Revision Posterior Cruciate Ligament Reconstruction or Repair: A Systematic Review

Introduction: The purpose of the present study is to evaluate the clinical and radiographic results of simultaneous surgical correction for bilateral hallux valgus compared with unilateral correction using Percutaneous Forefoot Surgery Techniques (PFS).

Material and methods: A prospective cohort study of 82 patients (106 feet). The mean follow-up was 58.7 ± 31.5 months (range 22.3 to 112.1). Patients were divided into two groups, unilateral surgical group (group U, 58 feet) and simultaneous bilateral surgical group (group B, 48 feet).

Results: Preoperative mean Visual Analog Scale (VAS) was 6.2 points in group U and 6.3 in group B (p = 0.170), at the last follow-up it decreased in both groups (1.6 group U and 1.8 group B, p = 0.277). American Orthopaedic Foot and Ankle Society (AOFAS) score improved from approximately 50 points preoperative in both groups, to 88 at the last follow-up. Mean hallux valgus angles in groups U and B changed from 34.7 degrees and 34.3 degrees preoperatively (p = 0.838), to 21.3 degrees and 22.4 degrees follow-up, respectively (p = 0.635). With the numbers available, no significant inter-group differences were observed in clinical and radiographic outcomes.

Conclusions: PFS is a valid procedure for outpatient simultaneous surgical correction in patients with bilateral hallux valgus.

Level of evidence: II Prospective Comparative Cohort Study

Minimally Invasive Surgery (MIS) continues to play an important role in surgery as an alternative to traditional open surgery as well as traditional laparoscopic techniques. Since the 1980s, technological advancement and innovation has seen surgical techniques in MIS rapidly grow as it is viewed as more desirable. MIS, which includes Natural Orifice Transluminal Endoscopic Surgery (NOTES) and Single Incision Laparoscopic Surgery (SILS), is less invasive and has better cosmetic results. The technological growth and adoption of NOTES and SILS by clinicians in the last decade has however not been uniform. We review the differences in new developments and advancement in the different techniques in the last ten years. We also aim to explain these differences as well as the implications for the future.

Introduction: Central obesity is a side effect of Cushing’s disease. Patients with pituitary-based tumors who have failed other surgical and medical treatments often face the option of bilateral end organ (adrenalectomy) removal.

Methods: In the past two years, four obese patients underwent robotic bilateral transabdominal adrenalectomy (RBTA) at our institution. One patient was obese (body mass index (BMI) 30.6 kg/m2 ), another was severely obese (BMI 37 kg/m2 ), another morbidly obese (BMI 40.4 kg/m2 ) and one was super-obese (BMI 53.2 kg/m2 )

Results: The operative times for the super obese, morbidly obese, severely obese and obese patients were 350, 310, 202 and 165 minutes, respectively. Removal of the left adrenal gland took longer (average 133 minutes) than right side (average 90 minutes). Blood loss was minimal (<25 mi). There was a minor liver laceration in the super obese patient. No other complications were observed at a median follow-up of IO months. The obese and severely obese patients were discharged post-op day 1 and 2; the morbidly and super obesepatients were discharged post-op day 4.

Conclusion: Despite the higher anesthetic risks, difficulties with positioning, thick abdominal walls and limited working space in obese patients, RBTA is a safe and effective method to remove the adrenal glands allowing this subset of patients the opportunity to undergo minimally invasive surgery.

Recurrent pyloric stenosis is a rare occurrence that presents weeks after initial operative management and a history of complete cessation of symptoms. We report on a case managed with a repeat laparoscopic pyloromyotomy with a successful outcome. Brief commentary is provided on the emerging significance of administration of general anesthesia and the possible long-lasting deleterious neurocognitive effects in the pediatric population

Background: Reports of cholecystectomy under local or regional anesthesia are rare. Nevertheless, it can be a useful tool in selected patients with high risk or unwillingness for general anesthesia. An updated review of the cases published in the medical literature was conducted.

Method: The Medline/PubMed database and the Medical Subject Headings (MeSH) vocabulary were used to search original articles regarding cholecystectomy under local or regional anesthesia. The main terms used for the literature review were: “local anesthesia”, “spinal anesthesia”, “epidural anesthesia”, “nerve block” and “cholecystectomy”.

Findings: In regard to local anesthesia, four studies were found with a total of 125 patients in which an open cholecystectomy was performed under local anesthesia plus sedation through a small abdominal incision. Operative duration varies from 40 to 101 minutes. Regarding regional anesthesia 14 studies, all using a laparoscopic approach, were included in our review. The most common complications of this approach were severe shoulder pain (6-55% of patients) and hypotension (5-59% of patients). An inconvenience of all these procedures is the occasional need for conversion into general anesthesia (up to 37%). When reported, patient satisfaction is 100%.

Conclusion: Cholecystectomy under local or regional anesthesia plus sedation can be a safe and feasible procedure in selected patients, when there is a high risk or unwillingness for general anesthesia.

