Sample records for endoscopic nasal surgery

  1. Balloon sinuplasty: a new concept in the endoscopic nasal surgery

    Nogueira Júnior, João Flávio


    Full Text Available Introduction: Sinus diseases affect millions of people annually. Clinical treatment is effective in most patients, but in case of failure of this therapy the functional endoscopic surgery is currently the treatment choice for surgical treatment. The objective of the functional endoscopic surgery is to increase the aeration and drainage of the involved paranasal sinuses, which allows for the adequate functioning of the nasal mucosa mucociliary clearance. However, this method still has some limitations, mainly because it removes the nasal mucosa and bone tissue, and it may lead to physiologic alterations of the nasosinusal mucosa and cicatricial fibrosis. Many of these patients could be benefited from less invasive methods, with larger nasal mucosa preservation. Since 2006, an even less invasive procedure was remarked in our specialty: the balloon dilatation of the paranasal sinus ostia. Objective: The objective of this article is to define the concept of sinuplasty, its action mechanism, and present the necessary material for the procedures performance; to describe the techniques with the equipment in a nasosinusal endoscopic surgery simulator model and review the current literature about the indications, complications, results, and follow-up of patients submitted to this procedure. Balloon sinuplasty is safe and appears to be effective in the improvement of the quality of life of patients not responsive to conventional clinical therapy. New applications and indications for this equipment should be described and researched.

  2. Does amphotericin B nasal douching help prevent polyp recurrence following functional endoscopic sinus surgery?

    Sayyed Mostafa Hashemi


    Conclusions: This study showed no benefits for topical amphotericin B solution over normal saline. It might be better to retreat to the traditional normal saline nasal douching following functional endoscopic sinus surgery in the treatment of polyposis.

  3. Endoscopic sinus surgery in chronic rhinosinusitis and nasal polyposis: a comparative study.

    Nair, Satish; Dutta, Angshuman; Rajagopalan, Ramakrishnan; Nambiar, Sapna


    Nasal polyposis are common presentations in patients of chronic rhinosinusitis and are considered to be associated with more severe forms of disease with poor treatment outcome. The presentation and treatment outcome after endoscopic sinus surgery in patients of chronic rhinosinusitis and nasal polyposis have been analysed in this study. A prospective analysis of 90 patients of chronic rhinosinusitis who were classified into two groups depending on presence and absence of nasal polyps was performed in the study. The two groups were evaluated using subjective (patient complaints) and objective (computed tomography scan and endoscopy scores) criteria. Preoperative data were compared with data obtained 12 months post endoscopic sinus surgery. The study included 38 patients of chronic rhinosinusitis and 52 patients of nasal polyps. The patients of nasal polyp group presented with increased severity of symptoms of nasal blockage, nasal discharge and reduced sense of smell as compared to the chronic rhinosinusitis group who had significantly higher presentation of headache and facial pain. The preoperative CT scan revealed significantly higher bilateral disease with increased involvement of multiple sinuses in nasal polyp group. Post endoscopic sinus surgery both the groups showed significant improvement in their symptoms with the nasal polyp group demonstrating reduction in improvement on 1 year follow up. In our study we have found the patients with chronic rhinosinusitis and nasal polyp have varied severity of symptoms with the nasal polyp group having higher nasal symptoms and increased severity as compared to chronic rhinosinusitis group. Though the universal rationale of management by adequate drainage and ventilation of sinus is similar in both groups, there is a reduction in both objective and subjective scores during 1 year follow up in the nasal polyp group.

  4. Functional Endoscopic Sinus Surgery as a primary modality of treatment for primary and recurrent nasal polyposis.

    Gohar, Mohammad Shahid; Niazi, Saleem Asif; Niazi, Sohail Baber


    To describe the efficacy of Functional Endoscopic Sinus Surgery(FESS) in our set up in comparison with other published studies to treat primary and recurrent nasal polyposis. This descriptive study was conducted in 02 years at Ear Nose Throat Department Combined Military Hospital (CMH) Multan from October 2013 to October 2015. Convenient sample comprising 116 patients of both sexes of age group from 18 to 60 years were selected from ENT Out Patient Department, with documented diagnosis of nasal polyposis that underwent functional endoscopic sinus surgery. Out of 116 patients, 15 (12.9%) had recurrent nasal polyposis while 101 (87.1%) had primary nasal polyposis. Patients were assessed clinically. Preoperative nasal endoscopy and CT scan of nose and paranasal sinuses were performed in every patient to assess the extent of disease and evaluate the surgical anatomy. Patients were followed up 03 monthly, 06 monthly and after 01 year. Clinical signs of nasal polyposis were evaluated by nasal endoscopy at each follow up visit. There were 116 patients with documented diagnosis of nasal polyposis. Among these, 75 (64.7%) were male and 41 (35.3%) were female patients. Mean age of presentation in males was 39.1 years and that of females was 36.7 years. Only 15 patients (12.9%) developed recurrent disease within a year. Functional endoscopic sinus surgery is preferred as a primary treatment modality for primary and recurrent nasal polyposis. Mucosal polyps can be carefully debrided, the natural ostia enlarged, the ethmoid sinuses are unroofed, and sphenoid sinuses are opened in nasal cavity and sinus nasal mucosa is mostly preserved due to excellent visualization and surgical technique. Improvement in symptoms with minimal chance of recurrence may be expected in more than 90% patients.

  5. Clinical analysis on intracranial infection after nasal endoscopic repair surgery for cerebrospinal fluid rhinorrhea

    Xiang ZHAI


    Full Text Available From June 2005 to October 2012, there were 135 cases with cerebrospinal fluid (CSF rhinorrhea admitted in our hospital who underwent nasal endoscopic repair surgery, and intracranial infection happened in 3 cases after surgery, including intracranial mucormycosis in one case, brain abscess in one case and bacterial infection in one case. These 3 cases underwent surgery to clear up the focus of infection, supplemented by antifungal drugs or antibiotic therapy. Case 1 and Case 2 were followed up for 2 years without CSF rhinorrhea or intracranial infection; Case 3 died due to multiple organ failure. The intracranial complications after nasal endoscopic surgery for repairing CSF leakage are rare and need combined treatment of relevant departments. doi: 10.3969/j.issn.1672-6731.2014.08.016

  6. Nasal Functional Evaluation Using Nasal Endoscopy, Acoustic Rhinometry, and Rhinomanometry on Nasal Airway-Obstructed Patients after Endoscopic Septoplasty, Corrective Rhinoplasty, and Internal Nasal Valve Surgery

    Yiğit Özer Tiftikcioğlu


    Full Text Available Objective: Rhinoplasty is a very common surgical procedure that is performed throughout the world as well as in our country for aesthetic concerns, nasal obstruction, or both. However, functional results still remain subjective, and compared to the vast number of operations, studies about functional results in the literature are very limited. The aim of this study is to evaluate respiratory functions after corrective rhinoplasty and to find the benefits both numerically and statistically. Material and Methods: Thirty patients who were admitted to our department with nasal obstruction based on the statements of the patients were included in the study. Patients who were admitted only for aesthetic considerations were excluded from the study. These patients were preoperatively evaluated with radiographic and endoscopic imaging; preoperative nasal resistance and nasal airway cross-sectional area values were measured and recorded with acoustic rhinometry and rhinomanometry devices. Then, patients were operated by open rhinoplasty technique, and measurements were repeated at three months and one year postoperative follow-ups. Results: As a result of measurements made with rhinomanometry one year after the surgery, a decrease in resistance value was observed in 20 patients, and an increase in minimal cross-sectional area measured with acoustic rhinometry was observed in 24 patients. The values measured by both methods were found to be statistically significant. Conclusion: As a result of our study, we advocate performing both functional and aesthetic rhinoplasty operations instead of functional or aesthetic purposes alone.

  7. Registration and fusion quantification of augmented reality based nasal endoscopic surgery.

    Chu, Yakui; Yang, Jian; Ma, Shaodong; Ai, Danni; Li, Wenjie; Song, Hong; Li, Liang; Chen, Duanduan; Chen, Lei; Wang, Yongtian


    This paper quantifies the registration and fusion display errors of augmented reality-based nasal endoscopic surgery (ARNES). We comparatively investigated the spatial calibration process for front-end endoscopy and redefined the accuracy level of a calibrated endoscope by using a calibration tool with improved structural reliability. We also studied how registration accuracy was combined with the number and distribution of the deployed fiducial points (FPs) for positioning and the measured registration time. A physically integrated ARNES prototype was customarily configured for performance evaluation in skull base tumor resection surgery with an innovative approach of dynamic endoscopic vision expansion. As advised by surgical experts in otolaryngology, we proposed a hierarchical rendering scheme to properly adapt the fused images with the required visual sensation. By constraining the rendered sight in a known depth and radius, the visual focus of the surgeon can be induced only on the anticipated critical anatomies and vessel structures to avoid misguidance. Furthermore, error analysis was conducted to examine the feasibility of hybrid optical tracking based on point cloud, which was proposed in our previous work as an in-surgery registration solution. Measured results indicated that the error of target registration for ARNES can be reduced to 0.77 ± 0.07 mm. For initial registration, our results suggest that a trade-off for a new minimal time of registration can be reached when the distribution of five FPs is considered. For in-surgery registration, our findings reveal that the intrinsic registration error is a major cause of performance loss. Rigid model and cadaver experiments confirmed that the scenic integration and display fluency of ARNES are smooth, as demonstrated by three clinical trials that surpassed practicality. Copyright © 2017 Elsevier B.V. All rights reserved.

  8. Administering of pregabalin and acetaminophen on management of postoperative pain in patients with nasal polyposis undergoing functional endoscopic sinus surgery.

    Rezaeian, Ahmad


    Management of postoperative pain is a common problem in endoscopic sinus surgery. The objective of this study is the evaluation of pregabalin and acetaminophen effects on the management of postoperative pain in patients with nasal polyposis undergoing functional endoscopic sinus surgery (FESS). In this clinical trial, double-blinded study, 70 patients with nasal polyposis who have indication of FESS were enrolled to this study. After operation, patients were divided randomly into pregabalin and acetaminophen therapy groups. The pregabalin group (n = 35) was treated under pregabalin 50 mg TDS and the acetaminophen group (n = 35) was treated under tablet acetaminophen 500 mg/6 h. Each group was administered for 3 d. The visual analogue scale (VAS) was measured in onset, 12, 24, 48 and 72 h after surgery. All data were entered into SPSS software (SPSS Inc., Chicago, IL) and appropriate statistical tests were assessed to every relation. In this study, there was no significant difference between two groups according to VAS in onset (p = .37); however, VAS in 12, 24, 48 and 72 h after operation was significantly lower in the pregabalin group compared with the acetaminophen group (p acetaminophen group (p acetaminophen on the management of postoperative pain in the patients with nasal polyposis undergoing functional endoscopic sinus surgery.

  9. Safety analysis of long-term budesonide nasal irrigations in patients with chronic rhinosinusitis post endoscopic sinus surgery.

    Soudry, Ethan; Wang, Jane; Vaezeafshar, Reza; Katznelson, Laurence; Hwang, Peter H


    Although the safety of topical nasal steroids is well established for nasal spray forms, data regarding the safety of steroid irrigations is limited. We studied the effect of long-term budesonide nasal irrigations (>6 months) on hypothalamic-pituitary-adrenal axis (HPAA) function and intraocular pressure (IOP) in patients post-endoscopic sinus surgery. This was retrospective case series. Adrenal function was assessed by using the high-dose cosyntropin stimulation test. A total of 48 patients were assessed, with a mean duration of budesonide irrigations of 22 months. Stimulated cortisol levels were abnormally low in 11 patients (23%). None reported to have symptoms of adrenal suppression. Three of 4 patients who repeated the study being off budesonide for at least 1 month returned to near normal levels. Logistic regression analysis revealed that concomitant use of both nasal steroid sprays and pulmonary steroid inhalers was significantly associated with HPAA suppression (p = 0.024). Patients with low stimulated cortisol levels were able to continue budesonide irrigations under the supervision of an endocrinologist without frank clinical manifestations of adrenal insufficiency. IOP was within normal limits in all patients. Long-term use of budesonide nasal irrigations is generally safe, but asymptomatic HPAA suppression may occur in selected patients. Concomitant use of both nasal steroid sprays and pulmonary steroid inhalers while using daily budesonide nasal irrigations is associated with an increased risk. Rhinologists should be alerted to the potential risks of long-term use of budesonide nasal irrigations, and monitoring for HPAA suppression may be warranted in patients receiving long-term budesonide irrigation therapy. © 2016 ARS-AAOA, LLC.

  10. 鼻内镜手术3587例护理配合%Cooperation for 3 587 cases of nasal endoscopic surgery

    王红; 丁元吉; 车军生


    目的:探讨鼻内镜手术患者的手术配合及护理措施。方法对全身麻醉下实施鼻内镜手术的患者进行围术期护理并观察效果。结果患者均顺利完成手术,均未发生术中并发症。结论加强鼻内镜手术患者的手术配合及护理是手术成功的重要保障。%ObjectiveInvestigate on patients with nasal endoscopic surgery operation cooperation and nursing measures.MethodsPatients with nasal endoscopic surgery are under general nesthesia for perioperative nursing and observation results.ResultsPatients were successfully completed surger,No intraoperative complications ccurred. ConclusionTo strenthen the operation cooperation and nursing of patients with nasal endoscopic surgery is assurance of success of operation.

  11. Comparison of calcium alginate and carboxymethyl cellulose for nasal packing after endoscopic sinus surgery: a prospective, randomised, controlled single-blinded trial.

    Park, D-Y; Chung, H J; Sim, N S; Jo, K H; Kim, D H; Kim, C-H; Yoon, J-H


    Calcium alginate is a biodegradable gel-transforming agent widely used for nasal packing. It can reduce pain and improve comfort. However, few randomised controlled trials have compared the efficacy of calcium alginate nasal packing with that of other biodegradable gel-transforming materials. Prospective, randomised, single-blinded controlled study. Yonsei University Severance Hospital, a tertiary academic medical centre. Twenty-seven patients (54 nostrils) with chronic rhinosinusitis who were scheduled for bilateral endoscopic sinus surgery were enrolled. After surgery, one nostril was packed with calcium alginate and the other with carboxymethyl cellulose. Only patients with an intersinus chronic rhinosinusitis severity score difference of ≤1 were included. Visual analogue scale (VAS) scores for postoperative pain, discomfort from nasal discharge and pain during packing removal were analysed. Two independent rhinologists who were blinded to the assessments separately scored adhesions, oedema and infection by endoscopic digital photography at 1, 4 and 8 weeks postoperatively. There were no significant differences in VAS scores for postoperative pain, discomfort from nasal discharge or pain during packing removal between calcium alginate packings and carboxymethyl cellulose packings. Inter-rater variability of adhesion, oedema and infection scores was acceptable. Adhesion severity and oedema scores at 4 weeks were significantly lower with calcium alginate packing than with carboxymethyl cellulose. Infection severity scores also tended to be lower with calcium alginate than with carboxymethyl cellulose, but the difference was not significant. Calcium alginate nasal packing is associated with reduced severity of oedema and adhesions after endoscopic sinus surgery. © 2015 John Wiley & Sons Ltd.

  12. The Effectiveness of Budesonide Nasal Irrigation After Endoscopic Sinus Surgery in Chronic Rhinosinusitis With Asthma

    Kang, Tae Wook; Chung, Jae Ho; Cho, Seok Hyun; Lee, Seung Hwan; Kim, Kyung Rae; Jeong, Jin Hyeok


    Objectives Budesonide nasal irrigation was introduced recently for postoperative management of patients with chronic rhinosinusitis. The safety and therapeutic effectiveness of this procedure is becoming accepted by many physicians. The objective of this study was to evaluate the efficacy of postoperative steroid irrigation in patients with chronic rhinosinusitis and asthma. Methods This prospective study involved 12 chronic rhinosinusitis patients with nasal polyps and asthma who received oral steroid treatment for recurring or worsening disease. The 22-item Sinonasal Outcomes Test (SNOT-22) and Lund-Kennedy endoscopy scores were checked before nasal budesonide irrigation, and 1, 2, 4, and 6 months after irrigation. We also calculated the total amount of oral steroids and inhaled steroids in the 6 months before irrigation and the 6 months after it. Results The mean SNOT-22 score improved from 30.8±14.4 before irrigation to 14.2±8.7 after 6 months of irrigation (P=0.030). The endoscopy score also improved from 7.4±4.7 before irrigation to 2.2±2.7 after 6 months (Pirrigation to 72.7±99.7 mg over the 6 months after irrigation (Pirrigation with budesonide is an effective postoperative treatment for chronic rhinosinusitis with asthma, which recurs frequently, reducing the oral steroid intake. PMID:27440128

  13. Effect of advanced blood pressure control with nifedipine delayed-release tablets on the blood pressure in patients underwent nasal endoscope surgery

    Qing-Hua Xiao; Li Yang; Rong-Ping Chen; Wei-Dong Qiu


    Objective:To explore the effect of advanced blood pressure control with nifedipine delayed-release tablets on the blood pressure in patients underwent nasal endoscope surgery and its feasibility.Methods:A total of 80 patients who were admitted in ENT department from June, 2012 to June, 2015 for nasal endoscope surgery were included in the study and randomized into the observation group and the control group with 40 cases in each group. The patients in the observation group were given nifedipine delayed-release tablets for advanced blood pressure control before operation, and were given routine blood pressure control during operation; while the patients in the control group were only given blood pressure control during operation. The changes of blood pressure, mean central arterial pressure, and heart rate before anesthesia (T0), after intubation (T1), during operation (T2), extubation when waking (T3), 30 min after extubation (T4), and 3 h after back to wards (T5) in the two groups were compared. The intraoperative situation and the surgical field quality in the two groups were compared.Results: SBP, DBP, and MAP levels at T1-5 in the two groups were significantly lower than those at T0. SBP, DBP, and MAP levels at T2 were significantly lower than those at other timing points, and were gradually recovered after operation, but were significantly lower than those at T0. The effect taking time of blood pressure reducing, intraoperative nitroglycerin dosage, and postoperative wound surface exudation amount in the observation group were significantly less than those in the control group. The surgical field quality scores in the observation group were significantly superior to those in the control group.Conclusions:Advanced blood pressure control with nifedipine delayed-release tablets can stabilize the blood pressure during the perioperative period in patients underwent nasal endoscope surgery, and enhance the surgical field qualities.

  14. Evaluation of intraoperative bleeding during an endoscopic surgery of nasal polyposis after a pre-operative single dose versus a 5-day course of corticosteroid.

    Atighechi, Saeid; Azimi, Mohammad Reza; Mirvakili, Seyyed Abbas; Baradaranfar, Mohammad Hossein; Dadgarnia, Mohammad Hossein


    Nasal polyps are associated with the inflammation of the nasal cavity and the sinus mucosa. When medical treatment cannot solve a patient's problem, a functional endoscopic sinus surgery may be indicated. Bleeding impairs the surgery field during operation and increases the operation risk and time. Pre-operative corticosteroids can reduce bleeding during surgery. In this study, we have evaluated the effect of pre-operative single-dose prednisolone (1 mg/Kg/dose 24 h before surgery) versus 5-day prednisolone (1 mg/Kg/day before operation) on the bleeding volume and the surgery field quality during FESS. In this mono blind randomized clinical trial, 80 patients with bilateral nasal polyps were randomly assigned in two groups. The first group (A) received a single dose of 1 mg/Kg/dose prednisolone on the day before the surgery. The second group (B) received 1 mg/Kg/day prednisolone for 5 days before the operation. The patients were operated on under general anesthesia through the same protocol. The mean arterial blood pressure was 70-80 mm Hg in both groups. The surgeons were not aware of the patients' group. The bleeding volume and the surgeons' opinion about the surgery field quality were recorded at the end of the procedure and analyzed by Chi-square and t test. The two groups were not significantly different in their overall demographic and clinical characteristics. The mean bleeding volume during the operation was 266.5 ± 96.31 ml in group A and 206 ± 52.81 ml in group B; there was a significant difference between the groups (P value = 0.038). There was no significant difference between the groups in the surgeons' opinion about the surgery field quality (P value = 0.09). In conclusion, unlike a single dose (1 mg/kg/dose), treatment with 5-day prednisolone (1 mg/kg/day) can reduce blood loss during FESS more efficiently and may improve the surgery field quality slightly. But this difference is not clinically significant.

  15. Endoscopic removal of nasal septum chondrosarcoma in paediatric patient

    Muhammad Nasri Abu Bakar


    We report a boy with progressive history of nasal obstruction and epistaxis. Nasal endoscopy revealed a mass arising from nasal septum. Endoscopic excision of the tumour was successfully done followed by radiotherapy. Endoscopic excision of chondrosarcoma of the nasal septum in its early stage should be considered for better outcome.

  16. Effect Comparison of Different Rinse on Nasal Cavity after Nasal Endoscopic Surgery%鼻内镜术后不同冲洗液冲洗鼻腔的效果对比#



    Objective: To observe the different effect of Biyuan Tongqiao dilution and physiologic saline on nasal endoscopic post-surgery nasal cavity rinse.Methods:Ninety patients were covered in the functional endoscopic sinus surgery (FESS). Biyuan Tongqiao dilution was given to the study group and physiologic saline was given to the control group.Regular weekly nasal endoscope inspection were performed to observe physical sign changes, including nasal symptoms, surgical cavity cleaning, vesicle formation, and melt granulation of the two groups in four weeks.Results:In comparison, both two groups had therapeutic effects after four weeks rinse treatment, and the treatment effects were similar. However, Biyuan Tongqiao dilution turned out to be better on surgical cavity scab off, mucosal edema, nasal secretion decrease, and vesicle formation than physiologic saline,with significant difference (P0.05). Conclusion:Biyuan Tongqiao dilution can effectively clean post-FESS nasal, with effects of nasal mucosal edema relief, coated vesicle regeneration, and promoting membrana mucosa function recovery.%目的:观察鼻渊通窍颗粒稀释液与生理盐水对鼻内镜术后鼻腔冲洗的效果。方法:临床纳入进行功能性内窥镜鼻窦手术患者90例,研究组给予鼻渊通窍颗粒稀释液,对照组给予生理盐水。每周定期对患者进行鼻内窥镜的检查,观察两组患者4周内鼻腔症状以及术腔清洁、囊泡形成、肉芽生成等体征变化情况。结果:两组术后4周冲洗治疗结果表明,两者均有治疗作用,且治疗效果相当,但鼻渊通窍颗粒稀释液冲洗在术后第2周时对术腔痂皮脱落、黏膜水肿、鼻分泌物减少、囊泡形成治疗作用较生理盐水冲洗要好,差异有显著性(P<0.05);研究组治疗4周,总有效率为93.33%,对照组有效率为91.11%,差异无显著性(P>0.05)。结论:鼻渊通窍颗粒稀释液能够有效清洁术后的鼻腔,

  17. The clinical study of modified nasal endoscopic sinus surgery for nasal cavity%改良经鼻内镜下泪囊鼻腔造孔术临床探讨



    Objective To investigate the clinical effect of improving the treatment of chronic lacrimal sac with the treatment of chronic in-flammation of the lacrimal sac through the endoscopic treatment of nasal endoscope. Method 45 cases of chronic dacryocystitis bursitis pa-tients were selected,according to the different surgical methods,they were divided into two groups,the treatment group and the control group, after operation were compared between the two groups of patients with differences in efficacy. Results Observation group,23 cases of chronic dacryocystitis bursitis patients,improved under nasal endoscope of lacrimal sac and nasal cavity made hole surgery treatment,the total efficien-cy of 100%. The operations were successful;after 6 to 24 months follow - up,patients with overflow tears symptoms disappear,anatomical structure and opening up to the outside world,irrigation of lacrimal passage unobstructed and no purulent sex secretion. Conclusion The modi-fied by nasal endoscopic nasal lacrimal sac made hole technique has the advantages of simple operation,with no facial scar and less complica-tion in the treatment of chronic dacryocystitis,the clinical practice proved to have very good treatment effect and application prospect.%目的:探讨改良经鼻内镜下泪囊鼻腔造孔术治疗慢性泪囊炎的临床效果。方法:选择45例慢性泪囊炎患者,根据手术方式不同,将其分为2组,对照组和治疗组,术后比较两组患者的疗效差异。结果:观察组23例慢性泪囊炎患者,经改良经鼻内镜下泪囊鼻腔造孔术治疗,总有效率为100%,手术均获得成功;经过6~24个月的随访,患者溢泪症状消失,解剖结构开放,泪道冲洗通畅并无黏液脓性分泌物。结论:改良经鼻内镜下泪囊鼻腔造孔术治疗慢性泪囊炎具有操作简便、无面部疤痕、并发症少等优点,经临床实践证实具有非常好的治疗效果和应用前景。

  18. Fundus imaging with a nasal endoscope

    P Mahesh Shanmugam


    Full Text Available Wide field fundus imaging is needed to diagnose, treat, and follow-up patients with retinal pathology. This is more applicable for pediatric patients as repeated evaluation is a challenge. The presently available imaging machines though provide high definition images, but carry the obvious disadvantages of either being costly or bulky or sometimes both, which limits its usage only to large centers. We hereby report a technique of fundus imaging using a nasal endoscope coupled with viscoelastic. A regular nasal endoscope with viscoelastic coupling was placed on the cornea to image the fundus of infants under general anesthesia. Wide angle fundus images of various fundus pathologies in infants could be obtained easily with readily available instruments and without the much financial investment for the institutes.

  19. Comprehensive review on endonasal endoscopic sinus surgery

    Weber, Rainer K.; Hosemann, Werner


    Endonasal endoscopic sinus surgery is the standard procedure for surgery of most paranasal sinus diseases. Appropriate frame conditions provided, the respective procedures are safe and successful. These prerequisites encompass appropriate technical equipment, anatomical oriented surgical technique, proper patient selection, and individually adapted extent of surgery. The range of endonasal sinus operations has dramatically increased during the last 20 years and reaches from partial uncinectomy to pansinus surgery with extended surgery of the frontal (Draf type III), maxillary (grade 3–4, medial maxillectomy, prelacrimal approach) and sphenoid sinus. In addition there are operations outside and beyond the paranasal sinuses. The development of surgical technique is still constantly evolving. This article gives a comprehensive review on the most recent state of the art in endoscopic sinus surgery according to the literature with the following aspects: principles and fundamentals, surgical techniques, indications, outcome, postoperative care, nasal packing and stents, technical equipment. PMID:26770282

  20. Robot-assisted endoscopic surgery

    Ruurda, J.P.


    During the last three years, robot-assisted surgery systems are increasingly being applied in endoscopic surgery. They were introduced with the objective to overcome the challenges of standard endoscopic surgery. With the improvements in manipulation and visualisation that robotic-assistance offers,

  1. 鼻内镜手术治疗慢性鼻窦炎患者的临床效果观察%Clinical Effect of Nasal Endoscopic Surgery in the Treatment of Chronic Sinusitis



    目的:研究鼻内镜手术治疗慢性鼻窦炎患者的临床效果。方法:选取2014年3月-2016年3月在本院慢性鼻窦炎患者100例,根据随机数字表法分为鼻内镜组和传统径路组两组,每组各50例。传统径路组采取传统经鼻外径路手术治疗,鼻内镜组采取鼻内镜手术治疗。两组患者慢性鼻窦炎治疗总有效率、临床复发率、鼻中隔和下鼻甲粘连、眶周软组织淤血、上颌窦开口狭窄等并发症发生率、术前术后生活质量进行比较。结果:鼻内镜组慢性鼻窦炎治疗总有效率98.00%明显高于传统径路组78.00%,两组比较差异有统计学意义(P0.05),术后鼻内镜组生活质量(92.02±5.53)分明显优于传统径路组(82.98±4.72)分,两组比较差异有统计学意义(P>0.05)。结论:鼻内镜手术治疗慢性鼻窦炎患者的临床效果确切,具有微创性、安全性,术中损伤小,可确切改善患者临床症状,减少并发症的发生,降低复发率,改善患者生活质量,值得推广应用。%Objective:To study the clinical effect of nasal endoscopic surgery in the treatment of patients with chronic sinusitis.Method:100 cases of chronic sinusitis in our hospital from March 2016 to March 2014 were selected and divided into two groups according to the random number table,50 cases of nasal endoscopic group and 50 cases in the traditional path group.Traditional route group was treated by traditional external nasal surgery, nasal endoscopic group was treated with nasal endoscopic surgery.The chronic sinusitis treatment total efficiency, clinical relapse rate,nasal septum and inferior turbinate adhesions,periorbital soft tissue congestion, maxillary sinus ostium stenosis and other complications, and quality life before and after surgery of two groups were compared. Result: The total effective rate of the nasal endoscopic group was 98.00% significantly higher than that of the traditional

  2. The importance of investigation of anatomic variations in the ethmoid cells by computerized tomography in the planning of endoscopic nasal surgery; A importancia da investigacao de variacoes anatomicas das celulas etmoidais atraves da tomografia computadorizada no planejamento da cirurgia endoscopica nasal

    Ruiz, Cristiane Regina; Wafae, Nader; Nascimento, Sergio Ricardo Rios; Camelo, Julio Cesar; Maciel, Luana Teixeira; Consolari, Mario Agostinho Severo [Centro Universitario Sao Camilo, Sao Paulo, SP (Brazil)], e-mail:, e-mail:


    The ethmoidal cells comprise many cavities that show many anatomical variations. Some of these variations deserve special attention when associated with sinusitis and the need of surgery. Computed tomography, considered a gold standard on the pathological investigation of the nasal cavity and the anatomic description of paranasal sinus, offers information about these cells, essential to minimize the surgical risks. The authors present a bibliographic revision of the importance of computed tomography on the investigation of anatomic variations of ethmoid cells. Not recurrent cells in all individuals, like Haller's cells, Onodi's cells and pneumatization of agger nasi, will do the endoscopic approach with precaution. The ethmoidal roof evaluation will result in more safety on the upper limits of the nasal cavity. The size and pneumatization level of ethmoidal bulla, ethmoidal crest, and middle nasal concha are important on the evaluation of the endoscopic accesses and the gravity of the stroked pathology and even diagnose your origin. (author)

  3. Nasal valve surgery.

    Apaydin, Fazil


    Nasal obstruction can be due to internal and external valve problems that can be seen before and after rhinoplasty. The main scope of this article is to concentrate on surgical solutions to these problems. To overcome nasal obstruction at the internal valve, spreader grafts, spreader flaps, upper lateral splay graft, butterfly graft, flaring suture, M-plasty, Z-plasty, and suspension sutures have been described. The management of the external valve problems is possible by using lateral crural dissection and repositioning, lateral crural strut grafts, alar battens, lateral crural turn-in flap, alar rim grafts, and various other methods. It is not easy to decide which techniques would work best in every case. After a thorough examination and analysis, the underlying cause of the nasal obstruction can be understood, and one or multiple procedures can be chosen according to each individual problem.

  4. Endoscope ambulatory nasal polipectomy. Introduction in Sancti Spiritus province.

    Raquel M. García Alemán


    Full Text Available A longitudinal retrospective descriptive study carried out in the Otorrinolaringology Services of the “Camilo Cienfuegos” General Hospital in Sancti Spiritus from september 2007 to september 2009.The population comprised 130 patients diagnosed with Chronic rhinosinusitis and the sample included 48 who showed Bilateral Poliposis grade III-IV who fulfilled the inclusion criteria. The general objective was to determine the results of the endoscopic ambulatory nasal polipectomy; specific objective to evaluate the variables of age and gender clinical manifestations, endoscopic findings, complication histological findings and degree of satisfaction. The statistical analysis included the calculation of frequency stadigraphs expressed in numbers and percentages. Chronic rhinosinusitis which nasal polyposis was more frequent in white men over 40 years-old, the primary symptoms were nasal obstruction and anosmia. The post-surgical medical treatment was carried out depending on the histological study with a predominance of eosinophils. The endoscopy determined the degree of grade III; the classic bilateral anterior tamponing was remplaced by surgical neurolentins made in the room. No patient showed pain during the surgery act, they improved their life quality.

  5. 心理干预在缓解鼻内镜手术患者围手术期焦虑情绪中的应用%Effects of psychological intervention on reducing anxiety of patients with nasal endoscopic surgery

    白桦; 王小丽


    Objective To evaluate the effects of psychological intervention on reducing anxiety of patients with nasal endoscopic surgery. Meth-ods 92 patients with nasal endoscopic surgery were randomly divided into observation group and control group with 46 for each group. Usual care was for both groups, systematic psychological intervention was only used in observation group. Blood pressure, heart rate were compared be-tween two groups 30 minutes before surgery;scores of anxiety self-assessment scale ( SAS) were compared as well at two time points, 30 mi-nutes before surgery and 12 hours after surgery. Results Variations of blood pressure and heart rate 30 minutes before surgery were significant lower in observation group than that in control group after intervention (P<0. 05);anxiety was also improved in observation group than in control group either at the time point of 30 minutes before surgery or 12 hours after surgery(P<0. 05). Conclusion Systematic psychological interven-tion can effectively help patients with nasal endoscopic surgery to balance their physiological change and reduce the anxiety level.%目的:探讨心理干预对缓解鼻内镜手术患者围手术期焦虑情绪的效果。方法将92例拟行鼻内镜手术的患者随机分成观察组与对照组,每组46例,对照组实施常规护理,观察组实施系统性心理干预,观察2组患者术前30min血压、心率的变化,术前30min及术后12h焦虑自评量表(SAS)评分。结果观察组患者实施系统性心理干预后术前30min血压及心率变化幅度明显小于对照组(P<0.05);术前30min及术后12h SAS评分明显少于对照组(P<0.05)。结论对鼻内镜手术患者实施系统性心理干预,有助于稳定患者的生理变化,缓解患者焦虑情绪,是一种有效的护理干预方法,值得推广。

  6. Analysis of olfaction changes after nasal endoscopic surgery for chronic rhinosinusitis and nasal polyp ;complicated with dysosmia patients%慢性鼻-鼻窦炎及鼻息肉伴嗅觉障碍患者鼻内镜术后嗅觉变化分析

    王士美; 王义杰


    目的:探讨鼻内镜手术对恢复慢性鼻-鼻窦炎及鼻息肉嗅觉功能的临床疗效。方法对120例慢性鼻-鼻窦炎及鼻息肉伴嗅觉障碍患者行鼻内镜下手术,术后观察嗅觉功能变化。结果术后嗅觉不同程度改善占91.67%,嗅觉不变占6.67%,另有1.67%嗅觉减退。结论鼻内镜手术治疗慢性鼻-鼻窦炎及鼻息肉可不同程度改善患者的嗅觉功能,解决其鼻腔通气障碍及嗅黏膜炎性反应,能极大程度恢复部分嗅上皮功能,但应注意操作技巧和术后随访有效处理,避免并发症发生。%Objective To investigate clinical effect of nasal endoscopic surgery for chronic rhinosinusitis and nasal polyp complicated with dysosmia. Methods A total of 120 chronic rhinosinusitis and nasal polyp complicated with dysosmia patients received nasal endoscopic surgery. Their changes of olfaction function were observed after surgery. Results There were 91.67%of patients had different degree in improvement of olfaction after surgery, 6.67% of them had no changes, and 1.67% had hyposmia. Conclusion Implement of nasal endoscopic surgery can improve olfaction function by different degree in chronic rhinosinusitis and nasal polyp complicated with dysosmia. This method can relieve nasal cavity ventilatory disorder and inflammatory reaction in olfactory mucosa, and it can retrieve major olfactory epithelium function. It is necessary for effective operational skill and postoperative follow-up to avoid occurrence of complications.

  7. Endoscopic surgery in a child with unilateral choanal atresia



    Full Text Available Introduction and objective: Choanal atresia is rare, being twice as common in women than in men, and in 50% of cases approximately it is associated with other congenital anomalies. Although there has been some controvesia about the treatment of choice of this malformation, in the last decade, the introduction of endoscopes in sinus surgery has improved the outcome. Case description: We report the case of a child who has left chronic rhinorrhea with persistent nasal obstruction. By endoscopy and CT diagnosis, left choanal atresia is confirmed. Unilateral choanal atresia endoscopic surgery is performed by creating flaps with intranasal mucosa, preventing nasal packing. Discussion: Different techniques have been considered for the treatment of choanal atresia, which include traditional and endoscopic approach. The results of endoscopic surgery in the choanal atresia vary according to different authors. The two most important aspects of these results are the creation of nasal mucosa flaps and avoiding nasal packing. Conclusions: Surgical treatment of unilateral choanal atresia by endoscopic surgery can reduce the risk of restenosis.

  8. Endoscopic surgery- exploring the modalities

    Daniel; Jin; Keat; Lee; Kok-Yang; Tan


    The adoption of endoscopic surgery continues to expand in clinical situations with the recent natural orifice transluminal endoscopic surgery technique enabling abdominal organ resection to be performed without necessitating any skin incision. In recent years,the development of numerous devices and platforms have allowed for such procedures to be carried out in a safer and more efficient manner, and in some ways to better simulate triangulation and surgical tasks(e.g., suturing and dissection). Furthermore, new novel techniques such as submucosal tunneling, endoscopic full-thickness resection and hybrid endo-laparoscopic approaches have further widened its use in more advanced diseases. Nevertheless, many of these new innovations are still at their pre-clinical stage. This review focuses on the various innovations in endoscopic surgery, with emphasis on devices and techniques that are currently in human use.

  9. 全麻鼻内镜术后应用普米克令舒雾化吸入的护理%The Nursing of General Anesthesia Nasal Endoscopic Surgery Patients with Inhaling Pulmicort

    邬燕平; 刘伟


    Objective:Observation of ultrasonic atomizer inhaled Pulmicort respules adjuvant therapy nasal endoscopy surgery patients complicating odynophagia and cracked curative effect and nursing. Methods: Select 68 cases of general anesthesia nasal endosciouc surgery patients do application of ultrasonic atomizer inhaled Pulmicort respules adjuvant therapy,and corresponding nursing.Results:68 patients had the odynophagia,cracked alleviate time is 2d 24 example,3d 36 cases,4d 6 cases,5d 2 cases.60 case excellence, 8 cases effectively, invalid to 0.Conclusion:ultrasonic atomizer inhaled Pulmicort respules to improve general anesthesia nasal endoscopic surgery patients odynophagia, cracked complications have clinical significance.%目的:观察超卢雾化吸入普米克令舒辅助治疗全麻鼻内镜手术后患者并发吞咽痛及声音嘶哑的疗效与护理.方法:选取68例全麻行鼻内镜手术患者应用超声雾化吸入普米克令舒进行辅助治疗,并采取相应的护珲措施.结果:68例患者术后吞咽痛、声音嘶哑缓解时间为2d24例,3d 36例,4d 6例,5d 2例.60例显效,8例有效,无效为0.结论:超声雾化吸入普米克令舒对改善全麻鼻内镜术后患者吞咽痛、声音嘶哑并发症具有临床意义.

  10. Prevention and management of complications of endoscopic surgery for nasal-skull base neoplasms%鼻颅底肿瘤内镜手术并发症分析

    蒋卫红; 谢志海; 肖健云; 章华; 赵素萍


    Objective To analyze the surgical complications of endoscopic nasal-skull base surgery.The secondary objective Was to propose the preliminary strategies for prevention and treatment of complications.Methods One hundred and thirty two patients with nasal-skull base tumors undergoing endoscopic or endoscope-assisted surgery were included in this study.Surgical approaches included endoscopic endonasal transethmoidal approaches,endoscopic endonasal transseptal transsphenoidal approach,extended endoscopic endonasal transseptal transsphenoidal approach,endoscopic transmaxillary posterial wall approach,extended endoscopic transmaxillary posterial wall approach,endoscopic nasal lateral wall dissection,maxillary osteotomy approach and endoscopic transoropharyngeal approach.These approaches were selectively used to resect the tumors in the area of nasal-skull base.Results The total resection of the tumors Was obtained in 104 patients(104/132,78.8%),with 29.5%(39/132)incidence of complications,including profuse bleeding,nerve injury,cerebrospinal fluid leakage,diabetes insipidus,electrolyte imbalance,hyperglycemia,and psychological disturbance.No catastrophic complications, sequelae and operative mortality encountered.Four months to 8 years'follow up(median 3.0 years) indicated that recurrence rate of the benign tumor Was 9%(9/100)without died case,and 3-year and 5-year survival rates of the malignant tumor were 75.0%and 55.6%,respectively.Conclusions Strategies proved to be effective in reduction of the overall incidence of the complications,especially in minimizing the catastrophic complications and sequelae.The strategies were as follows:first,according to original site,extension and characteristics of the tumor,designing appropriate endoscopic approaches for the treatment of skull base tumor;second,recognizing reliable surgical access points and safe plane of the dissection;third, predicting surgical risks preoperatively and proposing the corresponding plan to avoid these

  11. Outcomes in Endoscopic Ear Surgery.

    Kiringoda, Ruwan; Kozin, Elliott D; Lee, Daniel J


    Endoscopic ear surgery (EES) provides several advantages compared with traditional binocular microscopy, including a wide-field view, improved resolution with high magnification, and visual access to hidden corridors of the middle ear. Although binocular microscopic-assisted surgical techniques remain the gold standard for most otologists, EES is slowly emerging as a viable alternative for performing otologic surgery at several centers in the United States and abroad. In this review, we evaluate the current body of literature regarding EES outcomes, summarize our EES outcomes at the Massachusetts Eye and Ear Infirmary, and compare these results with data for microscopic-assisted otologic surgery.

  12. Gynecological endoscopic surgery in Cienfuegos.

    Alberto Jorge Fernández


    Full Text Available Background: In the last few years less invasive techniques for patients have been developed and endoscopic surgery is important example. Objective: To determine the advantages of endoscopic surgery and to relate ultrasonographic findings with surgical diagnoses. Method: Case study of 73 surgeries performed by gynaecological endoscopic surgery at the University Hospital ¨Dr. Gustavo Aldereguía Lima¨ from Cienfuegos province in the period January 1998- May 2002. urgencies and and Salpingoclasias were excluded from this search. The statistical study included tests of percentage, accumulated frequency, Kappla´s index, mean and standard deviation. Results: The most recent gynaecological pathologies were: Pelvic Inflammatory Disease, infertility and ovarian cyst. The relationship between ultrasonographic and surgical diagnosis was good for P.I.D and the intrauterine device in the abdominal cavity but not for endometritis. The most frequent laparoscopic procedures were salpingovariolasis and fimbrioplasty , ovarian cystectomy and contrasted laparoscopy. The two complications were bleeding which was controlled and facial subcutaneous emphysema.

  13. Acute Vision Loss Following Endoscopic Sinus Surgery

    Antisdel, Jastin


    A 41-year-old female with a history of uterine cancer and Celiac and Raynaud's Disease presented to our institution with frequent migraines and nasal congestion. She underwent functional endoscopic sinus surgery (FESS) and experienced acute unilateral vision loss postoperatively. Rapid recognition of the etiology and effective treatment are paramount given the permanent and irreversible vision loss that can result. Arterial vasospasm following FESS is rare. Patients with autoimmune diseases have perhaps an increased risk for vasospasm secondary to an increased vasoreactive profile. We present the first documented case of nitroglycerin sublingual therapy to successfully treat ophthalmic artery vasospasm following FESS. Nitroglycerin sublingual therapy is a promising treatment for ophthalmic vasospasm secondary to its ability to cross the blood-ocular barrier, its rapid onset of action, and its ability to promote relaxation of vascular smooth muscle.

  14. Acute Vision Loss Following Endoscopic Sinus Surgery

    Serena Byrd


    Full Text Available A 41-year-old female with a history of uterine cancer and Celiac and Raynaud’s Disease presented to our institution with frequent migraines and nasal congestion. She underwent functional endoscopic sinus surgery (FESS and experienced acute unilateral vision loss postoperatively. Rapid recognition of the etiology and effective treatment are paramount given the permanent and irreversible vision loss that can result. Arterial vasospasm following FESS is rare. Patients with autoimmune diseases have perhaps an increased risk for vasospasm secondary to an increased vasoreactive profile. We present the first documented case of nitroglycerin sublingual therapy to successfully treat ophthalmic artery vasospasm following FESS. Nitroglycerin sublingual therapy is a promising treatment for ophthalmic vasospasm secondary to its ability to cross the blood-ocular barrier, its rapid onset of action, and its ability to promote relaxation of vascular smooth muscle.

  15. 右美托咪定复合七氟醚控制性降压在鼻内窥镜手术中的应用%Application of Dexmedetomidine Combined Sevoflurane in Deliberate Hypotension for Nasal Endoscopic Surgery

    陈本军; 黄昌林; 孟哲贤


    [目的]观察右美托咪定复合七氟醚控制性降压用于鼻内窥镜手术的有效性和安全性.[方法]鼻内窥镜手术患者40例,ASAⅠ~Ⅱ级,随机分成两组.Ⅰ组(20例)采用右美托咪定复合七氟醚控制性降压,Ⅱ组(20例)采用七氟醚麻醉.两组病人麻醉诱导均采用咪达唑仑,顺式苯磺酸阿曲库铵,芬太尼,依托咪酯.手术开始后Ⅰ组吸入1%~2%七氟醚,用微量泵泵入右美托咪定,使平均动脉压(MAP)控制在65 mmHg左右并维持,Ⅱ组吸入1%~3%七氟醚,维持血压在术前基础水平,两组均用微量泵泵入丙泊酚,间断静注芬太尼和顺式苯磺酸阿曲库铵维持麻醉.观察术中出血量,手术时间以及麻醉前(T1),手术开始后10 min(T2)、手术开始后60 min(T3)、手术结束拔管后即刻(T4)的MAP、心率(HR)的变化.[结果]Ⅰ组患者术中出血量、手术时间较Ⅱ组显著减少(P<0.05);Ⅰ组患者术中MAP、HR明显低于术前(P<0.05).[结论]右美托咪定复合七氟醚控制性降压用于鼻内窥镜手术能有效减少出血量,改善手术野,缩短手术时间.%[Objective]To observe the availability and safety of dexmedetomidine combined sevoflurane in deliberate hypotension for nasal endoscopic surgery. [Methods] Forty ASA Ⅰ~Ⅱ patients undergoing nasal endoscopic surgery were randomly divided into two groups. Group Ⅰ ( n=20) was given dexmedetomidine combined sevoflurane for deliberate hypotension and group Ⅱ ( n = 20) was anesthetized with sevoflurane. Mi-dazolam, cisatracurium besylate, fentanyl and etomidate were used for the anesthesia induction of two groups.After the start of surgery, in group Ⅰ , 1 % ~2% sevoflurane was inhaled and dexmedetomidine was infused into micro pump to maintain mean arterial pressure(MAP) around 65mmHg. In group Ⅱ , 1% ~3% sevoflufane was inhaled and blood pressure was maintained at the base level before operation. In two groups, propofol was infused into micro pump

  16. Clinical Observation on Treatment of 65 Cases of Chronic Sinusitis and Nasal Polyps with Endoscopic Sinus Surgery Combined with Chinese Medicine%鼻内窥镜鼻窦手术配合中药治疗慢性鼻窦炎鼻息肉



    目的 观察鼻内窥镜鼻窦手术配合中药治疗慢性鼻窦炎、鼻息肉的临床疗效.方法 将63例慢性鼻窦炎、鼻息肉患者随机分为两组,对照组32例给予鼻内窥镜鼻窦手术治疗,治疗组33例采用鼻内窥镜鼻窦手术配合中药治疗.结果 治疗组总有效率为90.9%,对照组总有效率为75.0%,两组总有效率比较,差异有统计学意义(p=0.0416,P<0.05).结论 采用鼻内窥镜鼻窦手术配合中药对慢性鼻窦炎、鼻息肉有疗.%Objective To observe clinical effect of treating chronic sinusitis and nasal polyps with endoscopic sinus surgery combined with Chinese medicine. Methods 65 patients with chronic sinusitis and nasal polyps were randomly divided into a control group and a treatment group. The control group was treated with endoscopic sinus surgery only, and the treatment group was treated with endoscopic sinus surgery combined with Chinese medicine. Results The total effective rate in the treatment group and the control group was 90.9% and 75.0%, respectively. There was a significant dieffference between two groups (P= 0.0416, P<0.05 ). Conclusion The treatment of endoscopic sinus surgery combined with Chinese medicine on chronic sinusitis and nasal polyps is better than endoscopic sinus surgery only.

  17. 鼻内镜下改良Denker术式在鼻腔鼻窦内翻性乳头状瘤手术中的应用%Application of modified Denker surgery in sinonasal inverted papilloma with nasal endoscope

    白有仁; 田青; 李莉; 拓明祥


    目的 探讨鼻内镜下改良Denker术式在鼻腔鼻窦内翻性乳头状瘤手术中的应用,术中保留鼻泪管和下鼻甲,进入上颌窦的方法.方法 35例住院手术患者,男21例,女14例,年龄39 ~ 76岁,平均45岁.术前均行组织病理学检查确诊为鼻腔鼻窦内翻性乳头状瘤.手术在全麻下进行.在下鼻甲前梨状孔缘弧形切开,暴露梨状孔缘,凿除下鼻道相对应的梨状孔缘,咬骨钳咬除部分下鼻道和犬齿窝骨壁,鼻内镜直视下完成窦内病灶清除,如病变范围较大可扩大骨窗解剖鼻泪管,鼻泪管受累则切除之,同期行鼻腔泪囊造孔术,术终完成下鼻道开窗.结果 35例患者均为单侧发病,鼻腔鼻窦内翻性乳头肿瘤Krouse分期Ⅱ级14例,Ⅲ级20例,Ⅳ级1例.术中见肿瘤起源于鼻腔外侧壁或上颌窦,上颌窦各壁均可受累,前、内壁明显.术后随访12 ~67个月,平均22个月,术腔上皮化,下鼻甲形态良好.1例术后6个月下鼻道开窗口局部复发,清理后再无复发.2例行鼻腔泪囊造孔术,术后无溢泪等并发症.结论 鼻内镜下改良Denker术式梨状孔缘切口进入上颌窦,最大限度地保留鼻腔及泪道的功能,为彻底切除鼻腔及上颌窦病灶提供新的微创入路和方法.%Objective To investigate the application of modified Denker surgical in sinonasal inverted papilloma surgery with intranasal endoscope,nasal canal and inferior turbinate were reserved and the maxillary sinus was open.Methods All 35 cases with sinonasal inverted papilloma were diagnosed by preoperative histopathological examination,all patients received general anaesthesia.Make an piriform aperture arcs incision before inferior nasal concha,expose the piriform aperture edge,chisel the edge of the piriform aperture corresponding to inferior meatus,and part of the inferior meatus and bony wall of canine fossa were removed by rongeur,sinus lesions were cleaned under nasal endoscope.When lesions area became


    V. V. Epishev


    Full Text Available Aim. Clinical use of implants based on patient’s individual topographic anatomical features. Materials and methods. The paper describes two case reports involving the correction of nasal anatomical structure affected during the surgery for facial cancer. Using selective laser sintering technology we manufactured 2 intricate 3D-deformed individual implants from Ti70V30 alloy powders. Implant design was based on CAT/MRT data. Clinical use was conducted on the premises of the department of head and neck surgery in Chelyabinsk Regional Oncological Dispensary. Results. In the fi rst case we obtained an impressive functional result – huge and wide nasal cavity, nose skeleton, and easy nasal breathing. In 30 days we performed endoscopic video-analysis (via nasal passages which showed that 65% of implant surface was covered with mucosa. In the second case, the designed implant allowed the combined surgery including excision of soft tissues, atypical resection of the upper jaw (left part and the left cheek, left maxillary sinusotomy and reconstruction of the left part of the nose and the left cheek with implant and skin fl ap. Conclusion. Clinical use revealed pros and contras of the applied technology. Among contras there are relatively high cost of technology, high standards of competency of a surgeon, a programmer and engineers. Pros include free modeling and setting the implant parameters before operation, exact match between implant size/shape and topographic anatomical data of a certain patient. 

  19. Olfaction in Endoscopic Sinus and Skull Base Surgery.

    Thompson, Christopher F; Kern, Robert C; Conley, David B


    Olfactory dysfunction is a common complaint for patients with chronic rhinosinusitis, because smell loss decreases a patient's quality of life. Smell loss is caused by obstruction from polyps, nasal discharge, and mucosal edema, as well as inflammatory changes within the olfactory epithelium. Addressing olfaction before endoscopic sinus and skull base surgery is important in order to set postoperative expectations, because an improvement in smell is difficult to predict. Several commercially available olfactory testing measures are available and can easily be administered in clinic. During surgery, careful dissection within the olfactory cleft is recommended in order to optimize postoperative olfactory function.

  20. Analysis of effect of three under nasal endoscope surgery in the treatment of maxillary sinus cyst%鼻窥镜下三种术式治疗上颌窦囊肿效果分析

    刘联合; 叶玉清; 程晋甫; 苏宏


    目的:探讨鼻窥镜下三种手术方式治疗上颌窦囊肿的临床疗效。方法选择上颌窦囊肿患者95例,分别采用上颌窦窦口开放扩大术、下鼻道上颌窦开窗术以及上颌窦前壁开窗术三种手术方式进行治疗,术后随访1年,分析三种手术方式的临床疗效。结果经上颌窦窦口开放扩大术39例,痊愈37例,2例复发;经下鼻道上颌窦开窗术27例,痊愈26例,1例复发;经上颌窦前壁开窗术29例,29例痊愈;三种手术方式治愈率差异无统计学意义(P >0.05)。结论治疗上颌窦囊肿术式的选择应根据囊肿的部位、大小以及是否伴有鼻-鼻窦疾病等多种因素确定。囊肿靠近窦口周围、窦腔外侧壁或伴有鼻窦疾病的上颌窦囊肿可采用上颌窦窦口开放扩大径路进行手术;靠近窦腔内侧壁、底壁的可采用下鼻道开窗径路;靠近窦腔前壁以及囊肿巨大或复发者可选择上颌窦前壁开窗手术径路;目的是达到彻底摘除囊肿,减轻组织损伤和并发症的发生。%Objective To explore three under nasal endoscope surgery treatment the clinical curative effect of maxillary sinus cyst.Methods 95 cases of maxillary sinus cyst patients were chosen,the maxillary sinus were used respectively to open to expand,the nasal passages of maxillary sinus fenestration and maxillary sinus anterior wall fen-estration three types of surgical treatment,postoperative follow -up of 1 year,the clinical curative effect of three kinds of operation method were analyzed.Results The maxillary sinus mouth open expansion of 39 cases during operation,37 cases were cured,2 cases of recurrence;The nasal passages under the maxillary sinus fenestration 27 cases, 26 cases cured,1 case of recurrence;The maxillary sinus anterior wall fenestration 29 cases,29 cases healed;Three kinds of operation cure rate difference had no statistical significance(P >0.05).Conclusion The treatment of max

  1. The analysis of clinical effect for endoscopic sinus surgery in the treatment of recurrent chronic sinusitis and nasal polyps%复发性慢性鼻窦炎鼻息肉的鼻内镜手术治疗的临床疗效分析

    张炜; 范崇盛; 薛柯凡; 刘亚男; 王红洛


    OBJECTIVE To investigate the clinical efficacy for nasal endoscopic surgery in the treatment of the recurrent sinus and nasal polyps. METHODS The clinical effects and complications of 325 cases with recurrent chronic sinusitis and nasal polyps by endoscopic sinus surgery were analyzed retrospectively. The clinical effect for endoscopic sinus surgery in the treatment of recurrent chronic sinusitis and nasal polyps was evaluated comprehensively. RESULTS 325 patients were taken the implementation of endoscopic sinus surgery, which carried out the first sinus surgery in 157 cases. 135 patients were cured after endoscopic nasal surgery, the cure rate was 85.99%. 93 cases were conducted with 2 sinus surgery after endoscopic nasal surgery, 69 cases were cured, and the cure rate was 73.91%. 52 cases were with three sinus surgery, 31 cases were cured, and the cure rate was 59.61%.23 cases were taken the implementation of over 4 sinus surgery, 11 cases were cured, and the cure rate was 47.83%. The cure rate for different patients with sinus surgery was significantly different (P < 0.05). The incidence of complications after endoscopic nasal surgery was increasing with the increase in the number of sinus surgery. CONCLUSION The endoscopic sinus surgery can cure for recurrent patients with chronic sinusitis and nasal polyps effectively. But the cure rate of endoscopic sinus surgery is declining with the increase in the number of relapses sinus surgery. So we should take endoscopic sinus surgery as soon as possible for recurrence in patients to avoid the decrease of treatment efficacy for the repeated incidence.%目的 探讨鼻内镜手术用于复发性鼻窦鼻息肉的临床疗效.方法 回顾性分析325例复发性慢性鼻窦炎鼻患内患者采用鼻内镜手术治疗的临床效果及并发症情况,综合评价鼻内镜手术在复发性慢性鼻窦鼻患肉治疗的临床效果.结果 325例患者均实施鼻内镜手术,其中进行过1次鼻窦手术者157

  2. Developments in flexible endoscopic surgery: a review

    Feussner H


    Full Text Available Hubertus Feussner,1 Valentin Becker,2 Margit Bauer,1 Michael Kranzfelder,1 Rebekka Schirren,1 Tim Lüth,3 Alexander Meining,2 Dirk Wilhelm1 1Department of Surgery, 22nd Medical Department, 3Institute of Microtechnology and Medical Device Technology, Klinikum rechts der Isar, Technische Universität München, Germany Abstract: Flexible endoscopy is increasingly developing into a therapeutic instead of a purely diagnostic discipline. Improved visualization makes early lesions easily detectable and allows us to decide ad hoc on the required treatment. Deep enteroscopy allows the exploration of even the small bowel – for long a "white spot" for gastrointestinal endoscopy – and to perform direct treatment. Endoscopic submucosal dissection is a considerable step forward in oncologically correct endoscopic treatment of (early malignant lesions. Though still technically challenging, it is increasingly facilitated by new manipulation techniques and tools that are being steadily optimized. Closure of wall defects and hemostasis could be improved significantly. Even the anatomy beyond the gastrointestinal wall is being explored by the therapeutic use of endoluminal ultrasound. Endosonographic-guided surgery is not only a suitable fallback solution if conventional endoscopic retrograde cholangiopancreatography fails, but even makes necrosectomy procedures, abscess drainage, and neurolysis feasible for the endoscopist. Newly developed endoscopic approaches aim at formerly distinctive surgical domains like gastroesophageal reflux disease, appendicitis, and cholecystitis. Combined endoscopic/laparoscopic interventional techniques could become the harbingers of natural orifice transluminal endoscopic surgery, whereas pure natural orifice transluminal endoscopic surgery is currently still in its beginnings. Keywords: flexible endoscopic surgery, endoscopic ultrasound, advanced techniques, natural orifice transluminal endoscopic surgery

  3. Robotics and allied technologies in endoscopic surgery.

    Buess, G F; Schurr, M O; Fischer, S C


    Endoscopic surgery was developed in the 1970s and 1980s, with initial work conducted by pioneering surgeons. After the development of laparoscopic cholecystectomy, the breakthrough of endoscopic surgery had a great effect on all surgical specialties. Starting with rather simple procedures, such as cholecystectomy, a rapid progression toward more complex procedures, such as reflux or colonic surgery, took place. It was realized at this time that the existing endoscopic instruments allowed only a limited preciseness when performing the procedures, and part of the information from inside the abdominal cavity was not available to the surgeon. This prompted a discussion with engineers concerning the development of more advanced technologies to give those performing endoscopic surgery the same quality of information and manipulation that surgeons have when performing open surgery. These qualities include (1) instruments and manipulators that allow surgical action under endoscopic control with all degrees of freedom; (2) devices that provide surgeons with tactile feedback; and (3) vision systems that provide surgeons with the same quality of visual information as with open surgery, namely, high resolution, excellent color quality, precise spatial information, and a constant clear view for optimal surgical action. At the end of 1999, some of the aforementioned quality concepts found their way into the surgical routine, but most of the concepts are still being developed. Another decade will pass before endoscopic surgery procedures will be closer to the technological goals.

  4. 瑞芬太尼复合七氟醚控制性降压用于鼻内镜手术的临床研究%Clinical study ofremifentanil-sevoflurane inducing deliberate hypotension in nasal endoscopic surgery

    侯明勇; 魏江涛; 刘海兵; 赵荣


    Objective To investigate the effectiveness and controllability of remifentanil-sevoflurane inducing deliberate hypotension in nasal endoscopic surgery. Methods 60 cases of elective nasal endoscopic surgery were randomly divided into trial group and control group. All the patients received sevoflurane combined anaesthesia. Remifetanil was intravenously injected by 0.2μg/kg and maintained by 0. 1~0. 5μg/(kg · min) in trial group. Nitroglycerin was intravenously injected by 2μg/kg and maintained by 0. 5~3μg/(kg · min) in trial group. MAP was maintained60 ~65mmHg until the operation was over. The MAP, Heart rate (HR) were recorded before hypotension(To) , 10min (T1) and 20min( T2) and 30min (T3) after blood pressure reached the point (T1) ,and hypotension was stopped(T4). We recorded the volume of hemorrhage, lime of controlled hypotension, time from operation over time to the decannulation time and scores of surgical field quality. Results HR was significantly lower than before controlled-blood pressure in trial group (P 0. 05). Operation field quality scores of the trial group was better than that of control group (P <0. 05). Conclusion Rachel fentanyl combined with sevoflurane nasal for controlled hypertension was effective and easy control in endoscopic surgery. Compared with nitroglycerin, rachel fentanyl for controlled hypertension has more advantages in slowing down the heart rate, controlling blood pressure smoothly and reducing the blood loss.%目的 探讨瑞芬太尼复合七氟醚控制性降压用于鼻内镜手术的有效性、可控性.方法 60例择期行鼻内镜手术的患者,随机分为试验组和对照组,每组各30例.两组均采用七氟醚静吸复合麻醉.试验组以瑞芬太尼0.2μg/kg静脉注射,0.1~0.5μg/(kg·min)维持.维持平均动脉压(MAP)为60 ~ 65mmHg,直至手术主要步骤结束.对照组以硝酸甘油2μg/kg静脉注射,0.5 ~3μg/(kg·min)维持.分别记录控制性降压前(T0)

  5. Uso tópico da adrenalina em diferentes concentrações na cirurgia endoscópica nasal Topical use of adrenaline in different concentrations for endoscopic sinus surgery

    Krishnamurti Matos de Araujo Sarmento Junior


    Full Text Available A concentração ideal de adrenalina tópica a promover hemostasia adequada sem toxicidade ainda é motivo de controvérsia. OBJETIVO: Comparar soluções tópicas de adrenalina em diferentes concentrações. DESENHO DO ESTUDO: Prospectivo, duplo-cego, seleção aleatória. MATERIAIS E MÉTODOS: 49 pacientes submetidos à cirurgia endoscópica nasal, divididos em 3 grupos usando exclusivamente adrenalina tópica, nas concentrações de 1:2000, 1:10.000 e 1:50.000. Comparou-se o tempo operatório, o sangramento, as concentrações plasmáticas de adrenalina e noradrenalina e a variação dos parâmetros cardiovasculares. RESULTADOS: O tempo operatório por procedimento foi menor no grupo que utilizou adrenalina 1:2000, assim como o sangramento (p The ideal adrenaline concentration remains unknown. AIM: Compare topical adrenaline solutions in different concentrations. STUDY DESIGN: Prospective, double blind, randomized trial. PATIENTS AND METHODS: 49 patients divided in 3 groups underwent endoscopic sinus surgery, using only topical solutions of adrenaline in different concentrations (1:2,000, 1:10,000 and 1:50,000. We compared the duration of surgery, intra-operative bleeding, plasmatic levels of catecholamines, hemodynamic parameters and changes in heart rhythm. RESULTS: Surgery time was shorter in the group using adrenaline 1:2,000, which also showed less bleeding in all evaluations (objective and subjective - p < 0.0001. Plasmatic levels of epinephrine rose in all groups, more sharply in the 1:2,000 group. There was a trend towards elevation of blood pressure in the groups using adrenaline 1:2,000 and 1:10,000, with a greater occurrence of hypertensive peaks. DISCUSSION: We found a very significance bleeding difference favoring the 1:2,000. The blood pressure elevation in the 1:2,000 and 1:10,000 groups was progressive but very slow throughout the procedure, which could be associated with the anesthesia technique. CONCLUSION: We favor the use

  6. 功能性内镜鼻窦手术后不同鼻窦黏膜的转归规律%Regularity of nasal mucous transitionary course of different sinuses after functional endoscopic sinus surgery

    左可军; 李华斌; 史剑波; 许庚


    目的 探讨慢性鼻-鼻窦炎患者功能性内镜鼻窦手术后不同鼻窦黏膜转归的时间规律.方法 前瞻性收集77例慢性鼻-鼻窦炎患者的临床资料,在实施功能性内镜鼻窦手术后的第2周、第1、2、3、6、9、12个月采用Lund-Kennedy内镜评分方法分别对每侧鼻腔每个鼻窦进行评估,比较不同时期不同鼻窦黏膜形态的评分数值和完成上皮化比例.结果 共计154个上颌窦、154个筛窦、138个额窦和129个蝶窦纳入内镜观察与评分分析.在术后第2周,蝶窦、筛窦、上颌窦和额窦黏膜形态评分分别为(3.5±1.5)、(3.6±1.4)、(3.7±1.5)、(3.8±1.5)分,差异无统计学意义(x2=1.674,P =0.643);在术后第2、3、6、9个月,4种鼻窦黏膜的转归过程呈现明显分离趋势,依次出现黏膜评分下降拐点和上皮化比例升高峰值;在术后第12个月,蝶窦、筛窦、上颌窦、额窦评分分别为(0.4±0.1)、(0.9±0.1)、(1.4±0.2)、(2.1±0.2)分,差异有统计学意义(x2=52.691,P=0.000);且蝶窦黏膜形态评分(Z=-3.417,P =0.001)和完成上皮化的比例(x2=4.313,P=0.038)明显优于筛窦,筛窦黏膜形态评分(Z=-2.218,P=0.027)和完成上皮化比例(x2=4.292,P=0.038)明显优于上颌窦,上颌窦黏膜形态评分(Z=-2.244,P =0.025)和完成上皮化比例(x2=4.100,P =0.043)明显优于额窦.结论 功能性内镜鼻窦手术后不同鼻窦的黏膜转归存在明显时间差异,上皮化进程的先后顺序依次是蝶窦、筛窦、上颌窦和额窦.%Objectives To explore the time regularity of nasal mucous transitionary course of different sinuses after functional endoscopic sinus surgery.Methods Seventy-seven chronic rhinosinusitis patients following functional endoscopic sinus surgery were prospectively collected. The endoscopic appearances of different sinuses were respectively evaluated with Lund-Kennedy scoring system in 2 weeks,1,2,3,6,9 months,and 12 months postoperatively. Then the endoscopic scores and

  7. Endoscopic epilepsy surgery: Emergence of a new procedure

    Sarat P Chandra


    Conclusion: The article emphasizes the role of endoscopic procedures for epilepsy surgery and provides a review of literature. This experience may subserve to coin the term "endoscopic epilepsy surgery" for a fast emerging subspeciality in the field of epilepsy surgery.

  8. 鼻内镜术辅以电凝治疗上颌窦后鼻孔息肉21例%21 cases of nasal endoscopic surgery with electrocoagulation for antrochoanal polyp

    陈林; 李利; 肖祥


    目的:观察鼻内镜术辅以电凝治疗上颌窦后鼻孔息肉的效果。方法回顾性分析我科21例后鼻孔息肉的病例,经鼻内镜下完全切除包括上颌窦内基部病变组织,基部辅以电凝。结果所有患者随访6~36个月未见复发,1例鼻腔局部粘连,2例局部囊肿形成局部处理后治愈。结论鼻内镜术辅以电凝治疗上颌窦后鼻孔息肉创伤小,复发率低,疗效确切。%Objective To observe the result of treating antrochoanal polyp ( ACP) by nasal endoscopic . Methods Twenty one cases of ACP were retrospectively analyized , the polyp in maxillary sinus were resected completely and the pedicle of the polyp treated with electrocoagulation .Results All patients were followed up between 6 to 36 months without any recurred , nasal adhesion happened on one patient after the operation and nasal cysts grown on two patients were extracred .Conclusions The way of curing ACP with endoscopic and electrocoagulation have the advantages of small trauma , low recurrence rate and exact effect .

  9. Power sources in endoscopic surgery.

    Sutton, C


    The power sources used in endoscopic surgery are varied and numerous, and will continue to improve as technology progresses. Early attempts at operative laparoscopy were crude, limited by the available instrumentation, and tended to be frustrating: scissors that had to be frequently sharpened and endocoagulators that took a seemingly interminable time to achieve their tissue effect. New developements in ultrasonic energy and different wavelengths of laser energy are used alongside increasingly sophisticated electrosurgical tools, employing both monopolar and bipolar systems, and innovative delivery systems such as the argon beam coagulator and the Helica Thermal Coagulator. All of these systems have their advocates and their detractors, but in the end the choice of power source is determined by the type of equipment that the operator feels most comfortable with. The surgeon must have a detailed knowledge of the physical concepts required to generate the power source, and be able to understand the complications that can be created by the energy, how to avoid them, how and to deal with them if they occur. Although there are subtle differences in the reaction of the different energy sources with human tissue, the clinical outcome appears to be much the same, and depends more on the skill of the individual surgeon than the power source employed.

  10. Nasal surgery in patients with systemic disorders

    Sachse, Florian


    Full Text Available Multisystemic disorders represent a heterogenous group of diseases which can primarily manifest at the nose and paranasal sinuses as limited disease or secondarily as part of systemic involvement. Rhinologists therefore play an important role in the diagnostic but also therapeutic process. Although therapy of multisystemic disorders is primary systemic, additional rhinosurgery may become necessary. The spectrum of procedures consists of sinus surgery, surgery of the orbit and lacrimal duct, septorhinoplasty and closure of nasal septal perforation. Since the prevalence of most systemic diseases is very rare, recommendations are based on the analysis of single case reports and case series with a limited number of patients only. Although data is still limited, experiences published so far have shown that autologous cartilage or bone grafts can be used in nasal reconstruction of deformities caused by tuberculosis, leprosy, Wegener’s granulomatosis, sarcoidosis and relapsing polychondritis. Experiences gained from these diseases support the concept that well-established techniques of septorhinoplasty can be used in systemic diseases as well. However, a state of remission is an essential condition before considering any rhinosurgery in these patients. Even under these circumstances revision surgery has to be expected more frequently compared to the typical collective of patients undergoing septorhinoplasty. In addition, experiences gained from saddle nose reconstruction may in part be of value for the treatment of nasal septal perforations since implantation of cartilage grafts often represents an essential step in multilayer techniques of closure of nasal septal perforations. Aside from the treatment of orbital complications sinus surgery has been proven beneficial in reducing nasal symptoms and increasing quality of life in patients refractory to systemic treatment.

  11. 鼻内窥镜手术治疗慢性鼻-鼻窦炎临床疗效及影响因素分析%Clinical Curative Effect and Analysis of Influence Factors of Endoscopic Nasal Surgery in Treatment of Chronic Rhinosinusitis



    目的:对鼻内窥镜手术治疗慢性鼻-鼻窦炎的临床疗效及影响因素进行回顾性分析。方法随机选取该院收治的慢性鼻-鼻窦炎患者共60例,患者收治年限均在2013年2月-2015年4月之间,对60例慢性鼻-鼻窦炎患者通过鼻内窥镜手术进行治疗,对其各项临床治疗数据进行统计,并根据统计结果评价鼻内窥镜手术的临床治疗效果。结果鼻内窥镜手术治疗的60例慢性鼻-鼻窦炎患者中,有46例痊愈,10例好转,4例无效,疗效总有效率为93.33%(56/60﹚;1例鼻塞,2例头痛,不良发应发生率为5%(3/60﹚。结论鼻内窥镜手术不仅能有效对慢性鼻-鼻窦炎患者的临床症状进行缓解,还具有较高的疗效总有效率,值得临床推荐应用。%Objective To retrospectively analyze the clinical curative effect and influence factors of endoscopic nasal surgery in treatment of chronic rhinosinusitis. Methods 60 cases of patients with chronic rhinosinusitis treated in our hospi-tal from February 2013 to April 2015 were selected and treated with endoscopic nasal surgery, the various clinical treatment data were given statistics, and the clinical treatment effect of the endoscopic nasal surgery was evaluated according to the statistical results. Results In the 60 cases, 46 cases were healed, 10 cases were improved, 4 cases were inefficient, the total effective rate of the curative effect was 93.33%(56/60﹚; 1 case had a stuffy nose, 2 cases had a headache, the incidence of adverse reaction was 5%(3/60﹚. Conclusion The endoscopic nasal surgery can not only effectively relieve the clinical symptoms of patients with chronic rhinosinusitis, but also has a higher total effective rate of curative effect, which is worthy of recommendation and application in clinic.

  12. Image guidance in endoscopic sinus surgery and skull base surgery

    Mitchell R.Gore; Brent A.Senior


    Objective The objective of this study was to review the current clinical applications and impact of intraoperative imaging on endoscopic sinonasal and skull base procedures in adult and pediatric patients.Methods The PubMed database was searched for articles related to the use of image guidance in otolaryngology using the search terms "image guidance otolaryngology".This was supplemented by the authors′ experience utilizing image guidance in nearly 3000 endoscopic sinus and skull base procedures.Results The literature demonstrates that intraoperative image guidance has utility in primary and revision endoscopic sinus surgery,as well as endoscopic surgery of the skull base.Image guidance also has applications in pediatric endoscopic surgery,such as pediatric sinus surgery and repair of choanal atresia.Conclusions Intraoperative image guidance,when combined with a thorough knowledge of paranasal sinus and skull base anatomy and technical proficiency,can provide improved safety when performing otolaryngologic procedures from endoscopic sinus surgery to endoscopic skull base surgery.While not a substitute for knowledge of anatomy,the increased availability and usability of image guidance systems make them a useful tool in the armamentarium of the otolaryngologist/head and neck surgeon and neurosurgeon.

  13. 鼻内镜手术无肌松药全身麻醉可行性探讨%Application of general anesthesia without muscle relaxant in nasal endoscopic surgery

    杨戈雄; 袁杰; 高爽; 李滔; 滕煜; 马军令


    Objective To investigate the effect and feasibility of anesthesia without muscle relaxant in nasal endoscopic opera-tion.Methods 120 patients with ASAⅠ-Ⅱundergoing nasal endoscopic operation were randomly divided into normal muscle relaxant use group ( group Ⅰ) and intubation without muscle relaxant maintenance group ( groupⅡ) , 60 cases in each.GroupⅠwas treated with vecuronium 0.08-0.1 mg/kg induced, in patients with body movement or per 40min intravenous infusion of 0.05 mg/kg maintai-ning muscle relaxation;group Ⅱtracheal intubation after complex full airway surface anesthesia but without muscle relaxants mainte-nance during operation.Blood pressure ( MAP) , heart rate ( HR) , pulse oxygen saturation ( SpO2 ) , end tidal carbon dioxide partial pressure ( PetCO2 ) were recorded in each time point in the two groups before anesthesia ( T0 ) , 2 min after anesthesia induction ( T1 ) , 2 min after endotracheal intubation ( T2 ) , 2 min after the start of operation ( T3 ) , 20 min after the start of operation ( T4 ) , and 5 min after extubation ( T5) .The body movement frequency intraoperation , recovery time from anesthesia and extubation time, adverse reac-tions and complications and intraoperative additional infusion dosage of remifentanil and propofol were compared between the two groups.Results In both groups, T0 ~T4 each observation point,HR, MAP, SpO2 and PetCO2 changes were not significantly different (P>0.05).Breathing the air after 5 min(T5), SPO2 in group Ⅱwere higher than those in groupⅠ, PetCO2 in groupⅡlower than that in groupⅠ, there were significant differences between the two groups (P<0.05).In groupⅡ,anesthesia recovery time and ex-tubation time were significantly shorter than those in group Ⅰ( P <0.01).There were no adverse reaction and complication. Conclusions The effect of nasal endoscopic surgery under tracheal intubation general anesthesia without muscle relaxant is reliable, safe and feasible.%目的:探讨在无肌

  14. Topical Mitomycin C in functional endoscopic sinus surgery.

    Venkatraman, Vaidyanathan; Balasubramanian, Deepak; Gopalakrishnan, Suria; Saxena, Sunil Kumar; Shanmugasundaram, Nirmal


    In recent literature, there has been an interest in the use of Mitomycin C to reduce post-operative complications following endoscopic sinus surgery. We report our results on a prospective, randomized controlled trial involving 50 patients with chronic bilateral rhino sinusitis. We eliminated various confounding factors by studying a single group of patients, with symmetrical disease, without pre-existing gross anatomical abnormalities. Patients requiring revision sinus surgery were excluded. On completion of the surgery, a cotton pledget soaked in Mitomycin C was placed in one nostril (test) and saline-soaked pledget (control) was placed in the other side of the nose, both in the middle meatus. The side of the nasal cavity receiving the topical Mitomycin C was randomized. The patients were assessed periodically (first week, first month, third month and sixth month) for synechiae formation and presence or absence of their symptoms. At the first week follow up, there was a statistically significant difference in the incidence of synechiae between the saline and Mitomycin C side. Furthermore, there was a statistically significant improvement with regards to patient symptoms (nasal block and discharge) in the Mitomycin C side when compared to the saline side. At the third and sixth month, there was no difference between the two groups. The incidence of adverse tissue reaction (granulation, discharge, polypoidal mucosa and crusting) was less in the Mitomycin C side when compared to the saline side at the first month follow up. Topically applied Mitomycin C reduces the incidence of synechiae in the immediate post-operative period in patients undergoing endoscopic sinus surgery. There is also an improvement in nasal obstruction and discharge with a reduction in the incidence of adverse tissue reaction in the early post-operative period.

