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At least 19 recordsLinked to original sources
PubMed1998

The tensionfree vaginal tape procedure (TVT) for treatment of female urinary incontinence. A minimal invasive surgical procedure.

BACKGROUND: To test the suitability of a new surgical procedure for treatment of female urinary incontinence to be used as an ambulatory and minimal invasive operation. METHODS: Thirty-one consecutive patients with urodynamically proven stress incontinence had a tensionfree vaginal tape procedure performed. Operation time, the amount of anesthetics and analgetics used, postoperative mobilization, voiding patterns, residual urine volumes, per- and postoperative complications, hospital stay and need for sick leave were prospectively recorded. RESULTS: All 31 patients were cured from stress incontinence. Local anesthesia was used in all cases and additional analgetics were needed in only small doses. Seventy per cent of the patients were released from the hospital on the same day of the operation. By medical criteria 90% could have been released on the same day. No significant per- or postoperative complications occurred. Three patients needed postoperative catheterization. All but one patient was able to empty her bladder within 24 hours from the operation. An average of 15 days sick leave was prescribed. CONCLUSION: The tensionfree vaginal tape procedure seems to fulfil the criteria for being regarded as a minimal invasive surgical procedure for treatment of female urinary stress incontinence. It is highly effective and is associated with very few intra and postoperative side effects.

Ambulatory Surgical Procedures↗
PubMed1996

Robotic arm enhancement to accommodate improved efficiency and decreased resource utilization in complex minimally invasive surgical procedures.

Resource allocation, including manpower and other expenses, have limited the evolution of minimally invasive surgical procedures to provide humanism and to improve surgical care for patients. Robotic enhancement has been proposed as a mechanism to improve the cost-benefit relationship for patients. To this end, we have used the robotic arm enhancement to minimize resource and personnel utilization during minimally invasive procedures. Phase I of our study has included the use of the robotic arm in 24 laparoscopic hernia repairs, cholecystectomies, and nissen fundoplications with the surgeon as a solo surgeon, i.e., the primary surgeon is the only participant in the operative sterile field. The scrub nurse did not participate in the procedures. During this study, there were no technical mishaps, no complications related to the solo surgeon-robotic arm concept, and the operative times were statistically similar to equivalent procedures utilizing multiple personnel. The hernia repair is least complex and most amenable to solo surgery due to the use of only three access ports; cholecystectomy occasionally requires four access ports increasing its complexity to a measurable degree. Nissen fundoplication, however, requires five access ports and proved to be the most complex of the procedures to adapt successfully to solo surgery utilizing robotic arm enhancement. Phase II of our study has involved the use of a combination of technologically complex and sophisticated technology to improve outcomes in complex laparoscopic procedures. The head-mounted display, the robotic arm, and the harmonic scalpel have been used in 140 complex minimally invasive procedures; the procedures were laparoscopic spine surgery (24 cases), laparoscopic gastric surgery (28 cases), and laparoscopic colon resection (88 cases). The use of these sophisticated technologies added safety, improved versatility, and did not increase the length of the operative procedures. The use of multiple technologies had an additive effect on the benefits. There were no experiences in which the technologies contributed to a technical complication or an adverse result for the patients. However, the successful use of these technologies requires an in depth educational experience for the surgeon and for the operating room team. In a further effort to improve efficiency and control of the visual fields during minimally invasive surgery, we have implemented a prototype voice activation, head-directed control, and instrument tracking by robotic arm enhancement in order to control the visual field through computer programming. Prototype voice activation and deactivation also allows instruments to be used in the visual field for the surgical procedure while not being used for tracking of the visual field. Tracking with the instrument utilizing a color-coded tracking system, and the head-directed control system have both been 100% effective in our hands, have not induced errors in technical performance of procedures, and have shortened the time required for performance of specific procedural tasks. Further, this process improves versatility for the surgeon, increases concentration, reduces fatigue and does not interfere with the position of the surgeon. Areas for improvement which have been observed utilizing these techniques are (1) the use of appropriate and consistent voice activation terminology, (2) the proper positioning of the instrument tracking unit in the most appropriate locations on the video screen and on the instrument within the visual field, and (3) the appropriate use of head-directed control of the robotic arm. We have concluded from these experiences that the robotic technology will continue to reduce costs and minimize risk for patients undergoing minimally invasive surgical procedures; moreover, safety, versatility, and diminished use of resources will accrue utilizing the additive benefit of sequential sophisticated technologies requiring a simultaneous educational

Animals↗
PubMedDate not supplied

Combined use of calcium infusion localization and a minimally invasive surgical procedure in the management of insulinoma.

