Abstract： Objective To explore a new videoassisted thoracoscopic surgical treatment for lone atrial fibrillation, in order to seek better efficacy, reduce invasiveness, and devise an easiertooperate surgical treatment for atrial fibrillation. Methods In June 2011, 3 women aged 40 years, 60 years, and 66 years with lone atrial fibrillation were treated in the Cardiovascular Surgery Department of West China Hospital. The patients underwent a videoassisted thoracoscopic “Box Lesion” bipolar radiofrequency atrial fibrillation therapy (bilateral pulmonary vein + left atrial posterior wall isolation), including three 5 to 10 mm small incisions on each side of the chest wall. The complications and sinus rhythm maintenance of the patients were observed. Results The operative times were 140 min, 170 min, and 155 min. The three patients were in sinus rhythm immediately after the surgery. Mean blood loss was approximately 80 ml, mean intensive care unit (ICU) stay was 1 day, and average hospital stay was 7 days. No deaths and serious complications occurred. The three patients were still in sinus rhythm one week and one month after the operation, as measured by electrocardiogram. Conclusion Box Lesion bipolar radiofrequency treatment for atrial fibrillation therapy shows fast postoperative recovery. It is a promising procedure in atrial fibrillation treatment and is worthy of further study.
Objective?To investigate the effectiveness of minimally invasive plate fixation in treatment of unstable pelvic fractures.?Methods?Between May 2006 and December 2009, 21 patients with unstable pelvic fractures were treated. There were 13 males and 8 females with an average age of 39 years (range, 21-66 years). The causes of injury included traffic accident in 9 cases, falling from height in 6 cases, and heavy pound injury in 6 cases. The time from injury to hospitalization was 1 to 4 hours with an average of 2.8 hours. According to Tile’s classification, there were 12 cases of type B and 9 cases of type C. After admission, bone traction and exo fixation were performed, and minimally invasive plate fixation was given at 5-24 days after injury.?Results?All incisions healed by first intention, and no complications of nerve and vessel injuries occurred. According to the reduction criteria of Matta radiography, anatomic reduction was achieved in 16 cases, satisfactory reduction in 4 cases, and fair reduction in 1 case. All patients were followed up 12 months. The X-ray films showed all fractures healed at 2-4 months (mean, 2.6 months). According to Majeed clinical evaluation, the results were excellent in 12 cases, good in 7 cases, and fair in 2 cases.?Conclusion?Minimally invasive plate fixation can provide effective fixation, reconstruct pelvic ring, and reduce perioperative complications in the treatment of unstable pelvic fractures.
Objective To investigate the development and appl ication of the computer aided surgery systems in the joint surgery field. Methods The l iteratures were extensively reviewed to analysis the usefulness of current active, semi-active and passive computer aided surgery systems in solving the cl inical problems of joint surgery. Results Several computer aided surgery systems have met the high technique demands, such as the precision of anatomical position and orientation, the accuracy of normal l imb al ignment restoration, the optimum of instrumentation control in arthroplasty, peri-articular osteotomy and minimally invasive procedure. Conclusion Computer aided joint surgery systems facil itate precise surgical techniques to achieve ideal operative outcome.
ObjectiveTo compare the outcomes of repeated tricuspid valve surgery for patients with late severe tricuspid regurgitation (TR) after cardiac surgery through right anterior minithoracotomy and conventional median sternotomy approaches. MethodsBetween June 2002 and June 2013, 89 patients with late severe tricuspid regurgitation after cardiac surgery underwent repeated tricuspid valve surgery through right anterior minithoracotomy in our hospital. The patients were divided into two groups. Fifty one patients were in a minimally invasive group with 28 males and 23 females at age of 46.59±11.53 years. Thirty eight patients were in a conventional median sternotomy (conventional group) with 15 males and 23 females at age of 50.42±9.30 years. The outcomes of the two groups were compared. ResultsThere was no statisitcal difference in preoperative clinical data between two groups. All patients successfully underwent repeated tricuspid valve surgery. Tricuspid valve replacement (TVR) was performed in 68 patients (38 patients vs. 30 patients), and tricuspid valvuloplasty (TVP) was performed in 21 patients (13 patients vs. 8 patients). Compared with the conventional group, operation time, time of establishing cardiopulmonary bypass and postoperative in-hospital time were significantly shorter in the minimally invasive group (P<0.001). The postoperative drainage was significantly reduced in the minimally invasive group compared with the value of the conventional group (P<0.001). Three patients died in the early postoperative period (1 patient vs. 2 patients). In the conventional group, one patient needed re-exploration for bleeding and 2 patients had wound infection. At discharge, transthoracic echocardiography showed that all patients had no or mild TR and no paravalvular leakage occurred. During the follow-up (12-144 months), 4 patients died (2 patients vs. 2 patients). In the minimally invasive group, one patient underwent repeated TVR due to severe TR associated with infective endocarditis, and another patient had moderate TR. In the conventional group, one patient underwent repeated TVR due to mechanical valve thrombosis. ConclusionRight anterior minithoracotomy is safe, effective and reliable for patients with late severe TR after cardiac surgery. It has the similar effect of the correction of valvular lesions with conventional median sternotomy, but right anterior minithoracotomy has more benefits, including more, minimally invasive, less blood loss, shorter operation time and faster recover.