  15. Kinect based real-time position calibration for nasal endoscopic surgical navigation system

    Fan, Jingfan; Yang, Jian; Chu, Yakui; Ma, Shaodong; Wang, Yongtian


    Unanticipated, reactive motion of the patient during skull based tumor resective surgery is the source of the consequence that the nasal endoscopic tracking system is compelled to be recalibrated. To accommodate the calibration process with patient's movement, this paper developed a Kinect based Real-time positional calibration method for nasal endoscopic surgical navigation system. In this method, a Kinect scanner was employed as the acquisition part of the point cloud volumetric reconstruction of the patient's head during surgery. Then, a convex hull based registration algorithm aligned the real-time image of the patient head with a model built upon the CT scans performed in the preoperative preparation to dynamically calibrate the tracking system if a movement was detected. Experimental results confirmed the robustness of the proposed method, presenting a total tracking error within 1 mm under the circumstance of relatively violent motions. These results point out the tracking accuracy can be retained stably and the potential to expedite the calibration of the tracking system against strong interfering conditions, demonstrating high suitability for a wide range of surgical applications.

  16. Advantages of using an image-guided system for transnasal endoscopic surgery

    韩德民; 周兵; 葛文彤; 张罗; 张永杰


    Objective To evaluate the advantages of image-guided system in transnasal endoscopic surgery.Methods Transnasal endoscopic surgery was performed with the aid of an image-guided system in 28 patients, supported with histopathologic diagnoses of chronic sinusitis with/without nasal polyps (10 cases), juvenile nasopharyngeal angiofibroma (4 cases), pituitary adenoma (6 cases), ethmoidal ossifying fibroma (3 cases), nasopharyngeal mixed tumor (2 cases), nasal leiomyoma (1 case), fungal sinusitis (1 case) and inverted nasal papilloma (1 case).Results For all the patients, the time periods from initialization to surgery ranged from 15 to 30 minutes (a mean of 26 minutes). The calibration coefficient ranged from 1.3 to 2.0. Accuracy of localization fell within 1 mm. Compared with traditional endoscopic surgery, operation times were not noticeably different. No complications occurred.Conclusions The image-guided system was able to identify borders and critical anatomical structures in real-time, especially of those with distorted anatomical markers. It provided a powerful means for a safer and less invasive endoscopic sinus surgery.

  17. Perception of Better Nasal Patency Correlates with Increased Mucosal Cooling after Surgery for Nasal Obstruction

    Garcia, Guilherme; Sullivan, Corbin; Frank-Ito, Dennis; Kimbell, Julia; Rhee, John


    Nasal airway obstruction (NAO) is a common health problem with 340,000 patients undergoing surgery annually in the United States. Traditionally, otolaryngologists have focused on airspace cross-sectional areas and nasal resistance to airflow as objective measures of nasal patency, but neither of these variables correlated consistently with patients' symptoms. Given that the sensation of nasal airflow is also associated with mucosal cooling (i.e., heat loss) during inspiration, we investigated the correlation between the sensation of nasal obstruction and mucosal cooling in 10 patients before and after NAO surgery. Three-dimensional models of the nasal anatomy were created based on pre- and post-surgery computed tomography scans. Computational fluid dynamics (CFD) simulations were conducted to quantify nasal resistance and mucosal cooling. Patient-reported symptoms were measured by a visual analog scale and the Nasal Obstruction Symptom Evaluation (NOSE), a disease-specific quality of life questionnaire. Our results revealed that the subjective sensation of nasal obstruction correlated with both nasal resistance and heat loss, but the strongest correlation was between the NOSE score and the nasal surface area where heat flux exceeds 50 W /m2 . In conclusion, a significant post-operative increase in mucosal cooling correlates well with patients' perception of better nasal patency after NAO surgery.

  18. 鼻内镜术后中药鼻腔雾化吸入辅佐治疗慢性鼻-鼻窦炎的主客观评估%Subjective and objective assessment on chronic rhinosinusitis following adjuvant therapy of nasal inhalation withChinese medicine after endoscopic sinus surgery

    张弢; 张治军; 蒋梦穗; 袁波; 李春芳


    Objective To evaluate the efficacy of nasal inhalation with Chinese medicine in chronic rhinosinusitis (CRS) after endoscopic sinus surgery (ESS). Methods 63 cases of CRS were randomly divided into the treatment group (33 cases) and the control group (30 cases), and all had nasal inhalation following endoscopic sinus surgery (ESS). Bidouyan-oral was used for the treatment group, twice a day, at 8 mL, for five consecutive days, and then changed to once a week for 3 months. The control group used saline nasal inhalation, in the same way. Before inhalation, 5 days and 3 months later, the two groups were assessed in visual analogue scale, Lund-Kennedy score system and Lund-Mackay score system. Results On subjective symptoms, nasal endoscopy and sinus CT scan to check assessment, the difference between the treatment and control groups were significant. Before and after the spray the difference was also significant in each groups. Conclusion CRS patients after ESS for adjuvant use of traditional Chinese medicine treatment of inhalation, can significantly improve the surgical effect.%目的 评价慢性鼻-鼻窦炎(chronic rhinosinusitis,CRS)患者在鼻内镜术(endoscopic sinus surgery,ESS)后用中药进行鼻腔超声雾化吸入辅佐治疗的疗效.方法 63例CRS患者随机分为治疗组(33例)和对照组(30例),ESS术后第3天行鼻腔超声雾化吸入.治疗组雾化用药为鼻窦炎口服液,每天早晚各1次,每次8mL,连续5d,后改为每周1次,连续3个月.对照组使用生理盐水鼻腔雾化吸入,方法相同.雾化前(术后第2天)、雾化5 d和3个月后分别采用视觉模拟量表、Lund-Kennedy评分系统、Lund-Mackay评分法进行相关评估.结果 通过对主观症状、鼻内镜及鼻窦CT扫描进行检查评估,治疗组与对照组在雾化前后及组间比较差异均有统计学意义.结论 CRS患者ESS术后中药雾化吸入能明显提高手术疗效.

  19. The usefulness of 3-dimensional endoscope systems in endoscopic surgery.

    Egi, Hiroyuki; Hattori, Minoru; Suzuki, Takahisa; Sawada, Hiroyuki; Kurita, Yuichi; Ohdan, Hideki


    The image quality and performance of 3-dimensional video image systems has improved along with improvements in technology. However, objective evaluation on the usefulness of 3-dimensional video image systems is insufficient. Therefore, we decided to investigate the usefulness of 3-dimensional video image systems using the objective endoscopic surgery technology evaluating apparatus that we have developed, the Hiroshima University Endoscopic Surgical Assessment Device (HUESAD). The participants were 28 student volunteers enrolled in Hiroshima University (17 men and 11 women, age: median 22.5, range 20-25), with no one having experienced endoscopic surgery training. Testing was carried out by dividing the subjects into two groups to initially carry out HUESAD with 2-dimensional video imaging (N = 14) and with 3-dimensional video imaging (N = 14). Questionnaires were carried out along with the investigation regarding both 2-dimensional and 3-dimensional video imaging. The task was carried out for approximately 15 min regarding both 2-dimensional and 3-dimensional video imaging. Lastly, the Mental Rotation Test, which is a standard space perception ability test, was used to evaluate the space perception ability. No difference was observed in the nauseous and uncomfortable feeling of practitioners between the two groups. Regarding smoothness, no difference was observed between 2-dimensional and 3-dimensional video imaging (p = 0.8665). Deviation (space perception ability) and approaching time (accuracy) were significantly lower with 3-dimensional video imaging compared to 2-dimensional video imaging. Moreover, the approaching time (accuracy) significantly improved in 3-dimensional video imaging compared to 2-dimensional video imaging in the group with low space perception ability (p = 0.0085). Objective evaluation using HUESAD and subjective evaluation by questionnaire revealed that endoscopic surgery techniques significantly improved in 3-dimensional video

  20. Frequency of Nasal Polyposis in Chronic Rhinosinusitis and Role of Endoscopic Examination in Correct Diagnosis

    F. Hashemian


    Full Text Available Introduction & Objective : Chronic rhinosinusitis (C.R.S. is one of the most common diseases in the world. Polyposis is a complication of C.R.S., due to allergy or inflammation. The purpose of this study was detection of the incidence of polyposis in patients with C.R.S. Materials & Methods : This study was carried out on 192 patients with C.R.S. who underwent functional endoscopic sinus surgery during 2000-2003 in Hamadan. All patients with C.R.S symptoms referred to ENT clinics were examined by otolaryngologist and after establishing diagnosis of C.R.S. they received medical treatment and after nose and para nasal sinuses CT scan, if there was indication, FESS was done. The patients who had polyps were followed up to one year, and the results analyzed with SPSS. Results : According to the results, incidence of polyposis in 192 patients with C.R.S. was 40%, the sex distribution of the patients with polyposis was 60% in male and 40% in female. The age mean was 39.2 year. Involved sinuses in decreasing order of frequency was, anterior ethmoid , maxilla, Posterior ethmaid, sphenoid, sphenoid and frontal. 43% of the patients had history of allergy. Recurrence happened in 6.6% after one year follow up.Conclusion : Because of disabling symptoms and severe complications of nasal polyposis, it is recommended more study in the future to find etiology and preventive ways for nasal polyposis in Hamadan.

  1. Effect of Azithromycin on NF-kBp65 and IL-8 in nasal mucosa of chronic sinusitis after endoscopic sinus surgery%阿奇霉素对慢性鼻-鼻窦炎患者术腔黏膜中NF-kBp65IL-8表达的影响

    白永; 李娜; 赵慎林; 张旻


    Objective To observe the effect of azithromycin on expressions of NF-kBp65 and IL-8 in nasal mucosa of chronic sinusitis after endoscopic sinus surgery. Methods 45 patients with chronic sinusitis and/or nasal polyps who were treated with endoscopic surgery 2 weeks previously were divided into 3 groups: 15 patients treated with local glucocorticoid as the control group, 15 patients were added with cephalosporin(500 mg, once a day) as another control group, others were added with Azithromycin(500 mg, once a day) as the experimental group. The PV-6000 immuno-histochemical method was applied to explore expressions of NF-kBp65 and IL-8 in nasal mucosa before and after 3-week medical therapy while counting the quantity of positive cells. Results Chronic inflammation was observed in nasal mucosa after endoscopic sinus surgery by HE staining. There were many inflammatory cells such as neutrophil cells and eosinophil cells under the mucosa] epithelium, and the neutrophil cells were the key cells. Expression of NF-kBp65 was positive in the cytoplasm and some nuclei of the mucosal epithelia and the inflammatory cells in nasal mucosa. Expression of IL-8 was positive in the cytoplasm of the mucosal epithelia and inflammatory cells in nasal mucosa. Expressions of NF-kBp65 and IL-8 were significantly reduced in the mucosal epithelia and inflammatory cells of nasal mucosa after 3 weeks medical treatment compared with that of pre-treatment in the three groups (P 0. 05).Conclusion Azithromycin in combination with local glucocorticoid is better than glucocorticoid to inhibit expressions of NF-kBp65 and IL-8 in mucosal epithelia and inflammatory cells in nasal mucosa of chronic sinusitis and/or nasal polyps after endoscopic sinus surgery. It is an effective method to cure chronic inflammation of nasal mucosa in the nasal cavity after endoscopic sinus surgery.%目的 观察阿奇霉素对慢性鼻-鼻窦炎患者术腔黏膜中NF-kBp65、IL-8表达的影响,探讨阿奇霉素治疗术

  2. Endoscopic Surgery for Traumatic Acute Subdural Hematoma

    Hiroyuki Kon


    Full Text Available Traumatic acute subdural hematoma (ASDH is generally addressed by craniotomy under general anesthesia. We report a patient whose traumatic ASDH was treated under local anesthesia by one-burr-hole endoscopic surgery. This 87-year-old woman had undergone coil embolization for a ruptured right middle-cerebral artery aneurysm and placement of a ventriculoperitoneal shunt for normal pressure hydrocephalus 5 years earlier. Upon admission, she manifested consciousness disturbance after suffering head trauma and right hemiplegia. Her Glasgow Coma Scale score was 8 (E2V2M4. Computed tomography (CT demonstrated a thick, left-frontotemporal ASDH. Due to her advanced age and poor condition, we performed endoscopic surgery rather than craniotomy to evacuate the ASDH. Under local anesthesia, we made a burr hole in her left forehead and increased its size to 15 mm in diameter. After introducing a transparent sheath into the hematoma cavity with a rigid endoscope, the clot was evacuated with a suction tube. The arterial bleeding point was electrically coagulated. A postoperative CT scan confirmed the reduction of the hematoma. There was neither brain compression nor brain swelling. Her consciousness disturbance and right hemiplegia improved immediately. Endoscopic surgery may represent a viable method to address traumatic intracranial hematomas in some patients.

  3. Packing in endoscopic sinus surgery: is it really required?

    Eliashar, Ron; Gross, Menachem; Wohlgelernter, Jay; Sichel, Jean-Yves


    The aim of this study was to evaluate the routine use of packing or local hemostatic agents in endoscopic sinus surgery (ESS). Packing and/or hemostatic agents were used only when necessary in 100 consecutive adult ESS patients in a tertiary academic hospital. Necessity for packing the nose after excessive bleeding was analyzed in relation to demographic characteristics, medical history, previous surgeries, current surgical procedure, type of anesthesia, and amount of intraoperative bleeding. Three patients who required packing because of other reasons (such as bolstering of mucosa) were excluded from the study. The remaining 97 patients included 61 males and 36 females between the ages of 16 to 86 (mean 44). Forty-nine patients underwent only ESS, 40 ESSs associated with nasal polypectomy, and 8 underwent other endoscopic procedures. Fifty-four underwent the operation under general anesthesia and 43 under local anesthesia. Intraoperative blood loss was less than 30 mL in 82 patients (85%), 30 to 50 mL in 11 (11%), and more than 50 mL in 4 (4%). In 89 patients (92%), packing or a hemostatic agent was not used. No patient had bleeding complications postoperatively. A comparison between patients who required packing to those who did not showed that the only statistically significant associations related to general anesthesia (P = 0.0082) and to the amount of intraoperative bleeding (P postoperative complications, and cost of surgery.

  4. Outcome of Endoscopic Transsphenoidal Surgery for Acromegaly.

    Kim, Jung Hee; Hur, Kyu Yeon; Lee, Jung Hyun; Lee, Ji Hyun; Se, Young-Bem; Kim, Hey In; Lee, Seung Hoon; Nam, Do-Hyun; Kim, Seong Yeon; Kim, Kwang-Won; Kong, Doo-Sik; Kim, Yong Hwy


    Endoscopic transsphenoidal surgery has recently been introduced in pituitary surgery. We investigated outcomes and complications of endoscopic surgery in 2 referral centers in Korea. We enrolled 134 patients with acromegaly (microadenomas, n = 15; macroadenomas, n = 119) who underwent endoscopic transsphenoidal surgery at Seoul National University Hospital (n = 74) and Samsung Medical Center (n = 60) between January 2009 and March 2016. Remission was defined as having a normal insulin-like growth factor-1 and a suppressed growth hormone (GH) <1 ng/mL during an oral glucose tolerance test. Remission was achieved in 73.1% of patients, including 13 of 15 microadenoma patients (86.7%) and 86 of 119 macroadenoma patients (72.3%). A multivariate analysis to determine a predictor of biochemical remission demonstrated that absence of cavernous sinus invasion and immediate postoperative GH levels <2.5 ng/dL were significant predictors of remission (adjusted odds ratio [OR], 5.14; 95% confidence interval [CI], 1.52-17.3 and OR, 9.60; 95% CI, 3.41-26.9, respectively). After surgery, normal pituitary function was maintained in 34 patients (25.4%). Sixty-four patients (47.7%) presented complete (n = 59, 44.0%) or incomplete (n = 5, 3.7%) recovery of pituitary function. Hypopituitarism persisted in 20 patients (14.9%) and worsened in 16 patients (11.9%). Postoperatively, transient diabetes insipidus was reported in 52 patients (38.8%) but only persisted in 2 patients (1.5%). Other postoperative complications were epistaxis (n = 2), cerebral fluid leakage (n = 4), infection (n = 1), and intracerebral hemorrhage (n = 1). Endoscopic transsphenoidal surgery for acromegaly presented high remission rates and a low incidence of endocrine deficits and complications. Regardless of surgical techniques, invasive pituitary tumors were associated with poor outcome. Copyright © 2017 Elsevier Inc. All rights reserved.

  5. Endoscope- and video-assisted endodontic surgery.

    von Arx, Thomas; Hunenbart, Stefan; Buser, Daniel


    Since the introduction of microsurgical principles in the 1990s, the field of endodontic surgery has made continuous and substantial progress. Particularly, root-end cavity preparation has been simplified and optimized by means of newly developed surgical microinstruments. However, the successful outcome of endodontic surgery depends to a large extent on accurate intraoperative diagnostics. Conventionally, micromirrors (retromirrors) and microprobes have been used for this purpose. Recently, the surgical microscope has been used to enhance visibility during dental procedures. In addition, endoscopy has been reported to provide the surgeon with outstanding vision and ease of use. This article describes the technical specifications and the diagnostic application of the endoscope during endodontic surgery.

  6. [Extended endoscopic endonasal transsphenoidal approaches in skull base surgery].

    Kalinin, P L; Fomichev, D V; Kutin, M A; Kadashev, B A; Faĭzullaev, R B


    The article deals with endoscopic endonasal transsphenoidal surgery, which has gained great interest among the modem trends of neurosurgery. Application of extended endoscopic endonasal transsphenoidal approaches significantly advances capabilities of transsphenoidal surgery. Pituitary adenomas and some other sellar tumors which traditionally require transcranial procedure now can be removed via endonasal route. The article describes several types of extended endoscopic endonasal transsphenoidal approaches.

  7. Endoscopic endonasal trans-sphenoid surgery of pituitary adenoma

    Y R Yadav


    Full Text Available Endoscopic endonasal trans-sphenoid surgery (EETS is increasingly used for pituitary lesions. Pre-operative CT and MRI scans and peroperative endoscopic visualization can provide useful anatomical information. EETS is indicated in sellar, suprasellar, intraventricular, retro-infundibular, and invasive tumors. Recurrent and residual lesions, pituitary apoplexy and empty sella syndrome can be managed by EETS. Modern neuronavigation techniques, ultrasonic aspirators, ultrasonic bone curette can add to the safety. The binostril approach provides a wider working area. High definition camera is much superior to three-chip camera. Most of the recent reports favor EETS in terms of safety, quality of life and tumor resection, hospital stay, better endocrinological, and visual outcome as compared to the microscopic technique. Nasal symptoms, blood loss, operating time are less in EETS. Various naso-septal flaps and other techniques of CSF leak repair could help reduce complications. Complications can be further reduced after achieving the learning curve, good understanding of limitations with proper patient selection. Use of neuronavigation, proper post-operative care of endocrine function, establishing pituitary center of excellence and more focused residency and endoscopic fellowship training could improve results. The faster and safe transition from microscopic to EETS can be done by the team concept of neurosurgeon/otolaryngologist, attending hands on cadaveric dissection, practice on models, and observation of live surgeries. Conversion to a microscopic or endoscopic-assisted approach may be required in selected patients. Multi-modality treatment could be required in giant and invasive tumors. EETS appears to be a better surgical option in most pituitary adenoma.

  8. Endoscopic endonasal trans-sphenoid surgery of pituitary adenoma.

    Yadav, Yr; Sachdev, S; Parihar, V; Namdev, H; Bhatele, Pr


    Endoscopic endonasal trans-sphenoid surgery (EETS) is increasingly used for pituitary lesions. Pre-operative CT and MRI scans and peroperative endoscopic visualization can provide useful anatomical information. EETS is indicated in sellar, suprasellar, intraventricular, retro-infundibular, and invasive tumors. Recurrent and residual lesions, pituitary apoplexy and empty sella syndrome can be managed by EETS. Modern neuronavigation techniques, ultrasonic aspirators, ultrasonic bone curette can add to the safety. The binostril approach provides a wider working area. High definition camera is much superior to three-chip camera. Most of the recent reports favor EETS in terms of safety, quality of life and tumor resection, hospital stay, better endocrinological, and visual outcome as compared to the microscopic technique. Nasal symptoms, blood loss, operating time are less in EETS. Various naso-septal flaps and other techniques of CSF leak repair could help reduce complications. Complications can be further reduced after achieving the learning curve, good understanding of limitations with proper patient selection. Use of neuronavigation, proper post-operative care of endocrine function, establishing pituitary center of excellence and more focused residency and endoscopic fellowship training could improve results. The faster and safe transition from microscopic to EETS can be done by the team concept of neurosurgeon/otolaryngologist, attending hands on cadaveric dissection, practice on models, and observation of live surgeries. Conversion to a microscopic or endoscopic-assisted approach may be required in selected patients. Multi-modality treatment could be required in giant and invasive tumors. EETS appears to be a better surgical option in most pituitary adenoma.

  9. [Use of Solcoseryl DAP after nasal septum surgery].

    Krzeski, A; Makowska, W


    Solcoseryl is a biological agent, which accelerates the healing tissue procedure. This influence was studied during the nasal septum surgery. In 25 patients the postoperational nasal plug was inserted with the Solcoseryl and in 10 (control) with the paraffin. The cytologic verifications were performed before and after the surgery. In the solcoseryl group the mucosa regeneration procedure was accelerated and the inflammation reduced.

  10. Effects of preoperative sleep disturbance on efficacy of flurbiprofen for postoperative analgesia in patients undergoing endoscopic nasal surgery%术前睡眠紊乱对鼻内镜手术患者氟比洛芬酯术后镇痛效果的影响

    王丽; 裴凌; 苏帆


    Objective To investigate the effects of preoperative sleep disturbance on the efficacy of flurbiprofen for postoperative analgesia in patients undergoing endoscopic nasal surgery.Methods Ninety-six ASA Ⅰ or Ⅱ patients of both sexes (aged 20-60 years and weighing 50-80 kg) undergoing endoscopic nasal surgery were enrolled in this study.Pittsburg sleep quality index was used to evaluate the long-term sleep quality before hospitalization and Athens sleep quality index was used to evaluate the short-term sleep quality in hospital.The patients were divided into four groups according to the types of preoperative sleep disturbance (n =24 each):no sleep disturbance (group Ⅰ),long-term sleep disturbance (group Ⅱ),acute short-term sleep disturbance (group Ⅲ),and long-term + acute short-term sleep disturbance (group Ⅳ).Anesthesia was induced with sufentanil,propofol and cis-atracurium and maintained with intravenous infusion of remifentanil and propofol.Then the patients received endotracheal intubation and mechanical ventilation.The end-tidal pressure of carbon dioxide was maintained at 30-35 mm Hg.Controlled hypotension was performed with nicardipine,and the mean arterial blood pressure was maintained at 50-70 mm Hg and heart rate at 60-90 bpm during operation.The patients received intravenous injection of flurbiprofen 50 mg 15 minutes before the end of operation for postoperative analgesia.When the visual analogue scale score was more than 3 during the first 6 hours after operation,flurbiprofen 50 mg was given intravenously as rescue analgesia.Results The incidence of rescue analgesia administered after operation was significantly greater in groups Ⅱ,Ⅲ and Ⅳ than in group Ⅰ,and greater in group Ⅳ than in groups Ⅱ and Ⅲ.There was no significant difference in the incidence of rescue analgesia administered during the first 6 hours after operation between groups Ⅱ and Ⅲ.Conclusion Preoperative sleep disturbance has adverse effects on the efficacy

  11. Evaluation of the nasal shape after orthognathic surgery

    Wagner Ranier Maciel Dantas


    Full Text Available Introduction: Patients with dentofacial deformities may benefit from orthognathic surgery in the maxilla. Maxillary osteotomy may include procedures in the bone, cartilaginous, and soft tissues of the nose, leading to shape alterations. Objective: To evaluate the anatomic alterations of the nasal region in patients undergoing a Le Fort I osteotomy for advancement or superior impaction. Methods: This is a clinical prospective study. Twenty-one patients were evaluated during the preand postoperative periods. The positioning of the nasal tip and the modification of the nasal base were evaluated. Results: The results showed that the nasal tip was superiorly positioned in 85% of the cases, advanced in 80%, rotated in 80%, and there was a wide nasal base in 95%, resulting in esthetic improvement. Conclusions: Surgeries of maxillary advancement and superior reposition tend to cause elevation and advancement of the nasal tip, as well as enlargement of the nasal base.

  12. Controversies in gynaecologic endoscopic surgery

    Darwish, A.M.M.


    Despite the widespread utilization of assisted reproductive techniques in recent years, hysteroscopic as well as laparoscopic surgery should be firstly offered for patients with adnexal and uterine lesions desiring fertility. Permanent correction of the patient’s problem with frequent chances of pre

  13. Treatment of nonseptic bursitis with endoscopic surgery

    Azad Yıldırım


    Full Text Available Objective: The aim of this study was to show that endoscopic surgery is a simple and acceptable method for various problems associated with wounds, range of motion and that such surgery ensures an early return to work after treatment of nonresponding nonseptic bursitis. Methods: Thirty-two patients with nonseptic bursitis caused by repeated minor trauma that did not respond to medical treatment from 2008 to 2012 were included in this study. Radiographic [anteroposterior and lateral], ultrasound, macro and microscopic analyses of drainage liquid and aerobic and anaerobic cultures were obtained from the patients for the diagnosis. Results: The mean age was 40.8 years. Fifteen patients had prepatellar bursitis, 13 had olecranon bursitis and 4 had ankle bursitis. Two patients had a history of falling on their knee. The other patients had a history of repetitive stimulation .The mean follow up period was 2.6 years [range. 2-5 years] and no medical complications occurred after the endoscopic surgery; such as scarring, loss of sensation and infection. One recurrence in response to medical treatment was observed. Conclusion: Endoscopic bursectomy is a short and acceptable procedure with excellent results in terms of returning to work early and minimal wound related problems. J Clin Exp Invest 2015; 6 (3: 220-223

  14. Single incision endoscopic surgery for lumbar hernia.

    Kawaguchi, Masahiko; Ishikawa, Norihiko; Shimizu, Satsuki; Shin, Hisato; Matsunoki, Aika; Watanabe, Go


    Single Incision Endoscopic Surgery (SIES) has emerged as a less invasive surgery among laparoscopic surgeries, and this approach for incisional hernia was reported recently. This is the first report of SIES for an incisional lumbar hernia. A 66-year-old Japanese woman was referred to our institution because of a left flank hernia that developed after left iliac crest bone harvesting. A 20-mm incision was created on the left side of the umbilicus and all three trocars (12, 5, and 5 mm) were inserted into the incision. The hernial defect was 14 × 9 cm and was repaired with intraperitoneal onlay mesh and a prosthetic graft. The postoperative course was uneventful. SIES for lumbar hernia offers a safe and effective outcome equivalent compared to laparoscopic surgery. In addition, SIES is less invasive and has a cosmetic benefit.

  15. Effect of Improved PVF Medical Sponge Complex for Nasal Packing after Endoscopic Sinus Surgery%鼻内镜鼻窦手术后应用改良PVF-医用海绵复合体填塞的效果观察

    韦燕飞; 韦福依; 李曼玲; 覃启才; 黄金雀; 黄丽群; 刘慧贤; 罗春月


    目的 探讨改良PVF-医用海绵复合体作为鼻内镜鼻窦手术后鼻腔填塞物的临床效果.方法 选择鼻内镜鼻窦手术患者150例,随机分为观察组和对照组各75例,两组患者在头痛、鼻部胀痛、睡眠、张口呼吸、鼻出血、血氧饱和度、吞咽困难和心理恐惧等方面的数据对比,采用x2检验处理.结果 两组患者术后鼻腔填塞期间,在头痛、鼻部胀痛、睡眠、张口呼吸、吞咽困难和心理恐惧等方面比较差异有统计学意义(P<0.叭),出血情况、血氧饱和度比较差异无统计学意义(P>0.05).结论 改良PVF-医用海绵复合体作为鼻内镜鼻窦手术后填塞物,既达到填塞的目的,又能提高患者舒适度和生活质量,同时给术后的护理工作提供了方便和安全保障.%Objective To investigate the clinical efficacy of improved PVF medical sponge complex for nasal packing after endoscopic sinus surgery.Methods One hundred and fifty patients were randomly divided into the observation group (n =75) and the control group (n =75).The symptoms such as headache,nasal cavity pain,sleep,mouth breathing,bleeding,oxygen saturation,deglutition disorders and psychological fear were observed and compared by Chi-square test.Results There was significant difference in indicators of headache,nasal cavity pain,sleep,mouth breathing,deglutition disorders and psychological fear between two groups (P<0.01),and there was no significant difference in indicators of bleeding and oxygen saturation between two groups (P>0.05).Conclusion Improved PVF medical sponge complex is a satisfactory nasal packing material and can be used as routine packs after endoscopic sinus surgery.

  16. Fuzzy zoning for feature matching technique in 3D reconstruction of nasal endoscopic images.

    Rattanalappaiboon, Surapong; Bhongmakapat, Thongchai; Ritthipravat, Panrasee


    3D reconstruction from nasal endoscopic images greatly supports an otolaryngologist in examining nasal passages, mucosa, polyps, sinuses, and nasopharyx. In general, structure from motion is a popular technique. It consists of four main steps; (1) camera calibration, (2) feature extraction, (3) feature matching, and (4) 3D reconstruction. Scale Invariant Feature Transform (SIFT) algorithm is normally used for both feature extraction and feature matching. However, SIFT algorithm relatively consumes computational time particularly in the feature matching process because each feature in an image of interest is compared with all features in the subsequent image in order to find the best matched pair. A fuzzy zoning approach is developed for confining feature matching area. Matching between two corresponding features from different images can be efficiently performed. With this approach, it can greatly reduce the matching time. The proposed technique is tested with endoscopic images created from phantoms and compared with the original SIFT technique in terms of the matching time and average errors of the reconstructed models. Finally, original SIFT and the proposed fuzzy-based technique are applied to 3D model reconstruction of real nasal cavity based on images taken from a rigid nasal endoscope. The results showed that the fuzzy-based approach was significantly faster than traditional SIFT technique and provided similar quality of the 3D models. It could be used for creating a nasal cavity taken by a rigid nasal endoscope.

  17. Pediatric endoscopic surgery: pride and prejudice.

    Delarue, A; Guys, J M; Louis-Borrione, C; Simeoni, J; Esposito, C


    82 endoscopic surgical procedures (abdominal: 77; thoracic: 5) were performed by the same surgeon on 75 children aged from 1 month to 17 years (median 8.1 years) during the two-year period from January 1991 to December 1992. Due to the multispecialization of the Children's Hospital, a variety of pathologies were explored or treated with appendectomy accounting for 33% (27/82). There were no perioperative deaths. Three major complications occurred (1 post-appendectomy peritonitis, 1 hemorrhage during splenectomy and 1 post-operative occlusion). 14 patients required conversion to open surgery. Indications for endoscopic exploration of advanced lesions, prospective indications, and policy when confronted with a healthy appendix are discussed.

  18. Analysis of the surgery causes and the recurrent parts of chronic-rhinosinusitis after nasal endoscopic surgery%慢性鼻-鼻窦炎术后复发的手术操作因素和复发部位分析

    郭仪; 柴卫芳; 张华; 郑艳


    Objective To evaluate the surgery causes and the main damage parts of the recurrent chronic rh-inosinusitis after nasal endoscopic surgery.Methods A retrospective analysis was adopted in the clinical data of 51 cases of patients with recurrent chronic rhinosinusitis in the Second Affiliated Hospital of Xin-jiang Medical University from April 2007 to April 2012 and a continuing analysis in follow-up survey of 46 cases among them,in which the cases of the surgery causes and main damage parts of the recurrent pa-tients were collected and analysed.Results The surgery causes inducing 46 cases recurrent chronic rhino-sinusitis included improper handling of the middle turbinate,with percentage of 32.6%,incomplete re-moval of the ethmoid sinus,with percentage of 23.9%,incomplete removal of the agger nasi air cells and the frontal recess,with percentage of 15.2%,improper handling of the maxillary sinus,with percentage of 10.9%,the deviation of the upper nasal septum,with percentage of 8.7%,incomplete removal of the unci-nate process end,with percentage of 6.5%,and unknown,with percentage of 2.2%;the main damaged parts were the middle turbinate,the ethmoid sinus,the agger nasi air cells and the frontal recess,the maxil-lary sinus,the upper nasal septum,the uncinate process end.Conclusion Improper handling of the middle turbinate,which is one of the surgery causes of the recurrent chronic rhinosinusitis after nasal endoscopic surgery,is the most common,then incomplete removal of the ethmoid sinus,incomplete removal of the agger nasi air cells and the frontal recess and so on.The main damaged part of the recurrent chronic rhino-sinusitis is located most often in he middle turbinate.%目的:探讨鼻内镜手术治疗慢性鼻-鼻窦炎术后复发病例的手术操作因素和病变主要集中的部位。方法回顾性分析2007年4月-2012年4月在新疆医科大学第二附属医院耳鼻咽喉科就诊的51例复发的慢性鼻-鼻窦炎患者的临床资料

  19. [Endoscopic surgery for benign esophageal diseases].

    Ozawa, Soji


    Gastroesophageal reflux disease (GERD) and esophageal achalasia are common benign esophageal diseases. Today minimally invasive surgery is recommended to treat these diseases. Surgical indications for GERD are failure of medical management, medical complications attributable to a large hiatal hernia, 'atypical' symptoms (asthma, hoarseness, cough, chest pain, aspiration), etc. according to the Society of American Gastrointestinal Endoscopic Surgeons (SAGES) guidelines. Laparoscopic Nissen fundoplication has emerged as the most widely accepted procedure for GERD patients with normal esophageal motility. Partial fundoplication (e.g., Toupet fundoplication) is also considered to decrease the possibility of postoperative dysphagia. Although pneumatic dilatation has been the first line treatment for esophageal achalasia, laparoscopic Heller myotomy and partial fundoplication (e.g., Dor fundoplication) to prevent reflux is preferred by most gastroenterologists and surgeons as the primary treatment modality. Laparoscopic surgery for GERD and esophageal achalasia are effective in most patients and safe in all patients. Finally, laparoscopic surgery should be performed only by skilled surgeons.

  20. [Natural orifice transluminal endoscopic surgery: current situation].

    Delgado, Salvadora; Ibarzábal, Ainitze; Fernández-Esparrach, Glòria


    Natural orifice transluminal endoscopic surgery (NOTES) is the paradigm of the evolution of minimally invasive surgery. The laparoscopic has introduced new ideas in general surgery, one of them being that modern surgery is the work of multidisciplinary teams. A clear example of this is provided by NOTES. The aim of this type of surgery is to perform conventional laparoscopic procedures without incision, using flexible endoscopic technology usually employed in the diagnosis and treatment of intraluminal lesions and reaching the inside of the abdominal cavity through natural orifices (mouth, anus, vagina and even urethra). This type of access opens a highly interesting field for certain types of patients, such as those with high surgical risk, the morbidly obese, and those with multiple prior abdominal interventions or surgical wound infections. Animal models have shown that a wide variety of interventions (cholecystectomy, appendicectomy, splenectomy, hysterectomy, tubal ligations, gastroenteroanastomosis, peritoneoscopy, liver biopsy and herniorrhaphy, among others) can be performed. However, before use in humans, this new technique must be shown to be safe and to provide real advantages for patients. To do this, a series of issues, including safe methods for closure of the gastric incision and the avoidance of infections, among others, must be solved. Another critical element for the development of this new type of surgery is the creation of appropriate instrumentation, requiring input not only from medical professionals but also from engineers and industry. The present article describes the major advances made in NOTES since this technique was first described and analyzes the risks and potential benefits associated with this novel procedure.

  1. Present and future of robot-assisted endoscopic thyroid surgery

    FAN Lin-jun; JIANG Jun


    Objective Robot-assisted endoscopic surgery has been increasingly accepted because of its unique three-dimensional vision and precise simulation-based technology.However,the utilization of robotic systems in thyroid surgery is limited.We conducted a systematic review to assess the application and development of robot-assisted endoscopic surgical technique in thyroid surgery.Data sources Articles published in PubMed before June,2011 about robot-assisted endoscopic surgery were selected.Study selection Original articles and critical reviews selected were related to robot-assisted (thyroid) surgery or endoscopic thyroid surgery,and a total of 3540 relevant articles were retrieved and 34 were finally cited.Results Robot-assisted operation of benign thyroid diseases were successfully performed,although the operation time is too long to exhibit its advantages.Nevertheless,the superiority of robot-assisted endoscopic surgical technique compared to conventional endoscopic surgery in the treatment of thyroid carcinoma were obvious,since robotic radical thyroidectomy with central and lateral neck lymph node dissection could be achieved while maintaining operative results and cosmetic outcomes equivalent to or better than conventional endoscopic surgery.Furthermore,the learning curve duration of robot-assisted endoscopic thyroid surgery was shorter than that of conventional endoscopy,especially for the novices without any endoscopic surgical basis.Conclusion Robot-assisted endoscopic thyroid surgery,with its safety,feasibility,thoroughness,cosmetic benefits,and ability to overcome the limitations of conventional endoscopic surgery,will be further improved and applied,and is worthy of attention.

  2. Combined cataract and glaucoma surgery: trabeculectomy versus endoscopic laser cycloablation.

    Gayton, J L; Van Der Karr, M; Sanders, V


    To determine whether combined cataract surgery with endoscopic laser cycloablation produces less inflammation than cataract surgery combined with a filtering procedure. Taylor Regional Hospital (surgeries) and EyeSight Associates (examinations), Warner Robins, Georgia, USA. A randomized prospective study was conducted of 58 eyes of 58 patients comparing endoscopic laser cycloablation performed through a cataract incision at the time of cataract surgery with combined trabeculectomy and cataract surgery. Mean follow-up was 2 years. At the final available visit, 30% of endoscopic laser patients achieved intraocular pressure control (below 19 mm Hg) without medication and 65% with medication. Forty percent of trabeculectomy patients achieved control without medication and 52% with medication. Four endoscopic laser patients (14%) and 3 trabeculectomy patients (10%) were considered treatment failures (required additional surgical intervention). Endoscopic laser cycloablation performed through a cataract incision was a reasonably safe and effective alternative to combined cataract and trabeculectomy surgery, providing an option for cataract patients who have glaucoma requiring surgical intervention.

  3. Analysis on the effect of recovery phase treatment on the functional recovery of the nasal cavity in patients after functional endoscopic sinus surgery%功能性鼻内镜术后恢复期治疗对鼻腔功能恢复的影响分析



    目的:分析恢复期治疗对功能性鼻内镜术后鼻腔功能恢复的影响。方法:收治行功能性鼻内镜术患者208例,按不同治疗方案平均分为两组,对照组予常规药物,研究组予鼻腔冲洗,观察两组Lund-Kennedy评分及黏膜愈合疗效。结果:对照组结痂及水肿评分均高于研究组;对照组黏膜愈合总有效率76.0%,显著低于研究组的93.3%,差异均具统计学意义(P<0.05)。结论:恢复期治疗对功能性鼻内镜术后鼻腔功能恢复的影响效果显著。%Objective:To analyze the effect of recovery phase treatment on the functional recovery of the nasal cavity in patients after functional endoscopic sinus surgery.Methods:208 patients with functional endoscopic sinus surgery were selected.According to different treatment regimens,they were divided into the two groups on average.Patients in the control group received conventional drugs.Patients in the study group were treated with nasal irrigation.We observed the Lund-Kennedy score and the efficacy of mucosal healing of the two groups.Results:The scores of scab and edema of the control group were significantly higher than those of the study group;the total effective rate of mucosal healing in the control group was 76%,significantly lower than that of the study group 93.3%;both were statistically significant(P<0.05).Conclusion:The recovery phase treatment has a significant effect on the recovery of nasal function.

  4. The Analysis of Applications of Remifentanil with Sevoflurane in the Controlling Hypotension for Nasal Endoscopic Surgery%瑞芬太尼复合七氟醚在鼻内镜手术控制性降压中的应用



    Objective:To analyze the application and clinical effects of remifentanil with sevoflurane in the controlling hypotension for nasal endoscopic surgery.Method:84 patients who were conducted the nasal endoscopic surgery in our hospital from March 2012 to June 2014 were taken as the research objects,and these patients were randomly divided into control group and observation group,with 42 patients in each group.Then,both of the two groups were adopted the sevoflurane combined intravenous with inhalation anesthesia.Then,in the control group,they were treated with the nitroglycerin while in the observation group,they were treated with the remifentanil.Then,the change of HR in the different periods during the operations and the situations after surgeries of both the two groups were observed.Result:The HR during the hypertension in the observation group was evidently lower than the control group.In addition,the SSFQ score and the intraaoperative blood volume in the observation group were evidently lower than that in the control group and the differences had the statistical significance (P0.05).Conclusion:The applications of remifentanil with sevoflurane in the controlling hypotension for nasal endoscopic surgery can effectively improve the bradycardiac,promote the steady blood pressure and decrease the blood volume during the surgeries.Thus,it should be promoted in the clinic applications.%目的:探讨瑞芬太尼复合七氟醚在内镜手术控制性降压中的应用及临床效果;方法:从本院2012年3月-2014年6月接受鼻内镜手术患者中选取84例为观察对象,随机数字表法分为观察组与对照组,每组42例,两组患者均采用七氟醚静吸复合麻醉,对照组使用硝酸甘油,观察组使用瑞芬太尼,观察两组患者手术各时间段HR变化及术后情况。结果:观察组降压期间HR明显低于对照组,SSFQ评分及术中出血量明显低于对照组,比较差异具有统计学意义(P<0.05),

  5. [Digital imaging and robotics in endoscopic surgery].

    Go, P M


    The introduction of endoscopical surgery has among other things influenced technical developments in surgery. Owing to digitalisation, major progress will be made in imaging and in the sophisticated technology sometimes called robotics. Digital storage makes the results of imaging diagnostics (e.g. the results of radiological examination) suitable for transmission via video conference systems for telediagnostic purposes. The availability of digital video technique renders possible the processing, storage and retrieval of moving images as well. During endoscopical operations use may be made of a robot arm which replaces the camera man. The arm does not grow tired and provides a stable image. The surgeon himself can operate or address the arm and it can remember fixed image positions to which it can return if ordered to do so. The next step is to carry out surgical manipulations via a robot arm. This may make operations more patient-friendly. A robot arm can also have remote control: telerobotics. At the Internet site of this journal a number of supplements to this article can be found, for instance three-dimensional (3D) illustrations (which is the purpose of the 3D spectacles enclosed with this issue) and a quiz (http:@appendix.niwi.

  6. Effect of temporal fascia wrapping ethmoid perpendicular plate on repair of nasal septal perforation through endoscopic surgery%鼻内镜下自体颞肌筋膜包裹筛骨垂直板修补鼻中隔穿孔疗效观察



    Objective To observe therapeutic effect of repairing nasal septum perforation with auto temporal fascia wrapping ethmoid perpendicular plate through endoscopic surgery. Methods Retrospective analysis of 50 cases of nasal septum perforation patient, among whom 30 cases were repaired by traditional surgery and 20 cases were repaired by sand⁃wich surgery. All patients were examine by CT scan and nasal irrigation therapy were also performed through nasal endosco⁃py to improves nasal mucosa situation. Endoscopic procedures were performed in the traditional surgical group under local anesthesia, and septum mucosa was separated and shifted to repair septal perforation. On the other hand, temporal fascia of more than 2 times the diameter of the perforation were isolated then, wrapped around the perforation through front line of na⁃sal incision after separating membrane of the nasal septum cartilage. Now,temporal fascia wrapping autologous ethmoid per⁃pendicular plates form a rigid vertical"sandwich prosthesis"and were inserted into perichondrium of septal to repair perfora⁃tion. Anti-infection and nasal moisturizing treatment were given after operation. Postoperative symptoms and the perfor⁃mance in follow-ups were recorded. Results Intraoperative blood loss (mL:3.6±1.2 vs 13.4±2.9), operative time (min:25.2± 6.3 vs 46.5 ±10.3), mucosal damage range (mm2:10.2±3.2 vs 20.5±5.3) and mucosal repair time postoperation (d:19.5±3.9 vs 30.2±3.1) were all less in sandwich group than those in traditional group (P<0.05). Successful rate in sandwich group is also higher than that in the traditional surgical group (90.00%vs 46.67%, χ2=9.780, P<0.01) . No recurrence was found during follow-up from 6 months to 1 year in both groups. Conclusion Application of autologous temporalis fascia wrapping per⁃pendicular plate of ethmoid bone to form a rigid"sandwich prosthesis"to repair nasal septal perforation by endoscopic sur⁃gery were effective. It can restore the

  7. Subcutaneous Cavernous Hemangioma in the Nasal Dorsum: Report of Case Treated with Endoscopic Rhinoplasty

    Socher, Jan Alessandro


    Full Text Available Introduction Hemangiomas are vascular malformations, with slow blood flow, that can occur in any part on the body. They are more common in women and, predominantly, are isolated lesions. The malformation does not spontaneously regress. Subcutaneous hemangioma is a rare variant with an aggressive growth pattern that sometimes recurs after excision. Objective Case report of a subcutaneous cavernous hemangioma in the nasal dorsum treated with endoscopic rhinoplasty. Case Report A 27-year-old woman had a fibroelastic tumor mass in the midline of the nasal dorsum, which was pulsatile; she had obstruction and nasal congestion with associated rhinorrhea, with evolution and worsening over the previous 2 years. Computed tomography showed a tumor demarcated in the nasal dorsum without evidence of intracranial communication. Endoscopic rhinoplasty with septoplasty and associated paranasal sinus sinusectomy was performed without arteriography embolization, sclerotherapy, or laser. Pathologic diagnosis showed cavernous hemangioma. Postoperative follow-up shows no recurrence at 3 years. Discussion This case presented with atypical features, thus making the diagnosis a challenge. Imaging studies were required to confirm the vascular nature of the tumor. Excisional biopsy is the procedure of choice for pathologic examination. Subcutaneous hemangiomas never involute and always need treatment. The surgical approach is exceptional because there was no preoperative diagnosis. In addition, the closed technique provided best aesthetic results in this case. Conclusion Endoscopic rhinoplasty is suitable for nasal dorsum tumor resection and has superior aesthetic result to open techniques.

  8. Role of endoscopic guided partial adenoidectomy in avoiding open nasality

    Eman Mostafa


    Conclusion: There is necessity to screen potential candidates for adenoidectomy in order to prevent postoperative velopharyngeal dysfunction. Nasoendoscopy and lateral videofluroscopy have been useful to examine the palatal mobility, palatal length, depth of the pharynx and to exclude possible occult cleft palate. Partial adenoidectomy should be taken into consideration for risky patients. Satisfactory results were obtained as regards relieving nasal symptoms and maintaining velopharyngeal competence but didn’t improve quite fully the closed nasality.

  9. Curative effects of nasal lacrimal sac anastomosis combined with tube insertion under nasal endoscope on patients with chronic dacryocystitis and nasolacrimal duct obstruction

    Hao Sun


    Full Text Available AIM: To explore the effects of nasal lacrimal sac anastomosis combined with tube insertion under nasal endoscope on patients with chronic dacryocystitis and nasolacrimal duct obstruction. METHODS: Totally 70 patients(70 eyeswith chronic dacryocystitis and nasolacrimal duct obstruction in our hospital from December 2011 to December 2014 were selected, and were randomly divided into control group and study group. The control group were treated with nasal cavity lacrimal sac anastomosis under nasal endoscope, and the study group were treated with nasal lacrimal sac anastomosis combined with tube insertion under nasal endoscope. Total effective rates and fistula areas at 1, 6 and 12mo before and after operation were compared between the two groups. RESULTS: At 1mo after operation, there was no significant difference in total effective rates between the control group(97%and the study group(100%; P>0.05. At 6mo after operation, the total effective rate in the study group(97%was significantly higher than that in the control group(77%; PPP>0.05, while fistula areas in the study group were larger than those in the control group at 6 and 12mo after operation(PCONCLUSION: The effects of nasal lacrimal sac anastomosis combined with tube insertion under nasal endoscope on patients with chronic dacryocystitis and nasolacrimal duct obstruction are remarkable.

  10. Nasal Endoscopic Surgery for Sphenoidal and Ethmoidal Cysts with Visual Loss:a Report of 11 Cases%鼻内镜下手术治疗伴视力减退的蝶筛窦囊肿(附11例报告)

    高松; 张国民; 谢铠鹏; 伍小琴; 吴文斌


    Objective To explore the clinical efficacy of sphenoidal and ethmoidal cysts with visual loss by nasal endoscopic surgery. Methods Eleven cases (11 eyes) of sphenoidal and ethmoidal cysts with visual impairment were reviewed retrospectively. The patients received endoscopic surgery to remove cysts. Steroid therapy was given postoperatively and routine examinations with endoscopy were carried out during the follow-up. Results The operation time was 50 -90 min ( mean, 65 min ) , and the intraoperative blood loss was 50-100 ml (mean, 60 ml).Postoperative pathological examinations showed mucous cysts. Follow-up observations for 6-12 months in the 11 cases found the majority of symptoms , such as pain in nose and headache , disappeared. The postoperative visual acuity outcomes were improved from fingers counting to 0.3 and 0.5 in 2 eyes, respectively, and recovered to premorbid level in 9 eyes. Conclusions Endoscopic surgery is effective to sphenoidal and ethmoidal cysts with visual loss. Prompt surgical intervention is crucial to visual recovery.%目的:探讨鼻内镜手术治疗伴视力减退的蝶筛窦囊肿的疗效。方法2006年1月~2013年6月对11例蝶筛窦囊肿行鼻内镜下鼻腔鼻窦探查,鼻窦开放术,清除窦腔内囊肿,术后常规使用激素并定期随访。结果手术时间50~90 min,平均65 min;出血量50~100 ml,平均60 ml。11例术后病理:黏液囊肿。术后随访6~12个月,头痛、鼻根部疼痛基本消失。视力恢复情况:2例由术前眼前指数分别提高到0.3、0.5,其余9例恢复到发病前水平。结论鼻内镜手术治疗伴有视力减退的鼻窦囊肿疗效满意,及时手术是恢复视力的关键。

  11. Diode laser and endoscopic laser surgery.

    Sullins, Kenneth E


    Two functionally important differences exist between the diode laser and the carbon dioxide (CO2) laser (used more commonly in small animal surgery). Diode laser energy is delivered through a quartz fiber instead of being reflected through an articulated arm or waveguide. Quartz fibers are generally more flexible and resilient than waveguides and can be inserted through an endoscope for minimally invasive procedures. Laser-tissue interaction is the other significant difference. The CO2 laser is completely absorbed by water, which limits the effect to visible tissue. The diode wavelength is minimally absorbed by water and may affect tissue as deep as 10 mm below the surface in the free-beam mode. With proper respect for the tissue effect, these differences can be used to the advantage of the patient.

  12. Advantages of laser application in endoscopic surgery.

    Hunter, J G


    This article discusses the various kinds of laser therapy used in endoscopic surgery and their respective indications. Following a brief introduction into the basics of laser-tissue-interaction it is shown how less expensive treatment modalities have narrowed the range of laser applications to very specific purposes. In upper gastrointestinal bleeding argon and KTP lasers are mainly used for treatment of pigmented gut lesions. In malignant disease the combined use of balloon dilatation and laser irradiation has proved efficient in restoring patency to the gastrointestinal tract. Argon and CO2 lasers are used by gynaecologists for ablation of endometrioma. In an assessment of future prospects it is concluded that the lasting value of the laser lies in its ability to selectively destroy pigmented pathologic tissues.

  13. Application of Traditional Chinese Medicine Sequential Therapy Combined with Functional Endoscopic Nasal Sinus Surgery and Peri-operative Comprehensive Treatment in Treating Chronic Rhinosinusitis Patients%中医序贯疗法联合功能性内镜鼻窦手术及围术期综合治疗对慢性鼻-鼻窦炎的疗效观察



    Objective To observe the therapeutic effect of traditional Chinese medicine sequential therapy combined with functional endoscopic nasal sinus surgery and peri-operative comprehensive treatment for chronic rhinosinusitis patients, thus to screen out more effective therapy for rhinosinusitis. Methods Sixty-six chronic rhinosinusitis patients admitted into our hospital from January of 2013 to December of 2013 were selected as the treatment group, and 63 chronic rhinosinusitis patients admitted into our hospital from January of 2012 to December of 2012 were selected as the control group. Both groups received functional endoscopic nasal sinus surgery and peri-operative comprehensive treatment, and the treatment group was given traditional Chinese medicine sequential therapy additionally, which included oral use of herbal medicine for expelling toxins to evacuate pus one month after operation, and acupoint catgut embedding therapy 2 months after operation. The scores of Sino-Nasal Outcome Test 20 ( SNOT-20) in both groups were observed 3, 6 months after operation, the therapeutic effect and patients’ satisfaction in both groups were also compared 6 months after operation. Results (1) Treatment group had better effect on improving the scores of nasal symptoms, associated symptoms, sleep disorders, emotional outcome and signs of SNOT-20, and on improving symptoms and signs integral scores than the control group 3, 6 months after operation (P<0.05). (2) In the treatment group, 57 cases were cured, 7 were relieved, 2 were ineffective, and the total effective rate was 97.0%; in the control group, 48 cases were cured, 10 were relieved, 5 were ineffective, and the total effective rate was 92.1%. The treatment group had better therapeutic effect than the control group (P<0.05). (3) The treatment group had higher patients’ satisfaction than the control group ( P<0.05). Conclusion Traditional Chinese medicine sequential therapy combined with functional endoscopic nasal sinus

  14. A Novel Augmented Reality Navigation System for Endoscopic Sinus and Skull Base Surgery: A Feasibility Study.

    Li, Liang; Yang, Jian; Chu, Yakui; Wu, Wenbo; Xue, Jin; Liang, Ping; Chen, Lei


    To verify the reliability and clinical feasibility of a self-developed navigation system based on an augmented reality technique for endoscopic sinus and skull base surgery. In this study we performed a head phantom and cadaver experiment to determine the display effect and accuracy of our navigational system. We compared cadaver head-based simulated operations, the target registration error, operation time, and National Aeronautics and Space Administration Task Load Index scores of our navigation system to conventional navigation systems. The navigation system developed in this study has a novel display mode capable of fusing endoscopic images to three-dimensional (3-D) virtual images. In the cadaver head experiment, the target registration error was 1.28 ± 0.45 mm, which met the accepted standards of a navigation system used for nasal endoscopic surgery. Compared with conventional navigation systems, the new system was more effective in terms of operation time and the mental workload of surgeons, which is especially important for less experienced surgeons. The self-developed augmented reality navigation system for endoscopic sinus and skull base surgery appears to have advantages that outweigh those of conventional navigation systems. We conclude that this navigational system will provide rhinologists with more intuitive and more detailed imaging information, thus reducing the judgment time and mental workload of surgeons when performing complex sinus and skull base surgeries. Ultimately, this new navigational system has potential to increase the quality of surgeries. In addition, the augmented reality navigational system could be of interest to junior doctors being trained in endoscopic techniques because it could speed up their learning. However, it should be noted that the navigation system serves as an adjunct to a surgeon's skills and knowledge, not as a substitute.

  15. A Novel Augmented Reality Navigation System for Endoscopic Sinus and Skull Base Surgery: A Feasibility Study

    Li, Liang; Yang, Jian; Chu, Yakui; Wu, Wenbo; Xue, Jin; Liang, Ping; Chen, Lei


    Objective To verify the reliability and clinical feasibility of a self-developed navigation system based on an augmented reality technique for endoscopic sinus and skull base surgery. Materials and Methods In this study we performed a head phantom and cadaver experiment to determine the display effect and accuracy of our navigational system. We compared cadaver head-based simulated operations, the target registration error, operation time, and National Aeronautics and Space Administration Task Load Index scores of our navigation system to conventional navigation systems. Results The navigation system developed in this study has a novel display mode capable of fusing endoscopic images to three-dimensional (3-D) virtual images. In the cadaver head experiment, the target registration error was 1.28 ± 0.45 mm, which met the accepted standards of a navigation system used for nasal endoscopic surgery. Compared with conventional navigation systems, the new system was more effective in terms of operation time and the mental workload of surgeons, which is especially important for less experienced surgeons. Conclusion The self-developed augmented reality navigation system for endoscopic sinus and skull base surgery appears to have advantages that outweigh those of conventional navigation systems. We conclude that this navigational system will provide rhinologists with more intuitive and more detailed imaging information, thus reducing the judgment time and mental workload of surgeons when performing complex sinus and skull base surgeries. Ultimately, this new navigational system has potential to increase the quality of surgeries. In addition, the augmented reality navigational system could be of interest to junior doctors being trained in endoscopic techniques because it could speed up their learning. However, it should be noted that the navigation system serves as an adjunct to a surgeon’s skills and knowledge, not as a substitute. PMID:26757365

  16. A Novel Augmented Reality Navigation System for Endoscopic Sinus and Skull Base Surgery: A Feasibility Study.

    Liang Li

    Full Text Available To verify the reliability and clinical feasibility of a self-developed navigation system based on an augmented reality technique for endoscopic sinus and skull base surgery.In this study we performed a head phantom and cadaver experiment to determine the display effect and accuracy of our navigational system. We compared cadaver head-based simulated operations, the target registration error, operation time, and National Aeronautics and Space Administration Task Load Index scores of our navigation system to conventional navigation systems.The navigation system developed in this study has a novel display mode capable of fusing endoscopic images to three-dimensional (3-D virtual images. In the cadaver head experiment, the target registration error was 1.28 ± 0.45 mm, which met the accepted standards of a navigation system used for nasal endoscopic surgery. Compared with conventional navigation systems, the new system was more effective in terms of operation time and the mental workload of surgeons, which is especially important for less experienced surgeons.The self-developed augmented reality navigation system for endoscopic sinus and skull base surgery appears to have advantages that outweigh those of conventional navigation systems. We conclude that this navigational system will provide rhinologists with more intuitive and more detailed imaging information, thus reducing the judgment time and mental workload of surgeons when performing complex sinus and skull base surgeries. Ultimately, this new navigational system has potential to increase the quality of surgeries. In addition, the augmented reality navigational system could be of interest to junior doctors being trained in endoscopic techniques because it could speed up their learning. However, it should be noted that the navigation system serves as an adjunct to a surgeon's skills and knowledge, not as a substitute.

  17. Advances in endoscopic surgery for small animal reproduction.

    Katic, N; Dupré, G


    Although endoscopic surgery entered its "golden era" in the mid-1980s, it is still advancing at a tremendous pace. Novel surgical techniques and devices are continuously developed and applied, and new indications (and/or contraindications) for the use of endoscopic surgery are routinely reported in the literature and subjected to systematic assessments. Although endoscopic surgery (laparoscopy in particular) has already become established as the gold standard in human medicine, it has yet to be proven as a viable alternative to open surgery in the field of veterinary medicine. The advantages of minimally invasive surgery include better intra-operative visualization, reduced postoperative pain, reduced scar formation and increased postoperative mobility. Therefore, it is reasonable to expect that the application of this will continue to expand. Small animal reproduction, a field within the broad discipline of veterinary medicine, has already recognized and begun to reap the benefits of endoscopic surgery. Herein, we retrospectively review the most recent successful novel applications of endoscopic surgery in the small animal reproduction system to provide small animal reproductive surgeons with important knowledge to help improve their own veterinarian medical practice.



    A robotic endoscope is mainly composed of a tactile array sensor, soft mobile mechanism for earthworm locomotion and turning mechanism based on shape memory effect. The tactile array sensor can provide the information about magnitude and orientation of interacting forces between the robotic endoscope and the wall of gastrointestinal tracts. The soft mobile mechanism contacts gastrointestinal tracts with air-in inflatable balloons, so it has better soft and non-invasive properties. The turning mechanism can be actively bent by shape memory alloy components and conform to the complex shape of gastrointestinal tracts. The working principle of robotic endoscope is dealt with.

  19. Gynaecological Endoscopic Surgical Education and Assessment. A diploma programme in gynaecological endoscopic surgery.

    Campo, Rudi; Wattiez, Arnaud; Tanos, Vasilis; Di Spiezio Sardo, Attilio; Grimbizis, Grigoris; Wallwiener, Diethelm; Brucker, Sara; Puga, Marco; Molinas, Roger; O'Donovan, Peter; Deprest, Jan; Van Belle, Yves; Lissens, Ann; Herrmann, Anja; Tahir, Mahmood; Benedetto, Chiara; Siebert, Igno; Rabischong, Benoit; De Wilde, Rudy Leon


    In recent years, training and education in endoscopic surgery has been critically reviewed. Clinicians, both surgeons as gynaecologist who perform endoscopic surgery without proper training of the specific psychomotor skills are at higher risk to increased patient morbidity and mortality. Although the apprentice-tutor model has long been a successful approach for training of surgeons, recently, clinicians have recognised that endoscopic surgery requires an important training phase outside the operating theatre. The Gynaecological Endoscopic Surgical Education and Assessment programme (GESEA), recognises the necessity of this structured approach and implements two separated stages in its learning strategy. In the first stage, a skill certificate on theoretical knowledge and specific practical psychomotor skills is acquired through a high stake exam; in the second stage, a clinical programme is completed to achieve surgical competence and receive the corresponding diploma. Three diplomas can be awarded: (a) the Bachelor in Endoscopy; (b) the Minimally Invasive Gynaecological Surgeon (MIGS); and (c) the Master level. The Master level is sub-divided into two separate diplomas: the Master in Laparoscopic Pelvic Surgery and the Master in Hysteroscopy. The complexity of modern surgery has increased the demands and challenges to surgical education and the quality control. This programme is based on the best available scientific evidence and it counteracts the problem of the traditional surgical apprentice tutor model. It is seen as a major step toward standardization of endoscopic surgical training in general.

  20. Endoscopic endonasal trans-sphenoid surgery of pituitary adenoma

    Yadav, Y. R.; Sachdev, S.; Parihar, V.; H Namdev; P R Bhatele


    Endoscopic endonasal trans-sphenoid surgery (EETS) is increasingly used for pituitary lesions. Pre-operative CT and MRI scans and peroperative endoscopic visualization can provide useful anatomical information. EETS is indicated in sellar, suprasellar, intraventricular, retro-infundibular, and invasive tumors. Recurrent and residual lesions, pituitary apoplexy and empty sella syndrome can be managed by EETS. Modern neuronavigation techniques, ultrasonic aspirators, ultrasonic bone curette can...

  1. Comparison of endoscopic surgery and open surgery for gluteal muscle contracture.

    Fu, Dehao; Yang, Shuhua; Xiao, Baojun; Wang, Hong; Meng, Chunqing


    To compare the clinical effects of endoscopic surgeries with traditional open surgeries in the treatment of gluteal muscle contracture and discuss their indications and value. In this retrospective study, 50 patients received traditional open surgeries and 52 received endoscopic surgeries. The 2 groups were compared in terms of surgery duration, incision lengths, postsurgical pain, complications, off-bed activity times, hospitalization duration, clinical outcome, and 1-year recurrence rates. The endoscopic surgery group was significantly superior to the open surgery group in regard to incision length, postsurgical pain, off-bed activity time, hospitalization duration, and patient cosmetic satisfaction. Differences were not statistically significant for the surgery duration, complications, clinical outcome, or the 1-year recurrence rate. All the endoscopic surgery group patients stated that they would choose endoscopic surgery again. The endoscopic release of gluteal muscle contracture is safe and reliable, with the advantages of less trauma and pain, shorter operative time, earlier rehabilitation, and return of functional activities. Its application, though, should be carefully controlled based on the indications. It is applicable to degree I and II patients, but may be used only very cautiously in degree III patients. Level III.

  2. Endoscopic surgery in children - the challenge goes on.

    van der Zee, David C


    Paediatric endoscopic surgery is greatly indebted to Karl Storz for developing paediatric endoscopic instruments. In more recent years, there is an increasing interest in endoscopic surgery in neonates. Now more complex procedures are being performed, although it will take another generation before these will be more generally applied. One of the key factors to success is training. More sophisticated training models are becoming available, allowing practicing in a safe environment before putting the procedure to practice. A key question in performing complex procedures is whether such procedures should not be concentrated into centres of expertise. Finally, a critical appraisal is warranted in regard to safety of surgery in neonates, as they fail to have cerebral autoregulation. As endoscopy may add additional risk factors, close monitoring is obligatory.

  3. Prevention of Adhesion after Endoscopic Sinus Surgery: Role of Mitomycin C

    Mohammad-Hossein Baradaranfar


    Full Text Available Adhesions after endoscopic sinus surgery (ESS are a potential cause of surgical failure. Mitomycin-C (MMC is recently proposed as a solution for these adhesions. This study was performed to investigate the effect of Mitomycin C in reducing scar formation and adhesion in the nasal mucosa after endoscopic nasal surgery. This double blind randomized clinical trial study was performed on 37 patients with bilateral chronic rhinosinusitis. At the end of ESS, randomly impregnated mesh with MMC was placed in one side and another mesh impregnated with saline in the opposite side for 5 minutes. Patients were followed at least for three months, and the results of diagnostic endoscopy were recorded. Post operative adhesion occurred in 12 (32.4% patients (2 bilateral/10 unilateral. Among total of 14 adhesions, 4 (10.8% were in the MMC side and 10 (27% in the control side. This differences was close to statistically significant (P=0.058. MMC may reduce adhesions after ESS, but further studies with different doses, sample size and frequent use of topical MMC is recommended.

  4. Dacriocistorrinostomia endoscópica nasal: resultados e vantagens sobre a abordagem externa Endoscopic nasal dacryocystorhinostomy: results and advantages over the external approach

    Daniel Salgado Küpper


    Full Text Available A Dacriocistorrinostomia (DCR consiste em criar uma via de drenagem lacrimal para a cavidade nasal, tendo como objetivo restabelecer a drenagem permanente deste sistema excretor previamente obstruído. OBJETIVO: Relatar nossos resultados com a técnica de DCR endoscópica, expondo vantagens e desvantagens em relação à técnica externa. FORMA DE ESTUDO: Coorte histórica. MATERIAL E MÉTODO: Foram analisadas retrospectivamente trinta e duas dacriocistorrinostomias realizadas pela Disciplina de Otorrinolaringologia de março de 2002 a janeiro de 2004 em pacientes com obstrução pós-saco lacrimal comprovada por dacriocistografia (DCG. Todos foram submetidos à sondagem com sonda de Crawford. RESULTADOS: Dos vinte e dois pacientes analisados, a cirurgia foi bilateral em dez totalizando trinta e dois procedimentos, sendo vinte e nove cirurgias primárias e três casos revisionais de insucessos com DCR externa. Nossa taxa de sucesso foi de 79,12%. CONCLUSÕES: A DCR endoscópica mostrou ser uma técnica segura, com baixa morbidade, além de evitar cicatrizes faciais e manter o mecanismo de bomba lacrimal, com resultados semelhantes à DCR externa.Dacryocystorhinostomy (DCR is a procedure used to create a lachrymal drainage pathway into the nasal cavity in order to reestablish the permanent drainage of a previously obstructed excretory system. AIM: to report our results obtained with endoscopic DCR technique, describing its advantages and disadvantages STUDY DESIGN: Historic cohort. MATERIAL AND METHOD: we retrospectively analyzed thirty-two dacryocystorhinostomies performed at the Otorhinolaryngology Discipline from March 2002 to January 2004 on patients with post-lachrymal sac obstruction confirmed by dacryocystorhinography (DCG. In all cases, the patients were submitted to probing with Crawford probe. RESULTS: surgery was bilateral in ten of the twenty-two analyzed patients, totaling thirty-two procedures, twenty-nine of which were primary


    Diego Benone dos Santos


    Full Text Available ABSTRACT Objective: Evaluate the nutritional status, vitamin D, the serum albumin, and the nasal colonization by bacteria in a Brazilian population sample that included specifically patients undergoing spine surgery Methods: The serum albumin and vitamin D tests were performed on blood samples; nasal microbiological research was performed by swab and demographic information was collected. We studied the correlation between the tests and gender and age groups of patients. Results: Seventy-five patients were included. Of this total, 74 patients underwent testing of albumin levels, 64 of vitamin D and 41 underwent nasal swab. The mean of serum albumin was 3.76 g/dl (SD = 0.53 g/dl; 70.3% of subjects were considered normal and 29.7% showed hypoalbuminemia. Regarding vitamin D, the mean was 16.64 ng/ml (SD: 7.43 ng/ml; 64.1% of patients were considered deficient, 32.8% insufficient, and 3.1% were considered normal. There was significant difference between albumin and age (p=0.007, being that the greater the age, the lower the albumin. Hypoalbuminemia was significantly more frequent over 60 years (p<0.001. There was no correlation between vitamin D or nasal swab and age (p=0.603 and 0.725, respectively. The correlation between the tests and gender showed no significant difference in any of the parameters. Conclusion: The serum albumin and vitamin D levels and results of nasal swab were presented for a Brazilian sample of patients undergoing spine surgery. It was found correlation between hypoalbuminemia (inferring malnutrition and age group of patients. Almost all the patients had some degree of vitamin D deficiency, with no correlation with age.

  6. 鼻窦灌注液冲洗在慢性鼻窦炎鼻内镜术后的应用及其机制探讨%Mechanism for the curative effect of douching with nasal sinuses perfusate in treating chronic sinusitis after endoscopic sinus surgery

    王芳; 王丹; 范晶晶


    Objective To investigate the mechanism for the curative effect of douching with nasal sinuses perfusate in treating chronic sinusitis after endoscopic sinus surgery.Methods Seventy-six chronic sinusitis patients after endoscopic sinus surgery were divided into treatment group and control group by random digits table with 38 cases each.Every group was given postoperatively sinus flush,treatment group was flushed with nasal sinuses perfusate,while contro group was flushed with 0.9% sodium chloride.Therapeutic effect was evaluated after two months.The therapeutic effects of the two groups were compared and the inflammation factor levels and changes of sinus mucosa were observed before and after treatment.Results In treatment group,there were 21 cases to be cured,13 cases to be improved,4 cases to be useless,the total effective rate was 89.5%(34/38),while in control group,there were 12 cases to be cured,15 cases to be improved,11 cases to be useless,the total effective rate was 71.1%(27/38),the total effective rates between two groups were statistically significant (P <0.05).The levels of interferon (IFN)-γ,interleukin(IL)-2,IL-4,IL-5 after treatment in treatment group were respectively ( 13.21 ± 1.38),( 14.59 ±1.43 ),(34.83 ± 5.31 ),( 39.93 ± 7.98 ) pg/L,which were significantly decreased compared with those before treatment [ (23.87 ± 1.76),( 16.13 ± 1.71 ),(67.37 ± 7.36),(81.82 ± 7.69) pg/L,P < 0.05 ].The levels of IFN- γ,IL-2,IL-4,IL-5 after treatment in control group were respectively (20.13 ± 2.73 ),( 14.82 ± 2.26),(48.92 ±7.62),(43.87 ±8.25) pg/L,which were significantly decreased compared with those before treatment [ (24.06 ± 1.82 ),( 15.96 ± 1.74),(66.81 ± 8.24),(82.16 ± 7.34) pg/L,P < 0.05 ].And the levels of IFN- γ,IL-4,IL-5 after treatment in treatment group were significantly lower than those in control group,the differences were statistically significant (P < 0.05).Conclusions That nasal flush with nasal sinuses perfusate

  7. Endoscopic Approach for Major Complications of Bariatric Surgery

    Joo, Moon Kyung


    As lifestyle and diet patterns have become westernized in East Asia, the prevalence of obesity has rapidly increased. Bariatric surgeries, such as Roux-en-Y gastric bypass (RYGB), sleeve gastrectomy (SG), and laparoscopic adjustable gastric banding (LAGB), are considered the first-line treatment option in patients with severe obesity. However, postoperative complications have increased and the proper management of these complications, including the use of endoscopic procedures, has become important. The most serious complications, such as leaks and fistulas, can be treated with endoscopic stent placement and injection of fibrin glue, and a novel full-thickness closure over-the-scope clip (OTSC) has been used for treatment of postoperative leaks. Stricture at the gastrojejunal (GJ) anastomosis site after RYGB or incisura angularis in SG can be managed using stents or endoscopic balloon dilation. Dilation of the GJ anastomosis or gastric pouch may lead to failure of weight loss, and the use of endoscopic sclerotherapy, novel endoscopic suturing devices, and OTSCs have been attempted. Intragastric migration of the gastric band can be successfully treated using various endoscopic tools. Endoscopy plays a pivotal role in the management of post-bariatric complications, and close cooperation between endoscopists and bariatric surgeons may further increase the success rate of endoscopic procedures. PMID:28008162

  8. Nasal packing and stenting

    Weber, Rainer K.


    Full Text Available Nasal packs are indispensable in ENT practice. This study reviews current indications, effectiveness and risks of nasal packs and stents. In endoscopic surgery, nasal packs should always have smooth surfaces to minimize mucosal damage, improve wound healing and increase patient comfort. Functional endoscopic endonasal sinus surgery allows the use of modern nasal packs, since pressure is no longer required. So called hemostatic/resorbable materials are a first step in this direction. However, they may lead to adhesions and foreign body reactions in mucosal membranes. Simple occlusion is an effective method for creating a moist milieu for improved wound healing and avoiding dryness. Stenting of the frontal sinus is recommended if surgery fails to produce a wide, physiologically shaped drainage path that is sufficiently covered by intact tissue.

  9. Orbital apex cyst: a rare cause of compressive optic neuropathy post-functional endoscopic sinus surgery

    Koh YN


    Full Text Available Yi Ni Koh,1,2 Shu Fen Ho,2 Letchumanan Pathma,3 Harvinder Singh,3 Embong Zunaina1 1Department of Ophthalmology, School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian, Kelantan, Malaysia; 2Department of Ophthalmology, 3Department of Otorhinolaryngology, Hospital Raja Permaisuri Bainun, Ipoh, Perak, Malaysia Abstract: There are various causes that can lead to compressive optic neuropathy. We present here orbital apex cyst as an unusual cause of compressive optic neuropathy in a 49-year-old male. He presented with 2 weeks painless loss of vision in the left eye with left-sided headache. He had had left functional endoscopic sinus surgery for left nasal polyps 4 years earlier. Magnetic resonance imaging of brain and orbit revealed a left discrete orbital nodule, possibly orbital cyst or mucocele, which was compressing on the left optic nerve. Left eye vision improved markedly from hand movement to 6/36 pinhole 6/18 after initiation of intravenous dexamethasone. A subsequent endoscopic endonasal left optic nerve decompression found the orbital nodule lesion to be an orbital cyst. Marsupialization was performed instead of excision, as the cyst ruptured intraoperatively. Postoperative vision improved to 6/7.5 with normal optic nerve function postoperatively. Possible cause of orbital apex cyst is discussed. Keywords: orbital cyst, compressive optic neuropathy, functional endoscopic sinus surgery

  10. Hybrid transvaginal natural orifice transluminal endoscopic surgery-kolecystektomi

    Boesen, Line; Meisner, Søren; Vilmann, Peter


    Natural orifice transluminal endoscopic surgery (NOTES) is a minimally invasive surgical technique where access to the abdominal cavity is achieved through one of the natural orifices of the body. Based on experience from gynaecology, transvaginal access has been the easiest NOTES technique...

  11. Endoscopic surgery of the maxillary sinuses in oral and maxillofacial surgery practice: a literature review

    Miroslav Andric


    Full Text Available Recently, a number of studies reported results of endoscopic surgery for treatment of odontogenic diseases of the maxillary sinuses and for sinus augmentation procedures. Therefore, the aim of this article was to review the literature data and to evaluate the level of current scientific evidence on this issue. Four retrospective and one prospective studies regarding functional endoscopic sinus surgery (FESS for odontogenic sinusitis were identified. Also, several case series of endoscope – assisted removal of odontogenic cysts and tumors involving the maxillary sinus were published. Finally, five studies regarding endoscope –controlled sinus augmentation procedures were analyzed. From available literature it seems that FESS for treatment of odontogenic sinusitis is a safe and predictable treatment option. Although scientific evidence is low, this is a clinically well documented procedure with low incidence of complications. In contrast to this, endoscopic surgery for odontogenic cysts and tumors is documented only in limited case series reports. Regarding treatment of implant – related complications, endoscopic surgery has a potential to provide effective treatment of those cases. On the other hand, endoscopic sinus augmentation needs scientific evidence of superiority to conventional techniques before it can be introduced into clinical practice.

