Mini-invasive Surgery Journal - Academia.edu (original) (raw)

Papers by Mini-invasive Surgery Journal

Research paper thumbnail of Conventional and robotic transanal minimally invasive surgery for rectal neoplasia

Mini-invasive Surgery , 2021

The treatment of rectal cancer is evolving at a rapid pace in parallel with advancements in surgi... more The treatment of rectal cancer is evolving at a rapid pace in parallel with advancements in surgical technique. One such advancement is the application of the laparoscopic platform to the transanal approach, coined transanal minimally invasive surgery (TAMIS). TAMIS overcomes many of the shortcomings of the traditional transanal approach to the local resection of rectal neoplasia, offering greater visualization and access to the middle and upper rectum with improved oncologic outcomes. Following the introduction of conventional TAMIS, the robotic platform was introduced and applied in analogous fashion. Over the past decade, data have accumulated enabling the comparison of the two approaches most notably with regard to patient morbidity, mortality, and oncologic outcomes. This review discusses the most recently available outcomes regarding conventional and robotic TAMIS and provides a comparison of the two platforms in the treatment of rectal neoplasia. While randomized controlled trials comparing the two platforms are lacking, important differences have been identified. Conventional TAMIS is the more cost-effective approach while advancements in the robotic platform allow the surgeon to be seated and ergonomically optimized, allowing greater visualization and ease of suturing. Differences in oncologic outcomes between the two platforms have not been identified. Head-to-head randomized controlled trials are required to determine if any differences in functional or oncologic outcomes exist.

Research paper thumbnail of Mini-invasive Surgery Large hiatal hernia: minimizing early and long-term complications after minimally invasive repair

Mini-invasive Surgery, 2021

Paraesophageal Hernia (PEH) is the protrusion of the stomach and/or other abdominal viscera into ... more Paraesophageal Hernia (PEH) is the protrusion of the stomach and/or other abdominal viscera into the mediastinum due to an enlargement of the diaphragmatic hiatus. The treatment of PEH is challenging: On the one hand, watchful waiting carries the risk of developing acute life-threatening complications requiring an emergency operation. On the other hand, elective repair of PEH has non-negligible morbidity and mortality rates, also due to the characteristics of PEH affected patients, who are generally elder and frail. A review of the literature is presented to highlight strategies that can be adopted to minimize early and long-term complications after PEH surgical repair. The laparoscopic approach has been shown to provide reduced hospital stay, postoperative morbidity and mortality, and overall costs compared to traditional open surgery, and it is currently considered the standard approach both to elective and emergency operations. The evidence suggests that strict adherence to surgical principles, such as hernia sac excision, extended mediastinal dissection of the esophagus, and tension-free crural repair with or without mesh are mandatory to achieve optimal surgical outcomes and reduce PEH recurrence rate. Different shapes, materials, and techniques of prosthetic repair and the use of relaxing incisions have been proposed, but long-term data are lacking, and no conclusions can be drawn regarding the ideal method of crural closure. When a short esophagus is recognized despite extensive mediastinal dissection, esophageal lengthening procedures are indicated. Systematic addition of a fundoplication is strongly encouraged, for either treating gastroesophageal reflux or reducing recurrence rate.

Research paper thumbnail of Sublobar resection in high-risk patients for lobectomy: current and future strategy

Mini-invasive Surgery, 2021

Surgical resection by lobectomy is the gold standard of therapy for early stage non-small cell lu... more Surgical resection by lobectomy is the gold standard of therapy for early stage non-small cell lung cancer. However, not all patients are medically fit to undergo surgery. In patients considered high-risk for lobectomy, alternative strategies have been developed including radiofrequency ablation, cryoablation, microwave ablation, stereotactic radiation therapy, wedge resection, and segmentectomy. This work reviews the definition of high-risk, and the outcomes that have been associated with each treatment technique. Some technical points regarding wedge resection versus segmentectomy are noted. Future directions are discussed in the context of treatment for patients considered at high-risk for lobectomy.

Research paper thumbnail of Metabolic and bariatric surgery

Mini-invasive Surgery, 2021

Obesity is a disease causing multiple comorbid health conditions such as type 2 diabetes, hyperte... more Obesity is a disease causing multiple comorbid health conditions such as type 2 diabetes, hypertension, obstructive sleep apnea, back pain, and cancers. Weight loss improves overall health and quality of life. When diets, exercise, and behavioral changes are not enough, weight loss operations can help patients lose 100 pounds or more, reverse associated health problems, and increase longevity.

Research paper thumbnail of Robotic liver surgery: literature review and current evidence

Mini-invasive Surgery , 2020

In the field of minimally invasive surgery, robotic surgery (RS) was introduced to overcome drawb... more In the field of minimally invasive surgery, robotic surgery (RS) was introduced to overcome drawbacks in laparoscopic surgery. However, its clinical application in hepatobiliary surgery is not yet standardized. This review analyzed the results of RS to clarify the benefits of robotic liver surgery in comparison with standard laparoscopy. Among 112 publications found in the literature, the 72 most relevant were selected and the following data were extracted: patients characteristics, operative procedures, histopathology, short-term and long-term outcomes, and costs. Twenty-nine articles on robotic liver resections, published in the last five years (2015-2020) and including 1831 patients, were analyzed. Twenty-five comparative studies between robotic and laparoscopic surgery were evaluated to underline the differences in operative outcomes. Eventually, 4 subgroup analyses were conducted on hepatocellular carcinoma, gallbladder cancer, hilar cholangiocarcinoma, and colorectal liver metastases. Almost all the authors reported data on safety, feasibility and oncologic effectiveness of RS reaching comparable results with laparoscopy. However, even if robotic surgery showed longer operative time and higher costs, in selected cases it allowed to increase the rate of minimally invasive approach when compared with laparoscopy. Thus, both open and minimally invasive surgery should be provided in a modern hepatobiliary center, including the robotic approach particularly to complex cases, otherwise very demanding by laparoscopy. In conclusion, different techniques should be tailored to each patient, choosing the minimally invasive approach when possible, enhancing patients' recovery after surgery, especially in cirrhotic livers and in the context of liver transplantation. Although many centers experienced robotic liver surgery, more and larger studies are necessary to define its real benefits relative to laparoscopy, in order to standardize patient selection criteria and techniques.

