Biportal endoscopic spinal surgery (BESS) is a minimally invasive spinal surgery, which is basically similar to microscopic spinal surgery in terms of the use of floating technique and technically similar to conventional percutaneous endoscopic spinal surgery in terms of the use of endoscopic or arthroscopic instruments. Using two independent portals (viewing and working) and maintaining a certain distance from the bony and neural structures allow closer access to the target lesion through a panoramic view by free handling of the scope and instruments rather than through a fixed view by docking into the Kambin's triangle. Minimally invasive surgery allows for reduced dissection and inevitable muscle injury, preserving stability and reducing risks of restabilization. The purpose of fusion surgery is the same as that of the three surgical techniques stated above. Its wider range of view helps to overcome limitations of conventional endoscopic spinal surgery and to supplement the weak points of microscopic spinal surgery, such as limited working space in a tubular retractor and difficulty in accessing the contralateral area. This technique provides an alternative to unilateral or bilateral decompression of lumbar central spinal stenosis, foraminal stenosis, low-grade spondylolisthesis, and adjacent segment degeneration. Early clinical outcomes are promising despite potential for complications, such as dural tearing and postoperative epidural hematoma, similar to other procedures. Merits of BESS include decreased postoperative infection rate due to continuous irrigation throughout the procedure and decreased need for fusion surgery for one- or two-level lumbar stenosis by wide sublaminar and foraminal decompression with minimal sacrifice of stabilizing structures.
Arthroscopy ; Constriction, Pathologic ; Decompression ; Endoscopy ; Hematoma ; Minimally Invasive Surgical Procedures ; Spinal Stenosis ; Spondylolisthesis ; Tears

Coronary artery bypass grafting (CABG) technique has been much developed but CABG under cardiopulmonary bypass has the unavoidable deficits such as generalized inflammatory reaction from cardiopulmonary bypass and myocardial ischemia from aortic-cross clamp. There has been remarkable advancement of CABG without cadiopulmonary bypass. We performed CABG successfully without cardiopulmonary bypass. We performed CABG successfully without cardiopulmonary bypass in two patients with multivessel coronary disease who were failed to intervene with percutaneous transluminal coronary angioplasty. We herein report the two cases.
Angioplasty, Balloon, Coronary ; Cardiopulmonary Bypass ; Coronary Artery Bypass ; Coronary Disease* ; Humans ; Myocardial Ischemia ; Surgical Procedures, Minimally Invasive ; Transplants*

Percutaneous coronary intervention including intracoronary stenting is currently an accepted treatment modality in the treatment of coronary artery disease and is widely performed to treat the patient with multivessel disease with decreased morbidities and less cost compared with conventional coronary rtery bypass grafting(CABG), Repeated interventions due to restenosis even after successful angioplasty are the major disadvantage of the angioplsty especially when the lesion is located inthe left anterior descending artery(LAD) Recently CABG through left anterior small thoracotomy using the left internal thoracic artery to revascularize the LAD territory without cardiopulmonary bypass so called Minimally Invasive Direct Coronary Artery Bypass(MIDCAB) was intrduced and performed with comparable early outcomes. In this regard the integrated approach with percutaneous coronary intervention and minimally invasive direct coronary artery bypass surgery so called 'Hybrid CABG' was suggested to be an effective treatment in suitable patients with multivessel coronary artery disease. We report three cases of Hybrid CABG.
Angioplasty ; Angioplasty, Balloon, Coronary* ; Cardiopulmonary Bypass ; Coronary Artery Bypass ; Coronary Artery Disease ; Coronary Vessels ; Humans ; Mammary Arteries ; Percutaneous Coronary Intervention ; Stents ; Surgical Procedures, Minimally Invasive ; Thoracotomy ; Transplants*

