Objective To review the feature, biomechanics, and cl inical appl ication of percutaneous 360 degree axial lumbar interbody fusion (AxiaLIF) technique. Methods Recent l iterature on investigation and appl ication of percutaneous360 degree AxiaLIF technique was reviewed. Results Percutaneous 360 degree AxiaLIF technique mainly contained operative approach, axial technique, and posterior fixation. It was obviously different from other lumbar interbody fusion techniques due to its capabil ity of maintaining the integrity of the bilateral facet joints, the anterior/posterior longitudinal l igament, and the annulus fibrosus. Three-dimensional AxiaLIF RodTM provided axial support and firmly fixation, thereby rel ieving stenosis of lumbar intervertebral foramen and restoring the intervertebral disc height and the whole height and physiological curvature of the lumbar spine. The recovery of the intervertebral disc height could restore the folded or crumpled flavum, the posterior longitudinal l igament, and the herniated annulus, resulting in the improvement of stenosis symptoms of nerve root canal or central vertebral canal. Conclusion Percutaneous 360 degree AxiaLIF technique achieves satisfying therapeutic effects, although it has fairly narrow indication and needs long-term follow-up observation.
Objective To explore the clinical value of preoperative neoadjuvant chemotherapy (NAC) combined with laparoscopic pancreatoduodenectomy (LPD) with multiple surgical approaches in the treatment of borderline resectable pancreatic head cancer. Methods The clinicopathologic data of 35 patients with critical resectable pancreatic head carcinoma admitted to the Department of Hepatobiliary and Pancreatic Surgery of Luoyang Central Hospital Affiliated to Zhengzhou University and the Department of Hepatobiliary and Pancreatic Surgery of the Fifth Affiliated Hospital of Zhengzhou University from January 2017 to June 2022 were retrospectively analyzed. All patients received NAC before operation (AG protocol). At the end of the course of treatment, according to the type of borderline resectable pancreatic cancer (BRPC) [venous invasion type (BRPC-V type) and arterial invasion type (BRPC-A type)], take the individualized surgical approach for LPD (BRPC-V type: inferior mesenteric vein approach; BRPC-A type: left posterior approach, medial uncinate process approach, anterior approach, or lower mesocolon approach). The intraoperative condition, R0/R1 resection rate, lymph node dissection, postoperative complications, average hospital stay, recovery, follow-up and survival were recorded. Results① Efficacy evaluation of NAC: 13 patients were partially relieved , 17 patients were stable and 5 patients were progressive after 4 weeks of treatment. Five progressive patients continued to receive comprehensive internal medicine treatment, and the remaining 30 patients underwent LPD. ② Intraoperative situation: LPD were successfully completed in 30 patients, 2 patients underwent extended pancreaticoduodenectomy combined with superior mesenteric vein (or) portal vein reconstruction among them. Among the 30 patients with LPD, there were 10 cases of inferior mesenteric vein approach, 10 cases of left posterior approach, 6 cases of medial uncinate process approach, 1 case of left posterior approach+medial uncinate process approach, 2 cases of anterior approach, and 1 case of inferior mesocolon approach. The mean operative time was (379.4±77.3) min, the intraoperative blood loss was (436.9±95.1) mL. ③ Postoperative situation: The incidence rate of postoperative surgery-related complications was 33.3% (10/30), including 4 cases of Clavien-Dindo grade Ⅰ [biliary fistula in 1 case (3.3%), A-grade pancreatic fistula in 1 case (3.3%), gastric draining dysfunction in 1 case (3.3%), diarrhea in 1 case (3.3%)], 5 cases of grade Ⅱ [pulmonary infection in 2 cases (6.6%), B-grade pancreatic fistula in 2 cases (6.6%), abdominal infection in 1 case (3.3%)], and 1 case of grade Ⅲ [gastroduodenal artery stump bleeding (3.3%)]. Among the 10 patients with complications, 9 cases recovered after symptomatic treatment, and 1 case died, with a fatality rate of 3.3% (1/30). The mean postoperative hospital stay was (17.3±5.5) days. ④ Excision rate and pathological results: R0 resection rate was 90.0% (9/10) in 10 patients with BR-PV type LPD, and R1 resection was performed in 1 patient. R0 resection rate was 75.0% (15/20) in 20 patients with BR-A type, and R1 resection was performed in 5 patients (2 patients with medial uncinate process approach; Left posterior approach in 2 cases; Submesocolon approach was used in 1 case). In 30 patients with LPD, the total R0 removal rate was 80.0% (24/30), the number of lymph nodes dissected was (11±5). Pathological type: There were 26 cases (86.7%) of ductal adenocarcinoma in 30 patients, 1 case of adeno-squamous carcinoma (3.3%), 1 case of mucinous carcinoma (3.3%), 2 cases of acinocytic cell carcinoma (6.7%). 23 cases (76.7%) of medium-high differentiation and 5 cases (16.6%) of low differentiation, two cases (6.7%) were undifferentiated. ⑤ Postoperative follow-up and survival: 30 patients were completely followed-up for 6-39 months, with a median follow-up time of 17 months. The median survival time of BRPC-V and BRPC-A patients was 24.0 months and 17.0 months, respectively. The overall survival rates of 30 patients at 1, 2 and 3 years after operation were 77.3%、46.5% and 13.7%, respectively. Conclusion The selection of preoperative NAC combined with individualized surgical approach for patients with borderline resectable pancreatic head cancer is beneficial to improve the radical resection rate and clinical therapeutic effect, and has good clinical application value.
