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2014 ESC/ESA Guidelines on non-cardiac surgery

European Journal of Anaesthesiology2014-08-12作者：Steen Dalby Kristensen, Juhani Knuuti, Antti Saraste

This article is accompanied by the following Invited Commentary: Longrois D, Hoeft A, De Hert S. 2014 European Society of Cardiology/European Society of Anaesthesiology guidelines on non-cardiac surgery: cardiovascular assessment and management. A short explanatory statement from the European Society of Anaesthesiology members who participated in the European Task Force. Eur J Anaesthesiol 2014; 31:513–516. ESC Committee for Practice Guidelines: Jose Luis Zamorano (Chairperson) (Spain), Stephan Achenbach (Germany), Helmut Baumgartner (Germany), Jeroen J. Bax (Spain), Luis (Spain), Stephan (Chairperson) De Committee (Spain), De Stephan ESC in of the and on the ESC of and of the in and for of of of and in on of in on of in of in in and of in the of and in the of of in and Society of in in and cardiovascular Committee for Practice cardiovascular and European Society of Anaesthesiology ESC European Society of in of in and and the of the on the of in the for the on the of and the in the by the in the and A of in by the European Society of and the European Society of Anaesthesiology by and of the on for the of guidelines in the for and on the ESC the of on and of Task by the ESC and the of in the of the for and of the ESC Committee for Practice and Committee A of and assessment of the of for of and the of of and in and of of of the and in of of of and on the ESC in of the the and Task from the ESC and from the ESC and the of by Task Committee is for the of ESC and by the and Committee and is by the in the Task Force. is by the for in the 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Pelvic ring fractures: should they be fixed?