Combined laparoscopic endoscopic procedures (CLEP) is a technical advance in minimally invasive approaches, combining the advantages of both laparoscopy and endoscopy. CLEP expands the use of minimally invasive surgery, and improves the safety, precision and efficacy in the treatment of colorectal neoplasms.Endoscopy-assisted laparoscopic surgery (EALS), laparoscopy- assisted endoscopic surgery (LAES), and laparoscopy endoscopy cooperative surgery (LECS) are being used. The combined application of laparoscopy and colonoscopy or transanal endoscopic microsurgery (TEM) provides a new minimally invasive approach for the treatment of colorectal benign and malignant tumors, especially suitable for the patients undergoing single laparoscopic or endoscopic surgery with greater difficulty and higher risk, or those who would have undergone open operation in the past. CLEP enhances the safety and efficacy of minimally invasive surgery, and achieves the minimal invasiveness and maximal preservation of physiological function at the same time. To a large extent, the integrated operating room and multidisciplinary team help to promote the development of these new minimally invasive procedures.
Colectomy ; Colonoscopy ; Colorectal Neoplasms ; Humans ; Laparoscopy ; Minimally Invasive Surgical Procedures

OBJECTIVETo give a conceptual description of natural orifice translumenal endoscopic surgery (NOTES), review the early efforts in the NOTES field, and discuss its challenges and limitations.

DATA SOURCESThe data were retrieved mainly from publications listed in MEDLINE, PubMed and China Wanfang Database from 2005 to 2009. The search term was "NOTES".

STUDY SELECTIONThe articles involved in the "NOTES" study were selected and the review articles were excluded from the comparison.

RESULTSA marked increase in quantity in articles was shown each year for NOTES studies from 2006 to 2009. Animal experiments with "NOTES" have been carried out in China from 2007, and two independent "NOTES" procedures on humans were reported in 2009.

CONCLUSIONAlthough still in its infancy, the "NOTES" procedure is promising as another type of minimally invasive surgery and favorable alternative to current interventions.

Endoscopy, Digestive System ; methods ; Humans ; Minimally Invasive Surgical Procedures ; methods

Endoscopy ; Humans ; Minimally Invasive Surgical Procedures ; Spine ; surgery

BACKGROUND: The possibility of incomplete revascularization and development of flow competition after revascularization of the borderline lesion made the hybrid strategy as an option for complete revascularization. MATERIAL AND METHOD: From January 1998 to July 2004, 25 (3.2%) patients underwent hybrid revascularization among 782 total OPCAB procedures. Clinical results and angiographic patencies were evalulated. Percutaneous coronary intervention (PCI) was performed before CABG in 8 patients and after CABG in 17 patients. RESULT: The causes of PCIs before CABG were to achieve complete revascularization with minimally invasive surgery (n=7) and emergent PCI for culprit lesion (n=1). The indications of PCIs after CABG were high possibility of flow competition in the borderline lesion of right coronary artery territory (n=8), diffuse atheromatous lesion preventing anastomosis of graft (n=5), severe calcified ascending aorta with no more arterial graft available (n=3), and intramyocardial coronary lesion (n=1). Mean number of distal anastomoses was 2.3+/-1.0. Mean number of lesions treated by PCI was 1.2+/-0.4. There was no operative or procedure-related mortality. PCI-related complication was periprocedural myocardial infarction in one patient, and complications related to CABG were transient atrial fibrillation (n=5), perioperative myocardial infarction (n=1), and transient renal dysfunction (n=1). Early postoperative coronary angiography (1.8+/-1.6 days) revealed 100% patency rate of grafts (57/57). The stenosis occurred in one patient performed PCI before CABG, which was successfully treated with re-ballooning. During midterm follow-up (mean; 25+/-26 months), 1 patient died of congestive heart failure. All survivors (n=24) accomplished follow-up coronary angiographics, which showed all grafts (56/57) were patent except one string sign. In-stent restenosis was developed in 2 patients who received bare metal stents. CONCLUSION: In selected patients, complete revascularization was achieved with low risk by taking the hybrid strategy.
Angioplasty, Balloon, Coronary ; Aorta ; Atrial Fibrillation ; Constriction, Pathologic ; Coronary Angiography ; Coronary Artery Bypass ; Coronary Artery Bypass, Off-Pump* ; Coronary Vessels ; Follow-Up Studies ; Heart Failure ; Humans ; Mortality ; Myocardial Infarction ; Percutaneous Coronary Intervention* ; Stents ; Surgical Procedures, Minimally Invasive ; Survivors ; Transplants

OBJECTIVETo explore the effects of surgical procedure combined with the intravascular minimal invasive technique for the treatment of deep vein thrombosis (DVT) of lower extremity.