  12. Olfactory functions after transsphenoidal pituitary surgery: endoscopic versus microscopic approach.

    Kahilogullari, Gokmen; Beton, Suha; Al-Beyati, Eyyub S M; Kantarcioglu, Ozlem; Bozkurt, Melih; Kantarcioglu, Emrah; Comert, Ayhan; Unlu, M Agahan; Meco, Cem


    Olfactory disturbances could be observed following transsphenoidal pituitary surgeries. To our knowledge, no previous comparative studies on olfactory functions after transsphenoidal endoscopic and microscopic approaches have been performed. Prospective study comparing olfactory functions between endoscopic and microscopic transsphenoidal pituitary surgery. Twenty-five patients operated on with the endoscopic approach and 25 patients operated on with the microscopic transsphenoidal approach have been evaluated. The Smell Diskettes Olfaction Test was used during the preoperative period, 1 month after the operation, and 6 months after the operation. In addition, the relationship between intraoperative cerebrospinal fluid leakage from the pituitary and postoperative synechiae formation with olfaction system was evaluated. The results were analyzed using the Friedman test, Mann-Whitney test, and Chi-Square test. In the endoscopic group, there were two hyposmic patients and no anosmic patients. In the microscopic group, there were 13 hyposmic patients and five anosmic patients. The data was statistically different between both groups (P microscopic group. There was no statistically significant difference between cerebrospinal fluid leakage and olfactory disturbances in both groups (P >0.05). Synechia was observed in nine patients in the microscopic group and in only one patient in the endoscopic group. There was a statistically significant difference between the presence of synechia and olfactory disturbances (P microscopic transsphenoidal approaches on the olfactory system during pituitary surgery. The obtained results indicate that an endoscopic approach seems to be more advantageous than a microscopic approach for protecting olfactory system and function. Copyright © 2013 The American Laryngological, Rhinological and Otological Society, Inc.

  13. Endoscope-assisted repair of large nasal septal perforation using a complex mucoperichondrial flap and free tissue graft

    张庆泉; 张杰; 李树峰


    Objective To improve the closure rate of large nasal septal perforations. Methods Using an endoscope, complex mucoperichondrial/mucoperiosteal flaps on one side and free tissue graft on the other, we designed a procedure to repair large nasal septal perforations.Results In our series, 8 patients were operated on with this procedure, resulting in complete closure of the perforation and subsequent relief of symptoms. Conclusion This technique may be used as an alter*$native for the repair of large nasal septal perforations.

  14. Evaluation of resident's training for endoscopic sinus surgery using a sheep's head.

    Delgado-Vargas, Beatriz; Romero-Salazar, Azucena Lloris; Reyes Burneo, Pablo M; Vásquez Hincapie, Catalina; de Los Santos Granado, Gonzalo; Del Castillo López, Raúl; Frágola Arnau, Claudio; Cobeta Marco, Ignacio


    Training in functional endoscopic sinus surgery (FESS) is an essential part of each ENT resident and it takes place on a very fragile area. This study focus on showing the learning curve of FESS, using an anatomical model such as the sheep's head. Four residents in our centre performed dissections. Each of these residents operated eight sheep's head. They performed an endoscopic septoplasty followed by maxillary antrostomy, total ethmoidectomy and frontal sinusotomy on every head. A staff member guided all procedures and checked for the appropriate dissection and complications occurred. Analysis was made upon the residents' performance of their first four septoplasties and eight nasal sides against their subsequent performance of the same. Final procedures presented better outcomes than the initial ones on every step of them. Results were measured by means of decrease of time (P < 0.0001) and complications, showing no major complications on the latest ones. Sheep's head is a suitable substitute for the cadaveric human head, to obtain the surgical skills needed for FESS procedures. Sheep's nasal cavity allows gaining dexterity and it is an easy model to obtain.

  15. Using preoperative unsupervised cluster analysis of chronic rhinosinusitis to inform patient decision and endoscopic sinus surgery outcome.

    Adnane, Choaib; Adouly, Taoufik; Khallouk, Amine; Rouadi, Sami; Abada, Redallah; Roubal, Mohamed; Mahtar, Mohamed


    The purpose of this study is to use unsupervised cluster methodology to identify phenotype and mucosal eosinophilia endotype subgroups of patients with medical refractory chronic rhinosinusitis (CRS), and evaluate the difference in quality of life (QOL) outcomes after endoscopic sinus surgery (ESS) between these clusters for better surgical case selection. A prospective cohort study included 131 patients with medical refractory CRS who elected ESS. The Sino-Nasal Outcome Test (SNOT-22) was used to evaluate QOL before and 12 months after surgery. Unsupervised two-step clustering method was performed. One hundred and thirteen subjects were retained in this study: 46 patients with CRS without nasal polyps and 67 patients with nasal polyps. Nasal polyps, gender, mucosal eosinophilia profile, and prior sinus surgery were the most discriminating factors in the generated clusters. Three clusters were identified. A significant clinical improvement was observed in all clusters 12 months after surgery with a reduction of SNOT-22 scores. There was a significant difference in QOL outcomes between clusters; cluster 1 had the worst QOL improvement after FESS in comparison with the other clusters 2 and 3. All patients in cluster 1 presented CRSwNP with the highest mucosal eosinophilia endotype. Clustering method is able to classify CRS phenotypes and endotypes with different associated surgical outcomes.

  16. Transsphenoidal Approach in Endoscopic Endonasal Surgery for Skull Base Lesions: What Radiologists and Surgeons Need to Know.

    García-Garrigós, Elena; Arenas-Jiménez, Juan José; Monjas-Cánovas, Irene; Abarca-Olivas, Javier; Cortés-Vela, Jesús Julián; De La Hoz-Rosa, Javier; Guirau-Rubio, Maria Dolores


    In the last 2 decades, endoscopic endonasal transsphenoidal surgery has become the most popular choice of neurosurgeons and otolaryngologists to treat lesions of the skull base, with minimal invasiveness, lower incidence of complications, and lower morbidity and mortality rates compared with traditional approaches. The transsphenoidal route is the surgical approach of choice for most sellar tumors because of the relationship of the sphenoid bone to the nasal cavity below and the pituitary gland above. More recently, extended approaches have expanded the indications for transsphenoidal surgery by using different corridors leading to specific target areas, from the crista galli to the spinomedullary junction. Computer-assisted surgery is an evolving technology that allows real-time anatomic navigation during endoscopic surgery by linking preoperative triplanar radiologic images and intraoperative endoscopic views, thus helping the surgeon avoid damage to vital structures. Preoperative computed tomography is the preferred modality to show bone landmarks and vascular structures. Radiologists play an important role in surgical planning by reporting extension of sphenoid pneumatization, recesses and septations of the sinus, and other relevant anatomic variants. Radiologists should understand the relationships of the sphenoid bone and skull base structures, anatomic variants, and image-guided neuronavigation techniques to prevent surgical complications and allow effective treatment of skull base lesions with the endoscopic endonasal transsphenoidal approach. ©RSNA, 2015.

  17. The application of Merogel in endoscopic dacryocystorhinostomy surgery

    Yu LIU


    Full Text Available Objective: To explore the application of Merogel in endoscopic dacryocystorhinostomy surgery. Methods: Merogel was used for filling postoperative wound in 32 cases. The circuit nurse and the patients check and count the pieces of the blood sucking cotton before the surgery or close the fistula, discard the hemostatic cotton and apply Merogel, non-wetted before application. Droplet-shaped Dexamethasone was employed for infiltration, and making it fit perfectly in the wound surface. The patients were examined 1 day, 7days and 14 days after the surgery and their recovery situation were recorded. Results: The incident of confusing Merogel and ordinary cotton did not occur, the wound recovered well without obvious scar. Conclusion: Merogel is the ideal surgical wound filler for endoscopic dacryocystorhinostomy, explicit cooperation is the important guarantee to achieve the best effect. 

  18. 113 Cases on Resection of Adenoidal Hypertrophy in Children by Nasal Endoscope%鼻内镜下儿童腺样体切除术113例报道

    丁元吉; 王红; 张利


    Objective To investigate the clinical effect of adenoidal hypertrophy resection in children by nasal endoscope with oral incision approach. Methods Retrospective analysis 113children with adenoid hypertrophy were treated using dynamic cutter with an oral incision approach under nasal endoscope. Compare the clinical effects with the traditional surgery group. Results In the revisit of 1 year, The surgery eliminated snoring and nasal obstruction. All the patients had no other complications such as epistaxis, injury of nasal mucosa, torus tubarius stricture,synechia nasal, after operation. Conclusion The resection of adenoidal hypertrophy in children by nasal endoscope with oral incision approach has the following advantages:relieving nasal obstruction, small trauma, less complication and better clinical effects.%  目的探讨鼻内镜下经口儿童腺样体切除术的疗效。方法回顾分析腺样体肥大患儿113例,在鼻内镜直视下,经口电动切削器切除腺样体,对其疗效与传统术式进行比较。结果术后随访1年,全部患儿术后打鼾、鼻塞等症状消失,无出血、鼻腔黏膜损伤、咽鼓管口狭窄、鼻腔粘连等并发症。结论鼻内镜下经口行腺样体切除术能彻底解除鼻咽部阻塞,创伤小,并发症少,手术疗效好。

  19. 3-D video techniques in endoscopic surgery.

    Becker, H; Melzer, A; Schurr, M O; Buess, G


    Three-dimensional visualisation of the operative field is an important requisite for precise and fast handling of open surgical operations. Up to now it has only been possible to display a two-dimensional image on the monitor during endoscopic procedures. The increasing complexity of minimal invasive interventions requires endoscopic suturing and ligatures of larger vessels which are difficult to perform without the impression of space. Three-dimensional vision therefore may decrease the operative risk, accelerate interventions and widen the operative spectrum. In April 1992 a 3-D video system developed at the Nuclear Research Center Karlsruhe, Germany (IAI Institute) was applied in various animal experimental procedures and clinically in laparoscopic cholecystectomy. The system works with a single monitor and active high-speed shutter glasses. Our first trials with this new 3-D imaging system clearly showed a facilitation of complex surgical manoeuvres like mobilisation of organs, preparation in the deep space and suture techniques. The 3-D-system introduced in this article will enter the market in 1993 (Opticon Co., Karlsruhe, Germany.

  20. Rhinoplasty and Functional Endoscopic Sinus Surgery

    George L. Murrell


    Full Text Available An increasing number of patients are opting for combining sinus surgery and cosmetic rhinoplasty. The author has been performing rhinoplasty with FESS since April of 1990. The technique and equipment used in early cases is much different than that used in more recent surgeries. Specific advances include high definition monitor, intraoperative navigation system, and powered dissecting instruments. The benefits of these advances are illustrated by a review of the more recent cases performed by the author. Combined rhinoplasty and FESS can be performed with good results (functional and cosmetic and minimal complications. Advances in sinus surgery technique and equipment have made the procedure safer, faster, more precise, and more comfortable.

  1. Navigation in endoscopic soft tissue surgery: perspectives and limitations.

    Baumhauer, Matthias; Feuerstein, Marco; Meinzer, Hans-Peter; Rassweiler, J


    Despite rapid developments in the research areas of medical imaging, medical image processing, and robotics, the use of computer assistance in surgical routine is still limited to diagnostics, surgical planning, and interventions on mostly rigid structures. In order to establish a computer-aided workflow from diagnosis to surgical treatment and follow-up, several proposals for computer-assisted soft tissue interventions have been made in recent years. By means of different pre- and intraoperative information sources, such as surgical planning, intraoperative imaging, and tracking devices, surgical navigation systems aim to support surgeons in localizing anatomical targets, observing critical structures, and sparing healthy tissue. Current research in particular addresses the problem of organ shift and tissue deformation, and obstacles in communication between navigation system and surgeon. In this paper, we review computer-assisted navigation systems for soft tissue surgery. We concentrate on approaches that can be applied in endoscopic thoracic and abdominal surgery, because endoscopic surgery has special needs for image guidance due to limitations in perception. Furthermore, this paper informs the reader about new trends and technologies in the area of computer-assisted surgery. Finally, a balancing of the key challenges and possible benefits of endoscopic navigation refines the perspectives of this increasingly important discipline of computer-aided medical procedures.

  2. Nasal Soft Tissue Change Following Bimaxillary Orthognathic Surgery.

    Jeong, Hye-In; Lee, Ho-Sung; Jung, Young-Soo; Park, Hyung-Sik; Jung, Hwi-Dong


    The purpose of this study is to identify the correlation between maxillary movement and nasal soft tissue changes on three-dimensional reconstructed cone beam computed tomography (CBCT) images after Le Fort I osteotomy. The authors also investigate the long-term change of alar base width (ABW) to determine the effect of cinch suture. The authors retrospectively studied 52 subjects (14 males and 38 females) who were treated by bimaxillary orthognathic surgery including Le Fort I osteotomy and mandibular ramus surgery. The landmarks and planes were established on three-dimensional reconstructed CBCT images. The authors measured each parameters preoperatively, 1 month postoperatively, and 1 year postoperatively. There was no significant correlation between the horizontal movement of A-point and the widening of ABW (P ABW (P ABW, nor was there a significant correlation between the nasal tip length and the vector of maxillary movement. There was no significant correlation between the ABW widening and the vector of surgical maxillary movement. The effect and stability of the alar base cinch suture is difficult to determine and require further investigation.

  3. Natural Orifice Transluminal Endoscopic Surgery (NOTES-an Emerging Technique in Surgery

    BM Shrestha


    Full Text Available Natural orifice transluminal endoscopic surgery (NOTES, which utilises natural anatomical passages for gaining access to the intra-abdominal organs for surgical interventions, that result in scarless surgery, is a recent advancement in the specialty of minimally invasive surgery and has gained significant momentum, It has been postulated as a promising alternative to laparoscopic surgery in the fi eld of minimal invasive surgery. Signifi cant advantages over conventional open surgery, such as less postoperative pain, a shorter hospital stay, early return to activity, avoidance of woundrelated complications and better cosmesis have been demonstrated. This article provides an update in the development, principles, practice and future applications of NOTES. Keywords: natural orifice, minimally invasive, scarless, endoscopic surgery.

  4. 3D Endoscope to Boost Safety, Cut Cost of Surgery


    Researchers at the Jet Propulsion Laboratory worked with the brain surgeon who directs the Skull Base Institute in Los Angeles to create the first endoscope fit for brain surgery and capable of producing 3D video images. It is also the first to be able to steer its lens back and forth. These improvements to visibility are expected to improve safety, speeding patient recovery and reducing medical costs.

  5. Predicting postoperative fever and bacterial colonization on packing material following endoscopic endonasal surgery.

    Nomura, Kazuhiro; Yamanaka, Yurika; Sekine, Yasuhiro; Yamamoto, Hiroki; Esu, Yoshihiko; Hara, Mariko; Hasegawa, Masayo; Shinnabe, Akihiro; Kanazawa, Hiromi; Kakuta, Risako; Ozawa, Daiki; Hidaka, Hiroshi; Katori, Yukio; Yoshida, Naohiro


    Postoperative fever following endoscopic endonasal surgery is a rare occurrence of concern to surgeons. To elucidate preoperative and operative predictors of postoperative fever, we analyzed the characteristics of patients and their perioperative background in association with postoperative fever. A retrospective review of 371 patients who had undergone endoscopic endonasal surgery was conducted. Predictors, including intake of antibiotics, steroids, history of asthma, preoperative nasal bacterial culture, duration of operation, duration of packing and intraoperative intravenous antibiotics on the occurrence of postoperative fever, and bacterial colonization on the packing material, were analyzed retrospectively. Fever (≥38 °C) occurred in 63 (17 %) patients. Most incidences of fever occurred on postoperative day one. In majority of these cases, the fever subsided after removal of the packing material without further antibiotic administration. However, one patient who experienced persistent fever after the removal of packing material developed meningitis. History of asthma, prolonged operation time (≥108 min), and intravenous cefazolin administration instead of cefmetazole were associated with postoperative fever. Odds ratios (ORs) for each were 2.3, 4.6, and 2.0, respectively. Positive preoperative bacterial colonization was associated with postoperative bacterial colonization on the packing material (OR 2.3). Postoperative fever subsided in most patients after removal of the packing material. When this postoperative fever persists, its underlying cause should be examined.

  6. Video. Pure natural orifice transluminal endoscopic surgery (NOTES) cholecystectomy.

    Bessler, Marc; Gumbs, Andrew A; Milone, Luca; Evanko, John C; Stevens, Peter; Fowler, Dennis


    Enthusiasm for natural orifice transluminal endoscopic surgery (NOTES) has been partly tempered by the reality that most NOTES procedures to date have been laparoscopically assisted. After safely performing transvaginal cholecystectomy in an IACUC-approved porcine model, the authors embarked on an institution review board (IRB)-approved protocol for ultimate performance of pure NOTES cholecystectomy in humans. They describe their experience performing a true NOTES transvaginal cholecystectomy after safely accomplishing three laparoscopically assisted or hybrid procedures in humans. One of the patients was a 35-year-old woman presenting with symptoms of biliary colic. Ultrasound confirmed gallstones, and her liver enzymes were normal. Pneumoperitoneum to 15 mmHg was obtained via a transvaginal trocar placed through a colpotomy made under direct vision. A double-channel endoscope then was advanced into the abdomen. To overcome the retracting limitations of currently available endoscopes, the authors used an extra-long 5-mm articulating retractor placed into the abdomen via a separate colpotomy made under direct vision using the flexible endoscope in a retroflexed position. Endoscopically placed clips were used for control of both the cystic duct and the artery. These techniques obviated the need for any transabdominally placed instruments or needles. This patient was the first to undergo a completely NOTES cholecystectomy at the authors' institution, and to their knowledge, in the United States. She was discharged on the day of surgery and at this writing has not experienced any complication after 1 month of follow-up evaluation. Performance of NOTES transvaginal cholecystectomy without aid of laparoscopic or needleoscopic instruments is feasible and safe for humans. Additional experience with this technique are required before studies comparing it with standard laparoscopy and hybrid techniques are appropriate.

  7. Emerging technologies including robotics and natural orifice transluminal endoscopic surgery (NOTES) colorectal surgery.

    Whiteford, Mark H; Swanstrom, Lee L


    Endoluminal and minimally invasive techniques have a long history and bright future in colorectal surgery. First, we will examine how old (colonoscopy) and new (laparoscopy) techniques combine in the form of laparoscopically assisted colonoscopic polypectomy for removal of "colonoscopically unresectable" colon polyps. Next, we will review the early experiences with robot-assisted minimally invasive colon resections. Lastly, we will introduce the next frontier in minimally invasive surgery, natural orifice transluminal endoscopic surgery (NOTES). 2007 Wiley-Liss, Inc

  8. History of power sources in endoscopic surgery.

    Sutton, Christopher; Abbott, Jason


    The history of energy sources used in surgery is inextricably linked to the history of electricity. Milestones include identification of safe electrical waveforms that can be used in the human body, patient isolation to prevent alternate-site burns, bipolar energy sources to negate capacitance injuries, laser energy, and the combination vessel sealing devices commonly used today. Engineering efforts to eliminate many of the hazards of electrosurgery are critical to how we practice modern gynecologic surgery. The introduction of bipolar instruments, increasing the safety of monopolar electrosurgery by not using hybrid trocars, and introduction of active shielding of the instruments from stray radiofrequency energy using intelligent secondary conductors have led to the re-emergence of electrosurgery as the universal surgical energy source. The low ongoing costs and the presence of electrosurgical generators in all hospitals readily enables electrosurgery to be the mainstay. Expensive lasers are confined to specialized centers, where they continue to be used, but for a long while filled a gap created by complications of electrosurgery. Sophisticated power sources continue to be introduced and include the ultrasonic scalpel, plasma surgery, and various devices for sealing vessels, all of which have advantages and disadvantages that are recognized as they begin to be subjected to scientific validation in randomized trials. Copyright © 2013 AAGL. Published by Elsevier Inc. All rights reserved.

  9. Clinical Pearls in Anaesthesia for Endoscopic Endonasal Transsphenoid Pituitary Macroadenoma Surgery

    Shah Shagun B; Kulkarni Anita


    Endoscopic Endonasal Trans-sphenoid Surgery (EETS) aided by avant-garde neuro-navigation techniques, ultrasonic aspirators and bone curettes has come of age. Endoscopic surgery supersedes conventional microscopic approach due to better visualization, avoidance of craniotomy, brain retraction and undue neurovascular manipulation with less morbidity, blood loss and improved safety. Anaesthetic techniques must be tailored to cater for such advances in surgery.

  10. Endoscopic laser scalpel for head and neck cancer surgery

    Patel, Snehal; Rajadhyaksha, Milind; Kirov, Stefan; Li, Yongbiao; Toledo-Crow, Ricardo


    Minimally invasive surgical (MIS) techniques, such as laparoscopic surgery and endoscopy, provide reliable disease control with reduced impact on the function of the diseased organ. Surgical lasers can ablate, cut and excise tissue while sealing small blood vessels minimizing bleeding and risk of lymphatic metastases from tumors. Lasers with wavelengths in the IR are readily absorbed by water causing minimal thermal damage to adjacent tissue, ideal for surgery near critical anatomical structures. MIS techniques have largely been unable to adopt the use of lasers partly due to the difficulty in bringing the laser into the endoscopic cavity. Hollow waveguide fibers have been adapted to bring surgical lasers to endoscopy. However, they deliver a beam that diverges rapidly and requires careful manipulation of the fiber tip relative to the target. Thus, the principal obstacle for surgical lasers in MIS procedures has been a lack of effective control instruments to manipulate the laser in the body cavity and accurately deliver it to the targeted tissue. To overcome this limitation, we have designed and built an endoscopic laser system that incorporates a miniature dual wedge beam steering device, a video camera, and the control system for remote and /or robotic operation. The dual wedge Risley device offers the smallest profile possible for endoscopic use. Clinical specifications and design considerations will be presented together with descriptions of the device and the development of its control system.

  11. The Olfactory Strip and Its Preservation in Endoscopic Pituitary Surgery Maintains Smell and Sinonasal Function.

    Harvey, Richard J; Winder, Mark; Davidson, Andrew; Steel, Tim; Nalavenkata, Sunny; Mrad, Nadine; Bokhari, Ali; Barham, Henry; Knisely, Anna


    Background The return of olfaction and of sinonasal function are important end points after pituitary surgery. Opinions differ on the impact of surgery because techniques vary greatly. A modified preservation of the so-called olfactory strip is described that utilizes a small nasoseptal flap and wide exposure. Methods A cohort of patients undergoing pituitary surgery and endoscopic sinonasal tumor surgery were assessed. Patient-reported outcomes (Sino-Nasal Outcome Test [SNOT22] and Nasal Symptom Score [NSS]) were recorded. A global score of sinonasal function and the impact on smell and taste were obtained. Objective smell discrimination testing was performed in the pituitary group with the Smell Identification Test. Outcomes were assessed at baseline and at 6 months. Results Ninety-eight patients, n = 40 pituitary (50.95 ± 15.31 years; 47.5% female) and n = 58 tumor (52.35 ± 18.51 years; 52.5% female) were assessed. For pituitary patients, NSSs were not significantly different pre- and postsurgery (2.75 ± 3.40 versus 3.05 ± 3.03; p = 0.53). SNOT22 scores improved postsurgery (1.02 ± 0.80 versus 0.83 ± 0.70; p = 0.046). Objective smell discrimination scores between baseline and 6 months were similar (31.63 ± 3.49 versus 31.35 ± 4.61; p = 0.68). No difference in change of olfaction was seen compared with controls (Kendall tau-b p = 0.46). Conclusions Preservation of the olfactory strip can provide a low morbidity approach without adversely affecting olfaction and maintaining reconstruction options.

  12. Endoscopic management of post-bariatric surgery complications.

    Boules, Mena; Chang, Julietta; Haskins, Ivy N; Sharma, Gautam; Froylich, Dvir; El-Hayek, Kevin; Rodriguez, John; Kroh, Matthew


    Understanding the technical constructs of bariatric surgery is important to the treating endoscopist to maximize effective endoluminal therapy. Post-operative complication rates vary widely based on the complication of interest, and have been reported to be as high as 68% following adjustable gastric banding. Similarly, there is a wide range of presenting symptoms for post-operative bariatric complications, including abdominal pain, nausea and vomiting, dysphagia, gastrointestinal hemorrhage, and weight regain, all of which may provoke an endoscopic assessment. Bleeding and anastomotic leak are considered to be early ( 30 d) complications. Treatment of complications in the immediate post-operative period may require unique considerations. Endoluminal therapies serve as adjuncts to surgical and radiographic procedures. This review aims to summarize the spectrum and efficacy of endoscopic management of post-operative bariatric complications.

  13. Experimental evaluation of water-jet dissection in endoscopic surgery.

    Cuschieri, A


    The problems associated with high-velocity high-pressure water-jet dissection were investigated by in-vivo experiments using endoscopic equipment. Three problems were identified: backspray with fouling of the optic, poor control of the depth of cut, and detachment of tissue fragments and isolated cells which contaminate the operative field. The first two problems have been resolved by adoption of a hooded hand-piece and the incorporation of an adjustable back stop. A "dry" system which enables the evacuation of the back spray may deal with the problem of contamination of the operative field by detached cells but further in-vivo experiments are needed to confirm this. Until then, water-jet cutting is considered unsafe for both open and endoscopic surgery in patients undergoing extirpative procedures for cancer because of the risk of tumour seeding within the peritoneal cavity.

  14. Audit of patient acceptance of nasal surgery as a day case procedure.

    Tierney, P A; Samuel, D; Patel, K S; Thomas, D M


    A greater emphasis on day case surgery within the health service is seen as a method of improving efficiency and reducing expenditure. We interviewed 90 consecutive patients undergoing nasal surgery who had been preoperatively assessed as being fit for day case surgery. They were randomised into three groups regarding the duration of postoperative nasal packing. All patients stayed overnight following surgery and were interviewed prior to discharge. Some 52% of the overall sample would be happy to have nasal surgery performed as a day case. If the nasal pack was removed after two hours, this figure rose to 67%. This difference in patient acceptance did not attain statistical significance overall, but there was a significant difference in those undergoing submucosal resection. There was no difference in the age, sex distribution or type of surgery performed between each group. The audit commission quotes patient satisfaction with day case surgery at 80%. Nasal surgery was not examined in their report, but was included as one of a set of procedures suitable for consideration. Although day case nasal surgery may be safe, further research regarding patient acceptance is required.

  15. [Diode laser surgery in the endoscopic treatment of laryngeal paralysis].

    Ferri, E; García Purriños, F J


    Several surgical procedures have been proposed for the treatment of respiratory distress secondary to bilateral vocal cord paralysis. The aim of all surgical techniques used is to restore a glottic lumen sufficient to guarantee adequate breathing through the natural airway, without tracheotomy and preserving an acceptable phonatory quality. In this study we present our experience from 1998 to 2004 concerning the use of the diode contact laser for a modified Dennis-Kashima posterior endoscopic cordectomy (extended to the false homolateral chord in 3 cases and to the homolateral arytenoid vocal process in 6 cases). 18 patients (15 male, 3 female) were treated; the age range was 35-84 years. The etiology of paralysis varied: iatrogenic post-thyroidectomy and post-thoracic surgery in 5 cases (28%), post-traumatic in 2 cases (11%), secondary to a central lesion in 11 (61%). The operation was carried out with a diode contact laser (60W; 810 nm). Follow-up was 20 months. Dyspnea improved in all patients; the 9 tracheostomized patients were decannulated within 2 months after surgery. Final voice quality was subjectively good in 16 patients (88%). None of patients had any complications after surgery. In conclusion, the endoscopic posterior cordectomy performed by contact diode laser is an effective and reliable method for the treatment of dyspnea secondary to bilateral laryngeal paralysis, guaranteing a sufficient airway without impairing swallowing and maintaining acceptable voice quality.

  16. Percutaneous endoscopic gastrostomy for postoperative rehabilitation after maxillofacial tumor surgery.

    Koehler, J; Buhl, K


    Despite the progress made in tumor and reconstructive surgery of the maxillofacial region, postoperative problems, such as malnutrition and dysfunction of the oral-oesophageal tract are still encountered. Nutrition via a nasogastric tube often complicates the rehabilitation process of these patients. Percutaneous endoscopic gastronomy (PEG), as opposed to nasogastral feeding, is presented. The technique, possible long-term complications, and the easy usage of the mechanical pump system, are presented. In our study of 40 patients, PEG, objectively, proved useful for functional, esthetic, practical, economical, and psychological reasons.

  17. Current progress on augmented reality visualization in endoscopic surgery.

    Nakamoto, Masahiko; Ukimura, Osamu; Faber, Kenneth; Gill, Inderbir S


    Advancements in surgery are progressing at a rapid rate; however, there are still limitations, including the ability to accurately visualize the target organ, in particular during laparoscopic surgery. Augmented reality visualization is a novel technique that has been developed to allow the fusion of three-dimensional medical images, such as those from transrectal ultrasound or computed tomography/MRI, with live camera images in real-time. In this review, we describe the current advancements and future directions of augmented reality and its application to laparoscopic surgery. Geometrically-correct superimposed images can be generated by tracking of the laparoscope and registration of the target organ. The fused image between the live laparoscopic images and the reconstructed three-dimensional organ model aides the surgeon in his or her understanding of anatomical structures. Laparoscopic and robot-assisted surgeries in both general surgery and urology have been performed with technical success to date. The primary limitation of the current augmented reality systems is its infancy in dynamic tracking of organ motion or deformation. Recently, augmented reality systems with organ tracking based on real-time image analysis were developed. Further improvement and/or development of such new technologies would resolve these issues. Augmented reality visualization is a significant advancement, improving the precision of laparoscopic/endoscopic surgery. New technologies to improve the dynamic tracking of organ motion or deformation are currently under investigation.

  18. [First clinical experiences with an endoscope manipulator system in endo- and transnasal surgery].

    Fischer, M; Gröbner, C; Dietz, A; Lueth, T C; Strauss, G


    Endo- and transnasal surgery needs optical support. The use of a microscope allows bimanual manipulation. More often the endoscopic technique is used which needs one hand for endoscope guidance "loosing" it for manipulation or demanding an assistant for endoscope guidance. In this work the use of a miniature endoscope manipulator system for endonasal and transnasal surgery was evaluated. 31 FESS with manipulator-assisted endoscope guidance were performed. The used endoscope positions, the number of position changes and conditional interruptions were documented. In addition, a transsphenoidal approach to the pituitary gland was performed in a cadaver trial. Non-inferiority was shown for the use of the endoscope manipulator with reference to time and accuracy of manipulator-assisted endoscope guidance. There were 6.4 position changes for each side. Bimanual manipulation was possible in all cases. In the region of high-risk structures (lamina papyracea, frontal recess) we conceptual switched to manual endoscope guidance. The evaluated endoscope manipulator fulfills the minimum requirements to be integrated into the surgical workflow of endo- and transnasal surgery. The number of required endoscope position changes is small allowing bimanual instrumentation. Still a disadvantage is the need for interrupting the workflow to remote the endoscope manipulator with the joystick console. Further development potential would be a forced-feedback function and hands-free navigated-controlled guidance. © Georg Thieme Verlag KG Stuttgart · New York.

  19. Minimally invasive endoscopic treatment of applied significance in nasal polyps%微创鼻内镜下手术治疗鼻息肉的临床意义

    刘艳; 刘新义


    Objective To investigate the significance and clinical effect of minimally invasive endoscopic treatment of nasal polyps.Methods Sixty cases of nasal polyps were devided into two groups:observation group(30 cases,minimally invasive endoscopic sinus surgery); control group of 30 patients(conventional surgery).Postoperative infection control; nasal stenosis; postoperative bleeding rate ; hospital stay of the two groups were compared.Results Each indicators of the two groups contrast,the observation group was better than the control group(P < 0.05).Conclusions Minimally invasive endoscopic sinus surgery in treating nasal polyps,can reduce the incidence of general surgical complications,reduce recovery time,shorten hospital stay,greatly improving the quality of life.%目的 探讨微创鼻内镜下手术治疗在鼻息肉中的应用意义及临床效果.方法 将60例鼻息肉患者分为观察组30例(微创鼻内镜手术治疗)、对照组30例(常规手术治疗),比较两组患者术后感染率、鼻腔狭窄率、术后出血率及住院天数.结果 两组各项指标对比,观察组明显优于对照组(P<0.05).结论 有效采取微创鼻内镜手术治疗鼻息肉,能够减少常规手术并发症发生率、减少康复时间、缩短住院时间,大大提高患者生活质量.

  20. Endoscopic versus microscopic transsphenoidal pituitary adenoma surgery: a meta-analysis


    Background Endoscopic transsphenoidal surgery has gradually come to be regarded as a preferred option in the treatment of pituitary adenomas because of its advantages of improved visualization and its minimal invasiveness. The aim of this study was to compare and evaluate the outcomes and complications of endoscopic and microscopic transsphenoidal surgery in the treatment of pituitary adenomas. Methods We performed a systematic literature search of MEDLINE, EMBASE, the Cochrane Library and the Web of Science between January 1992 and May 2013. Studies with consecutive patients that explicitly and fully compared endoscopic and microscopic approaches in the treatment of pituitary adenomas were included. Results A total of 15 studies (n = 1,014 patients) met the inclusion criteria among 487 studies that involved endoscopic surgery and 527 studies that dealt with microscopic surgery. The rate of gross tumor removal was higher in the endoscopic group than in the microscopic group. The post-operative rates of septal perforation were less frequent in patients who underwent endoscopic surgery. There was no significant difference between the two techniques in the incidence rates of meningitis, diabetes insipidus, cerebrospinal fluid leak, epistaxis or hypopituitarism. The post-operative hospital stay was significantly shorter for the endoscopic surgery group compared with the microscopic surgery group (P  0.05). Conclusions The present study indicates that the endoscopic transsphenoidal approach is safer and more effective than microscopic surgery in the treatment of pituitary adenomas. PMID:24721812

  1. The Rise of Tunnel Endoscopic Surgery: A Case Report and Literature Review

    Mingyan Cai


    Full Text Available There has been booming interest in natural orifice transluminal surgery since it was first described. Several techniques first developed for the safe transluminal access now derive into independent endoscopic surgical procedures. In this paper, we describe a case treated by a novel procedure by submucosal tunnelling technique and provide a literature review of the rise of tunnel endoscopic surgery.

  2. Treatment of paranasal sinuses mycosis with endoscopic sinus surgery%鼻内镜手术治疗非侵袭性鼻窦真菌病

    朱其新; 陈敏玲; 何植洲


    Objective To evaluate the treatment effect of endoscopic sinus surgery on the paranasal sinuses mycosis. Methods Twenty-one cases with nasal sinus mycoses were analyzed retrospectively .All of them had undergone endoscopic operation.Results In the follow up of 6~24 months, all cases were cured. Conclusion Endoscopic operation is the basic surgical method to treat the non-invasive nasal sinus mycoses. Excising the focus thoroughly, correcting the abnormal nasal cavity structure and resuming the cleanout function of nasal sinus cilia are the principle of treatment.%目的 探讨鼻内镜手术代替传统柯-陆手术治疗非侵袭性鼻窦真菌病的疗效.方法 总结分析我科近5年来采用鼻内镜手术治疗21例非侵袭性鼻窦真菌病患者.结果 21例患者术后随访6~24个月,原有症状消失,未见复发.结论 鼻内镜为治疗本病基本术式,彻底清除病灶、纠正鼻腔结构异常及恢复鼻窦纤毛功能为治疗原则.

  3. Patient satisfaction and treatment outcome of fungus ball rhinosinusitis treated by functional endoscopic sinus surgery.

    Lai, Jui-Chung; Lee, Hong-Shen; Chen, Mu-Kuan; Tsai, Yao-Lung


    Fungal rhinosinusitis is an important clinical problem with diverse manifestations. Although many literatures had found low recurrence rate after surgical treatment of fungus ball rhinosinusitis, patient satisfaction and treatment outcomes (symptom-free and symptom improvement rate, etc.) for fungus ball sinusitis are not yet well established. The purpose of this study is to estimate the patient satisfaction and treatment outcome in patients with fungus ball rhinosinusitis undergoing functional endoscopic sinus surgery (FESS). Medical records of consecutive patients with diagnosed fungus ball rhinosinusitis treated by FESS between 1995 and 2005 were reviewed retrospectively. The post-operative improvement in individual symptom was assessed by chart review and telephone visiting. Ninety consecutive patients (21 men and 69 women) were eligible for the study. Six patients (7%) presented bilateral fungus ball rhinosinusitis. Multiple paranasal sinus fungus ball involvements were found in 48 patients (53%). Complete resolution of complaints with respect to nasal discharge, postnasal drip, cough with sputum, nasal bleeding, fetid odor of nose, olfactory dysfunction, nasal obstruction, headache, and facial pain or pressure were described in 74 patients (82%). The overall patient satisfaction rate was 96%. The estimated recurrence rate of fungus ball rhinosinusitis treated with FESS was 3%, with a mean follow-up of 81 months. Treatment protocol of fungus ball rhinosinusitis with FESS and without postoperative antifungal drugs is efficient because of very low recurrence rate, high patient satisfaction, and very high symptom-free rate. Furthermore, the obvious difference of symptom-free rate between fungus ball rhinosinusitis and chronic rhinosinusitis highlights the need of further studies to discover the pathophysiology of fungal sinusitis.

  4. Robotics for Natural Orifice Transluminal Endoscopic Surgery: A Review

    Xiaona Wang


    Full Text Available Natural Orifice Transluminal Endoscopic Surgery (NOTES involves accessing the abdominal cavity via one of the bodies’ natural orifices, for example, mouth, anus, or vagina. This new surgical procedure is very appealing from patients’ perspectives because it eliminates completely abdominal wall aggression and promises to reduce postoperative pain, in addition to all other advantages brought by laparoscopic surgery. However, the constraints imposed by both the mode of access and the limited technology currently available make NOTES very challenging for the surgeons. Redesign of the instruments is imperative in order to make this emerging operative access safe and reproducible. In this paper, we survey on the state-of-the-art devices used in NOTES and introduce both the flexible instruments based on improvement of current endoscopic platforms and the revolutionary concept of robotic platforms based on the convergence of communication and micromechatronics technologies. The advantages and limitations of each category are addressed. Potential solutions are proposed to improve the existing designs and develop robust and stable robotic platforms for NOTES.

  5. Clinical observation of anastomotic stoma after dacryocystorhinostomy under improved nasal endoscope%经改良鼻内镜下泪囊鼻腔吻合术后对吻合口的临床观察

    王成义; 张梅


    Objective:To observe the anastomotic stoma after dacryocystorhinostomy under improved nasal endoscope and curative effect.Methods:The chronic dacryocystitis was given dacryocystorhinostomy under improved nasal endoscope and the postoperative anastomotic stoma was given timely handle.Results:30 patients recovered well after surgery.Conclusion:This method has clear vision,simple operation,small trauma,novelty surgical method,it is practical,feasible,its curative effect is satisfactory.And the nasal endoscope reduces the factors that affect the operation,the timely treatment of postoperative anastomotic stoma can obviously improve the curative effect.%目的:观察经改良鼻内镜下泪囊鼻腔吻合术后吻合口及疗效.方法:对慢性泪囊炎行改良鼻内镜下泪囊鼻腔吻合术及术后吻合口及时处理.结果:30例患者的术后恢复良好.结论:此方法视野清楚、操作简单、创伤小、手术方法新颖、实用、可行、疗效满意.同时,鼻内镜下的条件减少了影响手术的因素,对术后吻合口的及时处理能明显提高疗效.

  6. Numerical analysis for the efficacy of nasal surgery in obstructive sleep apnea hypopnea syndrome

    Yu, Shen; Liu, Ying-Xi; Sun, Xiu-Zhen; Su, Ying-Feng; Wang, Ying; Gai, Yin-Zhe


    In the present study, we reconstructed upper airway and soft palate models of 3 obstructive sleep apnea—hypopnea syndrome (OSAHS) patients with nasal obstruction. The airflow distribution and movement of the soft palate before and after surgery were described by a numerical simulation method. The curative effect of nasal surgery was evaluated for the three patients with OSAHS. The degree of nasal obstruction in the 3 patients was improved after surgery. For 2 patients with mild OSAHS, the upper airway resistance and soft palate displacement were reduced after surgery. These changes contributed to the mitigation of respiratory airflow limitation. For the patient with severe OSAHS, the upper airway resistance and soft palate displacement increased after surgery, which aggravated the airway obstruction. The efficacy of nasal surgery for patients with OSAHS is determined by the degree of improvement in nasal obstruction and whether the effects on the pharynx are beneficial. Numerical simulation results are consistent with the polysomnogram (PSG) test results, chief complaints, and clinical findings, and can indirectly reflect the degree of nasal patency and improvement of snoring symptoms, and further, provide a theoretical basis to solve relevant clinical problems. [Figure not available: see fulltext.

  7. Smell impairment in chronic rhinosinusitis – evaluation of endoscopic sinus surgery results and review of literature concerning olfactory function predictors.

    Szaleniec, Joanna; Wróbel, Agnieszka; Stręk, Paweł; Kowalczyk, Monika; Bylica, Ewa; Przeklasa, Maria; Żyła, Małgorzata; Składzień, Jacek


    Endoscopic sinus surgery (ESS) is the treatment of choice for patients with chronic rhinosinusitis (CRS) refractory to medical therapy. ESS successfully reduces most symptoms of CRS, but its effect on olfaction is always uncertain. The aim of this study was to assess the influence of sinus surgery on olfaction and to analyze the predictors of olfactory function before and after ESS in the context of a literature review. The study group comprised of 153 patients with CRS refractory to medical treatment. The patients evaluated their olfactory function before ESS, 3-6 months after ESS (121 individuals) and 12 months after ESS (58 individuals). Statistical analysis concerned the postoperative olfactory improvement as well as the influence of various predictors on the impairment of smell before and after surgery. Olfactory dysfunction was significantly reduced after ESS. The smell impairment before and after surgery depended on different predictors. Patients with severe preoperative olfactory dysfunction and extensive pathological changes in the nose and sinuses, including nasal polyps, reported most pronounced improvement after ESS. However, severely hyposmic subjects with nasal polyposis, asthma or aspirin intolerance as well as older patients reported worse postoperative smell scores.

  8. Gender-specific differences in chronic rhinosinusitis patients electing endoscopic sinus surgery.

    Lal, Devyani; Rounds, Alexis B; Divekar, Rohit


    The objective of this study was to investigate gender-specific differences in chronic rhinosinusitis (CRS) patients electing endoscopic sinus surgery (ESS). This study was a retrospective review of CRS patients electing ESS (2011-2013) at a tertiary-care center. ESS was elected by 272 patients (mean age 54.6 years; 48.5% female). Mean Lund-Mackay computed tomography (CT) score was 10.9; total 22-item Sino-Nasal Outcome Test (SNOT-22) score was 41.8. Compared to men, women electing ESS had lower CT score (10.1 vs 11.7; p = 0.01) but higher total SNOT-22 score (44.9 vs 39; p = 0.02). Women reported significantly worse postnasal drainage (p embarrassment (p = 0.0021). SNOT-22 scores declined with advancing age (women, p = 0.003; men, p = 0.0005). Reduction in CT scores with age was seen only in males (p = 0.03). Stratifying by age, females aged 61 to 80 years had higher SNOT-22 scores compared to male counterparts (p = 0.04), whereas CT scores were similar. More women underwent surgery for CRS without nasal polyps (CRSsNP) (54.9%) whereas more men underwent surgery for CRS with nasal polyps (CRSwNP) (57.4%), but this difference missed statistical significance (p = 0.052). Women with CRSwNP had higher SNOT-22 scores than men (p = 0.02) for similar CT scores. Men electing ESS for CRSsNP had higher CT scores than women (p = 0.02). Women with CRSsNP aged 18 to 40 years reported higher SNOT-22 scores than men (p = 0.003), even though CT scores were lower (p = 0.005). Equivalent numbers of men and women underwent ESS for CRS. Overall, women electing ESS had higher total SNOT-22 scores and lower Lund-Mackay CT scores than men. Women reported more problems with postnasal drainage (CRS overall, CRSsNP, and CRSwNP), embarrassment (CRS overall and CRSwNP), and facial pain (CRSwNP). Gender differences in CRS are poorly understood and merit further study. © 2015 ARS-AAOA, LLC.


    Ananth G


    Full Text Available BACKGROUND The endoscopic endonasal approach for the sellar region lesions is a novel technique and an effective surgical option. The evidence thus far has been conflicting with reports in favour and against a learning curve. We attempt to determine the learning curve associated with this approach. METHODS Retrospective and prospective data of the patients who were surgically treated for sellar region lesions between the year 2013 and 2016 was collected, 32 patients were operated by the endoscopic endonasal approach at Vydehi Institute of Medical Sciences and Research Centre, Bangalore. Age, sex, presenting symptoms, length of hospital stay, surgical approach, type of dissection, duration of surgery, sellar floor repair, intraoperative and postoperative complications were noted. All the procedures were performed by a single neurosurgeon. RESULTS A total of 32 patients were operated amongst which 21 patients were non-functioning pituitary adenomas, 2 were growth hormone secreting functional adenomas, 1 was an invasive pituitary adenoma, 4 were craniopharyngiomas, 2 were meningiomas, 1 was Rathke’s cleft cyst and 1 was a clival chordoma. Headache was the mode of presentation in 12 patients, 12 patients had visual deficits, 6 patients presented with hormonal disturbances amongst which 4 patients presented with features of panhypopituitarism and 2 with acromegaly. Amongst the 4 patients with panhypopituitarism, 2 also had DI, two patients presented with CSF rhinorrhoea. There was a 100% improvement in the patients who presented with visual symptoms. Gross total resection was achieved in all 4 cases of craniopharyngiomas and 13 cases of pituitary adenomas. Postoperative CSF leak was seen in 4 patients who underwent re-exploration and sellar floor repair, 9 patients had postoperative Diabetes Insipidus (DI which was transient, the incidence of DI reduced towards the end of the study. There was a 25% decrease in the operating time towards the end of

  10. Laparoscopic and Endoscopic Cooperative Surgery for Plexiform Angiomyxoid Myofibroblastic Tumor

    Yoshio Nagahisa


    Full Text Available Plexiform angiomyxoid myofibroblastic tumor (PAMT is a recently described distinctive gastric mesenchymal entity with a peculiar plexiform pattern, bland spindle cells and a myxoid stroma rich in arborizing blood vessels. In this study, we report a new case of this rare gastric tumor resected by laparoscopic and endoscopic cooperative surgery (LECS. A 39-year-old Japanese man was admitted with a gastric mass. Gastroscopy showed an elevated mass in the anterior wall of the gastric antrum. Endoscopic ultrasound examination revealed a focal hypoechoic lesion protruding into the lumen. A partial gastrectomy by LECS was performed, and the patient made an uneventful recovery and remains well 9 months later. The tumor in this case depicted all the typical histopathologic and immunochemical features of gastric PAMT (c-kit negative and smooth muscle actin-positive. Especially, it was characterized by multiple nodules protruding outward within the serosa. Therefore, it is important that the resection line is determined on the serosa to ensure the complete resection of these nodules together.

  11. Clinical Pearls in Anaesthesia for Endoscopic Endonasal Transsphenoid Pituitary Macroadenoma Surgery

    Shah Shagun B


    Full Text Available Endoscopic Endonasal Trans-sphenoid Surgery (EETS aided by avant-garde neuro-navigation techniques, ultrasonic aspirators and bone curettes has come of age. Endoscopic surgery supersedes conventional microscopic approach due to better visualization, avoidance of craniotomy, brain retraction and undue neurovascular manipulation with less morbidity, blood loss and improved safety. Anaesthetic techniques must be tailored to cater for such advances in surgery.

  12. High-flow nasal oxygen availability for sedation decreases the use of general anesthesia during endoscopic retrograde cholangiopancreatography and endoscopic ultrasound

    Schumann, Roman; Natov, Nikola S; Rocuts-Martinez, Klifford A; Finkelman, Matthew D; Phan, Tom V; Hegde, Sanjay R; Knapp, Robert M


    AIM To examine whether high-flow nasal oxygen (HFNO) availability influences the use of general anesthesia (GA) in patients undergoing endoscopic retrograde cholangiopancreatography (ERCP) and endoscopic ultrasound (EUS) and associated outcomes. METHODS In this retrospective study, patients were stratified into 3 eras between October 1, 2013 and June 30, 2014 based on HFNO availability for deep sedation at the time of their endoscopy. During the first and last 3-mo eras (era 1 and 3), no HFNO was available, whereas it was an option during the second 3-mo era (era 2). The primary outcome was the percent utilization of GA vs deep sedation in each period. Secondary outcomes included oxygen saturation nadir during sedation between periods, as well as procedure duration, and anesthesia-only time between periods and for GA vs sedation cases respectively. RESULTS During the study period 238 ERCP or EUS cases were identified for analysis. Statistical testing was employed and a P sedation was significantly higher in era 2 compared to era 3 (P sedation (P ≤ 0.007) as was the anesthesia-only time (P ≤ 0.001). CONCLUSION High-flow nasal oxygen availability was associated with decreased GA utilization and improved oxygenation for ERCP and EUS during sedation. PMID:28058020

  13. Natural orifice translumenal endoscopic surgery (NOTES): current status and challenges

    ZHANG Xiu-li; YANG Yun-sheng; SUN Gang; GUO Ming-zhou


    Objective To give a conceptual description of natural orifice translumenal endoscopic surgery (NOTES), review theearly efforts in the NOTES field, and discuss its challenges and limitations.Data sources The data were retrieved mainly from publications listed in MEDLINE, PubMed and China WanfangDatabase from 2005 to 2009. The search term was "NOTES". Study selection The articles involved in the "NOTES" study were selected and the review articles were excluded from the comparison. Results A marked increase in quantity in articles was shown each year for NOTES studies from 2006 to 2009. Animalexperiments with "NOTES" have been carried out in China from 2007, and two independent "NOTES" procedures onhumans were reported in 2009. Conclusion Although still in its infancy, the "NOTES" procedure is promising as another type of minimally invasivesurgery and favorable alternative to current interventions.


    E. N. Novozhilova


    Full Text Available The paper describes the experience with accompanying therapy in patients after endoscopic laryngeal surgery, which has been gained at the Unit of Head and Neck Tumors, Moscow City Cancer Hospital Sixty-Two. Endolaryngeal operations have been performed using robotic CO2 laser and alternative modes of mechanical ventilation. Methods for abolishing laser-induced reactive tissue changes with different groups of pharmaceuticals are considered. Both the possible side effects of some drugs and their potential interaction are taken into account. The high efficacy of current inhalation systems (PARI delivering the required doses of medicaments over a short period of time and with minimal losses and regulating their dispersion in relation to the drug used is noted.

  15. Reconstruction of nasal endoscopic treatment of nasal mucosal contact point structure of the clinical observation of headache%鼻内镜下重塑鼻腔结构治疗鼻腔粘膜接触点头痛的临床观察

    王国军; 白莎


    目的 探讨鼻内镜下重塑鼻腔结构治疗鼻解剖变异及粘膜接触点头痛的可行性.方法 对136例鼻解剖变异及粘膜接触点头痛患者进行CT及鼻内窥镜检查,进行鼻解剖结构评估,对药物治疗1个月无效患者采取鼻内镜下选择性多结构重塑手术治疗,随访6个月~2年,评估疗效.结果 106例治愈,25例有效,5例无效,有效率96.3%.结论 鼻中隔、中(下)鼻甲、钩突、筛泡等解剖变异是粘膜接触点头痛的主要原因,鼻内窥镜下重塑鼻腔结构治疗鼻腔粘膜接触点头痛以纠正鼻腔病理性改变、调整两侧气流的对称性分布为主,为鼻腔生理功能的恢复创造条件.%Objective Reconstruction of nasal endoscopic treatment of nasal anatomic variations of the structure and the feasibility of mucosal contact point headaches. Methods 136 patients with nasal anatomic variations and mucosal contact point headaches in patients with CT and nasal endoscopy to assess nasal anatomy,ineffective drug therapy in patients 1 month to more than selective remodeling of endoscopic surgery,followk-up June-2,the assessment of efficacy. Results 106 patients were cured,25 cases were effective,5 cases, efficiency 131 ( 96. 3 % ). Conclusion The nasal septum, middle (lower) middle turbinate,uncinate process, ethmoid bulla and other anatomical variation is the main reason for mucosal contact point headaches,nasal reshaping the structure under nasal endoscopy nasal mucosal contact point headaches treatment to correct the pathological changes of the nasal cavity, to adjust distribution of air flow on both sides of the symmetry of the main physiological function for the nasal cavity to create conditions for the recovery.

  16. [Computer-assisted video-endoscopic endonasal surgery].

    Schmerber, S; Chen, B; Lavallée, S; Coulomb, M; Chirossel, J P; Lavieille, J P; Reyt, E


    To make the surgical procedure safer and more precise in FESS, a non-invasive markerless computer-assisted system (CAS) is described for intra-operative navigation whenever the critical regions may be affected by surgical manipulation. Twenty patients with benign diseases of the paranasal sinuses were treated by Computer Assisted Video-endoscopic surgery, between December 1997 and March 1998. For the determination of accuracy and reproducibility of the system, ten anatomical landmarks on each side of the paranasal sinuses were chosen and measured. All of these points were identified on the direct live video-endoscopy image and compared to those obtained with the Optical Digitizing System (Flashpoint 5000(R)), on axial, coronal and sagittal view. The Optical Localizer we used detects the position of the relative coordinates of two rigid bodies made of IR-LED's each, one rigid body is secured to the head' of the patient with a headset, so that patient motion can be tracked, and the second rigid body attached to the operating instrument, leading to direct localization of the tip of the instrument. We use a markerless, skin surface-based registration method, which has the advantage to avoid doing a second CT scan examination usually performed to process the position of the fiducial markers. We register the data from the patient's usual paranasal CT scan. Computer-assisted surgery does not increase significantly the duration of the operation. Our markerless skin surface points registration method is reliable enabling of the movements patient's head during the procedure. Computer assistance can be used in almost any type of endoscopic sinonasal procedure. We obtained a registration and calibration accuracy of less than 1.5 mm in 89.2% of cases. CAS enables the surgeon to have a more thorough understanding of the complicated anatomy of paranasal sinuses, and may be especially helpful in revision surgery when normal anatomic landmarks are lacking. Due to the passive

  17. Extrathyroidal Implantation of Thyroid Hyperplastic/neoplastic Cells after Endoscopic Thyroid Surgery

    Cao Xi; Xie-qun Xu; Tao Hong; Bing-lu Li; Wei Liu


    Objective To report a case of the implantation of thyroid hyperplastic or neoplastic tissue after endoscopic thyroidectomy and discuss this complication in aspects of prevalence, pathogenesis, protection, and therapies. Methods A systematic search of literature from the PubMed database was conducted for identifying eligible studies on implantation of thyroid hyperplastic or neoplastic cells after endoscopic thyroid surgery. Results Overall, 5 reported cases on patients suffering from endoscopic thyroid surgery with implantation of thyroid hyperplastic or neoplastic cells were included in the systematic review. Conclusions Unskilled surgeons, rough intraoperative surgical treatment, scarification or rupture of tumor, contamination of instruments, chimney effect, aerosolization of tumor cells may be associated with the implantation after endoscopic thyroidectomy. To minimize the risk of such complication, we should be more meticulous and strict the endoscopic surgery indications.

  18. Transeptal suturing - a cost-efficient alternative for nasal packing in septal surgery.

    Plasencia, Daniel Pérez; Falcón, Juan Carlos; Barreiro, Silvia Borkoski; Bocanegra-Pérez, María Sacramento; Barrero, Mario Vicente; Macías, Ángel Ramos


    Nasal packing is routinely used in septal surgery to prevent postoperative bleeding. To demonstrate the possibility of transeptal suture as a safe and effective way to avoid nasal packing and to improve efficiency. This is a prospective, descriptive, inferential cost study comprising 92 patients. Two randomized groups of patients were analyzed, one with nasal packing and the other with transeptal suture. In the group of transeptal suture no patient experienced postoperative bleeding, and a statistically significant reduction of pain and headache was demonstrated. At the same time, we improved efficiency by saving on material costs. Transeptal suture is an effective and safe alternative to classic nasal packing in septal surgery. Moreover, it improves the efficiency of the intervention by saving costs. Copyright © 2015 Associação Brasileira de Otorrinolaringologia e Cirurgia Cérvico-Facial. Published by Elsevier Editora Ltda. All rights reserved.

  19. Transeptal suturing - a cost-efficient alternative for nasal packing in septal surgery

    Daniel Pérez Plasencia

    Full Text Available ABSTRACT INTRODUCTION: Nasal packing is routinely used in septal surgery to prevent postoperative bleeding. OBJECTIVE: To demonstrate the possibility of transeptal suture as a safe and effective way to avoid nasal packing and to improve efficiency. METHODS: This is a prospective, descriptive, inferential cost study comprising 92 patients. Two randomized groups of patients were analyzed, one with nasal packing and the other with transeptal suture. RESULTS: In the group of transeptal suture no patient experienced postoperative bleeding, and a statistically significant reduction of pain and headache was demonstrated. At the same time, we improved efficiency by saving on material costs. CONCLUSIONS: Transeptal suture is an effective and safe alternative to classic nasal packing in septal surgery. Moreover, it improves the efficiency of the intervention by saving costs.

  20. Suction Filter in Endoscopic Endonasal Surgery: A Technical Note.

    Zoli, Matteo; Marucci, Gianluca; Milanese, Laura; Bonfatti, Rocco; Sturiale, Carmelo; Ernesto, Pasquini; Frank, Giorgio; Mazzatenta, Diego


    The collection of the greatest possible amount of pathologic tissue is of paramount importance in neurosurgery to achieve the most accurate histopathologic diagnosis, to perform all of the necessary biomolecular tests on the pathologic specimen, and to collect biological material for basic or translational science studies. This problem is particularly relevant in pituitary surgery because of the possible small size and soft consistency of tumors, which make them suitable for removal through suction, reducing the amount of available pathologic tissue. To solve this issue, we adopted a filter connected to the suction tube, which allows the surgeon to collect all of the tissue aspirated during surgery. Our experience of 1734 endoscopic endonasal procedures, performed adopting this device since 1998 to December 2015, has been revised to assess its advantages and limitations. This system is easy-to-use, does not impair the surgical maneuvers, and does not add any relevant cost to the surgery. The tissue collected through the filter proved useful for diagnostic histologic and biomolecular analyses and for research purposes, without any relevant artifacts as a result of this method of collection. The use of a filter has allowed us to obtain the greatest amount possible of pathologic tissue at each surgery. This surgical material has revealed to be helpful both for diagnostic and basic science purposes. The use of the filter has proven to be of particular importance for microadenomas, soft tumors, and supradiaphragmatic or skull base lesions with heterogeneous features, improving the accuracy of histopathologic diagnosis. Copyright © 2016 Elsevier Inc. All rights reserved.

  1. Objective performance measures using motion sensors on an endoscopic tool for evaluating skills in natural orifice translumenal endoscopic surgery (NOTES).

    Chin, Lauren I; Sankaranarayanan, Ganesh; Dargar, Saurabh; Matthes, Kai; De, Suvranu


    Natural orifice translumenal endoscopic surgery is an emerging procedure. High fidelity virtual reality-based simulators allow development of new surgical procedures and tools and train medical personnel without risk to human patients. As part of a project funded by the National Institutes of Health, we are developing a Virtual Transluminal Endoscopic Surgery Trainer (VTEST TM) for this purpose. In this work, objective performance measures derived from motion tracking sensors attached to an endoscope was tested for the transgastric NOTES appendectomy procedure performed with ex-vivo pig organs using the EASIE-R(TM) trainer box. Results from our study shows that both completion time and economy of motion parameters were able to differentiate between expert and novice NOTES surgeons with p value of 0.039 and 0.02 respectively. Jerk computed on sensor 2 data also showed significant results (p = 0.02). We plan to incorporate these objective performance measures in VTEST(TM).

  2. An audit of pharyngeal pouch surgery using endoscopic stapling. The patient's viewpoint.

    Weller, M D; Porter, M J; Rowlands, J


    We report an audit designed to assess patient satisfaction resulting from pharyngeal pouch surgery using an endoscopic stapler. A personal series of 16 patients all operated on by the senior author over a 3-year period is reported. Information was gathered using a retrospective telephone questionnaire to establish pre- and postoperative symptoms, complications of surgery and patient satisfaction. This showed endoscopic pharyngeal pouch surgery to be successful in the majority of cases. Eighty-seven percent of patients felt better as a result of surgery. Seventy-five percent had no symptoms postoperatively. This series shows that surgery on pharyngeal pouches results in significant improvement in patient symptoms with minimal morbidity and mortality.

  3. Oral bisoprolol improves surgical field during functional endoscopic sinus surgery

    Sumitha Mary Jacob


    Full Text Available Background: The success of functional endoscopic sinus surgery (FESS depends on visual clarity of the surgical field, through the endoscope. The objective of this double-blind, randomized, controlled study was to determine if a pre-operative dose of bisoprolol (2.5 mg would reduce the bleeding during FESS and improve the visualization of the operative field. Materials and Methods: Thirty American Society of Anesthesiologists I or II patients, scheduled for FESS were randomized to receive either a placebo (Group A or 2.5 mg of bisoprolol (Group B 90 min prior to the surgery. All the patients received standard anesthesia and monitoring. The aim was to maintain the mean arterial pressure (MAP of 60-70 mmHg, by titrating dose of isoflurane and fentanyl. The concentration of isoflurane used was recorded every 15 min. At the end of the surgery, the volume of blood loss was measured and the surgeon was asked to grade the operative field as per the Fromme-Boezaart Scale. Result: The blood loss was significantly (P < 0.0001 more in the control group (398.67 ± 228.79 ml as compared with that in the bisoprolol group (110.67 ± 45.35 ml. The surgical field was graded better in those who received bisoprolol as compared with those in the control group ( P − 0.0001. The volume percent of isoflurane and the dose of fentanyl used was significantly lower in those who received bisoprolol. During the operative period, the MAPs were 70.0 ± 2.7 (Group A and 62.6 ± 3.6 mmHg (Group B and the heart rate was 99.8 ± 5.0/min (Group A and 69.2 ± 4.4/min (Group B. These differences were statistically significant ( P − 0.001. Conclusion: This clinical trial has demonstrated that administration of a single pre-operative dose of bisoprolol (2.5 mg can significantly reduce the blood loss during FESS and improve the visualization of the operating field.

  4. Complications of vision loss and ophthalmoplegia during endoscopic sinus surgery

    Maharshak I


    Full Text Available Idit Maharshak,1,2 Jenny K Hoang,3 M Tariq Bhatti2,4 1Department of Ophthalmology, Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel; 2Department of Ophthalmology, 3Department of Radiology (Division of Neuroradiology, 4Department of Medicine (Division of Neurology, Duke Eye Center and Duke University Medical Center, Durham, NC, USA Objective: To describe two rare cases of concurrent vision loss and external ophthalmoplegia following powered endoscopic sinus surgery (ESS. Design: Observational case report. Results: The records of two patients who underwent powered ESS and developed multiple concurrent ophthalmic complications were retrospectively reviewed for clinical history, neuro-ophthalmologic examination, and imaging findings. Patient 1 developed a retinal vascular occlusion and complete loss of adduction. Patient 2 developed an orbital hemorrhage, optic neuropathy, and a restrictive global ophthalmoplegia. Similar published case reports were also reviewed. Conclusion: Despite advances in powered ESS technique and instrumentation, serious ophthalmic complications can still occur. Inadvertent entry into the medial orbital wall can result in a combination of blindness and ocular motility dysfunction. The variety of mechanisms responsible for these complications underscores the importance of thorough pre- and postoperative clinical examination and review of imaging studies. Keywords: sinus surgery, orbit, extra ocular muscle injury, blindness

  5. Carotid-cavernous fistula after functional endoscopic sinus surgery.

    Karaman, Emin; Isildak, Huseyin; Haciyev, Yusuf; Kaytaz, Asim; Enver, Ozgun


    Carotid-cavernous fistulas (CCFs) are anomalous communications between the carotid arterial system and the venous cavernous sinus. They can arise because of spontaneous or trauma causes. Most caroticocavernous fistulas are of spontaneous origin and unknown etiology. Spontaneous CCF may also be associated with cavernous sinus pathology such as arteriosclerotic changes of the arterial wall, fibromuscular dysplasia, or Ehler-Danlos syndrome. Traumatic CCFs may occur after either blunt or penetrating head trauma. Their clinical presentation is related to their size and to the type of venous drainage, which can lead to a variety of symptoms, such as visual loss, proptosis, bruit, chemosis, cranial nerve impairment, intracranial hemorrhage (rare), and so on. Treatment by endovascular transarterial embolization with electrolytically detachable coils is a very effective method for CCF with good outcomes. Carotid-cavernous fistulas have been rarely reported after craniofacial surgery and are uncommon pathologies in otolaryngology practice. In this study, we report a 40-year-old woman with CCF secondary to blunt trauma of functional endoscopic sinus surgery.

  6. Application of fibrin sealing in endoscopic surgery%纤维蛋白封闭剂在鼻内镜手术中的应用

    彭帆; 赵金晓; 舒海荣; 宋建新; 许航宇


    Objective To investigate the clinical value of fibrin sealing(FS) in the endoscopic sinus surgery. Methods One hundred and sixty-three patients who would undergo endoscopic sinus surgery were divided into FS, Me-rocel highly expansive sponge and vaseline gaase groups. The postoperative response and the long-term curative effect was compared among the three groups. Results Compared with Merocel and vaseline gause, FS had an inferior hemostasis effect in the endoscopic sinus surgery, but a superior effect in the fullowing aspects: lighter headache and nasal cavity pain, gentler postoperative nasal mucosa response, shorter nasal mucosa epithelialization and less nasal cavity adhesion. Conclusions The using of FS in endoscopic sinus surgery could lead to a lighter headache and nasal cavity pain after the operation, which could be further applied in the clinical practice. (Chin J Ophthalmol and Otorhinolaryngol ,2009 ,9 :221-222)%目的 探讨纤维蛋白封闭剂(fibrin sealing,FS)在功能性鼻内镜鼻窦手术中的临床应用价值.方法 随机将163例行鼻内镜鼻窦手术患者分成FS组、Merocel高膨胀材料组和凡士林油纱条组,比较不同填塞材料的术后临床表现及远期影响.结果 FS组在鼻内镜鼻窦手术中止血效果差于高膨胀材料及凡士林油纱条组,但术后头痛及鼻腔疼痛较轻,鼻黏膜反应轻,创口愈合快,鼻黏膜上皮化快,鼻腔粘连少.结论 鼻内镜鼻窦手术中应用FS术后头痛及鼻黏膜反应轻,值得临床进一步实践、应用.

  7. Resultados em longo prazo da cirurgia endoscópica nasossinusal no tratamento da rinossinusite crônica com e sem pólipos nasais Long-term outcomes of endoscopic sinus surgery for chronic rhinosinusitis with and without nasal polyps

    Juliana Gama Mascarenhas


    Full Text Available Rinossinusite crônica (RSC afeta significativamente a qualidade de vida e o tratamento clínico e cirúrgico visa apenas seu controle clínico. OBJETIVO: Avaliar a qualidade de vida e o controle clínico da RSC em longo prazo em pacientes submetidos à cirurgia endoscópica nasossinusal. MÉTODO: Estudo observacional longitudinal prospectivo que seguiu pacientes com diagnóstico clínico de RSC no pré-operatório, pós-operatório de 3 meses e depois por no mínimo 2 anos após cirurgia nasossinusal endoscópica com a utilização do questionário Sinonasal Outcome Test 22 (SNOT-22 como principal medida de resposta ao tratamento, além da avaliação do controle clínico a longo prazo. RESULTADOS: Trinta e oito pacientes foram avaliados em todos os intervalos. Houve uma grande melhora dos valores do SNOT-22 entre o pré-operatório (61,3 e o pós-operatório de 3 (16,9 e 24 meses (32,3. Não houve diferença estatisticamente significante entre os pacientes com e sem pólipos nasais. Nota-se pouca proporção de pacientes controlados em ambos os grupos, e 7,89% foram submetidos à cirurgia revisional no período estudado. CONCLUSÃO: A cirurgia endoscópica nasossinusal promoveu importante melhora da qualidade de vida nos pacientes com rinossinusite crônica, atingindo controle clínico aceitável com baixa necessidade de reintervenção cirúrgica, mesmo após dois anos de seguimento pós-operatório.Chronic rhinosinusitis (CRS significantly affects patient quality of life. Medical and surgical treatments aim to clinically manage the condition. OBJECTIVE: To assess the long-term quality of life and clinical management of CRS in patients submitted to endoscopic sinus surgery. METHOD: This prospective cross-sectional cohort study enrolled 38 patients and looked into the follow-up data of subjects diagnosed with CRS before surgery, three months after surgery, and at least two years after surgery. The Sinonasal Outcome Test 22 (SNOT-22 was used to

  8. [Endoscopic surgery and reconstruction for extensive osteoradionecrosis of skull base after radiotherapy for nasopharyngeal carcinoma].

    Chen, Z; Qiu, Q H; Zhan, J B; Zhu, Z C; Peng, Y; Liu, H


    Objective: To investigate the clinical efficacy of endoscopic surgery for extensive osteoradionecrosis (ORN) of skull base in patients with nasopharyngeal carcinoma (NPC) after radiotherapy. Methods: Seventeen patients diagnosed as ORN of skull base after radiotherapy for NPC and underwent endoscopic surgery were retrospectively studied with their clinic data. Results: Based on the CT and endoscopic examination, all patients had large skull base defects with bone defects averaged 7.02 cm(2) (range, 3.60 - 14.19 cm(2)). Excepting for curetting the sequestra, endoscopic surgery was also used to repair the wound or to protect the internal carotid artery with flap in 12 patients. No bone reconstructions were conducted in all patients with the bone defects of skull base. CT examinations were taken after endoscopic surgery when required. The postoperative follow-up ranged from 8 months to 6 years (average, 14 months). Aside from 1 patient with delayed cerebrospinal fluid (CSF), others had no related complications. Conclusions: The patients with extensive ORN can be treated with endoscopic surgery to curette the necrotic bone of skull base, and endoscopic reconstruction provides an alternative technique. It may not be necessary to reconstruct the bone defects at skull base, however, the exposed important structures of skull base, such as internal carotid artery, need to repair with soft tissue such as flap.

  9. Assessing transgastric Natural Orifice Transluminal Endoscopic Surgery prior to clinical implementation

    Donatsky, Anders Meller


    The objective was to investigate whether transgastric Natural Orifice Transluminal Endoscopic Surgery (NOTES) could be implemented safely in clinical practice. The experimental studies proved ultrasonography guided access through the stomach to be feasible and safe without iatrogenic complication...

  10. Accuracy of Surgeon's Estimation of Sella Margins during Endoscopic Surgery for Pituitary Adenomas: Verification Using Neuronavigation

    Wang, Yi; Thiryayi, Wasiq; Ramaswamy, Ragu; Gnanalingham, Kanna


    ... types of pathology in which neuronavigation is of most benefit. We performed a prospective cohort study of 32 consecutive patients undergoing image-guided endoscopic transsphenoidal surgery for pituitary adenomas...

  11. Radiological findings in patients undergoing revision endoscopic sinus surgery: a retrospective case series study

    Eweiss Ahmed Z


    Full Text Available Abstract Background Functional endoscopic sinus surgery (FESS is now a well-established strategy for the treatment of chronic rhinosinusitis which has not responded to medical treatment. There is a wide variation in the practice of FESS by various surgeons within the UK and in other countries. Objectives To identify anatomic factors that may predispose to persistent or recurrent disease in patients undergoing revision FESS. Methods Retrospective review of axial and coronal CT scans of patients undergoing revision FESS between January 2005 and November 2008 in a tertiary referral centre in South West of England. Results The CT scans of 63 patients undergoing revision FESS were reviewed. Among the patients studied, 15.9% had significant deviation of the nasal septum. Lateralised middle turbinates were present in 11.1% of the studied sides, and residual uncinate processes were identified in 57.1% of the studied sides. There were residual cells in the frontal recess in 96% of the studied sides. There were persistent other anterior and posterior ethmoidal cells in 92.1% and 96% of the studied sides respectively. Conclusions Analysis of CT scans of patients undergoing revision FESS shows persistent structures and non-dissected cells that may be responsible for persistence or recurrence of rhinosinusitis symptoms. Trials comparing the outcome of conservative FESS techniques with more radical sinus dissections are required.

  12. The Effect of Endoscopic Sinus Surgery in Chronic Rhinosinusitis Patients With Concurrent Asthma



    Full Text Available Background Chronic rhinosinusitis (CRS and asthma are among the most important health-related conditions with evident socio-economic effects. The relationship between asthma and CRS has been considered in medical references for centuries. Previous studies have shown that treatment interventions targeting disease in one part of the airway are effective for general asthma management. However, the effect of endoscopic sinus surgery (ESS in CRS patients with concurrent asthma remains controversial. Therefore, we aimed to assess the effects of ESS on improvement of asthma in CRS patients with concurrent asthma. Objectives The aim of this study was to evaluate the impact of ESS on asthma in CRS patients. Methods Twenty-five CRS patients with asthma who met our inclusion criteria after taking a complete history underwent physical examination and diagnostic nasal endoscopy, and the asthma control test (ACT questionnaire was administered to them. Six months after ESS, the patients’ asthma was again assessed using the ACT questionnaire. Results Overall, the mean ACT score significantly increased from 12.56 at the baseline to 20.71 after a six-month follow up period (0.001. Conclusions Given the remarkable improvement in asthma control levels, ESS can be considered a useful method for treating CRS patients suffering from asthma.

  13. Effects of tranexamic acid during endoscopic sinsus surgery in children

    Ahmed A Eldaba


    Full Text Available Objectives: This study was conducted to evaluate the effect of tranexamic acid (TA on the intra-operative bleeding during the functional endoscopic sinus surgery (FESS in children. Methods: A total of 100 children recruited to undergo FESS were randomized into two groups. Group I: Was given just after induction, intra-venous 25 mg/kg TA diluted in 10 ml of normal saline. Group II: Was given 10 ml of normal saline. Non-invasive blood pressure, heart rate, and quality of the surgical field were estimated every 15 min. Volume of bleeding and duration of the surgical procedure were recorded. Results: Surgical field quality after 15 min revealed that seven patients in group I had minimal bleeding versus no one in group II, P=0.006. Meanwhile, 35 patients in group I had mild bleeding versus 26 patients in group II, P=0.064. Higher number of patients in group II than in group I had moderate bleeding, P=0006. Also, at 30 min, revealed that 10 patients in group I had minimal bleeding versus one patient in group II, P=0.004. Meanwhile, 37 patients in group I had mild bleeding versus 28 patients in group II, P=0.059. Higher number of patients in group II than in group I had moderate bleeding, P<0001. Duration of the surgeries and volume of bleeding were significantly less in tranexamic group than the placebo group, P<0.0001. Conclusion: Single intra-venous bolus dose of tranexamic in children during the FESS improves quality of surgical field, reduces intra-operative bleeding, and duration of surgery.

  14. Use of equine pericardium sheet (LYOMESH®) as dura mater substitute in endoscopic endonasal transsphenoidal surgery

    Cavallo, Luigi M.; Solari, Domenico; Somma, Teresa; Di Somma, Alberto; Chiaramonte, Carmela; Cappabianca, Paolo


    Objective: The aim of this study was to describe the use of equine pericardium sheet (Lyomesh®) as dural substitute for sellar reconstruction after endoscopic endonasal transsphenoidal surgery for the removal of pituitary adenomas. Methods: We reviewed data of patients that underwent surgery by means of an endoscopic endonasal transsphenoidal approach for the removal of pituitary adenomas over a 12-months period, starting in May 2012, i.e. when we adopted Lyomesh® (Audio Technologies, Pia...

  15. Endoscopic surgery in the 21subst century: Endoskopska kirurgija v 21. stoletju:

    Benhidjeb, Tahar; Stark, Michael


    In the last quarter of the 20th century, endoscopic procedures replaced most of the traditional abdominal operations. They shortened hospital stay and reduced morbidity. At the beginning of the 21st century, the progress in technology enhanced the development of translumenal endoscopic surgery in the field of gastroenterology. Parallel, the New European Surgical Academy foundedthe first European based Working Group on Natural Orifice Surgery (NOS). This group concentrates on the development o...

