简介：BackgroundHybridcoronaryrevascularization(HCR)isanalternativecoronaryrevascularizationstrategythatcombinesaminimallyinvasive,survivaladvantageoftheleftinternalmammaryartery(LIMA)-leftanteriordescending(LAD)coronaryarterybypasswithless-invasivepercutaneouscoronaryintervention(PCI)tonon-LADcoronarylesionsbyusingdrug-elutingstents.Wereportourexperienceofhybridminimallyinvasiveapproachin15patients.MethodsFromDecember2012toOctober2013,15patientsunderwentrevascularizationoftheleftanteriordescendingarterythroughminimallyinvasivecoronaryarterybypassgrafting(MIDCAB).Allpatientsbyendoscopicassistbeatingheartcoronaryarterybypassgrafting.Sevenpatientswerescheduledforahybridprocedure.Percutaneouscoronaryinterventionofnon-LADwasperformed3to5dayspreoperatively.Demographicdata,perioperativeoutcome,andannualfollow-upwereobtainedfromallthepatients.ResultsIn-hospitalmortalitywas6.67%.Therateofconversiontofullmediansternotomywas13.3%.Ventilationtimewas6.9±5.1h.Bloodlossvolumewas241±67.8mL.ICUstaywas21.3±10.8h.Hospitalpostoperativestaylastedfor7.5±1.3days.PriortoPCIpatientsshowed100%patentLIMA(Tables3and4).Ameanfollow-upwas8.5months.Oneyeargraftpatencyratewas100%(8/8patientsfor254-slicetomography).Twopatientsrequiredreintervention.ConclusionsMinimallyinvasivehybridcoronaryrevascularizationisasafe,feasibleandefficaciousapproachwithgoodresultsandshouldbeperformedinselectedpatientsbysurgeonswithexperienceinminimallyinvasivebypasssurgerypluscollaborationwithcardiologists.elutingstents.

简介：Primaryandmetastaticlivertumorsareanincreasingglobalhealthproblem,withhepatocellularcarcinoma(HCC)nowbeingthethirdleadingcauseofcancer-relatedmortalityworldwide.SystemictreatmentoptionsforHCCremainlimited,withSorafenibastheonlyprospectivelyvalidatedagentshowntoincreaseoverallsurvival.Surgicalresectionand/ortransplantation,locallyablativetherapiesandregionalorlocoregionaltherapieshavefilledthegapinlivertumortreatments,providingimprovedsurvivaloutcomesforbothprimaryandmetastatictumors.Minimallyinvasivelocaltherapieshaveanincreasingroleinthetreatmentofbothprimaryandmetastaticlivertumors.Forpatientswithlowvolumedisease,thesetherapieshavenowbeenestablishedintoconsensuspracticeguidelines.Thisreviewhighlightstechnicalaspectsandoutcomesofcommonlyutilized,minimallyinvasivelocaltherapiesincludinglaparoscopicliverresection(LLR),radiofrequencyablation(RFA),microwaveablation(MWA),high-intensityfocusedultrasound(HIFU),irreversibleelectroporation(IRE),andstereotacticbodyradiationtherapy(SBRT).Inaddition,theroleofcombinationtreatmentstrategiesutilizingtheseminimallyinvasivetechniquesisreviewed.

简介：由美国腹腔镜内镜外科医师协会（SLS）举办的“瓶美多学科峰会Ⅵ-腹腔镜与微创外科”将于2014年2月12～15日在美国夏威夷檀香山举行。会议涉及环太平洋亚太国家普通外科、妇科与泌尿外科腹腔镜和做创外科技术在多学科中诊断与治疗的最新进展。内容涉及最新的和标准的腹腔镜内镜没备，新技术、新概念以及如何提高对患者监护的标准，以及微创外科医师的培训和继续教育等。