Journal of Bone and Joint Surgery - British Volume1988-01-01作者：M. Tile

The Journal of Bone and Joint Surgery. British volumeVol. 70-B, No. 1 ArticlesFree AccessPelvic ring fractures: should they be fixed?M TileM TileSearch for more papers by this authorPublished Online:1 Jan 1988https://doi.org/10.1302/0301-620X.70B1.3276697AboutSectionsPDF/EPUB ToolsAdd to FavouritesDownload CitationsTrack CitationsPermissions ShareShare onFacebookTwitterLinked InRedditEmail FiguresReferencesRelatedDetailsCited byPreoperative CT simulation of iliosacral screws for treating unstable posterior pelvic ring injury8 March 2022 | BMC Musculoskeletal Disorders, Vol. 23, No. 1Functional outcome of unstable pelvic fractures treated in a level III hospital in a developing country: a 10-year prospective observational study4 April 2022 | Journal of Orthopaedic Surgery and Research, Vol. 17, No. 1Percutaneous posterior transiliac plate versus iliosacral screw fixation for posterior fixation of Tile C-type pelvic fractures: a retrospective comparative study16 June 2022 | BMC Musculoskeletal Disorders, Vol. 23, No. 1Equestrian-Related Pelvic Trauma in Women of Childbearing Age — a Review of the Experience of a National Pelvic & Acetabular Referral Centre27 July 2022 | SN Comprehensive Clinical Medicine, Vol. 4, No. 1CT of Sacral Fractures: Classification Systems and ManagementRadioGraphics, Vol. 42, No. 7Moving forward with the management of minimally displaced lateral compression pelvic ring injuries18 June 2022 | European Journal of Orthopaedic Surgery & Traumatology, Vol. 32, No. 7Biomechanical Comparison of 4 Transsacral Fixation Constructs in a Type 61C, Zone II Pelvic Fracture ModelJournal of Orthopaedic Trauma, Vol. 36, No. 10Rami Comminution Is Associated With Displacement of Minimally Displaced Lateral Compression Type 1 Injuries on Lateral Stress RadiographsJournal of Orthopaedic Trauma, Vol. 36, No. 10Surgical management of paediatric pelvic fractures: a prospective case series and early experience from a level one Egyptian trauma centre23 July 2022 | International Orthopaedics, Vol. 46, No. 10A Review on Management of Insufficiency Fractures of the Pelvis and AcetabulumOrthopedic Clinics of North America, Vol. 53, No. 4Lumbo-sacral Junction Instability by Traumatic Sacral Fractures: Isler’s Classification Revisited – A Narrative Review22 February 2022 | Global Spine Journal, Vol. 12, No. 8Prolonged ileus in traumatic pelvic ring injury patients who underwent arterial angio-embolization: A retrospective studyMedicine, Vol. 101, No. 39Surgical Versus Non-surgical Treatment of Unstable Lateral Compression Type I (LC1) Injuries of the Pelvis With Complete Sacral Fractures in Non-fragility Fracture Patients: A Systematic ReviewCureus, Vol. 15Analysis of Postoperative Gait, Hip Strength, and Patient-Reported Outcomes After OTA/AO 61-B and 61-C Pelvic Ring InjuriesJournal of Orthopaedic Trauma, Vol. 36, No. 9Dual-Energy CT and Cinematic Rendering to Improve Assessment of Pelvic Fracture InstabilityRadiology, Vol. 304, No. 2Mortality and functional outcomes of fragility fractures of the pelvis by fracture type with conservative treatment: a retrospective, multicenter TRON study1 December 2021 | European Journal of Trauma and Emergency Surgery, Vol. 48, No. 4Pelvic Fracture Urethral Distraction DefectUrologic Clinics of North America, Vol. 49, No. 3Paediatric pelvic fractures – an updated literature review3 July 2022 | ANZ Journal of Surgery, Vol. 36Sakrumfrakturen beim geriatrischen Patienten1 June 2022 | Zeitschrift für Gerontologie und Geriatrie, Vol. 55, No. 4Evolution of the AO Spine Sacral and Pelvic Classification System: a systematic reviewJournal of Neurosurgery: Spine, Vol. 78Nonoperative Management of Minimally Displaced Lateral Compression Type 1 Pelvic Ring Injuries With and Without Occult InstabilityJournal of Orthopaedic Trauma, Vol. 36, No. 6Reliability and reproducibility analysis of the AOSpine Sacral Fractures Classification System by spinal and pelvic surgeonsInjury, Vol. 53, No. 6Outcomes and complications of the INFIX technique for unstable pelvic ring injuries with high-velocity trauma: a systematic review and meta-analysis11 January 2021 | Archives of Orthopaedic and Trauma Surgery, Vol. 142, No. 5Anatomic reduction of the sacroiliac joint in unstable pelvic ring injuries and its correlation with functional outcome30 September 2020 | European Journal of Trauma and Emergency Surgery, Vol. 48, No. 2Emergency Department Stress Radiographs of Lateral Compression Type-1 Pelvic Ring Injuries Are Safe, Effective, and Reliable17 December 2021 | Journal of Bone and Joint Surgery, Vol. 104, No. 4Ligaments stabilizing the sacrum and sacroiliac joint: a comprehensive review25 August 2021 | Neurosurgical Review, Vol. 45, No. 1Pelvic ring and acetabular fracture: Concepts of traumatological forensic interestInjury, Vol. 53, No. 2Danger zone - The spermatic cord during anterior plating of the symphysis pubisInjury, Vol. 53, No. 2The pectineal ligament is a secondary stabilizer in anterior pelvic ring fractures - a biomechanical studyInjury, Vol. 53, No. 2Inter- and intra-observer agreement using the new AOSpine sacral fracture classification, with a comparison between spine and pelvic trauma surgeonsInjury, Vol. 53, No. 2Accuracy of Radiographic Displacement Measurement in a Pelvic Ring Injury Model13 September 2021 | Journal of the American Academy of Orthopaedic Surgeons, Vol. 30, No. 2The Influence of Regional Differences on the Reliability of the AO Spine Sacral Injury Classification System8 January 2022 | Global Spine Journal, Vol. 67Computer and magnetic resonance imaging for pelvic fractures in children12 May 2021 | Medical Visualization, Vol. 25, No. 4Nonoperative Treatment of Select Lateral Compression Type II Pelvic Ring Injuries (OTA/AO 61B2.2) Results in a Low Rate of Radiographic DisplacementJournal of Orthopaedic Trauma, Vol. 36, No. 1BibliographyManagement of Open Tile C Pelvic Fractures and Their Outcomes: A Retrospective Study of 30 Cases1 September 2022 | Therapeutics and Clinical Risk Management, Vol. Volume 18A nomogram to predict arterial bleeding in patients with pelvic fractures after blunt trauma: a retrospective cohort study8 February 2021 | Journal of Orthopaedic Surgery and Research, Vol. 16, No. 1Three‐dimensional‐printed customized prosthesis for pubic defect: clinical outcomes in 5 cases at a mean follow‐up of 24 months30 April 2021 | BMC Musculoskeletal Disorders, Vol. 22, No. 1Which factors influence treatment decision in fragility fractures of the pelvis? - results of a prospective study13 August 2021 | BMC Musculoskeletal Disorders, Vol. 22, No. 1Comparison of lumbopelvic fixation and iliosacral screw fixation for the treatment of bilateral sacral fractures16 October 2021 | Journal of Orthopaedic Surgery and Research, Vol. 16, No. 1Minimally displaced acetabulum fractures in geriatric patients: a comparison of open, percutaneous and non-operative treatment from the German Pelvic Injury Register data8 April 2020 | European Journal of Trauma and Emergency Surgery, Vol. 47, No. 6Transarterial embolisation is associated with improved survival in patients with pelvic fracture: propensity score matching analyses19 September 2020 | European Journal of Trauma and Emergency Surgery, Vol. 47, No. 6A retrospective study about functional outcome and quality of life after surgical fixation of insufficiency pelvic ring injuries13 December 2021 | BMC Musculoskeletal Disorders, Vol. 22, No. 1Is Anterior Plating Superior to the Bilateral Use of Retrograde Transpubic Screws for Treatment of Straddle Pelvic Ring Fractures? A Biomechanical Investigation28 October 2021 | Journal of Clinical Medicine, Vol. 10, No. 21Verification of High-Rate Vertical Loading Laboratory Skeletal Fractures by Comparison with Theater Injury Patterns15 October 2021 | Annals of Biomedical Engineering, Vol. 49, No. 11Reproductibilité intra- et inter-examinateur de la classification AO/OTA 2018 des ruptures de l’anneau pelvien à haute énergie : une étude rétrospectiveRevue de Chirurgie Orthopédique et Traumatologique, Vol. 107, No. 6Inter- and intraobserver reliability assessment of the 2018 AO/OTA classification for high-energy pelvic ring injuries: A retrospective studyOrthopaedics & Traumatology: Surgery & Research, Vol. 107, No. 6Management and outcomes of open pelvic fractures: An updateInjury, Vol. 52, No. 10One sacroiliac screw for posterior ring fixation in unstable pelvic fractures1 November 2021 | Acta Orthopaedica Belgica, Vol. 87, No. 3Endovascular management of haemorrhage in pelvic traumaSurgery in Practice and Science, Vol. 6The FFP-classification: From eminence to evidenceInjury, Vol. 94The Influence of Surgeon Experience and Subspeciality on the Reliability of the AO Spine Sacral Classification SystemSpine, Vol. Publish Ahead of PrintAssociation Between Stability and Urologic Lesions in Pelvic Ring Fractures. A Case Series Report6 January 2020 | Journal of Investigative Surgery, Vol. 34, No. 7Pelvic Ring Fractures and Lower Urinary Tract Injuries8 January 2020 | Journal of Investigative Surgery, Vol. 34, No. 7Validation of the AO Spine Sacral Classification SystemJournal of Orthopaedic Trauma, Vol. Publish Ahead of PrintLateral compression type 1 (LC1) pelvic ring injuries: a spectrum of fracture types and treatment algorithms16 April 2021 | European Journal of Orthopaedic Surgery & Traumatology, Vol. 31, No. 5An independent inter- and intraobserver agreement assessment of the AOSpine sacral fracture classification systemThe Spine Journal, Vol. 21, No. 7Incidence and Clinical Features of Urethral Injuries with Pelvic Fractures in Males: A 6-Year Retrospective Cohort Study at a Single Institution in South KoreaJournal of Trauma and Injury, Vol. 34, No. 2Short-Term Functional Outcomes and Quality of Life after B2.1 Type Pelvic Fractures for Surgically and Non-Surgically Treated Young Patients21 May 2021 | Medicina, Vol. 57, No. 6Pelvic and acetabular trauma in amateur equestrian enthusiasts – A retrospective reviewThe Surgeon, Vol. 120Bilateral vertical shear sacroiliac joint dislocations treated with bilateral triangular Osteosynthesis in a young female: A case reportTrauma Case Reports, Vol. 61Factors Associated With Failure of Superior Pubic Ramus ScrewsJournal of Orthopaedic Trauma, Vol. 35, No. 4Medium-Term Patient-Reported Quality of Life and Activities of Daily Living in Surgically Treated Trauma Patients With Pelvic, Acetabular or Combined Pelvic and Acetabular Fractures in a Retrospective Single-Center StudyJournal of Orthopaedic Trauma, Vol. 35, No. 4Relevant Clinical Findings of Patients with Extraperitoneal Bladder Injury Associated with Pelvic Fracture Who Underwent Operative Management: A 6-Year Retrospective StudyJournal of Acute Care Surgery, Vol. 11, No. 1Comparison of One-Year Functional Outcomes and Quality of Life between Posterior Pelvic Ring Fixation and Combined Anterior-Posterior Pelvic Ring Fixation after Lateral Compression (B2 Type) Pelvic Fracture26 February 2021 | Medicina, Vol. 57, No. 3Patient-reported Outcome in Surgically Treated Pelvic Ring Injuries at 5 Years Post-surgery19 September 2019 | Scandinavian Journal of Surgery, Vol. 110, No. 1Application of Pelvic Circumferential Compression Devices in Pelvic Ring Fractures—Are Guidelines Followed in Daily Practice?21 March 2021 | Journal of Clinical Medicine, Vol. 10, No. 6Interobserver reliability of the Tile classification system for pelvic fractures among radiologists and surgeons8 September 2020 | European Radiology, Vol. 31, No. 3An Automated Deep Learning Method for Tile AO/OTA Pelvic Fracture Severity Grading from Trauma whole-Body CT21 January 2021 | Journal of Digital Imaging, Vol. 34, No. 1The ‘nightstick’ ischial fracture: a unique oddity of the pelvic injury family26 February 2021 | BMJ Case Reports, Vol. 14, No. 2Treatment of Pelvic Fractures15 September 2020The History of Pelvic Fracture Treatment26 November 2020Classification of Pelvic Ring Injuries26 November 2020Biomechanics of the Pelvis26 November 2020Principles of Treatment of Pelvic Ring Injuries26 November 2020Ilium Fractures26 November 2020Retrograde Pubic Rami Screw26 November 2020Ilio-Iliacal Osteosynthesis26 November 2020Posterior pelvic ring injury of straddle fractures: Incidence, fixation methods, and clinical outcomesAsian Journal of Surgery, Vol. 44, No. 1Integrity of the pectineal ligament in MRI correlates with radiographic superior pubic ramus fracture displacement28 April 2020 | Acta Radiologica, Vol. 62, No. 1A systematic review of the transiliac internal fixator (TIFI) for posterior pelvic injuries26 July 2021 | SICOT-J, Vol. 7An Interpretable Approach to Automated Severity Scoring in Pelvic Trauma21 September 2021External Fixation in Pelvi-Acetabular Implantology3 December 2021Three-dimensional-printed customized prosthesis for pubic defect: prosthesis design and surgical techniques13 July 2020 | Journal of Orthopaedic Surgery and Research, Vol. 