Minimally invasive surgical procedures

微创外科手术
  • 文章类型: English Abstract
    拔牙是口腔颌面外科中常见且广泛使用的治疗方法。微创拔牙可以减少患者的生理和心理创伤,并被广泛推荐作为一线临床治疗。但是目前尚无指南或共识来系统地介绍微创拔牙来指导临床实践。为了解决这个问题,这一共识,基于全面的文献综述和专家的临床经验,系统地总结了适应症,目标患者,和微创拔牙的禁忌症,该程序的总体工作流程(术前准备,手术步骤,术后管理,术后指导,药物,和后续行动),及其术后常见并发症,为该技术的临床应用提供全面指导。
    Tooth extraction is a common and widely employed therapeutic procedure in oral and maxillofacial surgery. Minimally invasive tooth extraction can reduce both physical and psychological trauma to the patients, and is widely recommended as a first-line clinical treatment. But currently no guidelines or consensus has been available to provide a systematic introduction of minimally invasive tooth extraction to guide the clinical practices. To address this issue, this consensus, based on a comprehensive literature review and clinical experiences of experts, systematically summarizes the indications, target patients, and contraindications of minimally invasive tooth extraction, the overall workflow of this procedure (preoperative preparation, surgical steps, postoperative management, postoperative instructions, medications, and follow-up), and its common postoperative complications to provide a comprehensive guidance for clinical application of this technique.
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  • 文章类型: Journal Article
    Pancreatic cancer is a highly malignant tumor in the digestive system, and radical surgery is the only possible means to cure pancreatic cancer at present. In the past decade, pancreatic surgery has been developing rapidly, with various new technologies and concepts emerging, among which the use of minimally invasive techniques and the popularization of neoadjuvant therapy concepts are the most notable. At the same time, the surgical treatment of pancreatic cancer still has a long way to go, and many problems need to be solved urgently. This article introduces the surgical treatment of pancreatic cancer in the 2024 edition of the NCCN guidelines, focusing on minimally invasive and open surgical treatments, expanded lymph node dissection, combined vascular resection and reconstruction, surgical treatment of pancreatic neck cancer and neoadjuvant therapy, and briefly discussing the unresolved issues.
    胰腺癌是消化系统恶性程度较高的肿瘤,根治性手术是目前唯一可能治愈胰腺癌的手段。近十年来,胰腺外科发展迅速,各类新技术、新理念不断涌现,其中以微创技术的运用和新辅助治疗理念的普及最为引人注目;同时,胰腺癌的外科治疗仍有很长的道路要走,许多问题亟待解决。本文对2024版NCCN指南中胰腺癌外科治疗部分进行介绍,重点解读微创入路和开腹手术治疗、扩大淋巴结清扫、联合血管切除重建、胰颈癌的手术治疗和新辅助治疗这几方面,同时对其中尚未解决的问题做简要讨论。.
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  • 文章类型: Journal Article
    韩国妇科肿瘤学会管理宫颈癌实践指南的第五次修订版纳入了最新的研究结果和基于2020年发布的4.0版本的治疗策略的变化。每个关键问题都是通过关注宫颈癌领域的最新显着见解和重要的当代问题来开发的。评估了这些问题的重要性和对当前治疗的影响,并由发展委员会通过投票最终确定。选择的关键问题如下:免疫检查点抑制剂作为复发或转移性宫颈癌一线或二线治疗的有效性和安全性;早期宫颈癌微创根治性子宫切除术的肿瘤学安全性;局部晚期宫颈癌同步放化疗后辅助全身治疗的有效性和安全性;前哨淋巴结定位术与盆腔淋巴结清扫术相比的肿瘤学安全性。的建议,方向,本指南的优势是基于系统评价和荟萃分析,并最终通过公开听证会和外部审查得到确认。在这项研究中,我们描述了修订后的宫颈癌管理实践指南.
