Verbesserung der lokalen Kontrolle bei Patienten mit aggressiver Fibromatose durch die Kombination von Chirurgie und Strahlentherapie

INTRODUCTION: The purpose of this retrospective analysis is to evaluate whether the combination of surgery and radiation therapy in patients with aggressive fibromatosis influences the therapeutic outcome. METHOD: Clinical, radiological and pathological results of 23 consecutive cases with histologically proven aggressive fibromatosis were retrospectively analyzed. The median follow-up was 59 months. RESULTS: Twelve patients received surgery alone for their first treatment, 10 patients had a combination of surgery and radiotherapy and 1 patient had radiochemotherapy. Of 23 patients 14 (63%) had one or more local recurrences and 9 (39%) were recurrence-free. The patients received a total of 50 treatments: 29/50 (58%) treatments were followed by a local recurrence and 21/50 (42%) were without relapse. Twenty-nine treatments with local recurrence consisted of 25/29 (86%) surgical treatments, 3/29 (10%) combinations of surgery and radiation therapy, and 1/29 (3%) radiochemotherapy. Of the patients who had only surgery for their first treatment, after one year 8 of 12 (66%) and after 5 years all patients had a local recurrence. In the group with surgery and radiotherapy, there was no recurrence after 1 year and 1 recurrence after 5 years (p = 0.0001). CONCLUSION: We recommend a complete tumor resection, without mutilating the patient. Radiation therapy in combination with surgery in contrast to surgery alone is an efficient treatment option for reducing local recurrence.     

Minimalinvasive Pankreastumorchirurgie

Introduction and purpose

Despite being technically challenging, minimally-invasive pancreatic surgery is increasingly being used to treat pancreatic diseases. Therefore, the evaluation of its oncological safety and its advantages arebecoming increasingly more important. This review focuses on these questions based on the currently available literature.

Material and methods

The technically less demanding laparoscopic distal pancreatectomy has been evaluated in numerous meta-analyses. Minimally invasive pancreaticoduodenectomy has only been reported from a few centers worldwide.

Results and conclusion

Minimally invasive pancreatic surgery, in particular laparoscopic distal pancreatectomy, is increasingly being used to treat pancreatic tumors. The advantages of laparoscopy, such as less intraoperative blood loss, reduced postoperative pain and a shorter length of stay have all been demonstrated in large trials. However, a sufficient oncological treatment was only assessed via indirect surrogate parameters, such as the number of lymph nodes obtained and R0 resection rates; therefore, larger prospective trials are needed to prove adequate oncological treatment. To date, minimally invasive techniques should only be employed in trials on treatment of pancreatic malignancies.     

Minimalinvasive Unfallchirurgie

Arthroscopic operations on the major joints account for a large proportion of those described as ‘minimally invasive trauma surgery’. The frequency of such operations in the different joints varies with the frequency with which they are injured. The joints onwhich the most frequent arthroscopic procedures and the greatest number of different arthroscopic techniques are performed are the knee and the shoulder, followed in order by the ankle, the elbow and the wrist. Implants and surgical techniques have been developed to allow minimally invasive plate osteosynthesis (MIPO) and minimally invasive percutaneous plate osteosynthesis (MIPPO) in the treatment of metaphyseal fractures. These techniques have made it possible to significantly improve final outcomes and to reduce the incidence of major complications substantially. Continuous development of arthroscopic and minimally invasive surgical techniques, instruments and implants means that in the near future the treatment of joint injuries and metaphyseal fractures will be synonymous with minimally invasive trauma surgery.     

152. Der Stellenwert der Brustwandresektion in der Chirurgie von Lungenmetastasen extrathorakaler Tumoren

Zusammenfassung Bei 21 Patienten fand sich nach Resektion von Lungenmetastasen und befallener Brustwand unabhängig von der Grösse der Brustwandinfiltration eine mediane Überlebenszeit von 11 Monaten. Nur 1 Patient mit Hodenteratom-Metastasen überlebte 5 Jahre und ist tumorfrei. Die 30-Tage-Letalität betrug 0%. Hauptindikation sind Komplikationen, wie Exulceration und Schmerz. Trotz schlechter Prognose kann eine Lebensverlängerung bei verbesserter Lebensqualität erreicht werden. In seltenen Fällen ist nach Tumorreduktion bei chemotherapiesensiblen Tumoren eine Heilung möglich.     

Minimalinvasive Beckenchirurgie

The pelvis is the mechanical connection between the lower extremities and the spinal column. The aim of surgical treatment for pelvic and acetabular injuries is to compensate the strong mechanical forces needed here, without compromising wound healing and restricting muscle function due to additional soft tissue damage. In recent years, minimally invasive stabilizing techniques, which reduce surgical risks and recovery time as well as improving outcomes, have become increasingly established. The increased use of improved imaging modalities also plays a significant role here. Surgical errors can be avoided in the osteosynthesis of acetabular fractures by means of intraoperative visualization using 3D image converters. Navigated percutaneous pelvic sacroiliac screw fixation is the main procedure to be used for pelvic and acetabular navigation. New software enables a 2D representation of the hip area and a 3D calculation of instrument and implant positions, thereby reducing X-ray exposure and increasing intraoperative safety.     

Minimalinvasive Osteosyntheseverfahren

Trauma und Berufskrankheit - Minimalinvasive Osteosyntheseverfahren finden auch in der Unfallchirurgie immer mehr Verbreitung. Allerdings existieren minimalinvasive Methoden schon seit vielen...     

