Search Results (1,888)

Background: Native nephrectomy is frequently required in autosomal-dominant polycystic kidney disease (ADPKD) before or during transplantation, but the optimal minimally invasive approach is unsettled, and it is unclear whether the pattern of post-operative complications tracks with operative technique. We report a retrospective single-centre experience of hand-assisted laparoscopic (HAL) native nephrectomy and, alongside it, a technique-stratified scoping review of complications. Methods: We retrospectively reviewed all consecutive adults undergoing HAL native nephrectomy—with an infra-umbilical midline hand-port and free intraperitoneal cyst rupture—in preparation for transplantation in the period between December 2019 and December 2025. In parallel, we performed a PRISMA-ScR-compliant scoping review (MEDLINE, Embase, Scopus) of minimally invasive ADPKD nephrectomy, with duplicate independent screening and extraction, stratifying complications by operative approach and cyst-decompression method. No quantitative pooling was undertaken. Results: Twenty-three patients (mean age 52.8 ± 9.9 years; 87% dialysis-dependent; 78% for transplant preparation) were included. Median operative time was 102 min (IQR 90–122) with minimal blood loss, one transfusion (4%), and no open conversion. Complications occurred in 8/23 (35%) and were bowel-predominant: one small-bowel perforation, two obstructions, and one ileus—three of Clavien–Dindo grade IIIb, all in right-sided nephrectomies and independent of specimen weight. Peri-operative mortality was 1/23 (4%), from a non-technique-related mycotic aortic dissection. Of 481 records screened, 19 studies met inclusion; the cyst-decompression method was reported in only 7 (37%). Bowel events clustered in series using free intraperitoneal cyst rupture or puncture and were largely absent where decompression was contained, a pattern crossing platform boundaries and that is mechanistically consistent with intraperitoneal spillage of cyst contents. Conclusions: HAL native nephrectomy is a rapid and feasible means of removing massively enlarged polycystic kidneys before transplantation but, in our experience, carries a bowel-predominant morbidity that clustered in right-sided procedures and was independent of specimen weight. The sparse literature is consistent with—but cannot confirm—a relationship to intraperitoneal cyst spillage rather than to the hand-assisted approach itself. Whether contained cyst decompression can preserve operative efficiency while reducing bowel morbidity is a hypothesis warranting prospective study. Full article

Cholangiocarcinoma (CCA) is an aggressive malignancy associated with malignant biliary obstruction and it has poor overall survival. Most patients present with unresectable disease which limits curative treatment options and highlights the need for effective palliative therapies. Endobiliary radiofrequency ablation (RFA) has emerged as a minimally invasive technique aimed at reducing intraductal tumor burden, improving biliary drainage, and potentially prolonging survival. Recently, multiple randomized controlled trials, retrospective studies, and meta-analyses have evaluated the role of endobiliary RFA in patients with CCA, with mixed results. Available evidence suggests that RFA may provide a survival benefit in selected patients. However, its effects on stent patency and quality of life remain inconsistent across studies. Current data also demonstrate an overall acceptable safety profile. In this review, we summarize the procedural techniques, currently available evidence, adverse events, patient selection considerations, guideline recommendations, and future directions regarding the use of endobiliary RFA in CCA. Full article

