The incidence of thyroid tumors has been increasing recent years, the importance of quality of life has been more concerned in addition to radical treatment. Traditional open surgery has been unable ...to meet the needs of all patients. In recent years, the continuous innovation and vigorous development of minimally invasive techniques, including endoscopy, ablation, and robotics, have expanded the range of available surgical options. In this review, we summarized the advancements in minimally invasive surgery for thyroid tumors, focusing on how to select the most appropriate surgical approach based on the patient's condition and develop personalized treatment plans.
Background: As an alternative to back surgeries, endoscopic spinal operations is the most effective and safe procedure that does not impose the fear reaction to the patients. Objective: In this study ...the results, complications, and outcomes of 60 patients complaining from prolapsed lumbar inter-vertebral discs who experienced prolapsed endoscopic lumbar discectomy (PELD) were reported. Patients and Methods: This is a prospective study conducted in three sentinel hospitals over a period of 3 years (2013-2015) in Erbil city of Iraq. Clinical findings in addition to pre-operative MRI were the main diagnostic methods used for including patients who were suffering from lumbar disc herniation at different levels. Clinical appraisal was done utilizing the modified Macnab criteria. The Storz lens spinoscope was utilized to perform PELD. Results: Sixty patients (37 males and 23 females) with lumbar disc herniation were included in the study. The mean operative time was 50 minutes. Patients were discharged during 1st 24 hours post-operatively. After surgery, patients were followed up for two months to three years with a mean of 18 months. Seven (11.7%) patients developed complications including one (1.7%) instance of shallow nerve injury, three (5%) with dural tears, two (3.3%) instances of intermittent delayed disc prolapse and one patient (1.7%) had post-operative discitis. Modified Macnab criteria (excluding patients with long dural tear) showed excellence results for 36 patients, while good results were observed for 17 patients, reasonable results for 3 patients and poor results for 2 patients. The achievement rate was 91.4% . Conclusion:Although endoscopic spinal discectomy is a compelling procedure for management of lumbar disc prolapse, and although its final outcome is reasonable it is not devoid from complications.
Background: As an alternative to back surgeries, endoscopic spinal operations is the most effective and safe procedure that does not impose the fear reaction to the patients. Objective: In this study ...the results, complications, and outcomes of 60 patients complaining from prolapsed lumbar inter-vertebral discs who experienced prolapsed endoscopic lumbar discectomy (PELD) were reported. Patients and Methods: This is a prospective study conducted in three sentinel hospitals over a period of 3 years (2013-2015) in Erbil city of Iraq. Clinical findings in addition to pre-operative MRI were the main diagnostic methods used for including patients who were suffering from lumbar disc herniation at different levels. Clinical appraisal was done utilizing the modified Macnab criteria. The Storz lens spinoscope was utilized to perform PELD. Results: Sixty patients (37 males and 23 females) with lumbar disc herniation were included in the study. The mean operative time was 50 minutes. Patients were discharged during 1st 24 hours post-operatively. After surgery, patients were followed up for two months to three years with a mean of 18 months. Seven (11.7%) patients developed complications including one (1.7%) instance of shallow nerve injury, three (5%) with dural tears, two (3.3%) instances of intermittent delayed disc prolapse and one patient (1.7%) had post-operative discitis. Modified Macnab criteria (excluding patients with long dural tear) showed excellence results for 36 patients, while good results were observed for 17 patients, reasonable results for 3 patients and poor results for 2 patients. The achievement rate was 91.4% . Conclusion:Although endoscopic spinal discectomy is a compelling procedure for management of lumbar disc prolapse, and although its final outcome is reasonable it is not devoid from complications.
Aim. To review and analyze the basic methods of treating early laryngeal cancer used in clinical practice. Material and Methods. Scientific articles on the subject listed in the international ...science-computer bases were selected for analysis. The basic indications and contraindications for application of various surgical and non-surgical methods of treatment of early laryngeal cancer were determined. Results and Discussion. The goal of treatment of early laryngeal cancer at the present stage is not only ablastic elimination of the tumor, but also preservation of the organ and its linguistic function. The development of endoscopic and robotic surgical techniques as well as of radiation therapy equipment has greatly expanded the arsenal of procedures for a physician over the last decade. At the same time, the accumulated experience of large medical centers allowed to separate indications for each of the methods. Analysis and systematization of their results will allow changing the existing treatment principles, identifying groups of patients for the optimal surgical or radiotherapy treatment, which will preserve voice and reduce the frequency of relapse. Conclusions. In early laryngeal cancer patients have two main methods of treatment: radiotherapy or surgery. For the final choice, it is necessary to take into account a number of circumstances: the location and prevalence of the process; the duration of treatment; the cost and effectiveness of treatment; the experience and skills of ENT-surgeon.