  16. Endoscopic Endonasal Versus Microscopic Transsphenoidal Surgery for Recurrent and/or Residual Pituitary Adenomas.

    Esquenazi, Yoshua; Essayed, Walid I; Singh, Harminder; Mauer, Elizabeth; Ahmed, Mudassir; Christos, Paul J; Schwartz, Theodore H


    Surgery for recurrent/residual pituitary adenomas is increasingly being performed through endoscopic surgery. Whether this new technology has altered the indications and outcomes of surgery is unknown. We conducted a systematic review and meta-analysis of published studies to compare the indications and outcomes between microscopic and endoscopic approaches. A PubMed search was conducted (1985-2015) to identify surgical series of endoscopic endonasal and microscopic transsphenoidal resection of residual or recurrent pituitary adenomas. Data were extracted regarding tumor characteristics, surgical treatment, extent of resection, endocrine remission, visual outcome, and complications. Twenty-one studies met inclusion criteria. A total of 292 patients were in the endoscopic group, and 648 patients were in the microscopic group. Endoscopic cases were more likely nonfunctional (P microscopic group. Endocrine remission was achieved in 53.0% and 46.7% of patients, and visual improvement occurred in 73.2% and 49.6% for the endoscopic and microscopic groups. Cerebrospinal fluid leak and pituitary insufficiency were higher in the endoscopic group. This meta-analysis indicates that the use of the endoscope to reoperate on residual or recurrent adenomas has only led to modest increases in resection rates. However, larger more complex cases are being tackled, so direct comparisons are misleading. The most dramatic change has been in visual improvement along with modest increases in risk. Reoperation for recurrent or residual adenomas is a safe and effective treatment option. Copyright © 2017 Elsevier Inc. All rights reserved.

  17. [The recent news in endoscopic surgery: a review of the literature and meta-analysis].

    Klimenko, K É


    During a few recent years, endonasal surgery has become the principal tool for the operative treatment of many pathologies affecting the base of the skull. The present work was designed to estimate the possibilities of using endoscopic endonasal surgery to treat sinus and skull base lesions and illustrate the recent progress in the development of endoscopic equipment and instrumentation. The meta-analysis of the results of on-going research on the application of the endonasal endoscopic technology is described with the special emphasis on the plastic treatment of liquor fistulas, removal of juvenile nasopharyngeal angiofibromas, treatment of pathological changes in the clivial region and odontoid cervicomedullary junction.

  18. Three-dimensional Evaluation of Nasal Surgery in Patients with Obstructive Sleep Apnea

    Dan-Mo Cui; De-Min Han; Busaba Nicolas; Chang-Long Hu; Jun Wu; Min-Min Su


    Background:Obstructive sleep apnea (OSA) is a common sleep disorder and is characterized by airway collapse at multiple levels of upper airway.The effectiveness of nasal surgery has been discussed in several studies and shows a promising growing interest.In this study,we intended to evaluate the effects of nasal surgery on the upper airway dimensions in patients with OSA using three-dimensional (3D)reconstruction of cone-beam computed tomography (CT).Methods:Twelve patients with moderate to severe OSA who underwent nasal surgery were included in this study.All patients were diagnosed with OSA using polysomnography (PSG) in multi sleep health centers associated with Massachusetts General Hospital,Massachusetts Eye and Ear Infirmary and the Partners Health Care from May 31,2011 to December 14,2013.The effect of nasal surgery was evaluated by the examination of PSG,subjective complains,and 3D reconstructed CT scan.Cross-sectional area was measured in eleven coronal levels,and nasal cavity volume was evaluated from anterior nasal spine to posterior nasal spine.The thickness of soft tissue in oral pharynx region was also measured.Results:Five out of the 12 patients were successfully treated by nasal surgery,with more than 50% drop of apnea-hypopnea index.All the 12 patients showed significant increase of cross-sectional area and volume postoperatively.The thickness of soft tissue in oral pharynx region revealed significant decrease postoperatively,which decreased from 19.14 ± 2.40 cm2 and 6.11 ± 1.76 cm2 to 17.13 ± 1.91 cm2 and 5.22 ± 1.20 cm2.Conclusions:Nasal surgery improved OSA severity as measured by PSG,subjective complaints,and 3D reconstructed CT scan.3D assessment of upper airway can play an important role in the evaluation of treatment outcome.

  19. Techniques and applications of endoscopic spine surgery. Part I:overview of current techniques

    Kai-Xuan Liu; MD; PhD


    Background Spinal pain is a serious health and social-economic problem. Endoscopic spine surgery as a treatment option for spinal pain has gained tremendous attention and growth in the past 2 decades, and a variety of endoscopic techniques have been invented to treat a wide range of spinal conditions. Purposes The purposes of this 2-part review article are to 1 ) overview the published techniques of endoscopic spine surgery, 2 ) summarize the applications of these techniques in treating various spinal conditions, and 3 ) evaluate the clinical evidence of the safety and effectiveness of these endoscopic techniques in treating some of the most common spinal conditions. The first part of the review article provides an overview of currently most commonly used techniques. Methods We searched the PubMed database for publications concerning endoscopic spine surgery and reviewed the relevant articles published in the English language. Results Discectomy and foraminotomy are the most common types of spine surgery that can currently be done endoscopically. Endoscopic techniques have been used to treat a wide range of spinal disorders located in the lumbar, cervical, as well as the thoracic regions of the spine.

  20. A clinical study of deviated nasal septum with special reference to conventional and endoscopic septoplasty

    Mohammad Nizamuddin Khan


    Conclusions: Our study showed that functional outcome was better and post-operative complications were less in endoscopic septoplasty. Endoscopic septoplasty provides better illumination which helps to identify septal deviation accurately while reducing the postoperative complications due to limited dissection and lesser trauma to septal cartilage. [Int J Res Med Sci 2016; 4(12.000: 5165-5171

  1. Apnea–hypopnea index decreased significantly after nasal surgery for obstructive sleep apnea

    Wu, Jun; Zhao, Guoqiang; Li, Yunchuan; Zang, Hongrui; Wang, Tong; Wang, Dongbo; Han, Demin


    Abstract Background: Nasal surgeries have been applied to obstructive sleep apnea (OSA) patients with nasal obstruction for decades. However, the efficiency of nasal surgery in improving OSA remains controversial. The aim of this study was to identify whether isolated nasal surgery can improve apnea–hypopnea index (AHI). Methods: Computerized searches were performed in MEDLINE, Web of Science, Cochrane Library, and Scopus from January 1, 2000 to April 30, 2016. A total of 18 articles and 587 participants were included. There were 1 randomized controlled trials, 2 nonrandomized trials, 11 prospective studies, and 4 retrospective studies. Data regarding study design (prospective/retrospective clinical trial, randomized, and controlled), population size, participant characteristics (age, gender, and body mass index), surgical intervention, and outcomes (AHI, Epworth sleep scale [ESS]) was collected. Results: Statistically significant improvement in AHI (subgroup 1: weighted mean difference [WMD] [95%confidence interval (CI)], −4.17 [−7.62, −0.73]; subgroup 2: WMD [95%CI], −4.19 [−7.51, −0.88]; overall: WMD [95%CI], −4.15 [−6.48, −1.82]) and ESS (subgroup 1: WMD [95%CI], −2.14 [−3.08, −1.19]; subgroup 2: WMD [95%CI], −4.70 [−5.95, −3.44]; overall: WMD [95%CI], −4.08 [−5.27, −2.88]) was revealed. Conclusion: Both AHI and ESS improved significantly after isolated nasal surgery, but the improvement of AHI is slightly significant. Future randomized controlled trials are needed to confirm the long-term benefits of nasal surgery on OSA. PMID:28151900

  2. Aseptic Meningitis with Craniopharyngioma Resection: Consideration after Endoscopic Surgery

    Chen, Jenny X.; Alkire, Blake C.; Lam, Allen C.; Curry, William T.; Holbrook, Eric H.


    Objectives While bacterial meningitis is a concerning complication after endoscopic skull base surgery, the diagnosis can be made without consideration for aseptic meningitis. This article aims to (1) present a patient with recurrent craniopharyngioma and multiple postoperative episodes of aseptic meningitis and (2) discuss the diagnosis and management of aseptic meningitis. Design Case report and literature review. Results A 65-year-old female patient with a symptomatic craniopharyngioma underwent transsphenoidal resection. She returned postoperatively with symptoms concerning for cerebrospinal fluid (CSF) leak and bacterial meningitis. Lumbar puncture demonstrated mildly elevated leukocytes with normal glucose levels. Cultures were sterile and she was discharged on antibiotics. She returned 18 days postoperatively with altered mental status and fever. Again, negative CSF cultures suggested aseptic meningitis. Radiological and intraoperative findings were now concerning for widespread cerebrovascular vasospasm due to leaked craniopharyngioma fluids. In the following months, her craniopharyngioma recurred and required multiple surgical resections. Days after her last operation, she returned with mental status changes and a sterile CSF culture. She was diagnosed with recurrent aseptic meningitis and antibiotics were discontinued. The patient experienced near complete resolution of symptoms. Conclusions Consideration of aseptic meningitis following craniopharyngioma resection is critical to avoid unnecessary surgical re-exploration and prolonged courses of antibiotics. PMID:27722072

  3. Aseptic Meningitis with Craniopharyngioma Resection: Consideration after Endoscopic Surgery.

    Chen, Jenny X; Alkire, Blake C; Lam, Allen C; Curry, William T; Holbrook, Eric H


    Objectives While bacterial meningitis is a concerning complication after endoscopic skull base surgery, the diagnosis can be made without consideration for aseptic meningitis. This article aims to (1) present a patient with recurrent craniopharyngioma and multiple postoperative episodes of aseptic meningitis and (2) discuss the diagnosis and management of aseptic meningitis. Design Case report and literature review. Results A 65-year-old female patient with a symptomatic craniopharyngioma underwent transsphenoidal resection. She returned postoperatively with symptoms concerning for cerebrospinal fluid (CSF) leak and bacterial meningitis. Lumbar puncture demonstrated mildly elevated leukocytes with normal glucose levels. Cultures were sterile and she was discharged on antibiotics. She returned 18 days postoperatively with altered mental status and fever. Again, negative CSF cultures suggested aseptic meningitis. Radiological and intraoperative findings were now concerning for widespread cerebrovascular vasospasm due to leaked craniopharyngioma fluids. In the following months, her craniopharyngioma recurred and required multiple surgical resections. Days after her last operation, she returned with mental status changes and a sterile CSF culture. She was diagnosed with recurrent aseptic meningitis and antibiotics were discontinued. The patient experienced near complete resolution of symptoms. Conclusions Consideration of aseptic meningitis following craniopharyngioma resection is critical to avoid unnecessary surgical re-exploration and prolonged courses of antibiotics.

  4. Robotics and telemanipulation technologies for endoscopic surgery. A review of the ARTEMIS project. Advanced Robotic Telemanipulator for Minimally Invasive Surgery.

    Schurr, M O; Buess, G; Neisius, B; Voges, U


    In endoscopic surgery, the ability to guide the instrument is significantly decreased compared with open surgery. Rigid laparoscopic instruments offer only four of the six degrees of freedom required for the free handling of objects in space. Robotics technology can be used to restore full mobility of the endoscopic instrument. Therefore, we designed a master-slave manipulator system (ARTEMIS) for laparoscopic surgery as a prototype. The system consists of two robotic arms holding two steerable laparoscopic instruments. These two work units are controlled from a console equipped with two master arms operated by the surgeon. The systems and its components were evaluated experimentally. Laparoscopic manipulations were feasible with the ARTEMIS system. The placement of ligatures and sutures and the handling of catheters were possible in phantom models. The surgical practicability of the system was demonstrated in animal experiments. We conclude that robotic manipulators are feasible for experimental endoscopic surgery. Their clinical application requires further technical development.

  5. A follow up audit of pharyngeal pouch surgery using endoscopic stapling.

    Harris, Richard P; Weller, Matt D; Porter, Martin J


    The aim of this study is to assess patient satisfaction, success at controlling symptoms and conversion rates to open surgery in patients undergoing pharyngeal pouch surgery using an endoscopic stapler in a second cycle of audit. The design consisted of a review of patient records augmented by an electronic search of operation codes in the hospitals' theatre records. The setting was in Worcester Royal Hospital, BUPA Southbank Hospital and Hereford Hospital, UK. Participants include all patients with pharyngeal pouches undergoing endoscopic pharyngeal pouch repair by the senior author between July 2002 and July 2007. The total number of participants was 31. All patients were undergoing treatment for the first time. The main outcome measures were pre- and postoperative symptom prevalence, conversion rates to open surgery, patient satisfaction. Endoscopic pharyngeal pouch surgery was successful in the vast majority of cases, with 97% of patients being satisfied with the result. The conversion rate to open surgery was 9.7%. These figures are improved from the last round of audit. In conclusion, endoscopic surgery to treat pharyngeal pouches is safe, effective and patient selection is improving. A modified method of endoscopy using a Negus scope rather than a Baldwin scope has allowed more patients to be treated via endoscopic methods. Open surgery is still required in some patients.

  6. Olfactory Neuroblastoma Treated by Endoscopic Surgery Followed by Combined External Beam Radiation and Gamma Knife for Optic Nerve and Chiasm Sparing: A Case Report

    Hansi Z. Jiang


    Full Text Available We describe the multimodality treatment regimen of a 53-year-old man diagnosed with olfactory neuroblastoma (Kadish stage C in the right nasal cavity extending into the ethmoid sinus and across the cribriform plate. Endoscopic surgery for tumor resection was followed by a combination of external beam radiotherapy and stereotactic radiosurgery boost with concurrent chemotherapy. The novel combination of dual radiation therapies allowed for the preservation of the nearby optic structures while providing an adequate dosage to a sufficient volume of the afflicted tissue.

  7. Developing Modularized Virtual Reality Simulators for Natural Orifice Translumenal Endoscopic Surgery (NOTES).

    Ahn, Woojin; Dorozhkin, Denis; Schwaitzberg, Steven; Jones, Daniel B; De, Suvranu


    Natural orifice translumenal endoscopic surgery (NOTES) procedures are rapidly being developed in diverse surgical fields. We are developing a Virtual Translumenal Endoscopic Surgery Trainer (VTEST™) built on a modularized platform that facilitates rapid development of virtual reality (VR) NOTES simulators. Both the hardware interface and software components consist of independent reusable and customizable modules. The developed modules are integrated to build a VR-NOTES simulator for training in the hybrid transvaginal NOTES cholecystectomy. The simulator was demonstrated and evaluated by expert NOTES surgeons at the 2015 Natural Orifice Surgery Consortium for Assessment and Research (NOSCAR) summit.

  8. Virtual reality training for endoscopic surgery : composing a validated training program for basic skills

    Dongen, van Koen Willem


    Endoscopic surgery demands different specific psychomotor skills than open surgery. Virtual reality simulation training has the potential to be a valuable tool in training these skills, because simulation provides the opportunity to train psychomotor skills in a safe environment. In addition to trai

  9. Clonidine Reduce Bleeding Of Endoscopic Sinus Surgery Amir Alam Hospital (1398-2000

    Hajy Mohammadi F


    Full Text Available This study was conducted to evaluate effect of clonidine as a premedication on endoscopic sinus surgery bleeding."nMethods and Materials: during a randomized double blind clinical trial we compared two groups of patients who scheduled for endoscopic sinus surgery for polypectomy and etmoidectomy. 216 patients randomly assigned in two groups.In first group 2 hours befor surgery a 0.2mg tablet of clonidine orally adminestered to patients and in second group a 100 mg tablet of vit Bj(with same size and color- as"nplacebowas adminestered to patients. The amount of bleeding measured in two groups."nResults: mean bleeding volume in clonidine group was 113+76 ml and in control group was 211 + 113 ml. There was a significant statistical difference between two groups (pO.0001."nConclusion: Clonidine as premedication can reduce bleeding of endoscopic sinus surgery significantly.

  10. Current status of natural orifice trans-endoscopic surgery (NOTES and laparoendoscopic single site surgery (LESS in urologic surgery

    Rafael E. Sanchez-Salas


    Full Text Available Laparoendoscopic single site surgery (LESS and natural orifice transluminal endoscopic surgery (NOTES represent novel approaches in urological surgery. To perform a review of the literature in order describe the current status of LESS and NOTES in Urology. References for this manuscript were obtained by performing a review of the available literature in PubMed from 01-01-02 to 15-05-09. Search terms included single port, single site, NOTES, LESS and single incision. A total of 412 manuscripts were initially identified. Out of these, 64 manuscripts were selected based in their urological content. The manuscript features subheadings for experimental and clinical studies, as NOTES-LESS is a new surgical technique and its future evolution will probably rely in initial verified feasibility. A subheading for reviews presents information regarding common language and consensus for the techniques. The issue of complications published in clinical series and the future needs of NOTES-LESS, are also presented.

  11. Overview of Photogrammetric Measurement Techniques in Minimally Invasive Surgery Using Endoscopes

    Conen, N.; Luhmann, T.


    This contribution provides an overview of various photogrammetric measurement techniques in minimally invasive surgery and presents a self-developed prototypical trinocular endoscope for reliable surface measurements. Most of the presented techniques focus on applications regarding laparoscopy, which mean endoscopic operations in the abdominal or pelvic cavities. Since endoscopic operations are very demanding to the surgeon, various assistant systems have been developed. Imaging systems may use photogrammetric techniques in order to perform 3D measurements during operation. The intra-operatively acquired 3D data may be used for analysis, model registration, guidance or documentation. Passive and active techniques have been miniaturised, integrated into endoscopes and investigated by several research groups. The main advantages and disadvantages of several active and passive techniques adapted to laparoscopy are described in this contribution. Additionally, a self-developed trinocular endoscope is described and evaluated.

  12. Development and testing of a compact endoscope manipulator for minimally invasive surgery.

    Berkelman, Peter; Cinquin, Philippe; Boidard, Eric; Troccaz, Jocelyne; Létoublon, Christian; Long, Jean-Alexandre


    This report describes the design, development, and testing of a novel compact surgical assistant robot to control the orientation and insertion depth of a laparoscopic endoscope during minimally invasive abdominal surgery. In contrast to typical endoscope manipulators, the described robot is particularly compact and lightweight, is simple to set up and use, occupies no floor or operating table space, and does not limit access to the patient in any way. The sterilizable endoscope manipulator is sufficiently small and lightweight at 625 g and 110 mm in diameter that it can be placed directly on the abdomen of the patient without interfering with other handheld instruments during minimally invasive surgery. It consists of an annular base, a clamp to hold an endoscope trocar, and two joints which enable azimuth rotation and inclination of the endoscope about a pivot point at the incision. The endoscope insertion depth is controlled by a cable winding acting against a compression spring on the endoscope shaft. Voice recognition and miniature keypad user command interfaces are provided, and the manipulator motors are backdriveable for manual repositioning. Endoscope camera trajectory-following accuracy and response-time results were measured using an optical localizer. Experimental results are given comparing the current prototype with the previous cable-driven prototype. The endoscope manipulator and its user interface were tested and evaluated by several surgeons during a series of minimally invasive surgical training procedures on cadavers and animals. The endoscope manipulator described has been shown to be a viable, practical device with performance and functionality equivalent to those of commercially available models, yet with greatly reduced size, weight, and cost.

  13. In vivo experiments of a surgical robot with vision field control for Single Port Endoscopic Surgery.

    Sekiguchi, Yuta; Kobayashi, Yo; Watanabe, Hiroki; Tomono, Yu; Noguchi, Takehiko; Takahashi, Yu; Toyoda, Kazutaka; Uemura, Munenori; Ieiri, Satoshi; Ohdaira, Takeshi; Tomikawa, Morimasa; Hashizume, Makoto; Fujie, Masakatsu G


    Recently, robotics systems are focused to assist in Single Port Endoscopic Surgery (SPS). However, the existing system required a manual operation of vision and viewpoint, hindering the surgical task. We proposed a surgical endoscopic robot for SPS with dynamic vision control, the endoscopic view being manipulated by a master controller. The prototype robot consists of a manipulator for vision control, and dual tool tissue manipulators (gripping: 5DOFs, cautery: 3DOFs) can be attached at the tip of sheath manipulator. In particular, this paper focuses on an in vivo experiment. We showed that vision control in the stomach and a cautery task by a cautery tool could be effectively achieved.

  14. Delayed Failure after Endoscopic Staple Repair of an Anterior Spine Surgery Related Pharyngeal Diverticulum

    Samer Al-Khudari


    Full Text Available We present a rare complication of endoscopic staple repair of a pharyngeal diverticulum related to prior anterior cervical spine surgery. A 70-year-old male developed a symptomatic pharyngeal diverticulum 2 years after an anterior cervical fusion that was repaired via endoscopic stapler-assisted diverticulectomy. He initially had improvement of his symptoms after the stapler-assisted approach. Three years later, the patient presented with dysphagia and was found to have erosion of the cervical hardware into the pharyngeal lumen at the site of the prior repair. We present the first reported case of late hardware erosion into a pharyngeal diverticulum after endoscopic stapler repair.

  15. The Impact of Angiotensin-Modulating Antihypertensives on Time Interval to Revision Surgery for Nasal Polyps.

    Brook, Christopher D; Maxfield, Alice Z; Stankovic, Konstantina; Metson, Ralph B


    Angiotensin-converting enzyme inhibitors (ACEIs) and angiotensin receptor blockers (ARBs) have been shown to suppress expression of periostin, a matricellular protein that is markedly elevated in nasal polyp tissue. The purpose of this study was to determine whether use of these antihypertensive agents affects the time to revision sinus surgery in patients with polyp regrowth. Case series with chart review. Academic medical center. Records were reviewed for 330 patients who underwent ≥2 operations for chronic sinusitis with nasal polyps from April 1987 through August 2015. The time between surgical interventions was compared with patient demographics and clinical characteristics, including use of ACEIs and ARBs. Sixty patients were taking ACEIs or ARBs during the study period, of which 32 had concurrent asthma. The mean interval between polyp operations was 61.0 ± 45.2 months (range, 2-228.6 months). Among patients with asthma (n = 197), the mean time to revision surgery was prolonged by >2 years for those taking ACEIs or ARBs (81.0 vs 54.5 months, P = .006). A similar impact on time to revision surgery was not observed for nonasthmatics taking these medications (61.0 vs 65.2 months, P = .655). Use of ACEIs and ARBs is associated with an increased time to revision sinus surgery among patients with concurrent nasal polyps and asthma. A possible mechanism of this observed effect is suppression of periostin expression through inhibition of the angiotensin pathway. © American Academy of Otolaryngology—Head and Neck Surgery Foundation 2016.

  16. Robotics and systems technology for advanced endoscopic procedures: experiences in general surgery.

    Schurr, M O; Arezzo, A; Buess, G F


    The advent of endoscopic techniques changed surgery in many regards. This paper intends to describe an overview about technologies to facilitate endoscopic surgery. The systems described have been developed for the use in general surgery, but an easy application also in the field of cardiac surgery seems realistic. The introduction of system technology and robotic technology enables today to design a highly ergonomic solo-surgery platform. To relief the surgeon from fatigue we developed a new chair dedicated to the functional needs of endoscopic surgery. The foot pedals for high frequency, suction and irrigation are integrated into the basis of the chair. The chair is driven by electric motors controlled with an additional foot pedal joystick to achieve the desired position in the OR. A major enhancement for endoscopic technology is the introduction of robotic technology to design assisting devices for solo-surgery and manipulators for microsurgical instrumentation. A further step in the employment of robotic technology is the design of 'master-slave manipulators' to provide the surgeon with additional degrees of freedom of instrumentation. In 1996 a first prototype of an endoscopic manipulator system. named ARTEMIS, could be used in experimental applications. The system consists of a user station (master) and an instrument station (slave). The surgeon sits at a console which integrates endoscopic monitors, communication facilities and two master devices to control the two slave arms which are mounted to the operating table. Clinical use of the system, however, will require further development in the area of slave mechanics and the control system. Finally the implementation of telecommunication technology in combination with robotic instruments will open new frontiers, such as teleconsulting, teleassistance and telemanipulation.

  17. Disinfection of rigid nasal endoscopes following in vitro contamination with Staphylococcus aureus, Streptococcus pneumoniae, Pseudomonas aeruginosa, and Haemophilus influenzae.

    Bradford, Benjamin D; Seiberling, Kristin A; Park, Francine E; Hiebert, Jared C; Chang, Dennis F


    If not adequately cleaned, rigid nasal endoscopes (RNEs) have the potential to cause iatrogenic cross-contamination. To test the efficacy of various disinfection methods in reducing bacterial load on RNEs in vitro. In vitro model. Staphylococcus aureus, Streptococcus pneumoniae, Pseudomonas aeruginosa, and Haemophilus influenzae contamination was separately induced on RNEs in vitro. Two experimental sets were completed. The RNEs were disinfected using the following protocols: 30-second scrub with antimicrobial soap (ABS) and water, 30-second scrub with 70% isopropyl alcohol (IA), 30-second scrub with ABS followed by 30-second scrub with IA, 30-second scrub with germicidal cloth, isolated 5-minute soak in an enzymatic soap solution, 5- and 10-minute soaks in ortho-phthalaldehyde, 0.55%, solution (Cidex OPA), and isolated 30-second rinse with tap water, all with 30-second precleaning and postcleaning rinses with tap water. Two sets of experiments (experiment sets A and B) were carried out with a 30-second tap water rinse after inoculation of each RNE. This was followed by immediate cleaning in set A and a 1-hour air-dry delay in set B. Otherwise there were no differences in the disinfection protocols between sets for each method noted. Effectiveness of various disinfection protocols in cleaning rigid nasal endoscopes experimentally inoculated with bacteria commonly found in the upper aerodigestive tract. Positive cultures following disinfection indicated ineffective or incomplete disinfection. Most cleaning methods were effective in eliminating S aureus, S pneumoniae, and H influenzae from the scopes following experimental contamination. Continued growth of P aeruginosa was found after all of the disinfection trials in experiment set A with the exception of a 10-minute immersion in Cidex OPA, and in set B except for the 10-minute Cidex OPA immersion and ABS plus IA trials. Most cleaning methods used in our trials appear to properly disinfect RNEs after in vitro

  18. Minimally invasive endoscopic ulnar nerve assessment and surgery for cubital tunnel syndrome patients—Relation between endoscopic nerve findings and clinical symptoms

    Aya Yoshida


    Full Text Available To minimize damage to healthy tissues, we have been performing endoscopically assisted cubital tunnel syndrome surgery based on endoscopic nerve findings since 1995. This is the first study to focus on endoscopic surgery for cubital tunnel syndrome based on endoscopic ulnar nerve findings and the subsequent postoperative clinical results. We analysed 82 upper extremities of 74 cubital tunnel syndrome patients who had undergone endoscopically assisted release surgery using the Universal Subcutaneous Endoscope system. Endoscopic observations of the ulnar nerve were made from a single 1- to 3-cm endoscopic portal incision at the cubital tunnel to 10 cm proximal and 10 cm distal. The abnormal nerve areas were identified and released based on nerve degeneration findings under endoscopic observation. The abnormal areas spread eccentrically from the entrapment point(s. In 82 diseased upper extremities, ulnar nerve entrapment occurred at the cubital tunnel. However, one extremity suffered from entrapment at the arcade of Struthers' in addition to the cubital tunnel. All patients showed improved clinical symptoms following surgery. There is no statistical relation between pre- and postoperative clinical scores of Dellon's Staging and abnormal nerve length findings. Cubital tunnel syndrome is usually caused by entrapment at the cubital tunnel; however, in some cases, there are other point entrapment(s. Our endoscopically assisted procedure avoids any damage to healthy tissues because the surgeon can observe the entrapment point(s prior to release. Postoperative clinical recovery results clearly indicate that endoscopic nerve findings reveal entrapment points and ulnar nerve degeneration can spread maximally 10 cm distally and proximally from the entrapment point(s, even in clinically mild severity cases. All other possible entrapment points should, therefore, be observed and released using our procedure.

  19. Endoscopic versus microscopic microvascular decompression for trigeminal neuralgia: equivalent pain outcomes with possibly decreased postoperative headache after endoscopic surgery.

    Lee, John Y K; Pierce, John T; Sandhu, Sukhmeet K; Petrov, Dmitriy; Yang, Andrew I


    OBJECTIVE Endoscopic surgery has revolutionized surgery of the ventral skull base but has not yet been widely adopted for use in the cerebellopontine angle. Given the relatively normal anatomy of the cerebellopontine angle in patients with trigeminal neuralgia (TN), the authors hypothesized that a fully endoscopic microvascular decompression (E-MVD) might provide pain outcomes equivalent to those of microscopic MVD (M-MVD) but with fewer complications. METHODS The authors conducted a single-institution, single-surgeon retrospective study with patients treated in the period of 2006-2013. Before surgery, all patients completed a questionnaire that included a validated multidimensional pain-outcome tool, the Penn Facial Pain Scale (PFPS, formerly known as Brief Pain Inventory-Facial), an 11-point scale that measures pain intensity, interference with general activities of daily living (ADLs), and facial-specific ADLs. Using a standardized script, independent research assistants conducted follow-up telephone interviews. RESULTS In total, 167 patients were available for follow-ups (66.5% female; 93 patients underwent M-MVD and 74 underwent E-MVD). Preoperative characteristics (i.e., TN classification, PFPS components, and medication use) were similar for the 2 surgical groups except for 2 variables. Patients in the M-MVD group had slightly higher incidence of V3 pain, and the 2 groups differed in the date of surgery and hence in the length of follow-up (2.4 years for the M-MVD group and 1.3 years for the E-MVD group, p facial-specific ADLs. Actuarial freedom from pain recurrence was equivalent in the 2 groups, with 80% pain control at 3 years. CONCLUSIONS Both the fully endoscopic MVD and the conventional M-MVD appear to provide patients with equivalent pain outcomes. Complication rates were also similar between the groups, with the exception of the rate of headaches, which was significantly lower in the E-MVD group 1 month postoperatively.

  20. Endoscopic Versus Microscopic Approach in Stapes Surgery: Are Operative Times and Learning Curve Important for Making the Choice?

    Iannella, Giannicola; Magliulo, Giuseppe


    Analyze the surgical outcomes of endoscopic stapes surgery, comparing the results with a conventional stapes surgery under microscopic approach. Estimate the operation type of each surgical approach and show a learning curve of endoscopic stapes surgery. Retrospective study. Tertiary referral center. Twenty patients who underwent endoscopic stapedotomy for otosclerosis and 20 patients who underwent microscopic stapedotomy for otosclerosis. Endoscopic and microscopic stapes surgery. Operating time, preoperative and postoperative hearing, intraoperative findings, postoperative complications, and postoperative pain. The group of patients who underwent endoscopic stapes surgery showed a mean operative time calculated to be 45.0 min. The group of patients treated by microscopic approach had an estimated mean value of 36.5 min. Statistical difference was evident (p value = 0.01). The average duration of endoscopic surgery varied as the surgeon gained experience. There were no statistical differences between the average surgical times for the endoscopic and microscopic approaches (p >0.05) in the last 4-month period of surgery. Through the endoscopic approach the percentage of ears with a postoperative air-bone gap ≤20 dB was 95%. No difference from the percentage of the microscopic group (90%) (p >0.05) was reported. No difference regarding the incidence of intraoperative findings and postoperative complications between endoscopic and microscopic approaches was found. Audiological outcomes achieved by endoscopic surgery are similar to the results obtained through a microscopic approach. Longer initial operative times and a learning curve are the principal grounds that might discourage most ear-surgeons from commencing endoscopic stapes surgery.

  1. Muller's muscle, no longer vestigial in endoscopic surgery.

    De Battista, Juan Carlos; Zimmer, Lee A; Rodríguez-Vázquez, Jose Francisco; Froelich, Sebastien C; Theodosopoulos, Philip V; DePowell, John J; Keller, Jeffrey T


    As a thin filmy covering overlaying the inferior orbital fissure (IOF), Muller's muscle was considered a vestigial structure in humans, and for this reason, its anatomical significance was neglected. Because of increasing interest in endonasal approaches to the skull base that encompasses this region, we re-examined this structure's role as an anatomical landmark from an endoscopic perspective. In 10 cadaveric specimens, microanatomical dissections were performed (n = 5); endoscopic dissections were performed (n = 5) via approaches of the middle turbinate or inferior turbinate, and via the Caldwell-Luc approach through the maxillary sinus. Histological examinations were performed in 20 human fetuses (Embryology Institute, Universidad Complutense de Madrid, Madrid, Spain). In cadaveric dissections, Muller's muscle was demonstrated in all specimens, serving as a bridge-like structure that spanned the entire IOF and separated the orbit from the temporal, infratemporal, and pterygopalatine fossas. Depending on which endoscopic corridor was used, a different aspect of the IOF and Muller's muscle was identified. In our endoscopic and microscopic observations, Muller's muscle was extensive, not only spanning the IOF but also extending posteriorly to reach the superior orbital fissure (SOF) and anterior confluence of the cavernous sinus. Histological analysis identified many anastomotic connections between the ophthalmic venous system and pterygoid plexus that may explain how infection or tumor spreads between these regions. Muller's muscle serves as an anatomical landmark in the IOF and facilitates anatomical orientation in this region for endoscopic skull base approaches. Its recognition during endoscopic approaches allows for a better three-dimensional understanding of this anterior cranial base region. Copyright © 2011 Elsevier Inc. All rights reserved.

  2. The benefits of hypopharyngeal packing in nasal surgery: a pilot study.

    Fennessy, B G


    BACKGROUND: Hypopharyngeal packs are used in nasal surgery to reduce the risk of aspiration and postoperative nausea and vomiting. Side effects associated with their use range from throat pain to retained packs postoperatively. AIM: To evaluate, as a pilot study, postoperative nausea\\/vomiting and throat pain scores for patients undergoing nasal surgery in whom a wet or dry hypopharyngeal pack was placed compared with patients who received no packing. METHODS: A randomized, double-blind prospective trial in a general ENT unit. RESULTS: The study failed to show a statistically significant difference between the three groups in terms of their postoperative nausea\\/vomiting and throat pain scores at 2 and 6 h postoperatively. This is the first study in which dry packs have been compared with wet and absent packs. CONCLUSION: Based on our findings, the authors recommend against placing hypopharyngeal packs for the purpose of preventing postoperative nausea and vomiting.

  3. Efficacy of ESS in chronic rhinosinusitis with and without nasal polyposis

    Lind, Henrik; Joergensen, G.; Lange, Bibi;


    Endoscopic sinus surgery (ESS) for patients with severe chronic rhinosinusitis (CRS) has become a well-established treatment in cases where medical therapy fails. Even though CRS patients are divided into two subgroups, CRS with nasal polyposis (CRSwNP) and CRS without nasal polyposis (CRSs...

  4. Adjustable-Viewing-Angle Endoscopic Tool for Skull Base and Brain Surgery

    Bae, Youngsam; Liao, Anna; Manohara, Harish; Shahinian, Hrayr


    The term Multi-Angle and Rear Viewing Endoscopic tooL (MARVEL) denotes an auxiliary endoscope, now undergoing development, that a surgeon would use in conjunction with a conventional endoscope to obtain additional perspective. The role of the MARVEL in endoscopic brain surgery would be similar to the role of a mouth mirror in dentistry. Such a tool is potentially useful for in-situ planetary geology applications for the close-up imaging of unexposed rock surfaces in cracks or those not in the direct line of sight. A conventional endoscope provides mostly a frontal view that is, a view along its longitudinal axis and, hence, along a straight line extending from an opening through which it is inserted. The MARVEL could be inserted through the same opening as that of the conventional endoscope, but could be adjusted to provide a view from almost any desired angle. The MARVEL camera image would be displayed, on the same monitor as that of the conventional endoscopic image, as an inset within the conventional endoscopic image. For example, while viewing a tumor from the front in the conventional endoscopic image, the surgeon could simultaneously view the tumor from the side or the rear in the MARVEL image, and could thereby gain additional visual cues that would aid in precise three-dimensional positioning of surgical tools to excise the tumor. Indeed, a side or rear view through the MARVEL could be essential in a case in which the object of surgical interest was not visible from the front. The conceptual design of the MARVEL exploits the surgeon s familiarity with endoscopic surgical tools. The MARVEL would include a miniature electronic camera and miniature radio transmitter mounted on the tip of a surgical tool derived from an endo-scissor (see figure). The inclusion of the radio transmitter would eliminate the need for wires, which could interfere with manipulation of this and other surgical tools. The handgrip of the tool would be connected to a linkage similar to

  5. Comparison of Local Anesthetic Effect of Bupivacaine versus Bupivacaine plus Dexamethasone in Nasal Surgery

    Abdolhosein Ma’somi


    Full Text Available   Introduction: Adequate pain control is an important consideration in the post-surgical management of patients. Local nerve blockade added to general anesthesia can provide excellent pain control during and after most nasal surgical procedures. The aim of this study was to determine the combined effect of local anesthetic drugs with corticosteroids in nasal surgery. Materials and Methods: In this double-blind clinical study, 60 patients who underwent different nasal surgical procedures were matched and divided into two equal groups. Bilateral local nerve blockade was used in both groups. Bupivacaine or bupivacaine plus dexamethasone was administered by injection (groups B and B+D, respectively. Postoperative visual analog scale (VAS pain values and the need for oral/intramuscular analgesic treatment in the first 24 h were recorded in all patients. Results: Thirty-eight male (63.3% and 22 female (36.7% patients were included in this study, with a mean age of 28.3 ± 8.2 years. At 1, 2, 4, 6, and 12 h post surgery, VAS pain values were significantly lower in the B+D group than in the B group. The analgesic requirement was significantly lower in the B+D group compared with the B group. No relevant complications were seen during surgery or postoperative hospitalization. Conclusion: This study demonstrates the positive effect of a combination of a dexamethasone with a bupivacaine in reducing pain and the need for analgesic drugs after different nasal surgeries. No acute or short-term post-surgical complications were observed in this study.   

  6. Bilateral infraorbital nerve blocks decrease postoperative pain but do not reduce time to discharge following outpatient nasal surgery

    Mariano, Edward R.; Watson, Deborah; Loland, Vanessa J.; Chu, Larry F.; Cheng, Gloria S.; Mehta, Sachin H.; Maldonado, Rosalita C.; Ilfeld, Brian M.


    Purpose While infraorbital nerve blocks have demonstrated analgesic benefits for pediatric nasal and facial plastic surgery, no studies to date have explored the effect of this regional anesthetic technique on adult postoperative recovery. We designed this study to test the hypothesis that infraorbital nerve blocks combined with a standardized general anesthetic decrease the duration of recovery following outpatient nasal surgery. Methods At a tertiary care university hospital, healthy adult ...

  7. Endoscopic CO2-Laser Surgery for Vocal Cord Cancer

    J. Czigner


    Full Text Available A retrospective study is reported on endoscopic CO2-laser microsurgery in 69 patients with histologically verified early vocal cord cancer. A flexible nasopharyngolaryngoscope (STORZ Co was used for preoperative assessment and occasionally for postoperative follow-up.

  8. Danger points, complications and medico-legal aspects in endoscopic sinus surgery

    Hosemann, W.; Draf, C.


    Endoscopic endonasal sinus surgery represents the overall accepted type of surgical treatment for chronic rhinosinusitis. Notwithstanding raised and still evolving quality standards, surgeons performing routine endoscopic interventions are faced with minor complications in 5% and major complications in 0.5–1%. A comprehensive review on all minor and major complications of endoscopic surgery of the paranasal sinuses and also on the anterior skull base is presented listing the actual scientific literature. The pathogenesis, signs and symptoms of each complication are reviewed and therapeutic regimens are discussed in detail relating to actual publication references. Potential medico-legal aspects are explicated and recent algorithms of avoidance are mentioned taking into account options in surgical training and education. PMID:24403974


    Verma, Sidharth; Mehta, Nitika; Mehta, Nandita; Mehta, Satish; Verma, Jayeeta


    We present a case of confusing white foreign body in the nasal cavity detected during Endoscopic Sinus Surgery (ESS) in a 35-yr-old male which turned out to be a malposition of classic laryngeal mask airway (LMA). Although malposition of LMA is a known entity to the anesthesiologist, if ventilation is adequate, back folded LMA in nasal cavity might not be recognized by the surgeon and lead to catastrophic consequences during endoscopic sinus surgery. In principle, misfolding and malpositioning can be reduced by pre usage testing, using appropriate sizes, minimizing cuff volume, and early identification and correction of malposition.

  10. Nasal methicillin-resistant S. aureus is a major risk for mediastinitis in pediatric cardiac surgery.

    Katayanagi, Tomoyuki


    Mediastinitis caused by methicillin-resistant Staphylococcus aureus (MRSA) is a serious complication after pediatric cardiac surgery. An outbreak of surgical site infections (SSIs) provided the motivation to implement SSI prevention measures in our institution. Subjects comprised 174 pediatric patients who underwent open-heart surgery after undergoing preoperative nasal culture screening. The incidence of SSIs and mediastinitis was compared between an early group, who underwent surgery before SSI measures (Group E, n = 73), and a recent group, who underwent surgery after these measures (Group R, n = 101), and factors contributing to the occurrence of mediastinitis were investigated. The incidence of both SSIs and Mediastinitis has significantly decreased after SSI measures. With regard to factors that significantly affected mediastinitis, preoperative factors were "duration of preoperative hospitalization" and "preoperative MRSA colonization," intraoperative factors were "Aristotle basic complexity score," "operation time," "cardiopulmonary bypass circuit volume" and "lowest rectal temperature." And postoperative factor was "blood transfusion volume." Patients whose preoperative nasal cultures were MRSA-positive suggested higher risk of MRSA mediastinitis. SSI prevention measures significantly reduced the occurrence of SSIs and mediastinitis. Preoperative MRSA colonization should be a serious risk factor for mediastinitis following pediatric cardiac surgeries.

  11. [Clinical analysis of nasal sinus mucocele with eye symptoms as main manifestation: 3 cases report].

    Gu Qingjia; Li Jingxian; Fan Jiangang


    Endoscopic sinus surgery is effective to nasal sinus mucocele with eye symptoms as main manifestation. It is very importment to raise the awareness of the disease and to prompt imaging examination. Three cases were reviewed. One mucocele was found in the frontal sinus ethmoid sinus,1 in the fronto-ethmoid sinus and 1 in the spheno-ethmoid sinus. All cases were preoperatively diagnosed by CT, MRI or intranasal endoscopy. Nasal sinus mucocele with eye symptoms as main manifestation should be early diagnosed. Endoscopic sinus surgery is a safe and effective method for the treatment of nasal sinus mucocele,and could be the primary choice for it. All cases were treated by nasal endoscopic sinus surgery. The majority of symptoms, such as exophthalmos, epiphora and diplopia, disappeared in all patients. However, vision recovery was observed only in some patients.

  12. The developments and achievements of endoscopic surgery, robotic surgery and function-preserving surgery.

    Yoshida, Masashi; Furukawa, Toshiharu; Morikawa, Yasuhide; Kitagawa, Yuko; Kitajima, Masaki


    The breakthrough in laparoscopic surgery has been the development of a charge-coupled device camera system and Mouret performing cholecystectomy in 1987. The short-term benefits of laparoscopic surgery are widely accepted and the long-term benefit of less incidence of bowel obstruction can be expected. The important developments have been the articulating instrumentation via new laparoscopic access ports. Since 2007, single-incision laparoscopic surgery has spread all over the world. Not only single-scar but also no-scar operation is a current topic. In 2004, Kalloo reported the flexible transgastric peritoneoscopy as a novel approach to therapeutic interventions. In 2007, Marescaux reported transvaginal cholecystectomy in a patient. The breakthrough in robotic surgery was the development of the da Vinci Surgical System. It was introduced to Keio University Hospital in March 2000. Precision in the surgery will reach a higher level with the use of robotics. In collaboration with the faculty of technology and science, Keio University, the combined master-slave manipulator has been developed. The haptic forceps, which measure the elasticity of organs, have also been developed. The first possible sites of lymphatic metastasis are known as sentinel nodes. Otani reported vagus-sparing segmental gastrectomy under sentinel node navigation. This kind of function-preserving surgery will be performed frequently if the results of the multicenter prospective trial of the dual tracer method are favorable. Indocyanine green fluorescence-guided method using the HyperEye charge-coupled device camera system can be a highly sensitive method without using the radioactive colloid. 'Minimally invasive, function-preserving and precise surgery under sentinel node navigation in community hospital' may be a goal for us.

  13. 对比传统鼻镜手术与影像导航下鼻镜手术对鼻窦骨瘤患者疗效及预后影响的差异%Comparison of the effects and prognostic differences of traditional nasal endoscopic operation and image navigation under nasal endoscopic operation on patients with sinus osteoma



    目的 探讨传统鼻镜手术与影像导航下鼻镜手术对鼻窦骨瘤患者疗效及预后影响的差异.方法 选取59例鼻窦骨瘤患者为研究对象,根据其入院就诊次序分成影像导航组(A组,n =30)和传统手术组(B组,n =29).A组予以传统鼻镜手术方案,B组在影像导航下行鼻镜手术.比对两组患者术程、术中出血量、总住院时间等治疗指标的差异,行为期2年的随访,记录其复发及并发症发生情况.结果 ①两组患者术中出血量及术后住院时间等指标比较差异未见统计学意义(P>0.05);A组手术时间为(81.5±7.0) min,长于B组[(61.9±6.2) min],差异有统计学意义(P<0.05);②在为期2年的随访中,A组无复发病例,B组额窦复发2例,筛窦复发4例,复发率为20.7%,两组比较差异有统计学意义(P<0.05);A组术后相关并发症发生率为10.0%,与B组的41.4%比较差异有统计学意义(P<0.05).结论 对鼻窦骨瘤患者予以影像导航下鼻镜手术疗效确切,值得临床推广.%Objective To investigate the effect and prognostic differences of traditional nasal endoscopic operation and image navigation under nasal endoscopic operation on patients with sinus osteoma.Methods Fifty-nine cases with nasal sinus osteoma patients as the research object, according to the hospital admission sequence were divided into image navigation group(group A, n =30) and conventional operation group(group B, n =29).Group A was treated by traditional nasal endoscopic operation scheme, group B was treated by nasal endoscopic operation image navigation.The differences of bleeding volume at preoperative, intraoperative, the length of hospital stay and other indexed of patients in two groups were compared, followed-up for 2 years, recorded its recurrence and complications.Results ① The difference of amount of bleeding at intraoperative and hospital time after surgery and other indicators of two groups had no significant difference (P >0

  14. Comparison between magnesium sulfate and dexmedetomidine in controlled hypotension during functional endoscopic sinus surgery

    Adnan Bayram; Ayse Ülgey; Isin Günes; Ibrahim Ketenci; Ayse Çapar; Aliye Esmaoglu; Adem Boyaci


    BACKGROUND AND OBJECTIVES: It is crucial to decrease bleeding during functional endoscopic sinus surgery. Our primary goal was to investigate the effects of magnesium sulfate and dexmedetomidine used for controlled hypotension on the visibility of the surgical site. METHODS: 60 patients aged between 18 and 65 years were enrolled. In the magnesium sulfate ...

  15. Elective surgery after successful endoscopic decompression of sigmoid volvulus may be considered

    Hougaard, Helene Tarri; Qvist, Niels


    Volvulus is an axial twist of any part of the gastrointestinal tract along its mesentery. If it goes unattended, it will cause bowel obstruction and bowel ischaemia with gangrene and perforation. The primary treatment is endoscopic desufflation, but the place for elective surgery is controversial....... Volvulus is a rare condition in Western Europe and North America that most often affects elderly of either gender....

  16. Safe implementation of retroauricular robotic and endoscopic neck surgery in South America.

    Lira, Renan Bezerra; Chulam, Thiago Celestino; Kowalski, Luiz Paulo


    In the last three decades, otolaryngology and head and neck oncological surgery have shown remarkable progress with the development of several modalities of endoscopic-assisted minimally invasive surgeries. More recently, the Da Vinci robotic surgery system has promoted the development of several surgical approaches with less morbidity and better cosmetic results, including the transaxillary and retroauricular approaches for thyroid surgery and neck dissections. In South America, there are several shortcomings regarding financial resources as well as the lack of support for innovation leading to a significant delay in adoption of numerous technological advances in medical practice. Despite these obstacles, we obtained training in transoral robotic surgery and neck procedures, and then decided to implement neck endoscopic and robotic surgery at our institution. We developed a collaborative training program with Yonsei University that, together with several local measures, allowed for a safe implementation. From June 2014 to December 2016, we have performed a total of 121 retroauricular neck surgeries, of which 65 were robotic-assisted and 56 were endoscopic assisted procedures, with a complication rate that seems to be comparable to conventional procedures in our experience and a smooth learning curve. Safety compliance has been continuously assessed. Aiming to develop and disseminate these techniques, we have ongoing collaborative work with Yonsei University faculty, to continue increasing our clinical experience, and we are now preparing the group and infrastructure to establish a local training program for South American surgeons. We have been presenting our results at national and international medical meetings and started to publish the preliminary results in peer reviewed medical journals. The emphasis is that a retroauricular approach is a therapeutic option to be considered, especially for young patients. Media exposure has been avoided so far. As expected

  17. Comparison of Clonidine and Midazolam Premedication Before Endoscopic Sinus Surgery: Results of Clinical Trial

    Wawrzyniak, Katarzyna; Kusza, Krzysztof; Cywinski, Jacek B.


    Objectives Premedication with clonidine has been found to reduce the bleeding during endoscopic sinus surgery (ESS), therefore lowering the risk of surgical complications. Premedication is an essential part of pre-surgical care and can potentially affect magnitude of systemic stress response to a surgical procedure. The aim of this study was to compare the efficacy of premedication with clonidine and midazolam in patients undergoing sinus surgery. Methods Forty-four patients undergoing ESS fo...

  18. Technical skill set training in natural orifice transluminal endoscopic surgery: how should we approach it?

    Nugent, Emmeline


    The boundaries in minimally invasive techniques are continually being pushed further. Recent years have brought new and exciting changes with the advent of natural orifice transluminal endoscopic surgery. With the evolution of this field of surgery come challenges in the development of new instruments and the actual steps of the procedure. Included in these challenges is the idea of developing a proficiency-based curriculum for training.

  19. Risk factors for postoperative cerebrospinal fluid leak and meningitis after expanded endoscopic endonasal surgery.

    Ivan, Michael E; Iorgulescu, J Bryan; El-Sayed, Ivan; McDermott, Michael W; Parsa, Andrew T; Pletcher, Steven D; Jahangiri, Arman; Wagner, Jeffrey; Aghi, Manish K


    Postoperative cerebrospinal fluid (CSF) leak is a serious complication of transsphenoidal surgery, which can lead to meningitis and often requires reparative surgery. We sought to identify preoperative risk factors for CSF leaks and meningitis. We reviewed 98 consecutive expanded endoscopic endonasal surgeries performed from 2008-2012 and analyzed preoperative comorbidities, intraoperative techniques, and postoperative care. Univariate and multivariate analyses were performed. The most common pathologies addressed included pituitary adenoma, Rathke cyst, chordoma, esthesioneuroblastoma, meningioma, nasopharyngeal carcinoma, and squamous cell carcinoma. There were 11 CSF leaks (11%) and 10 central nervous system (CNS) infections (10%). Univariate and multivariate analysis of preoperative risk factors showed that patients with non-ideal body mass index (BMI) were associated with higher rate of postoperative CSF leak and meningitis (both p<0.01). Also, patients with increasing age were associated with increased CSF leak (p = 0.03) and the length of time a lumbar drain was used postoperatively was associated with infection in a univariate analysis. In addition, three of three endoscopic transsphenoidal surgeries combined with open cranial surgery had a postoperative CSF leak and CNS infection rate which was a considerably higher rate than for transsphenoidal surgeries alone or surgeries staged with open cases (p<0.01 and p=0.04, respectively) In this series of expanded endoscopic transsphenoidal surgeries, preoperative BMI remains the most important preoperative predictor for CSF leak and infection. Other risk factors include age, intraoperative CSF leak, lumbar drain duration, and cranial combined cases. Risks associated with complex surgical resections when combining open and endoscopic approaches could be minimized by staging these procedures.

  20. Comparison between nasal endoscopic suction cutter treatment of adenoidal hypertrophy and blind adenoid scraping by spatula

    Hong-Xia Zhang; Zhu-Lin Chen; Duo-Xi Mao; Jing Liu


    Objective:To analyze the wound degree during suction cutter treatment of adenoidal hypertrophy and its effect on postoperative ventilation function.Methods: A total of 112 patients with adenoidal hypertrophy were randomly divided into observation group and control group (n=56), control group received blind adenoid scraping by spatula, observation group received suction cutter treatment, and then differences in serum levels of inflammatory cytokines and apoptosis factors as well as nasal ventilation function and lung function indexes were compared between two groups of patients after treatment.Results:Inflammatory cytokines IL-4, IL-6, TNF-α, ECP and ICAM-1 content in serum of observation group 2d after treatment were lower than those of control group, and apoptotic factors survivin, caspase-3, sFas and sFasL content in serum were lower than those of control group (P<0.05); nasal ventilation function parameters TIR, TER, NPRi and NPRe levels of observation group 1 week after treatment were lower than those of control group while IC and EC levels were higher than those of control group, and pulmonary function parameters VT, MV, PIEF, FEF25%, FEF50% and FEF75% levels were higher than those of control group (P<0.05). Conclusions:Suction cutter treatment of adenoid hypertrophy outstandingly improves the patients’ ventilation function, and also has the advantage of small wound.

  1. A Panoramic Wireless Endoscope System Design for the Application of Minimally Invasive Surgery

    Chun-Hsiang Peng


    Full Text Available Minimally Invasive Surgery (MIS is the current trend in surgery. Compared to traditional surgery, MIS can substantially decrease recovery time and expenses needed by patients after surgeries, reduce pain during surgical procedures, and is highly regarded by physicians and patients. An endoscope is widely used in the diagnosis and treatments of various medical disciplines, such as hysteroscopy, laparoscopy, and colonoscopy, and have been adopted by many branches of medicine. However, the limited image field of MIS is often the most difficult obstacles faced by surgeons and medical students, especially to less experienced physicians and difficult surgical procedures; the limited field of view of endoscopic imaging does not provide a whole picture of the surgery area, making the procedures difficult and full of uncertainty. In light of this problem, we proposed a "Panoramic Wireless Endoscope System design", hoping to provide physicians with a wide field of view of the endoscopic image. We combine images captured from two parallel-mounted endoscope lenses into a single, wide-angle image, giving physicians a wider field of view and easier access to the surgical area. In addition, we developed a wireless transmission system so the image can be transmitted to various display platforms, eliminating the needs for excessive cabling on surgical tools and enable physicians to better operate on the patient. Finally, our system allows surgical assistants a better view of the operation process, and enables other physicians and nurses to remotely observe the process. Our experiment results have shown that we can increase the image to 152% of its original size. We used the PandaBoard ES platform with an ARM9 processor and 1G of onboard RAM, and continuously implementing animal trials to verify the reliability of our system.

  2. 鼻内镜下双极电凝治疗顽固性鼻出血96例临床分析%An analysis of treatment effect on 96 patients with stubborn epistaxis under nasal endoscopic surgery by bipolar-electrocoagulation

    谢成彬; 周维; 唐凤翔


    Objective To investigate the treatment effect of stubborn epistaxis under nasal endoscopy by bipolar-electrocoagulation. Methods Ninety-six patients with stubborn epistaxis were treated under nasal endoscopy by bipolar-electrocoagulation. Results All patients were treated successfully and cured in 6 months to 2 years follow-up. Conclusion The advantages of management in stubborn epistaxis under nasal endoscopy by bipolar-electrocoagulation were field clear,correctly to find the site of bleeding and easy for treatment of bleeding.%目的 探讨鼻内镜下双极电凝治疗顽固性鼻出血的临床效果.方法 对96例顽固性鼻出血患者在鼻内镜下行双极电凝治疗.结果 全部病例均经一次止血治疗成功,随访6个月至2年疗效满意,无复发者.结论 鼻内镜下双极电凝用于治疗鼻出血具有视野清楚、准确定位出血部位、止血迅速、疗效确切等优点,在治疗顽固性鼻出血中有推广应用价值.

  3. Modifications of transaxillary approach in endoscopic da Vinci-assisted thyroid and parathyroid gland surgery.

    Al Kadah, Basel; Piccoli, Micaela; Mullineris, Barbara; Colli, Giovanni; Janssen, Martin; Siemer, Stephan; Schick, Bernhard


    Endoscopic surgery for treatment of thyroid and parathyroid pathologies is increasingly gaining attention. The da Vinci system has already been widely used in different fields of medicine and quite recently in thyroid and parathyroid surgery. Herein, we report about modifications of the transaxillary approach in endoscopic surgery of thyroid and parathyroid gland pathologies using the da Vinci system. 16 patients suffering from struma nodosa in 14 cases and parathyroid adenomas in two cases were treated using the da Vinci system at the ENT Department of Homburg/Saar University and in cooperation with the Department of General Surgery in New Sant'Agostino Hospital, Modena/Italy. Two different retractors, endoscopic preparation of the access and three different incision modalities were used. The endoscopic preparation of the access allowed us to have a better view during preparation and reduced surgical time compared to the use of a headlamp. To introduce the da Vinci instruments at the end of the access preparation, the skin incisions were over the axilla with one incision in eight patients, two incisions in four patients and three incisions in a further four patients. The two and three skin incisions modality allowed introduction of the da Vinci instruments without arm conflicts. The use of a new retractor (Modena retractor) compared to a self-developed retractor made it easier during the endoscopic preparation of the access and the reposition of the retractor. The scar was hidden in the axilla and independent of the incisions selected, the cosmetic findings were judged by the patients to be excellent. The neurovascular structures such as inferior laryngeal nerve, superior laryngeal nerve and vessels, as well as the different pathologies, were clearly 3D visualized in all 16 cases. No paralysis of the vocal cord was observed. All patients had a benign pathology in their histological examination. The endoscopic surgery of the thyroid and parathyroid gland can be

  4. Image-guided endoscopic spine surgery: Part I. A feasibility study.

    Assaker, R; Cinquin, P; Cotten, A; Lejeune, J P


    A feasibility study was performed to determine the efficacy of computer assistance in endoscopic spine surgery. To assess a new method for computer assistance based on image guidance during thoracoscopic or any endoscopic spine procedure. To evaluate the reproducibility, the sensitivity and the reliability of the technique first in vitro and second in clinical use. The computer-based, image-guided surgery is now a routine tool used in open spine surgery. Exposure of the anatomy of the vertebra is needed for registration. This methodology is inapplicable in endoscopic approach. Fluoroscopic-based navigation combines the technology of image-guided surgery and C-arm fluoroscopy. The navigation is based on the fluoroscopic images acquired before surgery. This technology is applicable to endoscopic surgery but the navigation is based on fluoroscopic image. The computed tomography images are not exploited. There are no published data on a technique that allows image-guided surgery based on computed tomography and magnetic resonance imaging. A laboratory study was performed on a thoracic human spine. One vertebra was marked on the right lateral side of the body with five titanium marks. A percutaneous reference frame was specifically designed to be placed in the pedicle of the same marked vertebrae. The reference frame acted as a 3D localizer and a registration tool. The spine model was scanned including the reference frame. A standard Stealth station treatment guidance platform (Medtronic, Sofamor Danek, Memphis, TN) was used for simulation. The registration was obtained using the reference frame. Twenty navigation procedure trials were done and the error was recorded based on the distance between the anatomical point and the corresponding virtual one. Registration was always possible using the stealth station and a standard spine navigational software (spine 3, Medtronic Sofamor Danek, Memphis, TN). The mean error after registration given by the computer was 0.96 mm

  5. Cost-effectiveness of endoscopic sphenopalatine artery ligation versus nasal packing as first-line treatment for posterior epistaxis.

    Dedhia, Raj C; Desai, Shamit S; Smith, Kenneth J; Lee, Stella; Schaitkin, Barry M; Snyderman, Carl H; Wang, Eric W


    The advent of endoscopic sphenopalatine artery ligation (ESPAL) for the control of posterior epistaxis provides an effective, low-morbidity treatment option. In the current practice algorithm, ESPAL is pursued after failure of posterior packing. Given the morbidity and limited effectiveness of posterior packing, we sought to determine the cost-effectiveness of first-line ESPAL compared to the current practice model. A standard decision analysis model was constructed comparing first-line ESPAL and current practice algorithms. A literature search was performed to determine event probabilities and published Medicare data largely provided cost parameters. The primary outcomes were cost of treatment and resolution of epistaxis. One-way sensitivity analysis was performed for key parameters. Costs for the first-line ESPAL arm and the current practice arm were $6450 and $8246, respectively. One-way sensitivity analyses were performed for key variables including duration of packing. The baseline difference of $1796 in favor of the first-line ESPAL arm was increased to $6263 when the duration of nasal packing was increased from 3 to 5 days. Current practice was favored (cost savings of $437 per patient) if posterior packing duration was decreased from 3 to 2 days. This study demonstrates that ESPAL is cost-saving as first-line therapy for posterior epistaxis. Given the improved effectiveness and patient comfort of ESPAL compared to posterior packing, ESPAL should be offered as an initial treatment option for medically stable patients with posterior epistaxis. © 2013 ARS-AAOA, LLC.

  6. Leiomioma vascular nasal gigante Informe de un caso y su manejo endoscópico transnasal. Revisión de la literatura.

    Willfred Burkhardt


    Full Text Available An intranasal vascular leiomyoma is extremely rare. Less than 1% of all leiomyomas originate in the head and neck area, and of these, only 3% are found in the nasal cavity. The most common symptoms are nasal obstruction, epistaxis and pain. A rare case of nasal vascular leiomyoma that developed in a 35 year old woman is reported. Transnasal endoscopic sinus surgery to perform a resection on the biggest nasal vascular leiomyoma ever found was made.

  7. Minimally Invasive Cardiac Surgery Using a 3D High-Definition Endoscopic System.

    Ruttkay, Tamas; Götte, Julia; Walle, Ulrike; Doll, Nicolas


    We describe a minimally invasive heart surgery application of the EinsteinVision 2.0 3D high-definition endoscopic system (Aesculap AG, Tuttlingen, Germany) in an 81-year-old man with severe tricuspid valve insufficiency. Fourteen years ago, he underwent a Ross procedure followed by a DDD pacemaker implantation 4 years later for tachy-brady-syndrome. His biventricular function was normal. We recommended minimally invasive tricuspid valve repair. The application of the aformentioned endoscopic system was simple, and the impressive 3D depth view offered an easy and precise manipulation through a minimal thoracotomy incision, avoiding the need for a rib spreading retractor.

  8. High-definition fiber tracking guidance for intraparenchymal endoscopic port surgery.

    Fernandez-Miranda, Juan C; Engh, Johnathan A; Pathak, Sudhir K; Madhok, Ricky; Boada, Fernando E; Schneider, Walter; Kassam, Amin B


    The authors have applied high-definition fiber tracking (HDFT) to the resection of an intraparenchymal dermoid cyst by using a minimally invasive endoscopic port. The lesion was located within the mesial frontal lobe, septal area, hypothalamus, and suprasellar recess. Using high-dimensional (256 directions) diffusion imaging, more than 250,000 fiber tracts were imaged before and after surgery. Trajectory planning using HDFT in a computer model was used to facilitate cannulation of the cyst with the endoscopic port. Analysis of the proposed initial surgical route was overlaid onto the fiber tracts and was predicted to produce substantial disruption to prefrontal projection fibers (anterior limb of the internal capsule) and the cingulum. Adjustment of the cannulation entry point 1 cm medially was predicted to cross the corpus callosum instead of the anterior limb of the internal capsule or the cingulum. Following cyst resection performed using endoscopic port surgery, postoperative imaging demonstrated accurate cannulation of the lesion, with improved quantitative signal from both the anterior limb of the internal capsule and the cingulum. The observed fiber preservation from the cingulum and the anterior limb of the internal capsule, with minor injury to the corpus callosum, was in close agreement with preoperative trajectory modeling. Comparison of pre- and postoperative HDFT data facilitated quantification of the benefits and costs of the surgical trajectory. Future studies will help to determine whether HDFT combined with endoscopic port surgery facilitates anatomical and functional preservation in such challenging cases.

  9. Fatal antiphospholipid syndrome following endoscopic transnasal-transsphenoidal surgery for a pituitary tumor

    Li, Chiao-Zhu; Li, Chiao-Ching; Hsieh, Chih-Chuan; Lin, Meng-Chi; Hueng, Dueng-Yuan; Liu, Feng-Chen; Chen, Yuan-Hao


    Abstract Introduction: The fatal type of antiphospholipid syndrome is a rare but life-threating condition. It may be triggered by surgery or infection. Endoscopic transnasal-transsphenoidal surgery is a common procedure for pituitary tumor. We report a catastrophic case of a young woman died of fatal antiphospholipid syndrome following endoscopic transnasal-transsphenoidal surgery. Methods and Result: A 31-year-old woman of a history of stroke received endoscopic transnasal-transsphenoidal surgery for a pituitary tumor. The whole procedure was smooth. However, the patient suffered from acute delirium on postoperative day 4. Then, her consciousness became comatose state rapidly with dilatation of pupils. Urgent magnetic resonance imaging of brain demonstrated multiple acute lacunar infarcts. The positive antiphosphoipid antibody and severe thrombocytopenia were also noted. Fatal antiphospholipid syndrome was diagnosed. Plasma exchange, corticosteroids, anticoagulant agent were prescribed. The hemodynamic condition was gradually stable. However, the consciousness was still in deep coma. The patient died of organ donation 2 months later. Conclusion: If patients have a history of cerebral stroke in their early life, such as a young stroke, the APS and higher risk of developing fatal APS after major surgery should be considered. The optimal management of APS remains controversial. The best treatment strategies are only early diagnosis and aggressive therapies combing of anticoagulant, corticosteroid, and plasma exchange. The intravenous immunoglobulin is prescribed for patients with refractory APS. PMID:28072724

  10. The place of subfascial endoscopic perforator vein surgery (SEPS) in advanced chronic venous insufficiency treatment.

    Pesta, Wiesław; Kurpiewski, Waldemar; Kowalczyk, Marek; Szynkarczuk, Rafał; Luba, Magdalena; Zurada, Anna; Grabysa, Radosław


    In spite of medical science development and initiation of new technologies in minimally invasive surgery, treatment of advanced chronic venous insufficiency at the 5(th) and 6(th) degree of CEAP classification is still a great clinical challenge. In case of no satisfactory results of non-surgical treatment of recurrent venous ulcers, scientists search for alternative therapeutic methods which could be more effective and lasting. Subfascial endoscopic perforator vein surgery (SEPS) as a method of reducing venous pressure in the superficial venous system could provide healing of the recurrent venous ulcer. In this study we present a review of contemporary opinions about the place and significance of subfascial endoscopic perforator vein surgery as a treatment of advanced chronic venous insufficiency.

  11. Surgically induced astigmatism after 3.0 mm temporal and nasal clear corneal incisions in bilateral cataract surgery

    Je Hwan Yoon


    Full Text Available Aims: To compare the corneal refractive changes induced after 3.0 mm temporal and nasal corneal incisions in bilateral cataract surgery. Materials and Methods: This prospective study comprised a consecutive case series of 60 eyes from 30 patients with bilateral phacoemulsification that were implanted with a 6.0 mm foldable intraocular lens through a 3.0 mm horizontal clear corneal incision (temporal in the right eyes, nasal in the left eyes. The outcome measures were surgically induced astigmatism (SIA and uncorrected visual acuity (UCVA 1 and 3 months, post-operatively. Results: At 1 month, the mean SIA was 0.81 diopter (D for the temporal incisions and 0.92 D for nasal incisions (P = 0.139. At 3 months, the mean SIA were 0.53 D for temporal incisions and 0.62 D for nasal incisions (P = 0.309. The UCVA was similar in the 2 incision groups before surgery, and at 1 and 3 months post-operatively. Conclusion: After bilateral cataract surgery using 3.0 mm temporal and nasal horizontal corneal incisions, the induced corneal astigmatic change was similar in both incision groups. Especially in Asian eyes, both temporal and nasal incisions (3.0 mm or less would be favorable for astigmatism-neutral cataract surgery.

  12. Avaliação endoscópica nasal de crianças e adolescentes com fibrose cística Nasal endoscopic evaluation of children and adolescents with cystic fibrosis

    Letícia Paiva Franco


    questionnaire, ENT physical examination, nasal endoscopy and endoscopic staging of nasal polyps. RESULTS: The most frequent symptoms were: cough (45%, oral breathing (44%, sleep disorders (42% and nasal obstruction (37%. Twenty-eight patients (28% had purulent nasal discharge, and 41% had medial bulging of the nasal lateral wall. Nasal polyps were identified in only 14% of cases, none were obstructing. CONCLUSION:The questionnaire, clinical examination and especially nasal endoscopy lead to a detailed assessment of the nasal characteristics of children and adolescents with cystic fibrosis. Some findings were discordant with the literature, particularly the low prevalence of nasal polyps, and appear to be related to specific characteristics of the population studied. The best characterization of this group of patients, from the ENT standpoint, contributes to an appropriate multidisciplinary approach.

  13. Development of a new endoscope holder for head and neck surgery--from the technical design concept to implementation.

    Kristin, Julia; Kolmer, Armin; Kraus, Peter; Geiger, Robert; Klenzner, Thomas


    Endoscope holders are utilized by a variety of surgeons but are not commonplace in head and neck surgery. The SOLOASSIST active camera holder, which is currently used for abdominal surgery, will soon be adapted for head and neck surgery in collaboration with AKTORmed GmbH SOLO SURGERY (Barbing, Germany). In our pre-feasibility study, we analyzed the use of the existing endoscope holder on anatomical specimens during head and neck surgery. Based on these results, we are proceeding towards the development of a new endoscope holder for head and neck surgery. First, we drafted the technical concepts and discussed the advantages and disadvantages of the system. Then, we used anatomic specimens to measure the forces that occur intraoperatively during sinus surgery. Next, we designed a computer-aided design (CAD) model. Finally, we developed the first production prototype and used it for a frontal skull base procedure on an anatomical specimen. We present the three most promising concepts for a new holder. The resulting total force (F res = √(X (2) + Y (2) + Z (2))) was calculated to be 3.2 N during sinus surgery. We could observe all necessary intraoperative landmarks with the endoscope and its holder in a sinus and frontal skull base surgery. We developed a production prototype of a new endoscope holder and demonstrate satisfactory results in the use of anatomic specimens for skull base surgery.

  14. Modelling of a laser-pumped light source for endoscopic surgery

    Nadeau, Valerie J.; Elson, Daniel S.; Hanna, George B.; Neil, Mark A. A.


    A white light source, based on illumination of a yellow phosphor with a fibre-coupled blue-violet diode laser, has been designed and built for use in endoscopic surgery. This narrow light probe can be integrated into a standard laparoscope or inserted into the patient separately via a needle. We present a Monte Carlo model of light scattering and phosphorescence within the phosphor/silicone matrix at the probe tip, and measurements of the colour, intensity, and uniformity of the illumination. Images obtained under illumination with this light source are also presented, demonstrating the improvement in illumination quality over existing endoscopic light sources. This new approach to endoscopic lighting has the advantages of compact design, improved ergonomics, and more uniform illumination in comparison with current technologies.

  15. The Role of OsiriX Based Virtual Endoscopy in Planning Endoscopic Transsphenoidal Surgery for Pituitary Adenoma.

    Rotariu, Daniel Ilie; Ziyad, Faiyad; Budu, Alexandru; Poeata, Ion


    Virtual endoscopy (VE) is the navigation of a 3D model reconstructed from radiological image data. The aim of this paper is to evaluate the role and accuracy of the virtual endoscopy realized using commercially available software, OsiriX, as a method of planning of surgical interventions. The computed tomographies of 22 patients with pituitary adenomas proposed for endoscopic approach were reconstructed using OsiriX. VE was performed prior to surgery to assess the surgical corridor and particular anatomy. We evaluated the following landmarks: inferior and middle turbinate, sphenoid ostia (SO), choanal arch (Ch), sphenoethmoidal recess (SER), sphenoid septa, sella turcica, carotid prominences and opticocarotid recesses (OCR). The intraoperative endoscopic images were reviewed and compared with the virtual images. The virtual images had a good resemblance with the actual surgical images. All the structures from the nasal cavity were identified and had a perfect matching except the SO which was identified in 8 cases in VE vs. 12 intraoperative. All the structures from the sphenoid sinus were identified with perfect matching except the ipsilateral carotid prominence (14 in VE vs. 10 intraoperative) and the contralateral carotid prominence (16 in VE vs. 18 intraoperative). The VE could not show the state of the sellar floor and did not offer any information about the sellar content. VE realized in OsiriX represents an affordable alternative to the specially designed systems, offering reliable data and good quality images that are useful for the preoperative planning, but some limitations are present such as inability to obtain additional information in cases where the sphenoid sinus is fully occupied by tumor or not aerated, inability to clearly differentiate between structures at the level of the sella, and impossibility to simulate working instruments.

  16. Complications of laparo-endoscopic single-site surgery in urology

    Hagop Sarkissian


    Full Text Available The objective was to give a general overview of common complications and rates reported in the current literature during performance of a variety of urologic procedures using laparo-endoscopic single-site surgery or LESS. A search of published reports using Pubmed and MEDLINE was performed with the following search terms: laparo-endoscopic single-site surgery, LESS or laparo-endoscopic single-site surgery complications within the date range of 2005--2011. Studies that were deemed appropriate and relevant to the current symposium were chosen for review. Overall complication rates were reported as ranging between 10% and 25%. In general, reconstructive procedures had consistently higher rates of complications than their extirpative/ablative counterparts (27% vs. 8%. There remain insufficient data to comment on differences in the rates or types of complications related to variations in the approach (transperitoneal vs. retroperitoneal, site of surgery (upper tract vs. lower tract or specific technique used (instruments, access devices, robotic platforms, etc.. Complication rates associated with LESS in urology appear only slightly higher than with conventional laparoscopy. However, with proper patient selection and careful application of these techniques, proofs of concept and technical feasibility have been shown in several series. There continues to be a need for more standardization of the technique and reporting as well as more collaborative efforts to fully address questions of safety and efficacy of these new procedures.

  17. Hemostasis in endoscopic endonasal skull base surgery using the Aquamantys bipolar sealer: Technical note.

    Bram, Richard; Fiore, Susan; McHugh, Daryl; Samara, Ghassan J; Davis, Raphael P


    A major challenge during endoscopic transsphenoidal surgery is adequate intraoperative hemostasis. The Aquamantys® is a relatively new bipolar sealing device which uses radiofrequency energy and saline. This promotes hemostasis while decreasing charring and thermal spread. In this paper, we describe our experience with the Aquamantys® Mini EVS 3.4 Epidural Vein Sealer Bipolar Electrocautery System (Medtronic Advanced Energy, Portsmouth, NH, USA) during endoscopic surgery for tumors of the skull base with particular attention to ergonomic benefits and technical nuances. We conducted a retrospective review of all patients undergoing endoscopic surgery for skull base tumors from September 2012 to June 2016 at our institution. All procedures used the Aquamantys® system. 45 cases were identified. Successful hemostasis was achieved in all cases with an average estimated blood loss (EBL) of 46mL (Range 10-250). There were no intraoperative complications. The single-shaft design allowed for excellent manipulation compared to pistol-grip bipolar forceps. The thermal energy provided excellent radial coverage without extensive penetration into viable pituitary tissue. To our knowledge, this is the largest series documenting the use of the Aquamantys® system in skull base surgery. The device is easily mobile and highly effective within the endonasal corridor and should be a tool in the repertoire of the endoneurosurgeon. Randomized control trials would be useful in comparing EBL between the Aquamantys® and standard bipolar electrocautery. Copyright © 2017 Elsevier Ltd. All rights reserved.

  18. Computer-assessed performance of psychomotor skills in endoscopic otolaryngology surgery: construct validity of the Dundee Endoscopic Psychomotor Otolaryngology Surgery Trainer (DEPOST).

    Ross, Peter D; Steven, Richard; Zhang, Dong; Li, Heng; Abel, Eric W


    This study was undertaken to introduce and establish the value of the Dundee Endoscopic Psychomotor Otolaryngology Surgery Trainer (DEPOST) as a customisable, objective real-time scoring system for trainee assessment. The construct validity of the system was assessed by comparing the performance of experienced otolaryngologists with that of otolaryngology trainees, junior doctors and medical students. Forty two subjects (13 Consultants, 8 senior trainees, 13 junior trainees and 8 junior doctors/medical students) completed a single test on DEPOST. The test involved using a 30° rigid endoscope and a probe with position sensor, to identify a series of lights in a complex 3-dimensional model. The system scored subjects for time, success rate, and economy of movement (distance travelled). An analysis of variance and correlation analysis were used for the data analysis, with statistical significance set at 0.05. Increasing experience led to significantly improved performance with the DEPOST (p < 0.01). Senior trainees' results were significantly better than those of consultant otolaryngologists in success rate and time (p < 0.05 & p < 0.05). Consultants were the most efficient in their movement (p = 0.051) CONCLUSIONS: The system provides an accurate and customisable assessment of endoscopic skill in otolaryngologists. The DEPOST system has construct validity, with master surgeons and senior trainees completing the tasks more accurately without sacrificing execution time, success rate or efficiency of movement.

