51 minutes). There was no nerve root injury, dural tear, hematoma formation, or other serious complications. The hospitalization time was 3-8 days (mean, 5.3 days). All incisions healed well and no infection occurred. Patients were followed up 12-24 months (median, 16 months). MRI examination results showed that the dural sac and nerve root compression were sufficiently relieved at 3 months after operation. Patients obtained pain relief after operation. The postoperative VAS scores of buttock pain at 1 month, 3 months, 6 months, and last follow-up were 1.1±0.6, 0.9±0.3, 1.0±0.3, and 0.9±0.4 respectively, showing significant differences when compared with preoperative VAS scores (P<0.05); there was no significant difference in VAS score between the different time points after operation (P>0.05). At last follow-up, according to the modifed MacNab criteria, the results were excellent in 27 cases, good in 9 cases, and fair in 2 cases, and the excellent and good rate was 94.4%.ConclusionPELD can achieve satisfactory short-term results in the treatment of buttock pain associated with lumbar disc herniation and it is a safe and effective minimally invasive surgical technique.
Surgery has remained the cornerstone of lung cancer therapy. Sleeve lobectomy, which is featured by not only the maximal resection of tumors but also the maximal preservation of functional lung parenchyma, has been proved to be a valid therapeutic option for the treatment of some centrally located lung cancer . Evidence points toward equivalent oncologic outcomes with improved survival and quality of life after sleeve resections compared with pneumonectomy. However, the postoperative morbidities and the long-term results after sleeve lobectomy remain controversial, especially in relation to nodal involvement and after induction therapy. With the development of technology, minimally invasive procedures have been performed more and more widely.
Objective To evaluate the clinical efficacy and safety of biportal endoscopic discectomy combined with annulus fibrosus suture in the treatment of recurrent lumbar disc herniation (RLDH). Methods The clinical data of patients with RLDH who underwent biportal endoscopic discectomy combined with annulus fibrosus suture using a single-use suture device at Mianyang Orthopaedic Hospital between May 2020 and July 2022 were retrospectively collected. Visual Analogue Scale (VAS) scores for low back and leg pain and Oswestry Disability Index (ODI) scores on postoperative Day 3 and at the last follow-up were used to assess pain and functional status. Postoperative lumbar CT, MRI, and dynamic X-rays were obtained to evaluate the extent of decompression, disc removal, and spinal stability. Clinical efficacy during follow-up was assessed using the MacNab criteria since postoperative 3 months. Results Twenty-one RLDH patients (16 males, 5 females) with a mean age of (45.14±15.26) years (range: 17-62 years) were included. The involved segments were L3-L4 in 1 case, L4-L5 in 9 cases, and L5-S1 in 11 cases. All surgeries were successfully completed without complications such as nerve injury, symptomatic epidural hypertension, dural tear, cerebrospinal fluid leakage, or infection. All patients were followed up for a mean duration of (11.38±3.51) months (range: 4-17 months). No recurrence of disc herniation or segmental instability was observed during follow-up. Significant improvements were seen in VAS scores for low back pain (2.90±0.70, 1.38±0.81), leg pain (2.33±0.58, 1.29±0.46), and ODI scores [(24.12±5.05)%, (11.29±1.86)%] on postoperative Day 3 and at the last follow-up compared to the preoperative values [5.90±1.09, 6.10±0.77, (57.08±9.72)%; all P<0.05]. According to the MacNab criteria, the clinical efficacy was rated as excellent in 16 cases, good in 3 cases, and fair in 2 cases, yielding an excellent-good rate of 90.5%. Conclusion Biportal endoscopic discectomy with annulus fibrosus suture is a safe and effective treatment for RLDH, demonstrating favourable clinical outcomes and warranting further research and application.
Hybrid coronary revascularization (HCR) combines the advantages of minimally invasive direct coronary artery bypass grafting (MIDCAB) and percutaneous coronary intervention (PCI), and avoids its relative shortcomings, which has received particular attention in recent years. HCR seems to have become the third revascularization strategy for multi-vessel disease in coronary heart diseases. However, the clinical researches on HCR are still limited. This article will systematically review the comparison of HCR with coronary artery bypass grafting (CABG) and PCI, the results of HCR in specific patients, and the clinical results of different HCR strategies.