OBJECTIVE: To review our experience with current diagnostic localization techniques and a minimally invasive laparoscopic surgical procedure in the management of insulinoma. METHODS: We describe five patients with insulinoma, the results of diagnostic studies, and a proposed algorithm for management of this rare tumor. RESULTS: Four female patients and one male patient (age range, 34 to 72 years) underwent supervised fasting (mean duration, 12 hours; range, 3 to 28 hours) to establish the diagnosis of insulinoma. These patients had glucose values that ranged from 38 to 41 mg/dL and associated serum insulin levels of 11.3 to 61 microU/mL. C-peptide values ranged from 3.4 to 11.5 ng/mL, and proinsulin levels (measured in four patients) were 32.9 to 82 pmol/L. These biochemical findings were diagnostic for insulin-mediated hypoglycemia, and the high proinsulin and C-peptide levels, in conjunction with negative results of serum measurements for sulfonylureas, excluded an exogenous source of insulin as the cause of hypoglycemia. Four of the five study patients had nondiagnostic results of noninvasive localization studies and underwent selective arterial injection of calcium with hepatic venous sampling to help localize the insulinomas within the pancreas. This procedure correctly localized the lesion in three patients and was associated with no complications. In all five patients, surgical resection of a solitary insulinoma (with use of laparoscopic procedures in four, one of which was converted to an open procedure) yielded resolution of the hypoglycemia. CONCLUSION: The combination of calcium infusion localization and a minimally invasive surgical procedure is an efficient management approach in the diagnosis and treatment of insulinoma.

Adult↗
PubMedDate not supplied

[Video-assistive minimally invasive surgical procedures in the treatment of thyroid in children and adolescents].

Minimally invasive video-assisted (MIVA) surgery of the thyroid is now widely accepted by endocrinel surgeons, especially in adult age. This report describes indications, limits, technical aspects and results of MIVA in 10 young patients (mean age 16 years, range 11-18) enrolled in a study of 213 patients (mean age 45 years, range 11-81) operated with this technique, from October 1998 to August 2001, in the Department of Surgery at the University of Pisa. Young patients were submitted to surgery: 8 lobectomies (6 for microfollicular lesions and 2 for adenomas functionally autonomous) and 2 total thyroidectomies for papillary carcinoma. No case has been converted in "open" surgery and no post-operatory complications have been observed. Elective indications of MIVA are the volume of the nodule and the istological type. This technique cannot be performed in voluminous goiters, in medullary carcinomas and in scarcely differentiated carcinomas. Minimally invasive video-assisted surgery of the thyroid, in our experience, represents a reliable technique also in pediatric age.

Carcinoma, Papillary↗
PubMed2004

Manual versus automated methods for cleaning reusable accessory devices used for minimally invasive surgical procedures.

We undertook a simulated-use study using quantitative methods to evaluate the cleaning efficacy of ported and non-ported accessory devices used in minimally invasive surgery. We chose laparoscopic scissors and forceps to represent worst-case devices which were inoculated with artificial test soil containing 10(6) cfu/mL Enterococcus faecalis and Geobacillus stearothermophilus and allowed to dry for 1 h. Cleaning was performed manually, as well as by the automated SI-Auto Narrow lumen cleaner. Manual cleaning left two- to 50-fold more soil residuals (protein, haemoglobin and carbohydrate) inside the lumen of non-ported versus ported laparoscopic accessory devices. The SI-Auto Narrow lumen cleaner was more efficient than manual cleaning and achieved >99% reduction in soil parameters in both non-ported (using retro-flushing) and ported laparoscopic devices. Only the automated cleaning of ported devices achieved 10(3)-10(4)-fold reduction in bacterial numbers. Sonication alone (no flushing of inner channel) did not effectively remove soil or organisms from the inner channel. Our findings indicate that non-ported accessory devices cannot be as reliably cleaned as ported devices regardless of the cleaning method used. If non-ported accessory devices are reprocessed, they should be cleaned using retro-flushing in an automated narrow lumen cleaner.

