Background: Implementing invasive procedures is an important part of patient management by clinical nurses;however, there are gaps between nurses’ actual knowledge and skills and expected professional care capacity. ...Background: Implementing invasive procedures is an important part of patient management by clinical nurses;however, there are gaps between nurses’ actual knowledge and skills and expected professional care capacity. Purpose: This scoping review aimed to map the existing literature related to recent institution-provided educational programs for invasive procedures involving clinical nurses. This study seeks to understand the contents of educational programs and the methods for assessing educational effects. Methods: This scoping review was completed using the following four databases: PubMed (MEDLINE), Embase, Cochrane Library, and Emcare for the period 2000-2022. We included studies that used all forms of educational approaches (e.g., didactic lectures, hands-on training, or on-the-job training). This scoping review considered peer-reviewed publications published in English using quantitative, qualitative, or mixed approaches. A total of 83 studies underwent in the final analysis. Results and Conclusion: A combination of didactic lectures and hands-on training was provided as an educational program in most studies. Contrary to our prediction, educational interventions with advanced technologies such as VR are extremely rare, suggesting that the effectiveness of advanced technologies in learning invasive procedures should be examined to facilitate and retain educational effects more efficiently in future studies. Regarding the assessment of educational effects, nurses’ cognitive (i.e., theoretical knowledge about procedures), psychomotor (i.e., implementing procedures), and psychological aspects (e.g., confidence and self-efficacy in procedures) were evaluated using questionnaires and observational methods. While most studies used a one-group pretest-posttest design, the ratio of randomized controlled trials (RCT) was relatively low. Thus, an RCT design should be introduced in future studies to test the validity of the developed educational program more accurately.展开更多
Background: Prenatal diagnosis is the process of evaluating the presence of disease or potential disease in the fetus, this enables families to be better prepared before the birth of the baby. There are non-invasive p...Background: Prenatal diagnosis is the process of evaluating the presence of disease or potential disease in the fetus, this enables families to be better prepared before the birth of the baby. There are non-invasive prenatal diagnosis procedures and invasive prenatal diagnosis procedures. The invasive prenatal diagnosis procedures are CVS (chorionic villus sampling) and amniocentesis. The American College of Obstetricians and Gynecologists states that invasive diagnostic testing should be available to all women, regardless of age or risk. Objective: To determine the indications, outcome and results of diagnostic invasive prenatal procedures. Study setting: The obstetrics and Gynecology Department in Salmaniya Medical Complex in Kingdom of Bahrain. Study design: Retrospective descriptive study. Study subjects and Methods: This retrospective descriptive study was conducted on 175 pregnant women who underwent invasive prenatal procedures (CVS and amniocentesis) between January 2013 and December 2018 at SMC in Kingdom of Bahrain. All medical records of the participants were reviewed and entered the study. According to the implemented procedures, medical records were categorized into two chorionic villus sampling (CVS) and amniocentesis groups. The study subject will include indications of the procedures which are advanced maternal age, hematological disorders, genetic disorders, metabolic disorders, abnormal structural findings in fetal ultrasound and previous child with aneuploidy. In addition, the study will address the complications, outcome and results of procedures. Results: About half of our indications of the procedures were due to hematological disorders (47.6%) followed by abnormal structural findings in fetal ultrasound (30.1%) then genetic disorders (15.7%), metabolic disorders (4.8%) and advanced maternal age (1.8%). Regarding complications of the procedure;threatened miscarriage or loss of pregnancy within 3 weeks was (2.3%), amniotic fluid leakage (0.7%), abdominal cramps (0.7%) and Insufficient or contaminated sample (6.2%). Regarding outcome of the pregnancy, our results showed that the loss of pregnancy was (4.8%), intrauterine fetal death or still birth was (13.9%), live birth was (63.9%), preterm delivery was (7.8%), preterm premature rupture of membrane (PPROM) was (1.8%), limbs reduction was (0.0%). Termination of pregnancy outside the country was (7.8%) of chorionic villus sampling and amniocentesis. Conclusion: CVS and amniocentesis are useful outpatient procedures to detect diagnosis or to assess whether a patient is at increased risk of having an affected fetus and that will minimize the psychological impact on the patient and to provide a proper antenatal care to the pregnant women by her obstetrician and follow up to the baby by pediatrician. In this study it was observed that most of the patients who underwent the procedure were couples either carrier or affected to sickle cell disease or Beta thalassemia.展开更多
BACKGROUND Chronic liver disease(CLD)related thrombocytopenia increases the risk of bleeding and poor prognosis.Many liver disease patients require invasive procedures or surgeries,such as liver biopsy or endoscopic v...BACKGROUND Chronic liver disease(CLD)related thrombocytopenia increases the risk of bleeding and poor prognosis.Many liver disease patients require invasive procedures or surgeries,such as liver biopsy or endoscopic variceal ligation,and most of them have lower platelet counts,which could aggravate the risk of bleeding due to liver dysfunction and coagulation disorders.Unfortunately,there is no defined treatment modality for CLD-induced thrombocytopenia.Recombinant human thrombopoietin(rhTPO)is commonly used to treat primary immune thrombocytopenic purpura and thrombocytopenia caused by solid tumor chemotherapy;however,there are few reports on the use of rhTPO in the treatment of CLD-related thrombocytopenia.AIM To evaluate the efficacy of rhTPO in the treatment of patients with CLDassociated thrombocytopenia undergoing invasive procedures.METHODS All analyses were based on the retrospective collection of clinical data of patients with CLD who were treated in the Department of Infectious Diseases at The First Affiliated Hospital of Soochow University between June 2020 and December 2021.Fifty-nine male and 41 female patients with liver disease were enrolled in this study to assess the changes in platelet counts and parameters before and after the use of rhTPO for thrombocytopenia.Adverse events related to treatment,such as bleeding,thrombosis,and disseminated intravascular coagulation,were also investigated.RESULTS Among the enrolled patients,78(78%)showed a platelet count increase after rhTPO use,while 22(22%)showed no significant change in platelet count.The mean platelet count after rhTPO treatment in all patients was 101.53±81.81×10^(9)/L,which was significantly improved compared to that at baseline(42.88±16.72×10^(9)/L),and this difference was statistically significant(P<0.001).In addition,patients were further divided into three subgroups according to their baseline platelet counts(<30×10^(9)/L,30-50×10^(9)/L,>50×10^(9)/L).Subgroup analyses showed that the median platelet counts after treatment were significantly higher(P<0.001,all).Ninety(90%)patients did not require platelet transfusion partially due to an increase in platelet count after treatment with rhTPO.No serious adverse events related to rhTPO treatment were observed.Overall,rhTPO demonstrated good clinical efficacy for treating CLD-associated thrombocytopenia.CONCLUSION rhTPO can improve platelet count,reduce the risk of bleeding,and decrease the platelet transfusion rate,which may promote the safety of invasive procedures and improve overall survival of patients with CLD.展开更多