15, No. 1Radiostereometric Analysis Allows Assessment of the Stability and Inducible Displacement of Pelvic Ring Disruptions during Healing: A Case Series24 October 2020 | Journal of Clinical Medicine, Vol. 9, No. 11Minimal-invasive Stabilisierung bei Frakturen des Sakrums21 August 2020 | Der Unfallchirurg, Vol. 123, No. 10A Water Slide Accident Resulting in an Open Book Pelvic Injury and Subsequent Pulmonary Embolus: A Case Report5 August 2020 | Case Reports in Orthopedic Research, Vol. 3, No. 2Description and Reliability of the AOSpine Sacral Classification System21 April 2020 | Journal of Bone and Joint Surgery, Vol. 102, No. 16MRI Evaluation of the Posterior Pelvic Bony and Soft Tissue Injuries With Tile C Displaced Pelvic Fractures in Young Children20 March 2020 | Journal of Pediatric Orthopaedics, Vol. 40, No. 7Early fixation strategies for high energy pelvic ring injuries – the Zurich algorithmInjuryResults of open reduction internal fixation versus percutaneous iliosacral screw fixation for unstable pelvic ring injuries: retrospective study of 36 patients5 March 2020 | European Journal of Orthopaedic Surgery & Traumatology, Vol. 30, No. 5The Lateral Stress Radiograph Identifies Occult Instability of Lateral Compression Pelvic Ring Injuries Without SedationJournal of Orthopaedic Trauma, Vol. Publish Ahead of PrintFlegmasia cerúlea dolens posquirúrgica inmediata en el tratamiento de una fractura de pelvis. Reporte de Caso2 May 2020 | Revista de la Asociación Argentina de Ortopedia y Traumatología, Vol. 85, No. 2Long-term total hip arthroplasty rates in patients with acetabular and pelvic fractures after surgery: A population-based cohort study3 April 2020 | PLOS ONE, Vol. 15, No. 4Dual-energy CT as an innovative method for diagnosing fragility fractures of the pelvic ring: a retrospective comparison with MRI as the gold standard14 October 2019 | Archives of Orthopaedic and Trauma Surgery, Vol. 140, No. 4Radiologische Diagnostik von Beckenringfrakturen27 February 2020 | Der Radiologe, Vol. 60, No. 3High-energy Lateral Compression Type 1 Injuries of the PelvisJournal of the American Academy of Orthopaedic Surgeons, Vol. 28, No. 4CT-guided fixation of pelvic fractures after high-energy trauma, by interventional radiologists: technical and clinical outcome18 October 2019 | European Radiology, Vol. 30, No. 2Pelvic fractures in children (pelvic ring and acetabulum)Orthopaedics & Traumatology: Surgery & Research, Vol. 106, No. 1Combined 3D Printed Template to Guide Iliosacral Screw Insertion for Sacral Fracture and Dislocation: A Retrospective Analysis19 February 2020 | Orthopaedic Surgery, Vol. 12, No. 1Pelvic Vertical Shear Injuries and Sacroiliac Joint Disruptions2 January 2020Percutaneous removal of sacroiliac screw following iatrogenic neurologic injury in posterior pelvic ring injury: A case reportInternational Journal of Surgery Case Reports, Vol. 66Kinesiology of the pelvisPelvis16 April 2020Vertical shear pelvic ring injuries: do transsacral screws prevent fixation failure?1 September 2020 | OTA International: The Open Access Journal of Orthopaedic Trauma, Vol. 3, No. 3Outcome of pubic rami fractures with or without concomitant involvement of the posterior ring in elderly patients12 June 2018 | European Journal of Trauma and Emergency Surgery, Vol. 45, No. 6Modified less invasive anterior subcutaneous fixator for unstable Tile-C-pelvic ring fractures: a biomechanical study29 March 2019 | BioMedical Engineering OnLine, Vol. 18, No. 1Decision-making, therapy, and outcome in lateral compression fractures of the pelvis – analysis of a single center treatment15 May 2019 | BMC Musculoskeletal Disorders, Vol. 20, No. 1Operative Treatment of Pediatric Pelvic and Acetabulum FracturesJournal of Orthopaedic Trauma, Vol. 33, No. 8Surgery for Unilateral Sacral Fractures: Are the Indications Clear?Journal of Orthopaedic Trauma, Vol. 33, No. 12Is a Fracture of the Transverse Process of L5 an Indicator of the Presence and/or Severity of a Pelvic Fracture?Spine Surgery and Related Research, Vol. 3, No. 4Minimally Invasive Screw Fixation of Unstable Pelvic Fractures Using the “Blunt End” Kirschner Wire Technique Assisted by 3D Printed External TemplateBioMed Research International, Vol. 2019COMPARISON OF X-RAY AND CT METHODS FOR ASSESSING SACRAL SHAPE VARIANTS AND IDENTIFYING A SECURE SACROILIAC SCREW FIXATION CORRIDOR14 May 2020 | Journal of Musculoskeletal Research, Vol. 22, No. 03n04Pelvic TraumaYoung–Burgess classification: Inter-observer and inter-method agreement between pelvic radiograph and computed tomography in emergency polytrauma management8 July 2019 | Hong Kong Journal of Emergency Medicine, Vol. 71Management of male pelvic fracture urethral injuries: Review and current topics20 March 2019 | International Journal of Urology, Vol. 26, No. 6Interactive Flying Frustums (IFFs): spatially aware surgical data visualization12 March 2019 | International Journal of Computer Assisted Radiology and Surgery, Vol. 14, No. 6Ultrasound-guided supra-acetabular pelvic external fixator (US-SA FIX)Injury, Vol. 50AOSpine—Spine Trauma Classification System: The Value of Modifiers: A Narrative Review With Commentary on Evolving Descriptive Principles8 May 2019 | Global Spine Journal, Vol. 9, No. 1_supplTreatment of Partial Traumatic HemipelvectomyJournal of Bone and Joint Surgery, Vol. 101, No. 9Minimally invasive internal fixator for unstable pelvic ring injuries with a pedicle screw–rod system: a retrospective study of 23 patients after 13.5 months8 December 2018 | Archives of Orthopaedic and Trauma Surgery, Vol. 139, No. 4Complex Open Pelvic Fracture in an 8-Year-Old Girl Treated With INFIX—A Case StudyJAAOS: Global Research and Reviews, Vol. 3, No. 4Conventional plate fixation method versus pre-operative virtual simulation and three-dimensional printing-assisted contoured plate fixation method in the treatment of anterior pelvic ring fracture3 May 2018 | International Orthopaedics, Vol. 43, No. 2Levels of evidence in pelvic trauma: a bibliometric analysis of the top 50 cited papers12 May 2018 | Irish Journal of Medical Science (1971 -), Vol. 188, No. 1A biomechanical study comparing minimally invasive anterior pelvic ring fixation techniques to external fixationInjury, Vol. 50, No. 2Unstable Pelvic Ring Injuries: How Soon Can Patients Safely Bear Weight?Journal of Orthopaedic Trauma, Vol. 33, No. 2Long-Term Patient-Reported Functional Outcome of Polytraumatized Patients With Operatively Treated Pelvic FracturesJournal of Orthopaedic Trauma, Vol. 33, No. 2Pediatric Pelvic Injuries29 June 2019Fractures du bassin chez l'enfant (anneau pelvien et cotyle)Biomechanical evaluation of location and mode of failure in three screw fixations for a comminuted transforaminal sacral fracture modelJournal of Orthopaedic Translation, Vol. 16American College of Surgeons Committee on Trauma verification level affects trauma center management of pelvic ring injuries and patient mortalityJournal of Trauma and Acute Care Surgery, Vol. 86, No. 1Sciatic Nerve Palsy After Distal Femoral Traction for Vertically Unstable Pelvic Fracture in a Neurologically Intact Patient1 September 2019 | JAAOS: Global Research and Reviews, Vol. 3, No. 9Intramedullary Stabilization of Pubic Ramus Fractures in Elderly Patients With a Photodynamic Bone Stabilization System (IlluminOss)25 April 2019 | Geriatric Orthopaedic Surgery & Rehabilitation, Vol. 10Open pelvic fracture: the killing fracture?13 April 2018 | Journal of Orthopaedic Surgery and Research, Vol. 13, No. 1Minimally invasive treatment for anterior pelvic ring injuries with modified pedicle screw-rod fixation: a retrospective study17 September 2018 | Journal of Orthopaedic Surgery and Research, Vol. 13, No. 1Clinical and radiographic outcome of isolated sacroiliac joint dislocationsMinerva Ortopedica e Traumatologica, Vol. 69, No. 4Vertical shear pelvic injury: evaluation, management, and fixation strategies26 March 2018 | International Orthopaedics, Vol. 42, No. 11High-Energy Pelvic Ring Disruptions with Complete Posterior Instability3 October 2018 | Journal of Bone and Joint Surgery, Vol. 100, No. 19Paediatric pelvic ring injuriesOrthopaedics and Trauma, Vol. 32, No. 5Quantitative MDCT assessment of binder effects after pelvic ring disruptions using segmented pelvic and March 2018 | European Radiology, Vol. 28, No. Use of External Fixation for the Management of the Unstable Anterior Pelvic of Orthopaedic Trauma, Vol. 32, No. and of Tile C pelvic ring injuries using a external fixation December | European Journal of Orthopaedic Surgery & Traumatology, Vol. 28, No. of After Operative Treatment of Pelvic Ring InjuriesJournal of Orthopaedic Trauma, Vol. 32, No. 7Biomechanical of fixation techniques in sacrum type II fracture with December | Journal of Orthopaedic Vol. 36, No. for Injury after Pelvic Ring Vol. No. of Fractures Using a Clinical and Operative June 2018 | Journal of Orthopaedics, Trauma and Rehabilitation, Vol. No. 1The trauma from a A case study the of vertical Science International, Vol. Posterior Pelvic for Unstable Sacral Fractures: A Fixation of Orthopaedic Trauma, Vol. 32, No. compression type pelvic ring fractures in young patients do May | European Journal of Trauma and Emergency Surgery, Vol. 44, No. analysis of anterior ring fixation of the ramus in type C pelvis April | European Journal of Trauma and Emergency Surgery, Vol. 44, No. of life after pelvic ring fractures: A studyInjury, Vol. 49, No. fractures of the pelvic and Trauma, Vol. 32, No. in Trauma Emergency Vol. 34, No. of and bilateral sacroiliac joint of Neurosurgery: Spine, Vol. 28, No. fixation of and & Traumatology: Surgery & Research, Vol. 104, No. 1Pelvic Ring Injury May for Spine November Fractures in the and How to of the Fracture Vol. 31, No. screws CT to sacroiliac joint in C pelvic Outcomes at 5 of November 2018 | SICOT-J, Vol. 4Minimally invasive treatment of unstable pelvic ring injuries with modified pedicle screw–rod June | Journal of International Medical Research, Vol. 46, No. supra-acetabular in pelvic external fixation: of a surgical technique and Vol. of an anterior pelvic internal fixator to disruptions of the anterior pelvic of and September | The Bone & Joint Journal, Vol. No. of pelvic ring as a in – A case by of Clinical and Trauma, Vol. following anterior pelvic of a traumatic pubic symphysis treated with open reduction and internal of Clinical and Trauma, Vol. e do de Vol. 52, No. of pelvic ring fractures and de Ortopedia Vol. 52, No. and of after acetabular fractures October | Vol. 101, No. reduction internal fixation versus percutaneous iliosacral screw fixation for unstable posterior pelvic ring & Traumatology: Surgery & Research, Vol. No. Stress Pelvic Ring Without DisplacementJournal of Orthopaedic Trauma, Vol. 31, No. of in Analysis on Pelvic Biomechanical March | Orthopaedic Surgery, Vol. 9, No. spine and for or A Case for Care in the August of the internal fixator as an of pelvic ring March outcome of patients with unstable pelvic ring January | Journal of Orthopaedic Surgery, Vol. 25, No. en - Vol. 49, No. AND A FOR November | Journal of in and Vol. 16, No. MDCT Instability in Pelvic Ring Journal of Vol. No. de la Vol. 40, No. of the posterior Vol. 40, No. of Pelvic Ring and Acetabular in Vol. No. Surgery on with Pelvic Ring A Case of Trauma and Injury, Vol. No. Fixation of Pelvic Ring Injuries of Anterior Failure and of Bone and Joint Surgery, Vol. No. of Failure After Plating on Functional Outcome and of Orthopaedic Trauma, Vol. 30, No. internal fixation versus plate fixation for open pelvic ring injuries: a biomechanical study17 April | European Journal of Trauma and Emergency Surgery, Vol. 42, No. in sacral fracture and & Traumatology: Surgery & Research, Vol. 102, No. 1Pelvic ring injuries: management and of Clinical and Trauma, Vol. No. is the internal fixation in pelvic fracture with injury and anterior sacroiliac joint December | Medical Journal of Vol. No. Pelvic in Orthopaedics, Vol. 25, No. Fixation for Pelvic in Orthopaedics, Vol. 25, No. of the sacroiliac joint with unstable fractures of the pelvis and in a a case of Orthopaedic Science, Vol. 20, No. 6The internal fixator an innovative surgical technique for of fragility fractures of the Vol. Sacroiliac Screw Fixation of the Posterior Pelvic Clinics of North America, Vol. 46, No. and factors associated with in patients after pelvic Vol. No. pelvic injury in Journal of Traumatology, Vol. 18, No. iliosacral screw fixation after posterior ring fractures of the pelvis in elderly Vol. 46, No. study of the sacroiliac fracture fixation with and pedicle Vol. 23, No. paediatric pelvic of pelvic ring failure and the of of the May | The Bone & Joint Journal, Vol. No. classification, and of pelvic fracture urethral April 2019 | Journal of Urology, Vol. 13, No. 1Pelvic Ring November and about the Hip and of Pelvic Ring Fractures in November | Journal of Vol. Versus Care in the Treatment of Pelvic Vol. No. of a new of sacroiliac joint