Background and Objectives: Left atrial appendage (LAA) closure is a Class I recommendation in patients with atrial fibrillation to reduce the risk of cardioembolic stroke. Achieving reliable and complete LAA exclusion during minimally invasive mitral valve surgery via right minithoracotomy remains technically challenging. We report here to our knowledge the largest series of a novel technique for LAA exclusion using an epicardial clip device applied via right minithoracotomy during minimally invasive mitral valve surgery. Materials and Methods: Between June 2023 and May 2026, 40 patients with atrial fibrillation underwent minimally invasive mitral valve surgery via right minithoracotomy with concomitant LAA exclusion. Cardiopulmonary bypass was established via percutaneous femoral cannulation. Following completion of the intracardiac procedure and prior to aortic cross-clamp removal, a suture was placed around the LAA base via the transverse sinus and used to guide clip deployment under direct vision. Successful closure was confirmed by intraoperative transesophageal echocardiography. Results: Mean patient age was 66.6 ± 8.0 years; 21 patients (53%) were female. Mitral valve repair was performed in 36 patients (90%) and replacement in 4 (10%). Concomitant cryoablation for AF was performed in 31 patients (78%). Successful LAA clip deployment was achieved in all 40 patients (100%). The 35 mm clip was used in 36 patients (90%), the 40 mm clip in 3 patients (8%), and the 45 mm clip in 1 patient (2%). Mean total operative time was 183 ± 58 min; mean CPB time was 134 ± 42 min; mean aortic cross-clamp time was 70 ± 27 min. In-hospital mortality was 0%. One patient (3%) required re-thoracotomy for bleeding, one developed a postoperative stroke, and two required ECMO support. Median hospital stay was 9 days. At discharge, 18 patients (45%) were in sinus rhythm; among the 31 who underwent concomitant cryoablation, 16 (52%) were discharged in sinus rhythm. Conclusions: Minimally invasive LAA exclusion is feasible and safe when performed via right minithoracotomy during minimally invasive mitral valve surgery. The technique achieves high rates of successful deployment and avoids the need for additional incisions or access sites. This approach represents a valuable addition to the armamentarium of concomitant stroke prevention strategies in patients with AF undergoing minimally invasive valvular surgery. Full article

Background/Objectives: The aim of this study was to evaluate the efficacy and safety of avatrombopag in patients with chronic liver disease (CLD) and thrombocytopenia scheduled for elective invasive/minimally invasive procedures, providing clinical guidance for patients requiring platelet (PLT) elevation. Methods: In this single-center, prospective study, patients with CLD and PLT counts <50 × 10⁹/L were scheduled for elective invasive/minimally invasive surgery, receiving 5-day avatrombopag plus standard CLD management. PLT response, dynamics, and safety were assessed. Results: A total of 108 patients with CLD and baseline PLT counts <50 × 10⁹/L were enrolled, showing an 83.33% response rate. Responders exhibited significantly higher baseline white blood cell (WBC, p = 0.009), neutrophil (p = 0.016), hemoglobin (HGB, p = 0.011), and PLT (p = 0.001) levels compared to non-responders. Baseline PLT correlated positively with age (p = 0.014), WBC (p = 0.046), HGB (p = 0.001), and prothrombin activity (p = 0.023). Logistic regression identified baseline PLT as an independent predictor of treatment response (p = 0.002). PLT began rising by day 5 post-treatment, peaked around day 10, and declined to baseline by day 40 in overall cases and responders. Non-responders showed only mild PLT elevation by day 5 (remaining <50 × 10⁹/L), with no further increase by day 10. No adverse events were observed. No thrombotic or bleeding events were recorded in this small cohort; however, the limited sample size precludes definitive conclusions on thrombosis risk. Conclusions: Avatrombopag demonstrated high efficacy and favorable safety for elevating PLT in patients with CLD, with a higher baseline PLT predicting a better response. Full article

Background/Objectives: Minimally invasive (percutaneous) pedicle screw fixation (PPSF) was initially introduced for the treatment of degenerative spinal deformities. Since then, its indications have progressively expanded to a broad spectrum of spinal pathologies. This method has gained increasing acceptance in spinal surgery due to lower morbidity when compared with conventional open procedures. This study presents a comprehensive review of the recent literature on hybrid minimally invasive spinal instrumentation techniques, focusing on the combined use of PPSF with open or mini-open approaches and their roles in personalized surgical management. Methods: A literature search was conducted in PubMed and Web of Science to identify studies reporting expanded indications of percutaneous pedicle screw fixation (combined with other approaches), novel surgical techniques, and their clinical outcomes. Results: Thirty-five studies met the inclusion criteria and were categorized according to pathology. Most included studies were retrospective observational investigations corresponding to Oxford CEBM Levels III–IV evidence, with a smaller number of prospective studies and systematic reviews. Conclusions: The findings from this review highlight the expanding role of hybrid methods in the management of complex spinal disorders. These approaches provide adequate stability and enable decompression or deformity correction, while minimizing tissue trauma, blood loss, and perioperative morbidity, thereby facilitating improved recovery and functional outcomes. The included literature predominantly represents moderate levels of evidence, supporting a patient-specific, pathology-driven surgical strategy that optimizes individualized outcomes in spinal surgery. Full article