The incidence, mortality, and disability rate of spontaneous intracerebral hemorrhage (SICH) are high, and its surgical and medical treatment is still controversial. With the development of micro-neurosurgical technology, minimally invasive surgery (MIS) has made great progress in the treatment of SICH. It can remove intracerebral hematoma in the early stage after SICH and minimize or eliminate secondary brain injury, which is of great significance to reducing the mortality and disability rate. For many years, due to its continuous progress, MIS has been more and more widely used in the treatment of SICH. This article mainly reviews the progress of MIS in SICH and related clinical research at home and abroad, and briefly describes several innovative techniques related to MIS, which aims to promote the exchange of clinical experience in MIS of SICH.
Objective To explore the effectiveness of minimally invasive transforaminal lumbar interbody fusion (MI-TLIF) for degenerative lumbar scoliosis stenosis by expandable tubular retractor. Methods Between April 2009 and October 2010, 39 patients with degenerative lumbar scoliosis stenosis were treated. Of 39 patients, 20 underwent MI-TLIF (group A) and 19 underwent open surgery (group B). There was no significant differences in gender, age, disease duration, range of lumbar degenerative scoliosis, Cobb angle, Oswestry disability index (ODI), and visual analogue scale (VAS) between 2 groups (P gt; 0.05). The operation time, intraoperative blood loss, postoperative independently turning over time, postoperative complication rate, Cobb angle, fusion rates, ODI score, and VAS score were compared between 2 groups. Results The operation time of group A was significantly longer than that of group B (P lt; 0.05), and the intraoperative blood loss of group A was significantly less than that of group B (P lt; 0.05); no significant difference was found in postoperative independently turning over time between 2 groups (t=1.869, P=0.069). The complication rate was 20.0% (4/20) in group A and 26.3% (5/19) in group B, showing no significant difference (χ2=0.219, P=0.640). All patients were followed up 2 years to 3 years and 6 months (mean, 2.9 years). At last follow-up, the fusion rate of bone graft was 92.9% (78/84) in group A and 95.2% (80/84) in group B, showing no significant difference (χ2=0.425, P=0.514). According to the Macnab standard for effectiveness evaluation, the results were excellent in 12 cases, good in 6 cases, fair in 1 case, and poor in 1 case, with an excellent and good rate of 90.0% in group A; the results were excellent in 12 cases, good in 5 cases, and fair in 2 cases, with an excellent and good rate of 89.5% in group B; there was no significant difference between 2 groups (Z= — 0.258, P=0.835). The postoperative VAS score, ODI score, and Cobb angle were significantly improved when compared with preoperative ones in 2 groups (P lt; 0.05); and there was no significant differences between 2 groups at 2 weeks after operation and last follow-up (P gt; 0.05). Conclusion MI-TLIF by expandable tubular retractor is an available clinical choice in treating degenerative lumbar scoliosis stenosis. It can obtain the same effectiveness as the open surgery.
Objective To compare the difference of traumatic related index in serum and its significance between minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF) and open TLIF. Methods Sixty patients were enrolled by the entry criteria between May and November 2012, and were divided into MIS-TLIF group (n=30) and open TLIF group (n=30). There was no significant difference in gender, age, type of lesions, disease segment, and disease duration between 2 groups (P gt; 0.05). The operation time, intraoperative blood loss, and postoperative hospitalization time were recorded, and the pain severity of incision was evaluated by visual analog scale (VAS). The serum levels of C-reactive protein (CRP) and creatine kinase (CK) were measured at preoperation and at 24 hours postoperatively. The levels of interleukin 6 (IL-6), IL-10, and tumor necrosis factor α (TNF-α) in serum were measured at preoperation and at 2, 4, 8, and 24 hours after operation. Results The operation time, intraoperative blood loss, and postoperative hospitalization time of MIS-TLIF group were significantly smaller than those of open TLIF group (P lt; 0.05), and the VAS score for incision pain in MIS-TLIF group was significantly lower than that of open TLIF group at 1, 2, and 3 days after operation (P lt; 0.05). The levels of CRP, CK, IL-6, and IL-10 in MIS-TLIF group were significantly lower than those in open TLIF group at 24 hours after operation (P lt; 0.05), but there was no significant difference between 2 groups before operation (P gt; 0.05). No significant difference was found in TNF-α level between 2 groups at pre- and post-operation (P gt; 0.05). Conclusion Compared with the open-TLIF, MIS-TLIF may significantly reduce tissue injury and systemic inflammatory reactions during the early postoperative period.
