Minimally invasive treatment of hepatic hemangioma by transcatheter arterial embolization combined with microwave ablation:A case report

BACKGROUND Hepatic hemangioma is the most common benign tumor of the liver.However,patients with large hemangiomas that cause compression symptoms or that are at risk of rupture may need further intervention.It is necessary to explore additional minimally invasive and personalized treatment options for hemangiomas.CASE SUMMARY A 47-year-old woman was diagnosed with a right hepatic hemangioma for more than 10 years.Abdominal contrast-enhanced computed tomography(CT)and contrast-enhanced ultrasound revealed that there was a large hemangioma in the right liver,with a size of approximately 95 mm×97 mm×117 mm.Due to the patient's refusal of surgical treatment,hepatic artery embolization was performed in the first stage.After 25 d of liver protection treatment,the liver function indexes decreased to normal levels.Then,ultrasound-guided microwave ablation of the giant hepatic hemangioma was performed.Ten days after the treatment,hepatobiliary ultrasonography showed that the hemangioma of the right liver was smaller than the previous size(the volume was reduced by approximately 30%).Then the patient was discharged from the hospital.One year after discharge,CT showed that the hepatic hemangioma had shrunk by about 80%CONCLUSION Transcatheter arterial embolization combined with microwave ablation is a safe and effective minimally invasive treatment for hepatic hemangioma.

Advances in minimally invasive treatment of hemorrhagic and ischemic stroke

Cerebrovascular diseases,including ischemic and hemorrhagic strokes,affect more than 6 million US adults annually.Strokes cause high rates of morbidity and mortality due to the central nervous system’s sensitivity to disruptions in blood flow,and are refractory to traditional surgical interventions.A variety of minimally invasive surgical and endovascular approaches have recently been developed to improve patient outcomes following stroke.

Advances in Minimally Invasive Treatment of Benign Prostatic Hyperplasia

Benign prostatic hyperplasia (BPH) is a chronic condition that is more common in older men. BPH most commonly causes symptoms associated with LUTS and bladder outlet obstruction. Lower urinary tract symptoms (LUTS) in men with BPH are a major cause of reduced quality of life in older men. If bladder outlet obstruction persists for a longer period of time, the contractility and voiding capacity of the detrusor muscle will gradually be affected by the obstructive factors, eventually leading to a loss of compensatory phase, characterised by a reduced electrical stimulation response, replacement of bladder muscle tissue by connective tissue, and a possible increase in voiding pressure, but a decrease in contractility of the detrusor muscle. As BOO progresses, it eventually leads to permanent contractile dysfunction of the detrusor muscle. Therefore, early initiation of surgical treatment in patients who are not well controlled by medication can reduce the complications associated with prostate enlargement. With the rise of minimally invasive treatment and the complications of open surgery, minimally invasive treatment of BPH has attracted increasing attention. Various emerging minimally invasive surgical modalities are being developed in clinical practice, and more and more minimally invasive techniques and concepts are focusing on safety, improving quality of life and reducing long-term complications to meet the different needs of different patients. Transurethral resection of the prostate (TURP) is currently the “gold standard” of minimally invasive surgical treatment, but with concerns about post-operative complications, the search for safer and more effective minimally invasive surgical options has become even more important. In recent years, with the increasing clinical application of new minimally invasive techniques such as various lasers, interventional treatments and implantable devices, there are more options for minimally invasive treatment of BPH. This article provides a brief review of research advances in the minimally invasive treatment of benign prostatic hyperplasia, with a view to informing clinical decisions.

Minimally invasive esophagectomy for the treatment of esophageal cancer:a report of 81 cases

Objective To assess the feasibility and clinical efficacy of minimally invasive esophagectomy for esophageal cancer. Methods From July 2007 to December 2009,eighty-one patients with esophageal cancer received combined thoracoscopic and laparoscopic esophagectomy with anastomosis in the neck. All clinical data were retrospectively reviewed. Results The median operative

Clinical efficacy of integral theory–guided laparoscopic integral pelvic floor/ligament repair in the treatment of internal rectal prolapse in females