    This fifth revised version of the Korean Society of Gynecologic Oncology practice guidelines for the management of cervical cancer incorporates recent research findings and changes in treatment strategies based on version 4.0 released in 2020. Each key question was developed by focusing on recent notable insights and crucial contemporary issues in the field of cervical cancer. These questions were evaluated for their significance and impact on the current treatment and were finalized through voting by the development committee. The selected key questions were as follows: the efficacy and safety of immune checkpoint inhibitors as first- or second-line treatment for recurrent or metastatic cervical cancer; the oncologic safety of minimally invasive radical hysterectomy in early stage cervical cancer; the efficacy and safety of adjuvant systemic treatment after concurrent chemoradiotherapy in locally advanced cervical cancer; and the oncologic safety of sentinel lymph node mapping compared to pelvic lymph node dissection. The recommendations, directions, and strengths of this guideline were based on systematic reviews and meta-analyses, and were finally confirmed through public hearings and external reviews. In this study, we describe the revised practice guidelines for the management of cervical cancer.
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  • 文章类型: Journal Article
    背景:尽管已确定接受新辅助化疗可改善局部晚期胃癌(LAGC)患者的不良生存结局,几项随机对照试验未显示接受微创手术(MIS)和开腹胃切除术的患者在肿瘤结局/总生存期(OS)方面存在差异.这项研究旨在调查接受MIS与LAGC开放手术的患者的国家综合癌症网络(NCCN)指南依从性和教科书肿瘤学结果(TOO)。
    方法:在这项横断面研究中,我们使用国家癌症数据库评估了2013年至2019年期间接受根治性治疗的II/III期LAGC(cT2-T4N0-3M0)患者.进行了多变量分析以评估手术入路,NCCN指南遵守情况,TOO,和OS。该研究已在国际标准随机对照试验编号注册表(注册号:ISRCTN53410429)上注册,并根据《加强外科队列研究报告和加强流行病学观察研究报告指南》进行。
    结果:在13,885名患者中,诊断时的中位年龄为68岁(IQR,59-76);大多数患者为男性(n=9887,71.2%),鉴定为白人(n=10,295,74.1%)。与接受开放手术的患者相比,接受MIS(n=4692,33.8%)的NCCN指南依从性和TOO有所提高(51.3%vs43.5%和36.7%vs27.3%,分别;两者P<.001)。从2013年到2019年,遵守NCCN指南和实现TOO的可能性增加(35.6%对50.9%和31.4%对46.4%,分别;两者P<.001)。此外,在接受MIS手术的NCCN指南依从性和TOO患者中,观察到中位OS改善(57.3vs49.8个月[P=.041]和68.4vs60.6个月[P=.025],分别)。
    结论:在美国接受多模式和治愈性治疗的LAGC患者中,指南依从性治疗和TOO成就的总体增加。采用微创胃切除术可能会改善短期和长期预后。
    BACKGROUND: Although receipt of neoadjuvant chemotherapy has been identified to improve unfavorable survival outcomes among patients with locally advanced gastric cancer (LAGC), several randomized controlled trials have not demonstrated a difference in oncological outcomes/overall survival (OS) among patients undergoing minimally invasive surgery (MIS) versus open gastrectomy. This study aimed to investigate National Comprehensive Cancer Network (NCCN) guideline adherence and textbook oncological outcome (TOO) among patients undergoing MIS versus open surgery for LAGC.
    METHODS: In this cross-sectional study, patients with stage II/III LAGC (cT2-T4N0-3M0) who underwent curative-intent treatment between 2013 and 2019 were evaluated using the National Cancer Database. Multivariable analysis was performed to assess the association between surgical approach, NCCN guideline adherence, TOO, and OS. The study was registered on the International Standard Randomised Controlled Trial Number registry (registration number: ISRCTN53410429) and conducted according to the Strengthening The Reporting Of Cohort Studies in Surgery and Strengthening the Reporting of Observational Studies in Epidemiology guidelines.
    RESULTS: Among 13,885 patients, median age at diagnosis was 68 years (IQR, 59-76); most patients were male (n = 9887, 71.2%) and identified as White (n = 10,295, 74.1%). Patients who underwent MIS (n = 4692, 33.8%) had improved NCCN guideline adherence and TOO compared with patients who underwent open surgery (51.3% vs 43.5% and 36.7% vs 27.3%, respectively; both P < .001). Adherence to NCCN guidelines and likelihood to achieve TOO increased from 2013 to 2019 (35.6% vs 50.9% and 31.4% vs 46.4%, respectively; both P < .001). Moreover, improved median OS was observed among patients with NCCN guideline adherence and TOO undergoing MIS versus open surgery (57.3 vs 49.8 months [P = .041] and 68.4 vs 60.6 months [P = .025], respectively).