Objective:This study aimed to describe the implementation of the surgical safety check policy and the surgical safety checklist for invasive procedures outside the operating room(OR)and evaluate its effectiveness.Meth...Objective:This study aimed to describe the implementation of the surgical safety check policy and the surgical safety checklist for invasive procedures outside the operating room(OR)and evaluate its effectiveness.Methods:In 2017,to improve the safety of patients who underwent invasive procedures outside of the OR,the hospital quality and safety committee established the surgery safety check committee responsible for developing a new working plan,revise the surgery safety check policy,surgery safety check Keywords:Invasive procedures outside the operating room Safety management Surgical safety checklist Patient safety form,and provide training to the related staff,evaluated their competency,and implemented the updated surgical safety check policy and checklist.The study compared the data of pre-implementation(Apr to Sep 2017)and two post-implementation phases(Apr to Sep 2018,Apr to Sep 2019).It also evaluated the number of completed surgery safety checklist,correct signature,and correct timing of signature.Results:The results showed an increase in the completion rate of the safety checklist after the program implementation from 41.7%(521/1,249)to 90.4%(3,572/3,950),the correct rates of signature from 41.9%(218/521)to 99.0%(4,423/4,465),and the correct timing rates of signature from 34.4%(179/521)to 98.5%(4,401/4,465),with statistical significance(P<0.01).Conclusion:Implementing the updated surgery safety check significantly is a necessary and effective measure to ensure patient safety for those who underwent invasive procedures outside the OR.Implementing surgical safety checks roused up the clinical staff's compliance in performing safety checks,and enhanced team collaboration and communication.展开更多
Liver cancer is known as the“silent killer”because it often lurks within the body undetected until it has progressed to an advanced stage.In China,both the incidence and mortality remain consistently high.The most c...Liver cancer is known as the“silent killer”because it often lurks within the body undetected until it has progressed to an advanced stage.In China,both the incidence and mortality remain consistently high.The most common type of liver cancer is hepatocellular carcinoma(HCC),which accounts for approximately 75%–85%of all cases.It is closely associated with hepatitis B,hepatitis C,long-term heavy drinking,fatty liver disease,and foods contaminated with aflatoxin.展开更多
Obesity is a major global health issue,contributing to numerous comorbidities such as type 2 diabetes mellitus,hypertension,and cardiovascular diseases.While bariatric surgery remains the gold standard for treating se...Obesity is a major global health issue,contributing to numerous comorbidities such as type 2 diabetes mellitus,hypertension,and cardiovascular diseases.While bariatric surgery remains the gold standard for treating severe obesity,its invasive nature has led to the development of minimally invasive alternatives.Endoscopic sleeve gastroplasty(ESG)is a promising,minimally invasive procedure for weight loss,offering significant weight reduction without the need for surgical incisions.This editorial evaluates the efficacy and safety of ESG,highlighting its weight loss outcomes,safety profile,and comparison with other bariatric procedures,including intragastric balloon,laparoscopic sleeve gastrectomy,and robotic sleeve gastrectomy.ESG has shown substantial weight loss with a mean total weight loss ranging from 15.03%to 17.51%at 12 months and sustained weight reduction over 36 months.The safety profile is favorable,with low rates of serious adverse events and minimal complications compared to surgical alternatives.ESG is particularly suited for patients with mild to moderate obesity or those not eligible for surgical options.However,further long-term studies and standardized protocols are needed to refine patient selection and optimize treatment outcomes.展开更多
BACKGROUND Colorectal cancer is the third most common cancer and the second highest cause of cancer-related mortality worldwide.About 5%-10%of patients are diagnosed with locally advanced rectal cancer(LARC)on present...BACKGROUND Colorectal cancer is the third most common cancer and the second highest cause of cancer-related mortality worldwide.About 5%-10%of patients are diagnosed with locally advanced rectal cancer(LARC)on presentation.For LARC invading into other structures(i.e.T4b),multivisceral resection(MVR)and/or pelvic ex-enteration(PE)remains the only potential curative surgical treatment.MVR and/or PE is a major and complex surgery with high post-operative morbidity.Minimally invasive surgery(MIS)has been shown to improve short-term post-operative outcomes in other gastrointestinal malignancies,but there is little evi-dence on its use in MVR,especially so for robotic MVR.This is a single-center retrospective cohort study from 1st January 2015 to 31st March 2023.Inclusion criteria were patients diagnosed with cT4b rectal cancer and underwent MVR,or stage 4 disease with resectable systemic metastases.Pa-tients who underwent curative MVR for locally recurrent rectal cancer,or me-tachronous rectal cancer were also included.Exclusion criteria were patients with systemic metastases with non-resectable disease.All patients planned for elective surgery were enrolled into the standard enhanced recovery after surgery pathway with standard peri-operative management for colorectal surgery.Complex sur-gery was defined based on technical difficulty of surgery(i.e.total PE,bladder-sparing prostatectomy,pelvic lymph node dissection or need for flap creation).Our primary outcomes were the margin status,and complication rates.Cate-gorical values were described as percentages and analysed by the chi-square test.Continuous variables were expressed as median(range)and analysed by Mann-Whitney U test.Cumulative overall survival(OS)and recurrence-free survival(RFS)were analysed using Kaplan-Meier estimates with life table analysis.Log-rank test was performed to determine statistical significance between cumulative estimates.Statistical significance was defined as P<0.05.Meier estimates with life table analysis.Log-rank test was performed to determine statistical significance between cumulative estimates.Statistical significance was defined as P<0.05.RESULTS A total of 46 patients were included in this study[open MVR(oMVR):12(26.1%),miMVR:36(73.9%)].Patients’American Society of Anesthesiologists score,body mass index and co-morbidities were comparable between oMVR and miMVR.There is an increasing trend towards robotic MVR from 2015 to 2023.MiMVR was associated with lower estimated blood loss(EBL)(median 450 vs 1200 mL,P=0.008),major morbidity(14.7%vs 50.0%,P=0.014),post-operative intra-abdominal collections(11.8%vs 50.0%,P=0.006),post-operative ileus(32.4%vs 66.7%,P=0.04)and surgical site infection(11.8%vs 50.0%,P=0.006)compared with oMVR.Length of stay was also shorter for miMVR compared with oMVR(median 10 vs 30 d,P=0.001).Oncological outcomes-R0 resection,recurrence,OS and RFS were comparable between miMVR and oMVR.There was no 30-d mortality.More patients underwent robotic compared with laparoscopic MVR for complex cases(robotic 57.1%vs laparoscopic 7.7%,P=0.004).The operating time was longer for robotic compared with laparoscopic MVR[robotic:602(400-900)min,laparoscopic:Median 455(275-675)min,P<0.001].Incidence of R0 resection was similar(laparoscopic:84.6%vs robotic:76.2%,P=0.555).Overall complication rates,major morbidity rates and 30-d readmission rates were similar between la-paroscopic and robotic MVR.Interestingly,3-year OS(robotic 83.1%vs 58.6%,P=0.008)and RFS(robotic 72.9%vs 34.3%,P=0.002)was superior for robotic compared with laparoscopic MVR.CONCLUSION MiMVR had lower post-operative complications compared to oMVR.Robotic MVR was also safe,with acceptable post-operative complication rates.Prospective studies should be conducted to compare short-term and long-term outcomes between robotic vs laparoscopic MVR.展开更多
1.Introduction Due to the continuous progress in surgical methodologies and the swift evolution of surgical tools,minimally invasive procedures have emerged as the dominant approach in urologic oncology surgeries.Nota...1.Introduction Due to the continuous progress in surgical methodologies and the swift evolution of surgical tools,minimally invasive procedures have emerged as the dominant approach in urologic oncology surgeries.Notably,robot-assisted surgery(RAS)has led to its extensive adoption in the surgical management of urinary system tumors due to its enhanced maneuverability,precision in suturing,and anastomotic capabilities.展开更多
Surgeons have grappled with the treatment of recurrent and T4b locally advanced rectal cancer(LARC)for many years.Their main objectives are to increase the overall survival and quality of life of the patients and to m...Surgeons have grappled with the treatment of recurrent and T4b locally advanced rectal cancer(LARC)for many years.Their main objectives are to increase the overall survival and quality of life of the patients and to mitigate postoperative complications.Currently,pelvic exenteration(PE)with or without neoadjuvant treatment is a curative treatment when negative resection margins are achieved.The traditional open approach has been favored by many surgeons.However,the technological advancements in minimally invasive surgery have radically changed the surgical options.Recent studies have demonstrated promising results in postoperative complications and oncological outcomes after robotic or laparoscopic PE.A recent retrospective study entitled“Feasibility and safety of minimally invasive multivisceral resection for T4b rectal cancer:A 9-year review”was published in the World Journal of Gastrointestinal Surgery.As we read this article with great interest,we decided to delve into the latest data regarding the benefits and risks of minimally invasive PE for LARC.Currently,the small number of suitable patients,limited surgeon experience,and steep learning curve are hindering the establishment of minimally invasive PE.展开更多