Background and Objectives: Endoscopic beating-heart tricuspid valve (TV) surgery is increasingly adopted in cardiac surgery due to its association with improved postoperative recovery. Conventional approaches require jugular vein cannulation to establish adequate bicaval venous drainage, and caval snaring is considered mandatory during beating-heart TV procedures to prevent intraoperative air lock. We report our single-center experience with a novel percutaneously placed venous cannula (Smart Cannula) that enables minimally invasive TV surgery without jugular cannulation or caval snaring. Materials and Methods: Between February 2025 and May 2026, 31 consecutive patients underwent endoscopic beating-heart TV surgery using the Smart Cannula system for venous drainage. The device is a stent-like cannula with distributed wall perforations allowing sufficient venous return while preventing air lock. Preoperative atrial fibrillation was present in 21 patients (68%). Six patients (19%) underwent isolated TV procedures; the remainder had concomitant procedures. Mean age was 68.2 ± 10.8 years; 16 patients (52%) were female. Two different cannula lengths were used: 680 mm (n = 15) and 730 mm (n = 16). Six patients (19%) had history of prior cardiac surgery. Results: All procedures were completed without intraoperative air lock. Two patients (6%) required intraoperative conversion to sternotomy. Mean cardiopulmonary bypass time was 163 ± 52 min. Seven patients (23%) underwent beating-heart procedures with no aortic cross-clamping; in 24 patients (77%), aortic cross-clamping was required for concomitant procedures (mean cross-clamp time 79 ± 28 min), with tricuspid repair completed on the reperfused beating heart. Re-exploration for bleeding occurred in two patients (6%). Median ICU stay was 5 days and median hospital stay was 10 days. New permanent pacemaker implantation was required in three patients (10%). Thirty-day mortality was 0%. Postoperative echocardiography at discharge demonstrated TR Grade 0 in 61%, mild TR in 32%, and moderate TR in 3% of patients. Conclusions: In this first and largest published series on endoscopic beating-heart TV surgery without caval snaring or jugular vein cannulation, we have shown that the process is feasible and safe, eliminating the need for jugular vein cannulation and caval snaring while maintaining no occurrence of intraoperative air lock. The device enables a simplified venous drainage strategy without compromising operative safety or early clinical outcomes. Full article

Background and Objectives: The recent adoption of RATS (robot-assisted thoracic surgery) alongside VATS (video-assisted thoracoscopic surgery) in minimally invasive thoracic surgery highlights the need for comparative evaluation of both techniques regarding postoperative pain and clinical outcomes. This study compared acute postoperative pain within the first 24 h, as well as postoperative complications, 30-day mortality, and length of hospital and ICU stay. Materials and Methods: A retrospective observational study was conducted including all patients scheduled for VATS or RATS at a tertiary hospital between November 2021 and December 2024. Demographic characteristics, surgical procedures, surgical approach, and pain-related outcomes at 24 h (Numeric Rating Scale [NRS], subjective assessment scale, and rescue analgesia) were obtained from the Acute Pain Unit database of the Department of Anesthesiology. Other variables were collected from the electronic medical record. Results: A total of 148 patients were analyzed, of whom 118 underwent VATS and 30 RATS. Surgical duration was significantly longer in the RATS group (130 vs. 218 min, p < 0.05). No significant differences were observed in NRS scores (2.57 ± 1.06 vs. 2.3 ± 0.79, p = 0.195) or subjective pain assessment (good: 78% vs. 83.3%, p = 0.472). RATS required less rescue analgesia in the unadjusted analysis (30.0% vs. 52.5% in VATS, p = 0.022); however, this association was no longer statistically significant after multivariable adjustment (VATS: OR 2.40, 95% CI 0.93–6.25; p = 0.071). There were no significant differences in postoperative complications (17.8% in VATS vs. 16.7% in RATS, p = 0.85), length of hospital stay (4.9 ± 6.2 days in VATS vs. 3.4 ± 3 days in RATS, p = 0.2), or 30-day mortality (0.8% in VATS vs. 0% in RATS, p = 1). ICU length of stay was longer in the RATS group (0.32 ± 0.78 days in VATS vs. 0.73 ± 1.23 days in RATS, p = 0.024). Conclusions: RATS did not demonstrate superiority over VATS in terms of postoperative pain, patient satisfaction, or clinical outcomes. Full article