BACKGROUND Internal rectal prolapse(IRP)is one of the most common causes of obstructive constipation.The incidence of IRP in women is approximately three times that in men.IRP is mainly treated by surgery,which can be divided into two categories:Abdominal procedures and perineal procedures.This study offers a better procedure for the treatment of IRP.AIM To compare the clinical efficacy of laparoscopic integral pelvic floor/ligament repair(IPFLR)combined with a procedure for prolapse and hemorrhoids(PPH)and the laparoscopic IPFLR alone in the treatment of IRP in women.METHODS This study collected the clinical data of 130 female patients with IRP who underwent surgery from January 2012 to October 2014.The patients were divided into groups A and B.Group A had 63 patients who underwent laparoscopic IPFLR alone,and group B had 67 patients who underwent the laparoscopic IPFLR combined with PPH.The degree of internal rectal prolapse(DIRP),Wexner constipation scale(WCS)score,Wexner incontinence scale(WIS)score,and Gastrointestinal Quality of Life Index(GIQLI)score were compared between groups and within groups before surgery and 6 mo and 2 years after surgery.RESULTS All laparoscopic surgeries were successful.The general information,number of bowel movements before surgery,DIRP,GIQLI score,WIS score,and WCS score before surgery were not significantly different between the two groups(all P>0.05).The WCS score,WIS score,GIQLI score,and DIRP in each group 6 mo,and 2 years after surgery were significantly better than before surgery(P<0.001).In group A,the DIRP and WCS score gradually improved from 6 mo to 2 years after surgery(P<0.001),and the GIQLI score progressively improved from 6 mo to 2 years after surgery(P<0.05).In group B,the DIRP,WCS score and WIS score significantly improved from 6 mo to 2 years after surgery(P<0.05),and the GIQLI score 2 years after surgery was significantly higher than that 6 mo after surgery(P<0.05).The WCS score,WIS score,GIQLI score,and DIRP of group B were significantly better than those of group A 6 mo and 2 years after surgery(all P<0.001,Bonferroni)except DIRP at 2 years after surgery.There was a significant difference in the recurrence rate of IRP between the two groups 6 mo after surgery(P=0.011).There was no significant difference in postoperative grade I-III complications between the two groups(P=0.822).CONCLUSION Integral theory–guided laparoscopic IPFLR combined with PPH has a higher cure rate and a better clinical efficacy than laparoscopic IPFLR alone.

Clinical Application of Minimally Invasive Surgery in Pain and Complications after Spinal Trauma

Objective:To study and evaluate the incidence of pain and complications in patients with spinal trauma after minimally invasive treatment.Methods:The research period was selected from January 2018 to December 2020,and 40 patients with spinal trauma were selected.According to the random number table scheme,they were divided into the study group and the control group.The treatment scheme of the control group was traditional surgery,and the treatment scheme of the study group was minimally invasive surgery.The indicators of the two groups were compared and analyzed.Results:Compared with the two groups of surgery and postoperative recovery related indicators,the study group had more advantages(P<0.05);Compared two groups of postoperative NRS score,VAS score and the incidence of complications,the study group had more advantages(P<0.05).Conclusion:Minimally invasive treatment of spinal trauma has significant clinical effect,which can effectively relieve postoperative pain and reduce the incidence of various complications.

Minimally invasive method to treat a rare wrist injury with simultaneous fractures of the scaphoid and hook of hamate: A case report and literature review

Concomitant fractures of the hook of hamate and scaphoid are rare injuries to the wrist. Whenever these fractures cannot be effectively managed, nonunion or osteonecrosis is encountered. Subsequent treatment is thus much more challenging for a hand surgeon or orthopedist. Minimally invasive percutaneous internal fixation is an optimal treatment with the potential to minimize injury and reduce fractures. However, the control of iatrogenic injuries, including possible damage to the adjacent vital tissue, is a challenge that needs to be addressed. Herein,we describe the case of a 26-year-old man who presented with fractures to the scaphoid and hook of hamate in his left wrist. Minimally invasive treatment-with closed reduction and percutaneous fixation of the scaphoid, wrist arthroscopy, and closed reduction and percutaneous fixation of the hook of hamate-was performed at our institution. The Mayo score of the wrist, visual analog scale(VAS) for pain, grip strength, pinch strength, and wrist motion in radial/ulnar and flexion/extension deviation were recorded. Primary healing was achieved in both fractures. At the final follow-up, the Mayo score of the wrist was 100(excellent), the VAS score was 0(no pain),and the grip and pinch strength of his injured hand were 90.9% and 83.3%, respectively, compared with the contralateral hand(grip strength: left, 50 kg;right, 55 kg. Pinch strength: left, 20 kg;right, 24 kg). The radialulnar, flexion-extension, and forearm pronation-supination directions were 30°, 140°, and 90°, respectively.Minimally invasive closed reduction with percutaneous internal fixation is an optimal technique with satisfactory outcomes for simultaneous fractures of the hook of hamate and scaphoid. Provided in this paper are details of the technique and technical suggestions for performing the procedure.