METHODSAt the curse of disease from six hours to ninety days, one hundred and two patients with DVT including one hundred and three lower extremities had received surgical procedure and intravascular minimal invasive treatment.

RESULTSThere were not procedure-related morbidities in 102 cases, and symptoms disappeared, all procedures were successful based on angiography. The detecting head for the intravascular ultrasound ablation was entered to inferior vena cava (IVC) in 74 cases (78%), Forgarty catheter was entered to IVC in 21 cases (21%), the stenosis in the confluence of the common iliac vein and IVC was dilated by sacculus rotundus catheter in 89 cases (88%), including 9 patients underwent percutaneous transluminal stenting. One hundred and two patients followed up for twenty months, follow-up by angiography showed no restenosis in 91 cases, restenosis in ilio-femoral vein in 1 cases, and thrombus recontouring in 4 cases, as well as 6 cases died caused by primary disease.

CONCLUSIONSurgical procedure combined with the intravascular minimal invasive technique is a safe and effective therapeutic method for DVT.

Adult ; Aged ; Aged, 80 and over ; Angioplasty, Balloon ; Catheter Ablation ; methods ; Combined Modality Therapy ; Female ; Follow-Up Studies ; Humans ; Lower Extremity ; Male ; Middle Aged ; Minimally Invasive Surgical Procedures ; Stents ; Ultrasonic Therapy ; Venous Thrombosis ; surgery ; therapy

OBJECTIVETo introduce the procedure of carotid stenting, and to summary experiences of 55 cases. To study the theory and clinical significance of carotid stenting for carotid artery stenosis.

METHODSFifty-five patients with severe carotid atheromatous stenoses were treated by stent implantation. Fifty-eight stents were implanted. Forty-one of these stents were Wallstent, 14 were Smart stents and 3 were OptiMed stents. Cerebral protection device was furnished for 18 patients.

RESULTSDuring operation, there were 2 cases of small stroke and 2 cases of major stroke. One patient suffered from left eye area deficit, who had a little signs after 3 months. Another patient had consciousness loss and right-side paralysis and had a recovery in consciousness after salvage. The incidence of nervous system complications was 6.9%. Serious stroke rate was 3.5%. The incidence of circulatory system complications was 10.3%. Those patients who received cerebral protection device did not have nervous complication.

CONCLUSIONCarotid stenting is effective for the treatment of carotid artery stenosis. The experienced surgeon can make this procedure safe. The procedure's safety is enhanced by using cerebral protection device.

Aged ; Angioplasty, Balloon ; adverse effects ; methods ; Carotid Stenosis ; surgery ; Female ; Follow-Up Studies ; Humans ; Male ; Middle Aged ; Minimally Invasive Surgical Procedures ; Postoperative Complications ; etiology ; prevention & control ; Stents ; Treatment Outcome

OBJECTIVETo explore the clinical effect of percutaneous transluminal angioplasty (PTA) and stent on the subclavian steal syndrome.

METHODSThe clinical results of PTA and stent in the treatment of subclavian steal syndrome in 78 patients were analysed.

RESULTS100% interventional procedure success rate was achieved with a mean systolic arterial pressure difference of

CONCLUSIONPTA with stent placement is a good method in the treatment of subclavian steal syndrome. It is a safe, easy to be performed, minimally invasive procedure with good clinical results.

Adolescent ; Adult ; Aged ; Angioplasty, Balloon ; Arterial Occlusive Diseases ; complications ; surgery ; Child ; Female ; Follow-Up Studies ; Humans ; Male ; Middle Aged ; Minimally Invasive Surgical Procedures ; Retrospective Studies ; Stents ; Subclavian Steal Syndrome ; etiology ; surgery ; Treatment Outcome ; Young Adult