简介：BackgroundThroughaministernotomy'J'shapedapproach,leftinternalmammaryartery(LIMA)bypassgraftingtotheleftanteriordescendingartery(LAD)canbeperformedsafelyoff-pump.Toachieveacompleterevascularization,percutaneouscoronaryinterventions(PCI)withdrugelutingstentimplantationtoothercoronaryarterieswasused.Wereportedoutcomesofthetreatmentofmultivesselcoronaryarterydiseasewithminimallyinvasivecoronaryarterybypass(MICAB)andPCI.MethodsBetweenJanuary2009andDec2012,14patients(11males,3females,meanagewas64.8±10.1years.Two-vesseldiseaseaccountfor35.7%(5/14)ofthesepatients,three-vesseldisease64.2%(9/14)(Table1).Allpatientsunderwentaminimallyinvasivecoronaryarterybypassgraftingviamini-sternotomy'J'shapedapproach.SevenpatientswerefollowedbyPCI,7forobtusemarginalcircumflex,5forrightcoronaryartery(RCA).AngiographicassessmentofgraftpatencywasperformedinallpatientsduringthePCIprocedure.Theclinicalfollow-upperiodlastsfrom11-24months.ResultsThein-hospitalmortalitywas0%.Therewasneitherconversiontoafullmediansternotomynorintraoperativecomplications.Ventilationtimewas6.6±4.1h.Bloodlossranged341±78.8mL.ICUstayranged22.3±12.8h.Hospitalpostoperativestaylastedfor6.5±1.6days.PriortoPCIpatientsshowed100%patentleftinternalmammaryartery.Onepatienthadmediastinitis(Tables2-3).Rateoffreedomfromcardiacreinterventionduringthefollow-upperiodwas92.8%(13/14).ConclusionsTheinferiorJ-shapedsternotomyissimple,reproducible,andthesafesttechniqueforperformingminimallyinvasivecoronarybypasssurgery.MICAB+PCIisalsosafe,feasibleandefficacious.

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简介：Objective:Toreportthedevelopmentofatechniqueforminimallyinvasivethyroidlobectomy.Method:Theprocedurewasacceptedby200patientswithanoduleofthelobeofthethyroid.Weperformedhemithyroidectomysthrougha2-4cmlow-collarhorizontalskinincisionbyconventionalinstrumentation.Results:Therecurrentlaryngealnerveandtheparathyroidglandswereeasilyidentifiedandpreserved.Theamountofbleedingrangedfrom5to50ml(mean15ml).MeanOperationtimewas52.2minutes(ranged32to80minutes).Nocomplicationoccurred.Meanpostoperativestaywas5.5days(ranged4to7days).Theincisionprovidedexcellentcometicresultsbecausethesmallandlowerincisionswerecompletelyhiddenbyclothingcollar.Conclusion:Theabovetechniqueisfeasible,safe,minimallyinvasive,lesstimeandcostconsumingandcosmetical.

简介：AbstractBackground:Piriformis syndrome accounts for approximately 6% of patients who present with sciatic pain. There are many treatment options ranging from physical therapy, to trigger point injections, to surgical intervention. We discuss a surgical method that represents a minimally invasive technique for the treatment of piriformis syndrome.Methods:We describe a novel operative approach and technique for release of the piriformis muscle in the treatment of piriformis syndrome. Described are the preoperative planning, incision and approach, and technique for identifying and releasing the piriformis muscle.Results:Three patients were treated for piriformis syndrome using the described technique. Each patient displayed successful relief of their symptoms immediately following the surgical procedure and at delayed follow-up.Conclusion:Early experience with our method of piriformis release suggests that it is well suited for the treatment of piriformis syndrome. The novel integration of pre-operative trigger point localization coupled with intraoperative neuromonitoring allows effective pain relief with minimal morbidity.

简介：AbstractBackground:Minimally invasive pancreatic surgery (MIPS) has developed over the last 3 decades and is nowadays experiencing an increased interest from the surgical community. With increasing awareness of both the public and the surgical community on patient safety, optimization of training has gained importance. For implementation of MIPS we propose 3 training phases. The first phase focuses on developing basic skills and procedure specific skills with the help of simulation, biotissue drills, video libraries, live case observations, and training courses. The second phase consists of index procedures, fellowships, and proctoring programs to ensure patient safety during the first procedures. During the third phase the surgeons aim is to safely implement the procedure into standard practice while minimizing learning curve related excess morbidity and mortality. Case selection, skills assessment, feedback, and mentoring are important methods to optimize this phase. The residual learning curve can reach up to 100 cases depending on the surgeons’ previous experience, selection of cases, and definition of the parameters used to assess the learning curve. Adequate training and high procedural volume are key to implementing MIPS safely.