Surgery Emergency Medicine Surgery

Minimally invasive endodontics: a new diagnostic system for assessing pulpitis and subsequent treatment needs

International Endodontic Journal2017-08-04作者：W. J. Wolters, Henry F. Duncan, Phillip L. Tomson

To introduce a new way of thinking about the inflamed pulp. We want to highlight that there is reversibly inflamed tissue in pulps that are currently diagnosed as irreversibly inflamed. This implies that the currently employed terminology may not reflect the actual inflammatory status of pulps evaluated clinically. We therefore propose and introduce a new diagnostic system with new terminology to highlight the healing potential of the pulp. This also implies that current treatment strategies are evaluated and revised to maintain pulp vitality with associated benefits. In the majority of cases of mature teeth diagnosed with irreversible pulpitis or apical periodontitis, root canal treatment is the therapy of choice to save the tooth. Inherent in this procedure is loss of dental hard tissue and subsequent weakening of the treated tooth (Kishen 2006, Al-Omiri et al. 2010), making them more prone to fracture (Reeh et al. 1989, Al-Omiri et al. 2010). Irreversible pulp inflammation and apical periodontitis indicate a dental infectious disease related to the presence of microorganisms in and/or outside the root canal system (Haapasalo et al. 2011). To resolve apical periodontitis and more advanced pulpal disease, the conventional treatment is removal of the complete pulp (root canal treatment) with the aim to reduce the number of bacteria in the root canal system which cause infection. However, cross-sectional research in the Netherlands has shown that around forty per cent of root filled teeth are associated with an apical radiolucency when examined using two-dimensional dental radiographs (Peters et al. 2011), indicating failure of the procedure, as only a small proportion of apical radiolucencies remain visible as fibrotic healing scars (Nair et al. 1999, Love & Firth 2009). This trend is seen worldwide (Wu et al. 2009). Furthermore, endodontically treated teeth without visible radiographic signs of apical periodontitis can still be infected (Molander et al. 1998, Ricucci et al. 2014). Therefore, the actual failure rate of standard root canal treatments performed in general practice is significantly higher than expected. Furthermore, these treatments are lengthy and costly and are often subject to retreatment (Figdor 2002). Less invasive alternative strategies could be used to treat pulpitis and increase the success of endodontic procedures beyond the improvement of the ‘tools and gadgets’ used during conventional root canal treatment. As new insights in pulp biology have been gained, recent clinical research on vital pulp therapy now provides options for developing new biologically driven treatment protocols (Aguilar & Linsuwanont 2011, Simon et al. 2013, Tomson et al. 2017). Such treatment modalities have two major advantages: first, pulp tissue is preserved, thus maintaining its physiological and defensive functions; secondly, less hard tooth tissue is removed, which results in less weakening of the tooth. Combining knowledge of pulp biology with insight into why conventional therapies often fail stimulates a shift in thinking about endodontic treatment. Avoiding full pulpectomies (complete removal of the pulp to the apical constriction), where possible, could be the first step in improving treatment outcomes. A biological immune response from even a partially retained pulp could improve the treatment outcome by preventing infection of the apical area (Aguilar & Linsuwanont 2011), and research has shown that results of vital pulp treatments are comparable to conventional root canal treatment (Asgary et al. 2015). With increasing knowledge regarding the biological healing processes in response to infected carious dentine and pulp, a new understanding of vital pulpal therapy has emerged (Simon et al. 2011). Dentine is a vital, cellular tissue, containing the cellular processes of the odontoblasts that lay in the pulp. Therefore, dentine and pulp must be considered together as a pulpo-dentinal complex (Pashley 1996). Recent research shows that the pulp is more resilient to significant microbial attacks than previously thought (Farges et al. 2013, Bjørndal et al. 2014, Cooper et al. 2014). Pulpal defence mechanisms to reduce the diffusion of microbes and microbial products towards the pulp include sclerosis of dentinal tubules and the formation of tertiary dentine (Bjørndal 2008). Apart from sclerosis and the replacement of dead odontoblasts, a host of growth factors, including TGF-β, ADM and IGF-1/-2, are released from the pulpo-dentinal complex when dentine is demineralized during the progression of a carious lesion (Finkelman et al. 1990, Cassidy et al. 1997, Cooper et al. 2010, 2011). These growth factors can have a positive effect on pulpal responses by enhancing the processes involved in pulp repair and regeneration (Smith et al. 2012, 2016). Ongoing research shows the impact of different growth factors encapsulated in dentine (Tomson et al. 2017). The fact that the regenerative potential of the pulpo-dentinal complex is evident in teeth with symptoms indicative of irreversible pulpitis suggests that the current classification of pulpitis may need to be revised (Ricucci et al. 2014). Probably cases traditionally deemed irreversible may in fact still be salvageable, thereby shifting the balance of what was irreversible towards reversible, when the correct treatment is applied (Ricucci et al. 2014, Taha et al. 2017). Traditionally, it was thought that there is a poor relationship between clinical signs and symptoms and the histological state of the pulp in mature teeth (Seltzer & Bender 1963, Garfunkel et al. 1973, Dummer et al. 1980); however, recently this was questioned, and a histological study showed that there is a good correlation between clinical symptoms of pulpitis and the corresponding histological state of a diseased pulp (Ricucci et al. 2014). In cases with irreversible pulpitis, the morphological changes indicating inflammation or necrosis were principally occurring in the coronal pulp whilst the radicular pulp was viable. This suggests that the radicular pulp could potentially be retained when a pulpotomy procedure is performed, thus preventing the need for a pulpectomy. This less invasive treatment approach (‘Endolight’) has the following advantages: Using vital pulp therapy, proper case selection and treatment protocols are essential if it is to be successful (Taha et al. 2017). Teeth exhibiting symptoms suggestive of irreversible pulpitis have little chance to revert to normal if no other intervention takes place than removal of irritants. In these cases, the section of the pulp that is inflamed must be removed so that the remaining uninflamed tissue can recover and heal (Ricucci et al. 2014). This has proven to be successful, and teeth diagnosed with irreversible pulpitis have been successfully treated with a pulpotomy (Taha et al. 2017, Qudeimat et al. 2017). If with the proper intervention, extensively inflamed pulps can be maintained, this then begs the questions, should the term ‘irreversible’ be used in our diagnostic criteria? Such a term condemns the pulp, resulting in pulpectomy or tooth extraction. Therefore, as long as there is some uninflamed pulp tissue and the complete pulp has not become necrotic, this uninflamed vital tissue can be managed and retained. Such an approach would carry the advantages outlined above. With the introduction of the ‘Endolight’ concept, the authors propose a new diagnostic system of pulpitis and associated treatment options for how pulpal disease should be managed. In light of the information reported in the above-mentioned recent studies, it becomes clear that it is time for traditional thinking and conventional root canal treatment procedures to be revisited. Caries progression in itself does not dictate treatment modalities, but observed clinical symptoms are important in predicting pulpal conditions and therefore indicate the choice of treatment. Probably, many pulps diagnosed with irreversible pulpitis have the potential to heal after implementing the appropriate minimally invasive or ‘light’ treatments. This means that lingering pain after a stimulus, normally recognized as indicative for irreversible pulpitis, may not necessarily correspond to an irreversible state of inflammation of the entire pulp. Often, only pulp tissue located in the pulp chamber is irreversibly inflamed if symptoms of prolonged lingering pain after cold/hot stimulus are present. Therefore, symptoms of pulpitis and pulpal diagnosis need to be considered carefully and followed by appropriate intervention. Indirect pulp treatment (IPT) or coronal pulpotomy could be excellent less-invasive alternative treatments that allow uninflamed pulp tissue to remain in place to regenerate and heal (Asgary et al. 2014, Taha et al. 2017). A recent positive development in pulpal diagnosis was the introduction of a new classification based on clinical symptoms (Hashem et al. 2015). Hashem and co-workers classified pulpitis as: We propose to change the criteria for the clinical diagnosis of (ir)reversible pulpitis and suggest the following expansion of the diagnostic classification of pulpal inflammation, relating the diagnosis to minimally invasive treatments, whereby the extensively inflamed tissue is removed, leaving uninflamed vital tissue in place. This means that there is always vital pulp tissue that has the potential to heal if it is managed correctly. Heightened but not lengthened response to the cold test, not sensitive to percussion and no spontaneous pain. Therapy: IPT (van der Sluis et al. 2013, Asgary et al. 2015) Heightened and lengthened reaction to cold, warmth and sweet stimuli that can last up to 20 s but then subsides, possibly percussion sensitive. According to the histological situation that fits these findings, it would be implied that there is limited local inflammation confined to the crown pulp. Therapy: IPT (van der Sluis et al. 2013, Asgary et al. 2015) Clear symptoms, strong, heightened and prolonged reaction to cold, which can last for minutes, possibly percussion sensitive and spontaneous dull pain that can be more or less suppressed with pain medication. According to the histological situation that fits these findings, it would be implied that there is extensive local inflammation confined to the crown pulp. Therapy: Coronal pulpotomy – partly/completely Severe spontaneous pain and clear pain reaction to warmth and cold stimuli, often, sharp to dull throbbing pain, patients have trouble sleeping because of the pain (gets worse when lying down). Tooth is very sensitive to touch and percussion. According to the histological situation that fits these findings, it would be implied that there is extensive local inflammation in the crown pulp that possibly extends into the root canals. Therapy: Coronal pulpotomy – if there is no prolonged bleeding of pulp stumps in the orifices of the canals, these will be covered with MTA in mature teeth, followed by restoration (Alqaderi et al. 2014). If one or more of the pulp stumps keeps bleeding after rinsing with 2 mL 2% NaOCl, a superficial pulpotomy can be carried out, whereby more inflamed tissue is removed from the canal up to 3–4 mm from the radiographic apex. If bleeding ceases, then the root canal up to the vital pulp tissue is filled with gutta-percha and sealer at this working length. If bleeding persists, a full pulpectomy needs to be performed in order to remove all inflamed tissue from the canal (Matsuo et al. 1996). If endodontic treatment fails, the following alternatives can be considered: endodontic retreatment and apical surgery or extraction. Vital pulp treatment has been shown to be highly successful if the intervention has been performed with the accompanying clinical symptoms as a guideline. There is good correlation between clinical symptoms of pulpitis and the corresponding histological state of an inflamed pulp. This information, together with the pre-treatment and mid-operative clinical findings, can be used to potentially save and retain pulp and tooth tissue with associated benefits. Developments in our understanding of pulp biology and the response of the pulp to the release of dentine-bound bioactive growth factors have made it clear that the pulp has substantial regenerative capabilities and that inflammation is a normal part of the healing response of the pulp. Vital pulp tissue that has been managed properly is quite resilient, and a diseased pulp can heal if most of the inflamed/necrotic tissue is removed. This gives the remaining tissue a chance to recover. The authors hope that with the proposition of a new system for diagnosing different stages of pulpitis, using associated symptoms and implementing new minimally invasive treatment strategies, new debate and research in the area of vital pulp treatment will be stimulated with improvement in treatment results for patients in the future. The authors have stated explicitly that there are no conflict of interest in connection with this article.