Research paper thumbnail of Searching for a better definition of robotic surgery: is it really different from laparoscopy

Mini-invasive Surgery , 2020

Although both laparoscopic surgery and robotic surgery are minimally invasive techniques, the hop... more Although both laparoscopic surgery and robotic surgery are minimally invasive techniques, the hope for robotic surgery is that it represents an evolution of minimally invasive technology that will improve the precision of surgeons movements in ever increasingly narrow and small anatomic spaces. It is widely believed that robotic technology works as a filter for the involuntary tremors of the surgeon, theoretically resulting in a minimization of involuntary inaccuracies, thus helping surgeons to further perfect their art. That robotic surgery is a natural evolution of minimally invasive surgery is not questioned; however, the veritable explosion of robotic enhancement begs the questions: Are all surgical robots created equal? What should be considered robotic surgery and what should be considered robot-assisted? The meaning of the words robot and robotics are surprisingly complex. The etymology of robot comes from the Slavic word "robot" that means servitude, servant, and disturbingly slave. It first appeared in print in 1920 in the play R.U.R. (Rossum's Universal Robots) about a factory that makes androids and was written by the Czech writer Karel Čapek [1]. Isaac Asimov is then credited with coining the term robotics in a short story tilted "Liar!" that was first published in 1941 [2]. Since then, the term robot has taken on a number of meanings with its main definition being a machine or device that does the work of a human either autonomously or under computer control. Robotics has become a field of engineering that utilizes computer science to design, manufacture, operate, and utilize robots. It has become an interdisciplinary field that uses aspects of electronic, computer, mechanical, and information engineering. The field of robotics has innumerable potential applications,

Research paper thumbnail of The endoscope and instruments for minimally invasive neurosurgery

Mini-invasive Surgery , 2020

The advent of neuroendoscopy catalyzed the ongoing development of minimally invasive neurosurgery... more The advent of neuroendoscopy catalyzed the ongoing development of minimally invasive neurosurgery in the 1990s. This millennium has seen rapid developments in the design of scopes, improved high-definition visualization systems, and a plethora of dedicated instruments. Many minimally invasive and endoscopic procedures have become the new "standard of care" today. Endoscopic third ventriculostomy and endonasal pituitary surgeries have replaced alternative techniques in most major institutes in the world and the indications are rapidly increasing to tackle many midline skullbase, intraventricular, and some parenchymal lesions as well. The scope of minimally invasive neurosurgery has extended to spine surgery, peripheral nerve surgery, and unique indications, viz. craniosynostosis repair. This review describes many of these developments over the years, evaluates current scenario, and tries to give a glimpse of the "not so distant" future.

Research paper thumbnail of Endoscope-assisted transcranial surgery for anterior skull base meningiomas

Mini-invasive Surgery , 2020

How to cite this article: Azab WA, Elmaghraby MA, Zaidan SN, Mostafa KH. Endoscope-assisted trans... more How to cite this article: Azab WA, Elmaghraby MA, Zaidan SN, Mostafa KH. Endoscope-assisted transcranial surgery for anterior skull base meningiomas. Mini-invasive Surg 2020;4:88. http://dx. Abstract Anterior skull base meningiomas are benign, dural-based tumors that originate from the tuberculum sellae, planum sphenoidale or olfactory groove. A multitude of traditional transcranial approaches have been effectively used for resection of these tumors. However, in the era of minimally invasive neurosurgery, the endoscopic endonasal and the endoscope-assisted or endoscope-controlled supraorbital keyhole eyebrow approaches stand out as the two main options utilized to resect these tumors. The supraorbital keyhole approach minimizes brain retraction, tissue dissection and length of the skin incision. Consequently, this approach is associated with a lower complication profile and much better cosmetic results in comparison to classic approaches. With endoscopic assistance or control, the approach provides an excellent view of anterior skull base meningiomas and enables optic nerve decompression when angled scopes are used. In our opinion, endoscopes will ultimately replace the surgical microscopes as the viewing tools in this type of surgery. A limited number of studies have directly compared the endoscopic endonasal approach versus the supraorbital keyhole one for resection of anterior cranial base meningiomas. In these studies, scores and algorithms have been suggested to help select the suitable approach. The practical value of these algorithms still needs to be validated by further research. Although the endoscope-assisted or-controlled supraorbital keyhole approach offers a minimally invasive and highly effective approach for excision of anterior cranial base meningiomas, the ideal approach should be tailored to the individual patient according to the tumor size, lateral extension, optic canal involvement, extent of vascular encasement and surgeon's experience.

Research paper thumbnail of A systematic review and meta-analysis comparing intracorporeal anastomosis and extracorporeal anastomosis in minimally invasive colectomies

Mini-invasive Surgery , 2020

Aim: This systemic review aims to determine if intracorporeal anastomosis (IA) adds value to pati... more Aim: This systemic review aims to determine if intracorporeal anastomosis (IA) adds value to patient outcomes without compromising operative and oncological safety when compared to extracorporeal anastomosis (EA) in laparoscopic colectomies. This is the first systematic review with meta-analysis to evaluate the outcomes in a combined fashion including both laparoscopic right and left colectomies. Methods: A systematic review of Medline, EMBASE, Cochrane Library, and PubMed was performed on studies analysing direct comparison between IA and EA. The primary outcome was anastomotic leakage. Quality assessment was carried out using a modified Institute of Health Economics appraisal tool. Meta-analysis was performed using a random-effects model. Results: A total of 24 papers with 2,674 patients were included in the analysis. No significant difference was found in anastomotic leakage (OR = 0.84; 95%CI: 0.54-1.31; P = 0.44) and short-term mortality (OR = 0.56; 95%CI: 0.20-1.58; P = 0.27) between the IA and EA cohorts. The IA cohort was associated with faster return of bowel function [MD =-0.53 days; 95%CI:-0.67-(-0.39); P < 0.00001] and lower incidence of surgical site infection