Rectal cancer is a malignant neoplasm that constitutes a significant public health challenge due to its high incidence and associated mortality.In this editorial,we comment on the article by Chan et al.In recent years...Rectal cancer is a malignant neoplasm that constitutes a significant public health challenge due to its high incidence and associated mortality.In this editorial,we comment on the article by Chan et al.In recent years,there has been progress in the development of new treatments for initial and metastatic rectal cancer due to introduction of techniques of innovative and minimally-invasive surgery(MIS)such as laparoscopy and robotic surgery.However,only a few studies have ana-lyzed the feasibility,safety,and results of MIS in relation to open surgery,thereby highlighting the promising and superior results of MIS in functional and oncolo-gical terms.The findings were corroborated by the comparative study of Chan et al which evaluated the feasibility and safety of minimally invasive multivisceral resection(miMVR).A comparison of postoperative outcomes between open MVR and miMVR showed that miMVR presented less blood loss,fewer postoperative complications,and less morbidity.This editorial article is focused specifically on analysis of the characteristics of new minimally-invasive surgical techniques in rectal cancer,particularly in advanced stages.The importance of future research is emphasized by progress in knowledge,training,and clinical practice in the appli-cation of these surgical procedures for the treatment of advanced colorectal cancer.展开更多
Introduction: Treatments for cardiovascular diseases have increasingly evolved with the tendency to offer minimally invasive or transcatheter procedures instead of conventional sternotomy surgery. In this context, we ...Introduction: Treatments for cardiovascular diseases have increasingly evolved with the tendency to offer minimally invasive or transcatheter procedures instead of conventional sternotomy surgery. In this context, we highlight minimally invasive mitral valve surgery (MIMVS), which has been shown to be an increasingly solid option with some superior results when compared to the conventional technique: better pain control, shorter hospital stays, shorter recovery time, shorter readmission rate in the first postoperative year, better aesthetic results, and lower overall cost. Aim: This study aims to evaluate the stages of MIMVS, by primary mitral valve consultation, in our service and compare these results with data from the literature. Methods: All electronic medical records of patients who underwent MIMVS for primary mitral valve injury in the Encore Hospital from January 2020 to February 2023 were analyzed. Tabulation and statistical analysis were performed using the Microsoft Excel<sup>®</sup> program. Quantitative variables were presented as means, standard deviations. Results: 46 patients were enrolled in our study (Age: 59.1 ± 12.4 years old;60.8% Female, BMI: 26 ± 4.4 Kg/m<sup>2</sup>, Low risk STS score: 82.6%). The observed 30-day mortality was 2.1%, plastic rate of 23.9%, blood transfusion rate of 41.3%, length of stay in an intensive care bed (ICB) of 3.3 ± 3.3 days and hospital stay of 6.4 ± 5.1 days. Conclusions: We noticed that the MIMVS results carried out in our service agree with data from national and international literature with approximately 1.3 days more hospitalization in ICB.展开更多
BACKGROUND Comminuted calcaneal fractures present significant treatment challenges.Open reduction and internal fixation carries risks such as infection and skin necrosis,while minimally invasive techniques may comprom...BACKGROUND Comminuted calcaneal fractures present significant treatment challenges.Open reduction and internal fixation carries risks such as infection and skin necrosis,while minimally invasive techniques may compromise reduction stability.Conservative management is generally limited to minimally displaced fractures.Traditional Chinese manual bone-setting has a long history in fracture treatment and is renowned globally for achieving functional reduction.It offers distinct advantages including lower cost,minimal soft tissue trauma,and the avoidance of expensive reduction equipment or internal fixation materials.CASE SUMMARY A 60-year-old female presented with left foot pain and limited mobility following a fall.Computed tomography scan revealed a Sanders type IV calcaneal fracture with a Böhler angle of 0°.A standardized,stepwise Traditional Chinese manual bone-setting was initially performed,followed by percutaneous screw fixation through several mini-incisions after satisfactory alignment was confirmed under fluoroscopy.The Visual Analog Scale score decreased from 5 on postoperative day 1 to 3 by day 3.The American Orthopaedic Foot and Ankle Society score improved from 73 at 6 weeks to 90 at 3 months,indicating rapid functional recovery and high patient satisfaction.At 7 months postoperatively,the American Orthopaedic Foot and Ankle Society score reached 95,prompting removal of internal fixation.At the 6-year follow-up,reduction remained well maintained,with the Böhler angle preserved at 22°.CONCLUSION The combination of Traditional Chinese manual bone-setting and percutaneous screw fixation achieved satisfactory functional reduction for comminuted calcaneal fractures.展开更多
BACKGROUND Minimally invasive lumbar interbody fusion(LIF)procedures have evolved rapidly in recent years,with robot-assisted(RA)techniques increasingly integrated into clinical practice.However,questions remain regar...BACKGROUND Minimally invasive lumbar interbody fusion(LIF)procedures have evolved rapidly in recent years,with robot-assisted(RA)techniques increasingly integrated into clinical practice.However,questions remain regarding the relative advantages of RA over traditional fluoroscopy-guided and navigation-assisted methods in terms of perioperative,radiographic,and clinical outcomes.This systematic review synthesizes current evidence on these comparisons,focusing on the accuracy of screw placement,perioperative efficiency,radiographic and clinical outcomes,and complications.AIM To investigate the comparative effectiveness of RA vs conventional LIF techniques.METHODS A systematic review and meta-analysis was conducted in accordance with PRISMA 2020 and Cochrane guidelines.Databases searched included PubMed,EMBASE,Web of Science,Scopus,and the Cochrane Library(through May 2025).Eligible studies were randomized controlled trials and observational studies comparing RA with fluoroscopy-or navigation-guided LIF(transforaminal lumbar interbody fusion,lateral lumbar interbody fusion,oblique lumbar interbody fusion)in adults.Two reviewers independently extracted data and assessed risk of bias.The Grading of Recommendations Assessment,Development and Evaluation framework was used to evaluate certainty of evidence.Meta-analyses were performed where data were sufficiently homogeneous.RESULTS Twenty-two studies were included,encompassing a total of 2313 patients-1046 who underwent RA-guided procedures and 1267 who received comparator techniques.Meta-analyses showed that RA significantly improved perfect pedicle screw placement[pooled odds ratio=2.93;95%confidence interval(CI):1.40-6.14;I2=78.2%]and reduced intraoperative blood loss(pooled standardized mean difference=-0.28;95%CI:-0.47 to-0.08;I2=0%).Operative time did not significantly differ between groups(pooled standardized mean difference=0.01;95%CI:-0.30 to 0.31;I2=66%).Radiation dose could not be synthesized quantitatively due to heterogeneous definitions and measurement units.Narratively,RA demonstrated consistent advantages in reducing surgical exposure and adjacent segment degeneration.Clinical and radiographic outcomes,fusion success,and complication rates were generally comparable across groups.CONCLUSION RA LIF improves pedicle screw placement accuracy and reduces blood loss and surgeon radiation exposure while maintaining similar clinical outcomes and safety profiles to conventional techniques.These findings support the integration of RA into spine surgery but highlight the need for high-quality multicenter randomized controlled trials and cost-effectiveness studies to guide broader implementation.展开更多
