Surgical strategy used in multilevel cervical disc replacement and cervical hybrid surgery:Four case reports

BACKGROUND Multilevel artificial cervical disc replacement and anterior hybrid surgery have been introduced as reliable treatments for multilevel cervical degenerative disc disease.Surgical techniques are important for resolving patients’symptoms and maintaining the normal functioning of cervical implants.However,the use of inappropriate surgical strategies could lead to complications such as implant migration and neurological deficit.In this paper,we summarize our surgical strategies used in multilevel cervical disc replacement and hybrid surgery into five major notes.CASE SUMMARY We share the key notes and our surgical procedures in the form of four typical case presentations.All patients were diagnosed with cervical degenerative disc disease with myelopathy or radiculopathy and needed multilevel cervical spine surgery.The first case demonstrated that index levels indicating the presence of highly serious spinal cord compression required a prioritized decompression.The second case demonstrated that the disc replacement should be performed before fusion in cervical hybrid surgery.The third and forth cases demonstrated that a top-down implantation sequence was needed in continuous two-level cervical disc replacement.The symptoms of all patients were significantly relieved after surgery.CONCLUSION We hope that our surgical strategies can help improve the performance and outcomes of multilevel cervical spine surgery.

Hybrid IPOM: A Novel Technique for the Management of Incisional Hernia

Background and Aim: The incidence of incisional hernias has been reported to be around 15%. In the present scenario, a wide array of surgical procedures are available for their better management. In this study, we intend to share our experience with one novel technique, “Hybrid IPOM (Intraperitoneal onlay meshplasty)” as a management option for a selected cohort of patients. Methods: This prospective study was undertaken during January 2019 to July 2023 at King Abdullah medical city, Makkah. A total of 51 cases were selected for Hybrid IPOM repair as per inclusion criteria;medium sized (4 - 10 cm) hernia defects;uncomplicated hernias;age more than 18 years. The follow-up period of the patients varied from 6 months to 4 years. The operation commenced with open hernia dissection, mesh deployment into abdomen, defect closure and then conversion to laparoscopy for the posterior mesh placement. Results: A total of 51 cases were repaired successfully with this technique. 48 out of 51 cases were incisional hernias secondary to some primary procedure done either for hernias itself or some other intra-abdominal pathology. The three cases were primary hernias falling in medium to large category with unaesthetic overlying skin. The age range was 19 to 72 years. The mean (range) operative time was 135 (90 - 240) min, and the average blood loss was 70 ml. The mean (range) hospital stay was 3 (2 - 11) days. All patients returned to routine work within 2 - 3 weeks of surgery. The median follow-up was 15 (6 - 48) months. Of the 51 cases, 3 patients developed seroma (managed conservatively), 1 patient developed a large hematoma (needed evacuation), and 1 patient developed superficial wound infection (managed with antibiotics). Two patients had recurrences;one patient had previously failed multiple repairs, and the other developed a postoperative hematoma. None of our patients had an iatrogenic bowel injury. Conclusion: Hybrid IPOM technique is a safe, feasible and easily reproducible technique. It may prove easier especially for beginners in laparoscopy, as it achieves faster and easy adhesiolysis thereby reducing operative time and easier establishment of the pneumoperitoneum. Besides, it gives the chance to excise ugly scars and improve the cosmesis.

Quality improvement of nursing on patients with complex cerebral arteriovenous malformation undergoing hybrid surgery:a prospective single-center study

Background:We sought to explore an optimal clinical nursing mode following a hybrid surgery for cerebral arteriovenous malformation.Methods:Patients with complex cerebral arteriovenous malformations seen in our neurosurgery department from January 2016 to December 2017 were prospectively enrolled.The hybrid surgery protocol included“angiographic diagnosis,surgical resection,and intraoperative angiographic evaluation”and“angiographic diagnosis and embolization,surgical resection,and intraoperative angiographic evaluation”.The patients were randomly stratified into intensive care group and routine care group.After surgery,intensive or routine care was provided,and the prognosis of patients was evaluated,with a subsequent comparative analysis.Results:A total of 109 cases were divided into the routine nursing group(n=54 cases)and intensive nursing group(n=55 cases).There were no significant differences between the two groups in baseline data before surgery.Postoperative lung infection in the intensive nursing group was significantly less frequent than those in the routine nursing group(5.5%vs.18.5%,P=0.039)with pulmonary infection and lower extremity venous thrombosis(5.5%vs.24.1%,P=0.006).The average hospital stay in the intensive nursing group was 14.4±5.78 days,which was significantly lower than that in the routine nursing group(19.3±6.38 days,P=0.013).At 3 months’follow-up after surgery,the Generic Quality of Life Inventory-74(GQOLI-74)dimension score and GQOLI-74 total score in the enhanced group were significantly better than those in the routine nursing group(P=0.017 and 0.023,respectively).Conclusions:Intensive postoperative nursing can improve the safety of patients after hybrid surgery,reduce the postoperative complications and the average length of hospital stay,and improve the quality of life of patients.