Research paper thumbnail of Sublobar minimally invasive surgery vs. stereotactic ablative radiotherapy for early stage non-small cell lung cancer

Mini-invasive Surgery , 2020

How to cite this article: Galvez C, Bolufer S, Corcoles JM, Lirio F, Sesma J, Mafe JJ, Cerezal J.... more How to cite this article: Galvez C, Bolufer S, Corcoles JM, Lirio F, Sesma J, Mafe JJ, Cerezal J. Sublobar minimally invasive surgery vs. stereotactic ablative radiotherapy for early stage non-small cell lung cancer. Mini-invasive Surg 2020;4:86. http://dx. Abstract Although lobectomy has been traditionally considered the standard treatment for early stage non-small cell lung cancer (NSCLC), lung-sparing resections usually called "sublobar resections" have exponentially increased in their use in the age of minimally-invasive surgery. Sublobar resection, especially anatomical segmentectomy, has shown comparable oncological outcomes in tumors less than 2 cm in diameter without nodal involvement and distant metastasis. On the other hand, more advanced radiation techniques such as stereotactic ablative radiotherapy, have shown excellent local control rates in stage I NSCLC, with low rates of post-treatment complications, so not only is its role growing in inoperable patients, but also in standard-risk stage I patients. There is a need for multicenter randomized trials addressing specifically this issue. This review aims to collect comparative data about the outcomes of both treatment strategies in early stage NSCLC.

Research paper thumbnail of Awake minimally invasive surgery as a game changer in lung cancer

Mini-invasive Surgery , 2020

Surgery still offers the best option for patients with early stage non-small cell lung cancer tha... more Surgery still offers the best option for patients with early stage non-small cell lung cancer that can tolerate surgery. With the increase in screening programs, more patients are diagnosed at early stages of cancer. Sadly, not all of them are fit for surgery, but with minimally invasive approaches, large number of those patients can be offered surgery and get a better overall survival. Awake non-intubated video assisted thoracic surgery resection is one of the most recent technique that we believe to be a game changer in this spectrum of patients who were previously classified as medically inoperable.

Research paper thumbnail of Robotic or laparoscopic surgery for rectal cancer - which is the best answer? A comprehensive review of oncological outcomes

Mini-invasive Surgery, 2020

Treatment of rectal cancer is ever evolving with the introduction of newer surgical technologies ... more Treatment of rectal cancer is ever evolving with the introduction of newer surgical technologies and multimodal treatment approach. The literature evaluating the various surgical treatment options with regards to operative and nonoperative outcomes is abundant. This is a comprehensive review focused on oncological outcomes of rectal cancer resection performed robotically or laparoscopically. Based on the current literature available, there is no significant difference in total mesorectal excision completeness, lymph node harvest, positive circumferential resection margin, or proximal resection margin between robotic and laparoscopic approaches for rectal resection. Selection of surgical approach should not be based on pathological outcomes as they are equivalent.

Research paper thumbnail of Meningiomas: criteria for modern surgical indications

Mini-invasive Surgery , 2020

The contemporary management of meningiomas is the result of the continuous evolution of neurosurg... more The contemporary management of meningiomas is the result of the continuous evolution of neurosurgical techniques, along with the refinement of dedicated instrumentations. Above all, it is the magnification of the surgical view, thanks to the microscope and the endoscope, and their advancements, which allowed the improvement of surgical outcomes, in terms of both extent of resection and morbidity rates. Because of the benign nature of the vast majority of meningiomas, complete tumor resection is curative, and it is the gold-standard treatment. However, in the case of high risk of surgical morbidity, a less aggressive surgical treatment may be justified, also upon tailored analysis of the meningiomas' biological behavior and the improvements in postoperative strategies. The endoscopic technique plays a role, as a unique visualization tool or in combination with the microscope, in granting so-called maximum allowed resection. Considering the above, the most challenging task confronting modern meningioma surgery remains the selection of the most appropriate surgical approach, the latter greatly depending on location, anatomic tumor features, and relationships with critical neurovascular structures. Herein, we present a cogent analysis of the modern multifaceted indications for the endoscopic treatment of meningiomas, with a glimpse into the adjacent fields.

Research paper thumbnail of Minimizing complications after minimally invasive surgery for epiphrenic diverticula of the esophagus: technical tips

Mini-invasive Surgery , 2020

How to cite this article: Herbella FAM, Patti MG. Minimizing complications after minimally invasi... more How to cite this article: Herbella FAM, Patti MG. Minimizing complications after minimally invasive surgery for epiphrenic diverticula of the esophagus: technical tips. Mini-invasive Surg 2020;4:82. http://dx. Abstract Epiphrenic diverticula occur within the distal 10 cm of the esophagus. Because they are secondary to an underlying esophageal motility disorder, the surgical treatment of these diverticula must include a myotomy in addition to the resection of the diverticulum. In selected cases, the diverticulum can be left in place, performing only the myotomy and the partial fundoplication. Most patients will eventually become asymptomatic and the diverticulum can be left in place. Overall, it is a challenging operation that may be associated to significant morbidity. In this review, we illustrate the key technical elements and how to troubleshoot eventual problems.

Research paper thumbnail of Multimodality imaging for preprocedural planning of percutaneous mitral valve repair: a comprehensive review

Mini-invasive Surgery , 2020

New transcatheter mitral valve (MV) therapies are now available as alternatives to surgical and m... more New transcatheter mitral valve (MV) therapies are now available as alternatives to surgical and medical treatments in patients at high or prohibitive operative risk. Multimodality imaging including echocardiography, cardiac magnetic resonance, and cardiac computed tomography provide complementary information to guide patient and device selection. Morphology and functional anatomy of the MV should be carefully evaluated to determine the feasibility of percutaneous treatment; to identify the best therapeutic approach, either leaflet or annulus or combined; and to predict the probability of procedural success that is crucial for subsequent outcome and should be integrated by comprehensive preprocedural assessment of chamber size, biventricular systolic and diastolic function, valvopathy hemodynamic impact and aortic or peripheral vascular disease. The spectrum of transcatheter options is now wide and encompasses leaflet repair, direct or indirect annuloplasty, and cordal implantation. The aim of this review is to provide an overview on the role of multimodality imaging in the patient selection and preprocedural planning of percutaneous mitral valve repair.