Automation↗
PubMed1996

Synergistic benefits of combined technologies in complex, minimally invasive surgical procedures. Clinical experience and educational processes.

The new burden surgical technology must assume demands not only improved efficiency and reduced risk, but also diminished cost and resource utilization. To this end, we have instituted the use of multiple, sequential technologies in complex, minimally invasive procedures: laparoscopic gastric surgery (44 cases), spine procedures (38 cases), and colectomies (96 cases). The technologies include head-mounted display, 3-D optics, robotic arm, harmonic scalpel, and optical access trocars. The combined use of these technologies shortened operative times, diminished use of personnel, and as associated with no technical mishap. Surgeon concentration and control of the operative environment were increased. In an effort to promote combined use of technologies, a structured teaching process was designed and implemented. It required five (average) experiences for efficient, hands-on implementation of combined technologies. We conclude that combined use of sophisticated technologies is safe and efficient; is accomplished by structured, moderately intense educational experience; and diminishes cost and use of human resources.

Clinical Competence↗
PubMed2002

[Minimally invasive surgical procedures of the breast: comparison of different biopsy systems in a breast parenchymal model].

PURPOSE: The purpose of our study was to evaluate various systems for large core biopsy. First to determine the volume of specimen that can be removed with each minimal-invasive method and second to compare their consistency. With respect to the optimum of volume which can be acquired the 12-G system should be optimized by special modifications. METHODS: Examinations were performed on a phantom. We used 8 automatic, one sequential-automatic and 4 halfautomatic highspeed core biopsy systems of 16-, 14- and 12 G as well as the 11G vacuum biopsy. The weight and consistency of the specimen was determined in every case. The 12G system was optimized by enlargement of the biopsy chamber. RESULTS: The 11G vacuum biopsy exhibited best results concerning the weight of the specimen (93.7 +/- 13.5 mg). The results achieved with high speed core biopsy varied with the needle diameter as well as with the technique. Semi- and halfautomatic systems were superior to automatic systems. Best results among highspeed core biopsy systems were achieved with the modified 12G biopsy needle (41.3 +/- 4.4 mg). CONCLUSION: As expected, largest volume of specimen can be removed with vacuum biopsy. High speed core biopsy systems are inferior to vacuum biopsy. Nevertheless, the amount of volume achieved can be increased to 22.4 mg by using 14G needles and to 41.3 mg by using 12G needles. The modified 12-G needle may be considered as an less expensive alternative to 11G vacuum biopsy.

Biopsy↗
PubMed2003

[Minimally invasive surgical procedures in the treatment of destructive pancreatitis].

Results of treatment of 83 patients with destructive pancreonecrosis were analyzed. Miniinvasive method of transcutaneous introduction of a drain under ultrasonographic control was applied in 16 patients. The method is relatively simple, of a small traumaticity, permits to sanate and to drain purulent cavity quickly. Usage of miniinvasive technologies with low risk for the patient's life and minimal economic expense had permitted to reduce the treatment duration and the frequency of the complications occurrence.

Humans↗
PubMed1997

A technique for measuring contact force distribution in minimally invasive surgical procedures.

This paper investigates new methods for measuring forces and tactile sense as a contribution towards relaying the sense of touch to the surgeon. The approach used is to determine a distribution of contact force using a small number of sensory outputs to detect the bending of a surface of known behaviour. Software algorithms have been produced to interpret the contacting force from sensory data, and have achieved a bandwidth of 30 Hz and an accuracy of 2 per cent. The sensor construction is of sufficiently low cost to produce a disposable unit and uses materials that are compatible with the invasive working environment.