Esophageal gastrointestinal stromal tumors(GISTs)are exceedingly rare,often detected incidentally due to their asymptomatic nature.Historically,esophagec-tomy or enucleation has been the standard treatment,but these p...Esophageal gastrointestinal stromal tumors(GISTs)are exceedingly rare,often detected incidentally due to their asymptomatic nature.Historically,esophagec-tomy or enucleation has been the standard treatment,but these procedures carry significant morbidity.The retrospective study by Xu et al provides compelling evidence that endoscopic resection(ER)is a viable,minimally invasive alternative for low-risk esophageal GISTs,demonstrating a high en bloc resection rate(96.9%)and favorable long-term oncologic outcomes,including a 5-year overall survival rate of 100%and disease-free survival of 90.6%.These results challenge the con-ventional surgical paradigm and highlight the need for a paradigm shift towards endoscopic approaches in carefully selected patients.However,several critical questions remain unanswered:What are the precise selection criteria for ER candidacy?How does ER compare to traditional surgical methods in terms of recurrence risk and long-term functional outcomes?Could neoadjuvant therapy enhance the feasibility of ER for larger lesions?As endoscopic techniques continue to evolve,interdisciplinary collaboration among gastroenterologists,oncologists,and surgeons will be crucial to refining treatment algorithms and optimizing patient outcomes.Future prospective studies and randomized trials are warranted to solidify the role of ER as the standard of care for esophageal GISTs.展开更多
BACKGROUND The spectrum of gastric submucosal tumors(SMTs)in the upper gastrointestinal system ranges from non-neoplastic to malignant lesions,with gastrointestinal stromal tumors exhibiting inherent malignant potenti...BACKGROUND The spectrum of gastric submucosal tumors(SMTs)in the upper gastrointestinal system ranges from non-neoplastic to malignant lesions,with gastrointestinal stromal tumors exhibiting inherent malignant potential.However,the diagnosis of SMTs remains challenging,and treatment methods,especially for tumors located at the cardia or esophagogastric junction(EGJ),are not well established.Minimally invasive techniques-such as endoscopic submucosal dissection(ESD),submucosal tunneling endoscopic resection(STER),and laparoscopic wedge resection(LWR)-have been developed for these lesions.However,comparative data on their feasibility,safety,and clinical outcomes in these locations remain limited.AIM To compare ESD,STER,and LWR for SMTs at the EGJ or cardia,focusing on procedural feasibility.METHODS This single-center retrospective study included patients with SMTs less than 45 mm from the muscularis propria,growing intraluminally at the EGJ or cardia,and treated with ESD,STER,or LWR between July 2014 and September 2022.The primary outcome was relapse-free survival during follow-up.RESULTS The median age(interquartile range)was 53.0(40.0-57.5),43.0(39.0-57.0),and 56.0(43.0-64.0)years for ESD,STER,and LWR,respectively.The median follow-up time(interquartile range)was 60.0(26.5-66.5),24.0(13.0-38.0),and 35.0(21.0-60.0)months.LWR had the largest tumors(30.0 mm)and the highest rate of high-risk gastrointestinal stromal tumors(68.0%,P<0.001).Tumor recurrence occurred in one LWR patient(4.0%,P=0.600).En bloc and macroscopic resection rates were 100%(P=1.000),but microscopic resection rates differed(P=0.021).Significant minor complications occurred in 5 patients(10.0%),all grade IIIa.Tumor location(cardia/fundus,P=0.006)and prolonged procedure time(P<0.001)were significantly associated with complications.CONCLUSION ESD,STER,and LWR are effective for SMTs at the EGJ and cardia,with minor complications associated with tumor location and procedure time,and comparable recurrence rates.展开更多
Lymphatic-venous anastomosis(LVA)surgery has recently emerged as a potential treatment for Alzheimer’s disease(AD)in China.This minimally invasive microsurgical procedure has been used for decades to treat lymphoedem...Lymphatic-venous anastomosis(LVA)surgery has recently emerged as a potential treatment for Alzheimer’s disease(AD)in China.This minimally invasive microsurgical procedure has been used for decades to treat lymphoedema,typically in the limbs,to decompress blocked lymphatic drainage pathways.展开更多
Objective:Prostate cancer is a common malignancy in men over 50 years old,and radical prostatectomy,particularly via laparoscopic and robotic-assisted techniques,significantly impacts quality of life,especially in ter...Objective:Prostate cancer is a common malignancy in men over 50 years old,and radical prostatectomy,particularly via laparoscopic and robotic-assisted techniques,significantly impacts quality of life,especially in terms of erectile dysfunction.This systematic review and meta-analysis aimed to evaluate the preservation of erectile function following robotic-assisted and laparoscopic radical prostatectomy,with a separate analysis of randomized clinical trials and non-randomized studies.Methods:This review was carried out using randomized and non-randomized studies involving adult patients diagnosed with localized prostate cancer undergoing radical prostatectomy,according to Preferred Reporting Items for Systematic reviews and Meta-Analyses guidelines and registered in PROSPERO.Applicable literature from PubMed,Cochrane,Embase,and the Latin American and Caribbean Health Sciences Literature database was analysed.The bias in randomized clinical trials was assessed using the Cochrane Risk of Bias 2.0 tool,and observational studies were evaluated via the Newcastle-Ottawa Scale.The statistical analysis was performed using Review Manager version 5.4.Results:Our analysis included 13 studies involving 6281 patients.Comparative meta-analysis of non-randomized studies demonstrated that robotic techniques were significantly more effective in preserving erectile function at 3 months(risk difference[RD]0.05,95%confidence interval[CI]0.00-0.11;p=0.040),6 months(RD 0.10,95%CI 0.03-0.17;p=0.006),and 12 months postoperatively(RD 0.06,95%CI 0.02-0.10;p=0.002).Conclusion:Robotic-assisted surgery showed greater preservation of erectile function 3 months,6 months,and 12 months after radical prostatectomy.However,additional studies with meticulous methodological criteria are necessary for future analysis.展开更多
Surgical treatment and ESI （epidural steroid injection） are widely used forms of treatment for cervical radiculopathy but they are controversial and burdensome for patients. To relief pain fast without side effects,...Surgical treatment and ESI （epidural steroid injection） are widely used forms of treatment for cervical radiculopathy but they are controversial and burdensome for patients. To relief pain fast without side effects, we devised a new minimally invasive treatment method that widens the facet joints to decompress nerve roots and release the muscle spasm in cervical radiculopathy with acupuncture needles with blunt tip and mini-scalpel, and named it modified acupuncture procedure. MAP （Modified acupuncture procedure） was administered for 37 patients （mean age = 53.1 years, follow-up = 14.2 months） with cervical radiculopathy who did not recover from 4 weeks of nonsurgical treatment. We analyzed clinical outcomes of patients before and after the procedure through VAS （Visual Analogue Scale） and NDI （Neck Disability Index）. On average, patients received 1.4 MAP （modified acupuncture procedures）. The VAS score difference on the day after procedure and at 1 year follow-up was 36.8 ± 26.5 （from 60.1 ± 25.3 at the baseline to 25.3 ± 17.8 at the reading） （P 〈 0.01） and 31.0 ± 30.4 （29.0 ± 21.8 at the reading） respectively. The NDI value dropped by 19.9 ± 18.3 （from 37.2 ± 19.7 at the baseline to 17.2 ± 15.0 at the reading） （P〈 0.01） on 1 year follow up. MAP was found to have clinical efficacy for cervical radiculopathy.展开更多
Minimally invasive surgery (MIS) for upper gastrointestinal (GI) cancer, characterized by minimal access, has been increasingly performed worldwide. It not only results in better cosmetic outcomes, but also reduces in...Minimally invasive surgery (MIS) for upper gastrointestinal (GI) cancer, characterized by minimal access, has been increasingly performed worldwide. It not only results in better cosmetic outcomes, but also reduces intraoperative blood loss and postoperative pain, leading to faster recovery; however, endoscopically enhanced anatomy and improved hemostasis via positive intracorporeal pressure generated by CO<sub>2</sub> insufflation have not contributed to reduction in early postoperative complications or improvement in long-term outcomes. Since 1995, we have been actively using MIS for operable patients with resectable upper GI cancer and have developed stable and robust methodology in conducting totally laparoscopic gastrectomy for advanced gastric cancer and prone thoracoscopic esophagectomy for esophageal cancer using novel technology including da Vinci Surgical System (DVSS). We have recently demonstrated that use of DVSS might reduce postoperative local complications including pancreatic fistula after gastrectomy and recurrent laryngeal nerve palsy after esophagectomy. In this article, we present the current status and future perspectives on MIS for gastric and esophageal cancer based on our experience and a review of the literature.展开更多
