Comparative clinical study of ultrasound-guided A1 pulley release vs open surgical intervention in the treatment of trigger finger

AIM To investigate the effectiveness of ultrasound-guided release of the first annular pulley and compare results with the conventional open operative technique.METHODS In this prospective randomized, single-center, clinical study, 32 patients with trigger finger or trigger thumb, grade Ⅱ-Ⅳ according to Green classification system, were recruited. Two groups were formed; Group A(16 patients) was treated with an ultrasound-guided percutaneous release of the affected A1 pulley under local anesthesia. Group B(16 patients) underwent an open surgical release of the A1 pul ey, through a 10-15 mm incision. Patients were assessed pre- and postoperatively(follow-up:2,4 and 12 wk) by physicians blinded to the procedures. Treatment of triggering(primary variable of interest) was expressed as the "success rate" per digit. The time for taking postoperative pain killers, range of motion recovery, QuickD ASH test scores(Greek version), return to normal activities(including work), complications and cosmetic results were assessed.RESULTS The success rate in group A was 93.75%(15/16) and in group B 100%(16/16). Mean times in group A patients were 3.5 d for taking pain killers, 4.1 d for returning to normal activities, and 7.2 and 3.9 d for complete extension and flexion recovery, respectively. Mean Quick DASH scores in group A were 45.5 preoperatively and, 7.5, 0.5 and 0 after 2, 4, and 12 wk postoperatively. Mean times in group B patients were 2.9 d for taking pain killers, 17.8 d for returning to normal activities, and 5.6 and 3 d for complete extension and flexion recovery. Mean QuickD ASH scores in group B were 43.2 preoperatively and, 8.2, 1.3 and 0 after 2, 4, and 12 wk postoperatively. The cosmetic results found excellent or good in 87.5%(14/16) of group A patients, while in 56.25%(9/16) of group B patients were evaluated as fair or poor.CONCLUSION Treatment of the trigger finger using ultrasonography resulted in fewer absence of work days, and better cosmetic results, in comparison with the open surgery technique. It is a promising method that represents excellent results without major complications, so that it could be possibly be established as a first-line treatment in the trigger finger's disease.

Laparoscopic cholecystectomy: A report from a single center

AIM： To review and evaluate our experience in laparoscopic cholecystectomy. METHODS： A retrospective analysis was performed on data collected during a 13-year period （1992-2005） from 1220 patients who underwent laparoscopic cholecystectomy. RESULTS： Mortality rate was 0%. The overall morbidity rate was 5.08% （n = 62）, with the most serious complications arising from injuries to the biliary tree and the cystic artery. In 23 （1.88%） cases, cholecystectomy could not be completed laparoscopically and the operation was converted to an open procedure. Though the patients were scheduled as day-surgery cases, the average duration of hospital stay was 2.29 d, as the complicated cases with prolonged hospital stay were included in the calculation. CONCLUSION： Laparoscopic cholecystectomy is a safe, minimally invasive technique with favorable results for the patient.

Two-year outcomes of ab interno trabeculectomy with the Trabectome for Chinese primary open angle glaucoma： a retrospective multicenter study

AIM： To evaluate the 2-year efficacy and safety of ab interno trabeculectomy with the Trabectome in Chinese primary open angle glaucoma （POAG） patients. METHODS： This was a multicenter, retrospective, observational study and included POAG patients with or without visually-significant cataracts. The Chinese patients were enrolled from three glaucoma centers and a group of comparable Japanese POAG patients was analyzed from our international Trabectome database. The patients received Trabectome or a combined surgery with phacoemulsification and intraocular lens implantation. The primary outcome was intraocular pressure （IOP） reduction. Secondary outcomes included reduction of glaucoma medications, surgical complications, and success at 2y. Success was defined as： 1） IOP≤21 mm Hg and at least 20% IOP reduction from baseline after 3mo at any two consecutive visits; 2） no additional glaucoma surgery required. RESULTS： A total of 42 Chinese POAG patients from three glaucoma centers were enrolled. Twelve patients underwent Trabectome surgery combined with phacoemulsification and intraocular lens implantation while the remainder underwent Trabectome surgery alone. Thirteen patients had a history of failed glaucoma surgery and were considered as complicated cases. In China data, the mean preoperative IOP was 21.4±1.23 mm Hg. The Trabectome lowered IOP to 17.9±1.8 mm Hg at 2y （P=0.05）. The number of glaucoma medications also decreased significantly from a baseline of 2.0±0.9 to 1.1±0.8 at 2y post-surgery （P=0.04）. The overall 2-year success rate was 78%, with patients undergoing combined surgery having a higher success rate compared with those undergoing Trabectome surgery alone （100% vs 76%）. In Japan data, the mean preoperative IOP was 20.8±7.7 mm Hg. The Trabectome lowered IOP to 12.20±2.0 mm Hg at 2y. The number of glaucoma medications also decreased significantly from a baseline of 2.1±0.9 to 3.4±0.6 at 2y post-surgery. In all patients, no major complications were seen. CONCLUSION： Surgery with the Trabectome appears to be an efficient and safe procedure in Chinese POAG patients in the long-term.

Robot-assisted surgery for gastric cancer

Minimally invasive surgery for gastric cancer is a rela-tively new research field, with convincing results mostly stemming from Asian countries. The use of the robotic surgery platform, thus far assessed as a safe procedure, which is also easier to learn, sets the background for a wider spread of minimally invasive technique in the treatment of gastric cancer. This review will cover the literature published so far, analyzing the pros and cons of robotic surgery and highlighting the remaining study questions.

微创人工耳蜗植入技术

近几年来微创人工耳蜗植入（minimally invasive cochlear implantation，MICI）在国内、外耳科学界不断被提出。微创手术（minimallyinvasivesurgery）这一治疗理念始于1985年，当时英国泌尿外科医师Payne Wickham在内镜治疗泌尿道结石的报道中首次使用“minimally invasiveprocedure”一词来描述治疗过程，随后在医学各个学科领域内被广泛使用，微创手术这一理念也被广泛传播。

Endoscopy-assisted cerebral falx incision via unilateral approach for treatment of dissymmetric bilateral frontal contusion

Objective： To investigate the clinical features and treatment strategy of dissymmetric bilateral frontal contusion, and to summarize our experience in treating these patients by minimally invasive surgery. Methods： Over the past 3 years, we have treated a total of 31 patients with dissymmetric bilateral frontal contusion using endoscopy-assisted unilateral cerebral falx incision. ~ ~ther 30 patients treated by routine bilateral approaches within the same period were taken as control. Results： Seventeen cases （54.8%） in the unilateral operation group survived and were in good condition, 8 （25.8%） had moderate disability, 4 （12.9%） had severe disability, 1 （3.2%） was in vegetative state, and 1 （3.2%） died. Compared with the control group, the Glasgow Out- come Scale score was not significantly different in the uni-lateral operation group, but the operation time, blood trans- fusion volume, the length of hospital stay, the incidences of mental disorder and olfactory nerve injury were greatly reduced in the unilateral operation group. Conclusions： Endoscopy-assisted unilateral cerebral falx incision can shorten the operation time, reduce surgical trauma and complications in treatment of patients with dissymmetric bilateral frontal contusion. It can obviously diminish the chance of delayed intracerebral hematoma and subsequently minimize the incidences of subfalcial and centrencephalic herniation.