ObjectiveTo summarize the experience of robot-assisted lung basal segmentectomy, and analyze the clinical application value of intersegmental tunneling and pulmonary ligament approach for S9 and/or S10 segmentectomy. MethodsThe clinical data of 78 patients who underwent robotic lung basal segmentectomy in our hospital between January 2020 to May 2022 were retrospectively reviewed. There were 32 males and 46 females with a median age of 50 (33-72) years. The patients who underwent S9 and/or S10 segmentectomy were divided into a single-direction group (pulmonary ligament approach, n=19) and a bi-direction group (intersegmental tunneling, n=19) according to different approaches, and the perioperative outcomes between the two groups were compared. ResultsAll patients successfully completed the operation, without conversion to thoracotomy and lobectomy, serious complications, or perioperative death. The median operation time was 100 (40-185) min, the blood loss was 50 (10-210) mL, and the median number of dissected lymph nodes was 3 (1-14). There were 4 (5.1%) patients with postoperative air leakage, and 4 (5.1%) patients with hydropneumothorax. No patient showed localized atelectasis or lung congestion at 6 months after the operation. Further analysis showed that there was no significant difference in the operation time, blood loss, thoracic drainage time, complications or postoperative hospital stay between the single-direction and bi-direction groups (P>0.05). However, the number of dissected lymph nodes of the bi-direction group was more than that of the single-direction group [6 (1-13) vs. 5 (1-9), P=0.040]. ConclusionThe robotic lung basal segmentectomy for pulmonary nodules is safe and effective. The perioperative results of robotic S9 and/or S10 complex segmentectomy using intersegmental tunneling and pulmonary ligament approach are similar.
Objective To investigate a new surgical approach for presacral lesion by double door via S3- 5. Methods From June 2007 to January 2008, 5 female patients (56-84 years old) with presacral lesion were treated. One patient had straining feel ing in anus, 2 patients had difficult defecation and bloody stool and 2 patients had no symptoms. Digital rectal examination revealed rectal tumor in 2 cases and anus examination of presacral tumor showed no abnormal ity in 3 cases. B-ultrasound, CT and MRI examination displayed presacral tumor in 3 cases and rectumal tumor in 2 cases. The size ofthe lesions was 4 cm × 3 cm × 3 cm - 20 cm × 15 cm × 13 cm. The disease course was 12-50 days (average 18 days). All 5 patients received total resection of tumor through the surgical approach featured by double door via S3-5. Results The operations were successful in all the 5 patients, and no severe presacral venous hemorrhage, rectal injury, direct injury of pelvic nerve and structure damage of pelvic bottom occured during operation. The approach exposure time was 12-28 minutes (average 20 minutes) and the blood loss for approach was 30-130 mL (average 80 mL); and the operation time was 80-120 minutes (average 105 minutes) and the blood loss during operation was 100-350 mL (average 280 mL). All incision healed by first intention. Pathological examination of resected tissue after operation revealed presacral teratoma in 1 case, dermoid cyst in 1 case, spindle cell tumor in 1 case and rectal tubiform villus adenoma in 2 cases. All the patients suffered from perineal hypoesthesia to various degrees after operation, which were recovered to the normal 6 months later, and X-ray films showed bone union occurred in all the cases. No gatism occured. During the followed-up period of 6-13 months, no sacrum defect, pelvic instabil ity and sacroil iitis was observed in the 5 cases. B-ultrasound, CT and MRI examination showed no recurrence of tumor. Conclusion The approach of double door via S3-5 is a simple and safe surgical procedure featured by a good surgical exposure with less bleeding, short operative time, no sacrum defect, no severe sacral nerve damage, and early postoperative convalescence.