Application of Endovenous Laser Treatment Combined with Foam Sclerotherapy for the Minimally Invasive Treatment of Great Saphenous Vein Varicosity

Objective:To evaluate the efficacy of endovenous laser treatment(EVLT)combined with foam sclerotherapy(FS)in the treatment of great saphenous vein varicosity(GSVV).Methods:A total of 50 patients with GSVV,treated between March 2021 and March 2024,were selected and randomly divided into two groups using a random number table.The combination group(25 cases)underwent EVLT combined with FS,while the conventional group(25 cases)underwent EVLT alone.The total effective rate,complication rate,disease severity score,and serological indicators were compared between the two groups.Results:The total effective rate in the combination group was higher,and the complication rate was lower compared to the conventional group(P<0.05).One week after surgery,the disease severity score in the combination group was lower,coagulation function indicators were better,and inflammatory factor levels were lower compared to the conventional group(P<0.05).Conclusion:EVLT combined with FS can improve the clinical efficacy in GSVV patients,prevent postoperative complications,reduce disease severity,protect patients’coagulation function,and alleviate postoperative inflammatory responses,showing significant advantages in combined surgery.

Strategies of minimally invasive treatment for intrahepatic and extrahepatic bile duct stones

Cholellthiasis is a kind of common and multiple diseases. In recent years, traolttonal laparommy has been challenged by a minimally invasive surgery. Through literature review, the therapeutic method, effect, and complications of minimally invasive treatment of intrahepatic and extrahepatic bile duct stones by combining our practical experience were summarized as follows. （1） For intrahepatic bile duct stones, the operation may be selected by laparoscopie liver resection, laparoscopic common bile duct exploration （LCBDE）, or percutaneous transhepatic cholangioscopy. （2） For concomitant gallstones and common bile duct stones, the surgical approach can be selected as follows： laparoscopic cholecystectomy （LC） combined with endoscopic sphincterotomy （EST） or endoscopic papillary balloon dilatation, LC plus laparoscopic transcystic common bile duct exploration, LC plus LCBDE, and T-tube drainage or primary suture. （3） For concomitant intrahepatic and extrahepatic bile duct stones, laparoscopic liver resection, choledochoscopy through the hepatic duct orifice on the hepatectomy cross section, LCBDE, EST, and percutaneous transhepatic cholangioscopic lithotripsy could be used. According to the abovementioned principle, the minimally invasive treatment approach combined with the surgical technique and equipment condition will be significant in improving the therapeutic effect and avoiding the postoperative complications or hidden dangers of intrahepatic and extrahepatic bile duct stones.

Aluminum potassium sulfate and tannic acid sclerotherapy for Goligher Grades Ⅱ and Ⅲ hemorrhoids: Results from a multicenter study

AIM: To show that aluminum potassium sulfate and tannic acid(ALTA) sclerotherapy has a high success rate for Grade Ⅱ and Ⅲ hemorrhoids.METHODS: This study was based on the clinical data of 604 patients with hemorrhoids who underwent ALTA sclerotherapy between January 2009 and February 2015. The objective of this study was to assess the efficacy of this treatment for Grades Ⅱ and Ⅲ hemorrhoids. Preoperative and postoperative symptoms, complications and success rate were all assessed retrospectively. Follow-up consisted of a simple questionnaire, physical examination and an anoscopy. Patients were followed-up at one day, one week, two weeks, one month, one year, two years, three years, four years and five years after the ALTA sclerotherapy.RESULTS: One hundred and sixty-nine patients were diagnosed with Grade Ⅱ hemorrhoids and 435 patients were diagnosed with Grade Ⅲ hemorrhoids. The one year, three year and five year cumulative success rates of ALTA sclerotherapy for Grades Ⅱ and Ⅲ hemo-rrhoids were 95.9% and 93.1%; 89.3% and 83.7%; and 89.3% and 78.2%, respectively. No significant differences were observed in the cumulative success rates after ALTA sclerotherapy between Grades Ⅱ and Ⅲ hemorrhoids(P = 0.09). There were forty-seven post-operative complications(low grade fever; anal pain; urinary retention; rectal ulcer; and others). No serious or life-threatening complications occurred and all cases improved through conservative treatment. At univariate analysis there were no predictive factors of failure.CONCLUSION: ALTA sclerotherapy has had a high success rate for Grade Ⅱ and Ⅲ hemorrhoids during five years of post-operative treatment. However, additional studies are needed to evaluate the efficacy of this ALTA sclerotherapy in the management of hemorrhoidal disease.