Background
The endoscopic endonasal approach for optic nerve decompression is suited for the management of non-traumatic optic neuropathy but remains underreported, presumably due to transcranial ...approaches still being favoured at individual centres.
Method
The optic canal is approached endoscopically and transsphenoidally through the contralateral nostril. Its inferomedial wall is opened using an irrigated diamond drill, and neuronavigation is used to confirm anatomical bearings.
Conclusion
This technique provides rapid and easy access to the inferomedial aspect of the optic canal and nerve. Optic nerve decompression through this approach is associated with low morbidity and should be considered as an alternative to transcranial approaches.
AIM: To assess the morphological impact of transanal endoscopic surgery on the sphincter apparatus using the modified Starck classification. METHODS: A prospective,observational study of 118 ...consecutive patients undergoing Transanal Endoscopic Operation/Transanal Endoscopic Microsurgery(TEO/TEM) from March 2013 to May 2014 was performed. All the patients underwent an endoanal ultrasound prior to surgery and one and four months postoperatively in order to measure sphincter width,identify sphincter defects and to quantify them in terms of the level,depth and size of the affected anal canal. To assess the lesions,we used the "modified" Starck classifi-cation,which incorporates the variable "sphincter fragmentation". The results were correlated with the Wexner incontinence questionnaire.RESULTS: Of the 118 patients,twelve(sphincter lesions) were excluded. The results of the 106 patients were as follows after one month: 31(29.2%) lesions found on ultrasound after one month,median overall Starck score of 4(range 3-6); 10(9.4%) defects in the internal anal sphincter(IAS) and 3(2.8%) in the external anal sphincter(EAS); 17 patients(16%) had fragmentation of the sphincter apparatus with both sphincters affected in one case. At four months: 7(6.6%) defects,all in the IAS,overall median Starck score of 4(range 3-6). Mean IAS widths were 3.5 mm(SD 1.14) preoperatively,4.38 mm(SD 2.1) one month postoperatively and 4.03 mm(SD 1.46) four months postoperatively. The only statistically significant difference in sphincter width in the IAS measurements was between preoperatively and one month postoperatively. No incontinence was reported,even in cases of ultrasound abnormalities.CONCLUSION: TEO/TEM may produce ultrasounda b n o r m a l i t i e s b u t t h i s i s n o t a c c o m p a n i e d b y clinical changes in continence. The modified Starck classification is useful for describing and managing these disorders.
AIM: To apply the laparoscopic and endoscopic cooperative surgery concept, we investigated whether endoscopic cholecystectomy could be performed more safely and rapidly via only 1 port or ...not.METHODS: Two dogs(11 and 13-mo-old female Beagle) were used in this study. Only 1 blunt port was created, and a flexible endoscope with a tip attachment was inserted between the fundus of gallbladder and liver. After local injection of saline to the gallbladder bed, resection of the gallbladder bed from the liver was performed. After complete resection of the gallbladder bed, the gallbladder was pulled up to resect its neck using the Ring-shaped thread technique. The neck of the gallbladder was cut using scissor forceps. Resected gallbladder was retrieved using endoscopic net forceps via a port. RESULTS: The operation times from general anesthetizing with sevoflurane to finishing the closure of the blunt port site were about 50 min and 60 min respectively. The resection times of gallbladder bed were about 15 min and 13 min respectively without liver injury and bleeding at all. Feed were given just after next day of operation, and they had a good appetite. Two dogs are in good health now and no complications for 1 mo after endoscopic cholecystectomy using only a flexible endoscope via one port.CONCLUSION: We are sure of great feasibility of endoscopic cholecystectomy via single port for human.
For some gastric bypass patients, dilation of the gastrojejunal anastomosis (GJA) and/or gastric pouch is believed to contribute to weight regain. The present study had 2 objectives: (1) to assess ...the technical feasibility and safety of a novel endoscopic procedure called "revision obesity surgery endoscopic" (ROSE) using a second-generation, prototype endoscopic operating system that creates tissue plications to reduce the diameter of the GJA and the size of the gastric pouch; and (2) to assess the early outcomes regarding weight loss at a university hospital in the United States.
This was a prospective study of 5 patients who had regained a mean of 14.7 kg after gastric bypass with a dilated pouch and GJA on screening endoscopy. The gastric pouch and the GJA were measured before and after the procedure. The patients were followed up for a minimum of 3 months after the procedure. Weight changes were recorded.