  19. International Conference on Natural Orifice Transluminal Endoscopic Surgery (NOTES)


    scopic versus open appendectomy: prospective randomized trial. Surg Laparosc Endosc Percutan Tech 9: 187-189 35. Paik PS. Towson JA. Anthone GJ. Ortega...Maxwell4 R. Seifeldin5 1 North Oakland Medical Centers. Surgery Wayne State University United States 2 Caritas Carney Hospital. Internal Medicine...Tufts University School of Medicine United States North Oakland Medical. General Surgery Wayne State University United States 4 North Oakland

  20. Haptic Feedback in Natural Orifice Transluminal Endoscopic Surgery (NOTES)

    Do, Thanh Nho


    Flexible tendon sheath mechanism is commonly used in NOTES systems because it offers high flexibility, light weight, and easy transmission. Due to the size constraints and sterilization problems, traditional sensors like force/torque sensor are extremely difficult to place at the tool tips of surgical arms. In addition, nonlinear dynamic friction and backlash cause challenges to provide haptic feedback to the surgeons when the robotic arms are inside the patient's body. Hence, it is extremely difficult to provide the force information to haptic devices and subsequently to the surgeons. To deal with these problems, in this paper we propose a new approach of friction model in the tendon-sheath mechanism to provide the force at distal end of endoscopic system. In comparison with current approaches in the literature, the proposed model is able to provide force information at zero velocity and it is smooth. In addition, the model is independent configuration and able to capture friction force with any complex shea...

  1. Laparoscopic endoscopic cooperative surgery as a minimally invasive treatment for gastric submucosal tumor

    Tsutomu; Namikawa; Kazuhiro; Hanazaki


    Laparoscopic wedge resection is a useful procedure fortreating patients with submucosal tumor(SMT) including gastrointestinal stromal tumor(GIST) of the stomach. However, resection of intragastric-type SMTs can be problematic due to the difficulty in accurately judging the location of endoluminal tumor growth, and often excessive amounts of healthy mucosa are removed; thus, full-thickness local excision using laparoscopic and endoscopic cooperative surgery(LECS) is a promising procedure for these cases. Our experience with LECS has confirmed this procedure to be a safe, feasible, and minimally invasive treatment method for gastric GISTs less than 5 cm in diameter, with outcomes similar to conventional laparoscopic wedge resection. The important advantage of LECS is the reduction in the resected area of the gastric wall compared to that in conventional laparoscopic wedge resection using a linear stapler. Early gastric cancer fits the criteria for endoscopic resection; however, if performing endoscopic submucosal dissection is difficult, the LECS procedure might be a good alternative. In the future, LECS is also likely to be indicated for duodenal tumors, as well as gastric tumors. Furthermore, developments in endoscopic and laparoscopic technology have generated various modified LECS techniques, leading to even less invasive surgery.

  2. Development of preoperative planning software for transforaminal endoscopic surgery and the guidance for clinical applications.

    Chen, Xiaojun; Cheng, Jun; Gu, Xin; Sun, Yi; Politis, Constantinus


    Preoperative planning is of great importance for transforaminal endoscopic techniques applied in percutaneous endoscopic lumbar discectomy. In this study, a modular preoperative planning software for transforaminal endoscopic surgery was developed and demonstrated. The path searching method is based on collision detection, and the oriented bounding box was constructed for the anatomical models. Then, image reformatting algorithms were developed for multiplanar reconstruction which provides detailed anatomical information surrounding the virtual planned path. Finally, multithread technique was implemented to realize the steady-state condition of the software. A preoperative planning software for transforaminal endoscopic surgery (TE-Guider) was developed; seven cases of patients with symptomatic lumbar disc herniations were planned preoperatively using TE-Guider. The distances to the midlines and the direction of the optimal paths were exported, and each result was in line with the empirical value. TE-Guider provides an efficient and cost-effective way to search the ideal path and entry point for the puncture. However, more clinical cases will be conducted to demonstrate its feasibility and reliability.

  3. Small neuroendocrine tumor of the duodenal bulb: Endoscopic submucosal dissection, laparoscopic and endoscopic cooperative surgery or surgery?

    Nikolaos V Chrysanthos


    Full Text Available Neuroendocrine neoplasms of the gastric tube are less common than adenocarcinomas. Topography includes stomach, small intestine, Vater ampulla, and gross intestine. They are graded as neuroendocrine tumors grade I and II (NETs GI and GII and neuroendocrine carcinomas GIII based on Ki-67 index and mitotic count. [1] Endoscopic treatment for GI NETs ≤1 cm that does not extend beyond the submucosal layer and does not demonstrate lymph node metastasis is recommended. Tumors ≥2 cm, with lymph node metastasis, are indicated for surgical treatment. The treatment strategy for tumors between 10 and 20 mm in size remains controversial. [2] We present a rare case of a 60-year-old male patient with end-stage renal failure who underwent a screening pretransplantation endoscopic control. Colonoscopy had no pathological findings. Gastroscopy reveals an abnormal mucosa in the anterior upper part of the duodenal bulb that was described as a micronodular mucosa and a central nodule of 6 mm with erythematous mucosa. Histology of the micronodular mucosa reveals a heterotopic gastric mucosa and a small hyperplastic polyp. Biopsies from the nodule reveal a carcinoid tumor (NET GI. Immunohistochemistry: Positive chromogranin levels, low mitotic index (1/10 HPF, and Ki-67 index 2 cm and those of the duodenal bulb with histological extensions and the lack of assessing depth invasion.

  4. Motion Compensation of Tendon-Sheath Driven Continuum Manipulator for Endoscopic Surgery

    Lau K. C.


    Full Text Available Tendon-sheath actuation mechanism is widely used in surgical robot, especially in endoscopic surgery, due to its capable of providing remote force and action transmission through long and flexible channel. However, hysteresis, backlash, nonlinear friction are the drawbacks of this mechanism. Our surgical robot use continuum manipulator which is useful in endoscopic surgery, due to its flexible and simple structure. Unlike other literatures that focus on tendon-sheath compensation only, the continuum manipulator is also taken into application level analysis. A model based feedforward motion compensation for tendon-sheath driven continuum manipulator is presented. The model is validated by using optical tracking system to trace the distal end position. Experiment result shows that the proposed model reduces the position error less than 5%.

  5. Presidential address. Endoscopic surgery, cost effectiveness, and the quality of life.

    Hasson, H M


    One measure of mitigating escalating costs of health care is to create an economic market-based system that connects value to cost. Cost-effectiveness analysis compares treatments that produce different benefits and require different costs, and ranks them by the amount of net treatment benefit divided by cost. Evaluation of the impact of illness and treatment on the medical condition, quality of life, and productivity of individual patients is essential for capturing all dimensions of treatment outcome. When performed by efficient teams, laparoscopic surgery compared with conventional open surgery, adds value through reduced operative morbidity, earlier returns to work, and improved quality of life. These advantages have to be confirmed by cost-effectiveness analysis, however. Endoscopic surgery will be consistently more cost effective than conventional surgery only when performed by a dedicated team of surgeons, nurses, and technicians. The need for a specialized team arises from the fact that endoscopic surgery requires different skills, including the ability to develop a two-dimensional concept for tissue manipulation, perform major surgery through small incisions using a different type of hand-eye coordination, and operate and maintain highly sophisticated and sensitive equipment and instrumentation. Reusable instruments will contribute to lower costs.

  6. Effect of pubic bone marrow edema on recovery from endoscopic surgery for athletic pubalgia.

    Kuikka, L; Hermunen, H; Paajanen, H


    Athletic pubalgia (sportsman's hernia) is often repaired by surgery. The presence of pubic bone marrow edema (BME) in magnetic resonance imaging (MRI) may effect on the outcome of surgery. Surgical treatment of 30 patients with athletic pubalgia was performed by placement of totally extraperitoneal endoscopic mesh behind the painful groin area. The presence of pre-operative BME was graded from 0 to 3 using MRI and correlated to post-operative pain scores and recovery to sports activity 2 years after operation. The operated athletes participated in our previous prospective randomized study. The athletes with (n = 21) or without (n = 9) pubic BME had similar patients' characteristics and pain scores before surgery. Periostic and intraosseous edema at symphysis pubis was related to increase of post-operative pain scores only at 3 months after surgery (P = 0.03) but not to long-term recovery. Two years after surgery, three athletes in the BME group and three in the normal MRI group needed occasionally pain medication for chronic groin pain, and 87% were playing at the same level as before surgery. This study indicates that the presence of pubic BME had no remarkable long-term effect on recovery from endoscopic surgical treatment of athletic pubalgia.

  7. Short-term outcome of endoscopic versus microscopic pituitary adenoma surgery: a systematic review and meta-analysis.

    Ammirati, Mario; Wei, Lai; Ciric, Ivan


    Endoscopic transsphenoidal pituitary surgery has become increasingly more popular for the removal of pituitary adenomas. It is also widely recognised that transsphenoidal microscopic removal of pituitary adenomas is a well-established procedure with good outcomes. Our objective was to meta-analyse the short-term results of endoscopic and microscopic pituitary adenoma surgery. We undertook a systematic review of the English literature on results of transsphenoidal surgery, both microscopic and endoscopic from 1990 to 2011. Series with less than 10 patients were excluded. Pooled data were analysed using meta-analysis techniques to obtain estimate of death, complication rates and extent of tumour removal. Complications evaluated included cerebrospinal fluid leak, meningitis, vascular complications, visual complications, diabetes insipidus, hypopituitarism and cranial nerve injury. Data were also analysed for tumour size and sex. 38 studies met the inclusion criteria yielding 24 endoscopic and 22 microscopic datasets (eight studies included both endoscopic and microscopic series). Meta-analysis of the available literature showed that the endoscopic transsphenoidal technique was associated with a higher incidence of vascular complications (pmicroscopic technique and the incidence of reported vascular complications was higher with endoscopic than with microscopic removal of pituitary adenomas. While we recognise the limitations of meta-analysis, our study suggests that a multicentre, randomised, comparative effectiveness study of the microscopic and endoscopic transsphenoidal techniques may be a reasonable approach towards establishing a true valuation of these techniques.


    ZORRON, Ricardo; GALVÃO-NETO, Manoel Passos; CAMPOS, Josemberg; BRANCO, Alcides José; SAMPAIO, José; JUNGHANS, Tido; BOTHE, Claudia; BENZING, Christian; KRENZIEN, Felix


    ABSTRACT Background: Roux-en-Y gastric bypass (RYGB) is a standard therapy in bariatric surgery. Sleeve gastrectomy and gastric banding, although with good results in the literature, are showing higher rates of treatment failure to reduce obesity-associated morbidity and body weight. Other problems after bariatric may occur, as band erosion, gastroesophageal reflux disease and might be refractory to medication. Therefore, a laparoscopic conversion to a RYGB can be an effective alternative, as long as specific indications for revision are fulfilled. Objective: The objective of this study was to analyse own and literature data on revisional bariatric procedures to evaluate best alternatives to current practice. Methods: Institutional experience and systematic review from the literature on revisional bariatric surgery. Results: Endoscopic procedures are recently applied to ameliorate failure and complications of bariatric procedures. Therapy failure following RYGB occurs in up to 20%. Transoral outlet reduction is currently an alternative method to reduce the gastrojejunal anastomosis. The diameter and volume of sleeve gastrectomy can enlarge as well, which can be reduced by endoscopic full-thickness sutures longitudinally. Dumping syndrome and severe hypoglycemic episodes (neuroglycopenia) can be present in patients following RYGB. The hypoglycemic episodes have to be evaluated and usually can be treated conventionally. To avoid partial pancreatectomy or conversion to normal anatomy, a new laparoscopic approach with remnant gastric resection and jejunal interposition can be applied in non-responders alternatively. Hypoglycemic episodes are ameliorated while weight loss is sustained. Conclusion: Revisional and endoscopic procedures following bariatric surgery in patients with collateral symptomatic or treatment failure can be applied. Conventional non-surgical approaches should have been applied intensively before a revisional surgery will be indicated. Former complex

  9. Current developments in natural orifices transluminal endoscopic surgery:An evidence-based review

    Anthony; Yuen; Bun; Teoh; Philip; Wai; Yan; Chiu; Enders; Kwok; Wai; Ng


    Tremendous advances have been made in recent years addressing the key obstacles to safe performance and introduction of human natural orifice transluminal endoscopic surgery (NOTES). Animal studies have focused on identifying optimal solutions to these obstacles, in particular methods of creating transluminal access,safe closure of the point of access, and development of a multitasking platform with dedicated instruments. Whether the performance data generated from these animal studies can be reproduced in ...

  10. [The advantages of the short intensive training course in endoscopic surgery].

    Fedorov, A V; Khripun, A I; Ivanov, A A; Gushchin, A V; Tariverdiev, M L; Sazhin, A V


    The advantages of one-day training courses on the example of the short intensive course "manual suture in endoscopic surgery" are represented. The programme consists of the short 8-hours course, including theoretic lectures, practice seminars, virtual trainings and the trainee's self work under the control of the experienced supervisors. The preliminary assessment of the course, performed with the use of questionnaires and testing in small groups, showed it's unarguable efficacy for surgeons.

  11. The effects of inhaled anesthetics on nasal mucosal blood flow and surgical field in endoscopic sinus surgery%七氟烷和异氟烷对鼻内镜手术鼻黏膜血流及术野影响的比较

    宋晓红; 李天佐; 丁斌; 王彦; 李小葵; 周兵


    目的 研究七氟烷及异氟烷对血流动力学、鼻腔黏膜微循环血流及术野清晰度的影响.方法 ASA Ⅰ~Ⅱ级择期ESS手术30例,随机分为:七氟烷组(S组,15例)以氧化亚氮-氧-七氟烷维持麻醉;异氟烷组(Ⅰ组,15例)氧化亚氮-氧-异氟烷维持麻醉.两组均将BIS控制在40~50.监测记录术中平均动脉压、心率、诱导前及麻醉平稳后下鼻甲和鼻中隔黏膜血流,监测指标包括:灌注量(PU)、运动的血细胞浓度(CMBC)、血细胞平均运动速率(V).术中出血较多时以盐酸乌拉地尔控制性降压.术野清晰度评估采用5分法,由术者在手术结柬后即刻评估.结果 异氟烷在降低平均动脉压(MAP)的同时增加心率(HR)(P<0.05);S组麻醉时MAP降低,HR降低(P<0.05),鼻黏膜血流的PU值和V值降低(P<0.05);平均术野清晰度评分S组为2.33分低于Ⅰ组的2.8分(P<0.05).结论 与异氟烷相比,七氟烷更适于鼻内镜手术的麻醉.%Objective To compare the effects inhaled sevoflurane or isoflurane on nasal mucosal blood flow and visibility of surgical field. Method Thirty Ⅰ~Ⅱ ASA cases undertaking ESS were randomly divided into two groups.Group S (n=15, sevoflurane inhalation ), Group I(n=15, isoflurane inhalation). The BIS of the patient was 40~50 during the anesthesia. Invasive blood pressure was measured by dorsalis pedis artery catheterization and HR was recorded.The Laser-Doppler Flowmetry (LDF) was used to measure the mucosal blood flow (PU, CMBC, V) on inferior turbinate and nasal septum before and after anesthesia. Urapidil was applied to control blood pressure when necessary during the operation. The visibility of surgical field was assessed by the same surgeon immediately after the operation. Results In group S, the MAP, HR, PU and V were reduced after anesthesia. In group I, the MAP after anesthesia was decreased but the HR was increased (P < 0.05), PU and V in group I were not significantly changed before and after

  12. Use of equine pericardium sheet (LYOMESH®) as dura mater substitute in endoscopic endonasal transsphenoidal surgery

    Cavallo, Luigi M.; Solari, Domenico; Somma, Teresa; Di Somma, Alberto; Chiaramonte, Carmela; Cappabianca, Paolo

    Objective The aim of this study was to describe the use of equine pericardium sheet (Lyomesh ® ) as dural substitute for sellar reconstruction after endoscopic endonasal transsphenoidal surgery for the removal of pituitary adenomas. Methods We reviewed data of patients that underwent surgery by means of an endoscopic endonasal transsphenoidal approach for the removal of pituitary adenomas over a 12-months period, starting in May 2012, i.e. when we adopted Lyomesh ® (Audio Technologies, Piacenza, Italy) an equine pericardium sheet, as dura mater substitute. Results: During the 12-months period evaluated, we performed an endoscopic endonasal transsphenoidal operation for a variety of pituitary lesions on 102 consecutive patients. Among these, in 12 patients (9.4%) harboring a pituitary adenoma, the implant of the pericardium sheet was used. Four patients (33.3%) presented a small intraoperative cerebrospinal fluid (CSF) leak; in these cases the Lyomesh ® was placed intradurally with fibrin glue and, thereafter, several layers were positioned in extradural space. In 8 other subjects without any evidence of CSF leak, the dural substitute was placed intradurally and fibrin glue was injected intradurally to hold the material in place. Conclusions: Even if based on a relatively small patient series, our experience demonstrated that the use of equine pericardium sheet (Lyomesh ® ) as dura mater substitute in transsphenoidal surgery is safe and biocompatible, as compared with other dural substitutes. PMID:24251248

  13. Can use of a cold light source in endoscopic middle ear surgery cause sensorineural hearing loss?

    Suat Terzi


    Full Text Available Objectives: To investigate possible sensorineural hearing loss created by the use of a cold light source in patients undergoing endoscopic tympanoplasty surgery. Materials and Methods: The medical records of 203 patients, who underwent endoscopic Type 1 tympanoplasty surgery in our ear, nose, and throat clinic between 2012 and 2015, were checked retrospectively. Ninety-one patients were male and 112 were female, and their mean age was 34.4 ± 11.2 years. Results of audiometric measurements performed during the preoperative period and repeated 1 and 3 months postsurgery were compared to each other. Results: The mean duration of the operations was determined to be 52.4 ± 9.1 min. In addition, average preoperative bone-conduction was 11.4 ± 7.4 dB nHL. However, it was 9.57 ± 7.1 dB nHL and 9.51 ± 7.4 dB nHL, respectively, in the 1st and 3rd postoperative months. Levels of postoperative average bone-conduction at the 1st and 3rd month, as well as the thresholds of bone-conduction at 500, 1000, and 2000 Hz, were significantly lower than the preoperative results (P 0.05. Conclusion: Based on our findings, the increased heat generated by the use of a cold light source during an endoscopic tympanoplasty surgery is unlikely to cause the development of sensorineural hearing loss.

  14. Endoscopic Versus Microscopic Transsphenoidal Surgery in the Treatment of Pituitary Adenoma: A Systematic Review and Meta-Analysis.

    Li, Aijun; Liu, Weisheng; Cao, Peicheng; Zheng, Yuehua; Bu, Zhenfu; Zhou, Tao


    Inconsistent findings have been reported regarding the efficacy and safety of endoscopic and microscopic transsphenoidal surgery for pituitary adenoma. This study aimed to assess the benefits and shortcomings of these surgical methods in patients with pituitary adenoma. The electronic databases PubMed, Embase, and the Cochrane Library were systematically searched, as well as proceedings of major meetings. Eligible studies with a retrospective or prospective design that evaluated endoscopic versus microscopic methods in patients with pituitary adenoma were included. Primary outcomes included gross tumor removal, cerebrospinal fluid leak, diabetes insipidus, and other complications. Overall, 23 studies (4 prospective and 19 retrospective) assessing 2272 patients with pituitary adenoma were included in the final analysis. Endoscopic transsphenoidal surgery was associated with a higher incidence of gross tumor removal (odds ratio, 1.52; 95% confidence interval, 1.11-2.08; P = 0.009) than those with microscopic transsphenoidal surgery. In addition, endoscopic transsphenoidal surgery had no significant effect on the risk of cerebrospinal fluid leak, compared with microscopic transsphenoidal surgery. Furthermore, endoscopic transsphenoidal surgery was associated with a 22% reduction in risk of diabetes insipidus compared with microscopic transsphenoidal surgery, but the difference was not statistically significant. Endoscopic transsphenoidal surgery significantly reduced the risk of septal perforation (odds ratio, 0.29; 95% confidence interval, 0.11-0.78; P = 0.014) and was not associated with the risk of meningitis, epistaxis, hematoma, hypopituitarism, hypothyroidism, hypocortisolism, total mortality, and recurrence. Endoscopic transsphenoidal surgery is associated with higher gross tumor removal and lower incidence of septal perforation in patients with pituitary adenoma. Future large-scale prospective randomized controlled trials are needed to verify these findings

  15. Gasless endoscopic surgery through the upper chest in treatment of thyroid tumor

    FANG Ju-gao; FENG Ling; YU Zhen-kun; LI Ping-dong; HAN De-min


    Background Recently, there has been a surge of interest in minimally invasive techniques with endoscope in thyroid surgery. The aim of this study was to investigate the possibility of a scarless neck surgery under endoscopy for the treatment of thyroid tumor and to observe the results of this procedure.Methods A total of 68 patients (64 women and 4 men) underwent the surgery. Their ages ranged from 18 to 65 years,with a mean age of (34±3) years. There were 64 cases of thyroid adenoma, and 4 cases of nodular goiter. An incision was made on the surface of the chest bone. The operation cavity was made by dragging the skin. Sixty-four patients underwent partial thyroid lobectomy, four patients underwent thyroid lobectomy.Results All 68 cases showed healing in one stage. None of the cases showed paralysis of the recurrent laryngeal nerve or tumor recurrence within the next 2 to 60 months of follow-up. The patients experienced slight pain after the operation.The patients were satisfied with the cosmetic results of the surgery.Conclusion The gasless endoscopic surgery through the upper chest, which was performed to treat thyroid tumor, did not leave any scar, and was easy to handle, and gave good cosmetic results.

  16. Sinus augmentation surgery after endoscopic sinus surgery for the treatment of chronic maxillary sinusitis: a case report.

    Tobita, Takayoshi; Nakamura, Mikiko; Ueno, Takaaki; Sano, Kazuo


    Chronic sinusitis develops when the ostiomeatal complex becomes stenosed by the swelling of the sinus mucosa. Previously, the Caldwell-Luc method was performed for the treatment of chronic sinusitis. But postoperative complications, such as discomfort of the buccal skin and recurrence of sinusitis, frequently occurred after the operation. Today, endoscopic sinus surgery (ESS) has become widely used for the treatment of chronic sinusitis. The features of ESS allow for the restoration of the physical function of the sinus membrane and preservation of the physiological environment of the sinus. Therefore, sinus augmentation surgery can be safely performed at an insufficient alveolar bone height below the maxillary sinus when sinusitis is eliminated by the ESS. This article documents a patient history involving chronic sinusitis that was treated by the ESS therapy before sinus augmentation surgery as a pretreatment for insertion of dental implants.

  17. Transpedicular endoscopic surgery for lumbar spinal synovial cyst-report of two cases.

    Krzok, Guntram; Telfeian, Albert E; Wagner, Ralf; Iprenburg, Menno


    Lumbar facet cysts are a benign, degenerative, and fairly uncommon cause for lumbar radiculopathy. The standard surgical treatment for lumbar facet cysts often requires a laminectomy and medial facetectomy which can further destabilize a pathological motion segment. The authors present here a novel technique for transpedicular endoscopic access to the pathology that obviates the need to violate the lamina or facet. Two patient cases are described where the lumbar 4-5 facet cysts arise medial to the pedicle. Percutaneous access to the cysts was established by drilling through the adjacent pedicle creating a 7-mm corridor to establish access for the endoscopic tubular retractor and the working channel endoscope. Straight and bendable forceps were used to remove the cysts under direct visualization. Following surgery, the patients' symptoms showed immediate regression with complete relief of one patient's foot drop by 6 months. Transpedicular endoscopic access is described as novel minimally invasive surgical option in the awake patient for lumbar facet cysts adjacent to the Lumbar 4 or 5 pedicle.

  18. Endoscopic surgery in the treatment of crista galli pneumatization evolving with localizated frontal headaches

    Socher, Jan Alessandro


    Full Text Available Introduction: The crista galli is part of the ethmoid bone and thus may suffer from the process of pneumatization. Pneumatization occurs in between 3% and 14% of patients, resulting from air cells in the frontal or ethmoid sinuses. Aim: To describe 3 cases of crista galli pneumatization in which the patients developed infection and were treated surgically by endoscopic techniques. Method: We present 3 case studies of patients complaining of severe frontal headaches. The patients underwent ENT evaluation, examination by video-endoscopy, and computed tomography, which identified crista galli pneumatization with mucosal thickening and the presence of fluid. Patients underwent treatment with antibiotics and corticosteroids; however, they showed no symptomatic improvement, displayed recurrence of symptoms, and maintained radiographic changes. Thus, patients then underwent drainage through the crista galli via an endoscopic procedure. Discussion: During surgery, mucopurulence and/or mucosal thickening and edema were identified in the pneumatized crista galli. There were no complications during or after surgery. Postoperatively, headache was improved in patients after a minimum follow-up of 6 months. Conclusion: Crista galli pneumatization can result in infection, simulating rhinosinusitis. When there is little response to drug therapy, endoscopic surgical treatment is required; the current cases demonstrate that this technique is safe and effective.

  19. [Efficacy analysis of endoscopic endonasal transsphenoidal surgery for recurrent or regrowing pituitary adenomas].

    Xue, Yajun; Zhao, Yaodong; Cui, Daming; Wang, Ke; Shen, Zhaoli; Shen, Rui; Lou, Meiqing


    To analyze the safety and efficacy of surgical removal of recurrent or regrowing pituitary adenomas by endoscopic endonasal transsphenoidal approach. The clinical data were retrospectively reviewed for 28 patients undergoing endoscopic endonasal transsphenoidal surgery for recurrent or regrowing pituitary adenomas between April 2010 and December 2013. There were 9 males and 19 females with a mean age of 44. 2 (11 - 73) years. The maximal tumor diameter ranged from 2. 1 to 6.9 cm. The Knosp grades were 1 -2 (n = 11), 3 (n =8) and 4 (n =9). Fifteen tumors were endocrinically functional and the remainder endocrinically nonfunctional. All operations were performed with an assistance of intraoperative neuronavigation. Neuro-ophthalmological, neuroimaging and endocrinological results were followed up postoperatively. And surgical outcomes and risk factors were analyzed for incomplete tumor resection in previous operations. The mean follow-up period was 19. 1 (3 - 45) months. Gross total resection(n = 18, 64. 3%), subtotal resection(n = 6, 21. 4%) and partial resection(n = 4, 14. 3%) were achieved. Postoperatively, visual acuity improved in 11 patients (73. 3%) and 6 patients (40. 0%) showed endocrine remission. Qne patient had short-term postoperative leakage of cerebrospinal fluid (CSF). Endoscopic endonasal transsphenoidal surgery is both safe and effective for recurrent or regrowing pituitary adenomas.

  20. A Minimally Invasive Endoscopic Surgery for Infectious Spondylodiscitis of the Thoracic and Upper Lumbar Spine in Immunocompromised Patients

    Hsin-Chuan Chen


    Full Text Available This study evaluates the safety and effectiveness of computed tomography- (CT- assisted endoscopic surgery in the treatment of infectious spondylodiscitis of the thoracic and upper lumbar spine in immunocompromised patients. From October 2006 to March 2014, a total of 41 patients with infectious spondylodiscitis underwent percutaneous endoscopic surgery under local anesthesia, and 13 lesions from 13 patients on the thoracic or upper lumbar spine were selected for evaluation. A CT-guided catheter was placed before percutaneous endoscopic surgery as a guide to avoid injury to visceral organs, major vessels, and the spinal cord. All 13 patients had quick pain relief after endoscopic surgery without complications. The bacterial culture rate was 77%. Inflammatory parameters returned to normal after adequate antibiotic treatment. Postoperative radiographs showed no significant kyphotic deformity when compared with preoperative films. As of the last follow-up visit, no recurrent infections were noted. Traditional transthoracic or diaphragmatic surgery with or without posterior instrumentation is associated with high rates of morbidity and mortality, especially in elderly patients, patients with multiple comorbidities, or immunocompromised patients. Percutaneous endoscopic surgery assisted by a CT-guided catheter provides a safe and effective alternative treatment for infectious spondylodiscitis of the thoracic and upper lumbar spine.

  1. Clinical analysis of endoscopic surgery for rhinogenous orbital cellulitis%鼻源性眶蜂窝织炎鼻内镜手术治疗临床研究

    周昆; 刘玥; 王佳; 贾明辉


    目的 探讨鼻内镜在鼻窦源性眶蜂窝织炎治疗中的应用效果.方法 鼻窦源性眶蜂窝织炎14例.将继发于上呼吸道感染的急性鼻窦炎归于急性组(9例),将慢性鼻窦炎急性发作归于慢性组(5例).两组患者均进行经鼻窦的鼻内镜下手术,观察其疗效.结果 经鼻内镜下手术及敏感抗生素应用等综合治疗,两组患者均痊愈,未发现严重影响视力及全身健康的并发症.结论 鼻内镜下手术治疗鼻窦源性眶蜂窝织炎具有视野清晰、径路便利、损伤小、恢复快及无面部瘢痕等优势.%Objective To evaluate the clinical effect of endoscopic surgery for the treatment of rhinogenous orbital cellulitis.Methods Fourteen cases of rhinogenous orbital cellulitis were treated by endoscopic surgery via nasal sinus.The curative effect of the surgery and postoperative complications were recorded and analyzed.Results After endoscopic surgery combined with systemic antibiotics,all patients were cured and no serious complication was observed.Conclusion Compared with the traditional surgery,endoscopic surgery possessed more advantages for the treatment of rhinogenous orbital cellalitis,such as clear field,convenient surgical route,less bleeding,no facial scar,quick recovery and good effect.

  2. Design of a surgical robot with dynamic vision field control for Single Port Endoscopic Surgery.

    Kobayashi, Yo; Sekiguchi, Yuta; Tomono, Yu; Watanabe, Hiroki; Toyoda, Kazutaka; Konishi, Kozo; Tomikawa, Morimasa; Ieiri, Satoshi; Tanoue, Kazuo; Hashizume, Makoto; Fujie, Masaktsu G


    Recently, a robotic system was developed to assist Single Port Endoscopic Surgery (SPS). However, the existing system required a manual change of vision field, hindering the surgical task and increasing the degrees of freedom (DOFs) of the manipulator. We proposed a surgical robot for SPS with dynamic vision field control, the endoscope view being manipulated by a master controller. The prototype robot consisted of a positioning and sheath manipulator (6 DOF) for vision field control, and dual tool tissue manipulators (gripping: 5DOF, cautery: 3DOF). Feasibility of the robot was demonstrated in vitro. The "cut and vision field control" (using tool manipulators) is suitable for precise cutting tasks in risky areas while a "cut by vision field control" (using a vision field control manipulator) is effective for rapid macro cutting of tissues. A resection task was accomplished using a combination of both methods.

  3. Percutaneous Endoscopic Gastrostomy Experience Ižn A General Surgery Clinic

    Ahmet Serdar Karaca


    Full Text Available Aim: Percutaneous endoscopic gastrostomy is the most preferable procedure for nutritional support in patients starving for a long time, who have difficulty in swallowing or feeding by oral way due to various diseases. The five years%u2019 experience of this surgery clinic was obtained in this study. Material and Method: The indications, complications and long term follow-up were recorded by physicians for 197 patients who had undergone percutaneous endoscopic gastrostomy. We used standart pull method for lite application of gastrostomy. Results: Percutaneous endoscopic gastrostomy was performed successfully in 141 (%71 chronic neurological patients, 35 (%17 patients with malignancy and 21 (%10 patients with various diseases with especially long time ventilation. It was performed on 141 male and 56 female patients, with a median age of 52.7 years (range 14-93 years. One hundred thirdy nine (total mortality 71% patients died because of the primary disease and after being discharged from the hospital. There was no mortality attributable to the procedure. The median time the patients used percutaneous endoscopic gastrostomy was 101.4 days (range 1-322 days excluding 37 (19% patients in whom the communication was lost during follow-up. There were a catheter leakage early in 34 and later in 19 patients, unsettled cathether in 6 patients, obstruction in 8 patients and catheter area inflamation in patients. PEG was performed twice in 7 patients. Discussion: Percutaneous endoscopic gastrostomy is a safe and reliable procedure for enteral feeding. The important complications are generally related to catheter care. In order to reduce complicatoins in the long run, further education of caretakers of patients and organization of the nutrition outpatient unit is advisable.

  4. Usefulness of the indocyanine green fluorescence endoscope in endonasal transsphenoidal surgery.

    Hide, Takuichiro; Yano, Shigetoshi; Shinojima, Naoki; Kuratsu, Jun-ichi


    To avoid disorientation during endoscopic endonasal transsphenoidal surgery (ETSS), the confirmation of anatomical landmarks is essential. Neuronavigation systems can be pointed at exact sites, but their spatial resolution power is too low for the detection of vessels that cannot be seen on MR images. On Doppler ultrasonography the shape of concealed arteries and veins cannot be visualized. To address these problems, the authors evaluated the clinical usefulness of the indocyanine green (ICG) endoscope. The authors included 38 patients with pituitary adenomas (n = 26), tuberculum sellae meningiomas (n = 4), craniopharyngiomas (n = 3), chordomas (n = 2), Rathke's cleft cyst (n = 1), dermoid cyst (n = 1), or fibrous dysplasia (n = 1). After opening the sphenoid sinus and placing the ICG endoscope, the authors injected 12.5 mg of ICG into a peripheral vein as a bolus and observed the internal carotid arteries (ICAs), cavernous sinus, intercavernous sinus, and pituitary. The ICA was clearly identified by a strong fluorescence signal through the dura mater and the covering thin bone. The intercavernous and cavernous sinuses were visualized a few seconds later. In patients with tuberculum sellae meningiomas, the abnormal tumor arteries in the dura were seen and the vague outline of the attachment was identified. At the final inspection after tumor removal, perforators to the brain, optic nerves, chiasm, and pituitary stalk were visualized. ICG fluorescence signals from the hypophyseal arteries were strong enough to see and spread to the area of perfusion with the passage of time. The ICA and the patent cavernous sinus were detected with the ICG endoscope in real time and at high resolution. The ICG endoscope is very useful during ETSS. The authors suggest that the real-time observation of the blood supply to the optic nerves and pituitary helps to predict the preservation of their function.




    Full Text Available Introduction of nasal endoscope has revolutionized the field of rhinology. Endoscopic septoplasty is a minimally invasive technique that helps us to correct the deformity of the septum under excellent direct visualization using an endoscope. AIMS: Studied indication, technique result and complication of endoscopic septoplasty. METHODS AND MATERIAL: It was a prospective study carried out at our institute from August 2011 to December 2013 RESULTS: 57 patients having nasal obstruction were selected for the study. In present study 24(42.1% patients had only cartilagenous deviation, 9(15.7% patients had bony deviation, 15(26.3% had both bony and cartilage deviation, while 12(21% had spur and 5(8.7% had caudal dislocation. Minor complications were seen during study, no major occurred during endoscopic septoplasty or post- operative period. In 40(70% cases endoscopic septoplasty was performed as primary procedure and in 9(15.7% cases performed as conjugation with FESS, also in 8(14% patients septoplasty performed prior to endonasal DCR for good assess to lateral nasal. CONCLUSIONS: Endoscopic septoplasty is an effective technique that can be performed safely alone or in combination with endoscopic sinus surgery. It reduces the complication, hospital stay and has fast recovery of the patients postoperatively. It facilitates accurate identification of the pathology, and it is associated with significant reduction in patient’s morbidity in the postoperative period

  6. 鼻内镜鼻窦手术后额窦炎13例报告%Clinical Analysis of Frontal Sinusitis after Endoscopic Sinus Surgery

    刘春万; 张雁; 何淑琼


    目的 探讨功能性鼻内镜手术( FESS)后复发及继发性额窦炎的原因及二次手术方法. 方法 回顾性分析13例(16例)FESS后额窦炎患者的临床资料. 患者第二次手术均通过鼻内镜检查及鼻窦CT扫描确诊. 结合患者前期手术临床资料,其中复发性额窦炎8例,共9侧,继发性额窦炎5例,共7侧,13例均经第二次手术治疗. 结果 复发性额窦炎8例中,额窦引流通道瘢痕粘连致额窦口狭窄、闭锁6例;中鼻甲前端与外侧壁广泛性粘连1例;息肉复发堵塞窦口1例;5例继发性额窦炎中,因中鼻甲前端与外侧壁瘢痕粘连4例、6侧,因额隐窝息肉复发堵塞窦口1例. 13例患者经第二次手术后,按海口标准治愈12例,再复发1例. 结论 额窦引流通道瘢痕粘连特别是中鼻甲前端与外侧壁广泛性粘连、息肉复发是复发性额窦炎的主要原因. 再次手术是治疗复发性、继发性额窦炎重要手段之一.%Objective To explore the main causes and treatments of recurrent and secondary frontal sinusitis after endo-scopic sinus surgery. Methods Thirteen patients with frontal sinusitis were involved in this study. All of these patients had re-ceived nasal endoscopic surgeries before. Before receiving a re-operation,they were diagnosed according the results of endoscopy and CT scan with a recurrent headache as the commonest manifestation. Their clinical date of the first operations were reviewed. Eight recurrent and 5 secondary cases of frontal sinusitis were diagnosed. Results Among the recurrent sinusitis cases,6 patients were found had the problem of stenosis or obstruction of the frontal sinus drainage channel. One patient' s middle turbinate was ex-tensive adhered with the lateral nasal wall,while another one patients had the sinus polyps blocked the opening. The similar results were founded among the other 5 patients. Four cases were observed the extensive adhesion and the rest of one case had the sinus polyps

  7. 4-mm-diameter three-dimensional imaging endoscope with steerable camera for minimally invasive surgery (3-D-MARVEL).

    Bae, Sam Y; Korniski, Ronald J; Shearn, Michael; Manohara, Harish M; Shahinian, Hrayr


    High-resolution three-dimensional (3-D) imaging (stereo imaging) by endoscopes in minimally invasive surgery, especially in space-constrained applications such as brain surgery, is one of the most desired capabilities. Such capability exists at larger than 4-mm overall diameters. We report the development of a stereo imaging endoscope of 4-mm maximum diameter, called Multiangle, Rear-Viewing Endoscopic Tool (MARVEL) that uses a single-lens system with complementary multibandpass filter (CMBF) technology to achieve 3-D imaging. In addition, the system is endowed with the capability to pan from side-to-side over an angle of [Formula: see text], which is another unique aspect of MARVEL for such a class of endoscopes. The design and construction of a single-lens, CMBF aperture camera with integrated illumination to generate 3-D images, and the actuation mechanism built into it is summarized.

  8. Artificial nasolacrimal duct implantation under the nasal endoscope%鼻内窥镜下人工鼻泪管植入术

    蔡海林; 任鸿飞


    Objective To observe the treatment effect of artificial nasolacrimal duct implantation under the nasal endoscope for chronic dacryocystitis and nasolacrimal duct obstruction.Methods 48 cases (54 eyes) including 13 cases of chronic dacryocystitis and 35 cases of nasolacrimal duct obstruction were involved.Artificial nasolacrimal duct implantation under endoscope was done for them.Results The patients were followed up from 0.5 to 2 years.They were cured in 47 eyes (87.04%) ; improved in 5 eyes (9.26%),Failed in2 eyes (3.70%).The total effective rate was96.30%.Conclusion The treatmeut effect of artificial nasolacrimal duct implantation under the nasal endoscope is outstanding,superior to traditional operation.%目的 观察鼻内窥镜下人工鼻泪管植入术治疗慢性泪囊炎和鼻泪管阻塞的治疗效果.方法 慢性泪囊炎13眼,鼻泪管阻塞35眼,应用人工鼻泪管植入术治疗.结果 随访半年至2年,治愈47眼(87.04%),好转5眼(9.26%),无效2眼(3.70%),总有效率96.30%.结论 鼻内窥镜下人工鼻泪管植入术治疗慢性泪囊炎和鼻泪管阻塞疗效显著,与传统手术比较有多种优点.

  9. Application of design rationale for a robotic system for single-incision laparoscopic surgery and natural orifice transluminal endoscopic surgery.

    Yao, Wei; Childs, Peter R N


    Current endoscopes and instruments are inadequate in some respects for complex intra-abdominal surgery because they are too flexible and cannot provide robust grasping and anatomic retraction. Minimal invasive surgery devices represent a sophisticated class of mechanical instruments making use of a range of mechanisms integrated into modular platforms that can be combined to undertake complex medical procedures. Although the machine elements concerned represent classic mechanical engineering devices, issues of miniaturization, surgical procedure compliance and location control conspire to present a design challenge. In order to capture, document and resolve the design requirements for this complex application, quality functional deployment has been applied in combination with design rationale, captured through issue-based information system mapping. This article reports the use of these tools to produce robot designs with improved dexterity and triangulation that are basic requirements in laparoscopy.

  10. Fetus-supporting flexible manipulator with balloon-type stabilizer for endoscopic intrauterine surgery.

    Liao, Hongen; Suzuki, Hirokazu; Matsumiya, Kiyoshi; Masamune, Ken; Dohi, Takeyoshi; Chiba, Toshio


    Minimally invasive endoscopic fetal surgery enables intrauterine intervention with reduced risk to the mother and fetus. A novel surgical manipulator is described for stabilizing the fetus and restraining it from floating free during endoscopic intrauterine surgery. We designed and fabricated a prototype fetus-supporting manipulator equipped with flexible joint and bending mechanisms and a soft balloon stabilizer. The flexible joint and bending mechanisms enable the stabilizer to reach the target sites within the confined space of the uterus under the guidance of an ultrasound device. The balloon stabilizer could be inserted into the uterus through a small incision. The accuracy evaluation showed that the maximum error of the bending mechanism was as small as 7 mm and the standard deviation of the joint mechanism was just 1.6 degrees. In the experiments using a fetus model, the manipulator could be well controlled with guidance from ultrasound images and its bending mechanism with the balloon stabilizer could be clearly visualized while stabilizing the fetus model. The manipulator has the potential to be used in minimally invasive intrauterine surgery, although further improvements and experiments remain to be carried out.

  11. Feeding in Oral Cancer Patients After Massive Ablative Surgery: Percutaneous Endoscopic Gastrostomy or Nasogastric Tube.

    Tabrizi, Reza; Hosseinpour, Sepanta; Taghizadeh, Fateme


    Feeding after ablative oral cancer surgery is a major concern in postoperative care phase. The aim of this study was to compare postoperative phase of healing in patients undergoing nasogastric tube insertion and percutaneous endoscopic gastrostomy. In this single randomized clinical trial, 40 patients were randomly allocated to 2 groups according to a randomized list: group one (20 patients) had nasogastric tube for 4 weeks and group two (20 patients) underwent percutaneous endoscopic gastrostomy for 4 weeks or more after the surgery. Occurrence of infection and wound dehiscence was assessed. Weight loss was defined as reduction in patients' weight at 4 weeks after the surgery compared with preoperation. Weight loss was 7.9 ± 1.91 kg in group one and 5.3 ± 1.38 kg in group two; the difference in this regard between the 2 groups was statistically significant (P = 0.001). In group one, 10 subjects had dehiscence versus 3 subjects in group two; this difference was significant (P = 0.04). Analysis of the data demonstrated a significant difference in postsurgical infection between the 2 groups (P = 0.044). It seems that gastrostomy may be an appropriate method for feeding in patients with extensive oral cancer.

  12. Effect of endoscopic sinus surgery on chronic rhinosinusitis%鼻内镜手术治疗慢性鼻-鼻窦炎疗效分析



    目的 研究对慢性鼻-鼻窦炎患者采取鼻内镜手术治疗的临床效果及其对患者临床症状及生活质量的影响. 方法 将晋中市第二人民医院240例患者分为无鼻息肉组(观察组)与伴鼻息肉组(对照组) ,每组120例,两组均行鼻内镜手术治疗,比较两组术后临床症状及生活质量评分变化. 结果 治疗6个月后观察组和对照组痊愈率分别为80.33% 和68.33%,差异有统计学意义( P<0.05 );12 个月后观察组和对照组痊愈率分别为90.83%和80.33%,差异也有统计学意义( P<0.05);经过临床治疗1、6、12个月后,主要临床症状积分均呈显著下降趋势,较治疗前显著降低( P<0.05) ,其中鼻塞改善效果最为显著;SNOT-20及5个条目评分治疗1、6、12个月后均较术前显著降低( P<0.05). 结论 鼻内镜手术治疗慢性鼻-鼻窦炎疗效确切,可显著降低症状积分,改善患者术后生活质量,具有较高的临床推广价值.%Objective To study the clinical effect of nasal endoscopic operation on chronic rhinosinusitis , and its influence on clinical symptoms and quality of life .Methods A total of 240 patients in the second people ' s hospital of Jinzhong were divided into non nasal polyp group ( observation group ) and nasal polyp group ( control group ) , with 120 cases in each group.Both of the two groups underwent endoscopic surgery , and the changes of clinical symptoms and quality of life score after operation were compared .Results The cure rate after six months treatment were 58.33%and 42.50%in the two groups, and there was significant difference ( P<0.05).The cure rate after twelve months treatment were 90.83% and 80.33%in the two groups , and there was significant difference ( P <0.05 ) .After clinical treatment for one month , six months and twelve months , the main clinical symptom score were significantly decreased than that before treatment ( P<0.05) , which nasal obstruction improvement effect was most significant

  13. Is endoscopic ear surgery an alternative to the modified Bondy technique for limited epitympanic cholesteatoma?

    Prasad, Sampath Chandra; Giannuzzi, Annalisa; Nahleh, Eyad Abu; Donato, Giuseppe De; Russo, Alessandra; Sanna, Mario


    The objective of this study is to evaluate the outcomes of the modified Bondy's technique performed at our center and for limited epitympanic cholesteatomas and to debate the purported benefits of endoscopic surgery for the same indication. This is a retrospective study. 269 ears of 258 patients with a minimum of 5-year follow-up that were operated for limited epitympanic cholesteatoma using the modified Bondy's technique were included in the study. All patients had primary acquired cholesteatoma with good preoperative hearing in the affected ear and an intact ossicular chain. The outcomes of were analyzed and the results were compared with a literature review of outcomes of endoscopic ear surgery for the same indication. The mean follow-up was 81.63 months. The mean preoperative air-bone gap was 13.6 ± 7 dB. Intraoperatively, the ossicular chain was preserved in all patients. Postoperatively, there was no significant change from preoperative levels in mean air conduction, mean bone conduction and the air-bone gap. There were no recurrent cholesteatomas in our series. A residual pearl-like cholesteatoma was found lateral to the tympanic membrane in 8.1 % of ears, which was removed in the outpatient clinic. Three patients (1.2 %) developed stenosis of the meatoplasty. Eight (3.1 %) ears exhibited retraction pockets involving the attic. Postoperative ear discharge was observed in 1.5 % cases. The modified Bondy technique, which provides excellent postoperative outcomes, is the surgery of choice for limited epitympanic cholesteatomas. The endoscope, despite its better visualization of hidden areas does not provide a distinct overall technical advantage or better results over the microscope.

  14. Endoscopic findings in the excluded stomach after Roux-en-Y gastric bypass surgery.

    Kuga, Rogerio; Safatle-Ribeiro, Adriana V; Faintuch, Joel; Ishida, Robson K; Furuya, Carlos K; Garrido, Arthur B; Cecconello, Ivan; Ishioka, Shinichi; Sakai, Paulo


    After gastric bypass surgery performed because of morbid obesity, the excluded stomach can rarely be endoscopically examined. With the advent of a new apparatus and technique, possible mucosal changes can be routinely accessed and monitored, thus preventing potential benign and malignant complications. Prospective observational study in a homogeneous population with nonspecific symptoms. Outpatient clinic of a large public academic hospital. Forty consecutive patients (mean +/- SD age, 44.5 +/- 10.0 y ears; 85.0% women) were seen at a mean +/- SD of 77.3 +/- 19.4 months after Roux-en-Y gastric bypass surgery. Elective double-balloon enteroscopy of the excluded stomach was performed. Rate of successful intubation, endoscopic findings, and complications. The excluded stomach was reached in 35 of 40 patients (87.5%). Mean +/- SD time to enter the organ was 24.9 +/- 14.3 minutes (range, 5-75 minutes). Endoscopic findings were normal in 9 patients (25.7%), whereas in 26 (74.3%), various types of gastritis (erythematous, erosive, hemorrhagic erosive, and atrophic) were identified, primarily in the gastric body and antrum. No cancer was documented in the present series. Tolerance was good, and no complications were recorded during or after the intervention. The double-balloon method is useful and practical for access to the excluded stomach. Although cancer was not noted, most of the studied population had gastritis, including moderate and severe forms. Surveillance of the excluded stomach is recommended after Roux-en-Y gastric bypass surgery performed because of morbid obesity.

  15. Modeling and motion compensation of a bidirectional tendon-sheath actuated system for robotic endoscopic surgery.

    Sun, Zhenglong; Wang, Zheng; Phee, Soo Jay


    Recent study shows that tendon-sheath system (TSS) has great potential in the development of surgical robots for endoscopic surgery. It is able to deliver adequate power in a light-weight and compact package. And the flexibility and compliance of the tendon-sheath system make it capable of adapting to the long and winding path in the flexible endoscope. However, the main difficulties in precise control of such system fall on the nonlinearities of the system behavior and absence of necessary sensory feedback at the surgical end-effectors. Since accurate position control of the tool is a prerequisite for efficacy, safety and intuitive user-experience in robotic surgery, in this paper we propose a system modeling approach for motion compensation. Based on a bidirectional actuated system using two separate tendon-sheaths, motion transmission is firstly characterized. Two types of positional errors due to system backlash and environment loading are defined and modeled. Then a model-based feedforward compensation method is proposed for open-loop control, giving the system abilities to adjust according to changes in the transmission route configuration without any information feedback from the distal end. A dedicated experimental platform emulating a bidirectional TSS robotic system for endoscopic surgery is built for testing. Proposed positional errors are identified and verified. The performance of the proposed motion compensation is evaluated by trajectory tracking under different environment loading conditions. And the results demonstrate that accurate position control can be achieved even if the transmission route configuration is updated. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

  16. Anatomic variants of interest in endoscopic sinus surgery: role of computed tomography; Variantes anatomicas de interes en cirugia endoscopica nasosinusal. Papel de la tomografia computerizada

    Alonso, S.; Arenas, J.; Fernandez, F.; Gil, S.; Guirau, M. D. [Hospital General Universitario de Alicante (Spain)


    The detailed radiological study of the anatomy of the nasal cavities and paranasal sinus is essential prior to endoscopic sinus surgery since, on the one hand, it discloses the extent of the disease and, on the other hand, it aids in the detection of the numerous anatomic variants, some of which are of great interest to the endoscopic as the lack of preoperative knowledge of them may increase the risk of complications. the objective of the present report is to review these variants, stressing those that may be associated with a greater surgical risk. Although coronal computed tomography is the technique of choice for pre endoscopy examination, certain structures and anatomic variants are better viewed in axial images. These exceptions include anterior and posterior walls of the frontal sinuses, the anatomic relationships between posterior ethmoid complex and the sphenoid sinus, the relationships between the sphenoid sinus and the optic nerve, and the detection of Onodi cells. Thus, we recommend that the radiological examination include both coronal and axial images. (Author) 16 refs.

  17. Use of image guidance in endoscopic endonasal surgeries: a 5-year experience.

    Farhadi, M; Jalessi, M; Sharifi, G; Khamesi, S; Bahrami, E; Hammami, M R; Behzadi, A H


    Endoscopic endonasal surgery (EES) is standard practice in sinonasal disease and is becoming more accepted in the performance of anterior skull base resections. We report our experience with image-guided surgery (IGS) in difficult cases of paranasal sinus (PNS) and skull base pathologies and discuss advantages and disadvantages of this technique. A retrospective chart review was performed for the period 2004-2009. Degree of PNS involvement, indication for IGS, incidence of major complications, need for revision surgery, and technical data regarding the system were gathered. Sixty-two of 86 patients were followed for at least one year and therefore included in the analysis. Indications for IGS were mostly revision surgery for polyposis (42%), chronic rhinosinusitis (CRS) of frontal and/or sphenoid sinuses (14.5%), skull base tumours (30.6%), and foreign body removal (4.8%). Revision rates after IGS in polyposis, CRS, and benign skull base tumours were 7.7%, 11.11%, and 7.1%, respectively. IGS is of particular benefit in the management of sinonasal polyposis, benign skull base tumours, palliative surgery, and foreign body removal. IGS may avoid trauma to the orbit and anterior skull base and reduces the rate of revision surgeries rendering more meticulous and complete operations possible. We also think it could be helpful for foreign body removal.

  18. [Application of the neuro-endoscope to the intracranial aneurismal surgery].

    Zhao, Ji-zong; Wang, Shuo; Wang, Yong-gang; Zhao, Yuan-li; Yu, Shu-qing; Wang, Rong; Wang, De-jiang; Zhang, Dong; Li, Yong


    To study the role of neuro-endoscope in the intracranial aneurismal surgery, analyzing its benefits, and disadvantages. Endoscopy was used as an adjunct in the microsurgical treatment of clipping aneurysms on 88 patients with 89 aneurysms, of which 82 aneurysms in 81 patients were located in the anterior circulation and 7 were located in the posterior circulation. Keyhole approach was performed on all patients, and micro-Doppler ultrasound technique was used before and after clipping. In 84 aneurysms, endoscope-assisted microneurosurgery (EAM) was used in addition to microsurgical dissection and clipping so as to observe the neck anatomic features and perforators and to verify the optimal clipping position. Endoscope-controlled microneurosurgery was used for 5 aneurysms to observe the anatomy around aneurysm, such as the posterior communicating artery and the opposite anterior communicating artery behind the internal carotid artery. Postoperative angiography performed on 86 patients showed satisfactory aneurysm clipping. Operative mortality was 0. There were 7 cases of postoperative complications, with an incidence rate of 7.95%, and none case was directly related to endoscopy. Improving observation of regional anatomy because of its ability in magnification, illumination, and looking around dead angle, neuro-endoscopy is very useful for complex aneurysms.

  19. Evaluation of endoscopy in localizing transgastric access for natural orifice transluminal endoscopic surgery in humans.

    Linke, Georg R; Zerz, Andreas; Kapitza, Florian; Warschkow, Rene; Lange, Jochen; Meyenberger, Christa M; Binek, Janek


    To date, transgastric access in humans for natural orifice transluminal endoscopic surgery (NOTES) has been poorly evaluated. To compare endoscopic visualization of the transgastric access point with the laparoscopically defined ideal entrance to the peritoneal cavity. Prospective pilot study in humans. Single tertiary-care center. This study involved 31 patients referred for laparoscopic cholecystectomy. Access points were marked by endoscopy alone, endoscopy combined with diaphanoscopy, and endoscopy after pneumoperitoneum. Points were correlated with a laparoscopically visualized, previously defined ideal access area. To choose the appropriate access point within the laparoscopically defined ideal access area to the peritoneal cavity away from major vessels and adjacent organs, by using endoscopy and to establish landmarks for the endoscopist, look for a learning curve, and identify potential problems. The percentage of access points within the laparoscopically defined ideal area was 35.5% with endoscopy alone, 13.8% using the diaphanoscopy method, and 45.2% after transcutaneous pneumoperitoneum. A safe access point (> or = 3 cm from major gastric vessels) could be achieved with the 3 techniques in 83.9%, 65.5%, and 87.1% of patients, respectively. A positive learning curve for endoscopic localization was identified before (P = .008) and after (P = .014) pneumoperitoneum. Virtual complications were greater in obese patients. This was a small pilot study with hypothetical complications and problems, because actual transgastric access was not performed. The criteria for an ideal access area were very strict. Endoscopy, especially with the use of pneumoperitoneum, can reliably locate a safe transgastric entrance point. However, the endoscopically chosen site correlates poorly with the ideal laparoscopically determined site for transgastric access. 2010 American Society for Gastrointestinal Endoscopy. Published by Mosby, Inc. All rights reserved.

  20. 慢性鼻-鼻窦炎患者症状学特点及内镜鼻窦手术后主要症状的转归%Symptomatic characteristics of chronic rhinosinusitis patients and symptom-specific outcomes after endoscopic sinus surgery

    万龙; 石农; 王园园; 刘争; 崔永华


    目的:探讨慢性鼻-鼻窦炎患者的症状学特点及内镜鼻窦手术前后患者主观症状的变化.方法:采用视觉模拟量表对119例慢性鼻-鼻窦炎患者(52例不伴鼻息肉和67例伴鼻息肉)的鼻塞、头昏(头痛)、面部疼痛(胀满感)、嗅觉障碍和鼻分泌物(后鼻漏)5个主要症状进行评分,比较内镜鼻窦手术前和手术后12个月评分的变化.结果:伴和不伴鼻息肉的慢性鼻-鼻窦炎患者出现最多的症状均依次为鼻塞、鼻分泌物(后鼻漏)、头昏(头痛)、面部疼痛(胀满感)和嗅觉障碍.不伴鼻息肉的慢性鼻-鼻窦炎患者较伴鼻息肉者鼻分泌物评分显著增高(P<0.01),但嗅觉障碍评分者显著降低(P<0.01).在最令人困扰的症状方面,不伴鼻息肉和伴鼻息肉的慢性鼻-鼻窦炎患者分别是鼻分泌物(后鼻漏)和嗅觉障碍.术后伴鼻息肉和不伴鼻息肉的慢性鼻-鼻窦炎患者各个症状出现的频率和评分均较术前显著降低(P<0.01).结论:伴鼻息肉和不伴鼻息肉的慢性鼻-鼻窦炎患者症状学具有不同的特点,内镜鼻窦手术可以显著改善患者的主观症状,视觉模拟量表评估患者的主观症状是一简便、易于开展的慢性鼻-鼻窦炎疗效主观评估方法.%Objective:To explore the symptomatic characteristics of chronic rhinosinusitis patients and the report symptom-based outcomes after endoscopic sinus surgery. Method: One hundred and nineteen chronic rhinosinusitis patients underwent endoscopic sinus surgery, including 52 patients of chronic rhinosinusitis without nasal polyps and 67 patients of chronic rhinosinusitis with nasal polyps, were enrolled. Patients were asked to evaluate their symptoms before surgery and 12 months after endoscopic sinus surgery using 10 cm visual analog scale measures. Result: The most commonly reported symptoms were nasal obstruction, nasal discharge, headache, facial pressure and altered sense of smell. Compared with patients of

  1. Detection of helicobacter pylori in nasal polyps using rapid urease test and ELISA

    Masood Kaviani


    Full Text Available Introduction: Nasal polyposis is an inflammatory condition of unknown etiology. Recently concerns regarding gastroesophageal reflux or helicobacter pylori as a possible pathologic cause of nasal polyps have been increasing. The present study was planned to investigate the presence of helicobacter pylori in nasal polyps. Materials and Methods: This case-control study was undertaken enrolling 37 patients with nasal polyps who had undergone nasal endoscopic sinus surgery and 38 control subjects. Biopsy specimens of nasal polyps and inferior turbinates were assessed by rapid urease test. Blood samples of both study and control subjects were evaluated for anti H.pylori IgG by ELISA. H. pylori status was regarded positive, if both tests were positive. Results: Seropositivity was more common in the patients with nasal polyps (66.2% than control subjects (36.8% (P

  2. [Endoscopic sinus surgery for a paranasal sinuses mucocele with light guide and dacryoendoscopy].

    Iwahashi, Toshihiko; Shikina, Takashi; Kawamoto, Masahiro; Mochizuki, Ryuichi; Yamashita, Maki; Inohara, Hidenori


    It is hard to cure dacryocystitis caused by a paranasal sinus mucocele with treatment which only targets the mucocele. Also, it is difficult to identify the lacrimal sac and the nasolacrimal duct preoperatively and intraoperatively when the lacrimal passage is markedly changed by the mucocele or previous surgery. We experienced four cases of mucocele complicated by lacrimal stenosis or obstruction. We performed marsupialization of the mucocele and direct silicon intubation or endoscopic dacryocystorhinostomy simultaneously with the use of a fiberoptic illuminator or dacryoendoscopy. Assisted by those devices, lacrimal procedures can now be done quickly and safely regardless of the surgeon's experience. In addition, performing surgeries both for the lacrimal passage and for the mucocele at the same time can minimize the burden on patients.

  3. Sellar reconstruction without intrasellar packing after endoscopic surgery of pituitary macroadenomas is better than its reputation

    Ismail, Mostafa


    Full Text Available Objectives: Sellar reconstruction with intrasellar packing following endoscopic resection of pituitary macroadenomas remains a subject of clinical and radiological discussion particularly, when an intraoperative cerebrospinal fluid (CSF leakage is absent. This study was conducted to contribute our experience with sellar reconstruction after a standard endoscopic surgery of pituitary macroadenomas without intraoperative CSF leakage to the ongoing discussion between techniques with and without intrasellar packing.Methods: A consecutive series of 47 pituitary macroadenomas undergoing excision via a standard endoscopic endonasal transsphenoidal surgery (EETS without evident intraoperative CSF leakage were retrospectively evaluated over a 10-months mean follow-up period. According to the sellar reconstruction technique, three groups could be identified: Group A – with no intrasellar packing, Group B – with haemostatic materials packing, and Group C – with abdominal fat packing. Postoperative clinical and radiological assessments of the three groups were documented and analyzed for differences in outcome.Results: Postoperative clinical assessment did not differ significantly between the three groups. In group A, postoperative CSF leakage, sphenoid sinusitis and empty sella syndrome were not observed. However, a significant difference in radiological assessment could be identified; the interpretation of sellar contents in postoperative MRI of group A succeeded earlier and more reliably than in other groups with intrasellar packing. Conclusions: There is no difference in the incidence of postoperative CSF leakage and empty sella syndrome among the various reconstructive techniques with and without intrasellar packing, irrespective of size and extension of the pituitary adenoma. Sellar reconstruction without intrasellar packing following a standard EETS is not inferior to other techniques with packing and even shows more radiological advantages

  4. Mobile locally operated detachable end-effector manipulator for endoscopic surgery.

    Kawai, Toshikazu; Shin, Myongyu; Nishizawa, Yuji; Horise, Yuki; Nishikawa, Atsushi; Nakamura, Tatsuo


    Local surgery is safer than remote surgery because emergencies can be more easily addressed. Although many locally operated surgical robots and devices have been developed, none can safely grasp organs and provide traction. A new manipulator with a detachable commercial forceps was developed that can act as a third arm for a surgeon situated in a sterile area near the patient. This mechanism can be disassembled into compact parts that enable mobile use. A mobile locally operated detachable end-effector manipulator (LODEM) was developed and tested. This device uses crank-slider and cable-rod mechanisms to achieve 5 degrees of freedom and an acting force of more than 5 N. The total mass is less than 15 kg. The positional accuracy and speed of the prototype device were evaluated while performing simulated in vivo surgery. The accuracy of the mobile LODEM was 0.4 mm, sufficient for handling organs. The manipulator could be assembled and disassembled in 8 min, making it highly mobile. The manipulator could successfully handle the target organs with the required level of dexterity during an in vivo laparoscopic surgical procedure. A mobile LODEM was designed that allows minimally invasive robotically assisted endoscopic surgery by a surgeon working near the patient. This device is highly promising for robotic surgery applications.

  5. Role of Osteoplastic Frontal Sinus Obliteration in the Era of Endoscopic Sinus Surgery

    Joshua B. Silverman


    Full Text Available Objective. Determining the indications for osteoplastic frontal sinus obliteration (OFSO for the treatment of inflammatory frontal sinus disease. Study Design. Retrospective case series from a single tertiary care facility. Methods. Thirty-four patients who underwent OFSO for chronic frontal sinusitis ( and frontal sinus mucocele ( comprised our study group. Data reviewed included demographics, history of prior frontal sinus operation(s, imaging, diagnosis, and operative complications. Results. The age range was 19 to 76 years. Seventy percent of patients with chronic frontal sinusitis underwent OFSO as a salvage surgery after previous frontal sinus surgery failures, while 30% underwent OFSO as a primary surgery. For those in whom OFSO was a salvage procedure, the failed surgeries were endoscopic approaches to the frontal sinus (69%, Lynch procedure (12%, and OFSO outside this study period (19%. For patients with frontal sinus mucocele, 72% had OFSO as a first-line surgery. Within the total study population, 15% of patients presented for OFSO with history of prior obliteration, with a range of 3 to 30 years between representations. Conclusions. Osteoplastic frontal sinus obliteration remains a key surgical treatment for chronic inflammatory frontal sinus disease both as a salvage procedure and first-line surgical therapy.

  6. A virtual instrument ergonomics workstation for measuring the mental workload of performing video-endoscopic surgery.

    Smith, W D; Chung, Y H; Berguer, R


    The visual and physical interface imposed on the surgeon by video-endoscopic surgery (VES) increases the surgeon's mental workload. Ergonomic studies are needed to develop ways to reduce this workload. We used virtual instrumentation to devise a portable ergonomic workstation to compare the surgeon's mental workloads during simulated open surgery and VES. The system measures palmar tonic skin conductance level (SCL) and electrooculogram (EOG) and frontalis electrical activity to monitor mental stress and concentration levels. We used the system at a national surgery conference on volunteer subjects during a rest period and as they performed simulated surgery, consisting of typing knots using open and VES techniques. The subjects were asked to self-rate their levels of mental concentration and stress during these activities and reported that both progressively increased from rest to the open surgery task to the VES task. The subjects tied fewer knots during the VES than the open task, consistent with the increased demands of the VES task. The SCL progressively increased from rest to the open task to the VES task, correlating with the subjects' reported increase in mental stress level. Eye blinks and low frequency EOG activity decreased from rest to the open task, consistent with the subjects' reported increase in mental concentration level. From the open to the VES task, eye blinks and EOG activity increased, as expected given the greater demands of the VES task. High frequency frontalis activity merits further study as another indicator of the subjects' levels of mental concentration and stress.

  7. 鼻内窥镜手术治疗非侵袭性真性上颌窦炎的疗效观察%Curative effect of endoscopic sinus surgery on treatment of non-invasive fungal maxillary sinusitis



    Objective To explore the clinical efficacy of endoscopic sinus surgery on the treatment of non-invasive fangal the maxillary sinusitis. Methods 21 patients with non-invasive fungal maxillary sinusitis patients were given endoscopic sinus surgery. Completely remove of the nasal cavity and sinus disease, fully open, washing si-nusos and give nasal endoscopy on a regular fine. Results Follow-up of 6 months to 4 years,18 cases of cure,1 case of loss of information. 2 case of relapse. Cases of recurrence were cured by endoscopic sinus dressing. Conclusion Endoseopie sinus surgery is an effective measure on trentment of non-invasive fungal maxillary sinuses.%目的 探讨鼻内窥镜手术在治疗非侵袭性真菌性上颌窦炎的临床疗效.方法 对21例非侵袭性真菌性上颌窦炎患者行鼻内窥镜手术.彻底清除鼻腔、鼻窦病灶,充分开放、冲洗鼻窦,并定期行鼻内窥镜检查.结果 随访6个月至4年,治愈18例,失访1例,复发2例.复发病例经鼻内窥镜换药后治愈.结论 鼻内窥镜手术是治疗非侵袭性真菌性上颌窦炎的有效手段.

  8. Endoscopic video-assisted breast surgery: procedures and short-term results.

    Yamashita, Koji; Shimizu, Kazuo


    We devised a new endoscopic operation for breast diseases. We report the aesthetic and treatment results of this procedure. A 2.5-cm axillary skin incision was made for a single approaching port, and a working space was created by retraction. Under video assistance, we resected the mammary gland partially or totally, and in the case of malignant diseases we also performed a sentinel lymph node biopsy and dissected axillary lymph nodes (levels I and II). From December 2001 through April 2005, we performed endoscopic video-assisted breast surgery (VABS) in 100 patients with breast diseases. The diseases were benign in 18 patients and malignant in 82 patients. Of the malignant diseases, 80 underwent breast-conserving surgery and 2 underwent skin-sparing mastectomy. There was no significant difference in operation time, blood loss, or blood examinations related with the acute phase reaction between VABS and conventional breast-conserving procedures. All surgical margins were negative on examination of permanent histological preparations. The wounds healed without noticeable scarring. The original shapes of the breast were preserved. All patients expressed their great satisfaction with VABS. VABS can be considered as a surgical option and can provide aesthetic advantages for patients with breast disease.

  9. Healing results of prolonged acute frontal sinusitis treated with endoscopic sinus surgery.

    Wide, Kristina; Antila, Jukka; Sipilä, Jukka; Suonpää, Jouko; Parkkola, Riitta


    In a marked part of patients suffering from acute frontal sinusitis, the symptoms do not resolve after initial therapy (antibiotics and/or trephination). The prolongation of the healing or recurrences may be caused by persistent inflammation or by structural abnormalities at the nasofrontal connection. During the last decade endoscopic surgery (FES) has become a very useful method to restore the frontonasal drainage although long term results of this kind of population are rare. We evaluated the results of endoscopic surgery in two patient groups (total number of 50) both operated after prolongation (persistent symptoms after 4 weeks) of the initial acute phase of the frontal sinusitis. The first group (A, 15 patients, first trephined) was followed-up 4 years, the number of recurrences after the first FES was 60% and in the other group (B, no initial trephination) with over 6 months follow-up, 91% of patients had recurrences. In group A pre- and postoperative CT-scanning was used to determine the possible anatomical variations that could be causing the failures. All but 3 patients showed some kind of abnormal anatomical variation. In group B only preoperative CT was done. In most cases the reasons for recurrences of frontal sinusitis were polyps and/or chronic inflammation at the ethmoidal region.

  10. Anesthesia for pediatric day-case dental surgery: a study comparing the classic laryngeal mask airway with nasal trachea intubation.

    Zhao, Nan; Deng, Feng; Yu, Cong


    To study sevoflurane inhalation general anesthesia using the laryngeal mask airway (LMA) and nasal endotracheal (ET) intubation to maintain the airway in pediatric day-case dental surgery. A total of 171 children aged 2 to 7 years received elective day-case dental surgical procedure under general anesthesia. Children were randomly grouped into LMA groups (L) and nasal ET intubation group (N). In L groups, LMA was inserted after induction of anesthesia using 8% sevoflurane and were allowed to breathe spontaneously. Rocuronium and remifentanil were given intravenously during 8% sevoflurane induction by nasal ET intubation in the N group . The time of anesthetic induction, maintenance, recovery, surgical access, and bispectral index score were recorded. Postoperative nausea and vomiting and the incidence of adverse events during induction and recovery period were also recorded. The insertion time of LMA was significantly shorter than nasal ET (P index were not different between the 2 groups. However, recovery time was significantly shorter in group L (P < 0.05). The incidence of sore throat and postoperative nausea and vomiting (P < 0.01) were much less in group L as well. Sevoflurane inhalation anesthesia through LMA is a safe and reliable method for pediatric day-case dental surgery.

  11. [Complications of endoscopic nasal and sinus surgery: experience in 150 patients].

    Vargas-Aguayo, Alejandro Martín; Copado-Ceballos, Rosalba Elizabeth; Vivar-Acevedo, Eulalio; Waizel-Haiat, Salomón; Contreras-Herrera, Roxana; Desentis-Vargas, Eduardo


    INTRODUCCIÓN: la cirugía endoscópica de la nariz y senos paranasales ha tenido un gran auge para tratar la patología inflamatoria y tumoral, y para abordar estructuras extrasinusales. Aunque ha demostrado ser un método muy exitoso, no deja de ser motivo de complicaciones. El objetivo de esta investigación fue identificar la frecuencia de complicaciones en los pacientes con patología nasosinusal sometidos a cirugía endoscópica de nariz y senos paranasales. MÉTODOS: se evaluaron 150 pacientes operados por vía endoscópica, 75 mujeres y 75 hombres, en un hospital de especialidades del Instituto Mexicano del Seguro Social. Se registró tipo de patología, tipo de cirugía endoscópica realizada y sus complicaciones mayores y menores.

  12. In-Hospital Nonvariceal Upper Gastrointestinal Bleeding following Cardiac Surgery: Patient Characteristics, Endoscopic Lesions and Prognosis

    Marcos Amorim


    Full Text Available Background. Nonvariceal upper gastrointestinal bleeding (NVUGIB can occur following cardiac surgery, with sparse contemporary data on patient characteristics and predictors of outcome in this setting. Aim. To describe the clinical and endoscopic characteristics of patients with NVUGIB following cardiac surgery and characterize predictors of outcome. Methods. Retrospective review of 131 consecutive patients with NVUGIB following cardiac surgery from 2002 to 2005. Demographic characteristics, therapeutic management, and predictors of outcomes were determined. Results. 69.5% were male, mean age: 68.8 ± 10.2 yrs, mean Parsonnet score: 24.6 ± 14.2. Commonest symptoms included melena (59.4% or coffee ground emesis (25.8%. In-hospital medications included ASA (88.5%, heparin (95.4%, low molecular weight 6.9%, coumadin (48.1%, clopidogrel (22.9%, and NSAIDS (42%. Initial hemodynamic instability was noted in 47.1%. Associated laboratory results included hematocrit 26 ± 6, platelets 243 ± 133 109/L, INR 1.7 ± 1.6, and PTT 53.3 ± 35.6 s. Endoscopic evaluation (122 patients yielded ulcers (85.5% with high-risk lesions in 45.5%. Ulcers were located principally in the stomach (22.5% or duodenum (45.9%. Many patients had more than one lesion, including esophagitis (28.7% or erosions (26.8%. 48.8% received endoscopic therapy. Mean lengths of intensive care unit and overall stays were 10.4 ± 18.4 and 39.4 ± 46.9 days, respectively. Overall mortality was 19.1%. Only mechanical ventilation under 48 hours predicted mortality (O.R = 0.11; 95% CI = 0.04−0.34. Conclusions. This contemporary cohort of consecutive patients with NVUGIB following cardiac surgery bled most often from ulcers or esophagitis; many had multiple lesions. ICU and total hospital stays as well as mortality were significant. Mechanical ventilation for under 48 hours was associated with improved survival.

  13. [Shifting paradigm in skull base surgery: Roots, current state of the art and future trends of endonasal endoscopic approaches].

    Berhouma, M; Messerer, M; Jouanneau, E


    During the last two decades, endoscopic endonasal approach has completed the minimally invasive skull base surgery armamentarium. Endoscopic endonasal skull base surgery (EESBS) was initially developed in the field of pituitary adenomas, and gained an increasing place for the treatment of a wide variety of skull base pathologies, extending on the midline from crista galli process to the occipitocervical junction and laterally to the parasellar areas and petroclival apex. Until now, most studies are retrospective and lack sufficient methodological quality to confirm whether the endoscopic endonasal pituitary surgery has better results than the microsurgical trans-sphenoidal classical approach. The impressions of the expert teams show a trend toward better results for some pituitary adenomas with the endoscopic endonasal route, in terms of gross total resection rate and probably more comfortable postoperative course for the patient. Excepting intra- and suprasellar pituitary adenomas, EESBS seems useful for selected lesions extending onto the cavernous sinus and Meckel's cave but also for clival pathologies. Nevertheless, this infatuation toward endoscopic endonasal approaches has to be balanced with the critical issue of cerebrospinal fluid leaks, which constitutes actually the main limit of this approach. Through their experience and a review of the literature, the authors aim to present the state of the art of this approach as well as its limits.

  14. 鼻内镜下手术治疗真菌性鼻-鼻窦炎60例%The Clinical Observation of the 60 cases of fungal rhinosinusitis through the endoscopic sinus surgery

    邵渊; 白艳霞; 赵谦


    Objective: To discuss the endoscopic sinus surgery effect of the fungal rhinosinusitis and observe the clinical treating effect. Methods: Through the retrospective analysis of the 60 fungal rhinosinusitis patients cases who undergo the nasal endoscopic surgery,to discuss the operating methods、treating effect and results of the post operation follow-up. Result:The 60 cases of the fungal rhinosinusitis patients all be fully treated,without the obvious operating complication occurred,through the follow-up for 6 months to 2 year,l case recurred. Conclusion: the edema of the nasal cavity and nasal sinus mucous membrane that lead to local drainage dysfunction keep closely relationship with the occurrence of fungal rhinosinusitis, the nasal endoscopic sinus surgery is a kind of effective method for the treatment of it. Totally clean the local fungal tissue and maintain fluent drainage after the operation are the important factor for the treatment and transition of the fungal rhinosinusitis.%目的:探讨鼻内窥镜治疗真菌性鼻-鼻窦炎手术方法及临床疗效的观察.方法:对60例接受鼻内窥镜手术治疗的真菌性鼻-鼻窦炎患者的临床资料进行回顾性分析,探讨手术方式、手术疗效及术后随访结果.结果:60例真菌性鼻-鼻窦炎患者经手术治疗均获得临床治愈,无明显手术并发症,随访6个月至2年,1例复发.结论:鼻腔鼻窦粘膜肿胀造成的局部引流障碍与真菌性鼻-鼻窦炎的发生密切相关,鼻内镜手术是治疗真菌性鼻-鼻窦炎的有效方法,彻底清除病变及术后鼻窦引流通畅是影响疗效及转归的重要因素.

