Preserving normal tissue during surgery has become increasingly important for betteroutcomeafter operation.Because of this, minimally invasive procedures have been developed. There are many pain procedures with minimally invasive method to aid fluoroscopy.The percutaneous vertebroplasty or kyphoplasty instead of screw fixation for many kinds of compressed fractures with 90% success rate is a good example (1). The percutaneous radiofrequency ablation of medial branch of dorsal ramus for facet mediated vertebral pains is another example with good results (2)...

Context: minimally invasive procedures are used for treatment of nonresponsive hemorrhoids to conservative therapy. These OPD (Out-Patient Department) procedures are effective to eradicate the hemorrhoid symptoms with minimal postoperative pain and complications. Evidence Acquisition: In this review, data base of PubMed, and MEDLINE were searched with time limitation (2002- 2012). Recent articles in English journals were reviewed to evaluate and compare these minimally invasive procedures including Rubber band ligation (RBL), Infrared coagulation (IRC), Direct current Electrotherapy (DCE), and Sclerotherapy.Results: Upon the articles, 881 were treated with RBL, 454 with IRC, 1203 with DCE, and 2372 with sclerotherapy. Postoperative pain, which is a common complication of hemorrhoidectomy, was 3-25% in RBL, 2.13-4.3% in DCE, and 1.8-7% in sclerotherapy. Pain was mild to moderate and rarely needed analgesic. Postoperative rectal bleeding was seen in 1.26-32.4% of patients treated with RBL. Recurrence of preoperative symptoms was 1.9-39% for RBL, 6.9-21% for sclerotherapy, and 2.9-3% for DCE. Postoperative complications were minor in all procedures and for sclerotherapy it was seen in 6.9-21% of patients. Success rate was 69.4-96.4% in RBL, 80% in IRC, 89.3-99.7% in sclerotherapy, and 98.2% in DCE. Patient's satisfaction was 98% for DCE versus 99% for RBL and IRC. Operation time for each tag of hemorrhoid was 4.5-10 minutes for DCE, regarding different amplitudes of currency and degrees of hemorrhoid, and 13 minutes for sclerotherapy and not reported for other methods.Conclusions: minimally invasive procedures are used depending on surgeon's experience and preference. These modalities are comparable from different aspects. The cost of treatment and availability of equipment may affect the choice of modality. All of these techniques could be used in patients resulting in maximum success rate and minimum complications.

Introduction: Aortic valve surgery can be performed by various types of approaches including Sternotomy, upper mini-sternotomy and right anterior thoracotomy. We present our experience with the mini-sternotomy approach for AVR. Material and method: 73 patients underwent minimally invasive AVR between 2012 and 2014. There was no selection in patients who needed AVR, neither regarding hemodynamic or the structural factors. All patients needed only AVR and patients with concomitant coronary disease, aortic aneurysm and other vulvar disease were not included. The sternum opened down to the 3rd or 4th inter-costal space with right J extension, andfemoro – femoral or rarely femoro-aortic bypass used. Results: There was no morality and no early morbidity related to the procedure. Conversion to standard sternotomy was not needed in any patient. No complication related to peripheral cannulationoccurred. Dehiscence of the upper sternal segment occurred in two patients, one combined with infection. Conclusion: Considering the advantagees of minimally invasive approach such as less pain, less bleeding, and less trauma, and obvious cosmetic benefit, this approach can be used safely for patients who need AVR with excellent results. Revised technique of sternal closure can decrease the rate of sternal dehiscence.

Glaucoma management has changed dramatically over the last decades, through clinical advances and technological revolutions. This review discusses the latest innovations and challenges faced in the field around three major axes: minimally-invasive glaucoma surgery (MIGS), implantable sensors and injectable therapeutics. Indeed, the vast number of recently developed MIGS techniques has not only provided clinicians with a wide range of therapeutic options, but they have also enabled them to adjust their therapies more finely which may have contributed a more patient-centric decision-making process. Yet, despite considerable advances in the field, the wide heterogeneity in clinical trial designs blurs the surgical outcomes, specificities and indications. Thus, more high-quality data are required to make the choice of a specific MIGS procedure more than an educated guess. Beyond the scope of MIGS, the potential of IOP telemetry for self-assessment of IOP-control through implantable sensors is developing into a real option for clinicians and an empowering opportunity for patients. Indeed, providing patients with direct feedback enables them to take control and have a clearer representation of their care, in turn leading to a better control of the disease. However, there are potential issues with self-monitoring of IOP, such as increased anxiety levels induced by measured IOP fluctuations and peaks, leading to patients self-treating during IOP spikes and additional office visits. Furthermore, the advent of implantable therapeutics may soon provide yet another step towards personalized glaucoma treatment, by offering not only an efficient alternative to current treatments, but also a therapeutic option that may better adapt to patients’ lifestyle. After several decades of relative stagnation through the last century, glaucoma has now entered what many view as a golden age for the specialty. Like every revolution, this one brings its fair share of uncertainty, clinical questioning and uneasy periods of adaptation to ever-changing expectations. Yet, while it is impossible to guess what the landscape of glaucoma surgery will be like in ten or fifteen years, data suggest a bright outlook both for patients and clinicians.