Minimalinvasive therapie der cholezystolithiasis

Ohne Zusammenfassung     

Minimalinvasive Verfahren bei der Dupuytren-Kontraktur

Dupuytren’s contracture represents a degenerative disorder with fibromatosis of the palmar and digital collagenous fibers. A genetic disposition has been observed and a higher prevalence in male patients. Frequently, the disease starts with nodule formation in the palm and progresses distally to the fingers. The severity of flexion contracture can be described with Tubiana’s staging system, which gives the total impairment of movement in gradually increasing 45° steps. The following cords can contribute to the flexion contraction but are not always found simultaneously: pretendinous cord, central cord, spiral cord, lateral cord, retrovascular cord, thumb pretendinous cord and the abductor digiti quinti cord. The most frequently used operative therapy is partial aponeurectomy (synonymous with fasciectomy). Local cutaneous flaps are planned from the beginning in the operative process so that the skin can be closed without tension after resection of all affected cords and is frequently performed with VY flaps, homodigital or bilobed flaps. Especially in the region of the palmar proximal phalanx, skin closure can be difficult in highly advanced stages of contracture. Further operative procedures include complete fasciectomy, segmental fasciectomy and open faciotomy, which are employed less frequently. In addition so-called minimally invasive forms of treatment exist, such as percutaneous needle fasciotomy, which was rediscovered by French rheumatologists and in Europe was slowly transferred to the hand surgeons from 2001 onwards. Injectable collagenase (Xiapex®/Xiaflex®) was approved in 2010 in the USA and in 2011 in Europe and adopted for the treatment of Dupuytren’s contracture. In Germany the distribution of Xiapex® was terminated but in the USA and other countries, collagenase is still used. This poses the question whether this compound, which is difficult to obtain in Germany has nevertheless changed the therapy of the Dupuytren’s contraction.     

Minimalinvasive Plattenosteosynthese am proximalen Humerus

Proximal humerus fractures are one of the most common fractures which mainly occur in older patients. Historically these fractures had been treated mainly conservatively, but today a more anatomic reduction is advocated particularly of the tubercles with early functional aftercare. Besides the commonly used open deltapectoral approach, a minimally invasive anterolateral deltoid-splitting approach can be used even for proximal diaphyseal fractures for percutaneous plate fixation.     

Minimalinvasive Schultereckgelenkstabilisierung mit freiem Sehnentransplantat

Revision surgery following unsuccessful acromioclavicular (AC) joint stabilization and chronic joint instability presents a great challenge in orthopedics. In those cases, sufficient healing of the coracoclavicular (CC) ligaments cannot be expected. Different kinds of procedures are described for the operative treatment of chronic AC joint instability that can be divided into anatomic and non-anatomic techniques. The basic idea is to provide stability and a biological basis for the ligamentization process of the CC ligaments. The anatomic, minimally invasive operation techniques using TightRope? or similar pulley systems in combination with a free tendon autograft have turned to a widely accepted and used treatment for chronic acromioclavicular (AC) joint separations.     

Minimalinvasive Osteosynthese dislozierter proximaler Humerusfrakturen

Operationsziel  

Reposition und Retention dislozierter proximaler Humerusfrakturen mit minimalinvasiven Verfahren bis zur kn?chernen Heilung. Wiederherstellung der Form und Funktion des Schultergelenkes.     

Minimalinvasive Osteosynthesetechniken bei distalen Radiusfrakturen

Trauma und Berufskrankheit - Zusammenfassung Distale Radiusfrakturen sind vielgestaltig. Die AO-Klassifikation setzt sich auch hier allmählich durch. Die Therapie erstrebt die exakte...     

Minimalinvasive Akromioklavikulargelenkrekonstruktion (MINAR)

Objective

Reduction and retention of an acromioclavicular (AC) joint dislocation with a button/suture augmentation cerclage (Flip tack, Karl Storz, Tuttlingen, Germany).

Indications

Dislocation of the AC joint (Rockwood III and V). Chronic instabilities in combination with autogenous replacement of the coracoclavicular ligaments. Lateral clavicular fracture with rupture of the coracoclavicular ligaments.

Contraindications

Patients in poor general condition. Local soft-tissue infection. Low-degree dislocation of AC joint (Rockwood I und II). Fracture of the clavicular shaft. Chronic instabilities without ligament replacement.

Surgical Technique

The coracoid process is exposed by a 3 cm long skin incision. A hole is drilled through the coracoid process with the help of a specific aiming device. The suture cerclage is connected to two buttons. One of the buttons is then pushed through the coracoid process. The button is flipped and the suture thereby fixed to the coracoid process. The other anchor is pulled through a hole in the clavicle and the cerclage is secured with a surgical knot after reduction of the AC joint.

Postoperative Management

Application of an abduction splint for 4 weeks (15°).

Results

23 patients with an acute luxation of the AC joint were operated with a minimally invasive coracoclavicular cerclage (five patients with Rockwood type III and 18 patients with Rockwood type V). Mean operative time was 28.6 min. Perior postoperative complications such as nerve and vascular injuries, thoracic injuries, infection, thrombosis, and embolism did not occur. The mean Constant Score was 94.1 points (73–100 points) after a mean of 23.3 months (18–28 months). In two cases, a slight loss of reposition of less than half of the clavicle width in comparison with the contralateral side was observed.     

Minimalinvasive Verfahren bei der Dupuytren-Kontraktur

Trauma und Berufskrankheit - Die Dupuytren-Kontraktur ist eine degenerative Erkrankung, die eine Fibrosierung der palmaren und digitalen kollagenen Faserbündel (und der Aponeurose) darstellt....