Research paper thumbnail of Robotic Heller myotomy

Mini-invasive Surgery, 2020

Achalasia is a neurodegenerative disorder of the esophagus of unknown etiology, which affects mot... more Achalasia is a neurodegenerative disorder of the esophagus of unknown etiology, which affects motility, causing symptoms such as progressive dysphagia with liquids then solids, heartburn, regurgitation, odynophagia, weight loss, nocturnal cough, and chest pain. Evaluation will show a characteristic “bird’s beak” appearance on barium esophagram and diagnosis is confirmed with esophageal manometry. Durable relief from the symptoms of achalasia can be achieved with pneumatic dilation, per-oral endoscopic myotomy, or surgical myotomy. Laparoscopic Heller myotomy with Dor (or Toupet) fundoplication for many years had been considered the gold standard for therapy. Since its development in 2001, the robotic Heller myotomy (RHM) has gained increasing popularity. Studies have shown equivalent efficacy of relieving achalasia symptoms but decreased incidence of esophageal perforation with RHM. The higher cost of RHM remains the largest barrier. Our objective was to provide a brief review of the current literature related to RHM and provide a detailed description of how to perform the procedure.

Research paper thumbnail of Intraprocedural guidance in percutaneous mitral valve repair

Mini-invasive Surgery, 2020

Percutaneous mitral valve intervention is emerging as a valid alternative for patients affected b... more Percutaneous mitral valve intervention is emerging as a valid alternative for patients affected by mitral regurgitation. By addressing the pathophysiology, therapeutic options mainly target the leaflets, annulus or left ventricle. The present review will cover the intraprocedural guidance of the most used approaches, such as edge to edge repair, adjustable transapical beating-heart chordal implantation and percutaneous direct or indirect annuloplasty. Intraprocedural monitoring relies on integration of fluoroscopy and echocardiography, and is based on the continuous communication between the interventional imager and the interventional cardiologist.

Research paper thumbnail of 3D printing applications for percutaneous structural interventions in congenital heart disease

Mini-invasive Surgery , 2020

The past several decades have seen remarkable advancements in percutaneous interventions for trea... more The past several decades have seen remarkable advancements in percutaneous interventions for treatment of congenital heart disease (CHD). These advancements have been significantly aided by improvements in noninvasive diagnostic imaging. The use of three-dimensional (3D) printed models for planning and simulation of catheter-based procedures has been demonstrated for numerous cardiac defects and has been shown to reduce complications, procedure times, and limit radiation exposure. This paper reviews the process by which patient-specific 3D cardiac models are produced, as well as numerous applications of these models for use in percutaneous interventions in CHD.

Research paper thumbnail of Robotic surgery of gallbladder cancer

Mini-invasive Surgery , 2020

Aim: The aim of this study was to describe our technique for the surgical treatment of clinically... more Aim: The aim of this study was to describe our technique for the surgical treatment of clinically suspected or incidentally diagnosed gallbladder cancer (GBC) and to report the outcomes of our experience.
Methods: This is a retrospective observational study including consecutive patients operated by a robotic approach for the surgical treatment of clinically suspected or incidentally diagnosed GBC (with the intent of radical re-resection after index cholecystectomy) performed between January 2017 and December 2019. Clinical outcomes and technical details related to the robotic approach were analyzed.
Results: During the study period, 8 patients underwent robotic radical cholecystectomy with lymphadenectomy and atypical resection of segments IVb-V. No conversion or major complications occurred intraoperatively. All patients underwent a radical resection. There were one Clavien-Dindo grade II and one grade IIIb complication. Median hospital stay was 6 days (range 5-11). At a median follow-up of 17.5 months (range 29.3-7.3), all patients are alive and free from disease except one who had peritoneal recurrence and underwent chemotherapy. No trocar site recurrence was observed.
Conclusion: The present study describes a standardized step-by-step robotic technique for the surgical treatment of GBC and demonstrates the feasibility and safety of the robotic approach. More data and multicentre series are needed to confirm our results and to assess the oncologic outcomes of the robotic approach.

Research paper thumbnail of Predictors for procedural success and all-cause mortality in patients undergoing transcatheter mitral valve edge-to-edge repair for mitral regurgitation

Mini-invasive Surgery , 2020

A growing body of evidence shows that transcatheter mitral valve edge-to-edge repair (TMVr) for m... more A growing body of evidence shows that transcatheter mitral valve edge-to-edge repair (TMVr) for mitral regurgitation (MR) improves symptoms and prognosis of patients with heart failure. Still, as recently shown by two large randomized controlled trials (COAPT and MITRA-FR), there is differing information on which patients have the largest benefit. We aimed to summarize the current knowledge of clinical and anatomic predictors for acute procedural failure and long-term all-cause mortality after TMVr. TMVr is an effective treatment option for patients with symptomatic MR fulfilling certain echocardiographic and clinical criteria or being ineligible for surgery despite optimal medical therapy. Acute procedural failure is influenced by anatomic features of the mitral valve, among those are increased tenting and mitral valve leaflet configuration, leaflet-to-annulus index, as well as the mitral valve opening area. In contrast, anatomy of the mitral valve plays a minor role in predicting all-cause mortality after TMVr. This endpoint is associated with patient comorbidities (e.g., renal failure and chronic lung disease), severe heart failure as expressed by New York Hear Association functional class (NYHA) IV, left and right heart dysfunction, laboratory parameters (NT-proBNP), clinical scoring systems (STS and EuroScore), and procedural MR reduction. In patients undergoing TMVr for severe MR, careful preprocedural evaluation of relevant comorbidities, mitral valve anatomy, as well as left and right heart function can provide detailed prognostic value regarding acute procedural success and long-term survival.