Oral Surgery Oral Surgery Surgery

Worldwide Research Productivity in the Field of Minimally Invasive Spine Surgery

Spine2015-12-16作者：Guoxin Fan, Ruoshuang Han, Hailong Zhang

MINI: The time trend for the number of minimally invasive spine surgery articles showed a significant increase over time with an average of 93.23 articles per year. Among all related journals, Spine published the largest number of articles in minimally invasive spine surgery research and was the most popular one in the top five countries. STUDY DESIGN: Bibliometric analysis. OBJECTIVE: This study aimed to reveal the characteristics of world productivity in the field of minimally invasive spine surgery (MISS) research and to provide a general picture for surgeons and researchers. SUMMARY OF BACKGROUND DATA: Significant growth has been observed in the field of MISS research in recent years. However, bibliometric studies concerning the quantity and quality of articles published in MISS journals are scarce. METHODS: All the data concerning MISS in this study originate from the Web of Science (Thomson Reuters, New York, NY) without restrictions. All selected literates were evaluated in the following aspects: publication year, publication journals, author, times cited, Web of Science category, countries/territories. RESULTS: A total number of 2051 articles were published worldwide. The articles published during 2000 to 2015 are more than 11.28 times when compared to those published before 2000. The United States published the largest number of articles (855/2051, 41.7%), followed by Germany (245/2051, 11.9%), South Korea (160/2051, 7.8%), China (147/2051, 7.2%), and Japan (108/2051, 5.2%) and had the highest total citations (16,626). Additionally, the United States had the highest average citations per article (12.14), followed by Japan (11.98), Germany (11.19), South Korea (11.04), and China (10.95). High-income countries published 98.73% of articles, upper-middle-income countries published 0.24% of articles, and middle-income countries published 1.03% of articles. CONCLUSION: The time trend for the number of MISS articles showed a significant increase over time with an average of 93.23 articles per year. The United States was the most productive country and had the highest average citations per article. Among related journals, Spine published the largest number of articles in MISS research and was the most popular one in the top five countries. LEVEL OF EVIDENCE: 5.

Statistics, Probability and Uncertainty Pathology and Forensic Medicine Public Health, Environmental and Occupational Health

Hallux valgus: effectiveness and safety of minimally invasive surgery. A systematic review

British Medical Bulletin2010-08-14作者：Nicola Maffulli, Umile Giuseppe Longo, Andrea Marinozzi

Minimally invasive techniques for hallux valgus correction include arthroscopy, percutaneous and minimum incision surgery. In the last few decades, several techniques have been increasingly used. We performed a comprehensive search of CINAHL, Embase, Medline, HealthSTAR and the Cochrane Central Registry of Controlled Trials, from inception of the database to 4 January 2010, using various combinations of the keywords terms 'Bosch', 'PDO', 'percutaneous distal osteotomy', 'SERI', 'percutaneous', 'minimal incision', 'minimum incision', 'minimally invasive', 'less invasive', 'mini-invasive', 'hallux valgus', 'bunion', 'surgery', 'arthroscopy', 'metatarsal' 'forefoot'. Only articles published in peer reviewed journals were included in this systematic review. Several new techniques are available for minimally invasive correction of the hallux valgus. Minimally invasive correction of the hallux valgus may provide better outcome for patients who would not recover well from traditional open approaches, because of decreasing recovery and rehabilitation times, as surgical exposure and deep tissue dissection are smaller and gentler to the soft tissues. Data are lacking to allow definitive conclusions on the use of these techniques for routine management of patients with hallux valgus. Given the limitations of the current case series, especially the extensive clinical heterogeneity, it is not possible to determine clear recommendations regarding the systematic use of minimally invasive surgery for hallux valgus correction, even though preliminary results are encouraging. Studies of higher levels of evidence, concentrating on large adequately powered randomized trials, should be conducted to help answer these questions.

Surgery Orthopedics and Sports Medicine Surgery

Toward Teaching by Demonstration for Robot-Assisted Minimally Invasive Surgery

IEEE Transactions on Automation Science and Engineering2021-01-07作者：Hang Su, Andrea Mariani, Salih Ertug Ovur

Learning manipulation skills from open surgery provides more flexible access to the organ targets in the abdomen cavity and this could make the surgical robot working in a highly intelligent and friendly manner. Teaching by demonstration (TbD) is capable of transferring the manipulation skills from human to humanoid robots by employing active learning of multiple demonstrated tasks. This work aims to transfer motion skills from multiple human demonstrations in open surgery to robot manipulators in robot-assisted minimally invasive surgery (RA-MIS) by using TbD. However, the kinematic constraint should be respected during the performing of the learned skills by using a robot for minimally invasive surgery. In this article, we propose a novel methodology by integrating the cognitive learning techniques and the developed control techniques, allowing the robot to be highly intelligent to learn senior surgeons' skills and to perform the learned surgical operations in semiautonomous surgery in the future. Finally, experiments are performed to verify the efficiency of the proposed strategy, and the results demonstrate the ability of the system to transfer human manipulation skills to a robot in RA-MIS and also shows that the remote center of motion (RCM) constraint can be guaranteed simultaneously. Note to Practitioners-This article is inspired by limited access to the manipulation of laparoscopic surgery under a kinematic constraint at the point of incision. Current commercial surgical robots are mostly operated by teleoperation, which is representing less autonomy on surgery. Assisting and enhancing the surgeon's performance by increasing the autonomy of surgical robots has fundamental importance. The technique of teaching by demonstration (TbD) is capable of transferring the manipulation skills from human to humanoid robots by employing active learning of multiple demonstrated tasks. With the improved ability to interact with humans, such as flexibility and compliance, the new generation of serial robots becomes more and more popular in nonclinical research. Thus, advanced control strategies are required by integrating cognitive functions and learning techniques into the processes of surgical operation between robots, surgeon, and minimally invasive surgery (MIS). In this article, we propose a novel methodology to model the manipulation skill from multiple demonstrations and execute the learned operations in robot-assisted minimally invasive surgery (RA-MIS) by using a decoupled controller to respect the remote center of motion (RCM) constraint exploiting the redundancy of the robot. The developed control scheme has the following functionalities: 1) it enables the 3-D manipulation skill modeling after multiple demonstrations of the surgical tasks in open surgery by integrating dynamic time warping (DTW) and Gaussian mixture model (GMM)-based dynamic movement primitive (DMP) and 2) it maintains the RCM constraint in a smaller safe area while performing the learned operation in RA-MIS. The developed control strategy can also be potentially used in other industrial applications with a similar scenario.