    CONCLUSIONS: An overall increase in guideline-adherent treatment and achievement of TOO among patients with LAGC undergoing multimodal and curative-intent treatment in the United States was observed. Adoption of minimally invasive gastrectomy may result in improved short- and long-term outcomes.
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  • 文章类型: Journal Article
    背景:肥胖正在增加。先前的研究表明,肥胖与腰椎融合后的不良事件之间存在关联。关于肥胖对微创SI关节融合(SIJF)结局的影响的证据有限。
    目的:本研究的目的是研究肥胖对使用三角形钛植入物(TTI)进行SIJF手术的患者报告结局的影响。
    方法:基于四项前瞻性临床试验的回顾性队列研究(INSITE[NCT01681004],SFI[NCT01640353],iMIA[NCT01741025],andSALLY[NCT03122899]).
    方法:在2012年至2021年之间接受微创手术(MIS)骶髂关节(SIJ)融合的年龄≥18岁的成年患者。
    方法:视觉模拟量表(VAS疼痛),Oswestry残疾指数(ODI)。
    方法:使用美国国立卫生研究院体重指数(BMI)对参与者进行分类。BMI为30至39且无明显合并症的患者被认为是肥胖,BMI为35~39且有显著合并症或BMI为40或更高的患者被认为是病态肥胖.所有受试者均接受了带TTI的微创SIJ融合或非手术治疗(仅限INSITE和iMIA研究)。所有受试者在基线和24个月的预定访视时完成SIJ疼痛量表评分(用100点VAS测量)和残疾评分(用ODI测量)。重复测量方差分析用于检查BMI类别对得分变化的影响。
    结果:在SIJF组中,平均SIJ疼痛在24个月时改善了53.3分(p<.0001)。在24个月的随访期间,BMI类别不影响SIJ疼痛量表评分的平均改善(重复测量方差分析(ANOVA)p=0.44)。在SIJF组中,24个月时的平均ODI提高了25.8个百分点(p<0.0001)。BMI类别不影响ODI的平均改善(方差分析p=0.60)。在非手术管理(NSM)组中,SIJ疼痛量表和ODI的平均改善在临床上较小(8.7和5.2分,分别),不受BMI类别影响(方差分析p=.49和.40)。
    结论:这项研究表明,在所有BMI类别中,采用TTI的微创SIJ融合具有相似的益处和风险。此分析表明,肥胖患者受益于微创SIJ融合,不应仅基于BMI升高而拒绝此手术。
    BACKGROUND: Obesity is increasing. Previous studies have demonstrated an association between obesity and adverse events after lumbar fusion. There is limited evidence on the effect of obesity on minimally invasive SI joint fusion (SIJF) outcomes.
    OBJECTIVE: The purpose of this study was to investigate the impact of obesity on patient-reported outcomes in patients undergoing SIJF surgery using triangular titanium implants (TTI).
    METHODS: Retrospective cohort study based on four prospective clinical trials (INSITE [NCT01681004], SIFI [NCT01640353], iMIA [NCT01741025], and SALLY [NCT03122899]).
    METHODS: Adult patients ≥18 years of age who underwent minimally invasive surgery (MIS) sacroiliac joint (SIJ) fusion between 2012 and 2021.
    METHODS: Visual analog scale (VAS Pain), Oswestry Disability Index (ODI).
    METHODS: Participants were classified using the National Institutes of Health body mass index (BMI). Patients with a BMI of 30 to 39 with no significant comorbidity are considered obese, patients with a BMI of 35 to 39 with a significant comorbidity or a BMI of 40 or greater are considered morbidly obese. All subjects underwent either minimally invasive SIJ fusion with TTI or nonsurgical management (INSITE and iMIA studies only). All subjects completed SIJ pain scale scores (measured with a 100-point VAS) and disability scores (measured with ODI) at baseline and at scheduled visits to 24 months. Repeated measures analysis of variance was used to examine the impact of BMI category on score changes.