Research paper thumbnail of Conventional and robotic transanal minimally invasive surgery for rectal neoplasia

Mini-invasive Surgery , 2021

The treatment of rectal cancer is evolving at a rapid pace in parallel with advancements in surgi... more The treatment of rectal cancer is evolving at a rapid pace in parallel with advancements in surgical technique. One such advancement is the application of the laparoscopic platform to the transanal approach, coined transanal minimally invasive surgery (TAMIS). TAMIS overcomes many of the shortcomings of the traditional transanal approach to the local resection of rectal neoplasia, offering greater visualization and access to the middle and upper rectum with improved oncologic outcomes. Following the introduction of conventional TAMIS, the robotic platform was introduced and applied in analogous fashion. Over the past decade, data have accumulated enabling the comparison of the two approaches most notably with regard to patient morbidity, mortality, and oncologic outcomes. This review discusses the most recently available outcomes regarding conventional and robotic TAMIS and provides a comparison of the two platforms in the treatment of rectal neoplasia. While randomized controlled trials comparing the two platforms are lacking, important differences have been identified. Conventional TAMIS is the more cost-effective approach while advancements in the robotic platform allow the surgeon to be seated and ergonomically optimized, allowing greater visualization and ease of suturing. Differences in oncologic outcomes between the two platforms have not been identified. Head-to-head randomized controlled trials are required to determine if any differences in functional or oncologic outcomes exist.

Research paper thumbnail of Mini-invasive Surgery Large hiatal hernia: minimizing early and long-term complications after minimally invasive repair

Mini-invasive Surgery, 2021

Paraesophageal Hernia (PEH) is the protrusion of the stomach and/or other abdominal viscera into ... more Paraesophageal Hernia (PEH) is the protrusion of the stomach and/or other abdominal viscera into the mediastinum due to an enlargement of the diaphragmatic hiatus. The treatment of PEH is challenging: On the one hand, watchful waiting carries the risk of developing acute life-threatening complications requiring an emergency operation. On the other hand, elective repair of PEH has non-negligible morbidity and mortality rates, also due to the characteristics of PEH affected patients, who are generally elder and frail. A review of the literature is presented to highlight strategies that can be adopted to minimize early and long-term complications after PEH surgical repair. The laparoscopic approach has been shown to provide reduced hospital stay, postoperative morbidity and mortality, and overall costs compared to traditional open surgery, and it is currently considered the standard approach both to elective and emergency operations. The evidence suggests that strict adherence to surgical principles, such as hernia sac excision, extended mediastinal dissection of the esophagus, and tension-free crural repair with or without mesh are mandatory to achieve optimal surgical outcomes and reduce PEH recurrence rate. Different shapes, materials, and techniques of prosthetic repair and the use of relaxing incisions have been proposed, but long-term data are lacking, and no conclusions can be drawn regarding the ideal method of crural closure. When a short esophagus is recognized despite extensive mediastinal dissection, esophageal lengthening procedures are indicated. Systematic addition of a fundoplication is strongly encouraged, for either treating gastroesophageal reflux or reducing recurrence rate.

Research paper thumbnail of Sublobar resection in high-risk patients for lobectomy: current and future strategy

Mini-invasive Surgery, 2021

Surgical resection by lobectomy is the gold standard of therapy for early stage non-small cell lu... more Surgical resection by lobectomy is the gold standard of therapy for early stage non-small cell lung cancer. However, not all patients are medically fit to undergo surgery. In patients considered high-risk for lobectomy, alternative strategies have been developed including radiofrequency ablation, cryoablation, microwave ablation, stereotactic radiation therapy, wedge resection, and segmentectomy. This work reviews the definition of high-risk, and the outcomes that have been associated with each treatment technique. Some technical points regarding wedge resection versus segmentectomy are noted. Future directions are discussed in the context of treatment for patients considered at high-risk for lobectomy.

Research paper thumbnail of Metabolic and bariatric surgery

Mini-invasive Surgery, 2021

Obesity is a disease causing multiple comorbid health conditions such as type 2 diabetes, hyperte... more Obesity is a disease causing multiple comorbid health conditions such as type 2 diabetes, hypertension, obstructive sleep apnea, back pain, and cancers. Weight loss improves overall health and quality of life. When diets, exercise, and behavioral changes are not enough, weight loss operations can help patients lose 100 pounds or more, reverse associated health problems, and increase longevity.

Research paper thumbnail of Robotic liver surgery: literature review and current evidence

Mini-invasive Surgery , 2020

In the field of minimally invasive surgery, robotic surgery (RS) was introduced to overcome drawb... more In the field of minimally invasive surgery, robotic surgery (RS) was introduced to overcome drawbacks in laparoscopic surgery. However, its clinical application in hepatobiliary surgery is not yet standardized. This review analyzed the results of RS to clarify the benefits of robotic liver surgery in comparison with standard laparoscopy. Among 112 publications found in the literature, the 72 most relevant were selected and the following data were extracted: patients characteristics, operative procedures, histopathology, short-term and long-term outcomes, and costs. Twenty-nine articles on robotic liver resections, published in the last five years (2015-2020) and including 1831 patients, were analyzed. Twenty-five comparative studies between robotic and laparoscopic surgery were evaluated to underline the differences in operative outcomes. Eventually, 4 subgroup analyses were conducted on hepatocellular carcinoma, gallbladder cancer, hilar cholangiocarcinoma, and colorectal liver metastases. Almost all the authors reported data on safety, feasibility and oncologic effectiveness of RS reaching comparable results with laparoscopy. However, even if robotic surgery showed longer operative time and higher costs, in selected cases it allowed to increase the rate of minimally invasive approach when compared with laparoscopy. Thus, both open and minimally invasive surgery should be provided in a modern hepatobiliary center, including the robotic approach particularly to complex cases, otherwise very demanding by laparoscopy. In conclusion, different techniques should be tailored to each patient, choosing the minimally invasive approach when possible, enhancing patients' recovery after surgery, especially in cirrhotic livers and in the context of liver transplantation. Although many centers experienced robotic liver surgery, more and larger studies are necessary to define its real benefits relative to laparoscopy, in order to standardize patient selection criteria and techniques.