Is necrosectomy obsolete for infected necrotizing pancreatitis? Is a paradigm shift needed?

In 1886,Senn stated that removing necrotic pancreatic and peripancreatic tissue would benefit patients with severe acute pancreatitis.Since then,necrosectomy has been a mainstay of surgical procedures for infected necrotizing pancreatitis(NP).No published report has successfully questioned the role of necrosectomy.Recently,however,increasing evidence shows good outcomes when treating walled-off necrotizing pancreatitis without a necrosectomy.The literature concerning NP published primarily after 2000 was reviewed;it demonstrates the feasibility of a paradigm shift.The majority(75%)of minimally invasive necrosectomies show higher completion rates:between 80%and 100%.Transluminal endoscopic necrosectomy has shown remarkable results when combined with percutaneous drainage or a metallic stent.Related morbidities range from 40%to 92%.Single-digit mortality rates have been achieved with transluminal endoscopic necrosectomy,but not with video-assisted retroperitoneal necrosectomy series.Drainage procedures without necrosectomy have evolved from percutaneous drainage to transluminal endoscopic drainage with or without percutaneous endoscopic gastrostomy access for laparoscopic instruments.Most series have reached higher success rates of 79%-93%,and even 100%,using transcystic multiple drainage methods.It is becoming evident that transluminal endoscopic drainage treatment of walledoff NP without a necrosectomy is feasible.With further refinement of the drainage procedures,a paradigm shift from necrosectomy to drainage is inevitable.

Combined laparoscopic spleen-preserving distal pancreatectomy and islet autotransplantation for benign pancreatic neoplasm

AIM: To evaluate the safety and feasibility of laparoscopic spleen-preserving distal pancreatectomy (LSPDP) with autologous islet transplantation (AIT) for benign tumors of the pancreatic body-neck.

Management of BPH then 2000 and now 2016-From BPH to BPO

The diagnosis and treatment of benign prostatic obstruction(BPO)is based on a number of well-known lower urinary tract symptoms(LUTS)feared by all ageing males with functional testes.The ascent of modern urology turned this disease from lethal into an annoying but treatable health problem in the previous century.We are able to relieve the great majority of patients from their bothersome symptoms to a respectable quality of life by medication or removal of the obstructive part of the enlarged prostate.We can be proud of some progress made in the new millennium to reach a correct diagnosis and subsequent choice of treatment aiming for quality of life and cost-efficiency for public health.Still it remains symptomatic treatment and we expect the new generation of urologists to close some gaps in our knowledge on the regulation of prostatic growth to focus on prevention and elimination of the disease in the foreseeable future.

Predictive Factors of Lymph Node Metastasis in Early Mucinous Adenocarcinoma

OBJECTIVE To identify clinicopathologic factors which predictlymph node metastases (LNM) in early mucinous adenocarcinomapatients, and to further explore the possibility of using minimallyinvasive treatment for patients with the disease.METHODS Data was collected from 38 patients with earlymucinous adenocarcinoma who were surgically treated, and theassociation between clinicopathologic factors and the presenceof LNM was retrospectively analyzed using univariate andmultivariate logistic regression analysis.RESULTS Tumor size greater than 2.0 cm, the developmentof submucosal invasion, and the presence of lymphatic vesselinvolvement (LVI) were confirmed through univariate analysis ashaving a significant association with LNM and were consideredto be significant and independent risk factors for LNM throughmultivariate analysis.CONCLUSION Tumor size > 2.0 cm, the development ofsubmucosal invasion, and the presence of LVI are independentpredictive factors for LNM in early mucinous adenocarcinoma.Minimally invasive treatment may be an effective treatment forintramucosal early mucinous adenocarcinoma when the tumorsize is 2.0 cm or less, and if LVI has not occurred, as confirmed bypostoperative histologic examination.