    RESULTS: In the SIJF group, mean SIJ pain improved at 24 months by 53.3 points (p<.0001). Over the 24-month follow-up period, BMI category did not impact mean improvement in SIJ pain scale score (repeated measures analysis of variance (ANOVA) p=.44). In the SIJF group, mean ODI at 24 months improved by 25.8 points (p<.0001). BMI category did not impact mean improvement in ODI (ANOVA p=.60). In the nonsurgical management (NSM) group, mean improvements in SIJ pain scale and ODI were clinically small (8.7 and 5.2 points, respectively) and not affected by BMI category (ANOVA p=.49 and .40).
    CONCLUSIONS: This study demonstrates similar benefits and risks of minimally invasive SIJ fusion with TTI across all BMI categories. This analysis suggests that obese patients benefit from minimally invasive SIJ fusion and should not be denied this procedure based solely on elevated BMI.
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  • 文章类型: Journal Article
    在微创手术(MIS)期间,外科医生在没有开放手术切口的情况下创建小的经皮切口以进入内部结构。一些MIS设备对于围手术期护士的管理是复杂且具有挑战性的。患者在MIS过程中也可能经历危及生命的并发症。更新的AORN“微创手术指南”提供了围手术期护士在护理接受MIS手术的患者时可以使用的建议。本文概述了该指南,并讨论了一些建议,包括创建一个安全的环境来执行MIS程序;使用气体膨胀介质,灌溉和液体扩张介质,以及计算机辅助导航和机器人技术;并以混合OR进行术中磁共振成像。它还包括描述经历宫腔镜检查的患者的护理的场景。护理接受MIS手术的患者的围手术期护士应全面审查指南,并在其实践中应用适用的建议。
    During minimally invasive surgery (MIS), surgeons create small and percutaneous incisions to access internal structures without open surgical incisions. Some MIS equipment is complex and challenging for perioperative nurses to manage. Patients also can experience life-threatening complications during MIS procedures. The updated AORN \"Guideline for minimally invasive surgery\" provides recommendations that perioperative nurses can use when caring for patients undergoing MIS procedures. This article provides an overview of the guideline and discusses several recommendations, including creating a safe environment in which to perform MIS procedures; using gas distension media, irrigation and fluid distension media, and computer-assisted navigation and robotics; and performing intraoperative magnetic resonance imaging in a hybrid OR. It also includes a scenario describing care of a patient undergoing a hysteroscopy. Perioperative nurses who care for patients undergoing MIS procedures should review the guideline in its entirety and apply the recommendations as applicable in their practice.
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  • 文章类型: English Abstract
    Minimally invasive glaucoma surgery (MIGS) is widely used in China because of its effective reduction of intraocular pressure, small incisions, few surgical complications, and quick postoperative recovery. In order to regulate and promote the clinical application of MIGS, the Glaucoma Group of Ophthalmology Branch of Chinese Medical Association has formed consensus opinions on the clinical application and perioperative management of MIGS with subconjunctival implants on the basis of domestic and foreign research results and clinical practice, providing reference and guidance for clinical work.
    微创青光眼手术(MIGS)具有降低眼压效果明确、切口小、手术并发症少、术后恢复快等特点,在国内得到迅速推广。为规范促进MIGS的临床应用,中华医学会眼科学分会青光眼学组针对结膜下植入物滤过性MIGS的临床应用及围手术期管理,基于国内外研究结果和临床实践,经过充分讨论,提出共识性意见,以期为临床开展相关工作提供参考和指导。.
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  • 文章类型: Journal Article
    目的:制定和更新基于证据和共识的腹腔镜和机器人胰腺手术指南。
    背景:微创胰腺手术(MIPS),包括腹腔镜和机器人手术,是复杂和技术要求。最小化患者的风险需要严格的,循证指南。自2019年国际迈阿密MIPS指南以来,已经报道了新的发展和主要出版物,需要更新。
    方法:针对8个领域的22个主题提出了基于证据的指南:术语,适应症,病人,程序,外科技术和器械,评估工具,实施和培训,和人工智能。布雷西亚国际公认的微创胰腺手术欧洲指南(EGUMIPS,2022年9月)使用苏格兰校际指南网络(SIGN)方法来评估证据并制定指南建议,德尔菲法在专家委员会之间就建议达成共识,用于方法学指南质量评估的AGREEII-GRS工具,以及由验证委员会进行的外部验证。
    结果:总体而言,27位欧洲专家,6位国际专家,22名国际验证委员会成员,11名陪审团成员,18个研究委员会成员,在为期两天的会议中,121名注册与会者参与了指南的制定和验证.总的来说,提出了98项建议,包括33例腹腔镜手术,34个关于机器人,31个关于一般MIPS,涵盖8个领域的22个主题。在98项建议中,97在专家和大会与会者中达成了至少80%的共识,所有建议均由验证委员会外部验证。
    结论:关于腹腔镜和机器人MIPS的EGUMIPS循证指南可应用于当前的临床实践,为患者提供指导,外科医生,政策制定者和医疗社会。
    To develop and update evidence-based and consensus-based guidelines on laparoscopic and robotic pancreatic surgery.