Ever-changing endoscopic treatment for early gastric cancer:Yesterday-today-tomorrow

Endoscopic resection has been an optimal treatment for selected patients with early gastric cancer(EGC) based on advances in endoscopic instruments and techniques. As endoscopic submucosal dissection(ESD) has been widely used for treatment of EGC along with expanding ESD indication, concerns have been asked to achieve curative resection for EGC while guaranteeing precise prediction of lymph node metastasis(LNM). Recently, new techniques including ESD or endoscopic full-thickness resection combined with sentinel node navigation enable minimal tumor resection and a laparoscopic lymphadenectomy in cases of EGC with high risk of LNM. This review covers the development and challenges of endoscopic treatment for EGC. Moreover, a new microscopic imaging and endoscopic techniques for precise endoscopic diagnosis and minimally invasive treatment of EGC are introduced.

Staged and hybrid approach in the treatment of complex aortic dissection

Multilevel aortic disease presents a formidable challenge for vascular surgeons. In the past,multilevel aortic surgery was performed simultaneously or subsequently. Single-stage intervention is thought to be associated with a high incidence of complications, and sequential repair requires several major surgical interventions. The rupture of residual lesion, however, may take place while waiting the second operation. Endovascular treatment is recognized as a viable alternative to the treatment of the diseased aortic areas especially in the high-risk patient, as it could markedly lower the incidence of complications compared with other procedures. However, thoracic aortic anatomy must be favorable to the placement of a stent-grafi （SG）. Sufficient proximal and distal landing zone is mandatory to deploy the SG and ensure a satisfactory exclusion result. Therefore, complex dissection with multiple-tear located extremely near the orifice of the visceral arteries is excluded from orthodox endovascular therapy. Here we present a case of multi-teared dissecting aneurysm treated by a four-staged hybrid surgery with placement of 5 SGs.

Dissection-related carotid-cavernous fistula(CCF)following surgical revascularization of chronic internal carotid artery occlusion:a new subtype of CCF and proposed management

Background:The development of carotid-cavernous fistulas(CCFs)during surgical recanalization of chronic internal carotid artery occlusion(ICAO)may be secondary to severe ICA dissection rather than a focal tear of the cavernous ICA seen in typical traumatic CCFs.The purpose of this study is to investigate the causal relationship between the CCFs and severe ICA dissections and to characterize technical outcomes after treatment with stenting.Methods:Five patients underwent treatment with self-expanding stents due to intraprocedural CCF and ICA dissection following surgical removal of ICAO plaque.The stents were telescopically placed via true channel of the dissection.Safety of the procedure was evaluated with 30-day stroke and death rate.Procedural success was determined by the efficacy of CCF obliteration and ICAO recanalization with angiography.Results:All CCFs were associated with spiral and long segmental dissection from the cervical to cavernous ICA.After stenting,successful dissection reconstruction with TICI 3 was achieved in all patients,with complete(n=4)or partial CCF(n=1)obliteration.No patient had CCF syndrome,stroke,or death during follow-up of 6 to 37 months;but one patient had pulsatile tinnitus,which resolved 1 year later.Angiography at 6 to 24 months demonstrated CCF obliteration in all 5 patients and durable ICA patency in 4 patients.Conclusions:Intraprocedural CCFs with spiral and cervical-to-cavernous ICA dissection during ICAO surgery are dissection-related because of successful obliteration after stenting for dissection reconstruction.Self-expanding stenting through true channel of the dissection,serving as implanting stent-autograft,may be an optimal therapy for the atypical CCF complication from ICAO surgery.