Background: Minimally Invasive Surgery (MIS) is gaining traction within surgical oncology. We aim to evaluate outcomes of patients with gallbladder cancer undergoing MIS surgery compared to open surgery.

Methods: Using the institutional cancer registry and administrative databases, we retrospectively reviewed patients who underwent a central hepatectomy with portal lymphadenectomy for gallbladder cancer from 2011-2014. We excluded gallbladder cancer patients without oncologic resection and those with metastatic disease.

Results: Thirty-four patients underwent surgery: 17 MIS (14 robotic; 3 laparoscopic) and 17 open. There was no statistically significant difference in median operative time (MIS=182 vs open=190 min; p=0.23) or R0 resection (MIS=88.2% vs open=88.2%; p=1.0); however, the MIS cohort had less intraoperative blood loss (median 50 ml vs 400 ml; p=0.006) and placement of peri-hepatic drains (29.4% vs 76.5%; p=0.01) compared to open.MIS cohort went to oral pain medications quicker (2 vs 3 days; p=0.02) and discharged home earlier (4 vs 6 days; p=0.018), than the open cohort. No differences in postoperative 30-day complication rates (52.9% vs 52.9%; p=1.0).

Conclusion: The minimally invasive approach to liver surgery is a safe and equally effective technique for the management of the gallbladder cancer with improvement in blood loss and length of stay.

Background: Different surgical techniques and types of mesh have been used in the prevention of parastomal hernia. However, the evidence in laparoscopic abdominoperineal resection with end colostomy has been analysed in few randomized clinical trials. The aim of this review article was to outline use of prophylactic mesh in laparoscopic surgery.

Methods: A literature search using electronic databases was performed to find articles that analysed prophylactic placement of mesh to prevent parastomal hernia. The search was limited to English-language, randomised controlled trials and laparoscopic abdominoperineal resection with a permanent colostomy for rectal cancer patients.

Results: Three randomized controlled trials were found and analyzed in our study. A total of 158 patients were included, with no significant difference in general characteristics and stoma-related complications across their study groups. A significant reduction in radiologically-defined parastomal hernia was demonstrated in two trials (P=0.008, P=0.005), whilst prophylactic mesh reduced clinically-diagnosed parastomal hernia in one trial (P=0.049).

Conclusion: The use of prophylactic mesh to prevent parastomal hernia during laparoscopic surgery is safe and appears to be effective. Further trials to clarify the effectiveness of prophylactic parastomal hernia mesh are required with tighter definition of what constitutes a parastomal hernia.

Hydrocephalus secondary to bone remodeling of cranial base in Paget’s disease is rare with few cases reported in the post TC era. There were not previous reports of endoscopic assisted ventriculo peritoneal shunts in these cases. We describe an elderly lady, diagnosed to have Paget’s disease who suffered dementia, gait disturbances and urinary incontinence. Obstructive hydrocephalus secondary to cranial base crowding was present. Fibreoptic intubation was doing and an endoscopic assisted occipital ventriculo-peritoneal shunt was inserted. She improved immediately following CSF diversion. Hydrocephalus in Paget’s disease is an uncommon and challenging complication. Timely surgery yields good results. There are some anesthetic and surgical precautions that we need to take account in order to ensure good results. Endoscopic visualization ensures an optimal colocation of ventricular catheter far too choroid plexus minimizing the risk of shunt failure and a subsequent reintervention in these difficult cases.

Current minimally invasive surgery (MIS) technology, although advantageous compared to open cavity surgery in many aspects, has limitations that prevents its use for general purpose MIS. This is due to reduced dexterity, cost, and required complex training of the currently practiced technology. The main challenges in reducing cost and amount of training is to have an accurate inner body navigation advisory system to help guide the surgeon to reach the surgery location. As a first step in making minimally invasive surgery affordable and more users friendly, quality images inside the patient as well as the surgical tool location should be provided automatically and accurately in real time in a common reference frame. The objective of this paper is to build a platform to accomplish this goal. It is shown that a set of three heterogeneous asynchronous sensors is a minimum requirement for navigation inside the human body. The sensors have different data rate, different reference frames, and independent time clocks. A prerequisite for successful information fusion is to represent all the sensors data in a common reference frame. The focus of this paper is on off line calibration of the three sensors, i.e. before the surgical device is inserted in the human body. This is a pre-requisite for real time navigation inside the human body. The proposed off-line sensor registration technique was tested using experimental laboratory data. The result of calibration was promising with an average error of 0.1081mm and 0.0872mm along the x and y directions, respectively, in the 2D camera image.

In the timeline of innovations of hip arthroscopy, there have been few issues that have sparked as much discussion as the management of the joint capsule. Historically, surgeons often performed a capsulotomy–cutting through the fibrous envelope of the hip to access the joint–without repairing it at the end of the procedure.