ObjectiveTo evaluate the early effectiveness of the robot-assisted total hip arthroplasty (THA) via direct superior approach (DSA).MethodsBetween March 2021 and April 2021, 11 patients (11 hips) were treated with a robot-assisted THA via DSA. There were 7 males and 4 females, with an average age of 55 years (range, 26-73 years). There were 5 patients of osteoarthritis secondary to hip dysplasia and 6 patients of osteonecrosis of femoral head. Preoperative hip Harris score was 55.8±6.3. The operation time, volume of blood loss, length of incision, postoperative blood transfusion and hospital stay, and the incidence of surgical complications were recorded. The visual analogue scale (VAS) score and Harris score were used to evaluate hip joint pain and function. The leg length discrepancy (LLD) was measured on the X-ray films. The inclination angle and anteversion angle of the acetabular component were also measured, and the difference between the planned and actual values were compared.ResultsOne THA was performed via conventional posterolateral approach finally because of poor exposure. The rest of 10 THAs were performed with assistance of robotic arm via DSA. The average operation time was 89 minutes (range, 65-120 minutes); the average length of incision was 10.5 cm (range, 9-13 cm); and the average blood loss was 400 mL (range, 110-740 mL). One patient was given a blood transfusion for 2 unit. All incisions healed by first intention and no neurovascular injury, deep vein thrombosis, or fracture occurred. The length of hospital stay after operation was 2-6 days (mean, 4.4 days). The duration of follow-up was 1-3 months (mean, 2.1 months). The VAS score was 0 in 9 patients and 2 in 1 patient at the day of discharge. At last follow-up, the hip Harris score was 84.9±6.7, showing significant difference when compared with that before operation (t=−8.717, P=0.000). The inclination and anteversion angles were (37.4±2.0)° and (17.1±4.5)°, respectively, and there was no significant difference when compared with the planned values [(38.2±1.6)°, (16.6±3.7)°] (t=1.809, P=0.104; t=–1.103, P=0.299). The LLD ranged from –2 to 4 mm. No complication such as dislocation, aseptic loosening, or periprosthetic joint infection occurred. ConclusionThe robot-assisted THA via DSA has encouraged early effectiveness.
Since the advent of coronary artery bypass grafting (CABG), it has been one of the main ways to treat coronary heart disease. However, compared with percutaneous coronary intervention (PCI), it causes more trauma, complications and pain which discourage many patients. Recently, minimally invasive CABG has gradually become one of the main choices in some medical centers with the progress of technology and the development of surgical instruments. Compared with traditional CABG, minimally invasive CABG has the advantages of less trauma, less pain, faster recovery, lower perioperative mortality and less demand for blood transfusion. In this paper, we will mainly focus on the current stage and prospect of minimally invasive CABG.
ObjectiveTo summarize the minimally invasive experiences and medium-long-term results of perventricular device closure of ventricular septal defects (VSD) under transesophageal echocardiography (TEE) guidance.MethodsWe retrospectively analyzed the clinical data and medium-long-term follow-up results of 783 patients who undertook perventricular device closure under TEE guidance in Dalian Children’s Hospital from July 2011 to January 2020, in which perimembrane VSD were found in 598 patients, VSD with aortic valve prolapse in 135 patients and muscular VSD in 2 patients. There were 463 males and 320 females at age of 5 months to 13 years with average age of 3.3±1.2 years, and body weight of 5.9-51.0 (15.9±8.3) kg. The left ventricular defect diameter of the VSD ranged from 5.0 to 11.0 mm, with an average of 6.3±1.2 mm. The right ventricular defect diameter of the VSD ranged from 2.3 to 8.0 mm, with an average of 4.3±0.9 mm.ResultsThe procedures were completed successfully in 753 patients. The device of 1 patient (0.1%) fell off and embedded in the right pulmonary artery after the operation, and the occluder was taken out and the VSD was closed with cardiopulmonary bypass (CPB) in the secondary operation. One patient (0.1%) appeared Ⅲ degree atrioventricular block in 2 years after operation. The device was taken out and VSD was closed with CPB in the secondary operation, and the patient gradually reached to sinus rhythm in post-operation. Eight patients (1.1%) presented delayed pericardial effusion in 1 week after operation, and were cured by pericardiocentesis with ultrasound-guided. Symmetric occluders were used in 580 patients, eccentric occleders were used in 171 patients and muscular occluders were used in 2 patients. The follow-up time was 9 months to 9 years. The rate of loss to follow-up was 96.7% (704/728). No residual shunt, occlude-loss or arrhythmia was found during follow-up. Conclusion The minimally invasive penventricular device closure of VSD guided by TEE is safe and availabe. Medium-long-term follow-up results are satisfactory, it is worthy of clinical promotion, and longer term follow-up is still needed.