Transurethral resection of the prostate(TURP)became the gold standard surgical treatment for benign prostatic obstruction without undergoing randomized controlled trials against the predecessor standard in open suprap...Transurethral resection of the prostate(TURP)became the gold standard surgical treatment for benign prostatic obstruction without undergoing randomized controlled trials against the predecessor standard in open suprapubic prostatectomy.TURP has historically been associated with significant morbidity and this has fuelled the development of minimally invasive surgical treatment options.Improvements in perioperative morbidity for TURP has been creating an ever increasing standard that must be met by any new technologies that are to be compared to this gold standard.Over recent years,there has been the emergence of novel minimally invasive treatments such as the prostatic urethral lift(PUL;UroLift System),convective WAter Vapor Energy(WAVE;Rezum System),Aquablation(AQUABEAM System),Histotripsy(Vortx Rx System)and temporary implantable nitinol device(TIND).Intraprostatic injections(NX-1207,PRX-302,botulinum toxin A,ethanol)have mostly been used with limited efficacy,but may be suitable for selected patients.This review evaluates these novel minimally invasive surgical options with special reference to the literature published in the past 5 years.展开更多
文摘Background: Implementing invasive procedures is an important part of patient management by clinical nurses;however, there are gaps between nurses’ actual knowledge and skills and expected professional care capacity. Purpose: This scoping review aimed to map the existing literature related to recent institution-provided educational programs for invasive procedures involving clinical nurses. This study seeks to understand the contents of educational programs and the methods for assessing educational effects. Methods: This scoping review was completed using the following four databases: PubMed (MEDLINE), Embase, Cochrane Library, and Emcare for the period 2000-2022. We included studies that used all forms of educational approaches (e.g., didactic lectures, hands-on training, or on-the-job training). This scoping review considered peer-reviewed publications published in English using quantitative, qualitative, or mixed approaches. A total of 83 studies underwent in the final analysis. Results and Conclusion: A combination of didactic lectures and hands-on training was provided as an educational program in most studies. Contrary to our prediction, educational interventions with advanced technologies such as VR are extremely rare, suggesting that the effectiveness of advanced technologies in learning invasive procedures should be examined to facilitate and retain educational effects more efficiently in future studies. Regarding the assessment of educational effects, nurses’ cognitive (i.e., theoretical knowledge about procedures), psychomotor (i.e., implementing procedures), and psychological aspects (e.g., confidence and self-efficacy in procedures) were evaluated using questionnaires and observational methods. While most studies used a one-group pretest-posttest design, the ratio of randomized controlled trials (RCT) was relatively low. Thus, an RCT design should be introduced in future studies to test the validity of the developed educational program more accurately.
文摘Background: Prenatal diagnosis is the process of evaluating the presence of disease or potential disease in the fetus, this enables families to be better prepared before the birth of the baby. There are non-invasive prenatal diagnosis procedures and invasive prenatal diagnosis procedures. The invasive prenatal diagnosis procedures are CVS (chorionic villus sampling) and amniocentesis. The American College of Obstetricians and Gynecologists states that invasive diagnostic testing should be available to all women, regardless of age or risk. Objective: To determine the indications, outcome and results of diagnostic invasive prenatal procedures. Study setting: The obstetrics and Gynecology Department in Salmaniya Medical Complex in Kingdom of Bahrain. Study design: Retrospective descriptive study. Study subjects and Methods: This retrospective descriptive study was conducted on 175 pregnant women who underwent invasive prenatal procedures (CVS and amniocentesis) between January 2013 and December 2018 at SMC in Kingdom of Bahrain. All medical records of the participants were reviewed and entered the study. According to the implemented procedures, medical records were categorized into two chorionic villus sampling (CVS) and amniocentesis groups. The study subject will include indications of the procedures which are advanced maternal age, hematological disorders, genetic disorders, metabolic disorders, abnormal structural findings in fetal ultrasound and previous child with aneuploidy. In addition, the study will address the complications, outcome and results of procedures. Results: About half of our indications of the procedures were due to hematological disorders (47.6%) followed by abnormal structural findings in fetal ultrasound (30.1%) then genetic disorders (15.7%), metabolic disorders (4.8%) and advanced maternal age (1.8%). Regarding complications of the procedure;threatened miscarriage or loss of pregnancy within 3 weeks was (2.3%), amniotic fluid leakage (0.7%), abdominal cramps (0.7%) and Insufficient or contaminated sample (6.2%). Regarding outcome of the pregnancy, our results showed that the loss of pregnancy was (4.8%), intrauterine fetal death or still birth was (13.9%), live birth was (63.9%), preterm delivery was (7.8%), preterm premature rupture of membrane (PPROM) was (1.8%), limbs reduction was (0.0%). Termination of pregnancy outside the country was (7.8%) of chorionic villus sampling and amniocentesis. Conclusion: CVS and amniocentesis are useful outpatient procedures to detect diagnosis or to assess whether a patient is at increased risk of having an affected fetus and that will minimize the psychological impact on the patient and to provide a proper antenatal care to the pregnant women by her obstetrician and follow up to the baby by pediatrician. In this study it was observed that most of the patients who underwent the procedure were couples either carrier or affected to sickle cell disease or Beta thalassemia.
基金Supported by the Science and Technology Development Plan of Suzhou,Jiangsu Province,China,No.SYS2020009.
文摘BACKGROUND Chronic liver disease(CLD)related thrombocytopenia increases the risk of bleeding and poor prognosis.Many liver disease patients require invasive procedures or surgeries,such as liver biopsy or endoscopic variceal ligation,and most of them have lower platelet counts,which could aggravate the risk of bleeding due to liver dysfunction and coagulation disorders.Unfortunately,there is no defined treatment modality for CLD-induced thrombocytopenia.Recombinant human thrombopoietin(rhTPO)is commonly used to treat primary immune thrombocytopenic purpura and thrombocytopenia caused by solid tumor chemotherapy;however,there are few reports on the use of rhTPO in the treatment of CLD-related thrombocytopenia.AIM To evaluate the efficacy of rhTPO in the treatment of patients with CLDassociated thrombocytopenia undergoing invasive procedures.METHODS All analyses were based on the retrospective collection of clinical data of patients with CLD who were treated in the Department of Infectious Diseases at The First Affiliated Hospital of Soochow University between June 2020 and December 2021.Fifty-nine male and 41 female patients with liver disease were enrolled in this study to assess the changes in platelet counts and parameters before and after the use of rhTPO for thrombocytopenia.Adverse events related to treatment,such as bleeding,thrombosis,and disseminated intravascular coagulation,were also investigated.RESULTS Among the enrolled patients,78(78%)showed a platelet count increase after rhTPO use,while 22(22%)showed no significant change in platelet count.The mean platelet count after rhTPO treatment in all patients was 101.53±81.81×10^(9)/L,which was significantly improved compared to that at baseline(42.88±16.72×10^(9)/L),and this difference was statistically significant(P<0.001).In addition,patients were further divided into three subgroups according to their baseline platelet counts(<30×10^(9)/L,30-50×10^(9)/L,>50×10^(9)/L).Subgroup analyses showed that the median platelet counts after treatment were significantly higher(P<0.001,all).Ninety(90%)patients did not require platelet transfusion partially due to an increase in platelet count after treatment with rhTPO.No serious adverse events related to rhTPO treatment were observed.Overall,rhTPO demonstrated good clinical efficacy for treating CLD-associated thrombocytopenia.CONCLUSION rhTPO can improve platelet count,reduce the risk of bleeding,and decrease the platelet transfusion rate,which may promote the safety of invasive procedures and improve overall survival of patients with CLD.