Objective To discuss the optimal approach to treat suprascapular nerve compression syndrome. Methods From January 2000 to June 2003, 8 cases of suprascapular nerve compression syndrome were treated by surgical intervention to cut the transverse scapular ligament through posterior approach. Of the 8 patients, there were 2 males and 6 females (age ranged from 21 to 53) with duration of 6 months to 3 years. The change of symptom, muscle power, and muscle atrophy after operation were observed. Results One week after operation, pain around the scapular disappeared, muscle power of supraspinatus and infraspinatus muscles recovered to normal. One, 6, 12 and 16 months after the operation, the patients were followed up. No recurrence was observed. Muscle atrophy didn’t recover.Conclusion To treat suprascapular nerve compression syndrome with operation through posterior approach is easy to operate. When the suprascapular nerve is entrapped in scapular notch, this approach is a good choice.
From Jan. 1991 to Jan. 1994, 11 cases ofdifferent hip lesions with flexon contracture deformity were treated by combination of SmithPeterson and WatsonJones incisions in replacement of hip joint. All of them were followed-up for 1 to 3 years (an average of 1.9 years). According to pain, joint function, the excellent and good results were rated at 90.9%. This showed that from using the combined incisions, the hip joint was very well exposed, and release of hip flexion contracture could be acomplished in the same time. Bleeding fromoperation was reduced and the procedure was simple.
ObjectiveTo evaluate the long-term effectiveness of patients received surgical treatment under the guidance of “West China Classification” of desmoid-type fibromatosis (DTF) in the shoulder girdle.MethodsThe clinical data of 32 patients with DTF in the shoulder girdle admitted between June 2003 and December 2016 were retrospectively analyzed, including 14 males and 18 females, aged 14-56 years with an average age of 36.8 years. The maximum diameter of the tumor was 7-19 cm, with an average of 11.1 cm. According to the “West China Classification” of DTF in the shoulder girdle, there were 4 cases of region Ⅰ, 3 cases of region Ⅱ, 6 cases of region Ⅲ, 3 cases of region Ⅳ, 5 cases of regions Ⅰ+Ⅱ, 5 cases of regions Ⅱ+Ⅲ, and 6 cases of regions Ⅰ+Ⅱ+Ⅲ. In addition, the involvement of blood vessels and nerves was also taken into consideration for choosing a surgical approach. Finally, 12 cases were operated via anteroposterior approach (group A), 14 via posterior approach (group B), and 6 via combined anterior-posterior approach (group C). The 1993 Musculoskeletal Tumor Society (MSTS93) score (including pain, limb function, satisfaction, hand position, hand flexibility, and lifting ability), Japanese Orthopedic Association (JOA) score, range of motion (ROM) of shoulder joint (including flexion, extension, abduction, and adduction), and complications of patients in the 3 groups were recorded and compared.ResultsAll the 32 patients were followed up 30-190 months, with an average of 94.6 months. At last follow-up, complications occurred in 5 cases (15.6%), including 2 cases (16.6%) in group A, 2 (14.3%) in group B, and 1 (16.6%) in group C. There was no significant difference in the incidence of complications among the 3 groups (P=1.000). Tumor recurrence occurred in 5 (15.6%) cases, including 1 (8.3%) case in group A, 2 (14.3%) in group B, and 1 (16.6%) in group C. No significant difference was found in the recurrence rate among the 3 groups (P=1.000). At last follow-up, MSTS93 score of pain, limb function, satisfaction, hand flexibility, and hand position in groups A and B were significantly better than those in group C (P<0.05), even though no significant difference existed between group A and group B (P>0.05). The lifting ability score in group C was significantly lower than in group A (P<0.05), and no significant difference was found between other groups (P>0.05). The JOA score and flexion, extension, abduction, and adduction activities of shoulder in groups A and B were significantly better than those in group C (P<0.05). The extension activity in group A was significantly better than that in group B (P<0.05), the flexion activity in group B was significantly better than that in group A (P<0.05). There was no significant difference in other indexes between groups A and B (P>0.05).ConclusionTaking a rational approach to fully expose and completely remove the tumor is the key point of surgical treatment for patients with DTF in the shoulder girdle. At the same time, preservation of vital structures and reconstruction of soft tissues should also be taken into consideration. Overall, surgical treatment under the guidance of “West China Classification” of DTF in the shoulder girdle has achieved satisfactory long-term effectiveness.