Objective To compare the effectiveness of unilateral biportal endoscopy (UBE) technique with the interlaminar uniportal endoscopy (IUE) technique for the treatment of L5, S1 lumbar disc herniation. MethodsThe clinical data of 69 patients with L5, S1 lumbar disc herniation who met the selection criteria between January 2020 and December 2020 were retrospectively analysed. The patients were divided into UBE group (30 cases) and IUE group (39 cases) according to endoscopic surgical technique. The general data, such as gender, age, body mass index, disease duration, and preoperative visual analogue scale (VAS) scores of low back/leg pain and Oswestry disability index (ODI), was not significantly different between the two groups (P>0.05). Perioperative outcomes [estimated blood loss (EBL), total operation time, extracanal operation time, intracanal decompression time, intraoperative radiation exposure dose, incision length, operative related complications, and postoperative hospitalization stay] and clinical outcomes (VAS score of low back/leg pain before operation and at 3 days, 3 months, 6 months, and 12 months after operation as well as the ODI before operation and at 3 months, 6 months, and 12 months after operation) were recorded and compared between the two groups. ResultsAll patients completed the surgery successfully. The incision length, EBL, and extracanal operation time in UBE group were significantly longer than those in IUE group (P<0.05), and the intracanal decompression time in UBE group was significantly shorter than that in IUE group (P<0.05). There was no significant difference in the total operation time, intraoperative radiation exposure dose, and postoperative hospitalization stay between the two groups (P>0.05). Patients in both groups were followed up 12-15 months (mean, 13.3 months). Dural tear ocurred in 1 patient of the UBE group, and recurrence ocurred in 1 patient of the IUE group, the others of both groups had no surgery-related complications and recovered well after operation. The VAS scores of low back/leg pain and ODI in both groups at each time point after operation significantly improved when compared with those before operation (P<0.05); there was no significant difference in VAS scores and ODI at each time point after operation between two groups (P>0.05). ConclusionThe effectiveness of UBE technique in the treatment of L5, S1 lumbar disc herniation is similar to that of IUE technique, and the efficiency of intraspinal operation is better than that of IUE technique. Although UBE technique is inferior to IUE technique in terms of surgical trauma, there is no significant difference in postoperative recovery between the two techniques.
Silicone oil is widely used in intraocular filling of fundus disease after vitrectomy, which improves retinal reattachment rate andpostoperative visual function of patients. With the era of minimally invasive vitreous surgery coming, the utilization rate of silicone oil filling is decreasing, however, it still plays an indispensable role in the surgical treatment of complex fundus diseases. In the process of using silicone oil, the indications should be strictly selected, and the potential risks should be fully considered and possibly avoided. The study of vitreous substitutes with certain physiological functions is currently a research hotspot in the field of fundus diseases.
ObjectiveTo summarize the clinical progress of minimally invasive techniques in treatment of pilonidal disease.MethodThe relevant literatures about minimally invasive techniques in the treatment of pilonidal disease in recent years were reviewed.ResultsAbout hair removal and carbolic acid injection, they had less damage, fewer complications, higher recurrence rate compared to other surgery, and did not affect the second treatment. The fibrin injection could not clarify its role in the treatment of pilonidal disease due to some defects in the clinical design. Bascom Ⅰhad the advantages of fast recovery and no need for hospitalization, with a recurrence rate of 8%–16%. According to the results of some current clinical researches, it was a promising operation. Sinus resection required further clinical evaluation due to the limited results of current researches. A clinical study of more than 1 000 cases over 10 years showed that the recurrence rate in 10 years was 16%. Compared with frequently used pilonidal operations, the trephine technique was associated with a lower recurrence rate and a lower incidence of postoperative complication. Some short-term clinical researches showed that endoscopic pilonidal sinus treatment was a safe, minimally invasive, and less complication treatment.ConclusionsCompared with frequently used pilonidal operations, minimally invasive technique has the advantages of shortening the hospital stay, shortening the healing time, and reducing complications. It is worth of application.