Pain and stress are frequent and clinically relevant challenges in neonatal intensive care, particularly among preterm and critically ill newborns exposed to repeated invasive procedures, mechanical ventilation, surgery, and advanced life-support interventions. Effective analgosedation is essential to reduce discomfort, attenuate physiological instability, improve tolerance of intensive care procedures, and potentially limit adverse neurodevelopmental consequences. However, neonatal pain and analgosedation management remain complex because of developmental immaturity, pharmacokinetic and pharmacodynamic variability, and the need to balance adequate analgosedation against treatment-related complications. This narrative review summarizes current evidence on analgosedation in the Neonatal Intensive Care Unit, focusing on clinical indications, pharmacological agents, non-pharmacological strategies, monitoring tools, adverse effects, and future perspectives. Opioids, benzodiazepines, dexmedetomidine, and ketamine each have specific potential benefits and limitations, requiring individualized selection, careful titration, and continuous reassessment. Non-pharmacological interventions, including oral sucrose, non-nutritive sucking, facilitated tucking, breastfeeding, skin-to-skin care, and environmental modulation, should be integrated into multimodal pain-management protocols. Validated instruments such as COMFORTneo, N-PASS, and PIPP-R support standardized assessment and guide therapeutic decisions. Future advances may derive from objective monitoring technologies, artificial intelligence, developmental pharmacology, and precision-medicine approaches. A multidisciplinary, protocol-driven, and family-centered strategy is essential to optimize neonatal comfort while minimizing avoidable drug exposure. Full article

Background/Objectives: Recurrent temporomandibular joint dislocation is associated with repeated dislocation episodes, pain, impaired jaw function, and psychosocial burden. Injectable intra- and periarticular therapies have been proposed as minimally invasive methods of improving joint stability, but the available evidence is heterogeneous and frequently involves adjunctive procedures. This mapping review aimed to characterize injectable treatments whose effects could be assessed independently from simultaneous non-injectable interventions. Methods: PubMed (MEDLINE), Europe PMC, and BASE were searched from inception to 7 April 2026. Reference lists of included studies and relevant reviews were also screened. Studies reporting clinical outcomes of injectable intra- or periarticular treatments for recurrent mandibular dislocation were eligible when the effect of the injectable component could be evaluated independently. Study selection, data charting, and critical appraisal were performed using predefined methods. Results: Five primary clinical studies and eight secondary mapping or reference-checking sources were included. The primary studies evaluated autologous blood injection, dextrose prolotherapy, and sodium morrhuate or other sclerosing-agent injections. Most studies reported reductions in recurrent dislocation or subluxation and improvements in joint stability. Some also reported improvements in maximal mouth opening, clicking, pain, or other clinical outcomes. However, the evidence was limited by small sample sizes, heterogeneous protocols, variable injection sites, and limited comparative data. Conclusions: The available literature on injectable therapies for recurrent mandibular dislocation is limited and heterogeneous. Although included studies generally reported favorable outcomes, the evidence does not permit conclusions regarding the comparative effectiveness or superiority of any specific injectable modality. Full article

The left atrial appendage is well recognized as the site of thrombus formation in patients with atrial fibrillation. However, in patients who are either unsuitable for long-term oral anticoagulation or in whom this therapy is inefficient, left atrial occlusion has emerged as a mechanical strategy option to diminish stroke risk. Minimally invasive percutaneous and standalone surgical thoracoscopic techniques are appearing as viable options for left atrial appendage exclusion, each with distinct procedural risk profiles and characteristics, as well as evidence from trials or registers. We suggest that the choice between percutaneous and thoracoscopic left atrial appendage occlusion should be individualized, ideally within the multidisciplinary heart team, considering left atrial appendage anatomy, patient bleeding and thromboembolic risk profile, comorbidities, prior cardiac interventions, and institutional expertise and resources. We aim to present in this review the value of multimodality imaging in patient selection for minimally invasive left atrial appendage occlusion to minimize the possibility of complications, and to compare technical advancements and indications for percutaneous and standalone thoracoscopic left atrial appendage occlusion. Full article