  15. Outcome of Endoscopic Sinus Surgery in the Treatment of Chronic Rhinosinusitis.

    Rahman, T; Alam, M M; Ahmed, S; Karim, M A; Rahman, M; Wahiduzzaman, M


    This prospective study was conducted to compare the outcome of endoscopic sinus surgery (ESS) using SNOT-20 score chart (subjective) and Lund & Kennedy scoring chart (objective) and carried out in the Department of Otolaryngology & Head-Neck Surgery, Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, Dhaka Medical College Hospital (DMCH) & Shaheed Suhrawardy Medical College Hospital (ShSMCH) from July 2010 to March 2012. Total 73 admitted cases were selected purposively for ESS, male 53(72.60%) and female 20(27.40%). Among the study participants 10(13.7%) had chronic rhinosinusitis with bilateral polyposis and 26(35.62%) had chronic rhinosinusitis with unilateral polyposis and 12(16.44%) had bilateral chronic rhinosinusitis without polyposis and 25(34.25%) had unilateral chronic rhinosinusitis without polyposis. Surgical procedures done among the patients were Uncinectomy (infundibulectomy), Middle Meatal Antrostomy; Anterior Ethmoidectomy; Sphenoidotomy, Associated septoplasty and no significant per or post operative complications were noted. In Chronic rhinosinusitis (CRS) with polyposis pre operative SNOT-20 mean and SD 1.322±0.341 and post ESS snot-20 mean and SD 0.3472±0.0755, CRS without polyposis pre operative SNOT-20 mean and SD 0.9297±0.86 and post ESS SNOT-20 mean and SD 1986±0.0558. In CRS with polyposis pre operative Lund & Kennedy score of endoscopic assessment, mean and SD 5.333±2.255 and post ESS mean and SD 1.31±1.009. In CRS without polyposis pre op Lund & Kennedy score mean and SD 3.108±1.074 and post ESS mean and SD 0.76±0.641.Post ESS SNOT-20 in CRS with Polyposis, 't' test result was 27.58 which was significant (ptreatment of CRS with or without polyposis had statistically significant role. Symptomatic relief and quality of life improvement after ESS was compared by improvement in post operative scores of SNOT-20 & Lund-Kennedy score of endoscopic assessment. Post operative lower values were considered to be better improvement

  16. Comparison of Isoflurane and Sevoflurane for Controlled Hypotension in Endoscopic Sinus Surgeries and Tympanomastoidectomy

    B. Yazdi


    Full Text Available Introduction & Objective: Even a little bleeding can adversely affect the surgeon's ability to visualize the region to be operated in ENT operations. The aim of this study is to compare the effects of isoflurane and sevoflurane on hemodynamics and bleeding in controlled hypoten-sion. Materials & Methods: This study was a double-blind clinical trial. Ninety patients who were candidates for endoscopic sinus surgery and tympanomastoidectomy in Amirkabir hospital of Arak were randomly assigned into two groups of isoflurane and sevoflurane. Remifentanil was infused at 0.1 µg/kg/min for both groups during surgery and the amount of bleeding and hemodynamic parameter were recorded. The data was analyzed by SPSS-20 and ANOVA statistical test. Results: Underlying and hemodynamic variables were similar between the two groups preop-eratively. The amount of blood loss during surgery showed that there were no significant dif-ferences between the two groups (P=0.802 and no significant differences in hemodynamic variables (heart rate, systolic/diastolic blood pressure and arterial oxygen saturation were observed between the two groups during the surgery. Conclusion: It is concluded that there is no difference between sevoflurane and isoflurane in controlled hypotension. Thus, using these drugs in operations with excessive bleeding is rec-ommended. (Sci J Hamadan Univ Med Sci 2014; 21(2:85-91

  17. Nasal chondromesenchymal hamartoma with no nasal symptoms.

    Uzomefuna, Vincent


    The authors present a case of nasal chondromesenchymal hamartoma (NCMH) in an 8-year-old boy with a 4-month history of frontal headache and no symptoms of nasal obstruction, rhinorrhoea or postnasal drip. An ENT examination as well as ophthalmology assessment presented normal results. CT scan showed a lesion involving the sphenoid and ethmoid sinuses. The patient had an endoscopic resection of the lesion that was confirmed histologically to be a NCMH. Though NCMH is known to present usually in infants with obstructing nasal mass, an unusual presentation of a patient with throbbing headache without any nasal symptoms is reported here.

  18. Evaluation of modified nasal to oral endotracheal tube switch-For modified alar base cinching after maxillary orthognathic surgery.

    Shaik, Taj Nizam Shakeel; Meka, Sridhar; Ch, Pavan Kumar; Kolli, Naga Neelima Devi; Chakravarthi, P Srinivas; Kattimani, Vivekanand S; L, Krishna Prasad


    Soft tissue changes secondary to Maxillary orthognathic surgery are many fold. The alar flare is one among them, which affects the appearance of the patient. Cinch suture has been used to prevent alar flare; but the presence of anaesthetic tube hinders cinching. So, the study was aimed to assess an efficacy of modified nasal to oral tube switch technique for modified alar cinching to prevent alar flare after orthognathic and nasal corrective surgeries. Patients were randomly allocated in each group, who underwent modified alar base cinching with and without nasal to oral tube switch. Changes in alar base width, upper lip length was measured with Digital Vernier Caliper and nasolabial angle (Cotg-Sn-Ls) on lateral cephalogram at 1st, 3rd, 6th, and 12th months after surgery. The time taken and ease of tube switch were noted. The data obtained were tabulated and interpreted using a test of significance. Study results showed no statistical significant difference in perinasal soft changes among both groups. But tube switch appears to be beneficial to prevent alar flare. Modified alar base cinching was performed effectively in patients with a modified tube switch technique. It increased positive results in comparison with non-shift. The technique of tube switch used is effective in prevention of alar flare. Because of small sample size and limited period of follow up, our study suggests multi centre, randomized studies to know the technical difficulties of tube switch for cinching and aesthetic results with varying anaesthetist and the surgeon's experience.

  19. Impact of Mucosal Eosinophilia and Nasal Polyposis on Quality of Life Outcomes after Sinus Surgery

    Soler, Zachary M.; Sauer, David; Mace, Jess; Smith, Timothy L.


    Objective Assess whether the presence of mucosal eosinophilia correlates with surgical outcomes in patients with chronic rhinosinusitis. Study Design Prospective cohort Setting Tertiary medical center Subjects and Methods Adult patients with chronic rhinosinusitis were prospectively enrolled and demographic data and medical comorbidities recorded. Preoperative quality-of-life (QOL) was measured by the Chronic Sinusitis Survey (CSS), Rhinosinusitis Disability Index (RSDI), and Short Form-36 General Health Survey (SF-36). Sinus mucosal specimens were collected at the time of surgery and the degree of eosinophilia quantified. Postoperative QOL was measured and differences in QOL improvement were compared between those with and without eosinophilia. Results A total of 102 patients had both histopathologic and QOL outcome data available for review. Follow-up averaged 16.5 months. Patients with eosinophilia showed significantly less improvement in the RSDI total (17.9 vs 25.0; p=0.044), RSDI functional (5.7 vs 8.8; p=0.018), CSS medication (3.6 vs 17.3; p=0.013), SF-36 general health (0.6 vs 9.6; p=0.008), SF-36 physical role (16.1 vs 34.7; p=0.036), and SF-36 vitality (11.9 vs 21.2; p=0.034) scales than those without eosinophilia. The greatest improvement in QOL was seen in patients without eosinophilia or polyps and the least improvement seen in those with eosinophilia but without polyps. Conclusion The presence of mucosal eosinophilia at the time of surgery consistently predicted less improvement in both disease-specific and general QOL compared to those without eosinophilia. The impact of eosinophilia on outcomes was greatest for patients without nasal polyposis, a group which demonstrated the least improvement in QOL measures. PMID:20096225

  20. Pure natural orifice transluminal endoscopic surgery (NOTES) with ultrasonography-guided transgastric access and over-the-scope-clip closure

    Donatsky, Anders Meller; Andersen, Luise; Nielsen, Ole Lerberg


    Most natural orifice transluminal endoscopic surgery (NOTES) procedures to date rely on the hybrid technique with simultaneous laparoscopic access to protect against access-related complications and to achieve adequate triangulation for dissection. This is done at the cost of the potential benefits...

  1. Percutaneous endoscopic gastrojejunostomy for a patient with an intractable small bowel injury after repeat surgeries: a case report

    Takeyama Hiromitsu; Takayama Satoru; Hara Masayasu


    Abstract Introduction The management of intestinal injury can be challenging, because of the intractable nature of the condition. Surgical treatment for patients with severe adhesions sometimes results in further intestinal injury. We report a conservative management strategy using percutaneous endoscopic gastrojejunostomy for an intractable small bowel surgical injury after repeated surgeries. Case presentation A 78-year-old Japanese woman had undergone several abdominal surgeries including ...

  2. Endoscopic carpal tunnel release surgery: retrospective study of 390 consecutive cases.

    Quaglietta, P; Corriero, G


    Endoscopic carpal tunnel release (ECTR) surgery was developed by Okutsu and Chow in 1989. Many reports indicated that the endoscopic technique reduces postoperative morbidity with minimal incision, minimal pain and scarring, a shortened recovery period and high level of patient satisfaction. To evaluate these reports, a retrospective study was conducted with 390 procedures of two-portal Chow technique for idiopathic carpal tunnel syndrome. Follow-up was performed at 1, 3 and 6 months and overall results were backed up by telephone questionnaire (Health Outcomes Carpal Tunnel Questionnaire, Health Outcomes, Bloomington, MN, USA). Results were favourable in 98% and 2% unfavorable for persistent pain. Rate of satisfaction of the patients was 90%. Average time of patient's return to work was 20 days. Eleven procedures (2.8%) were converted to open release. There was one case (0.2%) of incompleted section of the perineurium due to failure of endoscopic visualization of the ligament. In this case the procedure was converted to open and was completed with perineurium sutura. In six cases (1.5%) there were injury to superficial palmar arch. During the follow-up period there were no recurrences and no re-exploration. The mean preoperatively obtainable distal motor latency (DML) and sensory conduction velocity (SCV) values were 6.7 m/s and 29.2 m/s, respectively. The mean DML and SVC values at final follow-up were 3.8 msec and 42.3 m/s, respectively. In conclusion, ECTR can be used in the carpal tunnel syndrome and is a reliable alternative to the open procedure with excellent self-report of patient satisfaction. Reduced recovery period with minimal tissue violation and incisional pain can be expected.

  3. First intraoperative experience with three-dimensional (3D) high-definition (HD) nasal endoscopy for lacrimal surgeries.

    Ali, Mohammad Javed; Naik, Milind N


    The aim of this study is to report our preliminary experiences with regard to safety and feasibility of three-dimensional (3D) endoscopic lacrimal surgeries with a recently launched latest generation 3D endoscope. A 4-mm rigid three-dimensional (3D) endoscope (TIPCAM 1S 3D ORL(R), Karl Storz, Tuttlingen, Germany) was used. Fifteen patients who underwent various endoscopic lacrimal procedures by a single surgeon (MJA) were included. The procedures included probing with nasolacrimal intubation, cruciate marsupialization of intranasal cysts for congenital dacryoceles, powered endoscopic dacryocystorhinostomy, post-operative stent removal with ostium granuloma excision. The implementation, visualization, optical performance, ease of tissue handling and complications were noted. Ten surgical observers filled a questionnaire to rate their experiences. Enhanced depth perception was found to be very beneficial intraoperatively. Greater anatomical delineation facilitated improved hand-eye coordination and dexterity. Intraoperative assessment and handling of tissues and surgical manoeuvring were precise and did not require the additional spatial cues that the surgeon derives from a two-dimensional image. These benefits were more appreciated in the complex cases. The setup was easy on previous endoscopic platforms and did not consume any additional time. All the surgical procedures were completed successfully without any complications. The surgical observers unanimously noted enhanced anatomical understanding and surgical learning as compared to the routine 2D planes. Operating in 3D planes enhances depth perception, dexterity and precision. Although initial results are promising, further randomized studies with head-on comparisons between 3D and 2D would help formulate specific guidelines.

  4. Indications of percutaneous endoscopic spine surgery be controlled strictly%严格掌握经皮脊柱内镜技术的手术指征

    杨惠林; 孟斌; 吴凯伦


    Percutaneous endoscopic spine surgery differs from other minimally invasive spinal techniques because of use of the spinal endoscope. With the development and improvement of endoscopic optical technology, endoscopic surgical techniques and instrumentation, central, paracentral, foraminal and far lateral lumbar disc herniation can now be treated by endoscopic techniques. Endoscopic systems are also used for posterior interlaminar lumbar decompression, anterior and posterior cervical discectomy. Some unilevel lumbar stenosis may be treated by the endoscopic techniques as well. Although the surgical indications for endoscopic techniques are evolving, there are many potential complications, such as nerve root injury, durotomy, infection, retro-peritoneal cavity injury, cauda equine injury, great vessel injury, muscular hematoma, re-herniation, piriformis syndrome, and/or epidural hematoma. So, the endoscopic spine surgery can only be practiced after the completion of learning curve which could be improved through training, mentorship and clinic surgical experience. Surgical training, including didactic lectures, hands on cadaveric training, and surgical observation, should all be essential for surgical education and instruction. Appropriate preoperative planning and strictly controlled indications of percutaneous endoscopic spine surgery are necessary and important for optimal outcomes.

  5. Case of Superficial Cancer Located at the Pharyngoesophageal Junction Which Was Dissected by Endoscopic Laryngopharyngeal Surgery Combined with Endoscopic Submucosal Dissection

    Kawano, Tatsuyuki; Sugimoto, Taro; Yamaguchi, Kazuya; Kawamura, Yuudai; Matsui, Toshihiro; Okuda, Masafumi; Ogo, Taichi; Kume, Yuuichiro; Nakajima, Yutaka; Mora, Andres; Okada, Takuya; Hoshino, Akihiro; Tokairin, Yutaka; Nakajima, Yasuaki; Okada, Ryuhei; Kiyokawa, Yusuke; Nomura, Fuminori; Asakage, Takahiro; Shimoda, Ryo; Ito, Takashi


    Aims. In order to determine the indications of transoral surgery for a tumor located at the pharyngoesophageal junction, the trumpet maneuver with transnasal endoscopy was used. Its efficacy is reported here. Material and Methods. An 88-year-old woman complaining of dysphagia, diagnosed with cervical esophageal cancer, and hoping to preserve her voice and swallowing function was admitted to our hospital. Conventional endoscopy showed that the tumor had invaded the hypopharynx. When inspecting the hypopharynx and the orifice of the esophagus, we asked the patient to blow hard and puff her cheeks with her mouth closed (trumpet maneuver). After the trumpet maneuver, the pharyngeal mucosa was stretched out. The pedicle of the tumor arose from the left-anterior wall of the pharyngoesophageal junction, so we decided to perform endoscopic resection. Result. Under general anesthesia, the curved laryngoscope made it possible to view the whole hypopharynx, including the apex of the piriform sinus and the orifice of the esophagus. The cervical esophageal cancer was pulled up to the hypopharynx. Under collaboration between a head and neck surgeon and an endoscopist, the tumor was resected en bloc by endoscopic laryngopharyngeal surgery combined with endoscopic submucosal dissection. Conclusion. Transnasal endoscopy using the trumpet maneuver is useful for a precise diagnosis of the pharyngoesophageal junction. Close collaboration between head and neck surgeons and endoscopists can provide good results in treating tumors of the pharyngoesophageal junction. PMID:28154766

  6. Estapedotomia totalmente endoscópica: técnica e resultados preliminares Fully endoscopic stapes surgery (stapedotomy: technique and preliminary results

    João Flávio Nogueira Júnior


    Full Text Available Estapedotomias são realizadas atualmente com o auxílio de microscópios cirúrgicos. Entretanto, o uso do microscópio possui algumas limitações, podendo causar algumas complicações, como lesão no nervo corda do tímpano. Há poucos casos e nenhuma série publicada sobre a utilização de endoscópios nasossinusais na realização de estapedotomias. OBJETIVOS: a Investigar o uso do endoscópio nasossinusal em estapedotomias, com foco na visualização de estruturas importantes. b Mostrar os resultados iniciais, discutindo as possíveis vantagens e desvantagens deste instrumento. METODOLOGIA: 15 pacientes com otosclerose foram selecionados para realizar estapedotomias em 2010. Os dados e vídeo cirúrgico foram analisados retrospectivamente (estudo de série de casos. As condições anatômicas do nicho da janela oval e passos cirúrgicos foram descritos para avaliar possíveis benefícios do procedimento endoscópico. RESULTADOS: As cirurgias foram realizadas exclusivamente com endoscópios e todas as estruturas com relevância anatômica, visualizadas sem maiores dificuldades. Nenhuma complicação foi observada e 14 dos 15 pacientes referiram melhora auditiva, confirmada com exames audiológicos pós-operatórios. CONCLUSÃO: Estapedotomias totalmente endoscópicas são tecnicamente viáveis, seguras e promissoras. Nesta pequena série as principais vantagens foram: praticamente nenhum trauma no nervo corda do tímpano e excelente campo de visão. As desvantagens foram falta de visão estereoscópica, trabalho unimanual e curva de aprendizado.Stapedotomies are perfomed with the aid of surgical microscopes. However, the microscope has some limitations and may cause complications such as damage to the chorda tympani nerve. There are just a few cases and no series published on the use of sino-nasal endoscopes in stapedotomies. OBJECTIVES: a To investigate the feasibility of using sino-nasal endoscopes in stapedotomies, focusing on the

  7. Development of miniaturized light endoscope-holder robot for laparoscopic surgery

    Long, Jean-Alexandre; Troccaz, Jocelyne; Voros, Sandrine; Descotes, Jean-Luc; Berkelman, Peter; Letoublon, Christian; Rambeaud, Jean-Jacques


    PURPOSE: We have conducted experiments with an innovatively designed robot endoscope holder for laparoscopic surgery that is small and low cost. MATERIALS AND METHODS: A compact light endoscope robot (LER) that is placed on the patient's skin and can be used with the patient in the lateral or dorsal supine position was tested on cadavers and laboratory pigs in order to allow successive modifications. The current control system is based on voice recognition. The range of vision is 360 degrees with an angle of 160 degrees . Twenty-three procedures were performed. RESULTS: The tests made it possible to advance the prototype on a variety of aspects, including reliability, steadiness, ergonomics, and dimensions. The ease of installation of the robot, which takes only 5 minutes, and the easy handling made it possible for 21 of the 23 procedures to be performed without an assistant. CONCLUSION: The LER is a camera holder guided by the surgeon's voice that can eliminate the need for an assistant during laparoscopic s...

  8. A review on the status of natural orifice transluminal endoscopic surgery (NOTES cholecystectomy: techniques and challenges

    Michael C Meadows


    Full Text Available Michael C Meadows1,3, Ronald S Chamberlain1,2,31Department of Surgery, Saint Barnabas Medical Center, Livingston, NJ, USA; 2Department of Surgery, University of Medicine and Dentistry of New Jersey, Newark, NJ, USA; 3Saint George’s University, School of Medicine, West Indies, GrenadaIntroduction: The evolution of techniques for the performance of a cholecystectomy over the last 25 years has been swift. The laparoscopic approach is now the gold standard for removal of the gall bladder and is the most frequently performed minimally invasive procedure globally. Currently in its infancy stage, natural orifice transluminal endoscopy surgery, or NOTES, is purported to be the next leap forward in minimally invasive approaches. The safety, feasibility, and effectiveness of this procedure, as well as the significance of potential benefits to patients beyond current surgical approaches are yet undetermined.Methods: A comprehensive literature search was conducted using PubMed, a search engine ­created by the National Library of Medicine. Keywords used in the search included “natural orifice transluminal endoscopic surgery”, “NOTES”, “cholecystectomy”, “transcolonic”, “transvaginal”, and “transgastric”. The accumulated literature was critically analyzed and reviewed.Results: One-hundred and eighty-six cases of NOTES cholecystectomies have been published to date. Of these, 174 have been performed through a transvaginal approach. The remainder of the procedures were performed transgastrically. There are no published reports of ­transcolonic cholecystectomies performed in humans. Four of 186 cases (2.15% were converted to traditional laparoscopy due to intraoperative complications. No significant complications or mortalities have been reported.Conclusion: NOTES cholecystectomy appears to be a feasible procedure. However, technical, safety, and ethical issues remain relatively unresolved. Besides improved cosmesis, whether additional

  9. Endoscopic extraction of adjustable gastric bands after intragastric migration as a complication of bariatric surgery: technique and advice

    Collado-Pacheco, David; Rábago-Torre, Luis Ramon; Arias-Rivera, Maria; Ortega-Carbonel, Alejandro; Olivares-Valles, Ana; Alonso-Prada, Alicia; Vázquez-Echarri, Jaime; Herrera-Merino, Norberto


    Background: Surgery has been the method most widely used to manage the extraction of gastric bands with inclusion as a late complication of bariatric surgery; however, surgical extraction entails morbidity and limits future surgical procedures. The development of endoscopic techniques has provided an important means of improving the treatment of this complication, enabling minimally invasive and safe procedures that have a high success rate. Methods: A retrospective analysis was conducted of patients who had laparoscopic gastric banding complicated by intragastric migration and were treated endoscopically. A technique already described for managing this complication was employed. An MTW Endoskopie Dormia basket for mechanical lithotripsy or a standard 0.0035-in guidewire was placed around the band, and an MTW Endoskopie emergency lithotripter was used to section it, after which the band was extracted with a standard polypectomy snare. Also analyzed were the initial symptoms of patients with this complication, the mean time from surgery to development of the event, the success rate of endoscopic treatment, and complications, Results: A total of 127 patients had undergone gastric banding surgery in our Bariatric Surgery Center; of these, 12 patients (9.4 %) developed a complication such as intragastric migration of the band. Weight gain and pain were the main symptoms in 11 patients (92 %), and the mean time to the development of symptoms was 51.3 months. A single endoscopic treatment was successful in 7 of 9 patients (78 %). Only 1 complication, involving ventilation during anesthesia, occurred; no other adverse events were recorded. Conclusions: The endoscopic extraction of bands with inclusion is feasible and can be performed easily and successfully. The procedure is available in all hospitals and has a low incidence of related complications, so that unnecessary surgical procedures can be avoided. PMID:27556077

  10. The Epidemiological and Clinical Aspects of Nasal Polyps that Require Surgery

    Ahmad Meymane Jahromi


    Full Text Available Introduction: The objective of this retrospective cross-sectional study was to obtain epidemiological data from the charts of 297 patients with nasal polyposis who were operated on in a referral hospital in Mashhad and to determine the frequency of the presenting symptoms of nasal polyps.  Materials and Methods: The variables recorded included age, gender, the presence of asthma or allergic rhinitis, family history, and previous treatments. We studied the main symptoms of nasal polyposis (nasal obstruction, rhinorrhea, anosmia, headache, epistaxis, snoring, and so on, as well as ear problems and facial deformity.  Results: Nasal polyposis affects men (60.3% more frequently, at a mean age of 39.5 years. The most frequent symptom was nasal blockage (81.1 % followed by rhinorrhea (37.7%. A total of 11.1% of the patients had a history of epistaxis. Asthma was found in 10.4% of patients with nasal polyposis and the ears were affected in 5.1% of patients. In all, 7.4% of patients had first-degree relatives who suffered from asthma or allergic rhinitis.  Conclusion: This study highlights the need for large-scale epidemiologic research exploring the prevalence and incidence of nasal polyposis in Iran.

  11. Results of the open surgery after endoscopic basketimpaction during ERCP procedure

    Sezgin Yilmaz; Ogun Ersen; Taner Ozkececi; Kadir S Turel; Serdar Kokulu; Emre Kacar; Murat Akici; Murat Cilekar; Ozgur Kavak; Yuksel Arikan


    AIM: To report the results of open surgery for patientswith basket impaction during endoscopic retrogradecholangiopancreatography (ERCP) procedure.METHODS: Basket impaction of either classicalDormia basket or mechanical lithotripter basket with anentrapped stone occurred in six patients. These patientswere immediately operated for removal of stone(s) andimpacted basket. The postoperative course, length ofhospital stay, diameter of the stone, complication andthe surgical procedure of the patients were reportedretrospectively.RESULTS: Six patients (M/F, 0/6) were operateddue to impacted basket during ERCP procedure. Themean age of the patients was 64.33 ± 14.41 years.In all cases the surgery was performed immediatelyafter the failed ERCP procedure by making a right Yilmaz S et al . Surgery for basket impaction during ERCP subcostal incision. The baskets containing the stone were removed through longitudinal choledochotomy with the stone. The choledochotomy incisions were closed by primary closure in four patients and T tube placement in two patients. All patients were also performed cholecystectomy additionally since they had cholelithiasis. In patients with T-tube placement it was removed on the 13th day after a normal T-tube cholangiogram. The patients remained stable at postoperative period and discharged without any complication at median 7 d. CONCLUSION: Open surgical procedures can be applied in patients with basket impaction during ERCP procedure in selected cases.




    Full Text Available BACKGROUND Clonidine an ideal agent for hypotensive anaesthesia, also attenuates stress response to laryngoscopy, decreases requirement of inhalational anaesthetic agents, decreases postoperative analgesic requirements, prevents post-operative shivering. MATERIAL AND METHODS 60 patients under 16-60 years age group posted for functional endoscopic sinus surgery (FESS were randomly divided into 2 groups of 30 each. Placebo group (Group P received 20 mL normal saline intravenously and Clonidine group (Group C received 2.5 micrograms Clonidine per kilogram body weight in 20 mL saline intravenously 20 mins before surgery. Haemodynamic variability during surgery, intraoperative inhalational agent requirement and perioperative bleeding as assessed by surgeon, postoperative analgesic requirement and post-operative shivering were compared between two groups. RESULTS There was statistically significant reduction in heart rate, systolic blood pressure, diastolic blood pressure and mean blood pressure in Group C compared to Group P. There was statistically significant decrease in requirement of Isoflurane, decreased bleeding from surgical site, decreased analgesic consumption and nil incidence of postoperative shivering in Group C compared to Group P. CONCLUSION Clonidine is an ideal agent for hypotensive anaesthesia as it has got other favourable effects along with controlled hypotension, as it was observed in this study

  13. VIRGY: a virtual reality and force feedback based endoscopic surgery simulator.

    Baur, C; Guzzoni, D; Georg, O


    This paper describes the VIRGY project at the VRAI Group (Virtual Reality and Active Interface), Swiss Federal Institute of Technology (Lausanne, Switzerland). Since 1994, we have been investigating a variety of virtual-reality based methods for simulating laparoscopic surgery procedures. Our goal is to develop an endoscopic surgical training tool which realistically simulates the interactions between one or more surgical instruments and gastrointestinal organs. To support real-time interaction and manipulation between instruments and organs, we have developed several novel graphic simulation techniques. In particular, we are using live video texturing to achieve dynamic effects such as bleeding or vaporization of fatty tissues. Special texture manipulations allows us to generate pulsing objects while minimizing processor load. Additionally, we have created a new surface deformation algorithm which enables real-time deformations under external constraints. Lastly, we have developed a new 3D object definition which allows us to perform operations such as total or partial object cuttings, as well as to selectively render objects with different levels of detail. To provide realistic physical simulation of the forces and torques on surgical instruments encountered during an operation, we have also designed a new haptic device dedicated to endososcopic surgery constraints. We are using special interpolation and extrapolation techniques to integrate our 25 Hz visual simulation with the 300 Hz feedback required for realistic tactile interaction. The fully VIRGY simulator has been tested by surgeons and the quality of both our visual and haptic simulation has been judged sufficient for training basic surgery gestures.

  14. 3D-printed pediatric endoscopic ear surgery simulator for surgical training.

    Barber, Samuel R; Kozin, Elliott D; Dedmon, Matthew; Lin, Brian M; Lee, Kyuwon; Sinha, Sumi; Black, Nicole; Remenschneider, Aaron K; Lee, Daniel J


    Surgical simulators are designed to improve operative skills and patient safety. Transcanal Endoscopic Ear Surgery (TEES) is a relatively new surgical approach with a slow learning curve due to one-handed dissection. A reusable and customizable 3-dimensional (3D)-printed endoscopic ear surgery simulator may facilitate the development of surgical skills with high fidelity and low cost. Herein, we aim to design, fabricate, and test a low-cost and reusable 3D-printed TEES simulator. The TEES simulator was designed in computer-aided design (CAD) software using anatomic measurements taken from anthropometric studies. Cross sections from external auditory canal samples were traced as vectors and serially combined into a mesh construct. A modified tympanic cavity with a modular testing platform for simulator tasks was incorporated. Components were fabricated using calcium sulfate hemihydrate powder and multiple colored infiltrants via a commercial inkjet 3D-printing service. All components of a left-sided ear were printed to scale. Six right-handed trainees completed three trials each. Mean trial time (n = 3) ranged from 23.03 to 62.77 s using the dominant hand for all dissection. Statistically significant differences between first and last completion time with the dominant hand (p < 0.05) and average completion time for junior and senior residents (p < 0.05) suggest construct validity. A 3D-printed simulator is feasible for TEES simulation. Otolaryngology training programs with access to a 3D printer may readily fabricate a TEES simulator, resulting in inexpensive yet high-fidelity surgical simulation. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

  15. Nasal Physiology

    ... Caregivers Contact ARS HOME ANATOMY Nasal Anatomy Sinus Anatomy Nasal Physiology Nasal Endoscopy Skull Base Anatomy Virtual Anatomy Disclosure ... Patient Education About this Website Font Size + - Home > ANATOMY > Nasal Physiology Nasal Anatomy Sinus Anatomy Nasal Physiology Nasal Endoscopy ...

  16. Nasal Anatomy

    ... Caregivers Contact ARS HOME ANATOMY Nasal Anatomy Sinus Anatomy Nasal Physiology Nasal Endoscopy Skull Base Anatomy Virtual Anatomy Disclosure ... Size + - Home > ANATOMY > Nasal Anatomy Nasal Anatomy Sinus Anatomy Nasal Physiology Nasal Endoscopy Skull Base Anatomy Virtual Anatomy Disclosure ...

  17. Endoscopic closure instead of surgery to close an ileal pouch fistula with the over-the-scope clip system

    Wei, Yao; Gong, Jian-Feng; Zhu, Wei-Ming


    An ileal pouch fistula is an uncommon complication after an ileal pouch anal anastomosis. Most patients who suffer from an ileal pouch fistula will need surgical intervention. However, the surgery can be invasive and has a high risk compared to endoscopic treatment. The over-the-scope clip (OTSC) system was initially developed for hemostasis and leakage closure in the gastrointestinal tract during flexible endoscopy. There have been many successes in using this approach to apply perforations to the upper gastrointestinal tract. However, this approach has not been used for ileal pouch fistulas until currently. In this report, we describe one patient who suffered a leak from the tip of the “J” pouch and was successfully treated with endoscopic closure via the OTSC system. A 26-year-old male patient had an intestinal fistula at the tip of the “J” pouch after an ileal pouch anal anastomosis procedure. He received endoscopic treatment via OTSC under intravenous anesthesia, and the leak was closed successfully. Endoscopic closure of a pouch fistula could be a simpler alternative to surgery and could help avoid surgery-related complications. PMID:28250903

  18. Comparison of Esmolol to Nitroglycerine in Controlling Hypotension During Nasal Surgery

    Guney, Ayla; Kaya, Fatma Nur; Yavascaoglu, Belgin; Gurbet, Alp; Selmi, Nazan Has; Kaya, Sener; Kutlay, Oya


    Objective: The aim of this study was to compare esmolol to nitroglycerine in terms of effectiveness in controlling hypotension during nasal surgery. Materials and Methods: After approval by our institutional Ethics Committee, 40 patients were recruited and randomized into two drug groups: esmolol (Group E) and nitroglycerine (Group N). In group E, a bolus dose of 500 μg/kg esmolol was administered over 30 sec followed by continuous administration at a dose of 25–300 μg/ kg/min to maintain systolic arterial pressure at 80 mmHg. In group N, nitroglycerine was administered at a dose of 0.5–2 μg/kg/min. Results: During the hypotensive period, systolic arterial pressure, diastolic arterial pressure, mean arterial pressure, and heart rate were decreased 24%, 33%, 27% and 35%, respectively, in group E (p<0.001, p<0.001, p<0.001, p<0.001) and were decreased 30%, 33%, 34% and 23%, respectively, in group N (p<0.001, p<0.001, p<0.001, p<0.001). The decrease in heart rate was higher in group E during the hypotensive period (p=0.048). During the recovery period, diastolic arterial pressure and heart rate were decreased 9% and 18%, respectively, in group E (p=0.044, p<0.001). Systolic arterial pressure, diastolic arterial pressure, and mean arterial pressure were decreased 7%, 3% and 7%, respectively, in group N (p=0.049, p=0.451, p=0.045). Conclusion: Esmolol provides hemodynamic stability and good surgical field visibility and should be considered as an alternative to nitroglycerine. PMID:25610218

  19. Comparison between magnesium sulfate and dexmedetomidine in controlled hypotension during functional endoscopic sinus surgery

    Adnan Bayram


    Full Text Available BACKGROUND AND OBJECTIVES: It is crucial to decrease bleeding during functional endoscopic sinus surgery. Our primary goal was to investigate the effects of magnesium sulfate and dexmedetomidine used for controlled hypotension on the visibility of the surgical site. METHODS: 60 patients aged between 18 and 65 years were enrolled. In the magnesium sulfate group (Group M, patients were administered 40 mg/kg magnesium sulfate in 100 mL saline solution over 10 min as the intravenous loading dose 10 min before induction, with a subsequent 10-15 µg/kg/h infusion during surgery. In the dexmedetomidine group (Group D, patients were administered 1 µg/kg dexmedetomidine in 100 mL saline solution as the loading dose 10 min before surgery and 0.5-1 µg/kg/h dexmedetomidine during surgery. Deliberate hypotension was defined as a mean arterial pressure of 60-70 mmHg. RESULTS: Bleeding score was significantly decreased in Group D (p = 0.002. Mean arterial pressure values were significantly decreased in Group D compared to that in Group M, except for the initial stage, after induction and 5 min after intubation (p < 0.05. The number of patients who required nitroglycerine was significantly lower in Group D (p = 0.01 and surgeon satisfaction was significantly increased in the same group (p = 0.001. Aldrete recovery score ≥9 duration was significantly shorter in Group D (p = 0.001. There was no difference between the two groups in terms of recovery room verbal numerical rating scale. CONCLUSIONS: Dexmedetomidine can provide more effective controlled hypotension and thus contribute to improved visibility of the surgical site.

  20. Unrecognized odontogenic maxillary sinusitis: a cause of endoscopic sinus surgery failure.

    Longhini, Anthony B; Branstetter, Barton F; Ferguson, Berrylin J


    Endoscopic sinus surgery (ESS) is reported to improve symptoms in approximately 85% of patients. Reasons for failure include misdiagnosis, technical inadequacies, underlying severe hyperplastic disease, biofilm, and immunodeficiency. Only one previous case of unrecognized odontogenic maxillary sinusitis has been cited in the literature as a reason for failure to improve with sinus surgery. This study was designed to characterize clinical and radiographic findings in patients who fail to improve with ESS because of an unrecognized dental etiology. Five patients, with odontogenic maxillary sinusitis with prior unsuccessful ESS, were prospectively enrolled. Demographics and clinical aspects including duration of illness, prior sinus surgeries and therapies, and radiographic data were assessed. Five adults underwent an average of 2.8 sinus surgeries with persistence of disease and symptoms until their dental infection was treated. Duration of symptoms ranged from 3 to 15 years. In four of five patients, the periapical abscess was not noted on the original CT report but could be seen in retrospect. Three of five patients had been seen by their dentists and told they had no dental pathology. All five patients underwent dental extractions and one patient underwent an additional ESS after dental extraction. These procedures led to a resolution of sinusitis symptoms in all five patients. Unrecognized periapical abscess is a cause of ESS failure and the radiological report frequently will fail to note the periapical infection. Dentists are unable to recognize periapical abscesses reliably with dental x-rays and exam. In patients with maxillary sinus disease, the teeth should be specifically examined as part of the radiological workup.

  1. Sinonasal imaging after Caldwell-Luc surgery: MDCT findings of an abandoned procedure in times of functional endoscopic sinus surgery

    Nemec, Stefan Franz; Peloschek, Philipp; Koelblinger, Claus; Mehrain, Sheida; Krestan, Christian Robert; Czerny, Christian [Department of Radiology, Division of Neuroradiology and Musculoskeletalradiology, Medical University of Vienna, Waehringerguertel 18-20, 1090 Vienna (Austria)


    Background and purpose: Today, functional endoscopic sinus surgery (FESS) is performed in most of the patients with sinonasal inflammatory disease. The postoperative imaging findings of FESS in multidetector computed tomography (MDCT) considerably differ from those of historic Caldwell-Luc (CL) maxillary sinus surgery which is an uncommon procedure today. Thus, the postoperative CL imaging findings may lead to diagnostic confusion and misinterpretation. Therefore, this study explicitly presents the MDCT findings of post-CL patients which have not been described previously. Methods: Twenty-eight patients with clinically suspected sinusitis and documented history of CL-procedure underwent 16 row MDCT (MDCT Mx8000 IDT Philips) with multiplanar reconstructions of the paranasal sinuses in the axial plane. The following parameters were used: 140 kV, 50 mAs; 16 mm x 0.75 mm detector collimation; 1 mm reconstructed slice thickness; 0.5 mm increment. The studies were reconstructed with a bone algorithm (W3000/L600; 1 mm slice thickness) in axial plane and coronal plane (3 mm slice thickness). The images were retrospectively evaluated for the presence of normal surgery-related and pathological findings. Results: Surgery-related imaging characteristics presented as follows: an anterior and a medial bony wall defect and sclerosis and sinus wall thickening were observed in all 28/28 cases (100%). Collaps of the sinus cavity was seen in 26/28 cases (92.9%). Furthermore, inflammatory disease of the operated sinus(es) was found in 23/28 cases (82.1%): 14/28 patients (50%) had inflammatory mucosal thickening of the operated sinus(es) as well as of other sinonasal cavities and 9/28 patients (32.1%) had inflammatory mucosal thickening limited to the operated sinus(es). A postoperative mucocele was depicted in 3/28 cases (10.7%). 2/28 patients (7.1%) showed neither maxillary nor other mucosal swelling. Conclusion: MDCT with multiplanar reconstructions is a precise method to evaluate

  2. Oral Clonidine Premedication Decreases Intraoperative Bleeding in Patients Undergoing Endoscopic Sinus Surgery

    M Jabalameli


    Full Text Available Background: The antihypertensive drug, clonidine, is a centrally acting alpha 2 agonist, useful as a premedication because of its sedative and analgesic properties. We examined the effect of clonidine given as an oral premedication in producing a bloodless surgical field in patients undergoing endoscopic sinus surgery. We also evaluated the relation between bleeding volume and consumption of fentanyl and hydralazine to control hypotension. Methods: This prospective double - blinded clinical trial was performed on 113 patients (ASA I, ASA II. Fifty-two patients received oral clonidine (5 µg/kg while the other 61 patients received placebo. During general anesthesia, the hemodynamic endpoint of the anesthetic management was maintenance of hypotension (MAP at 70 mmHg for producing a bloodless surgical field. The direct control of MAP was attained with inspired concentration increments of halothane up to maximum of 1.5 vol % as needed. When it was unsuccessful, an intravenous fentanyl bolus of 2 µg/kg was also added. When both drugs failed, hydralazine , was given intravenously as a bolus and intermittently, 0.1mg/kg up to a maximum dose of 40 mg. Intraoperative bleeding was assessed on a six – point scale from 0 (= no bleeding to 5 (= severe bleeding. Data were compared with chisquare test, fisher's exact test and Student t-test. Results: There was less bleeding volume in the clonidine group (mean ± SD than in the placebo group (144 ± 75 Vs 225 ± 72 ml, P<0.05. Frequency of bleeding severity scores 3 and 4 (troublesome with repeated suction were lower in the clonidine group than in the placebo group (12% Vs 35%, P< 0.05. Fentanyl requirement was significantly lower (112 ± 18 Vs 142 ± 21 µg, P < 0.05 in the clonidine group. Hydralazine requirement was significantly lower (0.45 ± 1.68 Vs 2.67 ± 4.33 Conclusion: Premedication with oral clonidine reduces bleeding in endoscopic sinus surgery and also decreases fentanyl, and hydralazine

  3. Concurrent functional endoscopic sinus surgery and septorhinoplasty: using evidence to make clinical decisions.

    Patel, Zara M; Setzen, Michael; Sclafani, Anthony P; Del Gaudio, John M


    Concurrent septorhinoplasty (SRP) and functional endoscopic sinus surgery (FESS) has been a controversial topic in the literature over the last decade. Warnings and admonitions about the risks of performing these procedures together in a single surgery are both published and voiced at national meetings. Although pros and cons have been discussed in the literature, there have been no guidelines published based solely on a review of the level of evidence. A systematic review of the literature was performed and the Clinical Practice Guideline Manual, Conference on Guideline Standardization (COGS), and the Appraisal of Guidelines and Research Evaluation (AGREE) instrument recommendations were followed. Study inclusion criteria were an adult population >18 years old, description or implication of study design available, concurrent FESS and SRP performed without additional procedures, and report of complications included in the study. We identified and evaluated the literature meeting those criteria: 11 retrospective studies. The literature was reviewed for both quality of research design as well as benefit and harm of the proposed interventions. If a patient is in need of FESS and SRP, either for functional or cosmetic reasons, and is found on the risk matrix to either have low or moderate risk, that patient is a good candidate for a concurrent procedure. If the patient is found to have higher risk, it is not an absolute contraindication, but the surgeon must use best clinical judgment when deciding to move forward and must counsel the patient preoperatively about possible increased risks. © 2013 ARS-AAOA, LLC.

  4. Clinical Features of Patients Treated with Endoscopic Sinus Surgery for Posttraumatic Paranasal Sinus Mucocele.

    Kojima, Yusuke; Tsuzuki, Kenzo; Yukitatsu, Yoriko; Oka, Hideki; Takebayashi, Hironori; Sakagami, Masafumi


    The purpose of this study was to analyze the clinical features of patients with posttraumatic paranasal sinus mucocele (PSM). Between 2009 and 2013, we performed endoscopic sinus surgery (ESS) on 68 patients with PSM at the Department of Otolaryngology - Head and Neck Surgery at Hyogo College of Medicine. Five male patients (age range, 45-76 years) with posttraumatic PSM were analyzed retrospectively. Diagnosis was based on the history of injury and radiological findings. Posttraumatic PSM was found in 7% (5/68) of patients. The mean interval from injury to diagnosis was 28.4 years. All patients had frontal sinus mucocele. Four patients had symptoms of headache, diplopia, visual field defect, and forehead swelling, and 1 patient was asymptomatic. ESS was performed under general anesthesia in all cases, and the symptoms improved postoperatively. Reoperation was required in 1 patient (20%) because headache developed with obstruction of the frontal drainage route 7 months after ESS. Posttraumatic PSM was the least frequent form of PSM and was located predominantly in the frontal sinus, causing symptoms long after the forehead injury. The important lessons to be learned for treating posttraumatic PSM are to obtain a detailed history and to enlarge the route to the cyst to avoid its recurrence.

  5. Feasibility of dexmedetomidine assisting sevoflurane for controlled hypotension in endoscopic sinus surgery

    Guang-jie GAO


    Full Text Available Objective  To explore the feasibility of dexmedetomidine as an adjuvant of sevoflurane for controlled hypotension in endoscopic sinus surgery. Methods  Forty-eight patients (ASA Ⅰor Ⅱ scheduled for endoscopic sinus surgery were randomly assigned into two groups (n=24: control group (group I and dexmedetomidine group (group Ⅱ. In both groups, intravenous injection of midazolam, propofol, fentanyl, and atracurium besilate was given to induce anesthesia, and propofol, fentanyl, atracurium besilate, together with sevoflurane inhalation were used to maintain anesthesia. The radial artery was cannulated to monitor the invasive mean arterial pressure (MAP. Controlled hypotension was induced by adjusting the sevoflurane concentration in group Ⅰ. In group Ⅱ, within 15min to 30min before the induction of anesthesia, dexmedetomidine was administered in a dose of 0.8μg/kg via intravenous infusion pump, then maintained at 0.4μg/(kg·h. Sevoflurane concentration was adjusted to maintain the target blood pressure at the beginning of surgery. The MAP was maintained at 65-75mmHg up to the end of operation. Meanwhile, the heart rate (HR, MAP, epinephrine (E, and norepinephrine (NE concentrations were recorded at the time of induction of anesthesia (T0, beginning of controlled hypotension (T1, 30min after controlled hypotension (T2, and at the time when extubation was performed (T3. Blood gas analysis and determination of lactic acid concentration were conducted using the blood drawn from the radial artery during the operation. The surgical field quality was assessed based on Fromme scores of surgical field quality (SSFQ. Meanwhile, the dose of sevoflurane, propofol, and fentanyl, MAP, the recovery time of anesthesia, and the incidence rate of untoward effects were recorded. Results  The doses of propofol, fentanyl and sevoflurane, and MAC value in group Ⅱwas significantly diminished compared with group Ⅰ(P<0.01. In addition, the surgical

  6. The lamina papyracea bust fracture reduction under nasal endoscope HE%眶内壁爆裂骨折的鼻内镜下手术修复

    何峰云; 张会娟; 赵娜


    目的:探讨鼻内镜下眼眶内壁爆裂性骨折手术修复的方法及临床疗效。方法:对19例伴有眼球内陷、眼球运动障碍、复视等症状、眼眶CT扫描显示眶内壁击出性骨折的患者,在确定骨折程度及范围后,于局麻加强化麻醉下行鼻内镜下取Messcolinger入路行筛窦眶纸板骨折修复术,分析其疗效。结果:术后鼻内镜下随诊6~12月,所有患者愈后理想,均达到治愈标准,无明显眼球凹陷及复视。结论:鼻内镜下经筛窦入路行眶内壁爆裂骨折修复具有创伤小、疗效稳定、手术时间短而且面部不留疤痕等特点,是一种有效的手术方法。%Objective:To evaluate the methods and clinical efficacy of the lamina papyracea bust fracture reduction under nasal endoscope. Methods:Al 19 cases had enophthalmos, eye movement disorders,and diplopia. The orbital CT scan of these cases show the medial orbital wal blow-out fracture clearly. The degree and range of the lamina papyracea displacement was measured on CT films. The reduction under nasalendoscope was performed with local and topical anesthesia. We selected the Meeserklinger 's route of entry,and then analyze the efficacy.Result: With 6~12 moths fol ow up, al patients were cured. The endophthalmos and diplopia disappeared in al cases.Conclusion:The The lamina papyracea bust fracture reduction under nasal endoscope has many advantages such as trauma, efficacy and stability, shorter operative time and no facial scar.It is an effective surgical methods.


    George W Williams


    Full Text Available The current practice of lowering mean arterial pressure (MAP during endoscopic sinus surgery (ESS is common, but unproven with regard to peer reviewed literature. The controlled hypotension induced is aimed for improved surgical field and lower the blood loss. Lower mean arterial pressures especially for prolonged surgeries may result in end organ hypoperfusion. The authors reviewed all patients who underwent outpatient endoscopic sinus surgery for the diagnosis of chronic sinusitis from January 1, 2012 to December 31, 2012 at Memorial Hermann Hospital – Texas Medical Centre. We individually reviewed case sheets of every patient and documented blood loss as recorded on the anaesthesia record or in the surgical procedure note, among other variables. A total of 326 patients were included in this study. The median estimated blood loss (EBL was found to be 50 ml. The multivariate regression analysis between these three groups showed that EBL was higher in MAP 75 group. The average of EBL in MAP75 group and the average of EBL in MAP 65-70 group is 42% higher than that in MAP>75 group when other variables were fixed. Hence we found the trend toward higher blood loss with lower MAP. The authors conclude that lower MAP does not result in lower EBL in endoscopic sinus surgery. Furthermore, increases in BMI and crystalloid administered during an aesthetic management of these cases correlates with increased estimate blood loss.

  8. Cirugía endoscópica transluminal por orificios naturales: NOTES Natural orifice transluminal endoscopic surgery: NOTES

    M. J. Varas Lorenzo


    Full Text Available Se presenta una revisión actual, puesta al día, y punto de vista de los autores sobre un tema sumamente novedoso y atractivo, como es la Cirugía Endoscópica Transluminal por Orificios Naturales (NOTES: Natural Orifice Translumenal Endoscopic Surgery. La mayoría de los trabajos revisados se han realizado en animales de experimentación, pero la publicación de la colecistectomía por vía transvaginal, y la aparición de editoriales y artículos de revisión sobre el tema, nos llevan a realizar una serie de preguntas no resueltas actualmente sobre este tipo de cirugía, que representa un avance potencial para conseguir "una cirugía endoscópica sin cicatrices, sin infecciones, con mínimos requerimientos de anestesia y una inmediata recuperación".A current review and update of an exceedingly novel and appealing topic, namely natural orifice transluminal endoscopic surgery (NOTES, is discussed, as well as the authors' viewpoint thereon. Most reviewed studies were performed in laboratory animals, but reports on transvaginal cholecystectomy and the emergence of editorials and review articles on this topic pose a number of as yet unanswered questions on this type of surgery, which represents a potential advance towards "endoscopic surgery with no scars, no infection, minimal anesthesia requirements, and immediate recovery".

  9. Comparison of the effects of magnesium sulphate and dexmedetomidine on surgical vision quality in endoscopic sinus surgery: randomized clinical study

    Akcan Akkaya


    Full Text Available Background and objectives: Even a small amount of bleeding during endoscopic sinus surgery can corrupt the endoscopic field and complicate the procedure. Various techniques, including induced hypotension, can minimize bleeding during endoscopic sinus surgery. The aim of this study was to compare the surgical vision quality, haemodynamic parameters, postoperative pain, and other effects of magnesium, a hypotensive agent, with that of dexmedetomidine, which was initially developed for short-term sedation in the intensive care unit but also is an alpha 2 agonist sedative. Method: 60 patients between the ages of 18 and 45 years were divided into either the magnesium group (Group M or the dexmedetomidine group (Group D. In Group M, magnesium sulphate was given at a pre-induction loading dose of 50 mg kg−1 over 10 min and maintained at 15 mg kg−1 h−1; in Group D, dexmedetomidine was given at 1 mcg kg−1 10 min before induction and maintained at 0.6 mcg kg−1 h−1. Intraoperatively, the haemodynamic and respiratory parameters and 6-point intraoperative surgical field evaluation scale were recorded. During the postoperative period, an 11-point numerical pain scale, the Ramsay sedation scale, the nausea/vomiting scale, the adverse effects profile, and itching parameters were noted. Results: Group D showed a significant decrease in intraoperative surgical field evaluation scale scale score and heart rate. The average operation time was 50 min, and Group M had a higher number of prolonged surgeries. No significant difference was found in the other parameters. Conclusions: Due to its reduction of bleeding and heart rate in endoscopic sinus surgery and its positive impacts on the duration of surgery, we consider dexmedetomidine to be a good alternative to magnesium.

  10. The expanding role of the endonasal endoscopic approach in pituitary and skull base surgery: A 2014 perspective

    Lobo, Bjorn; Heng, Annie; Barkhoudarian, Garni; Griffiths, Chester F.; Kelly, Daniel F.


    Background: The past two decades have been the setting for remarkable advancement in endonasal endoscopic neurosurgery. Refinements in camera definition, surgical instrumentation, navigation, and surgical technique, including the dual surgeon team, have facilitated purely endonasal endoscopic approaches to the majority of the midline skull base that were previously difficult to access through the transsphenoidal microscopic approach. Methods: This review article looks at many of the articles from 2011 to 2014 citing endonasal endoscopic surgery with regard to approaches and reconstructive techniques, pathologies treated and outcomes, and new technologies under consideration. Results: Refinements in approach and closure techniques have reduced the risk of cerebrospinal fluid leak and infection. This has allowed surgeons to more aggressively treat a variety of pathologies. Four main pathologies with outcomes after treatment were identified for discussion: pituitary adenomas, craniopharyngiomas, anterior skull base meningiomas, and chordomas. Within all four of these tumor types, articles have demonstrated the efficacy, and in certain cases, the advantages over more traditional microscope-based techniques, of the endonasal endoscopic technique. Conclusions: The endonasal endoscopic approach is a necessary tool in the modern skull base surgeon's armamentarium. Its efficacy for treatment of a wide variety of skull base pathologies has been repeatedly demonstrated. In the experienced surgeon's hands, this technique may offer the advantage of greater tumor removal with reduced overall complications over traditional craniotomies for select tumor pathologies centered near the midline skull base. PMID:26015870

  11. Rapid review: sinonasal surgery vs. medical therapy for asthma in patients with chronic rhinosinusitis with or without nasal polyps.

    de Bruin, Rick Johan Matthies; Hage, Rene; van der Zaag-Loonen, Hester; van Benthem, Peter Paul Germain


    The objective of the study was to compare the effect of sinonasal surgery vs. medical treatment on asthma in patients with chronic rhinosinusitis with or without nasal polyps. We executed a PRISMA guidelines-based systematic search of the following databases: PubMed, CENTRAL, Embase, Scopus and CINAHL. The search ran from database inception until 26 Feb 2014. We included controlled clinical trials comparing surgical intervention with medical intervention in patients with chronic rhinosinusitis with or without nasal polyps. We included only English papers. We used a pre-defined data collection form. Two authors independently assessed study quality. We assessed directness of evidence and risk of bias using pre-defined criteria. Our search yielded 2004 original articles, six of which satisfied our inclusion criteria. One article was excluded from further review because no comparison could be made of the subgroup of operated asthmatic patients versus the non-surgical control group. Only one study used objective pulmonary function measurements in asthmatics undergoing sinonasal surgery and therefore had the highest directness of evidence. Also it had a low risk of bias. Patient characteristics, treatments and outcome measures varied across studies, as did the observed effect. Risk of bias was high in most studies. Patient characteristics, treatment and outcome measurement differed across studies, making a comparison of the effects difficult. There is a risk of publication language bias. There is insufficient evidence either for or against sinonasal surgery for asthma control as compared to medical treatment.

  12. The mechanical master-slave manipulator: an instrument improving the performance in standardized tasks for endoscopic surgery.

    Diks, J; Jaspers, J E N; Wisselink, W; de Mol, B A M J; Grimbergen, C A


    This study aimed to evaluate the feasibility and efficacy of a mechanical minimally invasive manipulator for endoscopic surgery. In contrast to currently available motorized master-slave manipulators, this mechanical manipulator consists of two purely mechanical, hand-controlled endoscopic arms with joints that allow seven degrees of freedom (DOF). For the study, 30 medical students performed four different tasks in a pelvic trainer box using either two conventional endoscopic needleholders or a set of mechanical manipulators. The exercise consisted of four different tasks: repositioning of coins, rope passing, passing of a suture through rings, and tying of a surgical knot. All experiments were recorded on videotape (S-VHS), and the data were analyzed afterwards by an independent observer using a quantitative time-action analysis. A significant difference in the number of total actions (including failures) favoring the mechanical manipulator group was shown in most exercises. A significant difference in failures per task was shown in favor of the mechanical manipulator group as well. There was no significant difference shown in the total time per exercise. The tasks clearly demonstrated the efficacy of the mechanical manipulator, although some technical flaws emerged during the experiments. Considering the fact that a first prototype of the mechanical manipulator was tested, modifications are to be expected in a next model. These experiments show the potential of the mechanical manipulator, and it is expected to be a competitive and economical instrument for endoscopic surgery in the near future.

  13. Percutaneous endoscopic gastrojejunostomy for a patient with an intractable small bowel injury after repeat surgeries: a case report.

    Hara, Masayasu; Takayama, Satoru; Takeyama, Hiromitsu


    The management of intestinal injury can be challenging, because of the intractable nature of the condition. Surgical treatment for patients with severe adhesions sometimes results in further intestinal injury. We report a conservative management strategy using percutaneous endoscopic gastrojejunostomy for an intractable small bowel surgical injury after repeated surgeries. A 78-year-old Japanese woman had undergone several abdominal surgeries including urinary cystectomy for bladder cancer. After this operation, she developed peritonitis as a result of a small bowel perforation thought to be due to an injury sustained during the operation, with signs consistent with systemic inflammatory response syndrome: body temperature 38.5°C, heart rate 92 beats/minute, respiratory rate 23 breaths/minute, white blood cell count 11.7 × 109/L (normal range 4-11 × 109/μL). Two further surgical interventions failed to control the leak, and our patient's clinical condition and nutritional status continued to deteriorate. We then performed percutaneous endoscopic gastrojejunostomy, and continuous suction was applied as an alternative to a third surgical intervention. With this endoscopic intervention, the intestinal leak gradually closed and oral feeding became possible. We suggest that the technique of percutaneous endoscopic gastrojejunostomy combined with a somatostatin analog is a feasible alternative to surgical treatment for small bowel leakage, and is less invasive than a nasojejunal tube.

  14. Percutaneous endoscopic gastrojejunostomy for a patient with an intractable small bowel injury after repeat surgeries: a case report

    Takeyama Hiromitsu


    Full Text Available Abstract Introduction The management of intestinal injury can be challenging, because of the intractable nature of the condition. Surgical treatment for patients with severe adhesions sometimes results in further intestinal injury. We report a conservative management strategy using percutaneous endoscopic gastrojejunostomy for an intractable small bowel surgical injury after repeated surgeries. Case presentation A 78-year-old Japanese woman had undergone several abdominal surgeries including urinary cystectomy for bladder cancer. After this operation, she developed peritonitis as a result of a small bowel perforation thought to be due to an injury sustained during the operation, with signs consistent with systemic inflammatory response syndrome: body temperature 38.5°C, heart rate 92 beats/minute, respiratory rate 23 breaths/minute, white blood cell count 11.7 × 109/L (normal range 4-11 × 109/μL. Two further surgical interventions failed to control the leak, and our patient's clinical condition and nutritional status continued to deteriorate. We then performed percutaneous endoscopic gastrojejunostomy, and continuous suction was applied as an alternative to a third surgical intervention. With this endoscopic intervention, the intestinal leak gradually closed and oral feeding became possible. Conclusion We suggest that the technique of percutaneous endoscopic gastrojejunostomy combined with a somatostatin analog is a feasible alternative to surgical treatment for small bowel leakage, and is less invasive than a nasojejunal tube.

  15. The Expanding Role of Endoscopic Robotics in Mitral Valve Surgery: 1,257 Consecutive Procedures.

    Murphy, Douglas A; Moss, Emmanuel; Binongo, Jose; Miller, Jeffrey S; Macheers, Steven K; Sarin, Eric L; Herzog, Alexander M; Thourani, Vinod H; Guyton, Robert A; Halkos, Michael E


    The role of robotic instruments in mitral valve (MV) surgery continues to evolve. The purpose of this study was to assess the safety, efficacy, and scope of MV surgery using a lateral endoscopic approach with robotics (LEAR) technique. From 2006 to 2013, a dedicated LEAR team performed 1,257 consecutive isolated MV procedures with or without tricuspid valve repair or atrial ablation. The procedures were performed robotically through five right-side chest ports with femoral artery or ascending aortic perfusion and balloon occlusion. Operative videos and data were recorded on all procedures and reviewed retrospectively. The mean age of all patients was 59.3 ± 20.5 years, and 8.4% (n = 105) had previous cardiac surgery. The MV repair was performed in 1,167 patients (93%). The MV replacement was performed in 88 patients (7%), and paravalvular leak repair in 2 patients. Concomitant atrial ablation was performed in 226 patients (18%), and tricuspid valve repair in 138 patients (11%). Operative mortality occurred in 11 patients (0.9%) and stroke in 9 patients (0.7%). Predischarge echocardiograms demonstrated mild or less mitral regurgitation in 98.3% of MV repair patients. At mean follow-up of 50 ± 26 months, 44 patients (3.8%) required MV reoperation. Application of the LEAR technique to all institutional isolated MV procedures increased from 46% in the first year to more than 90% in the last 3 years. Mitral valve repair or replacement, including concomitant procedures, can be performed safely and effectively using the LEAR technique. With a dedicated robotic team, the vast majority of patients with MV disorders, either isolated or with concomitant problems, can be treated using the LEAR technique. Copyright © 2015 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.

  16. Neuronavigational endoscopic endonasal sellar and parasellar surgery using a 2-mm-diameter lens rigid-rod endoscope: a cadaver study.

    Di Rocco, Federico; Oi, Shizuo; Samii, Amir; Paternó, Vincenzo; Feigl, Günther C; Lüdemann, Wolf; Samii, Madjid


    Most of the endoscopes used for endonasal transsphenoidal surgery use 4-mm diameter lenses. The applicability of a newly developed neuroendoscope with a lens diameter of only 2 mm was tested in endonasal transsphenoidal pituitary surgery. The newly developed rigid-rod neuroendoscope with a 2-mm lens and an endoscope with a 4-mm lens were coupled with a navigation system and used for this comparative study. Comparison between the views obtained with these two devices was performed in a model and in formalin-fixed cadaver heads. A pure endonasal approach was used to reach and explore the sellar and parasellar regions. The navigation system was used to locate the same position in both lenses for image comparison. The sellar and parasellar regions could be reached and explored using the new endoscope with the 2-mm lens and an oval-shaped irrigation and suction channel. The visual field appeared to be reduced compared with that of the 4-mm lens. However, this reduction was compensated by greater mobility and easier introduction and maneuvering of the instruments at the sellar level. Reduced image size and brightness were also found using the 2-mm lens compared with the 4-mm lens. These differences could be overcome by increasing the amount of light and enlarging the image but with subsequent reduction in image resolution. The small diameter of this neuroendoscope resulted in good maneuverability and maintained a fine quality of vision. Children and patients with small nostrils are good candidates for the use of such a device.

  17. Inferior Turbinate Size and CPAP Titration Based Treatment Pressures: No Association Found among Patients Who Have Not Had Nasal Surgery

    Camacho, Macario; Zaghi, Soroush; Tran, Daniel; Song, Sungjin A.; Chang, Edward T.; Certal, Victor


    Objective. To evaluate the effect of turbinate sizes on the titrated continuous positive airway pressure (CPAP) therapeutic treatment pressures for patients with obstructive sleep apnea (OSA) who have not had nasal surgery. Study Design. Retrospective case series. Methods. A chart review was performed for 250 consecutive patients. Results. 45 patients met inclusion criteria. The mean ± standard deviation (M ± SD) for age was 54.6 ± 22.4 years and for body mass index was 28.5 ± 5.9 kg/m2. The Spearman's rank correlation coefficient (rs) between CPAP therapeutic treatment pressures and several variables were calculated and were weakly correlated (age rs = 0.29, nasal obstruction rs = −0.30), moderately correlated (body mass index rs = 0.42 and lowest oxygen saturation rs = −0.47), or strongly correlated (apnea-hypopnea index rs = 0.60 and oxygen desaturation index (rs = 0.62)). No statistical significance was found with one-way analysis of variance (ANOVA) between CPAP therapeutic treatment pressures and inferior turbinate size (right turbinates p value = 0.2012, left turbinate p value = 0.3064), nasal septal deviation (p value = 0.4979), or mask type (p value = 0.5136). Conclusion. In this study, CPAP titration based therapeutic treatment pressures were not found to be associated with inferior turbinate sizes; however, the CPAP therapeutic treatment pressures were strongly correlated with apnea-hypopnea index and oxygen desaturation index. PMID:26904126

  18. Inferior Turbinate Size and CPAP Titration Based Treatment Pressures: No Association Found among Patients Who Have Not Had Nasal Surgery

    Macario Camacho


    Full Text Available Objective. To evaluate the effect of turbinate sizes on the titrated continuous positive airway pressure (CPAP therapeutic treatment pressures for patients with obstructive sleep apnea (OSA who have not had nasal surgery. Study Design. Retrospective case series. Methods. A chart review was performed for 250 consecutive patients. Results. 45 patients met inclusion criteria. The mean ± standard deviation (M ± SD for age was 54.6±22.4 years and for body mass index was 28.5±5.9 kg/m2. The Spearman’s rank correlation coefficient (rs between CPAP therapeutic treatment pressures and several variables were calculated and were weakly correlated (age rs=0.29, nasal obstruction rs=-0.30, moderately correlated (body mass index rs=0.42 and lowest oxygen saturation rs=-0.47, or strongly correlated (apnea-hypopnea index rs=0.60 and oxygen desaturation index (rs=0.62. No statistical significance was found with one-way analysis of variance (ANOVA between CPAP therapeutic treatment pressures and inferior turbinate size (right turbinates p value = 0.2012, left turbinate p value = 0.3064, nasal septal deviation (p value = 0.4979, or mask type (p value = 0.5136. Conclusion. In this study, CPAP titration based therapeutic treatment pressures were not found to be associated with inferior turbinate sizes; however, the CPAP therapeutic treatment pressures were strongly correlated with apnea-hypopnea index and oxygen desaturation index.

  19. Comparison of Complications, Trends, and Costs in Endoscopic vs Microscopic Pituitary Surgery: Analysis From a US Health Claims Database.

    Asemota, Anthony O; Ishii, Masaru; Brem, Henry; Gallia, Gary L


    Microsurgical and endoscopic techniques are commonly utilized surgical approaches to pituitary pathologies. There are limited data comparing these 2 procedures. To evaluate postoperative complications, associated costs, and national and regional trends of microscopic and endoscopic techniques in the United States employing a nationwide database. The Truven MarketScan database 2010 to 2014 was queried and Current Procedural Terminology codes identified patients that underwent microscopic and/or endoscopic transsphenoidal pituitary surgery. International Classification of Diseases codes identified postoperative complications. Adjusted logistic regression and matched propensity analysis evaluated independent odds for complications. Among 5886 cases studied, 54.49% were microscopic and 45.51% endoscopic. The commonest surgical indications were benign pituitary tumors. Annual trends showed increasing utilization of endoscopic techniques vs microscopic procedures. Postoperative complications occurred in 40.04% of cases, including diabetes insipidus (DI; 16.90%), syndrome of inappropriate antidiuretic hormone (SIADH; 2.02%), iatrogenic hypopituitarism (1.36%), fluid/electrolyte abnormalities (hypoosmolality/hyponatraemia [5.03%] and hyperosmolality/hypernatraemia [2.48%]), and cerebrospinal fluid (CSF) leaks (CSF rhinorrhoea [4.42%] and other CSF leak [6.52%]). In our propensity-based model, patients that underwent endoscopic surgery were more likely to develop DI (odds ratio [OR] = 1.48; 95% confidence interval [CI] = 1.28-1.72), SIADH (OR = 1.53; 95% CI = 1.04-2.24), hypoosmolality/hyponatraemia (OR = 1.17; 95% CI = 1.01-1.34), CSF rhinorrhoea (OR = 2.48; 95% CI = 1.88-3.28), other CSF leak (OR = 1.59; 95% CI = 1.28-1.98), altered mental status (OR = 1.46; 95% CI = 1.01-2.60), and postoperative fever (OR = 4.31; 95% CI = 1.14-16.23). There were no differences in hemorrhagic complications, ophthalmological complications, or bacterial meningitis. Postoperative




    Full Text Available PURPOSE: To evaluate and compare the surgically induced astigmatism in phacoemulsification cataract surgery after 2.8 mm temporal and nasal clear corneal incision of same patient . MATERIAL AND METHOD : This prospective study comprised a consecutive case series of 60 eyes. Eyes from 30 patients with phacoemulsification those were implanted with a 6.00 mm foldable intraocular le ns through a 2.8 mm horizontal clear corneal incision (temporal in the right eye , nasal in the left eye. RESULTS : T he outcome measures were surgically induced astigmatism (SIA and uncorrected visual acuity (UCVA , at 1 and 3 months post - operatively. A 1 month the mean SIA was 0.81 D. for the temporal incision and 0.92 D for nasal incision (P = 0.139 at 3 months the mean SIA was 0.53 D for temporal incision and 0.62 D for nasal incision (P =0.309. The pre - operative parameters i.e. (UCVA , mean keratomet ry & keratometric cylinder between these groups were comparable. There was no statistically significant difference found between three groups pre - operatively . CONCLUSION : After cataract surgery using 2.8mm temporal and nasal horizontal corneal incision , t he induced corneal astigmatic changes was similar in both incision groups. Especially in Asian eyes , both temporal and nasal incisions (2.8 mm or less would be equally favourable for astigmatism neutral cataract surgery

  1. The Effect of Nasal Surgery on Continuous Positive Airway Pressure Device Use and Therapeutic Treatment Pressures: A Systematic Review and Meta-Analysis

    Camacho, Macario; Riaz, Muhammad; Capasso, Robson; Ruoff, Chad M.; Guilleminault, Christian; Kushida, Clete A.; Certal, Victor


    Background: The relationship between nasal surgery and its effect on continuous positive airway pressure (CPAP) device therapeutic treatment pressures and CPAP device use has not been previously systematically examined. Study Objectives: To conduct a systematic review and meta-analysis evaluating the effect of isolated nasal surgery on therapeutic CPAP device pressures and use in adults with obstructive sleep apnea. Methods: MEDLINE, Scopus, Web of Science, and The Cochrane Library were searched through July 15, 2014. The MOOSE consensus statement and PRISMA statement were followed. Results: Eighteen studies (279 patients) reported CPAP data after isolated nasal surgery. Seven studies (82 patients) reported preoperative and postoperative mean therapeutic CPAP device pressures and standard deviations, which reduced from 11.6 ± 2.2 to 9.5 ± 2.0 centimeters of water pressure (cwp) after nasal surgery. Pooled random effects analysis demonstrated a statistically significant pressure reduction, with a mean difference of −2.66 cwp (95% confidence intervals, −3.65 to −1.67); P < 0.00001. Eleven studies (153 patients) described subjective, self-reported data for CPAP use; and a subgroup analysis demonstrated that 89.1% (57 of 64 patients) who were not using CPAP prior to nasal surgery subsequently accepted, adhered to, or tolerated it after nasal surgery. Objective, device meter-based hours of use increased in 33 patients from 3.0 ± 3.1 to 5.5 ± 2.0 h in the short term (< 6 mo of follow-up). Conclusion: Isolated nasal surgery in patients with obstructive sleep apnea and nasal obstruction reduces therapeutic CPAP device pressures and the currently published literature's objective and subjective data consistently suggest that it also increases CPAP use in select patients. Citation: Camacho M, Riaz M, Capasso R, Ruoff CM, Guilleminault C, Kushida CA, Certal V. The effect of nasal surgery on continuous positive airway pressure device use and therapeutic treatment

  2. Frequency of surgery among children who have adenotonsillar hypertrophy and improve after treatment with nasal beclomethasone.

    Criscuoli, Gaetano; D'Amora, Stefania; Ripa, Giuseppe; Cinquegrana, Giovanni; Mansi, Nicola; Impagliazzo, Nicola; Pisacane, Alfredo


    To describe the long-term outcome of a cohort of children with symptomatic adenotonsillar hypertrophy treated with aqueous nasal beclomethasone. The children enrolled completed a 4-week single-blind, saline solution controlled crossover study of aqueous beclomethasone (total: 400 micro g/d). In a 24-week open-label follow-on study, beclomethasone 200 micro g/d was offered to all patients. During a 100-week follow-up, the degree of nasal obstruction and the frequency of adenotonsillectomy were assessed. Fifty-three children of the 60 enrolled completed the study. After the 4-week crossover trial, the severity of nasal obstruction of 24 children (45%) significantly decreased during the use of nasal steroids, but no child improved when saline solution was used. At 24, 52, and 100 weeks, the 24 children who had initially improved showed a significant decrease of the severity of nasal obstruction and of the frequency of adenotonsillectomy (54% vs 83%) compared with the 29 children who had not responded after the initial steroidal therapy. Evidence from this study suggests that 45% of children with adenoidal hypertrophy improved after 2 weeks of steroidal therapy. Among these children, an additional 24-week treatment at a lower steroid dosage was associated with a significant 52- and 100-week clinical improvement and with reduction of adenotonsillectomy compared with children (55%) who had not responded after the initial 2-week steroidal therapy.

  3. Could Eosinophilia predict clinical severity in nasal polyps?

    Aslan, Figen; Altun, Eren; Paksoy, Serpil; Turan, Gulay


    Although nasal polyps are one of the most frequent diseases, their etiopathogenesis remains unclear.Since eosinophils are the main inflammatory cells in the substantial proportion of nasal polyp tissues, they are considered potentially responsible for the etiopathogenesis and prognosis of the disease. Aim of this study was to investigate the relation between mucosal and peripheral eosinophilia and their relation with disease severity in nasal polyps. The study included 53 patients with nasal polyps who underwent endoscopic sinus surgery. Preoperative Lund-MacKay computed tomography (CT) scores and the Lund-Kennedy endoscopic scores of the patients were recorded. Nasal polyp tissues were stained with hematoxylin and eosin, eosinophil counts were performed using high-power field (HPF, 400×) under the light microscope, and the patients were grouped as those with high mucosal eosinophil count and those with low mucosal eosinophil count. The mean Lund-MacKay CT score and the mean Lund-Kennedy endoscopic score were higher in the patients with high mucosal eosinophil count than in those with low mucosal eosinophil count. Likewise, the mean Lund-MacKay CT score and the mean Lund-Kennedy endoscopic scores were significantly higher in the patients with high peripheral eosinophil count than in those with low peripheral eosinophil count (p < 0.05 for both). Moreover, the mean peripheral eosinophil count was significantly higher in the patients with high mucosal eosinophil count than in those with low mucosal eosinophil count (p < 0.05). Mucosal and peripheral eosinophilia can be used as a marker to predict disease severity in nasal polyps.

  4. Current treatment of nasal vestibular stenosis with CO2-laser surgery: prolonged vestibular stenting versus intraoperative mitomycin application. A case series of 3 patients.

    van Schijndel, Olaf; van Heerbeek, Niels; Ingels, Koen J A O


    These case studies describe three cases of unilateral nasal vestibular stenoses caused by chemical cauterization. Each case was treated with CO2-laser surgery together with intraoperative topic application of mitomycin or prolonged vestibular stenting for prevention of restenosis. Two patients received intraoperative mitomycin application and one patient received prolonged vestibular stenting. Results were documented using high-resolution photographs. The follow up period ranged from 1 year and 3 months to 4 years and 9 months. All patients improved after CO2-laser surgery. No complications were reported. We consider CO2-laser surgery for relief of nasal vestibular stenosis as a feasible surgical technique for relieve of nasal vestibular stenosis. Prolonged vestibular stenting seems to be an important factor for the prevention of restenosis in which the value of intraoperative mitomycin application without prolonged vestibular stenting remains uncertain.

  5. Automatic localization of endoscope in intraoperative CT image: A simple approach to augmented reality guidance in laparoscopic surgery.

    Bernhardt, Sylvain; Nicolau, Stéphane A; Agnus, Vincent; Soler, Luc; Doignon, Christophe; Marescaux, Jacques


    The use of augmented reality in minimally invasive surgery has been the subject of much research for more than a decade. The endoscopic view of the surgical scene is typically augmented with a 3D model extracted from a preoperative acquisition. However, the organs of interest often present major changes in shape and location because of the pneumoperitoneum and patient displacement. There have been numerous attempts to compensate for this distortion between the pre- and intraoperative states. Some have attempted to recover the visible surface of the organ through image analysis and register it to the preoperative data, but this has proven insufficiently robust and may be problematic with large organs. A second approach is to introduce an intraoperative 3D imaging system as a transition. Hybrid operating rooms are becoming more and more popular, so this seems to be a viable solution, but current techniques require yet another external and constraining piece of apparatus such as an optical tracking system to determine the relationship between the intraoperative images and the endoscopic view. In this article, we propose a new approach to automatically register the reconstruction from an intraoperative CT acquisition with the static endoscopic view, by locating the endoscope tip in the volume data. We first describe our method to localize the endoscope orientation in the intraoperative image using standard image processing algorithms. Secondly, we highlight that the axis of the endoscope needs a specific calibration process to ensure proper registration accuracy. In the last section, we present quantitative and qualitative results proving the feasibility and the clinical potential of our approach.

  6. Computational Fluid Dynamic Study of Nasal Respiratory Function Before and After Bimaxillary Orthognathic Surgery With Bone Trimming at the Inferior Edge of the Pyriform Aperture.