Research paper thumbnail of Searching for a better definition of robotic surgery: is it really different from laparoscopy

Mini-invasive Surgery , 2020

Although both laparoscopic surgery and robotic surgery are minimally invasive techniques, the hop... more Although both laparoscopic surgery and robotic surgery are minimally invasive techniques, the hope for robotic surgery is that it represents an evolution of minimally invasive technology that will improve the precision of surgeons movements in ever increasingly narrow and small anatomic spaces. It is widely believed that robotic technology works as a filter for the involuntary tremors of the surgeon, theoretically resulting in a minimization of involuntary inaccuracies, thus helping surgeons to further perfect their art. That robotic surgery is a natural evolution of minimally invasive surgery is not questioned; however, the veritable explosion of robotic enhancement begs the questions: Are all surgical robots created equal? What should be considered robotic surgery and what should be considered robot-assisted? The meaning of the words robot and robotics are surprisingly complex. The etymology of robot comes from the Slavic word "robot" that means servitude, servant, and disturbingly slave. It first appeared in print in 1920 in the play R.U.R. (Rossum's Universal Robots) about a factory that makes androids and was written by the Czech writer Karel Čapek [1]. Isaac Asimov is then credited with coining the term robotics in a short story tilted "Liar!" that was first published in 1941 [2]. Since then, the term robot has taken on a number of meanings with its main definition being a machine or device that does the work of a human either autonomously or under computer control. Robotics has become a field of engineering that utilizes computer science to design, manufacture, operate, and utilize robots. It has become an interdisciplinary field that uses aspects of electronic, computer, mechanical, and information engineering. The field of robotics has innumerable potential applications,

Research paper thumbnail of The endoscope and instruments for minimally invasive neurosurgery

Mini-invasive Surgery , 2020

The advent of neuroendoscopy catalyzed the ongoing development of minimally invasive neurosurgery... more The advent of neuroendoscopy catalyzed the ongoing development of minimally invasive neurosurgery in the 1990s. This millennium has seen rapid developments in the design of scopes, improved high-definition visualization systems, and a plethora of dedicated instruments. Many minimally invasive and endoscopic procedures have become the new "standard of care" today. Endoscopic third ventriculostomy and endonasal pituitary surgeries have replaced alternative techniques in most major institutes in the world and the indications are rapidly increasing to tackle many midline skullbase, intraventricular, and some parenchymal lesions as well. The scope of minimally invasive neurosurgery has extended to spine surgery, peripheral nerve surgery, and unique indications, viz. craniosynostosis repair. This review describes many of these developments over the years, evaluates current scenario, and tries to give a glimpse of the "not so distant" future.

Research paper thumbnail of Endoscope-assisted transcranial surgery for anterior skull base meningiomas

Mini-invasive Surgery , 2020

How to cite this article: Azab WA, Elmaghraby MA, Zaidan SN, Mostafa KH. Endoscope-assisted trans... more How to cite this article: Azab WA, Elmaghraby MA, Zaidan SN, Mostafa KH. Endoscope-assisted transcranial surgery for anterior skull base meningiomas. Mini-invasive Surg 2020;4:88. http://dx. Abstract Anterior skull base meningiomas are benign, dural-based tumors that originate from the tuberculum sellae, planum sphenoidale or olfactory groove. A multitude of traditional transcranial approaches have been effectively used for resection of these tumors. However, in the era of minimally invasive neurosurgery, the endoscopic endonasal and the endoscope-assisted or endoscope-controlled supraorbital keyhole eyebrow approaches stand out as the two main options utilized to resect these tumors. The supraorbital keyhole approach minimizes brain retraction, tissue dissection and length of the skin incision. Consequently, this approach is associated with a lower complication profile and much better cosmetic results in comparison to classic approaches. With endoscopic assistance or control, the approach provides an excellent view of anterior skull base meningiomas and enables optic nerve decompression when angled scopes are used. In our opinion, endoscopes will ultimately replace the surgical microscopes as the viewing tools in this type of surgery. A limited number of studies have directly compared the endoscopic endonasal approach versus the supraorbital keyhole one for resection of anterior cranial base meningiomas. In these studies, scores and algorithms have been suggested to help select the suitable approach. The practical value of these algorithms still needs to be validated by further research. Although the endoscope-assisted or-controlled supraorbital keyhole approach offers a minimally invasive and highly effective approach for excision of anterior cranial base meningiomas, the ideal approach should be tailored to the individual patient according to the tumor size, lateral extension, optic canal involvement, extent of vascular encasement and surgeon's experience.

Research paper thumbnail of A systematic review and meta-analysis comparing intracorporeal anastomosis and extracorporeal anastomosis in minimally invasive colectomies

Mini-invasive Surgery , 2020

Aim: This systemic review aims to determine if intracorporeal anastomosis (IA) adds value to pati... more Aim: This systemic review aims to determine if intracorporeal anastomosis (IA) adds value to patient outcomes without compromising operative and oncological safety when compared to extracorporeal anastomosis (EA) in laparoscopic colectomies. This is the first systematic review with meta-analysis to evaluate the outcomes in a combined fashion including both laparoscopic right and left colectomies. Methods: A systematic review of Medline, EMBASE, Cochrane Library, and PubMed was performed on studies analysing direct comparison between IA and EA. The primary outcome was anastomotic leakage. Quality assessment was carried out using a modified Institute of Health Economics appraisal tool. Meta-analysis was performed using a random-effects model. Results: A total of 24 papers with 2,674 patients were included in the analysis. No significant difference was found in anastomotic leakage (OR = 0.84; 95%CI: 0.54-1.31; P = 0.44) and short-term mortality (OR = 0.56; 95%CI: 0.20-1.58; P = 0.27) between the IA and EA cohorts. The IA cohort was associated with faster return of bowel function [MD =-0.53 days; 95%CI:-0.67-(-0.39); P < 0.00001] and lower incidence of surgical site infection