文摘Objective:This study aimed to describe the implementation of the surgical safety check policy and the surgical safety checklist for invasive procedures outside the operating room(OR)and evaluate its effectiveness.Methods:In 2017,to improve the safety of patients who underwent invasive procedures outside of the OR,the hospital quality and safety committee established the surgery safety check committee responsible for developing a new working plan,revise the surgery safety check policy,surgery safety check Keywords:Invasive procedures outside the operating room Safety management Surgical safety checklist Patient safety form,and provide training to the related staff,evaluated their competency,and implemented the updated surgical safety check policy and checklist.The study compared the data of pre-implementation(Apr to Sep 2017)and two post-implementation phases(Apr to Sep 2018,Apr to Sep 2019).It also evaluated the number of completed surgery safety checklist,correct signature,and correct timing of signature.Results:The results showed an increase in the completion rate of the safety checklist after the program implementation from 41.7%(521/1,249)to 90.4%(3,572/3,950),the correct rates of signature from 41.9%(218/521)to 99.0%(4,423/4,465),and the correct timing rates of signature from 34.4%(179/521)to 98.5%(4,401/4,465),with statistical significance(P<0.01).Conclusion:Implementing the updated surgery safety check significantly is a necessary and effective measure to ensure patient safety for those who underwent invasive procedures outside the OR.Implementing surgical safety checks roused up the clinical staff's compliance in performing safety checks,and enhanced team collaboration and communication.
文摘Liver cancer is known as the“silent killer”because it often lurks within the body undetected until it has progressed to an advanced stage.In China,both the incidence and mortality remain consistently high.The most common type of liver cancer is hepatocellular carcinoma(HCC),which accounts for approximately 75%–85%of all cases.It is closely associated with hepatitis B,hepatitis C,long-term heavy drinking,fatty liver disease,and foods contaminated with aflatoxin.
文摘Obesity is a major global health issue,contributing to numerous comorbidities such as type 2 diabetes mellitus,hypertension,and cardiovascular diseases.While bariatric surgery remains the gold standard for treating severe obesity,its invasive nature has led to the development of minimally invasive alternatives.Endoscopic sleeve gastroplasty(ESG)is a promising,minimally invasive procedure for weight loss,offering significant weight reduction without the need for surgical incisions.This editorial evaluates the efficacy and safety of ESG,highlighting its weight loss outcomes,safety profile,and comparison with other bariatric procedures,including intragastric balloon,laparoscopic sleeve gastrectomy,and robotic sleeve gastrectomy.ESG has shown substantial weight loss with a mean total weight loss ranging from 15.03%to 17.51%at 12 months and sustained weight reduction over 36 months.The safety profile is favorable,with low rates of serious adverse events and minimal complications compared to surgical alternatives.ESG is particularly suited for patients with mild to moderate obesity or those not eligible for surgical options.However,further long-term studies and standardized protocols are needed to refine patient selection and optimize treatment outcomes.
基金Informed consent was obtained from patients included(No.SDB-2023-0069-TTSH-01).
文摘BACKGROUND Colorectal cancer is the third most common cancer and the second highest cause of cancer-related mortality worldwide.About 5%-10%of patients are diagnosed with locally advanced rectal cancer(LARC)on presentation.For LARC invading into other structures(i.e.T4b),multivisceral resection(MVR)and/or pelvic ex-enteration(PE)remains the only potential curative surgical treatment.MVR and/or PE is a major and complex surgery with high post-operative morbidity.Minimally invasive surgery(MIS)has been shown to improve short-term post-operative outcomes in other gastrointestinal malignancies,but there is little evi-dence on its use in MVR,especially so for robotic MVR.This is a single-center retrospective cohort study from 1st January 2015 to 31st March 2023.Inclusion criteria were patients diagnosed with cT4b rectal cancer and underwent MVR,or stage 4 disease with resectable systemic metastases.Pa-tients who underwent curative MVR for locally recurrent rectal cancer,or me-tachronous rectal cancer were also included.Exclusion criteria were patients with systemic metastases with non-resectable disease.All patients planned for elective surgery were enrolled into the standard enhanced recovery after surgery pathway with standard peri-operative management for colorectal surgery.Complex sur-gery was defined based on technical difficulty of surgery(i.e.total PE,bladder-sparing prostatectomy,pelvic lymph node dissection or need for flap creation).Our primary outcomes were the margin status,and complication rates.Cate-gorical values were described as percentages and analysed by the chi-square test.Continuous variables were expressed as median(range)and analysed by Mann-Whitney U test.Cumulative overall survival(OS)and recurrence-free survival(RFS)were analysed using Kaplan-Meier estimates with life table analysis.Log-rank test was performed to determine statistical significance between cumulative estimates.Statistical significance was defined as P<0.05.Meier estimates with life table analysis.Log-rank test was performed to determine statistical significance between cumulative estimates.Statistical significance was defined as P<0.05.RESULTS A total of 46 patients were included in this study[open MVR(oMVR):12(26.1%),miMVR:36(73.9%)].Patients’American Society of Anesthesiologists score,body mass index and co-morbidities were comparable between oMVR and miMVR.There is an increasing trend towards robotic MVR from 2015 to 2023.MiMVR was associated with lower estimated blood loss(EBL)(median 450 vs 1200 mL,P=0.008),major morbidity(14.7%vs 50.0%,P=0.014),post-operative intra-abdominal collections(11.8%vs 50.0%,P=0.006),post-operative ileus(32.4%vs 66.7%,P=0.04)and surgical site infection(11.8%vs 50.0%,P=0.006)compared with oMVR.Length of stay was also shorter for miMVR compared with oMVR(median 10 vs 30 d,P=0.001).Oncological outcomes-R0 resection,recurrence,OS and RFS were comparable between miMVR and oMVR.There was no 30-d mortality.More patients underwent robotic compared with laparoscopic MVR for complex cases(robotic 57.1%vs laparoscopic 7.7%,P=0.004).The operating time was longer for robotic compared with laparoscopic MVR[robotic:602(400-900)min,laparoscopic:Median 455(275-675)min,P<0.001].Incidence of R0 resection was similar(laparoscopic:84.6%vs robotic:76.2%,P=0.555).Overall complication rates,major morbidity rates and 30-d readmission rates were similar between la-paroscopic and robotic MVR.Interestingly,3-year OS(robotic 83.1%vs 58.6%,P=0.008)and RFS(robotic 72.9%vs 34.3%,P=0.002)was superior for robotic compared with laparoscopic MVR.CONCLUSION MiMVR had lower post-operative complications compared to oMVR.Robotic MVR was also safe,with acceptable post-operative complication rates.Prospective studies should be conducted to compare short-term and long-term outcomes between robotic vs laparoscopic MVR.
基金supported by grants from the National Natural Science Foundation of China(No.82172741 to Ye D)Shanghai Municipal Health Bureau(No.2020CXJQ03 to Ye D)Xuhui District Hospital Local Cooperation Project(No.23XHYD-14 to Ye D).
文摘1.Introduction Due to the continuous progress in surgical methodologies and the swift evolution of surgical tools,minimally invasive procedures have emerged as the dominant approach in urologic oncology surgeries.Notably,robot-assisted surgery(RAS)has led to its extensive adoption in the surgical management of urinary system tumors due to its enhanced maneuverability,precision in suturing,and anastomotic capabilities.