    Minimally invasive pancreatic surgery (MIPS), including laparoscopic and robotic surgery, is complex and technically demanding. Minimizing the risk for patients requires stringent, evidence-based guidelines. Since the International Miami Guidelines on MIPS in 2019, new developments and key publications have been reported, necessitating an update.
    Evidence-based guidelines on 22 topics in 8 domains were proposed: terminology, indications, patients, procedures, surgical techniques and instrumentation, assessment tools, implementation and training, and artificial intelligence. The Brescia Internationally Validated European Guidelines on Minimally Invasive Pancreatic Surgery (EGUMIPS, September 2022) used the Scottish Intercollegiate Guidelines Network (SIGN) methodology to assess the evidence and develop guideline recommendations, the Delphi method to establish consensus on the recommendations among the Expert Committee, and the AGREE II-GRS tool for guideline quality assessment and external validation by a Validation Committee.
    Overall, 27 European experts, 6 international experts, 22 international Validation Committee members, 11 Jury Committee members, 18 Research Committee members, and 121 registered attendees of the 2-day meeting were involved in the development and validation of the guidelines. In total, 98 recommendations were developed, including 33 on laparoscopic, 34 on robotic, and 31 on general MIPS, covering 22 topics in 8 domains. Out of 98 recommendations, 97 reached at least 80% consensus among the experts and congress attendees, and all recommendations were externally validated by the Validation Committee.
    The EGUMIPS evidence-based guidelines on laparoscopic and robotic MIPS can be applied in current clinical practice to provide guidance to patients, surgeons, policy-makers, and medical societies.
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  • 文章类型: Editorial
    暂无摘要。
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  • 文章类型: Practice Guideline
    评估微创手术在不孕症患者管理中的益处和风险,并为管理这些患者常见疾病的妇科医生提供指导。
    接受调查和治疗的不孕患者(12个月无保护性交后不能怀孕)。
    微创生殖手术可用于治疗不孕症,改善生育治疗结果,或保持生育能力。所有手术都有风险和相关并发症。生殖手术可能不会改善生育结果,在某些情况下,损害卵巢储备。所有的程序都有成本,由患者或其健康保险提供者承担。
    我们在PubMed/MEDLINE搜索了2010年1月至2021年5月的英语文章,Embase,科学直接,Scopus,和Cochrane图书馆(MeSH搜索词见附录A)。
    作者使用建议分级评估对证据的质量和建议的强度进行了评估,开发和评估(等级)方法。参见在线附录B(表B1中的定义和B2中的强和有条件的[弱]建议的解释)。
    治疗不孕症患者常见疾病的妇科医生。
    建议。
    To evaluate the benefits and risks of minimally invasive procedures in the management of patients with infertility and provide guidance to gynaecologists who manage common conditions in these patients.
    Patients with infertility (inability to conceive after 12 months of unprotected intercourse) undergoing investigation and treatment.
    Minimally invasive reproductive surgery can be used to treat infertility, improve fertility treatment outcomes, or preserve fertility. All surgery has risks and associated complications. Reproductive surgery may not improve fertility outcomes and may, in some instances, damage ovarian reserve. All procedures have costs, which are borne either by the patient or their health insurance provider.
    We searched English-language articles from January 2010 to May 2021 in PubMed/MEDLINE, Embase, Science Direct, Scopus, and Cochrane Library (see Appendix A for MeSH search terms).
    The authors rated the quality of evidence and strength of recommendations using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach. See online Appendix B (Tables B1 for definitions and B2 for interpretations of strong and conditional [weak] recommendations).
    Gynaecologists who manage common conditions in patients with infertility.
    RECOMMENDATIONS.
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