Research paper thumbnail of Sublobar minimally invasive surgery vs. stereotactic ablative radiotherapy for early stage non-small cell lung cancer

Mini-invasive Surgery , 2020

How to cite this article: Galvez C, Bolufer S, Corcoles JM, Lirio F, Sesma J, Mafe JJ, Cerezal J.... more How to cite this article: Galvez C, Bolufer S, Corcoles JM, Lirio F, Sesma J, Mafe JJ, Cerezal J. Sublobar minimally invasive surgery vs. stereotactic ablative radiotherapy for early stage non-small cell lung cancer. Mini-invasive Surg 2020;4:86. http://dx. Abstract Although lobectomy has been traditionally considered the standard treatment for early stage non-small cell lung cancer (NSCLC), lung-sparing resections usually called "sublobar resections" have exponentially increased in their use in the age of minimally-invasive surgery. Sublobar resection, especially anatomical segmentectomy, has shown comparable oncological outcomes in tumors less than 2 cm in diameter without nodal involvement and distant metastasis. On the other hand, more advanced radiation techniques such as stereotactic ablative radiotherapy, have shown excellent local control rates in stage I NSCLC, with low rates of post-treatment complications, so not only is its role growing in inoperable patients, but also in standard-risk stage I patients. There is a need for multicenter randomized trials addressing specifically this issue. This review aims to collect comparative data about the outcomes of both treatment strategies in early stage NSCLC.

Research paper thumbnail of Awake minimally invasive surgery as a game changer in lung cancer

Mini-invasive Surgery , 2020

Surgery still offers the best option for patients with early stage non-small cell lung cancer tha... more Surgery still offers the best option for patients with early stage non-small cell lung cancer that can tolerate surgery. With the increase in screening programs, more patients are diagnosed at early stages of cancer. Sadly, not all of them are fit for surgery, but with minimally invasive approaches, large number of those patients can be offered surgery and get a better overall survival. Awake non-intubated video assisted thoracic surgery resection is one of the most recent technique that we believe to be a game changer in this spectrum of patients who were previously classified as medically inoperable.

Research paper thumbnail of Robotic or laparoscopic surgery for rectal cancer - which is the best answer? A comprehensive review of oncological outcomes

Mini-invasive Surgery, 2020

Treatment of rectal cancer is ever evolving with the introduction of newer surgical technologies ... more Treatment of rectal cancer is ever evolving with the introduction of newer surgical technologies and multimodal treatment approach. The literature evaluating the various surgical treatment options with regards to operative and nonoperative outcomes is abundant. This is a comprehensive review focused on oncological outcomes of rectal cancer resection performed robotically or laparoscopically. Based on the current literature available, there is no significant difference in total mesorectal excision completeness, lymph node harvest, positive circumferential resection margin, or proximal resection margin between robotic and laparoscopic approaches for rectal resection. Selection of surgical approach should not be based on pathological outcomes as they are equivalent.

Research paper thumbnail of Meningiomas: criteria for modern surgical indications

Mini-invasive Surgery , 2020

The contemporary management of meningiomas is the result of the continuous evolution of neurosurg... more The contemporary management of meningiomas is the result of the continuous evolution of neurosurgical techniques, along with the refinement of dedicated instrumentations. Above all, it is the magnification of the surgical view, thanks to the microscope and the endoscope, and their advancements, which allowed the improvement of surgical outcomes, in terms of both extent of resection and morbidity rates. Because of the benign nature of the vast majority of meningiomas, complete tumor resection is curative, and it is the gold-standard treatment. However, in the case of high risk of surgical morbidity, a less aggressive surgical treatment may be justified, also upon tailored analysis of the meningiomas' biological behavior and the improvements in postoperative strategies. The endoscopic technique plays a role, as a unique visualization tool or in combination with the microscope, in granting so-called maximum allowed resection. Considering the above, the most challenging task confronting modern meningioma surgery remains the selection of the most appropriate surgical approach, the latter greatly depending on location, anatomic tumor features, and relationships with critical neurovascular structures. Herein, we present a cogent analysis of the modern multifaceted indications for the endoscopic treatment of meningiomas, with a glimpse into the adjacent fields.

Research paper thumbnail of Minimizing complications after minimally invasive surgery for epiphrenic diverticula of the esophagus: technical tips

Mini-invasive Surgery , 2020

How to cite this article: Herbella FAM, Patti MG. Minimizing complications after minimally invasi... more How to cite this article: Herbella FAM, Patti MG. Minimizing complications after minimally invasive surgery for epiphrenic diverticula of the esophagus: technical tips. Mini-invasive Surg 2020;4:82. http://dx. Abstract Epiphrenic diverticula occur within the distal 10 cm of the esophagus. Because they are secondary to an underlying esophageal motility disorder, the surgical treatment of these diverticula must include a myotomy in addition to the resection of the diverticulum. In selected cases, the diverticulum can be left in place, performing only the myotomy and the partial fundoplication. Most patients will eventually become asymptomatic and the diverticulum can be left in place. Overall, it is a challenging operation that may be associated to significant morbidity. In this review, we illustrate the key technical elements and how to troubleshoot eventual problems.

Research paper thumbnail of Multimodality imaging for preprocedural planning of percutaneous mitral valve repair: a comprehensive review

Mini-invasive Surgery , 2020

New transcatheter mitral valve (MV) therapies are now available as alternatives to surgical and m... more New transcatheter mitral valve (MV) therapies are now available as alternatives to surgical and medical treatments in patients at high or prohibitive operative risk. Multimodality imaging including echocardiography, cardiac magnetic resonance, and cardiac computed tomography provide complementary information to guide patient and device selection. Morphology and functional anatomy of the MV should be carefully evaluated to determine the feasibility of percutaneous treatment; to identify the best therapeutic approach, either leaflet or annulus or combined; and to predict the probability of procedural success that is crucial for subsequent outcome and should be integrated by comprehensive preprocedural assessment of chamber size, biventricular systolic and diastolic function, valvopathy hemodynamic impact and aortic or peripheral vascular disease. The spectrum of transcatheter options is now wide and encompasses leaflet repair, direct or indirect annuloplasty, and cordal implantation. The aim of this review is to provide an overview on the role of multimodality imaging in the patient selection and preprocedural planning of percutaneous mitral valve repair.