简介：BackgroundThoracoscopicminimallyinvasivepectusexcavatumrepair(Nussoperation)featuresitslittletrauma,simple,shortoperationtime,andgoodoutcomecomparedwithtraditionaltreatmentofpectusexcavatumsurgery-sternalelevation(Ravitchoperation)andsternalturnover.Theeffectoftheoperationonpatients’heartandheartfunctionremainsunclear.ThisstudyaimedtounderstandthechangesofelectrocardiogramandcardiacfunctionafterNussprocedure.MethodsFrom2008Januaryto2013July,thoracoscopicNussoperationwasperformedin217patientswithpectusexcavatum.Allthepatientsunderwentthepreoperative,postoperativedetectionofECGandcardiacfunctionin3monthsto1yearafteroperation.ResultsAfter3monthsto1yearfollow-up,arrhythmiaspersistedin46outof135patientswithpreoperativesymptoms(P<0.05);Strokevolumeandcardiacoutputsignificantlyincreased(P<0.05);Andcardiacparametersgreatlyimproved(P<0.05).ConclusionsMinimallyinvasiverepairofpectusexcavatumdeformitycancorrectthechestmalformation,alleviatearrhythmia,andimprovecardiacfunction.

简介：Objective:Tointroducetheexperienceoftreatingfractureofbothtibiaandfibulawithmicro-invasivepercutaneousplateinternalfixationthroughfracturesiteapproach.Methods:Thedataof15patients(11malesand4females),including14adults(aged22-73years,mean=40years)and1child(aged10years),withfractureofbothtibiaandfibulawerestudiedretrospectivelyinthisstudy.Asmallincisionwasmadeatthefracturesiteoftibia.Thenrepositionwasmadeunderdirectvision,andinternalfixationwasemployedwithsteelplatesinsertingthroughthesmallincision.Results:Anatomicalreductionwasobtained.Nocomplicationwasfound.Unionoccurredontimein14patients.Onecasehealedafterasecondoperation.Conclusions:Micro-invasivepercutaneousplateinternalfixationisbeneficialtothehealingofboneandsofttissues.WithoutX-rayexamination,itisalsoeasytoreachanatomicalreductionandmaketibialinternalfixationwithbothplateswithmicro-invasivepercutaneousplateinternalfixation.

简介：由美国腹腔镜内镜外科医师协会(SLS)举办的'亚美多学科峰会Ⅷ-腹腔镜与微创外科'将于2016年2月17~20日在美国夏威夷檀香山举行。会议涉及环太平洋亚太国家普通外科、妇科与泌尿外科腹腔镜和微创外科技术在多学科中诊断与治疗的最新进展。内容涉及最新的和标准的腹腔镜内镜设备,新技术、新概念,如何提高对患者监护的标准,以及微创外科医师的培训和继续教育等。详情可登录SLS官方网站

简介：Themanagementofcastrate-resistantprostatecancerprogressingaftermaximumandrogenblockade(MAB)hasevolvedinthelastdecadewiththedevelopmentofseveralnoveltherapeuticoptions.However,theinitialtherapeuticstrategyinthesepatientsusuallyinvolveswithdrawalofanti-androgenthatcanbeassociatedwithbiochemicalresponseinapproximately20%ofpatients.Notably,wehaveobservedevidenceofsustainedbiochemicalresponseintwopatientsfollowingsecondandthird-lineMABusingrechallengescheduleofpreviouslyadministeredanti-androgenafterlatentinterval.ThepossibilityofresponsefollowingsequentialMABusingthesameanti-androgenagenthasnotyetbeenreported.

简介：AbstractPurpose:Treatment of distal tibia fractures poses significant challenge to orthopedic surgeon because of poor blood supply and paucity of soft tissue coverage. There is considerable controversy regarding the superior option of treatment for distal tibia fracture between the minimally invasive percutaneous plate osteosynthesis (MIPPO) technique and intramedullary interlocking (IMIL) nailing for extra-articular distal tibia fractures. The aim of our study is to compare the functional outcome between the two treatment methods.Methods:This was the prospective comparative study of 100 patients with distal third tibia fractures divided into two groups. The first group of patients were treated with MIPPO technique while the second group of patients were managed by IMIL nailing. Patients were followed up in outpatient department to assess the functional outcomes, malunion, delayed union, nonunion, superficial and deep infection between the two groups. Statistical analyses were performed using the SPSS software (version 16.0).Results:Average malunion (degrees) in the MIPPO group was 5 (3—7) ± 1.41 vs. 10.22 (8—14) ± 2.04 in the IMIL group (p= 0.001). Similarly postoperative knee pain in the IMIL group was 10% vs. 2% in the MIPPO group (p= 0.001). In terms of superficial infection and nonunion, the results were 8% vs. 4% and 2% vs. 6% for the MIPPO and IMIL group, respectively (p= 0.001).Conclusion:Both procedures have shown the reliable method of fixation for distal extra-articular tibia fractures preserving the soft tissue, bony vascularity and fracture hematoma that provide a favourable biological environment for fracture healing. Considering the results of the study, we have slightly more preference for the MIPPO technique.

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