Algorithms↗
PubMed2006

[Comparative assessment of short-term outcomes of cholecystectomy in minimally-invasive surgical procedures for chronic calculous cholecystitis].

A randomized blind trial was carried out for comparative evaluation of short-term results of surgical treatment of chronic calculous cholecystitis in 100 patients after laparoscopic cholecystectomy and in 100 patients after minimally-invasive cholecystectomy. Both groups contained geterogenous patients (morphology in gall bladder zone, concomitant diseases). Statistically significant (p=0.000001) decrease of hospital stay was revealed after laparoscopic cholecystectomy. It is necessary to keep exact selection criteria for each type of elective surgery in cholelithiasis.

Adult↗
PubMed2005

Laparoscopic Roux-en-Y feeding jejunostomy: a new minimally invasive surgical procedure for permanent feeding access in children with gastric dysfunction.

Long-term feeding access in children with foregut dysfunction has traditionally been achieved by gastrostomy tube placement with or without fundoplication. Alternatives after failed procedures have included re-do fundoplication, transpyloric gastrojejunal tube placement, loop jejunostomy (open or laparoscopic), and open Roux-en-Y jejunostomy. We describe a new technique, laparoscopic Roux-en-Y feeding jejunostomy (LRFJ), which offers a minimally invasive option in providing long-term enteral access to these children. Five children, ages 10 months to 9 years (mean age, 3.4 years), weighing 8.8 to 15.2 kilograms (mean weight, 12.3 kg), underwent LRFJ. Four children had mental retardation/cerebral palsy. In 3 children, LRFJ was the only intra-abdominal procedure performed. No technical complications related to the procedure were observed. Mean operative time was 98 minutes in the children in which LRFJ was the only procedure performed. Enteral feeds were typically begun by postoperative day (POD) 5. Follow-up has ranged from 12 to 30 months (mean follow-up, 23 months). All 4 survivors remain on full jejunal feedings and are doing well. One child developed stomal stenosis requiring dilatation. In summary, LRFJ can be performed safely in children with gastric dysfunction, may be performed in conjunction with a variety of other laparoscopic procedures, and offers a new option for nutritional access in this challenging pediatric population.

Anastomosis, Roux-en-Y↗
PubMed2006

[Cystic artery anatomy characteristics in minimally invasive surgical procedures].

UNLABELLED: Large patient series undergoing laparoscopic cholecystectomy fail to show anatomic variations which lead to intraoperative bleeding. METHOD: Cadaver material was used and corrosion casting and postmortem arteriography were employed. RESULTS: Three types of cystic artery were devised according to the results. Type 1 normal anatomy. Type 2 more than one artery in Calots triangle and Type 3 no artery in Calots triangle. DISCUSSION: only 40% of the second cystic artery is present in Calots triangle. The short second cystic artery is characteristic and its most often origin is from a segmental branch of the right hepatic artery. When there is no artery in Calots triangle its origin unusual, and the artery is either on the postero-lateral side of the cystic duct or it approaches the gallbladder through hepatic tissue. The specifics of MIS approach make changes in the way we understand the anatomic variations of the cystic artery. The classification is a result of practical experience and anatomical investigations.

Adult↗
PubMedDate not supplied

Minimally invasive treatment of esophageal cancer: laparoscopic staging to robotic esophagectomy.

Minimally invasive surgical (MIS) procedures have become commonplace in modern surgical practice. The term minimally invasive surgery has been and continues to be interchangeably applied to describe laparoscopic, laparoscopic-assisted, thoracoscopic, and telesurgical (robotic) procedures. Minimally invasive surgical procedures for the treatment of benign and malignant disorders of the esophagus are being developed, refined, and clinically applied in parallel with the exponential availability of novel technologies and instrumentation. Herein, we review the progression from laparoscopic/thoracoscopic esophagectomy to telesurgical esophagectomy, presently termed minimally invasive esophagectomy, and describe the telesurgical procedure as well as early the clinical outcome experience.

Esophageal Neoplasms↗