Biomedical Engineering Surgery Biomedical Engineering

Minimally Invasive versus Open Mitral Valve Surgery a Consensus Statement of the International Society of Minimally Invasive Coronary Surgery (ISMICS) 2010

Innovations Technology and Techniques in Cardiothoracic and Vascular Surgery2011-03-01作者：Volkmar Falk, Davy Cheng, Janet Martin

OBJECTIVE: : The purpose of this consensus conference was to deliberate the evidence regarding whether minimally invasive mitral valve surgery via thoracotomy improves clinical and resource outcomes compared with conventional open mitral valve surgery via median sternotomy in adults who require surgical intervention for mitral valve disease. METHODS: : Before the consensus conference, the consensus panel reviewed the best available evidence up to March 2010, whereby systematic reviews, randomized trials, and nonrandomized trials were considered in descending order of validity and importance. The accompanying meta-analysis article in this issue of the Journal provides the systematic review of the evidence. Based on this systematic review, evidence-based statements were created for prespecified clinical questions, and consensus processes were used to derive recommendations. The American Heart Association/American College of Cardiology system was used to label the level of evidence and class of each recommendation. RESULTS AND CONCLUSIONS: : Considering the underlying level of evidence, and notwithstanding the limitations of the evidence base (retrospective studies with important differences in baseline patient characteristics, which may produce bias in results of the evidence syntheses), the consensus panel provided the following evidence-based statements and overall recommendation:In patients with mitral valve disease, minimally invasive surgery may be an alternative to conventional mitral valve surgery (Class IIb), given that there was comparable short-term and long-term mortality (level B), comparable in-hospital morbidity (renal, pulmonary, cardiac complications, pain perception, and readmissions) (level B), reduced sternal complications, transfusions, postoperative atrial fibrillation, duration of ventilation, and intensive care unit and hospital length of stay (level B). However, this should be considered against the increased risk of stroke (2.1% vs 1.2%) (level B), aortic dissection (0.2% vs 0%) (level B), phrenic nerve palsy (3% vs 0%) (level B), groin infections/complications (2% vs 0%) (level B), and, prolonged cross-clamp time, cardiopulmonary bypass time, and procedure time (level B). The available evidence consists almost entirely of observational studies and must not be considered definitive until future adequately controlled randomized trials further address the risk of stroke, aortic complications, phrenic nerve complications, pain, long-term survival, need for reintervention, quality of life, and cost-effectiveness.

Surgery Cardiology and Cardiovascular Medicine Pulmonary and Respiratory Medicine

The use of robotics in minimally invasive spine surgery

Journal of Spine Surgery2019-06-01作者：Blake N. Staub, Saeed S. Sadrameli

The field of spine surgery has changed significantly over the past few decades as once technological fantasy has become reality. The advent of stereotaxis, intra-operative navigation, endoscopy, and percutaneous instrumentation have altered the landscape of spine surgery. The concept of minimally invasive spine (MIS) surgery has blossomed over the past ten years and now robot-assisted spine surgery is being championed by some as another potential paradigm altering technological advancement. The application of robotics in other surgical specialties has been shown to be a safe and feasible alternative to the traditional, open approach. In 2004 the Mazor Spine Assist robot was approved by FDA to assist with placement of pedicle screws and since then, more advanced robots with promising clinical outcomes have been introduced. Currently, robotic platforms are limited to pedicle screw placement. However, there are centers investigating the role of robotics in decompression, dural closure, and pre-planned osteotomies. Robot-assisted spine surgery has been shown to increase the accuracy of pedicle screw placement and decrease radiation exposure to surgeons. However, modern robotic technology also has certain disadvantages including a high introductory cost, steep learning curve, and inherent technological glitches. Currently, robotic spine surgery is in its infancy and most of the objective evidence available regarding its benefits draws from the use of robots in a shared-control model to assist with the placement of pedicle screws. As artificial intelligence software and feedback sensor design become more sophisticated, robots could facilitate other, more complex surgical tasks such as bony decompression or dural closure. The accuracy and precision afforded by the current robots available for use in spinal surgery potentially allow for even less tissue destructive and more meticulous MIS surgery. This article aims to provide a contemporary review of the use of robotics in MIS surgery.

Surgery Pathology and Forensic Medicine Biomedical Engineering

Survival after Minimally Invasive Radical Hysterectomy for Early-Stage Cervical Cancer

New England Journal of Medicine2018-10-31作者：Alexander Melamed, Daniel J. Margul, Ling Chen

BACKGROUND: Minimally invasive surgery was adopted as an alternative to laparotomy (open surgery) for radical hysterectomy in patients with early-stage cervical cancer before high-quality evidence regarding its effect on survival was available. We sought to determine the effect of minimally invasive surgery on all-cause mortality among women undergoing radical hysterectomy for cervical cancer. METHODS: We performed a cohort study involving women who underwent radical hysterectomy for stage IA2 or IB1 cervical cancer during the 2010-2013 period at Commission on Cancer-accredited hospitals in the United States. The study used inverse probability of treatment propensity-score weighting. We also conducted an interrupted time-series analysis involving women who underwent radical hysterectomy for cervical cancer during the 2000-2010 period, using the Surveillance, Epidemiology, and End Results program database. RESULTS: In the primary analysis, 1225 of 2461 women (49.8%) underwent minimally invasive surgery. Women treated with minimally invasive surgery were more often white, privately insured, and from ZIP Codes with higher socioeconomic status, had smaller, lower-grade tumors, and were more likely to have received a diagnosis later in the study period than women who underwent open surgery. Over a median follow-up of 45 months, the 4-year mortality was 9.1% among women who underwent minimally invasive surgery and 5.3% among those who underwent open surgery (hazard ratio, 1.65; 95% confidence interval [CI], 1.22 to 2.22; P=0.002 by the log-rank test). Before the adoption of minimally invasive radical hysterectomy (i.e., in the 2000-2006 period), the 4-year relative survival rate among women who underwent radical hysterectomy for cervical cancer remained stable (annual percentage change, 0.3%; 95% CI, -0.1 to 0.6). The adoption of minimally invasive surgery coincided with a decline in the 4-year relative survival rate of 0.8% (95% CI, 0.3 to 1.4) per year after 2006 (P=0.01 for change of trend). CONCLUSIONS: In an epidemiologic study, minimally invasive radical hysterectomy was associated with shorter overall survival than open surgery among women with stage IA2 or IB1 cervical carcinoma. (Funded by the National Cancer Institute and others.).

Obstetrics and Gynecology Epidemiology Cancer Research

Ultrafast Mid-IR Laser Scalpel: Protein Signals of the Fundamental Limits to Minimally Invasive Surgery

PLoS ONE2010-09-28作者：Saeid Amini‐Nik, Darren Kraemer, M. L. Cowan

Lasers have in principle the capability to cut at the level of a single cell, the fundamental limit to minimally invasive procedures and restructuring biological tissues. To date, this limit has not been achieved due to collateral damage on the macroscale that arises from thermal and shock wave induced collateral damage of surrounding tissue. Here, we report on a novel concept using a specifically designed Picosecond IR Laser (PIRL) that selectively energizes water molecules in the tissue to drive ablation or cutting process faster than thermal exchange of energy and shock wave propagation, without plasma formation or ionizing radiation effects. The targeted laser process imparts the least amount of energy in the remaining tissue without any of the deleterious photochemical or photothermal effects that accompanies other laser wavelengths and pulse parameters. Full thickness incisional and excisional wounds were generated in CD1 mice using the Picosecond IR Laser, a conventional surgical laser (DELight Er:YAG) or mechanical surgical tools. Transmission and scanning electron microscopy showed that the PIRL laser produced minimal tissue ablation with less damage of surrounding tissues than wounds formed using the other modalities. The width of scars formed by wounds made by the PIRL laser were half that of the scars produced using either a conventional surgical laser or a scalpel. Aniline blue staining showed higher levels of collagen in the early stage of the wounds produced using the PIRL laser, suggesting that these wounds mature faster. There were more viable cells extracted from skin using the PIRL laser, suggesting less cellular damage. β-catenin and TGF-β signalling, which are activated during the proliferative phase of wound healing, and whose level of activation correlates with the size of wounds was lower in wounds generated by the PIRL system. Wounds created with the PIRL systsem also showed a lower rate of cell proliferation. Direct comparison of wound healing responses to a conventional surgical laser, and standard mechanical instruments shows far less damage and near absence of scar formation by using PIRL laser. This new laser source appears to have achieved the long held promise of lasers in minimally invasive surgery.