Objective To review the latest comparative research of minimally invasive transforaminal lumbar interbody fusion (TLIF) and traditional open approach. Methods The domestic and foreign literature concerning the comparative research of minimally invasive TLIF and traditional open TLIF was reviewed, then intraoperative indicators, length of hospitalization, effectiveness, complication, fusion rate, and the effect on paraspinal muscles were analyzed respectively. Results Minimally invasive TLIF has less blood loss and shorter length of hospitalization, but with longer operation and fluoroscopic time. Minimally invasive surgery has the same high fusion rate as open surgery, however, its effectiveness is not superior to open surgery, and complication rate is relatively higher. In the aspect of the effect on paraspinal muscles, in creatine kinase, multifidus cross-sectional area, and atrophy grading, minimally invasive surgery has no significant reduced damage on paraspinal muscles. Conclusion Minimally invasive TLIF is not significantly superior to open TLIF, and it does not reduce the paraspinal muscles injury. But prospective double-blind randomized control trials are still needed for further study.
Artificial intelligence in robot system is mainly divided into two types: endoscopic robot system and intracavitary robot navigation system. The endoscopic robot system can effectively shorten the time of vascular anastomosis and occlusion during vascular bypass surgery, while the intracavitary robot navigation system has good localization and real-time observation function. Moreover, it has significant advantages in complex lesions and special anatomical locations. High cost and complicated equipment debugging are the main factors that limit the wide application of robot systems. Artificial intelligence represented by robot system has obvious advantages and broad prospects in the field of vascular surgery, but more research is needed to improve its shortcomings and to further clarify its standard operation and long-term results.
ObjectiveTo compare the outcomes of concomitant mitral valve surgery and tricuspid valve surgery through right minithoracotomy and conventional median sternotomy approaches. MethodsWe retrospectively analyzed clinical data of 475 patients underwent mitral valve surgery combined with tricuspid valve surgery through right minithoracotomy or conventional median sternotomy in Xinhua Hospital between June 2006 and June 2013. The patients were divided into two groups including a minimally invasive group(116 patients) and a conventional group (359 patients). ResultsAll the patients successfully underwent mitral valve and tricuspid valve surgery. During operation, there were 426 patients with no trivial mitral regurgitation (MR) and 49 patients with trivial MR. There were 282 patients with no tricuspid regurgitation (TR) and 193 patients with trivil TR. At discharge, transesophageal echocardiography showed that trivial MR in 38 patients, mild MR in 5 patients, trivial tricuspid regurgitation (TR) in 150 patients and mild TR in 7 patients. There was no significant difference between the two groups in complications. ConclusionRight minithoracotomy can achieve the similar therapeutic effect to conventional median sternotomy for patients with mitral valve disease and concomitant tricuspid valve disease. In addition, patients through right minithoracotomy had better cosmetic outcomes.
ObjectiveTo evaluate the effectiveness of percutaneous retrograde pubic screw implantation assisted by hollow pedicle opener in pubic branch fractures.MethodsThe clinical data of 42 patients with pubic branch fractures treated by hollow screw fixation between March 2008 and March 2019 were analyzed retrospectively. According to the operation method, they were divided into the traditional operation group (20 cases in group A, fixed with traditional retrograde pubic screws) and the modified operation group (22 cases in group B, fixed with percutaneous retrograde pubic screws assisted by hollow pedicle opener). There was no significant difference (P>0.05) between the two groups in terms of gender, age, cause of injury, fracture classification, comorbidity, and time from injury to operation. The operation time, blood loss, incision length, screw length, and complications were recorded and compared between the two groups. The fracture reduction was evaluated according to Matta standard on the next day after operation, and the function was evaluated by Majeed score at 12 months after operation.ResultsThe operation was successfully completed in both groups. The operation time, blood loss, and incision length of group B were significantly less than those of group A (P<0.05); there was no significant difference in screw length between the two groups (t=0.793, P=0.437). All patients were followed up 8-24 months, with an average of 16.8 months. There was no complication in the two groups, such as injury of blood vessels and nerves, fracture of internal fixation, screw entering into joint cavity, and nonunion of fracture. There was no significant difference in the fracture healing time between the two groups (t=−1.068, P=0.299). There were 2 cases of incision infection, 1 case of incision fat liquefaction, 2 cases of lower extremity deep vein thrombosis in group A, the incidence of complications was 25.0%; there was only 1 case of lower extremity deep vein thrombosis in group B, the incidence of complication was 4.5%, which was lower than that in group A, but the difference was not significant (χ2=2.104, P=0.147). In group A, 1 case was found to be dislocated, but in group B, there was no dislocated fracture. There was no significant difference between the two groups in the evaluation of Matta imaging on the next day after operation and the evaluation of Majeed function at 12 months after operation (P>0.05).ConclusionPercutaneous retrograde pubic screw implantation assisted by hollow pedicle opener is effect for the pubic branch fractures with the advantage of smaller incision, shorter operation time, and less bleeding compared with traditional methods.