Background: In recent years, aesthetic medicine has progressively prioritized conservative treatment volumes, subtle enhancements, and skin quality improvement over volumization. This study evaluates patient-reported psychosocial outcomes, satisfaction, and regret rates following minimally invasive aesthetic procedures using validated instruments. Methods: A review was conducted in accordance with PRISMA guidelines. PubMed, Scopus, and Cochrane Library were searched for studies reporting outcomes using validated PROMs (FACE-Q, GAIS, Decision Regret Scale, BDDQ, DCQ and COPS) with a minimum follow-up of 6 months. Studies evaluating facial botulinum neurotoxins, hyaluronic acid fillers, and biostimulation treatments were included. Given the heterogeneity in study design and outcome reporting, findings were synthesized narratively with descriptive comparisons across treatment modalities. Results: Increased treatment intensity was not consistently associated with greater satisfaction, and higher dose or volume often corresponded to more dissatisfaction and regret. The evidence for this pattern was stronger for botulinum toxin and hyaluronic acid fillers; weaker for biostimulators and preliminary for post-GLP-1 facial changes. Conservative approaches were associated with favorable PROMs, and unrealistic expectations, body dysmorphic disorder, and insufficient pre-treatment counseling were the principal predictors of poor outcomes. Conclusions: Patient satisfaction was not proportional to treatment intensity, particularly when results were perceived as unnatural or overcorrected. This relationship appears associative rather than causal, as patients receiving more intense treatment may differ in expectations, history, and psychological profile. A PROM-driven, patient-tailored approach seems more likely to produce durable satisfaction and minimize regret. Full article

Background/Objectives: Chronic plantar fasciitis refractory to conservative treatment remains a therapeutic challenge, and minimally invasive options targeting pathologic neovascularization are of growing interest. We evaluated the safety and early- to midterm clinical outcomes of transarterial microembolization in refractory plantar fasciitis, with emphasis on functional and patient-reported outcomes. Methods: In this single-center observational pilot study with ambispective data collection, 16 procedures in 13 patients were treated using imipenem/cilastatin. The primary outcome was pain intensity (Numeric Rating Scale, NRS); secondary outcomes included the Foot Function Index (FFI), the Patient Global Impression of Change (PGIC), analgesic use, return to activity, need for further treatment, and complications. Results: Technical success was 100%. Median NRS decreased from 10.0 at baseline to 3.0 at 1 month and 0.0 at 3 months, with significant improvement maintained through 18 months. Median FFI improved from 9.42 to near zero, and analgesic use declined. At 12 months, 90.9% of procedures reported clinical improvement. Reintervention was required once (6.3%); only minor complications occurred (12.5%), with no major events. Full return to normal activity was achieved in 68.8%. Conclusions: Transarterial microembolization was associated with rapid functional and patient-reported improvement and a favorable safety profile. These exploratory, hypothesis-generating findings warrant confirmation in controlled prospective studies. Full article

Background: Severe maxillary atrophy remains a major challenge for implant-supported rehabilitation, often requiring complex grafting procedures or zygomatic implants associated with increased surgical morbidity. Advances in digital planning and additive manufacturing have enabled the development of patient-specific subperiosteal implants supported by cortical bone anchorage. Materials and Methods: This study presents a fully digital workflow combining customized subperiosteal implants (SP3D) with guided pterygoid fixation (PT3D) to achieve stable distal support and allow immediate loading in severely atrophic maxillae. Results: Nine patients presenting with advanced maxillary atrophy were treated using computer-assisted design, guided surgery, and immediate prosthetic rehabilitation. All implants were successfully placed according to the digital plan, achieving stable fixation through bilateral pterygoid engagement. No major intraoperative or postoperative complications were observed. Immediate loading was performed in all cases with stable prosthetic outcomes during the follow-up period (average follow-up period was 12.7 months). Conclusions: The combined SP3D–PT3D approach represents a minimally invasive alternative for full-arch rehabilitation in extreme maxillary atrophy, potentially reducing the need for bone grafting while improving surgical predictability and biomechanical stability. Full article