Dermatology Radiology, Nuclear Medicine and Imaging Insect Science

A review of medical robotics for minimally invasive soft tissue surgery

Proceedings of the Institution of Mechanical Engineers Part H Journal of Engineering in Medicine2009-07-30作者：Gorkem Dogangil, Brian Davies, Ferdinando Rodriguez y Baena

This paper provides an overview of recent trends and developments in medical robotics for minimally invasive soft tissue surgery, with a view to highlight some of the issues posed and solutions proposed in the literature. The paper includes a thorough review of the literature, which focuses on soft tissue surgical robots developed and published in the last five years (between 2004 and 2008) in indexed journals and conference proceedings. Only surgical systems were considered; imaging and diagnostic devices were excluded from the review. The systems included in this paper are classified according to the following surgical specialties: neurosurgery; eye surgery and ear, nose, and throat (ENT); general, thoracic, and cardiac surgery; gastrointestinal and colorectal surgery; and urologic surgery. The systems are also cross-classified according to their engineering design and robotics technology, which is included in tabular form at the end of the paper. The review concludes with an overview of the field, along with some statistical considerations about the size, geographical spread, and impact of medical robotics for soft tissue surgery today.

Biomedical Engineering Condensed Matter Physics Pulmonary and Respiratory Medicine

The minimally invasive spinal deformity surgery algorithm: a reproducible rational framework for decision making in minimally invasive spinal deformity surgery

Neurosurgical FOCUS2014-05-01作者：Praveen V. Mummaneni, Christopher I. Shaffrey, Lawrence G. Lenke

OBJECT: Minimally invasive surgery (MIS) is an alternative to open deformity surgery for the treatment of patients with adult spinal deformity. However, at this time MIS techniques are not as versatile as open deformity techniques, and MIS techniques have been reported to result in suboptimal sagittal plane correction or pseudarthrosis when used for severe deformities. The minimally invasive spinal deformity surgery (MISDEF) algorithm was created to provide a framework for rational decision making for surgeons who are considering MIS versus open spine surgery. METHODS: A team of experienced spinal deformity surgeons developed the MISDEF algorithm that incorporates a patient's preoperative radiographic parameters and leads to one of 3 general plans ranging from MIS direct or indirect decompression to open deformity surgery with osteotomies. The authors surveyed fellowship-trained spine surgeons experienced with spinal deformity surgery to validate the algorithm using a set of 20 cases to establish interobserver reliability. They then resurveyed the same surgeons 2 months later with the same cases presented in a different sequence to establish intraobserver reliability. Responses were collected and tabulated. Fleiss' analysis was performed using MATLAB software. RESULTS: Over a 3-month period, 11 surgeons completed the surveys. Responses for MISDEF algorithm case review demonstrated an interobserver kappa of 0.58 for the first round of surveys and an interobserver kappa of 0.69 for the second round of surveys, consistent with substantial agreement. In at least 10 cases there was perfect agreement between the reviewing surgeons. The mean intraobserver kappa for the 2 surveys was 0.86 ± 0.15 (± SD) and ranged from 0.62 to 1. CONCLUSIONS: The use of the MISDEF algorithm provides consistent and straightforward guidance for surgeons who are considering either an MIS or an open approach for the treatment of patients with adult spinal deformity. The MISDEF algorithm was found to have substantial inter- and intraobserver agreement. Although further studies are needed, the application of this algorithm could provide a platform for surgeons to achieve the desired goals of surgery.

Surgery Surgery Pathology and Forensic Medicine

The evolution of minimally invasive mitral valve surgery – 2 year experience1

European Journal of Cardio-Thoracic Surgery1999-03-01作者：F. W. Mohr, J. Onnasch, Volkmar Falk

OBJECTIVES: The aim of the study was to evaluate the evolution of Port-Access minimally invasive mitral valve surgery to a robot assisted video assisted solo surgery approach. METHODS: One hundred and twenty-nine patients with non-ischemic mitral valve disease underwent 3D-video assisted mitral valve surgery via a 4 cm right lateral minithoracotomy using femoro-femoral bypass and endoaortic clamping. Transcranial Doppler and continuous transesophageal echocardiography were used to monitor placement and positional stability of the endoclamp. After the initial series (group I, n = 62), a simplified solo surgical technique using voice controlled robotic assistance for videoscope guidance was used in the last 67 patients (group II). RESULTS: After an initial learning curve and modifications of catheter design, the procedure could be steadily redefined and simplified. In the last 67 patients, the procedure was completed without the need for an additional assistant as 'solo surgery'. The mitral valve was repaired in 72 and replaced in all other patients. Duration of bypass and clamp time steadily improved during our study and in the most recent 67 patients average 107 +/- 34 and 48 +/- 16 min, respectively. The voice controlled robotic arm (AESOP 3000, Automated Endoscope System for Optimal Positioning) provided a stable and precise video image with excellent exposure of all valvular and subvalvular structures. Hospital mortality was high in the early series (mean survival 88.7% at 804 +/- 35 days; 95% CI: 735-873) and partially procedure related (aortic dissection in two patients). In group II, hospital mortality has declined to 3.0% (mean survival 97.0% at 568 +/- 12 days; 95% CI: 553-600). CONCLUSION: Port-Access minimally invasive mitral valve surgery has evolved to be a reliable video assisted technique with reproducible results. Surgery can now be performed almost in the same time as with conventional techniques. Robotic assistance has enabled a solo surgery approach.

Surgery Cardiology and Cardiovascular Medicine Biomedical Engineering

Tactile Sensors for Minimally Invasive Surgery: A Review of the State-of-the-Art, Applications, and Perspectives

IEEE Access2019-12-26作者：Naghmeh Bandari, Javad Dargahi, Muthukumaran Packirisamy

Minimally invasive surgery has been one of the most significant evolutions in medicine. In this approach, the surgeon inserts specially-designed instruments through a small incision on the patient's skin into the body cavities, abdomen, veins or, arteries and performs the surgery on organs. As a major limitation, surgeons lose their natural tactile perception due to indirect touch on the organs. Since the loss of tactile perception compromises the ability of surgeons in tissue distinction and maneuvers, researchers have proposed different tactile sensors. This review is to provide researchers with a literature map for the state-of-the-art of tactile sensors in minimally invasive surgery, e.g. in robotic, laparoscopic, palpation, biopsy, heart ablation, and valvuloplasty. In this regard, the pertinent literature from the year 2000 on sensing principles, design requirements, and specifications were reviewed in this study. The survey showed that size, range, resolution, variation, electrical passivity, and magnetic-resonance-compatibility were the most critical specification to study for tactile sensors. Based on the results, some of the requirements, e.g., magnetic-resonance-compatibility and electrical passivity are of less generality and more application-dependent; however, size, resolution, and range specifications differ for various applications and are of utmost importance.

Biomedical Engineering Biomedical Engineering Cognitive Neuroscience

Motion Compensation in Minimally Invasive Robotic Surgery

elib (German Aerospace Center)2003-01-01作者：Tobias Ortmaier

Minimally invasive beating heart surgery allows a very sparing operation, but increases the requirements for the surgeon: The remaining motion of the mechanically stabilized beating heart makes fast and safe surgery difficult. The goal of an advanced robotic surgery system is to compensate for this motion. This work presents control and vision algorithms necessary for such novel robotic surgery applications. Cartesian position and velocity control laws in a minimally invasive surgery environment allow correct hand eye coordination which the surgeon got used to in open surgery. In combination with appropriate filtering and scaling of input commands, high accuracy manipulation of fine structures is possible. A self-adapting Cartesian force control law reduces the risk of unintentional damage of delicate tissue structures. Motion of the mechanically stabilized beating heart is locally captured by tracking natural landmarks with an affine motion model. To circumvent disturbances of the tracking approach, specular reflections on the heart surface have to be handled appropriately. Automatic detection of landmarks allowing reliable determination of the affine model parameters can be achieved by special confidence measures. A new motion prediction framework is introduced to further increase robustness of the motion tracking scheme. This framework is able to compensate for short occlusions and small disturbances. Additional signals correlated with the heart motion (e.g. electrocardiogram) are included in this prediction scheme to reduce the dependency on visual information.

Biomedical Engineering Surgery Surgery

Percutaneous minimally invasive fetoscopic surgery for spina bifida aperta. Part I: surgical technique and perioperative outcome

Ultrasound in Obstetrics and Gynecology2014-06-02作者：Thomas Kohl

OBJECTIVES: To analyze the current technical approach of percutaneous minimal-access fetoscopic closure of spina bifida aperta (SBA) and provide an overview of its development in ovine and human fetuses. METHODS: Minimal-access percutaneous fetoscopic closure of SBA was performed at the German Center for Fetal Surgery & Minimal-access Therapy (DZFT) in 51 human fetuses at 21.0-29.1 weeks of gestation (mean age, 23.7 weeks). Various parameters of surgical relevance for the success and safety of the procedure and the early perioperative outcome were analyzed retrospectively. In addition, information from the early clinical cases was examined to determine how this shaped development of the approach. RESULTS: Percutaneous minimal-access fetoscopic closure of SBA was performed with a high rate of technical success, regardless of placental or fetal position. All fetuses survived surgery, but there was one very early preterm delivery 1 week after the procedure and this neonate died immediately, from early postoperative chorioamnionitis. Of the 50 surviving fetuses, 44 (88%) were delivered at or beyond 30 weeks and 25 (50%) at or beyond 34 weeks of gestation. There was one neonatal death from an uinsuspected case of trisomy 13 and two infant deaths from Chiari-II malformation. CONCLUSIONS: Following an adequate learning curve, minimal-access fetoscopic surgery for fetal spina bifida can be performed with a high rate of technical success, regardless of placental position.

