• Title/Summary/Keyword: Minimally Invasive

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The Role of Minimally Invasive Plate Osteosynthesis in Rib Fixation: A Review

  • Bemelman, Michael;van Baal, Mark;Yuan, Jian Zhang;Leenen, Luke
    • Journal of Chest Surgery
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    • v.49 no.1
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    • pp.1-8
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    • 2016
  • More than a century ago, the first scientific report was published about fracture fixation with plates. During the 1950's, open reduction and plate fixation for fractures were standardized by the founders of Arbeitsgemeinschaft $f{\ddot{u}}r$ osteosynthesefragen/Association for the Study of Internal Fixation. Since the introduction of plate fixation for fractures, several plates and screws have been developed, all with their own characteristics. To accomplice more fracture stability, it was thought the bigger the plate, the better. The counter side was a compromised blood supply of the bone, often resulting in bone necrosis and ultimately delayed or non-union. With the search and development of new materials and techniques for fracture fixation, less invasive procedures have become increasingly popular. This resulted in the minimally invasive plate osteosynthesis (MIPO) technique for fracture fixation. With the MIPO technique, procedures could be performed with smaller incisions and thus with less soft tissue damage and a better preserved blood supply. The last 5 years rib fixation has become increasingly popular, rising evidence has becomeavailable suggesting that surgical rib fixation improves outcome of patients with a flail chest or isolated rib fractures. Many surgical approaches for rib fixation have been described in the old literature, however, most of these techniques are obscure nowadays. Currently mostly large incisions with considerable surgical insult are used to stabilize rib fractures. We think that MIPO deserves a place in the surgical treatment of rib fractures. We present the aspects of diagnosis, preoperative planning and operative techniques in regard to MIPO rib fixation.

Cerebral Oxygenation Monitoring during a Variation of Isoflurane Concentration in a Minimally Invasive Rat Model

  • Choi, Dong-Hyuk;Kim, Sungchul;Shin, Teo Jeon;Kim, Seonghyun;Kim, Jae Gwan
    • Current Optics and Photonics
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    • v.6 no.5
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    • pp.489-496
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    • 2022
  • Our previous study on monitoring cerebral oxygenation with a variation of isoflurane concentration in a rat model showed that near-infrared spectroscopy (NIRS) signals have potential as a new depth of anesthesia (DOA) index. However, that study obtained results from the brain in a completely invasive way, which is inappropriate for clinical application. Therefore, in this follow-up study, it was investigated whether the NIRS signals measured in a minimally invasive model including the skull and cerebrospinal fluid layer (CSFL) are similar to the previous study used as a gold standard. The experimental method was the same as the previous study, and only the subject model was different. We continuously collected NIRS signals before, during, and after isoflurane anesthesia. The isoflurane concentration started at 2.5% (v/v) and decreased to 1.0% by 0.5% every 5 min. The results showed a positive linear correlation between isoflurane concentration and ratio of reflectance intensity (RRI) increase, which is based on NIRS signals. This indicates that the quality of NIRS signals passed through the skull and CSFL in the minimally invasive model is as good as the signal obtained directly from the brain. Therefore, we believe that the results of this study can be easily applied to clinics as a potential indicator to monitor DOA.

Clinical Outcomes of Minimally Invasive Surgical Stabilization of Rib Fractures Using Video-Assisted Thoracoscopic Surgery

  • Chae-Min Bae;Shin-Ah Son;Yong Jik Lee;Sang Cjeol Lee
    • Journal of Chest Surgery
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    • v.56 no.2
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    • pp.120-125
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    • 2023
  • Background: Multiple rib fractures are common in blunt chest trauma. Until recently, most surgical rib fixations for multiple rib fractures were performed via open thoracotomy. However, due to the invasive nature of tissue dissection and the resulting large wound, an alternative endoscopic approach has emerged that minimizes the postoperative complications caused by the manipulation of injured tissue and lung during an open thoracotomy. Methods: Our study concentrated on patients with multiple rib fractures who underwent surgical stabilization of rib fractures (SSRF) between June 2018 and May 2020. We found 27 patients who underwent SSRF using video-assisted thoracoscopic surgery. The study design was a retrospective review of the patients' charts and surgical records. Results: No intraoperative events or procedure-related deaths occurred. Implant-related irritation occurred in 4 patients, and 1 death resulted from concomitant trauma. The average hospital stay was 30.2±20.1 days, and ventilators were used for 12 of the 22 patients admitted to the intensive care unit. None of the patients experienced major pulmonary complications such as pneumonia or acute respiratory distress syndrome. Conclusion: Minimally invasive rib stabilization surgery with the assistance of a thoracoscope is expected to become more widely used in patients with multiple rib fractures. This method will also assist patients in a quick recovery.