Technical success was achieved in all 5 patients (100%). The mean weight loss in the successful cases was 7.8 kg at 3 months. No major complications developed.
The results of our study have shown that the ROSE procedure using this second-generation prototype endoscopic operating system is technically feasible and appears safe. Our preliminary results suggest that the ROSE procedure is effective in reducing the size of both the GJA and the gastric pouch and could therefore be an alternative therapy for weight regain in postgastric bypass patients.
Effect of temperature on fluidity of irrigation fluids de Freitas Fonseca, M; Andrade, C.M.; de Mello, M.J.E. ...
British journal of anaesthesia : BJA,
January 2011, 20110100, 2011, 2011-Jan, 2011-01-00, 20110101, Volume:
106, Issue:
1
Journal Article
Peer reviewed
Open access
Fluid overload is a major complication during surgical hysteroscopy and transurethral resection of the prostate. We evaluated the role of temperature on absorption of the irrigation solution (IRRSOL) ...in endoscopic surgery when warm fluids are used to minimize hypothermia.
We measured the density and dynamic fluidity of five IRRSOLs (0.9% saline, Ringer’s lactate, 1.5% glycine, 5% dextrose, and 2.5/0.54% sorbitol/mannitol) at three different temperatures (17°C, 27°C, and 37°C). Next, a hypothetical typical endoscopic resection surgery was defined as the reference: total IRRSOL absorption (750 ml), resection time (30 min), and IRRSOL temperature (17°C). On the basis of Poiseuille’s law, we calculated new values for intravasation using the predetermined dynamic fluidity values at 27°C and 37°C to assess the influence of the IRRSOL temperature on intravascular absorption (under identical conditions) and then estimated the time to reach fluid overload at each temperature with both electrolyte and non-electrolyte IRRSOLs.
Density and fluidity varied with temperature. In these specific conditions, when the temperature of the IRRSOL was increased from 17°C to 37°C, the mean absorption rate was predicted to increase about 54% and the theoretical ‘safe’ duration of surgery decreased by ∼65%, for both electrolyte and non-electrolyte IRRSOLs. The reduction in the ‘safe’ duration of surgery averaged 21.1 min for non-electrolyte IRRSOL (reduced from 60.0 to 38.9 min) and 35.2 min when electrolyte IRRSOLs were used (reduced from 100.0 to 64.8 min).
Compared with cold fluids, isothermic IRRSOL may increase the risk of fluid overload because dynamic viscosity decreases at higher temperatures.
Summary Background and objective: Since the introduction of the laryngeal mask into clinical practice, various additional supraglottic ventilatory devices have been developed. Although it has been ...demonstrated that the laryngeal tube is an effective airway device during positive pressure ventilation no clinical study has been performed thus far regarding its use in patients with predicted ventilation and intubation difficulties. Methods: The aim of this study was to prospectively evaluate the use of the laryngeal tube for temporary oxygenation and ventilation in adult patients with supraglottic airway tumours scheduled to undergo a pharyngeal–laryngeal oesophagoscopy and bronchoscopy under general anaesthesia. In addition to our standard airway management with face mask ventilation and rigid bronchoscopy, all patients were temporarily ventilated with an laryngeal tube. Also, in patients requiring laryngeal biopsies, endotracheal intubation was performed with a 6.0 mm microlaryngeal tracheal tube. Minute ventilation volumes, tidal volumes, ventilation pressures, end-expiratory CO2 concentration, oxygen saturation and arterial blood gas samples were measured. Results: From 54 enrolled patients only patients with relevant tumour masses were evaluated (n = 23). Mask ventilation was performed without difficulty in 15 of 23 patients. Mechanical ventilation with the laryngeal tube was possible in 22 of 23 patients with an audible leak present in three. Conventional endotracheal intubation was successfully performed in 19 of 23 patients. During face mask ventilation, minute volume, tidal volume, ventilation pressure, end-tidal CO2, oxygen saturation and arterial PO2 were significantly lower and PCO2 significantly higher (P < 0.05, paired t-test). No statistically significant differences were noted between the laryngeal tube and the microlaryngeal tracheal tube. Conclusions: The possibility of difficult ventilation and intubation must always be considered in patients with supraglottic airway tumours. In these cases, the laryngeal tube can be considered for routine airway management and may be useful in the ‘cannot-intubate’ situation although difficulties should be anticipated in patients with previous irradiation, specifically of the throat area.
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