Research paper thumbnail of Robotic Heller myotomy

Mini-invasive Surgery, 2020

Achalasia is a neurodegenerative disorder of the esophagus of unknown etiology, which affects mot... more Achalasia is a neurodegenerative disorder of the esophagus of unknown etiology, which affects motility, causing symptoms such as progressive dysphagia with liquids then solids, heartburn, regurgitation, odynophagia, weight loss, nocturnal cough, and chest pain. Evaluation will show a characteristic “bird’s beak” appearance on barium esophagram and diagnosis is confirmed with esophageal manometry. Durable relief from the symptoms of achalasia can be achieved with pneumatic dilation, per-oral endoscopic myotomy, or surgical myotomy. Laparoscopic Heller myotomy with Dor (or Toupet) fundoplication for many years had been considered the gold standard for therapy. Since its development in 2001, the robotic Heller myotomy (RHM) has gained increasing popularity. Studies have shown equivalent efficacy of relieving achalasia symptoms but decreased incidence of esophageal perforation with RHM. The higher cost of RHM remains the largest barrier. Our objective was to provide a brief review of the current literature related to RHM and provide a detailed description of how to perform the procedure.

Research paper thumbnail of Intraprocedural guidance in percutaneous mitral valve repair

Mini-invasive Surgery, 2020

Percutaneous mitral valve intervention is emerging as a valid alternative for patients affected b... more Percutaneous mitral valve intervention is emerging as a valid alternative for patients affected by mitral regurgitation. By addressing the pathophysiology, therapeutic options mainly target the leaflets, annulus or left ventricle. The present review will cover the intraprocedural guidance of the most used approaches, such as edge to edge repair, adjustable transapical beating-heart chordal implantation and percutaneous direct or indirect annuloplasty. Intraprocedural monitoring relies on integration of fluoroscopy and echocardiography, and is based on the continuous communication between the interventional imager and the interventional cardiologist.

Research paper thumbnail of 3D printing applications for percutaneous structural interventions in congenital heart disease

Mini-invasive Surgery , 2020

The past several decades have seen remarkable advancements in percutaneous interventions for trea... more The past several decades have seen remarkable advancements in percutaneous interventions for treatment of congenital heart disease (CHD). These advancements have been significantly aided by improvements in noninvasive diagnostic imaging. The use of three-dimensional (3D) printed models for planning and simulation of catheter-based procedures has been demonstrated for numerous cardiac defects and has been shown to reduce complications, procedure times, and limit radiation exposure. This paper reviews the process by which patient-specific 3D cardiac models are produced, as well as numerous applications of these models for use in percutaneous interventions in CHD.

Research paper thumbnail of Robotic surgery of gallbladder cancer

Mini-invasive Surgery , 2020

Aim: The aim of this study was to describe our technique for the surgical treatment of clinically... more Aim: The aim of this study was to describe our technique for the surgical treatment of clinically suspected or incidentally diagnosed gallbladder cancer (GBC) and to report the outcomes of our experience.
Methods: This is a retrospective observational study including consecutive patients operated by a robotic approach for the surgical treatment of clinically suspected or incidentally diagnosed GBC (with the intent of radical re-resection after index cholecystectomy) performed between January 2017 and December 2019. Clinical outcomes and technical details related to the robotic approach were analyzed.
Results: During the study period, 8 patients underwent robotic radical cholecystectomy with lymphadenectomy and atypical resection of segments IVb-V. No conversion or major complications occurred intraoperatively. All patients underwent a radical resection. There were one Clavien-Dindo grade II and one grade IIIb complication. Median hospital stay was 6 days (range 5-11). At a median follow-up of 17.5 months (range 29.3-7.3), all patients are alive and free from disease except one who had peritoneal recurrence and underwent chemotherapy. No trocar site recurrence was observed.
Conclusion: The present study describes a standardized step-by-step robotic technique for the surgical treatment of GBC and demonstrates the feasibility and safety of the robotic approach. More data and multicentre series are needed to confirm our results and to assess the oncologic outcomes of the robotic approach.

Research paper thumbnail of Predictors for procedural success and all-cause mortality in patients undergoing transcatheter mitral valve edge-to-edge repair for mitral regurgitation

Mini-invasive Surgery , 2020

A growing body of evidence shows that transcatheter mitral valve edge-to-edge repair (TMVr) for m... more A growing body of evidence shows that transcatheter mitral valve edge-to-edge repair (TMVr) for mitral regurgitation (MR) improves symptoms and prognosis of patients with heart failure. Still, as recently shown by two large randomized controlled trials (COAPT and MITRA-FR), there is differing information on which patients have the largest benefit. We aimed to summarize the current knowledge of clinical and anatomic predictors for acute procedural failure and long-term all-cause mortality after TMVr. TMVr is an effective treatment option for patients with symptomatic MR fulfilling certain echocardiographic and clinical criteria or being ineligible for surgery despite optimal medical therapy. Acute procedural failure is influenced by anatomic features of the mitral valve, among those are increased tenting and mitral valve leaflet configuration, leaflet-to-annulus index, as well as the mitral valve opening area. In contrast, anatomy of the mitral valve plays a minor role in predicting all-cause mortality after TMVr. This endpoint is associated with patient comorbidities (e.g., renal failure and chronic lung disease), severe heart failure as expressed by New York Hear Association functional class (NYHA) IV, left and right heart dysfunction, laboratory parameters (NT-proBNP), clinical scoring systems (STS and EuroScore), and procedural MR reduction. In patients undergoing TMVr for severe MR, careful preprocedural evaluation of relevant comorbidities, mitral valve anatomy, as well as left and right heart function can provide detailed prognostic value regarding acute procedural success and long-term survival.