ObjectiveTo conclude the effectiveness of arthroscopy combined with Burks and SchaVer's approach in the treatment of posterior cruciate ligament (PCL) avulsion fractures in a floppy lateral position. MethodsBetween May 2010 and March 2014, 21 patients with PCL avulsion fractures were treated. There were 13 males and 8 females, aged 21 to 62 years (mean, 39.1 years). The causes included traffic accident injury in 10 cases, sports injury in 5 cases, and falling injury from height in 6 cases. The time from injury to hospital was 1-6 days (mean, 2.5 days). The results of posterior drawer test were all positive, and the results of anterior drawer test and lateral stress test were all negative. The Lysholm score was 28.0±5.5 before operation. And the American Orthopaedic Foot and Ankle Society (IKDC) score was 46.2±7.6 before operation. According to Meyer standards for fractures classification, 11 cases were rated as type II and 10 cases as type III. Arthroscopy was used to inspect and treat the intra-articular lesions, then avulsion fracture was fixed by Burks and SchaVer's approach in lateral position. Postoperative functional exercises were performed. ResultsPrimary healing of incision was obtained, without nerve and vascular injury or joint infection. All patients were followed up 18-36 months (mean, 27.2 months). The X-ray films of the knee joint showed good fractures reduction and healing at 3 months after operation. The results of posterior drawer test and reverse Lachman test were negative. The knee range of motion was recovered to normal level. At last follow-up, the Lysholm score of the knee joint was significantly improved to 90.9±1.4 from preoperative one (t=54.584, P=0.000), and the IKDC score was significantly increased to 90.5±5.3 from preoperative one (t=15.638, P=0.000), including 19 cases of grade A and 2 cases of grade B. ConclusionA combination of arthroscopy and Burks and SchaVer's approach for the treatment of PCL avulsion fractures in a floppy lateral position has the advantages of minimal invasion and safe approach, short operative time, and early postoperative rehabilitation exercises, so it can provide satisfactory function recovery of the knee joint.
ObjectiveTo summarize the advantages and disadvantages of different surgical approaches in thyroidectomy using the da Vinci robotic surgical system. MethodThe relevant to articles about da Vinci robotic thyroidectomy via different surgical approaches at home and abroad were retrieved and reviewed. ResultsThe robot-assisted transaxillary thyroidectomy had a definite curative effect and was a mature technology. The bilateral axillary-breast approach thyroidectomy had a wide range of applications and was suitable for beginners. The robotic retroauricular approach thyroidectomy had great advantages in the dissection of lateral cervical lymph nodes. The transoral robotic thyroidectomy was a surgical approach that conformed to the minimally invasive concept. Conclusions Da Vinci robotic thyroidectomy via different surgical approaches has its corresponding application scope and advantages. Clinical surgeons should choose an optimal surgical approach according to the tumor location, size and number of patients and the advantages of the operator, so as to achieve the therapeutic effect of radical cure of tumors and reduction of injury.
Objective To investigate the efficacy of double-plating fixation via U-shaped incision in the treatment of type C3.3 distal femoral fractures. Methods From July 2006 to February 2009, 11 cases of type C3.3 distal femoral fractures were treated, including 5 open fractures and 6 closed fractures. Among them, there were 7 males and 4 females with an averageage of 43 years (range, 27-55 years). The locations were left side in 6 cases and right side in 5 cases. Fracture was caused by traffic accident in 8 cases and fall ing from height in 3 cases. The time from injury to hospital ization was 30 minutes to 7 days. After bone traction for 3 to 8 days, the operations were performed by double-plating fixation via U-shaped incision, and autograft of il iac bone or allogeneic bone grafting. Results The average time of operation was 128 minutes (range, 105-150 minutes). The average blood loss during operation was 344 mL (range, 290-380 mL). Shallow local skin flap necrosis occurred in 2 cases, and incision healed by first intention in others patients. All patients were followed up 22 months on average (range, 12-36 months). The bone union was achieved within 3-6 months (4.4 months on average). No implant loosening or refracture was found. According to Merchan et al criteria for knee joint function evaluation, the results were excellent in 4 cases, good in 5 cases, fair in 1 case, and poor in 1 case at last follow-up; the excellent and good rate was 81.8%. Conclusion The double-plating fixation via U-shaped incision has the advantages of better exposure, great convenience to manipulation, anatomical reduction, and rigid fixation. It provides an effective treatment for type C3.3 distal femoral fracture. However, its operation indications and operating instructions should be strictly followed.