    Kita, Soma; Oshima, Marie; Shimazaki, Kazuo; Iwai, Toshinori; Omura, Susumu; Ono, Takashi


    This study aimed to evaluate the influence of maxillary impaction orthognathic surgery on nasal respiratory function and the efficacy of bone trimming at the inferior edge of the pyriform aperture. The participants were 10 patients (3 male and 7 female patients) with mandibular prognathism who underwent bimaxillary orthognathic surgery with maxillary impaction. The surgical procedures performed were Le Fort I osteotomy with bone trimming at the inferior edge of the pyriform aperture and bilateral sagittal split osteotomy. Three-dimensional models of the nasal cavity were reconstructed from preoperative and postoperative computed tomography images. Furthermore, we remodeled the nasal valve region based on the postoperative models by adding a 1-mm and 2-mm stenosis to investigate the effects of bone trimming at the inferior edge of the pyriform aperture on the pressure effort. The 3-dimensional models were simulated with computational fluid dynamics, and the results of the pressure effort and the cross-sectional area (CSA) were compared for the anterior, middle, and posterior parts of the nasal cavity. The Wilcoxon signed rank test and Spearman rank correlation coefficients were used for statistical comparisons (P < .05). In the preoperative and postoperative models, there were considerable correlations between the CSA and the pressure effort in each part of the nasal cavity. The postoperative pressure effort showed a tendency to decrease and the CSA showed a tendency to increase in each part of the nasal cavity. In four 2-mm stenosis models, the pressure effort in the anterior nasal cavity was larger than the preoperative pressure effort and the CSA of the anterior nasal cavity was smaller than the preoperative CSA. Bone trimming at the inferior edge of the pyriform aperture appears to be useful for avoiding nasal respiratory complications with maxillary impaction. Copyright © 2016 American Association of Oral and Maxillofacial Surgeons. Published by Elsevier Inc

  7. Suture knot on the repair splint: a simple method to facilitate reconstruction of the sella turcica during endonasal endoscopic transsphenoidal surgery. Technical note.

    Kubo, Shigeki; Hasegawa, Hiroshi; Inui, Toshihiko; Tominaga, Shinsuke; Yoshimine, Toshiki


    Reconstruction of the sellar floor after pituitary tumor removal is sometimes difficult because the repair graft is difficult to handle in the narrow space. This is especially problematic if the endonasal endoscopic approach is used. The authors devised a technique to facilitate this procedure by placing a suture knot on the repair splint. This allows the material to be grasped securely with forceps and improves manipulation even within the narrow nasal cavity. This technique has proved useful when performing the endonasal endoscopic approach, and it is also expected to be useful when conducting the conventional sublabial transsphenoidal approach.

  8. Comparison of surgical condition in endoscopic sinus surgery using remifentanil combined with propofol, sevoflurane, or desflurane.

    Yoo, Hyung-Seok; Han, Jin Hee; Park, Sung Wook; Kim, Keon Sik


    Various maneuvers are commonly used to achieve the ideal operative field necessary for successful endoscopic sinus surgery (ESS). There are a few contradictory reports on this subject and the consensus is that propofol anesthesia results in a better or similar surgical field and less or similar amount of bleeding than volatile anesthesia. The aim of this study was to compare the surgical field in patients in whom intravenous anesthesia is used as opposed to balanced general anesthesia. SIXTY PATIENTS UNDERGOING ESS WERE RANDOMLY ASSIGNED INTO THREE GROUPS, EACH OF WHICH USED A DIFFERENT TYPE OF ANESTHESIA: propofol/remifentanil (PRO/REM) group, sevoflurane/remifentanil (SEV/REM) group, and desflurane/remifentanil (DES/REM) group. We aimed to maintain the intraoperative mean blood pressure (MBP) at 65 mmHg and the heartrate (HR) at about 75 beats per minute. The quality of visibility of the surgical field was graded, using a validated scoring system, 60 minutes after the start of the operation. All groups had a similar MBP and mean HR at 60 minutes after the operation started. There was no significant differences among the three groups for surgical grade score (P = 0.83). In this comparative study of three anesthetic combinations (PRO/REM, SEV/REM, and DES/REM) in patients undergoing ESS with controlled BP and HR, we did not observe any significant differences in the surgical grade scores.

  9. Safety and Feasibility of Salvage Endoscopic Combined Intrarenal Surgery in Embolized Kidney

    Nicolosi, Federico; Lughezzani, Giovanni; Buffi, Nicolò Maria; Casale, Paolo; Hurle, Rodolfo; Lazzeri, Massimo; Cardone, Pasquale; Guazzoni, Giorgio; Saita, Alberto


    Abstract Background: Although endoscopic combined intrarenal surgery (ECIRS) is well established as primary approach to complex lithiasis, no evidences are still available on its use in salvage context. Case Presentation: A male patient, of 55 years of age, underwent many unsuccessful surgical procedures to treat large and multiple right kidney stones, including percutaneous nephrolithotomy (PCNL). The latter was complicated by severe postoperative hemorrhage, managed with super-selective renal artery embolization (SRAE). Therefore he came to our institution to achieve a complete resolution of the urolithiasis. Preoperative evaluation included CT scan and renal scintigraphy to establish kidney and stone morphologic features and residual renal function. Salvage ECIRS was performed and postoperative assessment showed a complete resolution of lithiasis and absence of renal function impairment. Conclusion: To our knowledge, this is the first case of salvage ECIRS reported in literature after previous failed PCNL. Even after SRAE, this procedure appears as safe and as efficacious as standard salvage PCNL when performed by experienced hands. PMID:27579440


    E. N. Novozhilova


    Full Text Available  2 The paper describes the first experience in using robotic CO laser at the Department of Head and Neck Tumors, Moscow City Cancer Hospital Sixty-Two. With advances in endoscopic techniques and anesthesiology, there have been new possibilities of usingdirect (rigid larygoscopy in conjunction with laser systems.The Lumеnis laser assembly consists of three interconnected components: a videocamera, an operating microscope, and directly CO laser. It includes a computer system that sets a program to perform an operation.The heart of the laser system is a scanning Digital Acu Blade micromanipulator. This unique assembly makes itpossible to control the area and depth of incision, to cut intricate shapes in relation to the surface anatomy, and to precisely control ablation and hemostasis. The effect of tissue carbonization during surgery is minimal at the expense of the physical characteristics and different modes of radiation. It is noted that this system allows organ-sparing treatment in cancer patients and their prompt rehabilitation after surgical interventions.

  11. Evaluation of piroxicam-beta-cyclodextrin as a preemptive analgesic in functional endoscopic sinus surgery.

    Keleş, G T; Topçu, I; Ekici, Z; Yentür, A


    The preemptive analgesic efficacy and adverse effects of preoperatively administered piroxicam-beta-cyclodextrin for post-endoscopic sinus surgery pain was determined in a prospective, double-blind, randomized, clinical study. Seventy-five American Society of Anesthesiologists status I-II patients, aged 18-65 years, were divided into three groups with similar demographic characteristics: group 1 received 20 mg piroxicam-beta-cyclodextrin, group 2 received 40 mg piroxicam-beta-cyclodextrin and group 3 received placebo orally before induction of general anesthesia. A blinded observer recorded the incidence and severity of pain at admission to the post-anesthesia care unit (PACU), at 15, 30, and 45 min in the PACU, and 1, 2, 4, 6, and 24 h postoperatively. All patients received patient-controlled morphine analgesia during the postoperative period and consumption was recorded for 24 h. During the PACU period, mean visual analogue scale values were significantly lower in groups 1 and 2 compared to group 3 (P piroxicam-beta-cyclodextrin effectively reduced analgesic consumption, and 40 mg of the drug was more effective than 20 mg piroxicam-beta-cyclodextrin without side effects during the postoperative period.

  12. Development of a Haptic Interface for Natural Orifice Translumenal Endoscopic Surgery Simulation

    Dargar, Saurabh; Sankaranarayanan, Ganesh


    Natural orifice translumenal endoscopic surgery (NOTES) is a minimally invasive procedure, which utilizes the body’s natural orifices to gain access to the peritoneal cavity. The NOTES procedure is designed to minimize external scarring and patient trauma, however flexible endoscopy based pure NOTES procedures require critical scope handling skills. The delicate nature of the NOTES procedure requires extensive training, thus to improve access to training while reducing risk to patients we have designed and developed the VTEST©, a virtual reality NOTES simulator. As part of the simulator, a novel decoupled 2-DOF haptic device was developed to provide realistic force feedback to the user in training. A series of experiments were performed to determine the behavioral characteristics of the device. The device was found capable of rendering up to 5.62N and 0.190Nm of continuous force and torque in the translational and rotational DOF, respectively. The device possesses 18.1Hz and 5.7Hz of force bandwidth in the translational and rotational DOF, respectively. A feedforward friction compensator was also successfully implemented to minimize the negative impact of friction during the interaction with the device. In this work we have presented the detailed development and evaluation of the haptic device for the VTEST©. PMID:27008674


    Zorron, Ricardo; Galvão-Neto, Manoel Passos; Campos, Josemberg; Branco, Alcides José; Sampaio, José; Junghans, Tido; Bothe, Claudia; Benzing, Christian; Krenzien, Felix

    Roux-en-Y gastric bypass (RYGB) is a standard therapy in bariatric surgery. Sleeve gastrectomy and gastric banding, although with good results in the literature, are showing higher rates of treatment failure to reduce obesity-associated morbidity and body weight. Other problems after bariatric may occur, as band erosion, gastroesophageal reflux disease and might be refractory to medication. Therefore, a laparoscopic conversion to a RYGB can be an effective alternative, as long as specific indications for revision are fulfilled. The objective of this study was to analyse own and literature data on revisional bariatric procedures to evaluate best alternatives to current practice. Institutional experience and systematic review from the literature on revisional bariatric surgery. Endoscopic procedures are recently applied to ameliorate failure and complications of bariatric procedures. Therapy failure following RYGB occurs in up to 20%. Transoral outlet reduction is currently an alternative method to reduce the gastrojejunal anastomosis. The diameter and volume of sleeve gastrectomy can enlarge as well, which can be reduced by endoscopic full-thickness sutures longitudinally. Dumping syndrome and severe hypoglycemic episodes (neuroglycopenia) can be present in patients following RYGB. The hypoglycemic episodes have to be evaluated and usually can be treated conventionally. To avoid partial pancreatectomy or conversion to normal anatomy, a new laparoscopic approach with remnant gastric resection and jejunal interposition can be applied in non-responders alternatively. Hypoglycemic episodes are ameliorated while weight loss is sustained. Revisional and endoscopic procedures following bariatric surgery in patients with collateral symptomatic or treatment failure can be applied. Conventional non-surgical approaches should have been applied intensively before a revisional surgery will be indicated. Former complex surgical revisional procedures are evolving to less

  14. Natural orifice translumenal endoscopic surgery: Progress in humans since white paper

    Byron F Santos; Eric S Hungness


    Since the first description of the concept of natural orifice translumenal endoscopic surgery (NOTES), a substantial number of clinical NOTES reports have appeared in the literature. This editorial reviews the available human data addressing research questions originally proposed by the white paper, including determining the optimal method of access for NOTES, developing safe methods of lumenal closure, suturing and anastomotic devices,advanced multitasking platforms, addressing the risk of infection, managing complications, addressing challengeswith visualization, and training for NOTES procedures.An analysis of the literature reveals that so far transvaginal access and closure appear to be the most feasible techniques for NOTES, with a limited, but growing transgastric, transrectal, and transesophageal NOTES experience in humans. The theoretically increased risk of infection as a result of NOTES procedures has not been substantiated in transvaginal and transgastric procedures so far. Development of suturing and anastomotic devices and advanced platforms for NOTES has progressed slowly,with limited clinical data on their use so far. Data on the optimal management and incidence of intraoperative complications remain sparse, although possible factorscontributing to complications are discussed. Finally, this editorial discusses the likely direction of future NOTES development and its possible role in clinical practice.

  15. Surgical treatment of a calcified Rathke's cleft cyst with endoscopic extended transsphenoidal surgery--case report.

    Arai, Takao; Horiguchi, Kentaro; Saeki, Naokatsu; Oka, Hidehiro; Saito, Takatoshi; Takahashi-Fujigasaki, Junko; Sakamoto, Hiroki; Kato, Naoki; Dobashi, Hisashi; Tanaka, Toshihide; Hasegawa, Yuzuru; Abe, Toshiaki


    A 34-year-old male presented with a rare case of Rathke's cleft cyst (RCC) with calcification manifesting as persistent high fever and impaired consciousness. Physical findings revealed panhypopituitarism and bitemporal hemianopsia. Computed tomography showed mass lesions with marked calcification within the sella turcica and the suprasellar region. Magnetic resonance imaging showed solid and cystic components compressing the optic nerve. The preoperative diagnosis was craniopharyngioma. Initial endonasal transsphenoidal surgery (TSS) was performed with a surgical microscope, but the mass was extremely hard, so only partial removal was possible. Second endonasal extended TSS was performed with a neuroendoscope. The solid components were totally removed, but calcifications adhering to the optic nerve could not be removed completely. The histological diagnosis was RCC with marked granulation reaction. RCC with calcification is rare and difficult to differentiate from craniopharyngioma on neuroimages. Extremely thick calcification of the sella turcica enclosing granulation tissue and the cyst similar to armor, here called "armor-like calcification," is a characteristic imaging finding of RCC with calcification. The most important aspect is choosing a surgical approach to carefully and effectively relieve pressure upon the optic nerve. Endonasal extended TSS with an endoscope was effective in the present case.

  16. Readability assessment of Internet-based patient education materials related to endoscopic sinus surgery.

    Cherla, Deepa V; Sanghvi, Saurin; Choudhry, Osamah J; Liu, James K; Eloy, Jean Anderson


    Numerous professional societies, clinical practices, and hospitals provide Internet-based patient education materials (PEMs) to the general public, but not all of this information is written at a reading level appropriate for the average patient. The National Institutes of Health and the US Department of Health and Human Services recommend that PEMs be written at or below the sixth-grade level. Our purpose was to assess the readability of endoscopic sinus surgery (ESS)-related PEMs available on the Internet and compare readability levels of PEMs provided by three sources: professional societies, clinical practices, and hospitals. A descriptive and correlational design was used for this study. The readability of 31 ESS-related PEMs was assessed with four different readability indices: Flesch-Kincaid Grade Level (FKGL), Flesch Reading Ease Score (FRES), Simple Measure of Gobbledygook (SMOG), and Gunning Frequency of Gobbledygook (Gunning FOG). Averages were evaluated against national recommendations and between each source using analysis of variance and t tests. The majority of PEMs (96.8%) were written above the recommended sixth-grade reading level, based on FKGL (P Society, Inc.

  17. Disasters of endoscopic surgery and how to avoid them: error analysis.

    Troidl, H


    For every innovation there are two sides to consider. For endoscopic surgery the positive side is more comfort for the patient, and the negative side is new complications, even disasters, such as injuries to organs (e.g., the bowel), vessels, and the common bile duct. These disasters are rare and seldom reported in the scientific world, as at conferences, at symposiums, and in publications. Today there are many methods for testing an innovation (controlled clinical trials, consensus conferences, audits, and confidential inquiries). Reporting "complications," however, does not help to avoid them. We need real methods for avoiding negative failures. The failure analysis is the method of choice in industry. If an airplane crashes, error analysis starts immediately. Humans make errors, and making errors means punishment. Failure analysis means rigorously and objectively investigating a clinical situation to find clinical relevant information for avoiding these negative events in the future. Error analysis has four important steps: (1) What was the clinical situation? (2) What has happened? (3) Most important: Why did it happen? (4) How do we avoid the negative event or disaster in the future. Error analysis has decisive advantages. It is easy to perform; it supplies clinically relevant information to help avoid it; and there is no need for money. It can be done everywhere; and the information is available in a short time. The other side of the coin is that error analysis is of course retrospective, it may not be objective, and most important it will probably have legal consequences. To be more effective in medicine and surgery we must handle our errors using a different approach. According to Sir Karl Popper: "The consituation is that we have to learn from our errors. To cover up failure is therefore the biggest intellectual sin.

  18. Anatomic findings in revision endoscopic sinus surgery: Case series and review of contributory factors

    Bewick, Jessica; Egro, Francesco M.; Masterson, Liam; Javer, Amin R.


    Background: It is recognized that patients who undergo endoscopic sinus surgery (ESS) do not always achieve control of their disease. The causes are multifactorial; variations in surgical practice have been identified as possible factors in refractory disease. Objective: To reflect on the frequent anatomic findings of patients with chronic rhinosinusitis (CRS) who require revision ESS. Methods: A retrospective review of patients who required revision ESS at a tertiary institution over a 3-year period. Patients for whom maximal medical therapy failed for CRS underwent computed tomography of the paranasal sinuses and image-guided surgery. Surgical records of anatomic findings were reviewed and analyzed. Results: Over 3 years, a total of 75 patients underwent revision procedures, 28% of all ESS performed in the unit. The most frequent finding was a residual uncinate process in 64% of the patients (n = 48); other findings included a maxillary antrostomy not based on the natural ostium of the maxillary sinus in 47% (n = 35), an oversized antrostomy in 29% (n = 22), resected middle turbinates in 35% (n = 26), middle meatal stenosis in 15% (n = 11), synechiae in 29% (n = 22), and osteitic bone that required drilling in 13% (n = 10). Conclusion: Surgical technique can give rise to anatomic variations that may prevent adequate mucociliary clearance and medication delivery, which leads to failure in ESS in patients with CRS. This study demonstrated the surgical findings encountered in revision ESS that should be highlighted in the training of Ear, Nose and Throat surgeons to help prevent primary failure and reduce health care costs. PMID:28107148

  19. Turbinate surgery

    Turbinectomy; Turbinoplasty; Turbinate reduction; Nasal airway surgery; Nasal obstruction - turbinate surgery ... There are several types of turbinate surgery: Turbinectomy: All or ... This can be done in several different ways, but sometimes a ...

  20. Endoscopic sinus surgery in individuals with facial pain due to chronic maxillary sinusitis ? a functional controlled study

    Giuseppe Sanges


    Full Text Available Objective: To measure the intra-sinus pressure and the maxillary sinus functional efficiency (MSFE in individuals with chronic facial pain after conservative or conventional endoscopic maxillary surgery, as well as in controls. Method: Sinus manometry was performed 5 times during inhalation. Results: The resemblance of pressure values comparing those treated with minimally invasive surgery and controls was remarkable, while traditional surgery significantly decreased intrasinusal pressures. The MSFE was 100% in the three tested times for controls, close to that in those submitted to minimally invasive surgery (98.3%, 98.8%, and 98.0% and significantly impaired after conventional surgery (48.8%, 52.1%, 48.5 %, p<0.01. All patients submitted to minimally invasive surgery remained pain-free after three months of surgery, relative to 46.7% of the submitted to conventional surgery (p<0.05. Conclusion: Minimally invasive sinus surgery is associated with functionality of the chambers that resemble what is found in normal individuals.

  1. Altered nasal airflow : an unusual complication following implant surgery in the anterior maxilla

    Wolff, J.; Karagozoglu, K.H.; Bretschneider, J.H.; Forouzanfar, T.; Schulten, E.A.J.M.


    Dental implants have been in routine clinical use for over three decades and are a predictable treatment modality. However, as with all other aspects of dentistry, complications occur. A 50-year-old female patient with complaints of a long ongoing unpleasant altered nasal airflow presented herself a




    Full Text Available Introduction of Endoscope has revolutionized the surgical management of Pituitary tumors. Endoscopic endonasal approach has now become the most acceptable and routinely done procedure. In our tertiary center, we have analysed the data of 40 patients, who underwent endoscopic endonasal surgery over a period of one year. Clinical parameters, tumor excision, endocrinological status, complication rates were retrospectively analysed. One month follow up with repeat MRI and hormonal status was compared with pre-operative findings. There were 15 functioning and 25 non-functioning pituitary adenomas. There were 6 prolactinomas, 4 acromegaly, 4 Cushing and 1 FSH secreting pituitary adenoma. 25 were non-functioning adenomas. There was one microadenoma with Cushing syndrome. Subtotal excision was done in 76% of non-functioning and 66% of functioning adenomas. The remission rates were 80% in non-functional and almost 75% in functional pituitary adenoma. In our series, endoscopic approach proved to be less invasive, excellent tumors removal rate and better post-operative results. The complications were also less and comparable to other conventional methods. But it has steep learning curve and needs technical skills.

  3. Transnasal, Endoscopically Guided Skull-Based Surgery by Pharyngotomy for Mass Removal from the Sphenopalatine Sinus in a Horse.

    Radcliffe, Rolfe M; Messiaen, Yasmine; Irby, Nita L; Divers, Thomas J; Dewey, Curtis W; Mitchell, Katharyn J; Schnabel, Lauren V; Bezuidenhout, Abraham J; Scrivani, Peter V; Ducharme, Norm G


    To report a transnasal, endoscopically guided ventral surgical approach for accessing the cranial and caudal segments of the sphenopalatine sinus for mass removal in a horse. Case report. Adult horse with acute onset blindness referable to a soft tissue mass within the sphenopalatine sinus. A 7-year-old Warmblood gelding presented with a history of running into a fence and falling. No neurologic signs were identified at initial examination but acute blindness was noted 3 weeks later. On computed tomography (CT) the sphenopalatine sinus was filled with a large homogeneous mass with poor contrast enhancement that extended dorsally with thinning to the dorsal cortex of the sphenoid bone, just rostral to the entrance of the optic canals into the cranial cavity. Surgical access to the sphenopalatine sinus was achieved using a transnasal, endoscopically guided ventral pharyngotomy approach and the mass lesion was removed. A presumptive diagnosis of chondroma was made based on histopathology. The horse recovered well from surgery, and although it has not regained vision as of 6.5 years postoperatively, the disease has not progressed. Transnasal, endoscopically-guided ventral surgical access to the sphenopalatine sinus is possible in horses and may improve access in horses with disease extending caudally beyond the palatine portion of the sinus. Use of smaller diameter or specialized instruments, such as various endoscopic bone cutting instruments, and CT image guidance may improve sinus access by this route. © Copyright 2016 by The American College of Veterinary Surgeons.

  4. Histologic effects of different technologies for dissection in endoscopic surgery: Nd:YAG laser, high frequency and water-jet.

    Schurr, M O; Wehrmann, M; Kunert, W; Melzer, A; Lirici, M M; Trapp, R; Kanehira, E; Buess, G


    Precise cutting combined with reliable coagulation of the margins of the lesion is an important requirement for dissection techniques in endoscopic surgery. These requirements are met by the two most common ancillary energy sources applied for endoscopic dissection today, electrosurgery and "thermal lasers", mostly the Nd:YAG. For the comparison of the histological effects of monopolar and bipolar high frequency with the Nd:YAG laser an experimental in vitro and in vivo study has been performed. In order to evaluate the advantages of non thermal dissection for endoscopic procedures, a water jet cutting system was included in the in vitro study. In parenchymatous tissue the water jet was found to be the least traumatic technique, followed by bipolar high frequency, laser and monopolar high frequency. The water jet was not applicable for intestinal dissection since uncontrolled bloating of the rectal wall with uncontrolled disruption of the tissue layers occurred. A general disadvantage is that secure haemostasis in the line of incision is hard to achieve. In the microscopic comparison of the shape of the incision, the Nd:YAG laser produced the smoothest lesions with well-defined margins. The monopolar technique was more often associated with irregular and sometimes fissured margins. These results were confirmed in the in vivo part of the study (Transanal Endoscopic Microsurgery).

  5. Sliding alar cartilage (SAC) flap: a new technique for nasal tip surgery.

    Ozmen, Selahattin; Eryilmaz, Tolga; Sencan, Ayse; Cukurluoglu, Onur; Uygur, Safak; Ayhan, Suhan; Atabay, Kenan


    Congenital anatomic deformities or acquired weakness of the lateral crura of the lower lateral cartilages after rhinoplasty could cause alar rim deformities. As lower lateral cartilages are the structural cornerstone of the ala and tip support, deformities and weakness of the alar cartilages might lead to both functional and esthetic problems. In this article, we are introducing sliding alar cartilage flap as a new technique to reshape and support nasal tip. One hundred sixty consecutive patients between 18 and 55 years of age (mean age: 27.51) were included in the study between January 2007 and May 2008. Of the total number of patients 60 were male and 100 of them were female. None of the patients had rhinoplasty procedure including lower lateral cartilage excision previously. Sliding alar cartilage technique was used in an open rhinoplasty approach to shape the nasal tip in all patients. This technique necessitates about 2 to 3 minutes for suturing and undermining the alar cartilages. The follow-up period was between 4 and 18 months. In no patients any revision related to the sliding alar cartilage technique was required. Revision was applied in 3 patients due to thick nasal tip skin and in one patient due to unpleasant columellar scar. In this article, we are presenting the "sliding alar cartilage flap" as a new technique for creating natural looking nasal tip. This technique shapes and supports nasal tip by spontaneous sliding of the cephalic portion of the lower lateral cartilage beneath the caudal alar cartilage, with minimal manipulation, without any cartilage resection, or cartilage grafting.

  6. Paediatric adenoidectomy: endoscopic coblation technique compared to cold curettage.

    Di Rienzo Businco, L; Angelone, A M; Mattei, A; Ventura, L; Lauriello, M


    The aim of our study was to assess the efficacy and safety of endoscopic coblator adenoidectomy compared to cold curettage in paediatric patients. Forty homogeneous children (4-16 years of age) with adenoid hypertrophy were divided in 2 groups to receive adenoidectomy using cold curettage (A) or coblator (B). After surgery the following outcomes were evaluated: pain score on first day, days reporting pain, analgesic days, liquid diet days, absent from school days, pain score, days with nausea, days with fever, endoscopic adenoid grade and intraoperative bleeding. Forty days after surgery, basal rhinomanometry and nasal decongestion test were measured. The coblation group reported significantly less pain on the first post-operative day, days reporting pain, analgesic days, liquid diet days and absent school days. Patients in group A showed a higher grade of adenoid persistence by rhinoendoscopy, with high values of nasal resistances at the rhinomanometry even after nasal decongestion, consistent with greater adenoid persistence after cold curettage causing air flow obstruction even after turbinate decongestion. Intra-operative bleeding during coblation was significantly less compared the group undergoing cold curettage. Coblator treatment significantly improved patient recovery compared to curettage. Endoscopic coblation adenoidectomy ensures complete removal of adenoids and reduces postoperative adenoid grade. It can also be considered safer because it is under endoscopic control and can reach the cranial portion of the adenoid and its intranasal extension.

  7. Asthma in ear, nose, and throat primary care patients with chronic rhinosinusitis with nasal polyps

    Frendø, Martin; Håkansson, Kåre; Schwer, Susanne;


    BACKGROUND: Chronic rhinosinusitis with nasal polyps (CRSwNP) is a common inflammatory disorder associated with asthma. This association is well described in patients with CRSwNP undergoing endoscopic sinus surgery (ESS); however, some patients are never referred for surgery, and the frequency...... were prospectively recruited from nine PC ear, nose, and throat clinics in the Copenhagen area. CRSwNP was diagnosed according to the European Position Paper on Chronic Rhinosinusitis and Nasal Polyps; severity was assessed by using a visual analog scale. Allergy, lung function, and asthma tests...

  8. Penetration of prulifloxacin into sinus mucosa of patients undergoing paranasal sinus elective endoscopic surgery.

    De Benedetto, Michele; Passali, Desiderio; Tomacelli, Giovanni; Ruggieri, Alessandro; Rosignoli, Maria Teresa; Picollo, Rossella; Bellussi, Luisa; Dionisio, Paolo


    The aim of this study was to assess the concentration of ulifloxacin, the active metabolite of prulifloxacin, in sinuses mucosa and plasma of patients with chronic rhinosinusitis, requiring sinus elective endoscopic surgery. Thirty-nine patients (30 males, 9 females; age range 22-77 years) with chronic sinusitis were enrolled, 35 were treated with the investigational medication. Samples from four untreated patients were used to validate the analytical method, while four treated patients dropped out before surgery. One 600 mg prulifloxacin tablet once daily was administered for 5 days before surgery. The last dosing was scheduled from 2 to 12 hours from tissue and plasma sampling. In each patient, two samples of paranasal sinus mucosa (from ethmoid and turbinate, respectively) and one blood sample were collected. Concentrations of ulifloxacin in plasma and sinuses mucosa were measured using validated bioanalytical LC/MS/MS methods. Individual and mean ulifloxacin concentrations in tissues were always higher than the relevant plasma levels. The highest concentrations were observed between 2.5 and 4.5 hours after the last dosing in all districts. The mean tissue/plasma ratios were 2.5 and 3.0 for ethmoid and turbinate, respectively. Data expressed as Area Under the Curves (AUC±SD) showed that ulifloxacin concentrations in the ethmoid were slightly higher (18.68±6.48 μg/g*h) than in turbinate (15.00±2.89 μg/g*h), and definitely higher than in plasma (6.32±1.14 μg/ml*h). The AUC ratios between tissues and plasma were 3.0 for ethmoides and 2.4 for turbinates. One patient reported two treatment-related episodes of diarrhea, which spontaneously resolved after the drug suspension. Results from this study seem to suggest that prulifloxacin showed good distribution in sinus tissues, where it reaches concentrations significantly higher than in plasma. These findings strongly call for confirmatory clinical trials in patients with bacterial rhinosinusitis.

  9. Clinical studies of supporting laryngoscope and nasal endoscopic electro-coagulation resection lesions of vocal cord in treatment of early glottic carcinoma%支撑喉镜联合鼻内镜电凝切除病变声带治疗早期声门型喉癌的临床研究

    陈伟龙; 陈锦贤; 许奕乔; 陈展胜; 林楚标


    目的:探讨支撑喉镜联合鼻内镜电凝切除病变声带治疗早期声门型喉癌的手术技巧及效果。方法选择汕头市澄海人民医院耳鼻咽喉-头颈外科2010年1月~2014年6月收治的12例早期声门型喉癌患者为研究对象,所有患者均在支撑喉镜联合鼻内镜下电凝切除病变声带,观察治疗效果。结果随访至2014年7月10日,12例均存活;仅有1例局部复发,予再次治疗后恢复良好,无复发。结论支撑喉镜联合鼻内镜电凝切除病变声带治疗早期声门型喉癌视野清晰,手术精细,创伤小,复发率较低,既适应恶性肿瘤治疗原则,又符合现代恶性肿瘤治疗理念,可较大程度提高患者生活质量,值得临床推广。%Objective To investigate the operation skills and self retaining laryngoscope combined with nasal endoscop-ic electrocoagulation resection lesions of vocal cord in treatment of early glottic carcinoma. Methods 12 cases of early glottic carcinoma in Department of Otolaryngology-Head and Neck Surgery, Chenghai People's Hospital of Shantou City from January 2010 to June 2014 were selected as study objects. They were given the treated by electrocoagulation re-section lesions vocal cord under the laryngoscope and nasal endoscopy, the treatment effect was observed. Results Fol-low-up until 10 July 2014, all 12 patients survived, only 1 case had local recurrence, then got good recovery after re-treatment, no recurrence. Conclusion Supporting laryngoscope and nasal endoscopic electrocoagulation resection of vo-cal cord lesions early glottic carcinoma treated with a clear vision, fine operation, small trauma, the recurrence rate is low, not only adapt to the malignant tumor treatment principle, and in line with the modern concept of malignant tumor treatment, greatly improve the quality of life of the patients, which is worth of the clinical promotion.

  10. Radiologic anatomy of the paranasal sinuses in computed tomography for the need of the endoscopic surgery; Anatomia radiologiczna zatok przynosowych w obrazach tomografii komputerowej dla potrzeb chirurgii endoskopowej

    Boguslawska-Staniaszczyk, R.; Krzeski, A.; Mastalerski, J. [Centralny Szpital MSW, Warsaw (Poland)]|[Akademia Medyczna, Warsaw (Poland)


    Computed tomography is the most useful method in the endoscopic surgery of the nose and paranasal sinuses. CT examination is necessary for planing and the extent of the surgery. In this publication the method of CT examination and radiological anatomy of the nose and paranasal sinuses is described. (author). 15 refs, 10 figs.

  11. Long-term results of endoscopic sinus surgery-oriented treatment for chronic rhinosinusitis with asthma.

    Chen, Feng-Hong; Zuo, Ke-Jun; Guo, Yu-Biao; Li, Zhi-Ping; Xu, Geng; Xu, Rui; Shi, Jian-Bo


    The aims of this study were to evaluate the efficacy of functional endoscopic sinus surgery (FESS)-oriented multimodality treatment in chronic rhinosinusitis (CRS) patients with asthma and its impact on asthma. Prospective, nonrandomized cohort. Twenty-seven CRS patients with asthma who underwent FESS with postoperative topical corticosteroid spray were evaluated preoperatively; 25 of them were evaluated 1 year and 3 years postoperatively. CRS was evaluated by visual analogue scale, clinical control of CRS, and objective measurement endoscopy Lund-Kennedy scores. Asthma was assessed by subjective asthma control test and asthma control level, also by objective antiasthma medication use and pulmonary function tests. VAS scores of general symptoms (8.09 ± 0.87 preoperatively) were significantly improved at 1 year (2.94 ± 2.21) and 3 years (3.77 ± 2.16) postoperation (P = .000). No difference in these items was found between 1 year and 3 years (P = .463). Endoscopy Lund-Kennedy scores at 1 year (4.34 ± 3.09) and 3 years (5.80 ± 3.38) postoperatively were significantly better (9.33 ± 2.03 preoperatively, P = .000), and there was no difference between 1 year and 3 years of follow-up (P > .05). Significantly, asthma control level improved postoperatively (P = .025). However, antiasthma drug and pulmonary function showed no significant change postoperatively (P > .05). FESS-oriented multimodality treatment improves CRS with asthma significantly and persistently. Asthma control level improved. Antiasthma medication use and pulmonary function remained stable. © 2013 The American Laryngological, Rhinological and Otological Society, Inc.

  12. Serum cytocines values in patients after endoscopic surgery for ureteral lithiasis.

    Bantis, Athanasios; Tsakaldimis, Georgios; Zissimopoulos, Athanasios; Kalaitzis, Christos; Gianakopoulos, Stilianos; Pitiakoudis, Michail; Polichronidis, Alexandros; Touloupidis, Stavros


    Obstructive uropathy due to ureteral stones can cause renal infection and, if left untreated, can cause impairment of renal function. Endoscopic surgery such as ureteroscopy (URS) and laser lithotripsy are the primary therapeutic approach. Cytokines as non invasive markers may have a role to diagnose ureteral damage and infection. We aimed to evaluate serum cytokine levels of tumor necrosis factor-a (TNFa) and interleukin-6 (IL6) in patients undergoing URS and holmium laser lithotripsy. The study included 40 patients (male 25 and 15 female) with a mean age of 47 years and 10 healthy blood donors serving as the control group. None of them had any additional systemic diseases, previous insertion of a ureteral double "j" stent or of a nephrostomy tube, neoplasmatic disease ot renal insufficiency. Routine urine examination and urine culture were obtained to exclude urinary infection. Preoperatively and 1h, 2h, 24h and 48h postoperatively serum samples of TNF-a and IL-6 were collected and measured. Serum TNFa and IL-6 values were correlated with the other variables measured from blood samples after the URS using paired samples Students t-test with confidence interval 95%. A P value of less than 0.01 was considered statistically significant. Correlation between serum TNF-a and IL6 levels with healthy donors were statistically significant in 1h (0.004), 2h (0.001), 24h (0.001) and 48h (0.001 and 0.001) postoperatively, respectively. In conclusion, our study shows that cytokines could be helpful as markers of renal tissue damage. However, further studies are needed to get more accurate results.

  13. Evaluation of piroxicam-β-cyclodextrin as a preemptive analgesic in functional endoscopic sinus surgery

    G.T. Keleş


    Full Text Available The preemptive analgesic efficacy and adverse effects of preoperatively administered piroxicam-β-cyclodextrin for post-endoscopic sinus surgery pain was determined in a prospective, double-blind, randomized, clinical study. Seventy-five American Society of Anesthesiologists status I-II patients, aged 18-65 years, were divided into three groups with similar demographic characteristics: group 1 received 20 mg piroxicam-β-cyclodextrin, group 2 received 40 mg piroxicam-β-cyclodextrin and group 3 received placebo orally before induction of general anesthesia. A blinded observer recorded the incidence and severity of pain at admission to the post-anesthesia care unit (PACU, at 15, 30, and 45 min in the PACU, and 1, 2, 4, 6, and 24 h postoperatively. All patients received patient-controlled morphine analgesia during the postoperative period and consumption was recorded for 24 h. During the PACU period, mean visual analogue scale values were significantly lower in groups 1 and 2 compared to group 3 (P < 0.05. During the postoperative period, morphine consumption was 3.03 ± 2.54, 2.7 ± 2.8, and 5.56 ± 3.12 mg for each group, respectively (P < 0.05. As a side effect, bleeding was observed in groups 1 and 3, nausea and vomiting in all groups, and edema only in group 3. However, no significant differences were detected in any of the parameters analyzed, which also included epigastric pain, constipation/diarrhea and headache. Similar hematological test results were obtained for all groups. Preemptive administration of piroxicam-β-cyclodextrin effectively reduced analgesic consumption, and 40 mg of the drug was more effective than 20 mg piroxicam-β-cyclodextrin without side effects during the postoperative period.

  14. Comparison of percutaneous endoscopic lumbar discectomy and open lumbar surgery for adjacent segment degeneration and recurrent disc herniation.

    Chen, Huan-Chieh; Lee, Chih-Hsun; Wei, Li; Lui, Tai-Ngar; Lin, Tien-Jen


    Objective. The goal of the present study was to examine the clinical results of percutaneous endoscopic lumbar discectomy (PELD) and open lumbar surgery for patients with adjacent segment degeneration (ASD) and recurrence of disc herniation. Methods. From December 2011 to November 2013, we collected forty-three patients who underwent repeated lumbar surgery. These patients, either received PELD (18 patients) or repeated open lumbar surgery (25 patients), due to ASD or recurrence of disc herniation at L3-4, L4-5, or L5-S1 level, were assigned to different groups according to the surgical approaches. Clinical data were assessed and compared. Results. Mean blood loss was significantly less in the PELD group as compared to the open lumbar surgery group (P < 0.0001). Hospital stay and mean operating time were shorter significantly in the PELD group as compared to the open lumbar surgery group (P < 0.0001). Immediate postoperative pain improvement in VAS was 3.5 in the PELD group and -0.56 in the open lumbar surgery group (P < 0.0001). Conclusion. For ASD and recurrent lumbar disc herniation, PELD had more advantages over open lumbar surgery in terms of reduced blood loss, shorter hospital stay, operating time, fewer complications, and less postoperative discomfort.

  15. Comparison of Percutaneous Endoscopic Lumbar Discectomy and Open Lumbar Surgery for Adjacent Segment Degeneration and Recurrent Disc Herniation

    Huan-Chieh Chen


    Full Text Available Objective. The goal of the present study was to examine the clinical results of percutaneous endoscopic lumbar discectomy (PELD and open lumbar surgery for patients with adjacent segment degeneration (ASD and recurrence of disc herniation. Methods. From December 2011 to November 2013, we collected forty-three patients who underwent repeated lumbar surgery. These patients, either received PELD (18 patients or repeated open lumbar surgery (25 patients, due to ASD or recurrence of disc herniation at L3-4, L4-5, or L5-S1 level, were assigned to different groups according to the surgical approaches. Clinical data were assessed and compared. Results. Mean blood loss was significantly less in the PELD group as compared to the open lumbar surgery group P<0.0001. Hospital stay and mean operating time were shorter significantly in the PELD group as compared to the open lumbar surgery group P<0.0001. Immediate postoperative pain improvement in VAS was 3.5 in the PELD group and −0.56 in the open lumbar surgery group P<0.0001. Conclusion. For ASD and recurrent lumbar disc herniation, PELD had more advantages over open lumbar surgery in terms of reduced blood loss, shorter hospital stay, operating time, fewer complications, and less postoperative discomfort.

  16. Non-endoscopic Mechanical Endonasal Dacryocystorhinostomy

    Mohammad Etezad Razavi


    Full Text Available To circumvent the disadvantages of endoscopic dacryocystorhinostomy such as small rhinostomy size, high failure rate and expensive equipment, we hereby introduce a modified technique of non-endoscopic mechanical endonasal dacryocystorhinostomy (NE-MEDCR. Surgery is performed under general anesthesia with local decongestion of the nasal mucosa. A 20-gauge vitrectomy light probe is introduced through the upper canaliculus until it touches the bony medial wall of the lacrimal sac. While directly viewing the transilluminated target area, a nasal speculum with a fiber optic light carrier is inserted. An incision is made vertically or in a curvilinear fashion on the nasal mucosa in the lacrimal sac down to the bone using a Freer periosteum elevator. Approximately 1 to 1.5 cm of nasal mucosa is removed with Blakesley forceps. Using a lacrimal punch, the thick bone of the frontal process of the maxilla is removed and the inferior half of the sac is uncovered. The lacrimal sac is tented into the surgical site with the light probe and its medial wall is incised using a 3.2 mm keratome and then excised using the Blakesley forceps. The procedure is completed by silicone intubation. The NE-MEDCR technique does not require expensive instrumentation and is feasible in any standard ophthalmic surgical setting.

  17. Current treatment of nasal vestibular stenosis with CO2-laser surgery; prolonged vestibular stenting versus intraoperative mitomycin application. A case series of 3 patients

    Schijndel, O. van; Heerbeek, N. van; Ingels, K.J.A.O.


    These case studies describe three cases of unilateral nasal vestibular stenoses caused by chemical cauterization. Each case was treated with CO2-laser surgery together with intraoperative topic application of mitomycin or prolonged vestibular stenting for prevention of restenosis. Two patients recei

  18. Experience with adenoidectomy under nasal endoscope for children's snoring diseases%鼻内镜下腺样体切除术治疗儿童鼾症的体会

    刘建国; 李建瑞


    目的 总结鼻内镜下电动吸切器切除腺样体的技术优势.方法 在鼻内镜下行经鼻腔、口腔径路吸割腺样体20例,治疗由腺样体肥大引起的儿童鼾症.结果 术后腺样体切除彻底,无残留,鼻咽部结构显示良好,无出血、无咽鼓管损伤等并发症发生.随访6~12个月,患者睡眠打鼾、鼻阻塞、流脓涕及听力障碍等症状均消失或明显缓解.结论该法避免了操作的盲目性,增加了手术的安全性和准确性,提高了疗效,减少了手术并发症.%Objective To sum up the experience with adenoidectomy for children's snoring diseases at electrical cutter with suction under nasal endoscopes. Methods 20 cases with children chronic sinusitis, sleep respiratory disorder, heating loss caused by adenoid hypertrophy were operated through nose and month route un-der nasal endoscope in adenoidectomy, with the one year follow-up. Results The adenoid gland was removed completely without of destroying the normal anatomic character. Conclusion The application of double-route nasal endoscope provides a direct and clear view that allows the surgeon to remove adenoid tissue more accurate-ly and effectively with less complications.

  19. Nasal endoscopic plasma treatment in 90 cases of adenoid hypertrophy in children%鼻内镜下等离子治疗腺样体肥大90例



    objective:to observe the nasal endoscopic plasma radiofrequency treatment at low temperature of adenoid hypertrophy in children of efficacy and safety. Methods:a retrospective analysis of the fiber nasopharyngeal endoscopy diagnosed as children of adenoid hypertrophy in 90 cases of patients, the endotracheal intubation and vein compound general anesthesia, in diameter 4 mm nasal endoscopic down low temperature plasma ablation therapy. Results:al cases adenoidectomy clean, no bleeding and eustachian tube damage, and other complications. Were fol owed up for 6 months without recurrence. Conclusion:nasal endoscopic treatment of low temperature plasma ablation of adenoid hypertrophy in children is a safe, simple and effective method.%目的:观察鼻内镜下低温等离子消融术治疗儿童腺样体肥大的疗效和安全性。方法:回顾性分析经纤维鼻咽镜检查确诊为儿童腺样体肥大患者90例,采用气管插管加静脉复合全身麻醉,在直径4mm鼻内镜下行低温等离子消融治疗。结果:全部病例腺样体切除干净,无出血及咽鼓管损伤等并发症。随访6个月无复发。结论:鼻内镜下等离子低温消融治疗儿童腺样体肥大是一种安全、简捷、有效的方法。

  20. The ergonomics of natural orifice translumenal endoscopic surgery (NOTES) navigation in terms of performance, stress, and cognitive behavior.

    James, David R C; Orihuela-Espina, Felipe; Leff, Daniel R; Sodergren, Mikael H; Athanasiou, Thanos; Darzi, Ara W; Yang, Guang-Zhong


    The evolution toward minimally invasive surgery and subsequently to natural orifice translumenal endoscopic surgery (NOTES) poses challenges to the surgeon in terms of increased task complexity requiring greater visuospatial and navigational ability. Neuroergonomics is the study of the brain and behavior at work, and establishing the baseline cortical response for NOTES procedures will help to ascertain whether technological innovation such as navigational aids can alleviate the task-induced cognitive burden. The aims of the current study are to characterize the impact of navigation within a NOTES environment on the subject in terms of (1) performance, (2) stress, (3) prefrontal cortical activity, and (4) how this is influenced by expertise. In all, 29 subjects were assessed for performance, stress response, and prefrontal cortical activity during a NOTES navigational task within a validated NOTES simulator. Experts performed significantly better than novices (P < .05). Expertise was not a predictor for overall changes in prefrontal cortical activity. The differences between experts and novices were modulated by the location of prefrontal cortical activity, with experts demonstrating more pronounced lateral prefrontal cortical activation compared with novices. Stress was not an independent predictor of changes in prefrontal cortical hemodynamics. This study is the first to characterize the performance, stress, and neurocognitive behavior associated with natural orifice translumenal endoscopic surgery navigation. The results indicate the relevance of visuospatial centers in successful task execution, and they serve as a baseline within the neuroergonomic paradigm for investigating performance-enhancing technology. Copyright © 2011 Mosby, Inc. All rights reserved.

  1. Bilateral endoscopic endonasal marsupialization of nasopalatine duct cyst

    Yohei Honkura


    Full Text Available Nasopalatine duct cysts are the most common non-odontogenic cysts in the maxilla, and are conventionally treated through a sublabial or palatine approach. Recently, the endoscopic approach has been used, but experience is extremely limited. We treated a 29-year-old male with nasopalatine duct cyst by endoscopic marsupialization, but paresthesia of the incisor region occurred after surgery. This paresthesia gradually remitted within 6 months. The nasopalatine nerve, which innervates the upper incisor region, enters two lateral canals separately at the nasal floor and exits the central main canal at the palate. Damage to the bilateral nasopalatine nerves might lead to paresthesia, so we recommend careful examination for nerve fibers during endoscopic surgery, especially if fenestration is performed on both sides.

  2. Development and testing of a compact endoscope manipulator for minimally invasive surgery

    Berkelman, Peter; Cinquin, Philippe; Boidard, Eric; Troccaz, Jocelyne; Létoublon, Christian; Long, Jean-alexandre


    Objective: This report describes the design, development, and testing of a novel compact surgical assistant robot to control the orientation and insertion depth of a laparoscopic endoscope during minimally...

  3. Endoscopic surgery for tumors of the pineal region via a paramedian infratentorial supracerebellar keyhole approach (PISKA).

    Thaher, Firas; Kurucz, Peter; Fuellbier, Lars; Bittl, Markus; Hopf, Nikolai J


    The tumors of the pineal region represent a significant challenge in terms of patient selection and surgical approach. Traditional surgical options were commonly used to approach this area causing considerable surgical morbidity and mortality. We report for the first time on a series of endoscopic procedures for lesions of the pineal region performed via an infratentorial supracerebellar keyhole approach (PISKA) in the prone position using endoscope-assisted and endoscope-controlled technique. A single-institution series of 11 consecutive patients (five male and six female patients [11 total cases]; mean age 21 years, range 1-75 years) treated via the endoscope-assisted and endoscope-controlled PISKA for a pathological entity in the pineal region was retrospectively reviewed. The mean follow-up time was 24 months. The endoscopic PISKA was successfully used to approach a variety of pineal lesions, including pineocytoma (three patients), pineal cysts (four patients), germinoma, lipoma, medulloblastoma, and glioblastoma (one patient each). Gross total resection was achieved in ten cases and subtotal resection in one case. The mean preoperative tumor volumes were approximately 2 × 2 cm. Five patients developed postoperatively transient Parinaud's syndrome. One patient underwent surgical revision for cerebrospinal fluid leak. There was no mortality. Ten patients had an uneventful postoperative course with restitutio ad integrum after a mean follow-up duration of 13.5 months. The endoscopically PISKA is a safe and effective minimally invasive approach that enables endoscopic treatment of different lesions of the pineal region with comparable results to standard microsurgical technique but less morbidity.

  4. Anatomy of nasal SMAS tissue and its application in nasal plastic surgery%鼻端SMAS组织的解剖研究及其在鼻尖整形术中的应用

    敖健飞; 宋春琼


    Objective Anatomical analysis of nasal MAS tissue, and to observe the effect of nasal plastic surgery. Methods 8 cases of adult cadaveric head specimens, specimens using 10%formaldehyde solution ifxed,red latex via radial artery and femoral artery perfusion. Gross autopsy were observed at each level and photographed. Simulate the clinical surgery.nose SMAS tissue folding,placed on the tip of the nose,observe the effect.The use nasal SMAS tissue rhinoplasty patients clinical data and observation of plastic surgery patients before and after contrast effect and postoperative infection rate.For patients were followed up for half a year, and observation of patients in the ifrst half of complications and the tip of the nose shape. Results Nasal SMAS tissue including alar cartilage,nasal cartilage surface SMAS,anatomical experimental political nasal SMAS was placed on the tip of the nose can increase the thickness of the tip of the nose.Clinical trials showed postoperative nasal tip elevation, patients on the shaping effects expressed their satisfaction with and without postoperative infection;patients within 6 months after the operation the tip of the nose shape of natural beauty and the tip of the nose red does not appear, collapse and other adverse reactions. Conclusion Nasal SMAS tissue for signiifcant effect of nasal plastic surgery, postoperative nasal tip more natural, tip leakage occurred rate is lower,the value of clinical application and promotion.%目的:分析鼻端SMAS组织的解剖学基础,并观察其在鼻尖整形术中的应用效果。方法:选择8例成年尸体头部标本,标本使用10%甲醛溶液固定、红色乳胶经桡动脉及股动脉联合灌注。肉眼解剖尸体,观察各个层次并拍照。模拟临床手术,将鼻端SMAS组织折叠置于鼻尖,观察效果。对使用鼻端SMAS组织进行鼻尖整形患者的临床资料,观察患者整形前后效果对比和术后感染发生率。对患者进行半年随访

  5. Retrospective analysis of a concurrent series of microscopic versus endoscopic transsphenoidal surgeries for Knosp Grades 0-2 nonfunctioning pituitary macroadenomas at a single institution.

    Dallapiazza, Robert; Bond, Aaron E; Grober, Yuval; Louis, Robert G; Payne, Spencer C; Oldfield, Edward H; Jane, John A


    The object of this study was to compare surgical outcomes and complications in a contemporaneous series of patients undergoing either microscopic or endoscopic transsphenoidal surgery for nonfunctioning pituitary macroadenomas without imaging evidence of cavernous sinus invasion. This is a retrospective analysis of a prospectively collected database from a single institution. Data were collected from patients whose surgery had occurred in the period from June 2010 to January 2013. Patients who underwent microscopic or endoscopic surgery for Knosp Grade 0, 1, or 2 nonfunctioning pituitary macroadenomas were included in the study. Patients who had clinically secreting or Knosp Grade 3 or 4 tumors and patients who were undergoing revision surgery were excluded from analysis. Eligible patient records were analyzed for outcomes and complications. Statistical analyses were performed on tumor volume, intraoperative factors, postoperative complications, and degree of resection on 1-year postoperative MRI. The results were used to compare the outcomes after microscopic and endoscopic approaches. Forty-three patients underwent microscopic transsphenoidal surgery, and 56 underwent endoscopic transsphenoidal surgery. There were no statistical differences in the intraoperative extent of resection or endocrinological complications. There were significantly more intraoperative CSF leaks in the endoscopic group (58% vs 16%); however, there was no difference in the incidence of postoperative CSF rhinorrhea (12% microscopic vs 7% endoscopic). Length of hospitalization was significantly shorter in patients undergoing an endoscopic approach (3.0 days vs 2.4 days). Two-month follow-up imaging was available in 95% of patients, and 75% of patients had 1-year follow-up imaging. At 2 months postprocedure, there was no evidence of residual tumor in 79% (31 of 39) and 85% (47 of 55) of patients in the microscopic and endoscopic groups, respectively. At 1 year postprocedure, 83% (25 of 30) of

  6. CT诊断和鼻内窥镜手术对真菌性鼻-鼻窦炎的诊治探讨%To explore the CT scanning and endoscopic sinus surgery in diagnosis and treatment of fungal rhinosinusitis.

    杨羿容; 朱德姝; 吴勇


    目的 探讨真菌性鼻-鼻窦炎恰当的诊断及治疗方法.方法 回顾性对2005年4月~2009年4月我科收治的35例真菌性鼻-鼻窦炎的临床症状、CT表现及鼻内窥镜治疗效果分析.结果 35例真菌性鼻-鼻窦炎经鼻内窥镜下鼻窭开放手术后冲洗鼻窦治疗后随访6个月~2年,33例1次治愈,2例复发经再手术解除鼻窦口堵塞后用刮霉菌素冲洗鼻窦治疗后治愈,随访6个月无复发.结论 CT检查是诊断真菌性鼻-鼻窦炎的有效检查手段,鼻内窥镜下鼻窦开放后联合制霉菌素冲洗鼻窦是治疗真菌性鼻-鼻窦炎的有效方法.%Objective To study the pathological and clinicalfeatures of fungal sinusitis and its diagnosis and treatment methods. Methods The clinical symptoms, CT manifestations and treatments of fungal rhinosinusitis was analyzed retrospectively with data from 35 patients in our department between April 2005 and April 2009. All 35 patients were washed opened nasal sinus after endoscopic sinus surgery during a follow-up of 6 months to 2 years, Results among the 35 patients,33 patients had been cured. 2 had been healed after re-operation by using nystatin wash nasal sinus with 6 months of follow-up. Conclusion CT scanning is useful for the diagnosis of fungal rhinosinusitis. It's effective to cure the fungal rhinosinusitis with nystatin nasal sinus washouts after endoscopic sinus surgery.

  7. Anatomical mapping of the nasal muscles and application to cosmetic surgery.

    Konschake, Marko; Fritsch, Helga


    We present an anatomical mapping of the most important muscles influencing the nose, incorporating constant anatomical structures, and their spatial correlations. At our disposal were the midfaces of 18 bodies of both sexes, obtained by informed consent from body donors aged between 60 and 80 years. Macroscopically, we dissected the nasal regions of eight corpses, six midfaces were prepared according to plastination histology, four by creating plastinated slices. On their way from their periosteal origin to the edge of the skin, the muscles of the nose cross the subcutaneous adipose tissue, dividing it into superficial and deep layers. The individual muscle fibers insert into the skin directly at the reticular corium. Sometimes, they reach the border of the epidermis which represents a special arrangement of corial muscle attachments. The course of the anatomical fibers of individual nasal muscles presented macroscopically and microscopically in this study offers surgeons a detailed overview of the anatomically important muscular landmarks of the midface. © 2014 Wiley Periodicals, Inc.

  8. 鼻尖部神经鞘瘤切除及同期鼻尖成形术2例%Two cases with schwannoma in nasal tip by surgery and nasal tip plasty

    张佳凤; 王钟颖; 汪涛; 陈东; 吴晴伟; 王珮华


    Objective To review relevant literature by discussing the characteristics, pathological identity, clinical manifastations, surgical treatment combined with nasal tip plasty of nasal schwannoma. Methods Clinical and pathological data of two patients suffering from schwannoma in nasal tips was analyzed and relevant literature was reviewed. This two patients were cured by surgery, and one of them accepted the nasal tip plasty of autogenous septal cartilage transplantation. Result The pathological diagnosis was schwannoma in nasal tip. Both of them were very satisfied with the morphology of their noses. Conclusion Schwannoma can be treated by surgery with good prognosis. These patients can obtain good morphology of their noses by autogenous septal cartilage transplantation.%目的 通过近期相关文献复习了解鼻尖部神经鞘瘤的病史病理特点、临床表现和诊治,在外科切除的同时行鼻尖成形术.方法 报告2例鼻尖部神经鞘瘤的临床病理特点,同期行鼻尖成形术,其中1例应用自体鼻中隔软骨行鼻尖成形术.结果 病理显示神经鞘瘤,2例患者均对外鼻形态满意.结论 鼻尖部神经鞘瘤临床少见,在外科切除的同时应用自体鼻中隔软骨行鼻尖成形术可以得到满意的外鼻形态.

  9. Clinical analysis on treatment of non- invasive fungal rhinosinusitis by endoscopic sinus surgery%鼻内镜手术治疗非侵袭性真菌性鼻-鼻窦炎临床分析

    张世涛; 赵玉林; 苏红霞; 张远


    Objective To explore the etiology and clinical features of non - invasive fungal rhinosinusitis and to evaluate the methods and curative effects of endoscopic sinus surgery. Methods The denial and follow -up data of 57 patients with non -invasive fungal rhinosinusitis were retrospectively analyzed. Results All cases were cured without recurrence during a follow - up from 6 months to 2 years. Conclusions Anatomic abnormalities of the paranasal sinuses are the main reasons of the non invasive fungal rhinosinusitis, Clearing up the infected focus by endoscopic sinus surgery is an effective treatment, after surgery regularly sinus rinse and nasal endoscopy can prevent disease recurrence.%目的 探讨非侵袭性真菌性鼻-鼻窦炎的致病原因、临床特征、鼻内镜手术方法及临床疗效.方法 对2007年5月至2010年5月的57例非侵袭性真菌性鼻-鼻窦炎的临床资料进行回顾性分析.结果 随访6个月~2年,全部病例无复发,无1例并发症发生.结论 鼻腔、鼻窦局部解剖异常是非侵袭性真菌性鼻-鼻窦炎患者患病的主要原因,鼻内镜手术清除病灶是治疗非侵袭性真菌性鼻-鼻窦炎的最有效方法,手术后定期鼻窦窦腔冲洗及鼻内镜检查可防止疾病的复发.

  10. 鼻内镜下两种入路电动吸切器对Ⅲ~Ⅳ度腺样体肥大患儿手术切除的比较%A comparative study of therapeutic effect on adenoidal hypertrophy at Ⅲ~Ⅳ degrees removed under nasal endoscope via two different approaches for powered debrider



    Objective To investigate the surgical effect on adenoidal hypertrophy at Ⅲ~Ⅳ degrees removed under nasal endoscope via two different approaches for powered debrider in a comparative way. Methods Sixty children cases with Ⅲ~Ⅳ degree of adenoidal hypertrophy were included in this study, treated in our Hospital from January 2012 to August 2014. They were operated on under nasal endoscope with powered debrider to remove the hypertrophied adenoid, either via transnasal approach (nasal approaching group, NAG) or via transoral approach (oral approaching group, OAG), with 30 cases in each group. A period of postoperative following up lasted for 6 months was carried out among them to compare the differences in therapeutic effect and incidence of surgery related complications between these two groups of children. Results There was no statistical significance in the differences of operating time (t=0.537, P=0.296), content of blood lost (t=-0.860, P=0.196) and postoperative headache within the first week following the surgery (t=0.728, P=0.524) between the two groups, while the incidences of mucosal injury occurred during the operation (X2=10.153, P=0.001), nasal blockage feeling after the operation (X2=9.017, P=0.003) and postoperative soft palate edema (X2=12.342, P=0.001) were significantly higher in NAG than that in OAG. Conclusions Operation via transoral approach holds such advantage as to control the performing process easier but slightly difficult to just the depth of ablation, while operation via transnasal approach is simpler to perform but followed relatively higher incidences of postoperative nasal adhesion and adenoidal residue following the surgery.%目的 比较鼻内镜下不同入路电动吸切器切除Ⅲ~Ⅳ度肥大腺样体的手术效果. 方法 2012年1月至2013年8月在我院拟行鼻内镜下手术治疗的Ⅲ~Ⅳ度腺样体肥大患儿60例,分别经鼻入路(鼻入路组)和经口入路(口入路组)行电动吸

  11. Endoscopic dacryocystorhinostomy

    Milojević Milanko


    Full Text Available Background/Aim. Intensive epiphora (lacrimal apparatus disease can make difficult daily routine and cause ocular refraction disturbances. In most cases ethiology is unknown, rarely occurs after nose surgical procedures, face fractures, in Wegener granulomatosis, sarcoidosis and malignancies. The aim of this study was to evaluate efficacy of endonasal endoscopic surgical procedure with the conventional surgical instruments in treatment of nasolacrimal obstructions. Methods. This retrospective study included 12 female patients with endonasal endoscopic surgical procedure from Otorhinological and Ophtalmological Departments of Military Medical Academy, Belgrade from September 2007 to April 2009. Preoperative nasal endoscopy was performed in order to reveal concomitant pathological conditions and anatomic anomalies which could make surgical procedure impossible. Computerized tomography was performed only in suspect nose diseases. Surgical endonasal endoscopic procedure was performed by otorhinolaryngologist and ophtalmologist in all patients. The patients had regular controls from 2 to 20 months. Results. A total of 12 female patients, age 34-83 years, were included in our study. Epiphora was a dominant symptom in all patients. In two patients deviation of nasal septum was found, and in other one conha bulosa at the same side as chronic dacryocystitis. All patients were subjected to endonasal dacryocystorhinostomy (DCR by endoscopic surgical technique using conventional instruments. Concomitantly with DCR septoplastics in two patients and lateral lamictetomy in one patient were performed. There were no complications intraoperatively as well as in the immediate postoperative course. In two patients the need for reoperation occurred. Conclusion. Endoscopic DCR is minimally invasive and efficacious procedure for nasolacrymal obstructions performed by otorhinolaryngologist and ophtalmologist. Postoperative recovery is very fast.

  12. 鼻内镜术后病情迁延的细菌学分析%Bacteriological analysis of persistent rhinosinusitis after endoscopic sinus surgery

    代保强; 王全桂


    目的:探讨慢性鼻-鼻窦炎(CRS)鼻内镜术后迁延不愈者鼻腔分泌物的细菌学特征.方法:选取单纯鼻中隔偏曲患者20例(对照组),取其中鼻道分泌物;选取首次接受鼻内镜手术的CRS患者30例(手术组),术中取中鼻道分泌物;取FESS术后随访3个月以上未达治愈标准的患者20例(迁延组),在鼻内镜下取中鼻道分泌物,分别做细菌培养和药物敏感试验,3组结果进行比较分析.结果:对照组检出细菌13株,手术组检出15株,迁延组检出15株,其检出阳性率差异无统计学意义;迁延组G-菌检出率明显高于对照组和手术组;对常用抗生素耐药的菌株比例迁延组显著高于手术组.结论:需氧菌可存在于正常鼻腔内;CRS术后迁延不愈者,G-杆菌的感染和细菌的耐药性明显增加.因此,强调要合理应用抗生素,对术后迁延性鼻窦炎的抗生素治疗,应建立在细菌培养和药敏试验的基础上.%Objective:To investigate the bacterial characteristics of persistent rhinosinusitis after functional endoscopic sinus surgery(FESS). Method: Twenty patients with nasal septum deviation, 30 patients with chronic rh-inosinusitis(CRS) and 20 patients with persistent rhinosinusitis, were selected to take discharges from middle me-atus during the operation. Bacteria culture and drug susceptibility of the discharges were compared betweent three groups. Result:There were 13,15 and 15 isolates detected in nasal septum deviation group, CRS group and persis-tent rhinosinusitis group. There was no significant difference among the three groups at the detection rate of Gram-positive bacteria. But there was significant difference between the persistent rhinosinusitis group and the oth-er two groups at the detection rate of Gram-negative bacteria. The detection rate of antibiotic-resistant bacteria were significantly higher in persistent rhinosinusitis group than in CRS group. Conclusion) Aerobic bacteria can live in nasal

  13. The Effect of Pharyngeal Packing during Nasal Surgery on the Incidence of Post Operative Nausea, Vomiting, and Sore Throat

    Ali Karbasfrushan


    Full Text Available Introduction: Nausea and vomiting after ear, nose and throat (ENT surgery is one of the most common and notable problems facing anesthesiologists in this area. This study was conducted to determine the effect of a pharyngeal pack on the severity of nausea, vomiting, and sore throat among patients after ear, pharynx, and throat surgeries.   Materials and Methods: This randomized clinical study was performed in 140 patients (61 men and 79 women; age range, 20–40 years who had undergone nasal surgery in 2010. Patients were divided into two groups: the first group were treated using a pharyngeal pack (case group and the second group were managed without a pharyngeal pack (control group. Statistical analysis was performed using the Chi-square test and the Mann-Whitney U test. SPSS software was used for data analysis.   Results: The mean severity of nausea and vomiting in the two groups was 2.057, 1.371 and 1.100, respectively, with no significant differences between groups. However, the mean severity of sore throat was 1.714 in the group with the pharyngeal pack and 1.385 in the group without pharyngeal pack (P=0.010.   Conclusion:  Not only does a pharyngeal pack in ENT surgery not reduce the extent and severity of nausea and vomiting, but it also increases the severity of sore throat in patients when leaving the recovery room and discharging hospital.

  14. Induced hypotension for functional endoscopic sinus surgery: A comparative study of dexmedetomidine versus esmolol

    Tarek Shams


    Full Text Available Objective: A comparative study to evaluate the efficacy of dexmedetomidine as a hypotensive agent in comparison to esmolol in Functional Endoscopic Sinus Surgery (FESS. Methods: Forty patients ASA I or II scheduled for FESS were equally randomly assigned to receive either dexmedetomidine 1 μg/Kg over 10 min before induction of anesthesia followed by 0.4-0.8 μg/Kg/h infusion during maintenance (DEX group, or esmolol, loading dose 1mg/kg was infused over one min followed by 0.4-0.8 mg/kg/h infusion during maintenance (E group to maintain mean arterial blood pressure (MAP between (55-65 mmHg. General anesthesia was maintained with sevoflurane 2%-4%. The surgical field was assessed using Average Category Scale and average blood loss was calculated. Hemodynamic variables (MAP and HR; arterial blood gas analysis; plasma cortisol level; intraoperative fentanyl consumption; Emergence time and total recovery from anesthesia (Aldrete score ≥9 were recorded. Sedation score was determined at 15, 30, 60 min after tracheal extubation and time to first analgesic request was recorded. Result: Both DEX group and E group reached the desired MAP (55-65 mmHg with no intergroup differences in MAP or HR. The for the quality of the surgical filed in the range of MAP (55-65 mmHg were <=2 with no significant differences between group scores during hypotensive period. Mean intraoperative fentanyl consumption was significantly lower in DEX group than E group. Cortisol level showed no significant changes between or within groups. No significant changes were observed in arterial blood gases. Emergence time and time to achieve Aldrete score ≥9 were significantly lower in E group compared with DEX group. The sedation score were significantly lower in E group compared with DEX group at 15 and 30 minutes postoperatively. Time to first analgesic request was significantly longer in DEX group. Conclusion: Both dexmedetomidine or esmolol with sevoflurane are safe agents for

  15. Use of Nasal Septal Bone for Septal Extension Graft after Jaw Surgery

    Gui Rak Kim, MD


    Conclusions: Use of septal bone for septal extension graft may serve as a valuable option in septal cartilage–depleted patients. It gives a strong construct for tip surgery with patient satisfaction.

  16. First experience in pulsed YAG-laser clinical applications in endoscopic surgery for gallstone destruction and operations on peripapillary zone

    Yurchenko, S. V.; Manevich, V. D.; Meshkov, Vladimir M.; Kornilov, Yu. M.; Manenkov, Alexander A.; Upyrev, A. V.; Ryabykh, V. I.; Denisov, N. N.; Bagdasarov, V. H.; Starkovsky, A. N.


    1. Central Clinical Hospital No 1, the USSR Ministry of Communications, Moscow 2. II Surgery Department, Central Institute for Advanced Medical Training, Moscow 3. Central Clinical Hospital No 4, the USSR Ministry of Communications, Moscow 4. Central Clinical Hospital of the RSFSR Ministry of Health, Moscow 5. General Physics Institute of the USSR Academy of Sciences, Moscow Progress in biliferous system surgery is to a considerable extent associated with realization of endosurgery methods on gallbladder and main biliary tracts. Radical alterations in the treatment tactics and the up-date developments of this trend put forward new technical and methodical tasks. The problem of safe disintegration of one of them. Introduction into clinical practice of endoscopic draining operations on the distal section of hepaticocholedoch eliminating such complications as wedging into it of the stone remains and recurrent lithogenesis, inevitably puts forward the problem of lithotripsy which is often of top priority as determining the radical effect of endosurgical interference.

  17. Exploration of the Effect and Research Period Patients with Nasal Septum and Nasal Surgery Treatment of Nasal Deformtiy%同期鼻中隔与鼻整形术的外鼻畸形患者的效果观察

    李传荣; 谢德翠; 李艳; 牟方国


    目的:探讨和研究同期鼻中隔和鼻整形术治疗外鼻畸形患者的疗效。方法:以我院2012年1月~2013年1月之间所收治的32例伴有鼻中隔偏曲的外鼻畸形者为对象进行研究,行同期鼻中隔和鼻整形术进行治疗,在鼻侧软骨与大翼软骨间取手术切口,单面一边骨膜蒂骨瓣截骨法处理骨椎畸形,同时采用“转门法”进行鼻中隔矫正。结果:本组32例患者均顺利完成手术,效果满意,随访5~12个月,无1例出现复发或相关并发症。结论:同期进行鼻中隔和鼻整形术能够有效避免在术中造成的鼻骨及中隔软骨的移位,减少了对鼻粘膜的损害,确保了鼻骨的血供良好,在改善患者鼻腔通气功能的同时也取得了美容的效果,值得在临床上加以推广和应用。%Objective:To explore the effect and research period patients with nasal septum and nasal surgery treatment of nasal deformi -ty.Methods:32 patients in our hospital from 2012.1 to 2013.1 were analyzed with nasal septum deviation of nasal deformity as the object of study, underwent nasal septum and nasal plastic surgery treatment , the operation incision cartilage and alar cartilage in the nasal , single side periosteal bone flap pedicled bone osteotomy of vertebral deformity , at the same time correction of nasal septum using the “revolving door”.Results:of the 32 patients were successfully completed the operation , effect satisfaction, the follow-up of 5~12 months, no case of recurrence or complications .Conclusion:Simultaneous nasal septum and nasal surgery can effectively avoid the nasal septal cartilage re -sulting in displacement and during operation , reduce the nasal mucosa damage , to ensure that the nasal good blood supply ,also made the effect of beauty in improving nasal ventilation function of patients , is worthy of popularizing and applying in clinical .

  18. CT仿真内镜在内镜经鼻蝶窦垂体瘤手术中的应用%Application of computed tomography virtual endoscopy in endoscopic transsphenoidal pituitary surgery

    王清; 鲁晓杰; 陆风旗; 余迅; 苗增利; 李兵; 张追阳


    Objective To valuate the application of computed tomography virtual endoscopy (CTVE) for endoscopic transsphenoidal pituitary surgery.Method The CTVE was applied to a series of 38 patients with pituitary adenomas operated endoscopically via the transsphenoidal approach at the Wuxi Second Hospital Affiliated Nanjing Medical University between September 2010 and June 2011.Results CTVE can be applied to simulate the endoscopic endonasal transsphenoidal pituitary surgery,and indicate the anantomic structure through the endonasal transsphenoidal approach.CTVE can preoperatively assess the morphological images of the nasal,sphenoid sinus,sellar floor and around structure,which correlated well with the intraoperative endoscopic view.The degree of pneumatization of the sphenoid sinus,the size of the sella and the sept conditions may influence the application of CTVE.Conclusions CTVE can not only act as a training simulator for the endoscopic transsphenoidal pituitary surgery,but for the experienced surgeon,it can depict the individual patient's anatomical landmarks and variations,what may help make preoperative planning and increase the safety of the endoscopic endonasal transsphenoidal pituitary surgery.%目的 探讨CT仿真内镜( CTVE)技术在神经内镜经鼻蝶窦垂体腺瘤手术中的应用价值.方法 自2010年9月至2011年6月,应用神经内镜行经鼻蝶窦垂体瘤切除术38例,患者术前均行蝶鞍区320排CT容积扫描,进行CT仿真内镜图像重建,将术前CTVE和术中神经内镜图像进行比较,分析两者在该手术入路过程中的相关性及吻合度.结果 CTVE可于术前模拟神经内镜经鼻蝶窦垂体瘤手术,显示手术入路过程中各个解剖结构.CTVE能于术前很好显示鼻腔、蝶窦、鞍底及周围解剖标志的三维图像,与术中内镜图像非常相似,解剖结构的吻合度良好,而蝶窦的大小、气化程度和分隔情况是影响CTVE图像的重要因素.结论 CTVE不仅可以成为内

  19. 鼻镜下经口动力系统与传统手术治疗儿童OSAHS的对比研究%Comparative Study of Obstructive Sleep Apnoea Syndrome Breathing in Children Treated with Dynamical Cutterbar via Nasal Endoscope and Rout Curettage of Adenoids

    谷彬; 王东海


    目的 比较鼻内镜监视下经口动力系统和传统手术方式治疗儿童阻塞性呼吸睡眠暂停综合征的临床疗效及对心理行为的改善情况.方法 将370例患者随机分为传统手术组160例(A组),鼻内镜监视下经口动力系统组210例(B组),对经两种手术方法治疗的患儿术后的临床症状和心理行为异常等情况进行分析和比较.结果 A组术后平均随访14个月,B组平均随访16个月.两组手术后对患儿临床症状均有改善.B组在睡眠打鼾、鼻塞、鼻漏、听力、上课注意力不集中、多动等症状改善方面明显优于A组(P<0.05).结论 鼻内镜下经口动力系统腺样体切除及扁桃体部分切除术对儿童阻塞性呼吸睡眠暂停综合征的治疗效果明显优于传统手术方法.%Objective The aim of this study was to compare the clinical effectiveness and the improvement of the mentality and behavior of obstructive sleep apnoea syndrome breathing( OSAHS )in children of dynamical system cutterbar via nasal endoscope for adenoidectomy and part of tonsillectomy ( group B 210cases ) and rout curettage of adenoids( group A 160cases ). Methods Clinical date of 370 patients who had accepted the surgery therapy in two ways,were retrospectively analyzed. To compare their clinical symptoms and the improvement of the mentality and behavior of OSAHS in children. Results The post-operation patients of two groups have significantly different in the symptomatic improvement. It showed that group B had significantly greater improvements in aspects of Sleep snoring, nasal obstruction, rhinorrhea, hearing, inattention in class,and restlessness than that in group A. Conclusion Dynamical system cutterbar via nasal endoscope for adenoidectomy and part of tonsillectomy by mouth is the best way to cure OSAHS in children in present time.

  20. Elective nasal continuous positive airway pressure to support respiration after prolonged ventilation in infants after congenital cardiac surgery

    Gandhi, Hemang; Mishra, Amit; Thosani, Rajesh; Acharya, Himanshu; Shah, Ritesh; Surti, Jigar; Sarvaia, Alpesh


    Background: We sought to compare the effectiveness of oxygen (O2) treatment administered by an O2 mask and nasal continuous positive airway pressure (NCPAP) in infants after congenital cardiac surgery. Methods: In this retrospective observational study, 54 infants undergoing corrective cardiac surgery were enrolled. According to the anesthesiologist's preference, the patients ventilated for more than 48 h were either put on NCPAP or O2 mask immediately after extubation. From pre-extubation to 24 h after treatment, arterial blood gas and hemodynamic data were measured. Results: After 24 h of NCPAP institution, the patients showed a significant improvement in oxygenation compared to O2 mask group. Respiratory rate (per minute) decreased from 31.67 ± 4.55 to 24.31 ± 3.69 (P < 0.0001), PO2 (mmHg) increased from 112.12 ± 22.83 to 185.74 ± 14.81 (P < 0.0001), and PCO2 (mmHg) decreased from 42.88 ± 5.01 to 37.00 ± 7.22 (P < 0.0076) in patients on NCPAP. In this group, mean pediatric cardiac surgical Intensive Care Unit (PCSICU) stay was 4.72 ± 1.60 days, with only 2 (11.11%) patients requiring re-intubation. Conclusion: NCPAP can be used safely and effectively in infants undergoing congenital cardiac surgery to improve oxygenation/ventilation. It also reduces the work of breathing, PCSICU stay, and may reduce the likelihood of re-intubation. PMID:28163425

  1. Fibrosarcoma of the nasal cavity: A case report

    Omar Maliki


    Full Text Available Nasal fibrosarcoma is an infrequent malignant neoplasm. It usually presents as other sarcomas in this region, with nasal obstruction and epistaxis. The final diagnosis is based on the histopathology and immunohistochemistry. We report the case of a 37-year-old man with a 3-month history of recurrent epistaxis and nasal obstruction. Nasal endoscopy confirmed a right nasal neoplasia. Computed tomography and magnetic resonance image showed the tumor. TEP scan showed no metastasis. Complete removal was achieved through a combined surgery, by endoscopic endonasal approach and by incision in the right upper oral vestibule. Fibrosarcoma was found on histopathologic and immunohistochemistric examinations. After 12 months, the postoperative course was uneventful and follow-up information showed no recurrence of metastasis. However, in the 13th month, the patient suddenly died at home. Autopsy found no obvious cause for his death. To the best of our knowledge, no case of a fibrosarcoma of the nasal cavity with sudden death has been previously reported in the English-language.