文摘Surgeons have grappled with the treatment of recurrent and T4b locally advanced rectal cancer(LARC)for many years.Their main objectives are to increase the overall survival and quality of life of the patients and to mitigate postoperative complications.Currently,pelvic exenteration(PE)with or without neoadjuvant treatment is a curative treatment when negative resection margins are achieved.The traditional open approach has been favored by many surgeons.However,the technological advancements in minimally invasive surgery have radically changed the surgical options.Recent studies have demonstrated promising results in postoperative complications and oncological outcomes after robotic or laparoscopic PE.A recent retrospective study entitled“Feasibility and safety of minimally invasive multivisceral resection for T4b rectal cancer:A 9-year review”was published in the World Journal of Gastrointestinal Surgery.As we read this article with great interest,we decided to delve into the latest data regarding the benefits and risks of minimally invasive PE for LARC.Currently,the small number of suitable patients,limited surgeon experience,and steep learning curve are hindering the establishment of minimally invasive PE.
文摘Rectal cancer is a malignant neoplasm that constitutes a significant public health challenge due to its high incidence and associated mortality.In this editorial,we comment on the article by Chan et al.In recent years,there has been progress in the development of new treatments for initial and metastatic rectal cancer due to introduction of techniques of innovative and minimally-invasive surgery(MIS)such as laparoscopy and robotic surgery.However,only a few studies have ana-lyzed the feasibility,safety,and results of MIS in relation to open surgery,thereby highlighting the promising and superior results of MIS in functional and oncolo-gical terms.The findings were corroborated by the comparative study of Chan et al which evaluated the feasibility and safety of minimally invasive multivisceral resection(miMVR).A comparison of postoperative outcomes between open MVR and miMVR showed that miMVR presented less blood loss,fewer postoperative complications,and less morbidity.This editorial article is focused specifically on analysis of the characteristics of new minimally-invasive surgical techniques in rectal cancer,particularly in advanced stages.The importance of future research is emphasized by progress in knowledge,training,and clinical practice in the appli-cation of these surgical procedures for the treatment of advanced colorectal cancer.
文摘Introduction: Treatments for cardiovascular diseases have increasingly evolved with the tendency to offer minimally invasive or transcatheter procedures instead of conventional sternotomy surgery. In this context, we highlight minimally invasive mitral valve surgery (MIMVS), which has been shown to be an increasingly solid option with some superior results when compared to the conventional technique: better pain control, shorter hospital stays, shorter recovery time, shorter readmission rate in the first postoperative year, better aesthetic results, and lower overall cost. Aim: This study aims to evaluate the stages of MIMVS, by primary mitral valve consultation, in our service and compare these results with data from the literature. Methods: All electronic medical records of patients who underwent MIMVS for primary mitral valve injury in the Encore Hospital from January 2020 to February 2023 were analyzed. Tabulation and statistical analysis were performed using the Microsoft Excel<sup>®</sup> program. Quantitative variables were presented as means, standard deviations. Results: 46 patients were enrolled in our study (Age: 59.1 ± 12.4 years old;60.8% Female, BMI: 26 ± 4.4 Kg/m<sup>2</sup>, Low risk STS score: 82.6%). The observed 30-day mortality was 2.1%, plastic rate of 23.9%, blood transfusion rate of 41.3%, length of stay in an intensive care bed (ICB) of 3.3 ± 3.3 days and hospital stay of 6.4 ± 5.1 days. Conclusions: We noticed that the MIMVS results carried out in our service agree with data from national and international literature with approximately 1.3 days more hospitalization in ICB.
基金Supported by Jin-Wen Liu Academic Experience Heritage Studio Special Fund of National Famous Traditional Chinese Medicine,No.75.
文摘BACKGROUND Comminuted calcaneal fractures present significant treatment challenges.Open reduction and internal fixation carries risks such as infection and skin necrosis,while minimally invasive techniques may compromise reduction stability.Conservative management is generally limited to minimally displaced fractures.Traditional Chinese manual bone-setting has a long history in fracture treatment and is renowned globally for achieving functional reduction.It offers distinct advantages including lower cost,minimal soft tissue trauma,and the avoidance of expensive reduction equipment or internal fixation materials.CASE SUMMARY A 60-year-old female presented with left foot pain and limited mobility following a fall.Computed tomography scan revealed a Sanders type IV calcaneal fracture with a Böhler angle of 0°.A standardized,stepwise Traditional Chinese manual bone-setting was initially performed,followed by percutaneous screw fixation through several mini-incisions after satisfactory alignment was confirmed under fluoroscopy.The Visual Analog Scale score decreased from 5 on postoperative day 1 to 3 by day 3.The American Orthopaedic Foot and Ankle Society score improved from 73 at 6 weeks to 90 at 3 months,indicating rapid functional recovery and high patient satisfaction.At 7 months postoperatively,the American Orthopaedic Foot and Ankle Society score reached 95,prompting removal of internal fixation.At the 6-year follow-up,reduction remained well maintained,with the Böhler angle preserved at 22°.CONCLUSION The combination of Traditional Chinese manual bone-setting and percutaneous screw fixation achieved satisfactory functional reduction for comminuted calcaneal fractures.
文摘BACKGROUND Minimally invasive lumbar interbody fusion(LIF)procedures have evolved rapidly in recent years,with robot-assisted(RA)techniques increasingly integrated into clinical practice.However,questions remain regarding the relative advantages of RA over traditional fluoroscopy-guided and navigation-assisted methods in terms of perioperative,radiographic,and clinical outcomes.This systematic review synthesizes current evidence on these comparisons,focusing on the accuracy of screw placement,perioperative efficiency,radiographic and clinical outcomes,and complications.AIM To investigate the comparative effectiveness of RA vs conventional LIF techniques.METHODS A systematic review and meta-analysis was conducted in accordance with PRISMA 2020 and Cochrane guidelines.Databases searched included PubMed,EMBASE,Web of Science,Scopus,and the Cochrane Library(through May 2025).Eligible studies were randomized controlled trials and observational studies comparing RA with fluoroscopy-or navigation-guided LIF(transforaminal lumbar interbody fusion,lateral lumbar interbody fusion,oblique lumbar interbody fusion)in adults.Two reviewers independently extracted data and assessed risk of bias.The Grading of Recommendations Assessment,Development and Evaluation framework was used to evaluate certainty of evidence.Meta-analyses were performed where data were sufficiently homogeneous.RESULTS Twenty-two studies were included,encompassing a total of 2313 patients-1046 who underwent RA-guided procedures and 1267 who received comparator techniques.Meta-analyses showed that RA significantly improved perfect pedicle screw placement[pooled odds ratio=2.93;95%confidence interval(CI):1.40-6.14;I2=78.2%]and reduced intraoperative blood loss(pooled standardized mean difference=-0.28;95%CI:-0.47 to-0.08;I2=0%).Operative time did not significantly differ between groups(pooled standardized mean difference=0.01;95%CI:-0.30 to 0.31;I2=66%).Radiation dose could not be synthesized quantitatively due to heterogeneous definitions and measurement units.Narratively,RA demonstrated consistent advantages in reducing surgical exposure and adjacent segment degeneration.Clinical and radiographic outcomes,fusion success,and complication rates were generally comparable across groups.CONCLUSION RA LIF improves pedicle screw placement accuracy and reduces blood loss and surgeon radiation exposure while maintaining similar clinical outcomes and safety profiles to conventional techniques.These findings support the integration of RA into spine surgery but highlight the need for high-quality multicenter randomized controlled trials and cost-effectiveness studies to guide broader implementation.
文摘Esophageal gastrointestinal stromal tumors(GISTs)are exceedingly rare,often detected incidentally due to their asymptomatic nature.Historically,esophagec-tomy or enucleation has been the standard treatment,but these procedures carry significant morbidity.The retrospective study by Xu et al provides compelling evidence that endoscopic resection(ER)is a viable,minimally invasive alternative for low-risk esophageal GISTs,demonstrating a high en bloc resection rate(96.9%)and favorable long-term oncologic outcomes,including a 5-year overall survival rate of 100%and disease-free survival of 90.6%.These results challenge the con-ventional surgical paradigm and highlight the need for a paradigm shift towards endoscopic approaches in carefully selected patients.However,several critical questions remain unanswered:What are the precise selection criteria for ER candidacy?How does ER compare to traditional surgical methods in terms of recurrence risk and long-term functional outcomes?Could neoadjuvant therapy enhance the feasibility of ER for larger lesions?As endoscopic techniques continue to evolve,interdisciplinary collaboration among gastroenterologists,oncologists,and surgeons will be crucial to refining treatment algorithms and optimizing patient outcomes.Future prospective studies and randomized trials are warranted to solidify the role of ER as the standard of care for esophageal GISTs.