Minimally Invasive Anterior Decompression Technique without Instrumented Fusion for Huge Ossification of the Posterior Longitudinal Ligament in the Thoracic Spine : Technical Note And Literature Review

  • Yu, Jae Won;Yun, Sang-O;Hsieh, Chang-Sheng;Lee, Sang-Ho
    • Journal of Korean Neurosurgical Society
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    • v.60 no.5
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    • pp.597-603
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    • 2017
  • Objective : Several surgical methods have been reported for treatment of ossification of the posterior longitudinal ligament (OPLL) in the thoracic spine. Despite rapid innovation of instruments and techniques for spinal surgery, the postoperative outcomes are not always favorable. This article reports a minimally invasive anterior decompression technique without instrumented fusion, which was modified from the conventional procedure. The authors present 2 cases of huge beak-type OPLL. Patients underwent minimally invasive anterior decompression without fusion. This method created a space on the ventral side of the OPLL without violating global thoracic spinal stability. Via this space, the OPLL and anterior lateral side of the dural sac can be seen and manipulated directly. Then, total removal of the OPLL was accomplished. No orthosis was needed. In this article, we share our key technique and concepts for treatment of huge thoracic OPLL. Methods : Case 1. 51-year-old female was referred to our hospital with right lower limb radiating pain and paresis. Thoracic OPLL at T6-7 had been identified at our hospital, and conservative treatment had been tried without success. Case 2. This 54-year-old female with a 6-month history of progressive gait disturbance and bilateral lower extremity radiating pain (right>left) was admitted to our institute. She also had hypoesthesia in both lower legs. Her symptoms had been gradually progressing. Computed tomography scans showed massive OPLL at the T9-10 level. Magnetic resonance imaging of the thoracolumbar spine demonstrated ventral bony masses with severe anterior compression of the spinal cord at the same level. Results : We used this surgical method in 2 patients with a huge beaked-type OPLL in the thoracic level. Complete removal of the OPLL via anterior decompression without instrumented fusion was accomplished. The 1st case had no intraoperative or postoperative complications, and the 2nd case had 1 intraoperative complication (dural tear) and no postoperative complications. There were no residual symptoms of the lower extremities. Conclusion : This surgical technique allows the surgeon to safely and effectively perform minimally invasive anterior decompression without instrumented fusion via a transthoracic approach for thoracic OPLL. It can be applied at the mid and lower level of the thoracic spine and could become a standard procedure for treatment of huge beak-type thoracic OPLL.

Dynamic Modeling and Repulsive Force Control of Medical Hpatic Master (의료용 햅틱 마스터의 동적 모델링과 힘 반향 제어)

  • Oh, Jong-Seok;Choi, Seung-Bok
    • Transactions of the Korean Society for Noise and Vibration Engineering
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    • v.22 no.3
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    • pp.284-290
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    • 2012
  • In this research, a new type of haptic master device using electrorheological(ER) fluid for minimally invasive surgery(MIS) is devised and control performance of the proposed haptic master is evaluated. The proposed haptic master consists of ER bi-directional clutch/brake for 2 DOF rotational motion(X, Y) using gimbal structure and ER brake on the gripper for 1 DOF rotational motion (Z). Using Bingham characteristic of ER fluid and geometrical constraints, principal design variables of the haptic master are determined. Then, the generation of torque of the proposed master is experimentally evaluated as a function of applied field of voltage. A sliding mode controller which is robust to uncertainties is then designed and empirically realized. It has been demonstrated via experiment that the proposed haptic master associated with the controller can be effectively applied to MIS in real field conditions.

Minimally Invasive Approach to Esophageal Perforation after Endoscopic Ultrasound-Guided Fine-Needle Aspiration: A Report of 2 Cases

  • Geraedts, Anna C.M.;Broos, Pieter P.H.L.;Gronenschild, Michiel H.M.;Custers, Frank L.J.;Hulsewe, Karel W.E.;Vissers, Yvonne L.J.;de Loos, Erik R.
    • Journal of Chest Surgery
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    • v.53 no.5
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    • pp.313-316
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    • 2020
  • Esophageal perforation after endoscopic ultrasound-guided fine-needle aspiration for mediastinal staging is a rare but severe complication. We report 2 cases of patients with esophageal perforation who were treated using video-assisted thoracoscopic surgery in combination with esophageal stenting. Through these cases, the feasibility of minimally invasive thoracic surgery was evaluated.

Transoral Robotic Surgery (경구강 로봇 수술)

  • Park, Young Min;Kim, Se-Heon
    • Korean Journal of Head & Neck Oncology
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    • v.31 no.2
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    • pp.1-5
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    • 2015
  • The role of transoral robotic surgery in the treatment of upper aerodigestive tract tumor has expanded in recent. Since the approval of the da Vinci system, the number of transoral robotic surgery has increased significantly. The main indications of transoral robotic surgery are tumors of oropharynx, hypopharynx, and larynxs. Transoral robotic surgery is a minimally invasive surgical approach that offers surgical access to the laryngopharynx without the morbidity of open surgeries while achieving excellent oncologic and functional outcomes. The appropriate application of transoral robotic surgery is still being investigated and previous studies supports transoral robotic surgery as a viable option in the management of upper aerodigestive tract tumor.

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Thoracoscopic Patch Insulation for Phrenic Nerve Stimulation after Permanent Pacemaker Implantation

  • Kang, Yoonjin;Kim, Eung Rae;Kwak, Jae Gun;Kim, Woong-Han
    • Journal of Chest Surgery
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    • v.51 no.5
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    • pp.363-366
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    • 2018
  • One of the complications of permanent pacemaker implantation is unintended phrenic nerve stimulation. A 15-year-old boy with a permanent pacemaker presented with chest discomfort due to synchronous chest wall contraction with pacing beats. Even after reprogramming of the pacemaker, diaphragmatic stimulation persisted. Therefore, we performed thoracoscopic phrenic nerve insulation using a Gore-Tex patch to insulate the phrenic nerve from the wire. A minimally invasive approach using a thoracoscope is a feasible option for retractable phrenic nerve stimulation after pacemaker implantation.