  2. Observation the Therapeutic Effect of Endoscopic Coagulation and Hemostasis in the Treatment of Refractory Nasal Bleeding%鼻内镜下电凝止血对顽固性鼻出血的治疗效果观察



    目的:分析鼻内镜下电凝止血对顽固性鼻出血的治疗效果。方法将顽固性鼻出血患者76例分为两组,对照组行传统填塞,观察组行鼻内镜下电凝术,比较两组效果。结果观察组治疗总有效率为94.7%,高于对照组的73.7%,术后不良反应发生率为13.2%,低于对照组的42.1%,观察组的鼻腔通气恢复时间、住院时间少于对照组(P<0.05)。结论鼻内镜下电凝止血对顽固性鼻出血疗效较好。%Objective To analyze the effect of electrocoagulation under nasal endoscope in the treatment of intractable epistaxis. Methods 76 patients with intractable epistaxis were divided into two groups,the control group was treated with conventional therapy,observation group was treated with tamponade,electrocoagulation under nasal endoscopy,effects of two groups were compared.Results The total the efficiency of observation group was 94.7%,significantly higher than that of control group which was 73.7%,the incidence of postoperative adverse reactions was 13.2%,significantly lower than the control group which was 42.1%,nasal ventilation recovery time,hospitalization time in observation group was significantly less than the control group(P<0.05).Conclusion Endoscopic electrocoagulation has obvious curative effect on intractable epistaxis.

  3. 鼻内镜下改良泪囊鼻腔造口术治疗慢性泪囊炎的临床分析%Clinical Analysis of Nasal Endoscope Modified Dacryocystorhinostomy for Chronic Dacryocystitis



    目的鼻内镜下改良式泪囊鼻腔造口术治疗慢性泪囊炎的临床效果。方法对慢性泪囊炎患者71例共84只眼采用鼻内镜下改良泪囊鼻腔造口术治疗,观察并分析其临床疗效。结果71例患者,共84只眼均手术成功,术中均未见严重并发症发生。其中治愈77眼(91.67%),好转7眼(8.33%),无效1眼(1.19%),总有效率为98.81%。结论鼻内镜下改良式泪囊鼻腔造口术治疗慢性泪囊炎疗效较好,安全易行,值得临床推广应用。%Objective To study the clinical curative ef ect of nasal endoscope modified dacryocystorhinostomy for chronic dacryocystitis.Methods 71 cases (84 eyes)with chronic dacryocystitis were treated by nasal endoscope modified dacryocystorhinostomy,and the clinical curative ef ects were observed and analyzed.Results 71 cases (84 eyes)were operated successful y without any serious complications.77 eyes were cured (91.67%),7 eyes were relapsed (8.33%)and 1 eye was inef icient (1.19%).The total ef ective rate was 98.81%.Conclusion Modified intranasal endoscopic dacryocystorhinostomy for chronic dacryocystitis has good curative ef ect and safety.

  4. Endoscopic surgery and photodynamic therapy for behign and malignant neoplasms of colon

    А. А. Razzhivina


    Full Text Available The review of literature for current methods of endoscopic treatment for colon epithelial neoplasms is represented. Such types of endoscopic interventions as loop electroresection, submucosal dissection, coagulation and destruction of tumors and combination of several options depending on efficiency of previous therapy is analyzed. Limitations of every method, its special aspects and possible complications are described. Special focus is on specifics of neoplasms for which selected methods may be the most effective. Thus, hot biopsy and destruction using high-energy laser is efficient for small flat neoplasms, endoscopic electroexcision – far small pedunculated lesions, and fragmentation is adequate for exophytic tumors more than 2.0 cm. Long-term results of endoscopic treatment, recurrence rates after different options are represented. The literature for photodynamic therapy consists mostly articles about development (on pre-clenecal stage of new photosensitizers which are effective for colon cancer, new methods of treatment including combination with hyperthermia in low-dose light irradiation etc. The literature data shows the prospectivity of subsequent developments in this field. 

  5. Compact forceps manipulator with a spherical-coordinate linear and circular telescopic rail mechanism for endoscopic surgery.

    Kawai, Toshikazu; Hayashi, Hiroyuki; Nishizawa, Yuji; Nishikawa, Atsushi; Nakamura, Ryoichi; Kawahira, Hiroshi; Ito, Masaaki; Nakamura, Tatsuo


    By integrating locally operated small surgical robots in a sterilized area, a surgeon can perform safe and accurate robotically assisted laparoscopic surgery. At present, there is no locally operated compact forceps robot that can operate within a small space while providing a wide working area on the abdominal wall. In the present study, a new spherical-coordinate manipulator with a linear telescopic rail and two circular telescopic rails that can act as a third arm for the surgeon has been developed. A compact locally operated detachable end-effector manipulator (LODEM) was developed. This manipulator uses circular telescopic rails with linkage mechanisms for the yaw and pitch axes, and a linear telescopic rail for the insertion/extraction axis is attached to forceps. The dimensions of the manipulator are [Formula: see text] when contracted and [Formula: see text] when expanded. The positional accuracy, mechanical deflection, and backlash of the prototype were evaluated while performing simulated in vivo laparoscopic surgery. The positional accuracy, deflection, and backlash of the telescopic rail mechanism were 2.1, 1.8, and 5.1 mm, respectively. The manipulator could successfully handle the target and maintain stability, while the arms of the endoscope specialist were free from collisions with the manipulator during an in vivo laparoscopic surgery. A compact LODEM was designed to facilitate minimally invasive, robotically assisted laparoscopic surgery by a doctor working near the patient. This device could be used for such applications.

  6. Endoscopic versus external approach dacryocystorhinostomy: A comparative analysis

    Rinki Saha


    Full Text Available Background: Dacryocystorhinostomy (DCR consists of creating a lacrimal drainage pathway to the nasal cavity to restore permanent drainage of previously obstructed excreting system. Aim: To compare the result and advantages of both endonasal endoscopic and external DCR regarding the patency rate, patient compliance and complications. Study Design: Prospective non-randomized comparative study. Materials and Methods: Study was conducted for 16 months duration in a teaching hospital with 50 cases of endoscopic and 30 cases of external DCR with a follow-up of minimum 6 months. Data regarding surgical outcome and complications were analysed and compared using χ2 test. Results: Total 72 patients were included in the study with six having bilateral involvement, out of which 20 were male and 52 were female. The mean age for endoscopic and external DCR was 33.6 years and 46.0 years, respectively. Right eye (63.8% was involved more commonly than left eye (36.2%. Epiphora was the commonest presenting symptom (63.7%. Mean duration of surgery was much lengthier in external (mean 119.6 minutes than endoscopic (mean 49.0 minutes DCR. Bleeding was the most common immediate postoperative complication seen in 33.3% and 10.0% of external and endoscopic DCR cases, respectively. Primary surgical success rate was 90% and 96.7% for endoscopic and external DCR, respectively ( P = 0.046. Among the endoscopic DCR group, four patients underwent revision surgery giving a total successful surgical outcome of 98% at third month of follow-up. However, at 6 month of follow-up, success rate was 92% for endoscopic DCR and 93.3% for external DCR. The difference was not statistically significant ( P = 0.609. Conclusion: Intranasal endoscopic DCR is a simple, minimally invasive, day care procedure and had comparable result with conventional external DCR.

  7. Nitroglycerine, esmolol and dexmedetomidine for induced hypotension during functional endoscopic sinus surgery: A comparative evaluation

    Bajwa, Sukhminder Jit Singh; Kaur, Jasleen; Kulshrestha, Ashish; Haldar, Rudrashish; Sethi, Rakesh; Singh, Amarjit


    Background and Aim: Induced hypotension limits intra-operative blood loss to provide better visibility of the surgical field and diminishes the incidence of major complications during functional endoscopic sinus surgery (FESS). We aimed at comparing nitroglycerine, esmolol and dexmedetomidine for inducing controlled hypotension in patients undergoing FESS. Material and Methods: One hundred and fifty American Society of Anesthesiologists physical status I or II adult patients undergoing FESS under general anesthesia were randomly allocated to three groups of 50 patients each. Group E received esmolol in a loading and maintenance dose of 1 mg/kg over 1 min and 0.5-1.0 mg/kg/h, respectively. Group D received a loading dose of dexmedetomidine 1 μg/kg over 10 min followed by an infusion 0.5-1.0 μg/kg/h, and group N received nitroglycerine infusion at a dose of 0.5-2 μg/kg/min so as to maintain mean arterial pressure (MAP) between 60 and 70 mmHg in all the groups. The visibility of the surgical field was assessed by surgeon using Fromme and Boezaart scoring system. Hemodynamic variables, total intra-operative fentanyl consumption, emergence time and time to first analgesic request were recorded. Any side-effects were noted. The postoperative sedation was assessed using Ramsay Sedation Score. Result: The desired MAP (60-70 mmHg) could be achieved in all the three study groups albeit with titration of study drugs during intra-operative period. No significant intergroup difference was observed in Fromme's score during the intra-operative period. The mean total dose of fentanyl (μg/kg) used was found to be significantly lower in group D compared to groups E and N (1.2 ± 0.75 vs. 3.6 ± 1.3 and 2.9 ± 1.1 respectively). The mean heart rate was significantly lower in group D compared to groups E and N at all times of measurement (P < 0.05). The MAP was found to be significantly lower in group D compared to groups E and N after infusion of study drugs, after induction

  8. Nitroglycerine, esmolol and dexmedetomidine for induced hypotension during functional endoscopic sinus surgery: A comparative evaluation

    Sukhminder Jit Singh Bajwa


    Full Text Available Background and Aim: Induced hypotension limits intra-operative blood loss to provide better visibility of the surgical field and diminishes the incidence of major complications during functional endoscopic sinus surgery (FESS. We aimed at comparing nitroglycerine, esmolol and dexmedetomidine for inducing controlled hypotension in patients undergoing FESS. Material and Methods: One hundred and fifty American Society of Anesthesiologists physical status I or II adult patients undergoing FESS under general anesthesia were randomly allocated to three groups of 50 patients each. Group E received esmolol in a loading and maintenance dose of 1 mg/kg over 1 min and 0.5-1.0 mg/kg/h, respectively. Group D received a loading dose of dexmedetomidine 1 μg/kg over 10 min followed by an infusion 0.5-1.0 μg/kg/h, and group N received nitroglycerine infusion at a dose of 0.5-2 μg/kg/min so as to maintain mean arterial pressure (MAP between 60 and 70 mmHg in all the groups. The visibility of the surgical field was assessed by surgeon using Fromme and Boezaart scoring system. Hemodynamic variables, total intra-operative fentanyl consumption, emergence time and time to first analgesic request were recorded. Any side-effects were noted. The postoperative sedation was assessed using Ramsay Sedation Score. Result: The desired MAP (60-70 mmHg could be achieved in all the three study groups albeit with titration of study drugs during intra-operative period. No significant intergroup difference was observed in Fromme′s score during the intra-operative period. The mean total dose of fentanyl (μg/kg used was found to be significantly lower in group D compared to groups E and N (1.2 ± 0.75 vs. 3.6 ± 1.3 and 2.9 ± 1.1 respectively. The mean heart rate was significantly lower in group D compared to groups E and N at all times of measurement (P < 0.05. The MAP was found to be significantly lower in group D compared to groups E and N after infusion of study drugs

  9. Transnasal-transsphenoidal endoscopic surgery in hypophysectomy%鼻内镜下经鼻蝶垂体瘤切除术

    李厚恩; 钱进; 郭红光; 于新; 赵虎林


    Objective To evaluate the method and curative effect of transnasal and transsphenoidal endoscopic approach technique in hypophysectomy by rhinologist and neurosurgeon. Methods A group of 36 cases of pituitary tumor undergone trasnasal-transsphenoidal endoscopic surgery in between Oct. 2004 and Oct. 2009 was observed. The approach was began through the nasal cavity on the side of the major part of tumor or well-developed sphenoid sinus by a rhinologist. The 1/3 part of the posterior middle turbinate was removed and mucosa reserved for postoperative filling. The ostium of sphenoid sinus was found and enlarged enough on the anterior wall of the sphenoid sinus, the floor of sella turcica was fractured and enlarged adequately so the durra of pituitary was exposed. Next, the dura was incised cruciformly and the adenoma was resected with curette or tumor clamp by the neurosurgeon. Finally, the breach of the floor of sella turcica was repaired, and the cavity of nose and sphenoid sinus was packing with stuffing by the rhinologist. Results The post operation symptom improved or recovered. In 21 cases of impaired vision, 13 of them recovered, and 8 improved. The high level of hormones also improved in different degrees. Headache symptom is totally gone in 8 cases. Among the 36 cases, there were 29 cases of entire resection of the tumor (80.6%), 7 cases of subtotal resection. No serious complication or death cases were found except 5 cases of temporary cerebrospinal rhinorrhea and 3 cases of diabetes insipidus which recovered in 3 to 6 days after operation. Conclusion The transnasal-sphenoidal endoscopic technique in hypophysectomy operated by rhinologist and neurosurgeon carries out distinct advantages, such as be simple, safe and minitraumatic.%目的 探讨由鼻科和神经外科医师共同实施鼻内镜下经蝶窦行垂体瘤切除术的方法与效果.方法 手术小组在鼻内镜下对36例垂体瘤患者实施了手术治疗.先由鼻科医师行鼻腔及蝶窦

  10. 鼻腔自主神经临床解剖研究——鼻内镜下高能量聚焦超声治疗变应性鼻炎的靶点选择%Clinical anatomical study of nasal autonomic nerve-obtaining target points for the treatment of allergic rhinitis by blocking nasal autonomic nerve with high intensity focused ultrasound under nasal endoscope

    李强; 杨盈坡; 安伟


    Objective:To provide anatomical references for the treatment of allergic rhinitis by blocking nasal autonomic nerve with high intensity focused ultrasound under nasal endoscope.Methods:Ten (20 sides) adult head specimens sawn in midline sagittal were choosen,posterosuperior medial nasal branch and posterosuperior lateral nasal branch of sphenopalatine nerve as well as posteroinferior nasal nerve were anatomized under microscope to study and research their branches and ramification and to measure the distance from point of posterosuperior medial nasal branch started from nasal septum to superior border of choana and nasal bottom,the distance from posterosuperior lateral nasal branch in medial surface of middle turbinate to midpoint of inferior border of middle turbinate and the distance from point of posteroinferior nasal nerve reaching at inferior turbinate to posterior border of inferior turbinate.Results:(1)Posterosuperior medial nasal branch of sphenopalatine nerve disturbed on the nasal septum from backward and upward to forward and downward;the route approximated straight line and reverse-parabola line.The nerves in 10 sides disturbed on surface of nasal septum as a main never,all reaching the bottom of nasal septum from anterior-middle segment of nasal septum.The nerves in 8 sides disturbed on surface of nasal septum as two main never branches,the branch near nasal bottom(inferior branch) reaching the bottom of nasal septum from anterior-middle segment of nasal septum(two sides was destroyed when anatomized).The distances were (9.04 ± 1.51) mm(inferior branch) and (15.76 ±2.17) mm(superior branch) to superior border of choana,(18.95 ± 2.69)mm(inferior branch) and (23.39 ± 2.42) mm(superior branch)to nasal bottom.(2)Posterosuperior lateral nasal branch of spheno-palatine nerve distributed on medial surface of middle turbinate,and moved from posterior segment of superior border of middle turbinate,travelled slantingly and reached posterior segment of middle

  11. Application of a computer-assisted flexible endoscope system for transoral surgery of the hypopharynx and upper esophagus.

    Friedrich, Daniel T; Scheithauer, M O; Greve, J; Rotter, N; Doescher, J; Hoffmann, T K; Schuler, P J


    Zenker's diverticulum is a common pathology in the transition zone of the posterior hypopharynx and esophagus. Surgical treatment is routinely performed by ENT and general surgeons. Besides the traditional open transcervical diverticulectomy, the introduction of transoral rigid treatment led to a paradigm change and is now the preferred treatment option for patients who are fit for general anesthesia. The implementation of interventional flexible endoscopy has opened another new micro-invasive approach for patients with high morbidity. Here, we present the potential utilization of a flexible, single port, robot-assisted, and physician-controlled endoscope system to facilitate transoral surgical access to the hypopharynx and upper esophagus. Transoral surgery of the hypopharynx and upper esophagus was performed in human cadavers (n = 5) using the Flex System (Medrobotics, Raynham, USA). Anatomical landmarks were identified, and posterior cricothyroid myotomy was performed with compatible flexible instruments in all cases. The approach to the hypopharynx and upper esophagus using the Flex system is feasible in a cadaveric model. Myotomy with a flexible tool and needle knife (from the perspective of treatment of Zenker´s diverticulum) was successful in all cases. Visualization of the surgical site with the system's HD camera is suitable and the flexible instruments meet the special needs of a micro-invasive transoral approach. Zenker´s diverticulum can be potentially treated with a transoral minimally invasive approach using a computer-assisted flexible endoscope system. This setup could be of advantage in patients with reduced mobility of the cervical spine to prevent open transcervical surgery. In our study, the Flex system enabled advanced visualization of the surgical site and extended intervention options, compared to standard flexible endoscopic treatment. However, general anesthesia is mandatory for the presented approach. Application in live patients

  12. Transnasal endoscopic repair of pediatric meningoencephalocele

    Amit Kumar Keshri


    Full Text Available Introduction: Encephaloceles in relation to the nose are rare lesions affecting the skull base. In the pediatric population, majority are congenital lesions manifesting as nasal masses requiring surgical intervention. Materials and Methods: A retrospective study of 6 consecutive patients below 12 years of age with intranasal meningoencephalocele treated by endonasal endoscopic approach at our tertiary centre was done. The follow up period ranged from 6 months to 2 years. A detailed clinical and radiological evaluation of these cases was done. Endonasal endoscopic repair (gasket seal/fat plug was carried out in all cases. Results: Out of 6 patients, 4 patients had post-traumatic and rest 2 cases had congenital meningo-encephaloceles. All patients were asymptomatic in post-operative follow up period. One patient had minor complication of nasal alar collapse due to intra-operative adherence of encephalocele to cartilaginous framework. Conclusion: Transnasal endoscopic repair of anterior skull base meningoencephalocele is a minimally invasive single stage surgery, and has advantage in terms of lesser hospital stay, cost of treatment, and better cosmesis. The repair technique should be tailored to the size of defect to provide a water-tight seal for better outcome.

  13. Comparison of the therapeutic effects between nasal endosopic surgery and routine sinus surgery on rhinosinusitis accompanying rhinopolypus%鼻内窥镜手术与常规鼻窦手术治疗 鼻窦炎伴息肉疗效的比较观察

    张月飞; 罗国庆; 刘咏


    目的:观察鼻内窥镜手术与常规鼻窦手术治疗鼻窦炎伴鼻息肉的疗效及影响疗效的有关因素。方法:鼻窦炎伴鼻息肉患者132例(Ⅱ型或Ⅲ型),随机分二组,即内窥镜组:85例行鼻内窥镜手术;常规组:47例行常规鼻窦手术,二组除手术方式不同外,余治疗方法相同,术后两组随访2 a。结果:内窥镜组2 a治愈率为75.3%,常规组2 a治愈率为55.3%,差异有非常显著性(P<0.01)。内窥镜组术后随诊和综合治疗<6个月者,2 a治愈率为63.6%;6个月~1 a者,2 a治疗愈率为82.7%(P<0.05)。结论:鼻内窥镜手术治疗鼻窦炎伴鼻息肉组疗效显著高于常规手术组。疗效与手术技能、术后随诊和综合治疗密切相关%Objective:To investigate the effects and corresponding impact factors on the rhinosinusitis accompanied with rhinopolypus by nasal endoscopic surgery.Methods:132 patients cases with type Ⅱ or type Ⅲrhinosinusitis accompanied with rhinopolypus were randomly divided into two groups,namely(group A),85 cases underwent nasal endoscopic surgery,and 47 cases routine sinus surgery as control(group B),and followed up after the operation from 1996 to 1998. Results:The two-year curative rate was 75.3% in the group undergoing endoscopic surgery and 55.3% in the control group(P<0.01).When the postoperative follow-up and systematic treatment time was less than 6 months,the two-year curative rate of the group undergoing endoscoic surgery was 63.6%,while the time was from 6 to 12 months,the curative rate was 82.7%(P<0.05).Conclusions:The curative effect on the rhinosinusitis accompanied with multiple and recurring rhinopolypus treated with endoscopic surgery was higher than that in with routine operation.The operative effect was directly correlated with operative skills,postoperative follow-up and systematic

  14. Anatomy and surgery of the endoscopic endonasal approach to the skull base

    Solari, Domenico; Villa, Alessandro,; De Angelis, Michelangelo; Esposito, Felice; Cavallo, Luigi Maria; Cappabianca, Paolo


    Summary The midline skull base is an anatomical area, which extends from the anterior limit of the anterior cranial fossa down to the anterior border of the foramen magnum. For many lesions of this area, a variety of skull base approaches including anterior, antero-lateral, and postero-lateral routes, have been proposed over the last decades, either alone or in combination, often requiring extensive neurovascular manipulation. Recently the endoscopic endonasal approach to the skull base has b...

  15. Anatomy and surgery of the endoscopic endonasal approach to the skull base.

    Solari, Domenico; Villa, Alessandro; De Angelis, Michelangelo; Esposito, Felice; Cavallo, Luigi Maria; Cappabianca, Paolo


    The midline skull base is an anatomical area, which extends from the anterior limit of the anterior cranial fossa down to the anterior border of the foramen magnum. For many lesions of this area, a variety of skull base approaches including anterior, antero-lateral, and postero-lateral routes, have been proposed over the last decades, either alone or in combination, often requiring extensive neurovascular manipulation. Recently the endoscopic endonasal approach to the skull base has been introduced to access the midline skull base. The major potential advantage of the endoscopic endonasal technique is to provide a direct anatomical route to the lesion since it does not traverse any major neurovascular structures, thereby obviating brain retraction. The potential disadvantages include the relatively restricted exposure and the higher risk of CSF leak. In the present study we report the endoscopic endonasal anatomy of different areas of the midline skull base from the olfactory groove to the cranio-vertebral junction and accordingly describe the main features of the surgical approaches to each of these regions.

  16. Sutura de la mucosa en la cirugía funcional del tabique nasal Suture of the mucosa in the functional surgery of the nasal septum

    René Esteban Moreno Rajadle


    Full Text Available Se realizó un estudio descriptivo, longitudinal y prospectivo para evaluar la evolución posoperatoria de los pacientes intervenidos por desviación del tabique nasal, en los que se utilizó sutura de la mucosa como método hemostático. Se incluyeron los 502 pacientes intervenidos por desviación del tabique nasal, en los que se utilizó sutura de la mucosa y que fueron operados en el período comprendido entre julio de 1999 y julio del 2005, en el Servicio de Otorrinolaringología del Hospital Universitario «Dr. Gustavo Aldereguía Lima» de Cienfuegos. Las variables seleccionadas para el estudio fueron: edad, sexo, criterio para la intervención quirúrgica según localización de la deformidad del tabique nasal, comportamiento de las secreciones serohemáticas posquirúrgicas, síntomas posoperatorios y complicaciones. Predominó el sexo masculino (65,3 % y el mayor porcentaje de los operados se encontraba entre los 21 y 40 años de edad. Las desviaciones bajas del tabique nasal fueron el criterio quirúrgico más frecuentemente encontrado (88,4 %; fueron escasos los síntomas postoperatorios y sólo el 3,6 % de los pacientes intervenidos presentó complicaciones, entre las cuales el sangrado fue la más frecuente (2,0 %. Consideramos que este proceder es favorable por las múltiples ventajas que ofreció en el orden clinicoquirúrgico, de eficiencia hospitalaria y en términos de comodidad para el paciente

  17. Abulia following penetrating brain injury during endoscopic sinus surgery with disruption of the anterior cingulate circuit: Case report

    Login Ivan S


    Full Text Available Abstract Background It is common knowledge that the frontal lobes mediate complex human behavior and that damage to these regions can cause executive dysfunction, apathy, disinhibition and personality changes. However, it is less well known that subcortical structures such as the caudate and thalamus are part of functionally segregated fronto-subcortical circuits, that can also alter behavior after injury. Case presentation We present a 57 year old woman who suffered penetrating brain injury during endoscopic sinus surgery causing right basal ganglia injury which resulted in an abulic syndrome. Conclusion Abulia does not result solely from cortical injury but can occur after disruption anywhere in the anterior cingulate circuit – in the case of our patient, most prominently at the right caudate.

  18. 3 D technology for accurate treatment of transnasal endoscopic nasal skull base neoplasm resection and the func-tional reconstruction%3D技术在鼻内镜手术精准治疗鼻前颅底恶性肿瘤中的应用

    吴建; 范静平; 刘环海; 郎军添; 卢晓清; 徐亚平


    Objective To explore the value of 3 D technology for accurate treatment of transnasal endoscopic nasal skull base neoplasm resection and the functional reconstruction of the nasal skull base surgery.Methods A total of 2 1 cases of nasal skull base neoplasm were carried out sinus coronal CT/MRI scan parallel 3 D reconstruction and 3 D printing. The invasion scope of the nasal skull base neoplasm and the size/shape of the bony defect of the skull base and orbital wall were read according to 3 D reconstruction and 3 D model,then the surgery path and the accurate resection range and the accurate reconstruction method were determined.Results All patientsneoplasm had been removed in the first operation.6 cases had been performed accurate functional reconstruction of the skull base surgery without cerebrospinal fluid (CSF)leak and intracranial infection happened.Post-operative pathology indicated that there were 9 cases of squa-mous cell carcinoma,5 esthesioneuroblastoma,3 adenoid cystic carcinoma and 4 rhabdomyosarcoma.Patients accepted radiotherapy after surgery.Within a follow-up of 36 months on average,no neoplasm relapsed and no death that is con-nect whit the neoplasm appeared.Conclusion 3 D reconstruction and 3 D model could show the invasion scope of the nasal skull base neoplasm and the size/shape of the bony defect of the skull base and the orbital wall clearly.Also 3 D reconstruction and 3 D model could help surgeons to make the best operative schemes.3 D imaging and 3 D printing tech-nology has important guiding significance for accurate treatment of transnasal endoscopic nasal skull base neoplasm resection and the functional reconstruction of the nasal skull base surgery.%目的:探讨3D技术在鼻内镜手术精准治疗鼻前颅底恶性肿瘤及颅底功能重建手术中的作用。方法对21例鼻颅底恶性肿瘤患者术前行鼻窦冠状位CT或MRI扫描,并行3 D影像重建及模型打印,根据3 D成像及模型了解鼻颅底恶性肿

  19. Endoscopic sphincterotomy for common bile duct calculi in patients with gall bladder in situ considered unfit for surgery.

    Davidson, B R; Neoptolemos, J P; Carr-Locke, D L


    Endoscopic sphincterotomy (ES) was attempted in 106 patients with common bile duct (CBD) calculi and gall bladders present, who were considered unfit for surgery on the grounds of age and frailty alone (35%) and/or the presence of major medical problems (65%). Endoscopic sphincterotomy was successful in 105 patients (99%). Early ES related complications occurred in 21 patients (19.8%). Twelve hospital deaths occurred (11.3%), although this was due to biliary causes in only five (4.7%) and one of these was moribund on admission. Complications were more frequent in those in whom initial ES did not clear the common bile duct (30.4%) compared with those in whom this was (11.7%; p = 0.0164). The mortality was also greater in patients in whom there was no ERCP proof of CBD clearance (p = 0.01) unless operated upon. Twelve patients developed gall bladder complications (11.3%) including five with empyema (4.7%). Analysis of clinical, haematological, and biochemical factors together with ERCP findings showed that the only factor which had any value in predicting gall bladder complications was pre-existing cholangitis. The present series was compared with another using ES as a definitive procedure, and with a surgical series. Although there were significant differences in outcome, differences with respect to medical risk factors and the incidence of complications of CBD stones (jaundice, cholangitis, and acute pancreatitis) were striking. Further analysis of these factors may allow a clearer definition of patients most likely to benefit from either ES or surgery.

  20. Novel device for tissue cooling during endoscopic laryngeal laser surgery: thermal damage study in an ex vivo calf model.

    Koo, Hae Jin; Burns, James A; Kobler, James B; Heaton, James T; Zeitels, Steven M


    Minimizing collateral thermal damage during endoscopic laryngeal laser surgery remains a priority, and tissue cooling is one way to achieve this goal. Cooling systems utilizing compressed air have been shown to reduce the extent of thermal trauma on the vocal folds, but these units are not ideal for endoscopic applications because cooling is inefficient at the low airflows needed. We examined whether a novel vortex cooling device that generates cooled air at low flow rates would provide a cooling benefit beyond that which could be obtained by using room-temperature air for cooling tissue or by using no cooling during simulated laryngeal laser surgery. A continuous-wave thulium laser was used to incise glottic tissue in 12 calf vocal folds. Cooling was achieved with a prototype vortex cooler (9 degrees C air output; flow rate, 3 L/min), and tissue temperature measurements were compared to those with room-air cooling and no cooling. Thermal damage was analyzed histologically by measuring the depth of lactate dehydrogenase inactivation surrounding the mucosal incision. The cooling conditions were tested during time-constant cuts (8 seconds) and depth-constant cuts (into the thyroarytenoid muscle). During time-constant cuts, comparison between vortex cooling and room-air cooling revealed that vortex cooling resulted in a thermal damage zone that was 14% smaller (519 versus 603 microm; p cooling created a thermal damage zone that was 32% smaller than that created with no cooling (p cooling (p cooling reduces thermal damage more effectively than room-air cooling or no cooling during both time-constant and depth-constant thulium laser cuts.

  1. Sevoflurane anaesthesia for nasal surgery in a patient with multiple chemical sensitivity.

    Fernández Martín, M T; Álvarez López, J C


    Multiple chemical sensitivity syndrome is a group of complex disorders that include psychiatric disorders, chronic fatigue and/or respiratory problems. This syndrome could be triggered by specific allergens and toxins that cause neurophysiological sensitization and the appearance of the clinical symptomatology. Anaesthesia for these patients always poses a challenge for the anaesthetist, because they need to find and use drugs that do not trigger or aggravate the symptoms of the disease. Therefore, sevoflurane in these circumstances might be "the ideal anaesthetic". Performing general anaesthesia with sevoflurane as the sole anaesthetic agent, together with a series of environmental measures formed the basis for successful anaesthesia and surgery in our patient with a multiple chemical sensitivity syndrome. Copyright © 2017 Sociedad Española de Anestesiología, Reanimación y Terapéutica del Dolor. Publicado por Elsevier España, S.L.U. All rights reserved.

  2. Reduction effect of bacterial counts by preoperative saline lavage of the stomach in performing laparoscopic and endoscopic cooperative surgery.

    Mori, Hirohito; Kobara, Hideki; Tsushimi, Takaaki; Fujihara, Shintaro; Nishiyama, Noriko; Matsunaga, Tae; Ayaki, Maki; Yachida, Tatsuo; Tani, Joji; Miyoshi, Hisaaki; Morishita, Asahiro; Masaki, Tsutomu


    To investigate the effects of gastric lavage with 2000 mL of saline in laparoscopic and endoscopic cooperative surgery. Twenty two patients who were diagnosed with a gastric gastrointestinal stromal tumor were enrolled. In former term, irrigations of the stomach were conducted whenever it was necessary, not systematically (Non systemic lavage group). In latter term, the stomach was thoroughly cleaned with 2000 mL of saline using an endoscope with a water jet, and Duodenal balloon occlusion was conducted to prevent refluxed bile and pancreatic juice (Systemic lavage+balloon occlusion group). The gastric wall was sprayed with 20 mL of distilled water, and 20 mL of gastric juice was collected in a sterile tube and submitted for culture. 20 mL of ascites was also collected from the laparoscopic ports and submitted for culture. We compared WBC, CRP, BT between two groups, and verify the reduction effect of bacterial counts in Systemic lavage+balloon occlusion group. WBC count before, 1 d after, and 3 d after laparoscopic and endoscopic cooperative surgery (LECS) were 5060 (95%CI: 4250-9640), 12140 (6050-14110), and 6910 (5320-12520) in Non systemic lavage group, 4400 (3660-7620), 8910 (6480-10980), and 5950 (4840-7860) in Systemic lavage+balloon occlusion group. Significant differences between two groups at the day after LECS (P = 0.029) and the 3 d after LECS (P = 0.042). CRP levels in Non systemic lavage group and in Systemic lavage+balloon occlusion group were significantly different at the day after LECS (P = 0.005) and the 3 d after LECS (P = 0.028). BTs (°C) in Non systemic lavage group and in Systemic lavage+balloon occlusion group were also significantly different at the day after LECS (P = 0.004) and the 3 d after LECS (P = 0.006). In a logarithmic comparison, bacterial load before gastric lavage, after lavage, and ascites culture were 6.08 (95%CI: 4.04-6.97), 0.48 (0-0.85), and 0.21 (0-0.56). The bacterial counts before and after gastric lavage were

  3. Correction of Symptomatic Chronic Nasal Airway Obstruction in Conjunction With Bimaxillary Orthognathic Surgery: Does It Complicate Recovery and Is It Effective?

    Posnick, Jeffrey C; Choi, Elbert; Adachie, Anayo; Troost, Thomas


    The purpose of this study was to assess the safety and efficacy of intranasal procedures carried out simultaneously with bimaxillary orthognathic surgery. The authors executed a retrospective cohort study derived from patients treated by a single surgeon at 1 institution from 2004 through 2013 with a minimum follow-up of 1 year (range, 1 to 10 yr). An index study group consisting of a consecutive series of patients with symptomatic chronic obstructive nasal breathing (CONB) and a bimaxillary developmental dentofacial deformity (DFD) also involving the chin were identified. They underwent a minimum of: Le Fort I osteotomy, bilateral sagittal ramus osteotomies, septoplasty, inferior turbinate reduction (ITR), and osseous genioplasty. Study variables included age at operation, gender, pattern of presenting DFD, presence of obstructive sleep apnea, segmentation of the maxilla, and airway management. The primary outcome variable studied was residual CONB. During the study period, 262 patients met the inclusion criteria. Their age at operation averaged 25 years (range, 13 to 63 yr) and 134 were female (51%). The major patterns of presenting DFD included long face (29%) and maxillary deficiency (25%). No patients required nasal packing, reintubation, tracheostomy, or blood transfusion. In 6 of the 262 patients (2%), the intranasal procedures did not resolve nasal breathing difficulties. In these patients, procedures recommended included synechiae release (n = 3), revision septoplasty (n = 3), and further ITR (n = 4). An association between age at time of surgery and non-segmental Le Fort I osteotomy with the occurrence of residual nasal obstruction was confirmed. When completing septoplasty and ITR through a Le Fort I, airway management need not be altered from standard protocol. The management of CONB in conjunction with orthognathic surgery is highly effective, with few complications. Non-segmental Le Fort I in patients at least 40 years of age is more likely to be

  4. Analgesic Effects of Intravenous Acetaminophen vs Placebo for Endoscopic Sinus Surgery and Postoperative Pain: A Randomized Clinical Trial.

    Tyler, Matthew A; Lam, Kent; Ashoori, Faramarz; Cai, Chunyan; Kain, Joshua J; Fakhri, Samer; Citardi, Martin J; Cattano, Davide; Luong, Amber


    Intravenous acetaminophen is a commonly prescribed analgesic for the prevention and treatment of postsurgical pain. Its efficacy in the context of endoscopic sinus surgery (ESS) has yielded mixed results. To compare the efficacy of perioperative intravenous acetaminophen (IVAPAP) with that of placebo in improving early postoperative pain after endoscopic sinus surgery (ESS). A prospective, randomized clinical trial including 62 patients undergoing ESS for chronic rhinosinusitis in a single tertiary referral hospital. Participants were randomized to receive 1 g of IVAPAP or 100 mL of placebo consisting of saline infusions immediately before the start of surgery and 4 hours after the initial dose. The primary outcome was postoperative pain measured by visual analog scale (VAS) scores up to 24 hours after surgery by blinded observers. Secondary endpoints included postoperative opioid (intravenous and oral) use and adverse events in the 24-hour postoperative period. Of the 62 enrolled adult participants, 60 were randomized (31 to IVAPAP intervention and 29 to placebo). The mean (SD) age of participants was 53.7 (14.7) years and 35 (58%) of the participants were men and 25 (42%) were women. Within the first hour, mean pain scores were reduced in the IVAPAP group compared with the control group, reaching a maximum difference of 7.7 mm on a VAS scale favoring the treatment group with a true difference possibly as high as 22 mm, and the data are compatible with a clinically meaningful difference. At 12- and 24-hours, average pain scores were less in the placebo group and the data are compatible with a clinically meaningful difference of 5.8 (-5.2 to 16.8) and 8.2 (-1.9 to 18.4), respectively, favoring the placebo group. However, at all time points the CIs included the null value and were wide, thus preventing definitive conclusions. Inspection of the secondary outcomes favored IVAPAP, but the wide range of the CIs and inclusion of the null value prevent definitive

  5. Endoscopic Management of Esthesioneuroblastoma.

    Roxbury, Christopher R; Ishii, Masaru; Gallia, Gary L; Reh, Douglas D


    Esthesioneuroblastoma is a rare malignant tumor of sinonasal origin. These tumors typically present with unilateral nasal obstruction and epistaxis, and diagnosis is confirmed on biopsy. Over the past 15 years, significant advances have been made in endoscopic technology and techniques that have made this tumor amenable to expanded endonasal resection. There is growing evidence supporting the feasibility of safe and effective resection of esthesioneuroblastoma via an expanded endonasal approach. This article outlines a technique for endoscopic resection of esthesioneuroblastoma and reviews the current literature on esthesioneuroblastoma with emphasis on outcomes after endoscopic resection of these malignant tumors.

  6. European Association of Endoscopic Surgeons (EAES) consensus statement on the use of robotics in general surgery.

    Szold, Amir; Bergamaschi, Roberto; Broeders, Ivo; Dankelman, Jenny; Forgione, Antonello; Langø, Thomas; Melzer, Andreas; Mintz, Yoav; Morales-Conde, Salvador; Rhodes, Michael; Satava, Richard; Tang, Chung-Ngai; Vilallonga, Ramon


    Following an extensive literature search and a consensus conference with subject matter experts the following conclusions can be drawn: 1. Robotic surgery is still at its infancy, and there is a great potential in sophisticated electromechanical systems to perform complex surgical tasks when these systems evolve. 2. To date, in the vast majority of clinical settings, there is little or no advantage in using robotic systems in general surgery in terms of clinical outcome. Dedicated parameters should be addressed, and high quality research should focus on quality of care instead of routine parameters, where a clear advantage is not to be expected. 3. Preliminary data demonstrates that robotic system have a clinical benefit in performing complex procedures in confined spaces, especially in those that are located in unfavorable anatomical locations. 4. There is a severe lack of high quality data on robotic surgery, and there is a great need for rigorously controlled, unbiased clinical trials. These trials should be urged to address the cost-effectiveness issues as well. 5. Specific areas of research should include complex hepatobiliary surgery, surgery for gastric and esophageal cancer, revisional surgery in bariatric and upper GI surgery, surgery for large adrenal masses, and rectal surgery. All these fields show some potential for a true benefit of using current robotic systems. 6. Robotic surgery requires a specific set of skills, and needs to be trained using a dedicated, structured training program that addresses the specific knowledge, safety issues and skills essential to perform this type of surgery safely and with good outcomes. It is the responsibility of the corresponding professional organizations, not the industry, to define the training and credentialing of robotic basic skills and specific procedures. 7. Due to the special economic environment in which robotic surgery is currently employed special care should be taken in the decision making process when

  7. Sphenoid mucocele; Diagnostic evaluation end endoscopic sinus surgery. Mucocele i sinus sphenoidalis; Diagnostikk og endoskopisk kirurgi

    Elverland, H.H.; Melheim, I.; Anke, I.M.; Wideroee, E. (Regional Hospital, Tromsoe (Norway)); Rinck, P.A. (Regional Hospital, Trondheim (Norway))


    Two cases of sphenoid sinus mucocele are described. Diagnosis was based on insidious orbital symptoms, apex orbital syndrome, followed by CT and MRI examinations. In one case the mucocele was preceded by seven years of a successfully treated undifferentiated nasopharyngeal carcionma. Simple transnasal endoscopic drainage of the mucoceles gave good results, although a monocular blindness of long standing was irreversible. A high level of suspicion, combined with modern imaging techniques and prompt surgical intervention, are the prerequisites for avoiding persisting sequelae. 28 refs., 5 figs.

  8. 慢性鼻窦炎鼻内镜手术中额筛区骨瘤的处理%Surgical strategy for osteoma during endoscopic sinus surgery for chronic rhinosinusitis

    葛文彤; 李云川; 倪鑫


    Objective To realize the characteristics of occurrence and distribution of osteoma found in patients undergoing endoscopic sinus surgery (ESS) due to chronic rhinosinusitis with or without nasal polyps (CRSwNP/CRSsNP),and to discuss the surgical strategy for this tumor.Methods Clinical data of 520 adult patients undergoing ESS due to CRSwNP/CRSsNP from Nov.2006 to Jan.2010 was analyzed retrospectively.The clinical data included the occurrence and location of osteoma,involvement of lamina papyracea/anterior skull base,surgical strategy for the tumor,surgical complications and so on.Results Osteoma was found in 26 of the 520 cases.The occurrence rate was 5% (26/520 cases),with the size of0.4 cm×0.4 cm ×0.4 cm to 1.5 cm ×1.5 cm× 3.0 cm.Most of them were isolated (23/26) and located in frontal sinus (13 cases) or anterior ethmoid sinus (11 cases).Involvement of anterior skull base and orbital wall was respctively found in 7 and 4 cases.Of all the 26 patients,20 cases were treated with complete endoscopic resection,2 with partial endoscopic resection,and 7 without any intervention.All patients had neither immediate nor long-term postoperative orbit/skull base complications.Conclusions Osteoma is not uncommon in CRSwNP/CRSsNP patients undergoing ESS.This tumor is usually isolated without apparent symptoms and occasionally found in sinus CT.Anterior ethmoid sinus and frontal sinus are most frequently involved.Complete endoscopic resection of the tumor can be achieved in most cases.Under the premise of ensuring sufficient drainage,partial endoscopic resection or nonintervention of the tumor is also acceptable.%目的 了解因慢性鼻-鼻窦炎伴/不伴鼻息肉(chronic rhinosinusitis with or without nasal polyps,CRSwNP/CRSsNP)接受ESS的患者中骨瘤的发病情况、分布特点,讨论其术中处理原则.方法 回顾分析2006年11月~2010年1月因CRSwNP/CRSsNP接受ESS的520例患者中26例患者合并骨瘤的发病情况、术中

  9. 慢性鼻-鼻窦炎鼻内镜手术预后的影响因素分析%Analysis of the factors affecting the prognosis of functional endoscopic sinus surgery for chronic rhinosinusitis

    徐艳红; 何刚; 黄定强; 朱玉博; 石向阳


    目的 分析影响慢性鼻-鼻窦炎(chronic rhinosinusitis,CRS)功能性鼻内镜手术(functional endoscopic sinus surgery,FESS)预后的因素,为术前评价和术后治疗提供依据.方法 对有手术指征的59例CRS患者行术前检查,记录视觉类比法评分(visual analog scale,VAS)、鼻内镜评分、性别、年龄、血嗜酸性粒细胞数目以及是否合并哮喘、息肉资料.患者术后随访1年以上,共5次,每次随诊记录患者VAS及鼻内镜评分,根据结果判断手术预后,并进行影响预后的因素分析.结果 血嗜酸性粒细胞数目增高,伴有哮喘的患者FESS预后差,其他因素不是影响FESS术后预后情况的主要因素.结论 在所记录的指标中,血嗜酸性粒细胞数目增高,伴有哮喘评估手术效果意义重大,伴有息肉的CRS并不引起更差的手术效果,提示传统意义上的CRS的分型可能并不合理.%Objective To analyze the factors affecting the prognosis of functional endoscopic sinus surgery(FESS)for chronic rhinosinusitis( CRS)in order to provide the basis for preoperative evaluation and postoperative treatment. Methods The preoperative examinations were performed for fifty-nine patients with CRS including scores of visual analog scale (VAS) ,and nasal endoscopy, and gender,age,number of eosnophils,and whether or not combinated with asthma or nasal polyp. After the operation,the patients were fol-lowed-up for five times during the period of one year. The scores of VAS and nasal endoscopy were recorded. Factors affecting the prognosis were statistically analyzed. Results The increased number of blood esonophils and the combination with asthma had a negative effect on the prognosis of the operation while the other factors did not. Conclusions The number of blood esonophils and CRS combined with asthma are the major factors that affect the prognosis of FESS while CRS combined with nasal polyp had no significant effect. Therefore, the traditional classification of

  10. Relatively light general anesthesia is more effective than fluid expansion in reducing the severity of epinephrine-induced hypotension during functional endoscopic sinus surgery

    LI Wei-yan; ZHOU Zhi-qiang; JI Jun-feng; LI Ze-qing; YANG Jian-jun; SHANG Ruo-jing


    Background Epinephrine infiltration of the nasal mucosa causes hypotension during functional endoscopic sinus surgery (FESS) under general anesthesia. A prospective randomized-controlled study was designed to determine whether relatively light general anesthesia is superior to fluid expansion in reducing epinephrine-induced hypotension during FESS.Methods Ninety patients undergoing elective FESS under general anesthesia were randomly assigned to three groups with 30 patients in each. Each patient received local infiltration with adrenaline-containing (5 μg/ml) lidocaine (1%,4 ml) under different conditions. For Group Ⅰ, anesthesia was maintained with propofol 2 μg/ml and rimifentanil 2 ng/ml by TCI. Group Ⅱ (control group) and Group Ⅲ received propofol 4 μg/ml and rimifentanil 4 ng/ml, respectively. In Groups Ⅰ and Ⅱ, fluid expansion was performed with hetastarch 5 mi/kg within 20 minutes; hetastarch 10 ml/kg was used in Group Ⅲ. Mean arterial pressure (MAP) and heart rate (HR) were recorded at 30-second-intervals for 5 minutes after the beginning of local infiltration. Simultaneously, the lowest and the highest MAP were recorded to calculate the mean maximum increase or decrease percent in MAP for all patients in each group. Data analysis was performed by χ2 test,one-way analysis of variance, or one-way analysis of covariance.Results Hemodynamic changes, particularly a decrease in MAP accompanied by an increase in HR at 1.5 minutes(P<0.05), were observed in all groups. The mean maximum decrease in MAP below baseline was 14% in Group Ⅰ, 24% in Group Ⅲ and 26% in Group Ⅱ. There were statistically significant differences between Group Ⅰ and Groups Ⅱ and Ⅲ(P<0.05). The mean maximum increase in MAP above baseline was 9% in Group Ⅰ, 6% in Group Ⅲ and 2% in Group Ⅱ.Conclusion Relatively light general anesthesia can reduce the severity of epinephrine-induced hypotension more effectively than fluid expansion during FESS under general

  11. Functional results of endoscopic laser surgery in advanced head and neck tumors

    Sadick, Haneen; Baker-Schreyer, Antonio; Bergler, Wolfgang; Maurer, Joachim; Hoermann, Karl


    Functional results following lasersurgery of minor laryngeal carcinomas were very encouraging. The indication for lasersurgical intervention was then extended to larger carcinomas of the larynx and hypopharynx. The purpose of this study was to assess vocal function and swallowing ability after endoscopic lasersurgery and to compare the results with conventional surgical procedures. From January 1994 to December 1996, 72 patients with advanced squamous cell carcinoma of the larynx and hypopharynx were examined prospectively. The patients underwent endoscopic lasersurgery instead of laryngopharyngectomy. The voice quality was evaluated pre- and postoperatively by subjective assessment, registration of voice parameters and sonegraphic classification. The swallowing ability was judged according to individual scores. The necessity of tracheostomy and nasogastric tube were registered and the duration of hospitalization was documented. The results showed that laryngeal phonation and swallowing ability were significantly better 12 months after lasersurgery compared to the preoperative findings whereas the recurrence rate was similar or even better after conventional pharyngolaryngectomy. Lasersurgery as an alternative surgical procedure to laryngectomy enables patients to retain a sufficient voice function and swallowing ability.

  12. Results Of Endoscopic Transnasal Resection Of Sinonasal Inverted Papiloma

    Baradaranfar M. H


    Full Text Available Inverted papilloma is an uncommon benign neoplasm originating from lateral nasal wall. It commonly invades paranasal sinuses and sometimes invasion to orbit and intracranial structures are seen. There are many surgical methods for its treatment, one of them is endoscopic transnasal approach."nMaterials and Methods: Between 1997 and 2001, 11 patients with this tumor were operated in Amiralam hospital in Tehran and Shahid Rahnemun in Yazd. Nine patients were operated by endoscopic transnasal route and two patients by combined Caldwell-luc and endoscopic transnasal routes."nResults: Tumors were on the right side in 3 patients, on the left side in 7 patients, and bilateral in one patient. There were no intracranial or orbital extensions. No pathologic report of malignancy was made. Surgical technique included complete tumor resection, anterior and posterior ethomidectomies, sphenoidectomy, frontal recess tumor resection and wide maxillary antrostomy, in cases in whom tumor was attached to lamina papyracea, the lamina was removed without any manipulation to orbital periosteum. Mean follow-up time was 29.8 months. There was no recurrence in 82% of cases. Tumor recurred in 18% of cases. No complications were seen."nConclusion: Although the standard treatment for this tumor is medial maxillectomy but endoscopic resection is an effective method in surgery of this tumor. It seems that if tumor does not extend to areas unreachable by endoscopic surgery, due to lower morbidity and excellent visualization of tumor, this method is preferable.

  13. Endoscopic closure of large septal perforations with bilateral Hadad-Bassagasteguy flaps.

    Morera Serna, Eduardo; Ferrán de la Cierva, Luis; Fernández, Meritxell Tomás; Canut, Santiago Quer; Mesquida, Jacoba Alba; Purriños, Francisco José García


    Surgical closure of nasal septal perforations is one of the most challenging procedures in nasal surgery. Defects greater than 2 cm are especially difficult to repair with the traditional approaches due to the challenges of mobilizing enough mucosa to close big gaps, and avoiding airway stenosis in the process. We present a new technique to endoscopically close major septal perforations using bilateral Hadad-Bassagasteguy flaps. Four consecutive patients with septal perforations greater than 2 cm were operated at our institution. Bilateral Hadad-Bassagasteguy flaps were endoscopically raised, one of them above the defect and the other one below it, and rotated to partially cover the defect on each side. A deep temporalis fascia graft was sandwiched between the two flaps to provide a scaffold for schneiderian mucosa growth. Both flaps were covered with a silicone sheet for 3 weeks. A complete closure of the defect was accomplished in three of the four patients; partial closure was achieved in the other. Nasal crusting, epistaxis, and nasal breathing improved in all patients. Large defects of the nasal septum may be closed in selected cases by rotation of bilateral pedicled septal mucosal flaps partially covering the defect area, followed by secondary healing of the nasal mucosa over an autologous graft acting as an epithelial scaffold.

  14. Development of an Ultra-rapid, Small Tissue-collecting Device for Endoscopic Surgery--the Lymph Node Carrier: Useful in Protecting the Air-sealing Valves of the Trocar for Endoscopic Surgery and in Preventing Port Site Recurrence.

    Yamasaki, Tokihisa; Ohdaira, Takeshi


    In laparoscopic and thoracoscopic surgery for malignant tumors, it is often necessary to recognize intraoperative rapid diagnosis by sampling a small section of tissue that is suspected of the lymphatic or disseminated metastasis of malignant tumor cells, or of the direct invasion. However, sampling of the target tissue has to be carried out without dropping a section into the peritoneal or thoracic cavity and port-site tumor recurrence. We developed a device named the "lymph node carrier (LNC)" that is capable of instantaneously carrying a small piece of tissue out of the body after its insertion into the trocar for conventional laparoscopic surgery. LNC is composed of the following three parts: 1) the carrier container; 2) the external sheath that re-encloses the tissue, which protruded from the container, into the container; and 3) the air-sealing cap. In the in vivo study three sows were used to remove the sigmoid colon and to carry adipose tissue containing the dissected lymph nodes out of the body. Sliding of the external sheath and the LNC container allowed the re-enclosure of adipose tissue protruding from the container. Carriage time of the dissected lymph nodes out of three sows was 37.7±1.5 seconds in mean±SD. LNC was suggested to be a surgical device capable of allowing, in a very efficient manner and a very short period of time, the repeated collection of removed specimens out of the body without damaging the air-sealing valves of the trocar for endoscopic surgery.

  15. Value of free-run electromyographic monitoring of lower cranial nerves in endoscopic endonasal approach to skull base surgeries.

    Thirumala, Parthasarathy D; Mohanraj, Santhosh Kumar; Habeych, Miguel; Wichman, Kelley; Chang, Yue-Fang; Gardner, Paul; Snyderman, Carl; Crammond, Donald J; Balzer, Jeffrey


    Objective The main objective of this study was to evaluate the value of free-run electromyography (f-EMG) monitoring of cranial nerves (CNs) VII, IX, X, XI, and XII in skull base surgeries performed using endoscopic endonasal approach (EEA) to reduce iatrogenic CN deficits. Design We retrospectively identified 73 patients out of 990 patients who had EEA in our institution who had at least one CN monitored. In each CN group, we classified patients who had significant (SG) f-EMG activity as group I and those who did not as group II. Results We monitored a total of 342 CNs. A total of 62 nerves had SG f-EMG activity including CN VII = 18, CN IX = 16, CN X = 13, CN XI = 5, and CN XII = 10. No nerve deficit was found in the nerves that had significant activity during procedure. A total of five nerve deficits including (CN IX = 1, CN X = 2, CN XII = 2) were observed in the group that did not display SG f-EMG activity during surgery. Conclusions f-EMG seems highly sensitive to surgical manipulations and in locating CNs. It seems to have limited value in predicting postoperative neurological deficits. Future studies to evaluate the EMG of lower CNs during EEA procedures need to be done with both f-EMG and triggered EMG.

  16. Gynecological endoscopic surgery in Cienfuegos. Cirugía endoscópica ginecológica en Cienfuegos.

    Rafael Alejandro Gómez Baute


    Full Text Available Background: In the last few years less invasive techniques for patients have been developed and endoscopic surgery is important example. Objective: To determine the advantages of endoscopic surgery and to relate ultrasonographic findings with surgical diagnoses. Method: Case study of 73 surgeries performed by gynaecological endoscopic surgery at the University Hospital ¨Dr. Gustavo Aldereguía Lima¨ from Cienfuegos province in the period January 1998- May 2002. urgencies and and Salpingoclasias were excluded from this search. The statistical study included tests of percentage, accumulated frequency, Kappla´s index, mean and standard deviation. Results: The most recent gynaecological pathologies were: Pelvic Inflammatory Disease, infertility and ovarian cyst. The relationship between ultrasonographic and surgical diagnosis was good for P.I.D and the intrauterine device in the abdominal cavity but not for endometritis. The most frequent laparoscopic procedures were salpingovariolasis and fimbrioplasty , ovarian cystectomy and contrasted laparoscopy. The two complications were bleeding which was controlled and facial subcutaneous emphysema.

    Fundamento: En los últimos años se han desarrollado nuevas técnicas, cada vez menos invasivas para las pacientes. La cirugía endoscópica es quizás el ejemplo más importante. Objetivos: Determinar las ventajas del método de cirugía endoscópica y establecer la concordancia entre el diagnóstico ultrasonográfico y el operatorio. Métodos: Estudio de serie de casos en el que se analizan 73 intervenciones quirúrgicas por cirugía endoscópica ginecológica en el Hospital Universitario ¨Dr. Gustavo Aldereguía Lima¨, provincia de Cienfuegos, desde enero de 1998 hasta mayo del 2002. Se excluyeron las urgencias y las salpingoclasias. Se aplicaron las pruebas

  17. [Comparative study of two protocols of antibiotic prophylaxis in endoscopic urologic surgery].

    Lepage, J Y; Malinowsky, J M; Cozian, A; Viers, M F; Rolland, M T; Péron, M; Souron, R; Baron, D


    We report an open, prospective, randomized and double-blind study which compared two groups of patients without preoperative bacteriuria, undergoing transurethral urologic surgery. A first group received cefazoline 3 g perioperatively and a second group a single preoperative dose of cefotiam 1 g. A hundred patients were included in each group which were well matched on all essential characteristics, risk factors, surgery, anesthesia and postoperative temperature. The incidence of postoperative infection (bacteriemia and bacteriuria) was the same in both groups (16%). It is concluded that in transurethral urologic surgery performed in patients without preoperative bacteriuria, 1 preoperative dose cefotiam is as efficacious as 3 perioperative doses cefazoline.

  18. Extensive endoscopic image-guided sinus surgery decreases BPI-ANCA in patients with cystic fibrosis

    Aanaes, K; Rasmussen, N; Pressler, T


    of BPI-ANCA may be due to the costimulation of BPI when mounting an immune response against P. aeruginosa. The effect of surgery aiming to eradicate bacteria and infected tissue on BPI-ANCA levels is sparsely described. A cohort of patients with CF were included: 53 patients having extensive image......-guided sinus surgery (EIGSS) with topical postoperative antibiotic treatment, 131 non-operated controls and 36 who had double lung transplantation (LTX). In all 219 patients, serum samples before and after surgery or at similar intervals were analysed for IgG and IgA BPI-ANCA. The EIGSS group showed a highly...

  19. [Trans-septal endoscopic approach of pituitary tumors].

    Muñoz del Castillo, F; Jurado Ramos, A; De la Riva Aguilar, A; López Villarejo, P


    The advances in endoscopic instruments have eased the approach to the sellar region through the nasal cavity. We carry out an analysis of the surgical results on 20 patients that underwent surgery for sellar tumours through a transeptal-transphenoidal approach in the last 2 years in our hospital. The average was 45.6 years old, and 75% were females. 30% of cases were pituitary adenomas and another 30% acromegaly, 25% Cushing's disease and 10% prolactinomas. No complications were encountered during surgery being the most common postoperative complications, diabetes insipida in two cases (10%) and CSF leak in one case. At present 2 patients are having hormonal treatment for panhypopituitarism. No patients developed a septal perforation, nasal deformity, epistaxis, meningitis, lip numbness or oronasal fistula. The rest did have good results noith no recurrence and hormonal values back to normal.

  20. Analysis on efficacy of patients with nasal bone fracture and nasal septum fracture deviation of 68 cases%鼻骨骨折合并鼻中隔骨折偏曲68例I期手术疗效分析

    黄学勤; 束维龙; 程学仕


    目的:探讨鼻内镜下I期手术治疗外伤性鼻中隔骨折偏曲和鼻骨骨折的可行性及应用价值。方法选取经鼻骨CT扫描诊断为鼻骨骨折合并鼻中隔骨折偏曲并排除颅底骨折患者68例,34例鼻内镜下I期行鼻中隔成形术加鼻骨骨折闭合性复位术为治疗组,34例行单纯鼻骨骨折闭合性复位术(拒绝鼻内镜下开放手术者)作为对照组。结果治疗组34例,术后鼻外形矫正满意,鼻中隔基本居中,双侧鼻腔通气较好,随访1~12个月无鼻中隔血肿、穿孔,无鼻腔粘连等并发症。对照组术后有14例患者鼻腔通气欠佳,检查可见鼻中隔仍有骨折偏曲。结论鼻内镜下I期手术治疗外伤性鼻中隔骨折偏曲和鼻骨骨折安全有效,不会增加手术危险性和手术并发症,且同时解决鼻中隔矫正和鼻骨复位,避免了鼻中隔Ⅱ期手术,有较好的临床应用价值。%Objective To investigate the feasibility and application of intranasal endoscopic replacement surgery for patients with post-traumatic nasal bone fracture and nasal septum fracture deviation.Method 68 patients with history of nasal bone fracture were diag-nosed with nasal bone fracture accompanied with nasal septum fracture deviation excluding skull fracture by using nasal bone CT scan and di-vided into two groups.34 patients in treatment group were treated with intranasal endoscopic replacement surgery in nasal septum fracture de-viation and nasal bone fracture under local anesthesia while closed reduction of nasal bone fracture in nasal septum fracture deviation and na-sal bone fracture under local anesthesia was performed for other 34 in the control group.Result For treat group,nose shape correction is satisfactory,the nasal septum is almost centered and bilateral nasal ventilation is good.No nasal septum hematoma,perforation,nasal adhe-sions and other complications was found during follow-up sessions within 1 ~12 months.On the

  1. Results of endoscopic transsphenoidal pituitary surgery in 40 patients with a growth hormone-secreting macroadenoma

    Wagenmakers, M.A.; Netea-Maier, R.T.; Lindert, E.J. van; Pieters, G.F.F.M.; Grotenhuis, A.J.; Hermus, A.R.M.M.


    OBJECTIVE: Transsphenoidal pituitary surgery (TS) is the primary treatment of choice for patients with acromegaly. Macroadenomas (>1 cm) are more difficult to resect than microadenomas (remission rate +/- 50% compared to +/- 90%). Besides the conventional microscopic TS, the more recently introdu

  2. Endoscopic management of pancreatic fistula after pancreatic and other abdominal surgery.

    Le Moine, Olivier; Matos, Celso; Closset, Jean; Devière, Jacques


    Post-operative pancreatic fistulae represent a challenge for all the actors in gastroenterology: for surgeons, because they want to prevent and treat conservatively this complication since re-operation is associated with high morbidity and mortality rates; for radiologists, because they have to provide the best staging and informations without any additional risk; and for endoscopists, because endoluminal treatment is emerging as a safe and effective procedure provided it is performed in highly experienced tertiary centres in the setting of a multidisciplinary approach. Herein, we review the definitions, the causes, the staging and the possible options to prevent or treat post-operative pancreatic fistulae. Special attention is paid to the endoscopic management of this complication: including the relief of ductal obstructions, the stenting of leakages and the drainage of bulging or non-bulging fluid collections. Practical problems and issues are clearly outlined as well as the need for future improvements in staging and management of the patients having such complications.

  3. Subjective Voice Assessment after Endoscopic Surgery for an Obstructive Reinke Edema Using Voice Handicap Index

    Bassel Hallak


    Full Text Available Voice disorders exert a dramatic influence on patients’ quality of life (QOL. The physical, functional, and emotional impact can be accurately assessed using the conventional questionnaire of “voice handicap index” (VHI or its shorter version, the VHI-10. We evaluated the VHI scores of patients suffering from obstructive Reinke’s edema, a benign laryngeal disorder, before and after endoscopic treatment. Comparison of pre- and postoperative VHI scores showed the treatment efficacy. The scores achieved were similar to asymptomatic individuals (control group, thus improving their quality of life. Furthermore, both VHI and VHI-10 tests yielded similar scores. We suggest routine systematic incorporation of the VHI-10 test for pre- and postoperative routine evaluation of patients with Reinke’s edema. The results are faster and reliable.

  4. Endoscopic endonasal transphenoidal surgery using the BrainLAB® Headband for navigation without rigid fixation.

    Duque, Sara G; Gorrepati, Ramana; Kesavabhotla, Kartik; Huang, Clark; Boockvar, John A


    The number of lesions of the skull base currently resected via endoscopic, endonasal, transphenoidal approach has increased. We have successfully treated 63 consecutive patients with pituitary lesions using this technique in combination with BrainLAB reference headband and laser surface scanning (BrainLAB(®), Heimstetten, Germany) for surgical navigation. This technique affords several advantages over neuronavigation based on adhesive-mounted fiducial registration. Rigid fixation in a Mayfield clamp is not required, which allows for flexibility with respect to positioning of the head during the procedure. This is particularly important, as extension and flexion of the head provide greater exposure to the clivus and anterior skull base, respectively. Also, we demonstrate that this technique is safe, easy-to-use, and faster compared with other ones. Georg Thieme Verlag KG Stuttgart · New York.

  5. Endoscopic endonasal transsphenoidal surgery using a skull reference array and laser surface scanning.

    Greenfield, J P; Howard, B M; Huang, C; Boockvar, J A


    Lesions of the skull base are increasingly being resected via the endoscopic, endonasal, transphenoidal approach. We have successfully treated 33 consecutive patients with pituitary lesions using this technique in combination with BrainLAB skull reference array and laser surface scanning for surgical navigation. This technique affords several advantages over neuronavigation based on adhesive-mounted fiducial registration. Rigid fixation in a Mayfield clamp is not required, which allows for flexibility with respect to positioning of the head during the procedure. This is particularly important as extension and flexion of the head provide greater exposure to the clivus and anterior skull base respectively. Also, this technique obviates the need for additional preoperative MRI, thereby reducing cost and delays.

  6. Clinical Efficacy of Endoscopic Sinus Surgery for Fungal Sinusitis%鼻窦内窥镜手术治疗真菌性鼻窦炎的临床疗效观察



    目的:探究临床上使用鼻窦内窥镜用于真菌性的鼻窦炎(NIFS)的手术治疗的疗效。方法随机选取我院2012年3月~2015年3月份的80例 NIFS 患者,对其临床的病症以及体征进行回顾性的调查分析。将患者在局部麻醉的条件下采用 Messerklinger 方式进行鼻内镜手术。结果本研究中的80例患者,最终都康复出院。对其进行定期随访,随访时间在0.5~3年。随访过程中,发现患者的鼻道以及上颌窦口很通畅,鼻黏膜正常,在患者的鼻窦中大部分没有发现真菌性质的块状物质,也没有异常的鼻腔分泌物;有2例患者复发再次入院治疗后康复。复发率为2.5%。结论对患者使用 CT 检查,然后行鼻窦内窥镜的手术疗法,有利于对患者的鼻窦炎做出准确的诊断,但临床上的确诊还需借助病理学的进一步检查;对于 NIFS 的治疗,采取鼻内窥镜的手术疗法是首选。%Objective To explore the clinical use of endoscopic sinus for fungal sinusitis (NIFS) the efficacy of surgical treatment. Methods In March 2012 to March 2015, 80 cases of patients NIFS were randomly selected in our hospital, the investigation analyzed retrospectively the clinical signs of the disease as well. The patient under local anesthesia in surgery, the use of endoscopic surgery Messerklinger way. Results In this study, 80 patients were eventually discharged. Its regular follow-up, follow-up time of 0.5 to 3 years. During follow-up, patients with maxillary sinus and nasal passages are clear, 2 patients relapse rehabilitation after hospitalization. The recurrence rate was 2.5%. Conclusion NIFS patients for CT examination, then underwent endoscopic sinus surgery therapy is beneficial for patients with sinusitis make an accurate diagnosis, but the diagnosis of clinical pathology needs further examination of the aid, for NIFS treatment, take endoscopic sinus surgery is the preferred treatment.

  7. Comparison of manual steering and steering via joystick of a flexible rhino endoscope.

    Eckl, R; Gumprecht, J J; Strauss, G; Hofer, M; Dietz, A; Lueth, T C


    Flexible endoscopes are used in ENT surgery for examination tasks in cases wherever rigid endoscopes are unsuitable to reach certain positions in the nasal cavity. Until today they are steered by hand and no robotized system has been put into clinical practice. One qualification a robot manipulator system has to fulfill to be accepted is not to create new disadvantages compared to the conventional method in surgery. An important factor is the time needed to steer the new system compared to the time needed to steer the conventional system. In this article a robot manipulator system and an experiment are presented to compare the particular times test persons need to perform a certain task. This approach offers the possibility to benchmark the developed robot manipulator system and future systems for flexible rhino endoscopes.

  8. 鼻内镜下鼻泪管前径路和后径路切除上颌窦良性病变%Endoscopic maxillary sinus surgery through anterior or posterior nasolacrimal duct approach

    宋西成; 张庆泉; 孙岩; 张华; 陈秀梅; 王强; 王丽; 柳忠禄; 董蕾; 张天振


    通畅无闭锁.结论鼻内镜下鼻泪管前、后径路上颌窦手术可以减小创伤,充分暴露窦腔视野,并为术后内镜复查和复发后的处理提供了视窗;保留下鼻甲避免了鼻腔外侧壁去除过多而导致的术后干燥、结痂、头痛等并发症.%Objective To explore the feasibility and effectiveness of the approaches and methodology of the endoscopic surgery for maxillary sinus lesions through the medial wall of the maxillary sinus.Methods From Jun.2003 to Aug.2010,endoscopic surgery through anterior or posterior nasolacrimal duct approaches to remove maxillary sinus lesions were conducted in 139 patients.Among them there were 43 cases with inverted papilloma,63 cases with fungal maxillary sinusitis,28 cases with maxillary sinus cyst,3 cases with hemorrhagic necrotic polyps,and 2 cases with osteomas.All patients underwent preoperative CT scans,and patients with inverted papillomas also had MRI tests.Anterior-nasolacrimal canal paths included 3 ways:pyriform aperture,lacrimal bone recess (dissecting nasolacrimal duct or not were 2 subtypes),pyriform aperture-nasolacrimal duct approaches,and 97 patients were treated.Posterior-nasal lacrimal duct paths were also divided into 3 subtypes:the inferior turbinate flip flap,double pedicle inferior turbinate,single pedicle inferior turbinate,and 42 patients were treated.The postoperative effects were observed.Results All lesions were completely removed under endoscope,the nasolacrimal ducts and inferior turbinates were protected,no nasal lacrimal duct injury and inferior turbinate necrosis were found.Postoperative nasal congestion,headache,swelling discomfort,strange odor,dental pain and numbness and other symptoms gradually disappeared.Nine patients felt nasal dryness,and after nasal washing for about 1 month,the symptom gradually disappeared.Patients were followed up for 6 months to 79 months.In case of osteoma,and hemorrhagic and necrotic polyps,no recurrences were found

  9. 鼻内镜下额窦开放术治疗慢性额窦炎%Intranasal frontal sinusotomy under nasal en-doscope for chronic frontal sinusitis

    沈昌德; 王文; 黄静江; 王传喜


      目的:探讨鼻内镜下以钩突上端为标志开放额窦在治疗慢性额窦炎中的应用方法。方法:总结88例慢性额窦炎在鼻内镜下以钩突上端为标志开放额窦。术前仔细阅读鼻窦CT,了解额窦、额隐窝气房发育及病变情况、钩突附着方式,术中以钩突上端为标志准确定位额窦口,清除阻塞额窦口的病变组织,使额窦引流通畅。结果:88例以钩突上端为标志均成功找到额窦开口。术后随访6~12个月,全部病例症状消失或改善,无术后严重并发症发生。结论:鼻内镜下以钩突上端为标志开放额窦是一种解剖结构易辨认、安全有效的术式,适用于大多数额窦病变。%Objective:To explore the treatment methods for chronic frontal si-nusitis by using the mark access of superior attachment of the uncinate process to the frontal sinus .Methods:Eighty-eight patients with chronic fron-tal sinusitis undergone frontal sinus surgery were included .Before procedure , nasal CT findings were examined in great detail to fully understand the struc-ture and lesion condition of the frontal sinus and frontal recess cell as well as the attachment of the uncinate process .Intranasal frontal sinusotomy was per-formed by referring to the tip attachment of the unicinate process ,with remov-al of the diseased tissues around the aperture of frontal sinus to ensure open frontal sinus drainage .Results:Opening of the frontal sinus was successfully anchored in the total 88 cases by the approaches described above .Postopera-tive follow-up from 6 to 12 months showed that all patients had recovered or had partial relief , and no serious postoperative complications occurred . Conclusion:Intranasal frontal sinusotomy under endoscope starting with the superior attachment of the uncinate process ensures easy recognition of the anatomical characteristics of the frontal sinus and safe procedure ,which may be recommendation in most lesions at

  10. Nursing of endoscopic sinus surgery in the treatment of children with chronic rhinosinusitis%鼻内镜手术治疗儿童慢性鼻窦炎的护理



    目的 探讨鼻内镜手术治疗儿童慢性鼻窦炎的观察和护理.方法 对54例14岁以下慢性鼻窦炎患儿行功能性鼻内窥镜手术后术前、术后一般护理、术腔护理及并发症护理等环节进行回顾性分析.结果 54例儿童慢性鼻窦炎有效51例,有效率94.4%,无颅内及眼部并发症出现.随访1年以上,采用系统护理方法,能促进鼻腔鼻窦黏膜生理功能恢复,减少和预防并发症发生,与手术本身同样重要.结论 重视和加强术后一般护理及术腔护理,定期随访,可明显提高儿童慢性鼻窦炎治愈率.%Objective To explore the observation and nursing of endoscopic sinus surgery in the treatment of children with chronic rhinosinusitis. Methods Fifty - four children under 14 years old with chronic rhinosinusitis were included in the study and they received functional endoscopic sinus surgery. Preoperative nursing,postoperative nursing,surgical cavity nursing and nursing of complications were retrospectively reviewed and analyzed. Results In all 54 cases,51 cases were effectively cured with a cure rate of 94.4% ,and there were no ocular or intracranial complications. The results of over one - year follow - up showed that systematic nursing promoted the restoration of physiological functions of nasal cavity and paranasal sinus mucosa,and it also reduced and prevented the complications,which was as important as the surgery itself. Conclusion Emphasis and reinforcement of postoperative nursing and surgical cavity nursing as well as regular follow -up can improve the cure rate of chronic rhinosinusitis in children.

  11. 慢性鼻窦炎鼻内镜术后耳穴贴压辅助治疗的疗效观察%Clinical efficacy of adjuvant auricular point sticking on chronic rhinosinusitis patients after endoscopic sinus surgery

    郭成兵; 吴曙辉; 朱红; 杨艳; 闫勇; 朱静静


    Objective:To investigate the clinical efficacy of conventional western medicine combined with auricular point stickingon chronic rhinosinusitispatientsafter nasal endoscopic surgery . Methods: 124 cases of CRS patients were randomly divided into control group and treatment group .The control group was given routine treatment ,the treatment group was given auricular point sticking based on conventional medicine .The clinical efficacy and the improvement of the symptoms of both groups were observed .Results:The effective rate of the control group and the treatment group were 73 .77% and 90 .47%(P<0 .05) 6 months after the operation .At 1 month ,3 months and 6 months after surgery ,the VAS (visual analogue scale) scores of both groups were improved ,and the score of the treatment group became better with the treatment time(P<0 .05) . Conclusions :Conventional western medicine combined with auricular point stickinghas better efficacyin CRS patients after ESS , w hich can effectively improve the patients'subjective symptoms .%目的:探讨常规西医治疗结合耳穴贴压疗法在慢性鼻窦炎(chronic rhinosinusitis ,CRS )鼻内窥镜术(endoscopic sinus surgery ,ESS)后的临床疗效。方法:将124例CRS患者随机分为对照组和治疗组,对照组给予常规治疗,治疗组在此基础上给予耳穴贴压治疗。观察两组治疗的临床疗效和症状改善情况。结果:患者术后6个月,对照组与治疗组治疗的有效率分别为73.77%、90.47%(P<0.05)。术后1个月、3个月和6个月,两组视觉模拟评分(visual analogue scale ,VAS)评分均有改善,随着治疗时间的推移进一步改善,以治疗组更明显(P<0.05)。结论:CRS患者ESS术后在常规西医治疗基础上辅以耳穴贴压治疗的疗效更优,能有效改善患者症状。

  12. Endoscopic Evaluation of Symptomatic Patients following Bariatric Surgery: A Literature Review

    Miral Subhani


    Full Text Available Obesity is an epidemic in our society, and rates continue to rise, along with comorbid conditions associated with obesity. Unfortunately, obesity remains refractory to behavioral and drug therapy but has shown response to bariatric surgery. Not only can long-term weight loss be achieved, but a majority of patients have also shown improvement of the comorbid conditions associated with obesity. A rise in the use of surgical therapy for management of obesity presents a challenge with an increased number of patients with problems after bariatric surgery. It is important to be familiar with symptoms following bariatric surgery, such as nausea/vomiting, abdominal pain, dysphagia, and upper gastrointestinal bleeding and to utilize appropriate available tests for upper gastrointestinal tract pathology in the postoperative period.

  13. A comparative evaluation of intrathecal bupivacaine alone, sufentanil or butorphanol in combination with bupivacaine for endoscopic urological surgery

    Manpreet Kaur


    Full Text Available Background: The objective of the present study was to compare the onset, degree and recovery time of sensory and motor block and hemodynamic effects of intrathecal bupivacaine alone and bupivacaine with sufentanil or butorphanol in endoscopic urological surgeries. Methods: In a randomized, double-blind study, 90 patients of either sex and age, belonging to ASA Grades I and II, scheduled for elective endoscopic urological surgeries under spinal anesthe