文摘BACKGROUND The spectrum of gastric submucosal tumors(SMTs)in the upper gastrointestinal system ranges from non-neoplastic to malignant lesions,with gastrointestinal stromal tumors exhibiting inherent malignant potential.However,the diagnosis of SMTs remains challenging,and treatment methods,especially for tumors located at the cardia or esophagogastric junction(EGJ),are not well established.Minimally invasive techniques-such as endoscopic submucosal dissection(ESD),submucosal tunneling endoscopic resection(STER),and laparoscopic wedge resection(LWR)-have been developed for these lesions.However,comparative data on their feasibility,safety,and clinical outcomes in these locations remain limited.AIM To compare ESD,STER,and LWR for SMTs at the EGJ or cardia,focusing on procedural feasibility.METHODS This single-center retrospective study included patients with SMTs less than 45 mm from the muscularis propria,growing intraluminally at the EGJ or cardia,and treated with ESD,STER,or LWR between July 2014 and September 2022.The primary outcome was relapse-free survival during follow-up.RESULTS The median age(interquartile range)was 53.0(40.0-57.5),43.0(39.0-57.0),and 56.0(43.0-64.0)years for ESD,STER,and LWR,respectively.The median follow-up time(interquartile range)was 60.0(26.5-66.5),24.0(13.0-38.0),and 35.0(21.0-60.0)months.LWR had the largest tumors(30.0 mm)and the highest rate of high-risk gastrointestinal stromal tumors(68.0%,P<0.001).Tumor recurrence occurred in one LWR patient(4.0%,P=0.600).En bloc and macroscopic resection rates were 100%(P=1.000),but microscopic resection rates differed(P=0.021).Significant minor complications occurred in 5 patients(10.0%),all grade IIIa.Tumor location(cardia/fundus,P=0.006)and prolonged procedure time(P<0.001)were significantly associated with complications.CONCLUSION ESD,STER,and LWR are effective for SMTs at the EGJ and cardia,with minor complications associated with tumor location and procedure time,and comparable recurrence rates.
基金the Ministry of Science and Technology of the People's Republic of China(2021ZD0201804,GW)the National Natural Science Foundation of China(82371416,HW).
文摘Lymphatic-venous anastomosis(LVA)surgery has recently emerged as a potential treatment for Alzheimer’s disease(AD)in China.This minimally invasive microsurgical procedure has been used for decades to treat lymphoedema,typically in the limbs,to decompress blocked lymphatic drainage pathways.
文摘Objective:Prostate cancer is a common malignancy in men over 50 years old,and radical prostatectomy,particularly via laparoscopic and robotic-assisted techniques,significantly impacts quality of life,especially in terms of erectile dysfunction.This systematic review and meta-analysis aimed to evaluate the preservation of erectile function following robotic-assisted and laparoscopic radical prostatectomy,with a separate analysis of randomized clinical trials and non-randomized studies.Methods:This review was carried out using randomized and non-randomized studies involving adult patients diagnosed with localized prostate cancer undergoing radical prostatectomy,according to Preferred Reporting Items for Systematic reviews and Meta-Analyses guidelines and registered in PROSPERO.Applicable literature from PubMed,Cochrane,Embase,and the Latin American and Caribbean Health Sciences Literature database was analysed.The bias in randomized clinical trials was assessed using the Cochrane Risk of Bias 2.0 tool,and observational studies were evaluated via the Newcastle-Ottawa Scale.The statistical analysis was performed using Review Manager version 5.4.Results:Our analysis included 13 studies involving 6281 patients.Comparative meta-analysis of non-randomized studies demonstrated that robotic techniques were significantly more effective in preserving erectile function at 3 months(risk difference[RD]0.05,95%confidence interval[CI]0.00-0.11;p=0.040),6 months(RD 0.10,95%CI 0.03-0.17;p=0.006),and 12 months postoperatively(RD 0.06,95%CI 0.02-0.10;p=0.002).Conclusion:Robotic-assisted surgery showed greater preservation of erectile function 3 months,6 months,and 12 months after radical prostatectomy.However,additional studies with meticulous methodological criteria are necessary for future analysis.
文摘Surgical treatment and ESI （epidural steroid injection） are widely used forms of treatment for cervical radiculopathy but they are controversial and burdensome for patients. To relief pain fast without side effects, we devised a new minimally invasive treatment method that widens the facet joints to decompress nerve roots and release the muscle spasm in cervical radiculopathy with acupuncture needles with blunt tip and mini-scalpel, and named it modified acupuncture procedure. MAP （Modified acupuncture procedure） was administered for 37 patients （mean age = 53.1 years, follow-up = 14.2 months） with cervical radiculopathy who did not recover from 4 weeks of nonsurgical treatment. We analyzed clinical outcomes of patients before and after the procedure through VAS （Visual Analogue Scale） and NDI （Neck Disability Index）. On average, patients received 1.4 MAP （modified acupuncture procedures）. The VAS score difference on the day after procedure and at 1 year follow-up was 36.8 ± 26.5 （from 60.1 ± 25.3 at the baseline to 25.3 ± 17.8 at the reading） （P 〈 0.01） and 31.0 ± 30.4 （29.0 ± 21.8 at the reading） respectively. The NDI value dropped by 19.9 ± 18.3 （from 37.2 ± 19.7 at the baseline to 17.2 ± 15.0 at the reading） （P〈 0.01） on 1 year follow up. MAP was found to have clinical efficacy for cervical radiculopathy.
文摘Minimally invasive surgery (MIS) for upper gastrointestinal (GI) cancer, characterized by minimal access, has been increasingly performed worldwide. It not only results in better cosmetic outcomes, but also reduces intraoperative blood loss and postoperative pain, leading to faster recovery; however, endoscopically enhanced anatomy and improved hemostasis via positive intracorporeal pressure generated by CO<sub>2</sub> insufflation have not contributed to reduction in early postoperative complications or improvement in long-term outcomes. Since 1995, we have been actively using MIS for operable patients with resectable upper GI cancer and have developed stable and robust methodology in conducting totally laparoscopic gastrectomy for advanced gastric cancer and prone thoracoscopic esophagectomy for esophageal cancer using novel technology including da Vinci Surgical System (DVSS). We have recently demonstrated that use of DVSS might reduce postoperative local complications including pancreatic fistula after gastrectomy and recurrent laryngeal nerve palsy after esophagectomy. In this article, we present the current status and future perspectives on MIS for gastric and esophageal cancer based on our experience and a review of the literature.
文摘Transurethral resection of the prostate(TURP)became the gold standard surgical treatment for benign prostatic obstruction without undergoing randomized controlled trials against the predecessor standard in open suprapubic prostatectomy.TURP has historically been associated with significant morbidity and this has fuelled the development of minimally invasive surgical treatment options.Improvements in perioperative morbidity for TURP has been creating an ever increasing standard that must be met by any new technologies that are to be compared to this gold standard.Over recent years,there has been the emergence of novel minimally invasive treatments such as the prostatic urethral lift(PUL;UroLift System),convective WAter Vapor Energy(WAVE;Rezum System),Aquablation(AQUABEAM System),Histotripsy(Vortx Rx System)and temporary implantable nitinol device(TIND).Intraprostatic injections(NX-1207,PRX-302,botulinum toxin A,ethanol)have mostly been used with limited efficacy,but may be suitable for selected patients.This review evaluates these novel minimally invasive surgical options with special reference to the literature published in the past 5 years.