Background and Clinical Significance: Severe pediatric spastic equinovarus may significantly impair positioning, orthotic tolerance, hygiene management, caregiver-assisted mobilization, and assisted standing activities. In children with severe cerebral palsy, clinically meaningful outcomes frequently include reduction in caregiver burden and facilitation of daily care rather than restoration of autonomous gait. Ultrasound-guided cryoneurolysis has recently emerged as a minimally invasive option for focal spasticity management, although procedural workflow and tolerability remain challenging in severe deforming patterns. Case Presentation: We report a CARE-compliant same-patient bilateral technical comparison in a 9-year-old child with severe spastic cerebral palsy and bilateral dynamic equinovarus refractory to intensive rehabilitation and repeated botulinum toxin treatment. Baseline severity was consistent with GMFCS level IV. One lower limb was treated using the proposed posterior single-window ultrasound-guided cryoneurolysis approach through a single posterior proximal-calf window, whereas the contralateral limb underwent a conventional multi-point supine strategy. The posterior single-window approach enabled sequential targeting of multiple motor branches through a single posterior access corridor under continuous ultrasound guidance. The procedure required approximately 1 mL of 2% lidocaine without additional sedation and was completed in approximately 4 min, whereas the conventional supine strategy required multiple access points, repeated probe repositioning, minimal conscious sedation with midazolam, and approximately 20 min. At follow-up, lower-limb spasticity improved from approximately MAS 3 toward MAS 2, passive ankle angle, measured as the tibia–foot angle with 90° corresponding to the neutral ankle position, improved from approximately 80° to 95°, and semitendinosus-related hypertonia was reduced. Clinically meaningful improvement in positioning, hygiene management, assisted standing, and rehabilitation handling was observed. Caregiver-reported satisfaction and procedural tolerability were qualitatively perceived as better with the posterior single-window approach. Conclusions: The proposed posterior single-window cryoneurolysis strategy may represent a technically simplifying and clinically relevant minimally invasive approach for severe pediatric spastic equinovarus. Further prospective studies are required to confirm reproducibility, safety, and long-term outcomes. Full article

Background/Objectives: Schlemm canal-based minimally invasive glaucoma surgery (MIGS) can be combined with cataract surgery, but topical glaucoma therapy alone is not a sufficient indication for adding MIGS. This review addresses when cataract surgery alone may be sufficient, when combined cataract surgery and MIGS may be appropriate, and when filtration surgery should be considered. Methods: This narrative review used a targeted PubMed/MEDLINE search of English-language literature published from January 2000 to May 2026 to support source identification and reference selection. The review focused on cataract surgery combined with Schlemm canal- or trabecular meshwork-targeted MIGS, including stent-based Schlemm canal procedures and trabeculotomy/goniotomy-based procedures, medication burden, ocular surface disease, refractive and visual outcomes, corneal endothelial safety, complications, angle visibility, guideline-based decision-making, and patient selection. Final references were selected according to clinical relevance to cataract-surgeon decision-making and evidence priority, with emphasis on guidelines, systematic reviews or meta-analyses, randomized or prospective comparative studies, pivotal or long-term studies, large real-world or post-market studies, and clinically informative safety, refractive, endothelial, imaging, or complication-related studies. Results: Stent-based Schlemm canal procedures and trabeculotomy/goniotomy-based procedures can provide additional IOP and medication reduction compared with cataract surgery alone in selected eyes with mild-to-moderate open-angle glaucoma. Stent-based procedures generally have a lower hyphema risk, whereas trabeculotomy/goniotomy-based procedures may provide comparable or greater IOP reduction in selected eyes but are associated with more frequent hyphema. In normal-tension glaucoma or low-baseline-IOP eyes, the expected benefit is often medication reduction or modest IOP lowering rather than reliable achievement of very low target IOP. Available refractive evidence remains limited and procedure-specific, but suggests that major refractive instability is uncommon in appropriately selected eyes. Conclusions: The decision to combine Schlemm canal-based MIGS with cataract surgery should be goal-directed rather than based solely on the presence of topical therapy. Practical selection should integrate glaucoma subtype, disease stage, baseline and target IOP, expected phacoemulsification-only IOP reduction, medication burden, ocular surface status, adherence, angle visibility, endothelial reserve, refractive objectives, and future filtration surgery options. Full article