Public Health, Environmental and Occupational Health Surgery Surgery

Minimally Invasive Glaucoma Surgery: A Review of the Literature

Vision2023-08-21作者：Michael Balas, David J. Mathew

Minimally invasive glaucoma surgery (MIGS) has emerged as a novel approach in the glaucoma treatment spectrum, offering a range of diverse procedures and devices aimed at reducing intraocular pressure (IOP). MIGS can be broadly classified into several categories: those that enhance trabecular outflow (Trabectome, iStent, Hydrus Microstent, Kahook Dual Blade, high frequency deep sclerotomy, and gonioscopy-assisted transluminal trabeculotomy), those that augment suprachoroidal outflow (CyPass Microstent and iStent Supra), those that target Schlemm's canal (TRAB360 and the OMNI Surgical System, Streamline, and Ab Interno Canaloplasty), and conjunctival bleb-forming procedures (EX-PRESS Glaucoma Filtration Device, Xen Gel Stent and PreserFlo MicroShunt). MIGS is considered to have a shorter surgical time and fewer severe complications when compared to traditional glaucoma surgeries such as trabeculectomy and glaucoma drainage device implantation (Ahmed, Baerveldt, and Molteno valves). This literature review comprehensively examines the distinct MIGS devices and procedures, their underlying mechanisms, and clinical outcomes, emphasizing the importance of evaluating the efficacy and complications of each approach individually. As the field of MIGS continues to evolve, it is crucial to prioritize high-quality, long-term studies to better understand the safety and effectiveness of these innovative interventions in glaucoma management.

Ophthalmology Pathology and Forensic Medicine Radiology, Nuclear Medicine and Imaging

Minimally invasive surgical techniques versus open myomectomy for uterine fibroids

Cochrane Database of Systematic Reviews2014-10-21作者：Priya Bhave Chittawar, Sebastian Franik, Anne-Floor W. Pouwer

BACKGROUND: Fibroids are common benign tumours arising in the uterus. Myomectomy is the surgical treatment of choice for women with symptomatic fibroids who prefer or want uterine conservation. Myomectomy can be performed by conventional laparotomy, by mini-laparotomy or by minimal access techniques such as hysteroscopy and laparoscopy. OBJECTIVES: To determine the benefits and harms of laparoscopic or hysteroscopic myomectomy compared with open myomectomy. SEARCH METHODS: We searched the Cochrane Central Register of Controlled Trials (CENTRAL) (inception to July 2014), the Menstrual Disorders and Subfertility Group (MDSG) Specialised Register of Controlled Trials (inception to July 2014), MEDLINE(R) (inception to July 2014), EMBASE (inception to July 2014), PsycINFO (inception to July 2014) and the Cumulative Index to Nursing and Allied Health Literature (CINAHL) (inception to July 2014) to identify relevant randomised controlled trials (RCTs). We also searched trial registers and references from selected relevant trials and review articles. We applied no language restriction in these searches. SELECTION CRITERIA: All published and unpublished randomised controlled trials comparing myomectomy via laparotomy, mini-laparotomy or laparoscopically assisted mini-laparotomy versus laparoscopy or hysteroscopy in premenopausal women with uterine fibroids diagnosed by clinical and ultrasound examination were included in the meta-analysis. DATA COLLECTION AND ANALYSIS: We conducted study selection and extracted data in duplicate. Primary outcomes were postoperative pain, reported in six studies, and in-hospital adverse events, reported in eight studies. Secondary outcomes included length of hospital stay, reported in four studies, operating time, reported in eight studies and recurrence of fibroids, reported in three studies. Each of the other secondary outcomes-improvement in menstrual symptoms, change in quality of life, repeat myomectomy and hysterectomy at a later date-was reported in a single study. Odds ratios (ORs), mean differences (MDs) and 95% confidence intervals (CIs) were calculated and data combined using the fixed-effect model. The quality of evidence was assessed using Grades of Recommendation, Assessment, Development and Evaluation (GRADE) methods. MAIN RESULTS: We found 23 potentially relevant trials, of which nine were eligible for inclusion in this review. The nine trials included in our meta-analysis had a total of 808 women. The overall risk of bias of included studies was low, as most studies properly reported their methods.Postoperative pain: Postoperative pain was measured on a visual analogue scale (VAS), with zero meaning 'no pain at all' and 10 signifying 'pain as bad as it could be.' Postoperative pain was significantly less, as determined by subjectively assessed pain score at six hours (MD -2.40, 95% CI -2.88 to -1.92, one study, 148 women, moderate-quality evidence) and 48 hours postoperatively (MD -1.90, 95% CI -2.80 to -1.00, two studies, 80 women, I² = 0%, moderate-quality evidence) in the laparoscopic myomectomy group compared with the open myomectomy group. This means that among women undergoing laparoscopic myomectomy, mean pain score at six hours and 48 hours would be likely to range from about three points lower to one point lower on a VAS zero-to-10 scale. No significant difference in postoperative pain score was noted between the laparoscopic and open myomectomy groups at 24 hours (MD -0.29, 95% CI -0.7 to 0.12, four studies, 232 women, I² = 43%, moderate-quality evidence). The overall quality of these findings is moderate; therefore further research is likely to have an important impact on our confidence in the estimate of effect and may change the estimate.In-hospital adverse events: No evidence suggested a difference in unscheduled return to theatre (OR 3.04, 95% CI 0.12 to 75.86, two studies, 188 women, I² = 0%, low-quality evidence) and laparoconversion (OR 1.11, 95% CI 0.44 to 2.83, eight studies, 756 women, I² = 53%, moderate-quality evidence) when open myomectomy was compared with laparoscopic myomectomy. Only one study including 148 women reported injury to pelvic organs (no events were described in other studies), and no significant difference was noted between laparoscopic myomectomy and laparoscopically assisted mini-laparotomy myomectomy (OR 3.04, 95% CI 0.12 to 75.86). Significantly lower risk of postoperative fever was observed in the laparoscopic myomectomy group compared with groups treated with all types of open myomectomy (OR 0.44, 95% CI 0.26 to 0.77, I² = 0%, six studies, 635 women). This indicates that among women undergoing laparoscopic myomectomy, the risk of postoperative fever is 50% lower than among those treated with open surgery. No studies reported immediate hysterectomy, uterine rupture, thromboembolism or mortality. Six studies including 549 women reported haemoglobin drop, but these studies were not pooled because of extreme heterogeneity (I² = 97%) and therefore could not be included in the analysis. AUTHORS' CONCLUSIONS: Laparoscopic myomectomy is a procedure associated with less subjectively reported postoperative pain, lower postoperative fever and shorter hospital stay compared with all types of open myomectomy. No evidence suggested a difference in recurrence risk between laparoscopic and open myomectomy. More studies are needed to assess rates of uterine rupture, occurrence of thromboembolism, need for repeat myomectomy and hysterectomy at a later stage.

Obstetrics and Gynecology Obstetrics and Gynecology Surgery

Current state of minimally invasive spine surgery

Journal of Spine Surgery2019-06-01作者：Avani S. Vaishnav, Yahya A. Othman, Sohrab Virk

Over the past two decades, minimally invasive surgical approaches have become increasingly feasible, efficient and popular for the management of a wide range of spinal disorders, with a growing body of research demonstrating numerous advantages of these techniques over the traditional open approach. In this article, we review the technologies and innovations that are expanding the horizon of minimally invasive spine surgery (MISS), and highlight high-quality peer-reviewed literature in the past year that expands our knowledge and understanding of indications, advantages and limitations of MISS.

Pathology and Forensic Medicine Surgery Surgery

Update on Minimally Invasive Glaucoma Surgery (MIGS) and New Implants

Journal of Ophthalmology2013-01-01作者：Lívia M. Brandão, Matthias C. Grieshaber

Traditional glaucoma surgery has been challenged by the advent of innovative techniques and new implants in the past few years. There is an increasing demand for safer glaucoma surgery offering patients a timely surgical solution in reducing intraocular pressure (IOP) and improving their quality of life. The new procedures and devices aim to lower IOP with a higher safety profile than fistulating surgery (trabeculectomy/drainage tubes) and are collectively termed "minimally invasive glaucoma surgery (MIGS)." The main advantage of MIGS is that they are nonpenetrating and/or bleb-independent procedures, thus avoiding the major complications of fistulating surgery related to blebs and hypotony. In this review, the clinical results of the latest techniques and devices are presented by their approach, ab interno (trabeculotomy, excimer laser trabeculotomy, trabecular microbypass, suprachoroidal shunt, and intracanalicular scaffold) and ab externo (canaloplasty, Stegmann Canal Expander, suprachoroidal Gold microshunt). The drawback of MIGS is that some of these procedures produce a limited IOP reduction compared to trabeculectomy. Currently, MIGS is performed in glaucoma patients with early to moderate disease and preferably in combination with cataract surgery.

Ophthalmology Pathology and Forensic Medicine Radiology, Nuclear Medicine and Imaging