Objective To investigate the effectiveness of minimally invasive transforaminal lumbar interbody fusion (TLIF) assisted with microscope for lumbar degenerative disease. Methods Retrospective analysis was made on the clinical data of 82 patients with lumbar degenerative disease (minimally invasive group) undergoing minimally invasive TLIF assisted with microscope between January 2010 and June 2011, which was compared with those of 76 patients (traditional group) undergoing traditional open TLIF. There was no significant difference in age, gender, disease duration, disease type, lesion level, preoperative visual analogue scale (VAS), and preoperative Oswestry disability index (ODI) between 2 groups (P gt; 0.05). The perioperative related parameters, radiography index, and effectiveness were documented and compared. Results There was no significant difference in operation time and intraoperative radiological exposure time between 2 groups (P gt; 0.05), but intraoperative blood loss and postoperative drainage volume in the minimally invasive group were significantly less than those in the traditional group (P lt; 0.05). Dural tear occurred in 2 patients of the traditional group. Superficial infection of incision occurred in 1 case in each group, respectively; and primary healing of incision was obtained in the other patients. All patients were followed up 12-28 months (mean, 18 months). No failure of internal fixation occurred. Radiological analysis showed that the bone graft fusion rate was 96.1% (73/76) in the traditional group and 95.1% (78/82) in the minimally invasive group at last follow-up, showing no significant difference (χ2= 0.012 2, P= 0.912 0). The postoperative ODI and VAS score were significantly improved when compared with preoperative ones in 2 groups (P lt; 0.05); the ODI of the minimally invasive group were significantly better than those of the traditional group at 3 months (t= — 11.941 1, P=0.000 0), and the VAS score of the minimally invasive group was significantly lower than that of the traditional group at 1 day and 3 months (P lt; 0.05); but no significant difference was found in ODI and VAS score between 2 groups at 1 year and last follow-up (P gt; 0.05). Conclusion Minimally invasive TLIF is an effective method to treat lumbar degenerative disease. This procedure is safe and reliable because it has less injury, less blood loss, and milder pain than the traditional open TLIF, and the short-term effectiveness is comparable in 2 procedures.
ObjectiveTo assess the feasibility of the treatment of unresectable late pancreatic cancer with laparoscopic choledochojejunostomy and gastric bypass. MethodsFrom June 2000 to December 2003, laparoscopic choledochojejunostomy and gastric bypass were successfully performed in 15 patients with unresectable late pancreatic cancer. Endoscopic nosobiliary drainage (ENBD) was performed before the operation. ResultsAll procedures were completed laparoscopically. Jaundice and hepatic function of the patients were obviously improved after the bypass. Oral nutrition was recovered after operation. The mean operative time was (100±26) min (range 70-200 min); the mean operative blood loss was (60±15) ml (range 30-120 ml); the bowel function recovery was on the 3rd-5th postoperative day; the average hospital stay was (8.1±0.7) days (range 6-13 days). Incision infection ocurred in one patient. No operative complications occurred in other patients. ConclusionTreatment of unresectable late carcinoma of the pancreas with laparoscopic choledochojejunostomy and gastric bypass aided by ENBD is a minimally invasive technique with less postoperative pain，shorter hospital stay, lower procedurerelated morbidity,and better oral nutrition. The life quality of patients with late pancreatic cancer can be obviously improved.
ObjectiveTo summarize the data of robotic hysterectomy in patients with large and super-large uterus in single center, and explore the relevant clinical experience and advantages of robotic surgery.MethodsThe medical records of the patients with large uterus caused by gynecological diseases who underwent robotic hysterectomy in the Chinese PLA General Hospital from January 2016 to December 2018 were retrospectively analyzed. The patients with uterine size from 12 to 16 weeks of gestation were divided into large uterus group and those with uterine volume larger than 16 weeks of gestation were divided into super large uterus group.ResultsA total of 62 patients were included, including 28 in the large uterus group with the average uterus size of (14.3±2.1) gestational weeks, and 34 in the super large uterus group with the average uterus size of (19.9±2.8) gestational weeks. There was no significant difference in mean age, body mass index, history of abdominal surgery or diagnostic composition between the two groups (P>0.05), except for the size of the uterus (t=8.772, P<0.001). The operation time in the large uterus group was less than that in the super-large uterus group [(75.4±22.6) vs. (91.7±27.8) min; t=2.495, P=0.015]. The incidence of complications after robotic hysterectomy was 14.5% (9/62) in the 62 patients, including 14.3% (4/28) in the large uterus group and 14.7% (5/34) in the super-large uterus group. There was no significant difference in the amount of bleeding, blood transfusion rate, ratio of conversion to open surgery, average hospitalization days or incidence of postoperative complications between the two groups (P>0.05).ConclusionsRobotic hysterectomy has the advantages of flexible manipulator, 3-D operative field of vision and stability of manipulation. In addition, increased uterine volume does not lead to increased surgical trauma, nor apparently affect the prognosis.